Access to Mental Health Care or the Jackson Pollock of It All

by Monica A. Ross, LPC

Problem-solving.  Why would the ability to problem solve be a core component of resilience? My first thought on that one is that people who are struggling just to survive, for those who face steep obstacles in life, the ability to problem solve is critical in order to figure a way out of the crisis(es). 

Take a look at this clip, for instance, from the Center on the Developing Child at Harvard University “How Resilience is Built.”  It talks about the importance of relationships and the importance for the developing child of the ability to both monitor and problem solve. 

At the time of this posting, what comes up in a google search on “How to problem solve” is this method:

1.     Identify the issues.
2.     Understand everyone's interests.
3.     List the possible solutions (options)
4.     Evaluate the options.
5.     Select an option or options.
6.     Document the agreement(s).
7.     Agree on contingencies, monitoring, and evaluation.

This is of course geared towards problem-solving in the workplace. That sounds about right, but we also know that people who find themselves in crisis at work or at home can’t even begin to complete number 1 let alone move smoothly along to 2, 3, 4, etc.  The reason for this perhaps is because those living in crisis are living life from a scarcity mindset. 

Mullainathan and Shafir in their book Scarcity: Why having too little means so much explain that the focus on what we lack, or approaching life from a scarcity mindset forces a type of preoccupation in life.  When we are preoccupied we do not have the cognitive bandwidth to begin to address other problems.  Or at the very least, addressing other problems becomes a daunting task.

The scarcity mindset as the authors point out is not about lacking the capacity to process, but it is about lacking the mental resources. With the scarcity mindset we tend to do things like incorporate tunnel vision which is good when something deserves our sole focus and concentration, but towards how many singular things in life do we have the luxury of dedicating all of our attention? 

Scarcity also affects our executive control, making it hard to have self-control.

A lack of self-control can then interfere with problem-solving.  Lack of self-control more often than not can exacerbate a problem. It is these types of psychological biases affecting those living with a scarcity mindset that fuel sometimes poor choices despite the fact that the consequences of those choices can be extreme.

This lends itself to doing impulsive things despite the fact that the stakes are higher. Not only do those who are operating at the survival level (e.g. the poor) have less room to fail because they have fewer resources, but they also have a compromised ability to make good decisions. This, in turn, increases the likelihood of failure.

As clinicians, one of the modules we are typically called upon to utilize in working with clients and in conducting psychoeducation is the module on problem-solving. Why? Because people with severe mental health issues sometimes forget to take their medication and when that happens they may stop taking medication altogether. They may act on impulse and find themselves running up gambling debts or maxing out credit cards in an impulsive spree, or making hasty major life decisions like moving cross-country.

It’s important then both to gain some level of stability as a consumer or client either on or off medication and from there to work towards maintaining that stability. Stabilizing itself takes a certain amount of problem-solving ability and that problem-solving ability may never be reached if a person finds themselves in a constant state of making both impulsive and poor decisions.

Now let’s compound the issue for the person struggling with mental health issues by making access to help in and of itself confusing. If I were to describe the process of finding a psychotherapist from the consumer or clients’ side, well it’s a bit like this:

Some Issues for Consumers

To me the current marketplace is like…..my own artistic interpretation:

scribble

 

Or

Like a Pollock Painting

Pollock Painting

Or

Like my friend Yoon Lee’s paintings

Yoon Lee

It’s like a kindergartener took a piece of paper and did this:

kindergarten

To put it metaphorically….

It’s like a city wanted to build a new roadway system and they let everyone decide where they wanted to put the pavement, stoplights, lane markers, and highway signs.

Mullainathan, S., & Shafir, E. (2013). Scarcity: Why having too little means so much. London: Allen Lane.

Negative Core Beliefs and Underlying Insecurities: Chaos versus Rigidity

by Monica A. Ross, LPC

The time that I spent working at a community health clinic in East Texas was good training.  I got used to seeing a high volume of clients with a wide range of issues, much like I do today.  I value the time that I spent out there.

Here I am now back in Austin. Typically I schedule 7 to 8 sessions per day. There are several reasons for that.  For one, you never know when someone will have to cancel last minute.  Also, my rates are pretty competitive.  I offer sliding-scale. I see clients with insurance. 

At the moment, I am subleasing space.  I limit myself to just 4 days out of the week for sessions.  Those days are Friday, Saturday, Sunday, and Monday.  Working over the weekend is good for the 9-5 crowd and it’s good for families with adolescents that have extracurricular things going on during the week.

My style of counseling is psychoeducational.   I spend a lot of time listening, but I also spend quite a bit of time explaining the concepts behind the modalities that I incorporate. I’m very active and participatory and collaborative during sessions. I listen but I also challenge.

And my clients, well it always surprises me who finds me.  Such great people!  They keep me on my toes and thinking. I had several sessions this past week that really got me thinking in terms of Cognitive Behavioral Therapy (CBT) and the search for negative core beliefs underlying what show up for people as insecurities.

Negative core beliefs lead to behaviors that either correct or overcorrect for our thoughts, in other words, they lead to adaptive behaviors. They may show up as the need for control, or behaviors related to shame and guilt, behaviors that may even perpetuate a feeling of being unsafe.

