An unexpected perk to having a therapist on staff full time with us is hearing from her what my patients think of me. I have referred more than a few of my clients to her though some of them I’ve seen for over three years for medication management and for one reason or another they needed a therapist at this time. Apparently the impressions are hilarious.

Occasionally my clients will directly throw my words back at me. Recently a young adult attending college in state needed to see me urgently. After we processed the current crisis and made decisions about medication I smiled and said, “Isn’t this great that your in state and we can do telehealth?” The client laughed and said, “Well I recall you saying if I went to school in Iowa, one of my top choices, that I’d be in ‘East bum fuck middle of fucking nowhere and there’s no way in hell I’m managing your meds out there'” I have a chagrinned smirk including blushing cheeks that emerge when properly embarrassed and I replied, “Yes well, that does sound like something I’d say…” We were both able to laugh. Now I know that client didn’t go to school in Iowa for a few reasons, including COVID, not just because I wouldn’t manage their meds in east bum fuck nowhere. But it is a humbling reminder to know that I do play into people’s major life decisions.

One of my clients did an imitation of me to the therapist at my practice…who texted me while laughing to tears because it was incredibly accurate and I am funny without meaning to be which usually makes it funnier. The impression was from our intake. Our intake was over three years ago. I was very direct. I warn people I’m direct. I don’t think any one really believes me until they experience it. And again, I was humbled. Because these moments in time are so important to clients. They stick in their brains these intermittent appointments with me. Words are so powerful. Body language. Facial expressions. This client nailed it all.

What I learn over and over is that my clients are paying attention. That I have an hour intake and thirty minute follow-ups maybe once every three or six months if they are stable and those minutes are precious. I try and respect them. I swear a lot. That’s not going to change. But apparently between the swears, the sarcasm, the checking in, I impart an energy and words that stick with people. It’s a privilege to be that person. We in mental health should never take it for granted.

I have a client I have been seeing for a few years, and the parents brought up at our last appointment, “Hey do you remember when you made us leave the room because you had to have a ‘Come to Jesus’ moment with them?” The Dad was cracking up. He said, “We didn’t know if we would see our kid again! But we knew then we were in the right place.” I did that embarrassed smirk as I thought back a couple years, and in fact I did remember telling the parents to leave. I didn’t raise my voice. I got down at the kid’s level though and told them to take their ear buds out when I ask them to take them out. To respect my fucking time because I’ve shown them nothing but respect even when they are acting like a little entitled punk. I may also have told them to undo their wedgie and let’s start again.

Sometimes I remember those moments and do a facepalm. I obviously do not speak to all people this way. It’s my job to read people. I’m good at it. I know who it’s going to be effective for and who it won’t be. And that kid never wore the ear buds again, and honestly has been very respectful to this day in our appointments.

Recently a parent asked me if I thought their educational plan for their child was “crazy”. I didn’t hesitate when I responded nodding, “Yes. I do.” I remember the parent looked at me and laughed a little and said, “Well you’re the first one who’s at least been honest with me.”

Honesty can be a bitter pill for people to swallow. It’s definitely not for everyone. Again, I give myself a disclaimer up front to any prospective clients. “I’m direct. I will call you out. I encourage you to call me out too if there’s anything that needs to be addressed.” But it can open doors to take your head out of the sand. My honest response to that parent opened up an entire conversation about their own self doubts and their strengths and weaknesses as a parent. It allowed a space for them to be vulnerable that wouldn’t have been there if I had just smiled and said “No of course not,”.

I’ve also learned that as long as I’m honest without being judgmental…which is a hard skill to master…it goes over a lot smoother. My clients that I take time to build rapport with and I really get to know and who get to know me, they know when I give them direct feedback it’s not from a place of judgement. It’s from a place of genuine curiosity and caring. I want to know if I’m on target with my assessment. I want to know if they know I’m on target or not. I want them to think and feel things that they haven’t let themselves think and feel. I want them ultimately to get better.

I was asked recently by someone how I felt about “…profiting off the pain and sorrow of others. I mean people have to be suffering in order for you to get work right?!” This was not a friend. And was said with some malice toward mental health professionals. I responded that I think about that a lot. And that should there come a day when my services are no longer needed I will feel such immense joy that it actually brings tears to my eyes to think of that day existing.

I remember resisting the impulse to defend all that I do; all that I give to my work. It doesn’t feel like a profit when a client is hospitalized for suicidal ideation. It doesn’t feel like profit when I end a day sitting on my floor wiping away tears because of all the emotional trauma I’ve held space for in the last eight hours…trying to pull myself together in the five minutes I have before my sons bounce through the door. It doesn’t feel like a success to educate my client about their diagnosis of schizoaffective disorder- how it’s lifelong and they will have more episodes of psychosis and we need to plan for when not if.

Those are all the moments that stick with me. So it’s nice to hear from clients who remember other moments. Who remember me swearing with love. Who remember the limits I set with fond affection and admiration. Some of my clients have done impressions in front of me and they are pretty good. I should be a meme.

Clients send me videos of their engagements. Wedding pictures. Newborn baby pics. Those hilarious therapist memes. Some one sent me a Christmas card thanking me for all my help and crediting me with helping them be healthy enough to become a Mom. I cried hardcore when I opened that one. I am allowed into these intimate moments in people’s lives because I know more than anyone the emotional labor they have put in to get to these crucial turning points in life.

The positive feedback is few and far between for healthcare providers, especially mental healthcare providers, but it’s there. Even the impressions. They crack me up. This year more than any I needed the positive feedback. I am beyond grateful for it.

