#COVID-19 · Mental Health Stigma Suicide · Nursing

When I’m Called Out by Clients for Swearing, Caring, and Everything Else…With Love. A Day in The Life of a Mental Health Nurse.

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.

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