For example, being born into a turbulent family can lead to a kind of inflexibility in life that perpetuates the thoughts of being unsafe. By the same token being born into a strict family can lead to risk-seeking behaviors which perpetuate the thoughts of being not good enough.

I had one professor who put it this way—you can take all of the disorders found in the DSM and categorize them as one of two things.  They are often either disorders that come from a way of being that is chaotic or a way of being that is overly rigid. Think of mania.  Think of obsessive-compulsive disorder. That suggests then the value of balance in our lives. 

It's the playing off of opposites rigidity/chaos that’s got me thinking today.  And how even in relationships one partner may overcorrect for the other partner’s behaviors--a kind of counterbalance and adaptation. For example, a partner who thrives on structure may find themselves partnered with someone who is more laid back. A partner who lacks creativity might find themselves with someone highly creative.

The problem with identifying too closely with one role or another in relationships is that we can become stuck in our roles. One of the ways out of falling into a role whether it’s one that we place on ourselves or one that we inherit is to lay claim to that part of us which is forgotten or underused kind of like a muscle that atrophies. 

In other words, we have all of our parts. Though some of our parts may be experiencing neglect. The person who is structured does, in fact, have an unstructured and maybe more playful side.  The person who lays claim to no creativity does, in fact, have a creative side.

For all of us, I believe there is that part that prefers structure.  There is also that part that prefers fun.  There is that part that is laid back.  There is that part that is concerned. There is that part that is fill in the blank ________. 

And it’s important to feel as though we have access to all of our parts when we need them.  We don’t have to be estranged from the feelings of being playful or from the feelings of being in charge and responsible.  Though at one point in time, it may have served us better to adapt this way. No one part of us need to feel abandoned or trapped.

 

The Balancing Act of Empathy and Distance and Maintaining a Lifeline of Hope

By Monica A. Ross, LPC

When a person comes into therapy sometimes it’s all they can do to utter the words that bring them in.  Oftentimes those words are linked to tragedy or emotional distress. “I was raped,” “I had an affair,” “My mother passed away,” "I hate my job," “I’m so deeply sad or anxious I can barely get out of bed.” 

We as therapists hear these words every day.  We hear tales of abuse, tales of shortcomings, and tales of disconnect.  It takes a combination of things to balance out the low energy that these thoughts and feelings come with. 

While it’s important to have a measure of empathy, it’s also important to have a measure of distance. We each individual need I think to have a measure of distance from our own inner pain and we as clinicians I would argue need to have a measure of distance from our client’s emotional pain.

It is possible to have both empathy and distance.  It’s a balancing act.

The empathy helps with connection and the distance to a certain extent keeps us sane and practicing. I’ll never forget walking into the lobby of the community health clinic that I was working at and seeing one client who had the obvious appearance of having just had major surgery. My first thought as I saw the client and the nature of the injury and where it was located was that they had been the victim of violence by their own hands. 

That instinct was right. That particular individual had attempted suicide. That was not the first individual that I saw that came into the clinic having attempted to commit suicide in a violent manner. To pull back a client like that and enter into a conversation about mental health with someone who had stared down death at one point takes a measure of distance.

Because to lean too far into someone else’s pain risks losing professionalism and composure and the counterbalance that it takes to be a lifeline of hope. This is no different really than any other of the roles that a physician, a nurse, or any other type of healthcare provider might provide. People come seeking better health often because they are in some sort of pain, discomfort, or distress.

But that pain, discomfort, and distress is unique and separate although it's our shared connection to pain and suffering in general that helps with empathy. Want I guess I’m addressing today is the delicate nature of this job.  On the one hand, we as therapists are called daily to practice empathy and understanding.  I do my best to do that.  I get asked all the time, “How do you what you do?  I could never do that.” 

Well, actually I absolutely love what I do.  I love going into work every day and keeping this space for people to share their stories and hopefully find some kind of relief and buffer from the world.  And it’s not all tears and boxes of Kleenex.  It’s often also laughter and joy and celebration.

Quite often I get clients who come in having complained about something that a previous therapist did or said that was off-putting and I have no doubt that I at a moment of weakness may have rubbed someone the wrong way inadvertently. This does not make any of us bad practitioners.

There’s so much that goes into a delivery of a service especially when that service is intangible in some sense and the process is that of collaboration and co-creation. Perhaps there are times I think when I have tried to rush the process or introduce another perspective at a time it wasn’t in sync with a clients’ emotional needs.  That is an example of how an issue of timing can come across perhaps as a lack of empathy.

It’s hard for anyone to be good at what they do 100% of the time.  I’m not sure what my error rate is, but hopefully fairly low.  Lol.  So, when I get a client who comes in having had a bad experience with therapy I have both empathy for the client and the client’s former therapist who had they known would have likely tried to rectify their mistake. 

Clients have a right to terminate their therapy at any time and for any reason.  Though we suggest that if possible it’s good to try to work out whatever issues arise through the process of therapy within the therapy process itself.  It’s okay to be pissed off by something your therapist says and then walk in the next week and bring it up or gain clarification or what have you. It’s just part of the process.  But then there are other times when maybe it truly is time to move on and find a therapist who is a better fit.