To consumers of the mental health system- I thank you. For trusting me with your mental health. For seeing me for who I am even in moments of tough love. To families of consumers- I thank you. You have trusted me with your most precious cargo. I don’t accept that responsibility lightly. To the therapists who have to endure impressions of me- Enjoy. I’m pretty freaking funny especially when I’m not trying to be and yes. I swear that much.

I recently received a heavy metal coin in the mail from the hospital I work at per diem. It was accompanied by a trifold letter thanking me for my hard work during the pandemic and ended with a “we are all in this together” statement. It explained the coin too. Likening it to soldiers being honored with metal coins for acts of bravery.

I didn’t work much at the hospital this past year. I had enough to keep me busy with my practice. I also felt that the hospital left a lot to be desired in terms of infection control measures in the psychiatric hospital. I felt safer working remotely at my practice.

But there were many essential frontline workers working day and night caring for COVID patients. Caring for NICU patients during a pandemic. Caring for maternity patients who had to give birth alone wearing a mask after their partners tested positive.

I opened and read the generic letter, held the coin, and though of the scene in the Office when the CEO of the company, Robert California, looks at the regional manager Andy and says, “Sometimes I think you don’t know me at all,”

If you’ve seen The Office you know it’s satirical. It’s a commentary on how every one lower on the totem pole from management feels that management doesn’t actually know them at all.

I felt this viscerally holding that coin. I felt affirmed with every atom of my being with my decision to leave hospital and agency work full time and venture into the risky world of self employment via private practice. The few times I’ve worked at the hospital I thought I would have lost it if I was working there full time this past year. And the nurses and doctors and respiratory therapists working there full time for the past year deserve more than a worthless coin and generic thank-you letter.

I’m going to give the example of how I treat my employees. Because I’m a big bad boss now. My employees received everything necessary to do telehealth at home. Headphones. Lifted desks. Second monitors. Printers. Scanners. Anything they needed I got them. I screen all their calls and messages and deal with whatever I can on my own without bothering them. If they ask me to intervene and discharge some one I do it. No questions asked. Because I trust their judgement. For Christmas I gave my part time employee a bonus. I gave my full time employee the option of a cash bonus or tax exempt options like insurance premium, HSA contribution, student loan payment, etc.

I ask for their input on what charity to give to locally whenever I make a donation through the business.

I give them positive feedback whenever I get it from clinicians and patients. I pay them an extra hour a week if I know it was heavy on administrative time outside of client time. I say thank-you whenever I ask them to do something and they do it. I have never bought them pizza. I have bought them sushi and nice chocolate and wine and beer. I’ve given gift cards to restaurants and Amazon for nurses week.

One of my friends who is an APRN asked how much money I make from my employees. I told her I don’t make much because I didn’t take on employees to profit from them. I took them on because I wanted other prescribers to practice with me. And when I decided to take on employees I made a conscious decision to never treat them the way I had been treated by my employers and managers in hospital systems and private practice. I want my time that I spend doing their billing and scheduling and call backs to be covered. But aside from that I’d rather invest leftover money back into my business and subsequently back into my employees. Because I know what it feels like to work myself to the bone. Giving literal blood, sweat, and tears to a system that rewards you with pizza and a coin.

My fourth full time employee came on recently and took time to decide to increase to full time. The reason she gave for doing so was because she knew that the first two employees both started at less hours and both have continuously increased their hours in the past three years, one to full time and one to part time. She said that spoke to the business in terms of retention and in terms of them continuing to give more to the business. That moment felt good.

I despise how hospital systems cry poor. All the time. I didn’t get consistent raises my first eight years as a nurse. I felt powerless to fight for them. The systems were designed for us to fail to get increases. These are billion dollar organizations. Not million. Billion. Tell me they can’t give their employees something bigger. Why not cancel all current medical bills being held by their employees? Why not cover their health insurance premiums fully for at least a month? Why not provide free or discounted care for their employees? Why not pay 1000.00 toward every one’s student loans? Why not skip their CEO’s bonuses and give it back to their staff? Why not invest in their front lines essential heroic workers?

Freaking coin.

On the other end are burned out healthcare workers who think they don’t or can’t have better or more.

You can. You just have to work for it and you have to be willing to take risks.

Before the coin. Back before the pandemic back in 2017 when I opened my own practice. I put a 2$ fake paper bill from my hospital system on my wall. It’s still there. Taped over my desk. I treat employees of the system who recognize it and always ask why I have one of them taped on the wall. I encourage them to read the message on it. They lean in and then understanding dawns and they inhale sharply. Then they turn to me in disbelief. I nod. “Thanks for saving the life of a patient.” They always say it out loud. Like they are reading it wrong.

I nod again. “But I mean like you actually saved some one or it was just a close call?” they stammer trying to disbelieve it still.

“The patient was blue. I cleared her airway. I was told by multiple people there that day and after the patient would have died if I was not there.” Then they always nod their head and shrug their shoulders in resignation, “I believe it. 2 bucks. And a fake 2 bucks. That’s all we are worth around there.”

The two fake bucks that can only be used at the cafeteria of that particular system was not the first nor the last time I was let down by an employer in healthcare. But it was the first time I remember feeling resolute in my decision to get the hell out of there. I knew I needed to be somewhere that valued a patient life and my ability to save it. The coin six years later affirmed that decision.

To all my healthcare provider friends reading this. I see you. I know what you give every day. I know what it takes away from you. I’m sorry you are not valued more. But know that you are valued by me. I see you. You are not alone. You deserve more. If you are reading this and you have any say or control over how employees healthcare systems are treated: do better.

If you or someone you know is struggling with suicidal thoughts please call:

1-800-273-8255