Pushing Up

You owe me ten, Jess.” Katie punches my arm and laughs as we finish our last round of Combination 1, or the clueless newbie attempts at Combination 1

I step to the side and start my push-ups. Stupid s-words. C-words.

“Women, especially, y’all apologize for too much and sell yourselves short. For every time I hear you drop one of those words it’s 10 push-ups.”

This post isn’t really about about women belittling themselves. Or the super awesome MMA class Katie and I punch out our feelings with. It’s about you, dear client. 

Maui Thai meets four times a week. If we are lucky, on Tuesday evening we pull into the Y parking lot and hurry our way inside right as class begins. Notes might be left unwritten, our desk unorganized, and still half in work clothes. But by golly we are going to go at least once a week.

Orry-say and an’t-cay (sound it out. 5th grade will come back to you in a minute) are forbidden words, even as we rush in late, guilt ridden on our faces. He has to pause and start over explaining the workout. The class waits.

An hour earlier, 6:12pm, I sat on the crappy swivel chair we can’t afford to replace and are too stubborn to throw out. Looking at the clock, checking the calendar. “Hmm….wonder if my 6pm is going to show.”

Somewhere between late nights on my dorm room floor with books, friends, and milkshakes contemplating our role in restoring people to the fullest versions of themselves ….and now….working side-by-side some fierce warriors in the mental health field….somewhere in all of that you became “my 6pm.” 

And that, Dear Client, is where I failed you. 

Rather than calling you by name, your existence became a number, an hour for the quota, a measure in place to hold me accountable to an output to ensure the agency keeps its doors open. Open for anyone who may be in the pits of depression. On the high of mania. In the crowd of anxiety. In the fast lane of ADHD. For the family adopting a child with a history of trauma. For the kid who’s parents drink themselves to sleep each night. For the teen who’s harassed at school for her size.

You, dear client, have a story. And you share it. Treatment is about you, your family, and your surrounding environment. It’s not about me, you rest in the fact that I will not come up. Sometimes you pry, but they teach us ways to reflect and turn it back to you. Maybe you’ve noticed. 

Your story is important. And figuring out how you’re going to write the rest of it is what our time together is all about. 

Until you start cancelling. Or not showing up all together.

That’s where I failed you, dear client. That’s where I want to say our system failed you as well.

Dear client, the girl who dreamed of changing the world on her dorm room floor, she needs you here. Years later she thought that she could best serve you by being “sweet” and “accommodating.” But then she became bitter and frustrated, resorting to calling you by the time you were supposed to arrive but didn’t. 

How could you know? Afraid of stepping on toes, being too eager to dive into treatment, not wishing to self disclose in our initial sessions, I left out a very important detail. My time and your time. I should have considered telling you the following: 

I went into this field  because I believe everyone just needs a little extra help sometimes. I believe that our behaviors play a huge role in our physical well-being. I believe that behaviors play (in part) into our development of wealth. I believe that God has given us all different strengths and we have an opportunity to use them, but sometimes circumstances (or really, to better sum it up, SIN) cloud our ability to believe we are worthy, capable, loved, and called for a purpose. And I thought that counseling was a great way to reconcile people to  fuller relationships with God, others, self, and the rest of creation.

Therefore, your time and my time are important. When you make the bold step of entering into treatment, we should celebrate that. It takes courage to realize that maybe an outsider’s perspective would be helpful. I want to give you the best services I can. If I don’t know what to do, I work with coworkers/supervisors and study to find ways to best serve you. But in order for me to do that, you have to commit. When we agree on a time to meet, I come with the toolbox of skills that I spent years in school, on the job, and evenings studying to fill. This, coupled with your investment of time and energy, means we can get rolling. It may be uncomfortable, it may be difficult. But I’ll be here for you and will be working to build your social supports in the meantime so eventually someone else will be there for you too.
So for this to happen, it’s really quite simple: you need to be here.

For various reasons I will not get into, I’m limited in my ability to hold you accountable. Rest assured, accountability is in place on my end. I must document everything (and Medicaid is the litmus test for documentation expectations). Your insurance regulates how often I must see you and for how long. My notes must justify the time together and use evidence based interventions. We are a private company so to keep the doors open, I have to serve a certain number of people. While we can argue we are trying to fit mental health into a business model, it’s actually reassurance for you as far as my commitment to you.

So when I say that I will hold you to our no-show policy. I’m going to mean it. Three missed appointments without notification and services will close, to be reopened after 6 months, allowing you time to decide if this is something you’re ready to invest in and willing to make accommodations for. I want the best outcomes for you and that means that I am going to allow you to decide through your attendance whether you are committed or not. It is not in your best interests to receive sporadic services on an as-needed basis. For many of you, your parents and your teachers have failed you, not preparing you for the real world of responsibility. I don’t want to fail you. And so that might mean that one day I have to say “it seems like at this time you are not ready for services. Per our no-show policy of 3 missed appointments, your services have been closed.”  

As I punched Katie during Maui Thai on Tuesday, frustrated that 50% of my caseload had canceled, asked to reschedule last minute, or simply didn’t show up, I realized that I failed you. In effort to be “sweet” and “flexible” I allowed your progress to stall when I didn’t hold you accountable. I feared the way you would yell at me, complain to my supervisor, or make me feel like I am the worst person on the planet. I allowed my fear of hurting feelings or being assertive and coming across as inconsiderate to impede your therapeutic outcomes. 

Dear client, I will hold you to a higher standard from here on out. Not because you’re my 6pm who didn’t show up but because you are capable of achieving more and we won’t get there until treatment is consistent. I want to call you by name, know your strengths inside and out and help you to harness them and find your place in this world. I want to love my job and that joy to be a contagion in our agency. To do that, dear client, I have to make the tough call sometimes. I hope you will understand one day. 

If not, these push-ups are for you.


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