 

 

Taking a Leap of Faith or The Indiana Jones Effect of Reframing

By Monica A. Ross, LPC

This is one of those times I’m sitting here and have no idea where to start or what to write, but I’d like to keep these blog posts going even while I'm in school and working full-time.  Okay, so let’s see what I’ve got.  HHhhhmmm.  The topic of semiotics came up today but in an indirect way.

Semiotics is anything which symbolizes something else and can include things like words, objects, and images.  It’s the word, the object, the image that stands for something. As part of defining the social problem that we elect to tackle in class, we’re entering into a discussion about categories and labeling. 

When I say the word “safe,” or hold up a cross, or show you an image of a homeless person, each one of those things is heavily meaning-laden and no doubt evokes emotion. Each of these things is like a shortcut in a way to understanding just like broad categories such as the “mentally ill,” “the working poor,” “the formerly incarcerated” are all labels that no doubt bring up associations of their own—some negative and some positive.

Every social problem has its own set of categories and the way that we label and group and categorize effects how we behave towards that thing.  So what we’re really talking about here from a psychological perspective is reframing.  Here’s an inspirational video that came up in my facebook feed recently. 

Seth here is talking about the framing of the story of Icarus and how the framing of the story shaped our understanding of it. Shaped one way, Icarus’ hubris caused his downfall.  And shaped another way?  Well, Icarus lived a life not in fear but in hope.  He avoided the dangers of flying too low.

As Seth points out sometimes we fly too low in life out of fear of loss, or abandonment, or embarrassment, or failure, or even death.  But the reward for pushing ourselves to the maximum of our potential leads to other opportunities that we as of yet may not possibly be able to conceive.  I remember signing up for the first course I took in my master’s program and taking a deep breath and leap of faith.

There is so much discouragement these days surrounding going into social services or into the arts for that matter.  The fear is around not being able to find a job and support oneself once out.  And it’s not as though some of these fears aren't based in reality. 

It is a long road.  It can be difficult. There is competition for opportunities.  And I have starved.  Literally.  More on that later. Lol.

But seriously, I would not have chosen any other way through this life.  And the reward far outweighs the cost to this date.  And every day I continue to take another step of faith.

My mind’s flashing now on the Indiana Jones movie not that half my audience knows who Indiana Jones is or that I consider myself an Indiana Jones.  Well maybe, in a way. This clip demonstrates the limited CGI of the time.  But powerful moviemaking nonetheless.

Back to reframing.  Take a negative and reframe it into a positive and notice how it changes your behavior.  Instead of a walking away or giving up feeling, there’s almost a renewed energy in that thing.  But I will add one caveat. 

I do think that there are battles that are perhaps not worth fighting.  Even at the end of the day if it’s a battle to walk away from, still then we have the choice in how we put a spin on it and the meaning that we make of it. There are even times we walk away from the battlefield only to return another day and from a different approach.

Beverly Schwartz and Mr. Rogers and The Importance of Self-Care

By Monica A. Ross, LPC

            We had a great class last night.  The energy of class flows better some nights than others. I smile a little as I look at the tired and weary faces of my colleagues and then glance at my own image on screen also looking a little tired and weary. Many of us have full-time jobs in addition to attending class.  It’s a lot we’re tackling here--this business of changing the world. 

Last night the discussion went from Beverly Schwartz to Mr. Rogers to seed funding.  Beverly wrote a book called Rippling: How Social Entrepreneurs Spread Innovation Throughout the World.  In one of her lectures which we watched outside of class, she talks about the stickiness of past experience—"for each of these entrepreneurs there was something with their past that collided with their present and set their future in motion—the problem sought them out and stuck to them by virtue of their past experience.”        
 
It’s the stickiness of past experience that has brought my colleagues and me here.  For some of us that past experience starts in childhood.  There was an influential event or an influential person in our lives that caused us to take the actions that we took that led us here today. We saw problems that made it easy for us to see because we've experienced them in some way ourselves.

I was thinking yesterday about choices—the choices we make in life.  How we make choices based on values.  True to my INFP nature, I put a high value on education and on meaning-making.

Different people, different choices.  If I do a values-based exercise with a client I’m truly wanting to know—what are your values and how will you make choices based on those values?  I wouldn’t attempt to give guidance to someone else based on my own value system. 

There’s not a book that I’m going to pull down from any shelf and say “well actually according to this, you should do this….” while others have tried.  That book, if it existed, would be the book that my clients write. All of these psychological tools that are available are there to promote the free and responsible search for one's own truth and meaning. 

There have been people I have come across who have commented on the commitment I’m making to student loan debt to complete this program.  Yes, it's quite a commitment.  If I had put a higher value on other things in life they would have led to other choices, outside of an advanced education, no doubt.

Schwartz throws out another great quote, this one comes from a friend of hers—“When you invest in human value there are never any taxes and you come out richer no matter what happens and when you speak from your soul you speak from a universal language that everyone can understand.” I liked that one too. 

I have made a commitment to human value.  I’m doing my best to speak from my soul. Mr. Rogers?  He comes into play because there is the new documentary coming out soon. He spoke before the Senate in 1969 to defend federal funding of public programs like his own.  In this clip of his testimony found here, he read the poem below. 

