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19 - Challenges of a Rookie Therapist

Updated: May 25, 2022

After my internship, Southeast Mental Health Network offered me a job on the crisis team. I took it, even though I preferred doing longer term therapy. The team was a fun group, with practical jokes common. There was great camaraderie during the frequent down time, and great collaboration when working with the acutely suicidal. Crisis work entails getting people to safety and back to baseline, not facilitating long term positive change. The office itself was in a fortress-like one story building with barely any windows. It had once been some sort of financial institution and our office supplies were stored in what was literally a vault.

When there was an opening on the therapy team, I took it. Then the Oregon Health Plan kicked over, which made many more people eligible for benefits, including therapy. SEMHN grew and morphed into Network Behavioral Healthcare. I soon actually had an office with a window in a new office building. My view was of the revolving milk carton atop the Sunshine Dairy.

I was good at my job, learning how to listen to tales of trauma when I was a child. My mother, a survivor of Nazi Germany, had told me stories early on of just how dark the human condition could get. I was able to sit with clients and listen in a genuine way. Which is as helpful, maybe more so, than all the techniques and skills I learned in grad school.

Not every case had a happy ending. But in all my years of working with struggling clients, I have had only one die due to suicide. Of course, some are still alive thanks to the skills of ED doctors. Or their multiple suicide attempts being the proverbial cry for help and not at a level of lethality that would lead to the morgue.

One of the scariest clients was a man who mixed narcissism and paranoia with stimulant abuse. He started sending me death threats by e-mail. “You’re not going to do to me what you’ve done to others. I’m going to shoot you until you are dead.”

I contacted the police and was told, “People who make threats don’t usually follow through. Call 911 if you see him.” This was shortly after Portland Police Bureau officers had shot and killed a patient inside a psych ward. They were skittish about any action involving the mentally ill. Ultimately, the client threatened a judge and showed up at his chambers. The client then went to jail without passing go or collecting $200.


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