The Mad that You Feel

 

What do you do with the mad that you feel? This thinking is very much in line with Viktor Frankl and with existential psychotherapy—stimulus versus response. Between every situation or every stimulus and every response, there is a space.  That space is the power to choose. What I sometimes tell clients is that we can register our feelings about a situation very quickly—within milliseconds. 

The limbic or primitive portion of our brain that is also connected to the amygdala or our fear center makes it hard sometimes not to react immediately, especially when registering an event as threatening in some way.  This actually happened to me the other day at a social gathering. Ugh. It happens to us all, right? 

Before we know it we let some snarky comment get to us before we even know what happened.  Snarky comments can feel threatening.  And before you know it you can get caught in a kind of back and forth tit for tat. 

To be able to work on the ability to handle things tactfully when that happens is a real skill and so hard when our systems are down--when we’re stressed out to the max--all the more reason to implement acts of self-care.

Getting a Good Grip on Your Worth-Or Battling Perfectionism from the Standpoint of the Non Negotiable

By Monica Ross

There's a clip that I use in sessions. I keep coming back to it.  So, I'm just going to pause during my lunch break here and get this post out before entering into a block of sessions this afternoon.

The clip is less than a minute in length.  Anytime I use multimedia I ask for permission from my clients and try to keep it to a minimum. I also only use something, if I think it applies. As we know with the learning process in general, sometimes it helps with learning to go over the same material but in a different way.

Here’s the clip.  Brené Brown, of course, has gained in popularity over the past several years.  I have so many other readings that admittedly I haven’t taken the time to go through all of her stuff and in some sense, I feel like I’ve come across the material that she presents in other ways. 

But, in the above clip she’s talking about value, one’s own perceived value.  I incorporate a lot of cognitive behavioral therapy in sessions (CBT) and what Brené says at the beginning of this clip is very much CBT oriented.  She says: If you go through the world looking for evidence that you don’t belong you will always find it.

What I point out to my clients is that you can fill in the blank with all sorts of replacements “If you go through the world looking for evidence that __________”

-you are weak
-you are powerless
-you are bad
-you are inadequate
-you are a failure

Then she goes on to say “Our worth and our belonging are not negotiated with other people, we carry those inside of our hearts.”  I think that people who sometimes come in with issues related to self-esteem find themselves in life in some ways battling with someone or something over their self-worth.

I see that as entering the "negotiation phase" as Brené Brown says.  The automatic thinking goes something like this, “Well my boss did call me in to point out that I better improve my performance in this area and if I don’t I could possibly get laid off, so I must be a failure” or “My wife told me that if I don’t lose the weight she’s going to leave” or “I have difficulties letting people get close to me because they will find out how deeply flawed I am.”

In all of these fictionalized examples, the person speaking has placed a condition on their worth based on different situations they find themselves in.  The underlying thinking sounds something like: If I can keep my job, I can prove my worth.  If I can lose the weight, I can prove my worth.  If I can sustain this marriage, I can prove my worth.

What’s being left out are two things 1) all of the mitigating circumstances and contributing factors that lead to the situation 2) the idea in the first place that one’s worth could be a topic of conversation for the day. 

What if the person facing job loss is in the wrong profession?  What if the person with the weight issue doesn’t, in fact, have a weight issue, but a marital problem?  What if the person who does not find themselves in close friendship is not in anyway flawed, but has difficulty finding people to connect authentically with in a world that at many times can be so unauthentic?

In other words, there are alternative ways of looking at each of these scenarios.  But the one thing that remains constant throughout is that a person’s worth, a person’s dignity should never fall into question.  Because we all have inherent worth and dignity. 

This is a non-negotiable.  Part of the work of therapy is to get a lock-solid grip on that concept.  And there are various tools for getting there. Time and again in life we will encounter relationships that end, we’ll be the recipient of mean things said or done, we’ll make mistakes--it’s part of being human. 

Life can be god damn messy at times, no doubt due in large part to miscommunications and misperceptions and randomness. But here is the take away for me and part of what I want to try to impart to others as I do this work.

There doesn’t need to be the fear that people will hit on that thing of all things that we guard so well against, because if people only knew, then they’d reject us in the same way that we reject ourselves.  That thing whatever it is and whatever it causes us to believe about ourselves isn’t true.

So there's no need to fear it.  It’s an opinion, a false assumption.  

Once that is realized instead, the above list can be replaced with:

--you might feel powerless at times but you can control what you can control
--you may have done “bad” things, but that doesn’t make you a bad person
--there are times in life where we miss the mark and fall short in some way and feel inadequate, but we can accept ourselves despite our shortcomings, as we are on the path towards self-improvement

If perfectionism is about meeting all conditions.  And those conditions are tied to our self-worth. Then we can let go of the need to be perfect because our self-worth is nonnegotiable and from that perspective, we already all perfect.  Perfectly imperfect.

 

 

What is a DSW exactly? What Else are We Learning?--And My Faculty Advisor

by Monica Ross

I’ve been assigned an advisor for my thesis. Her name is Dr. Amanda Stylianou.  She’s an LCSW practicing out of New York and the Associate Vice President for Quality and Program Development at an organization called Safe Horizon

Safe Horizon is the largest non-profit victim services agency in the United States.  They work with victims of domestic violence, child abuse, sexual assault, and human trafficking. I’m very much looking forward to working with Dr. Stylianou.

Just about one month has gone by in this program.  The pace of working full-time and attending 4 hours of virtual class time a week in addition to the outside readings that we have to do has been challenging.

I feel like we’ve covered so much territory already.  That would make sense because we’re doing things at a very fast pace.  This program is only 24 months long. To those who would say how can a doctoral program be only 24 months long?

I’d say this...The licensure that I have for my LPC took approximately 6 years to complete from start to finish.  So in some sense, I feel as though my dues in terms of gaining an education at the graduate level and in time spent training for my profession have been paid.

These two years in the doctoral program will make it about 8 years of education and training post BA total.  Most traditional PhD programs require about the same amount of time to complete coming straight from undergraduate school.  So, in a way, I look it like I took the complicated route to a doctoral degree, which seems to be more in line with my style. 

Previous to even starting my master’s, I had accumulated over 20 years of work experience in a range of industries which gives me a wide perspective on office structures and organizational policies. Because the focus of this doctoral program is on social innovation and where systems in society overlap with social problems--that experience will help with the work that I’m doing, as well. 

Academic programs that are online or remote come under scrutiny for not being as rigorous as brick and mortar academic programs.  And there are some online academic programs out there that may not be. 

However, I can say that in this doctoral program, I’m meeting with a small group of up to 15 other students twice each week for a couple of hours each class.  This doesn't include time spent in group meetings that we have outside of class for group projects. We also have readings and assignments to complete consistent with more traditional academic programs.

The virtual environment as an educational tool is not going away and I’m excited to be participating in it with an academic institution that is on the leading edge of that front.  Some might ask, what is a DSW anyway?  It's a doctorate but, it's not the same as a PhD. 

The DSW is to social work as the PsyD is to psychology. A DSW degree is a bit like a PsyD in that it emphasizes professional practice over research.  That’s not to say that I can’t conduct research or teach for that matter, but solely conducting research and teaching isn’t my current aim.

What else are we doing in this DSW program?  We’re examining different organizational change models, we’re combing through databases from peer-reviewed journals, we're creating annotated bibliographies for our separate projects, we’re applying the models we’re learning in class to case study examples on various social problems. 

And we’re doing all this from the standpoint that at some point the models we are learning will be applied to the separate projects that we are working on for our capstone thesis. We’re also hearing from thought leaders in a kind of a guest lecturer format who have taken the time to sit for recorded interviews specifically for our class on the topics we are covering—Freddy Mutanguha of the Holocaust Memorial Trust gave a lecture for our class recently and Karen Freidt who is the Creativity and Innovation Program Manager for NASA’s Langley Research Center gave a lecture.

As I watch these leaders of industries with experience in anything from science and engineering to outreach and education programs in East Africa I feel truly inspired by the lessons they are imparting from the work they are doing in their various fields.  A couple of things stand out for me as lessons learned by these leaders of industry. 

#1 Is the importance of not trying to solve a problem for someone else that you don’t yourself understand.  I’m playing with the idea of using health disparities as my focus because it’s something that I intimately understand. When I use the term health disparities I’m talking about group differences in physical health that are influenced by inequalities in society that are socially determined by such as things as access to proper nutrition, education, employment, housing, and transportation. 

Both of my parents were chronically ill and social determinants in some sense affected both their access to care and the quality of care they received.  But I don't have to go there.  I can stop with the fact that I myself am a member of more than one social grouping that often faces stigma and discrimination in society. I could look to my friends who themselves are in groups that are stigmatized and discriminated against.  So, yes, a problem that I intimately understand, checkmark.

#2 While it’s important to be passionate about your work, it’s also important to set the intensity of that passion so that it’s not so high that your field of vision is narrowed. As far as dialing down the intensity goes, that's hard to do.  Because these issues for me are personal as I mentioned not just because my family members have been affected by these things, but my friends, myself.

My colleagues and I are doing this work doubtless because it feeds into our sense of purpose in life, but at the same time, a certain measure of detachment is needed in order to continue to learn and think critically and challenge long-held beliefs and presumptions, some of which might be our own.  David Perkins from the Graduate School of Education at Harvard is attributed as having said that 90% of errors in thinking are not errors of logic but errors of perception. 

I’ll take it a step further.  It's our perception arguably from which we derive our logic.  In other words, our perception or beliefs influence not only the way that we view ourselves but the way in which we view other people, and the way in which we view the very world in which we live.

 

 

Almost One Year of Blogging and Still Kicking...Point of Self-Reflection

by Monica Ross

I sat down today wanting to write another post, but not really sure what to write about.  Classes are going really well.  I’m loving being in this doctoral program at USC.  We’ve learned so much even in these first few weeks about social norms, deviance, and innovation dynamics. Jeff Leitner developed innovation dynamics.  

We’re starting in one of my classes with a case-study on decarceration and analyzing all of the actors involved with some of the problems surrounding that.  I have something to contribute to the discussion because I have had clients who were also former inmates.  As we go through each case study we’ll continue to hone our abilities to tackle the social problem of our choice for the capstone project. 

My professors this first semester are Dr. Terrance Fitzgerald Jr. who got his Ph.D. from the University of Illinois at Urbana-Champaign and Professor Jim Wind who received his MBA from Harvard Business School. Both are leaders within the fields of social work, education, and business.

It takes a bit of getting used to having classes in a virtual environment.  I love the concept of collaborating with colleagues all over the country/world and in different time zones--live and in real-time.  Classes sizes are kept small. The software that we use allows for the capability of chatting with everyone or with specific people while class is taking place. 

This has its pros and cons and invites moments of laughter.  Imagine the experience of listening to the professor lecture and being able to direct your gaze to the chat in the corner where a colleague included a link to an article or organization that contributes to the conversation.  It can be a very useful tool.

Also, people tend to loosen up a bit in the virtual environment and crack one-liners on chat which adds comedic relief. This too may take place during the actual live discussion itself.  

I started this blog almost one year ago.  I remember the feeling of whelp, this is post number one. I didn’t know then if I could sustain my motivation to write.  And I wasn’t sure at the time what my blog would be about.  Some things haven't changed in a year. =)

As a writer, sometimes you have broader concerns about how people will take what you write and in some ways, that sense feels compounded if you are a clinician in addition to being a writer. =/ But I've just kept at it.  And then several months into writing this blog, I became motivated to write a book.  And now I’m working on that.

I don’t have a set schedule, for example, to sit down every Monday morning at 8am and plan to publish by Wednesday.  I also don’t force myself to put one post out every week or what have you.  It’s just when I feel like sitting down to write, I do.

And what I end up writing about isn’t mapped out for the next 3 to 6 months around themed topic areas.  I’m not strategizing about covering such and such issues in mental health.  I did play with doing some of that early on.  I had all of those posts about the 10 unhelpful thinking styles that are the core of Cognitive Behavioral Therapy and then there were the posts about EMDR.

But when I wrote all of that it was more from a sense of just wanting to get the information out and less from a sense that I was building up a marketing strategy. I do remember writing one post that was formulaic and based on marketing strategy techniques. 

At the time I was listening to advice from a marketing consultant and actually, while the post has good information in it, I don’t really like it for that reason.  It's not really me.

It’s not as though I can’t follow a formula.  You hear things from marketing consultants like "only provide information in the post that is bite-sized and skimmable, aim for 1,500 words, write to your ideal client, start with a 'hook,' and add an emotional appeal that delivers a vision of a before and after scenario."

It’s not as though I’ve thrown all the advice out.  I think some of it has been helpful.  And for people wanting that type of structure and direction, I can see how having a plan can be good.  Maybe it's something I'll shift into?  Maybe not?  Who knows.

But by and large I’m just picking and choosing what I feel like writing about at the moment.  With taking on additional education, and as I begin to shape my capstone project, and what will eventually become my first book--my website, this blog, my life will begin to take on a different form I suspect, as well.  

This is just a moment captured in time.  Life is a process.  And I’m in process in that process right alongside the people that I help.  I guess that’s one of the major points I’ve been trying to get across from the very beginning.

That time I got arrested for a DWI—The Summer of 2017

by Monica Ross

arrested dwi dui jail

I had just moved back to Austin at the beginning of August of 2017.  It was my big reentry into the city after the two years of exile by choice and not by force that I had put into interning in East Texas.  I was two weeks into a new job as a psychotherapist here at successful group practice.  Things were looking good.

My friends had invited me out to a private music concert downtown.  These particular friends are long time friends—one is a mechanical engineer and the other a product manager for mobile software company.  They offered to pick me up and take me home that night because I was going solo and I decided at the last minute I would drive myself. 

The event itself was a lot of fun.  The company of friends was even better.  That night I had one vodka cranberry cocktail at 8:30pm when I arrived and by 10pm the event was over.  But instead of going home, I thought I would hang out a bit longer by myself downtown.  I was thinking maybe just one more hour. After all, I had just come from living in a place where the nearest night life that was anything similar to Austin's was a good 2 to 3 hour drive away.  

I headed down the street to the warehouse district and had another cocktail.  And then I ended up leaving downtown by I guess about 11ish.  I hadn’t eaten since early the afternoon that day, so I stopped by a popular place in South Austin on my way back home and had a light meal. 

It’s actually another nostalgic place for me—a homegrown wing and waffle fry place called Pluckers.  The first Pluckers opened up a few blocks from where I lived as an undergraduate in West Campus.  And dropping in there now and again makes me think of that time period.

So, I have my dinner and order a beer to drink with it.  I barely touched much of the beer.  And by then several hours had passed during the drinking of the alcoholic drinks. I had had my food by now to go with it.  I thought I was safe enough to get back on the road and go home which wasn’t too much of a further drive for me.

So, I proceeded to do that.  I headed home.  I drove down a residential street in south Austin.

And off went the swirling red lights behind me.  An officer pulled me over.  “Have you been drinking, tonight?”  Yes, officer I have.  “How much have you had to drink?”  About two cocktails.  “Please step outside the car.”

The officer pulled me over for speeding.  I had been driving over the speed limit because it was a street that I was not familiar with, it was also very dark at that point and the street signs were not well lit.  I was driving what I thought to be an appropriate enough average speed for a residential area and then aimed slightly above that.  It's what any average Texas driver would do.  

In all honestly I was also rushing to get home because I was exhausted. I was out well past my bedtime at that point.

The officer asked me questions about my entire day.  I answered every single one without missing a beat.  He then gave me a field sobriety test.  He had to give me a field sobriety test for liability reasons alone.  Here I had been pulled over for speeding and then add to that the fact that I admitted to drinking.

I thought I passed the field sobriety test.  Most people probably feel that way.  You go online and read all the reasons for which people fail these tests and how it can have nothing to do with how much one has or has not had to drink.

It was only when the officer said “Do you consent to a breathalyzer” that I began to think there is something about this that isn’t right. 

I asked him, by consent, do you mean I can refuse?  
He said, “Yes.” 
Then I said:  I refuse the breathalyzer.
He said, then I’m going to have to arrest you. 
I said, wait if arrest is on the table then go ahead give me the breathalyzer. 
He said, it’s too late at this point.  I’m going to have to arrest you.
And that’s what he proceeded to do.

I was handcuffed and taken to Travis County jail.  I put on jail garb—the whole thing.  I got my mugshot taken. I sat in a room full of people who also had been brought in that night for similar reasons. I met nurses and other career professionals in jail. 

I visited with students and ne'er-do-well types who also had been brought it.  It was a huge mix of both people who were repeat offenders and people who like myself were deer caught in highlights and kind of wondering wtf am I doing here?

They asked for my consent to draw blood, which I gave. They never explained the repercussions of refusing consent to a blood draw, by the way, but that didn’t matter because once I understood what was going on—that they intended to keep me in jail overnight--I consented to supplying evidence in my defense.

They took me down the road to Breckenridge where they proceeded to take my blood.  They then brought me back to the jail.

The temperature in the jail was set to just below arctic temperature.  They held us in an open space with benches and one shared bathroom.  If we wanted something to drink we had to drink from the fountain which was attached to the sink in the bathroom.  

They offered some of us food and not others.  Several of us asked questions about the nature of what was going to happen next?  The guards gave information out sparingly--at times misinformation--and a bit of teasing.

I witnessed a lot of crying.  A lot of handwringing.  A lot of worrying about how the arrest would impact people’s careers, finances, family life.  For some this was their second or third offense and for some it was their first.

There was a lot of regret expressed and a rehashing of events of the night—all the stories and all the details that led up to each individual’s arrest. I met people who were underage and people who were in their 50s or 60s or more.

Thankfully, I had been through a counseling training program and felt equipped not only to better deal with the hell I was going through, but to help others going through their separate hells as well.

There were a few phones provided for us and several of the women I was cordoned off with clamored around them and frantically tried calling friends and relatives and bail bondsmen all night long.  If I was brought into the jail at around 1am or so we didn’t get an actual hearing until later that morning. 

At the hearing, which was out in the open for all of the other jail mates to hear as we were handcuffed to each other, I was granted a personal bond and told that I was being charged with a Class B misdemeanor.  At that point, reality sunk in even further.  It was a "this is really happening" moment.

After the charges had been dealt, I was taken to a jail cell with one small window on the cell door and left locked behind it for several more hours--alone.  I had to wait until a guard came to check on me, if there were anything I needed. She came by sparse and sparingly.  So I spent much of that time desperately trying to sleep the night off.

I was in jail for a total of about 16 hours or so.  I had been up for over 30 hours at that point.  If I had been exhausted when the officer pulled me over at 12am I was well beyond exhausted by that time and with no idea how all of this would eventually play out. 

Had I been over the legal limit or under?

What I want to express is that for people going through this process, as I myself had to, there is an enormous amount of stress and waiting around and trying to figure the "what's next’s" of the whole process.  That stress doesn't end when you leave the jail.  It's something that one can carry with them for the days and months that follow release.

I went to Brackenridge the very next day after I got released and asked that they give me my blood alcohol test results for peace of mind, after all it’s my blood they took, shouldn't I have a right to see the results?

Wrong. 

They said they could not give them to me—it belonged to the City of Austin.

My blood was the property of the City of Austin?  Wow. 

My next question was that at the point of blood taking, why did no one ask me if would like a separate blood draw, property of me?  I guess that’s something they can’t do.

I found an attorney who was generous enough to work with me on the costs of representation.  And when I signed the contract to hire him I still did not know at that point how much of his services I would need. 

Hiring an attorney in that sense was a bit like buying insurance.  In other words, if my blood alcohol came back over for whatever reason, I would definitely need his help to argue some kind of defense for a first time offender, but then if it were under, as I had hoped, then maybe not so much.

Well we're into April now.  The blood alcohol test?  Let's just say I was pulled over on August 20, 2017.  The results of that test didn’t come back until March 15, 2018—seven months later.  That’s seven months of waiting and wondering and paying monthly fees to an attorney. 

That was seven months of potentially missed opportunities working for a well-known company that I made it all the way to the end of the interview process with and then another potential missed opportunity working for a government position that I had all but been offered--pending background check.  And we know what the background check at that point said.

The results--the bac test--what did the results say?  “NO ALCOHOL WAS DETECTED.” 

That's right.

I still at this moment have an arrest on my record for a DWI.  If I choose to get it expunged it’s another year of waiting before I can even begin that process. 

> On Mar 15, 2018, at 4:14 PM, Dan Garcia <dan@dunhamlaw.com> wrote:
>
> Hi Monica.
> Your blood results came back today.
> No Alcohol was detected.
> I have left a message with the prosecutor to call me to discuss how to
> dispose of your case.  I will contact you as soon as I speak with the
> prosecutor.
>
> -Dan

Rejection of Misdemeanor Charges

How I'm Currently Answering the Question: "What's the Book Going to Be About?"

by Monica Ross

Dorothea Lange-Migrant Mother

I’ve run into people lately who know my intent of writing a book and they’ve been asking me, “Well what's it about?”  I say that I have a loose sketch.  There are several themes that I want to tie in together. The general themes are poverty, stigma, mental health, physical health, behavioral economics, and therapeutic techniques like cognitive behavioral therapy. 

I’ve thought about going back to school to advance my studies even further.  And recently, I applied to a couple of doctoral programs.  Both of these programs are online and shorter in length than a traditional PhD track program which would be geared more towards someone who wants to end up conducting research and teaching in academia.  The one doctoral program that I am looking at in particular would place the emphasis on clinical practice.

I don’t know whether or not I’ll get into my program of choice or whether or not having gained the acceptance I’ll sign the piece of paper that commits myself to even more student loan debt. But I thought I’d use this post to explain some of my background or reasoning for wanting to pursue the idea of writing a book.

I made some of the following statements in my personal statement submitted to the doctoral program that elucidate my intent a little bit more:

Extreme economic inequality is a public health problem. As a health care provider, I want to advance well-being practices geared towards overcoming the unique psychological barriers that economic inequality perpetuates in order to stimulate behavioral and economic change. The government focuses on prevention and early intervention for “at risk” youth, and this leaves out our adult population, an even larger demographic.

Some of the adults I have treated were not able to get early interventions and therefore find themselves struggling later in life. I am intrigued by the work of Eldar Shafir and Johannes Haushofer, both from Princeton University, who are leading the conversation linking poverty to psychology and tracing this linkage to its economic impact.

In my early years, in Texas, I saw the struggles my parents had with chronic health impairments and economic inequality. This influenced my decision to go into psychology and sociology as an undergraduate student and to focus my studies on resilience and well-being later in life.

I did not see the burden of my parents’ health and financial issues or my own issues for that matter as resting solely on our shoulders. Instead, I had some sense there were environmental and societal factors affecting our overall health and well-being.  I am an advocate of personal agency and responsibility, while at the same time acknowledging that we, all of us, live in systems.

After graduation I spent many years working in California at corporate, government, nonprofit, and academic institutions. I choose this path of work because I chased after the financial security that these roles provided. In 2010 I made the decision to come back to Texas to be with family and I came up with a plan to pursue my calling—to return to the study of psychology and to become a psychotherapist.

By August of 2011, I was enrolled full-time in a counseling program at St. Edward’s University. By May of 2014 I finished my counseling program and graduated with a 4.0 GPA. With my master’s degree and LPC-intern license in hand, I made the decision to relocate to rural East Texas because of the experience it offered.

I began working at Burke, a Federally Qualified Health Center headquartered in Lufkin. It serves a 12 county region and houses services for people across the lifespan, from children to adults, with mental health and medical issues. At Burke, I worked initially with the most severely mentally ill in vivo as a caseworker.

In that role as an in vivo caseworker, I came face to face with the devastating effects of poverty in America and its relationship to mental health. After a year as a caseworker, I transitioned to the office and provided psychotherapy at the clinic for our clients that included 50 to 90 minute individual counseling, group therapy, and psychoeducational sessions.

I discovered a wellness self-management personal workbook from the New York State Office of Mental Health and used that as a tool to lead a 12 week series of group therapy sessions. I also drove once a week an hour outside of Lufkin to Crockett, a town of less than 7,000, in order to provide therapy to the neediest in that community. Crockett has a 39.1% poverty rate.

In some ways, I had escaped the financial and cultural struggles of my early years for an interlude while in working California only to willingly come back to my home state and face those same struggles again, but from a different perspective. Once I finished the licensure process, I moved back to Austin to embark upon my own private practice.

Throughout my experience as a counselor, I have continued to work with clients of all ages in all levels of socio-economic status. I have clients who have been in and out of prison, who have had Child Protective Services (CPS) involvement in their lives, and who are struggling to maintain independent housing, access to proper nutrition, and transportation.

I have also worked with top executives of well-known companies who are somewhat more economically privileged, but often face similar mental health challenges and have had to overcome sometimes similar childhood trauma.

By addressing the unique psychological barriers that people coming from a place of extreme economic inequality face, we can more adequately advance long and productive lives.  This may come through a process of creating social responses that include therapeutic techniques to adapt to the changing social environment.

The experiences that I have had throughout life, the witnessing of the effects of extreme inequality, which are influenced by both societal factors and internalized psychological barriers, have taken on new meaning for me. These experiences were not random occurrences, but instead have prepared me for the work that I currently do and for the legacy that I hope to one day leave.