I look like this cute, petite kindergarden teacher. Though, I can say I have worn that hat before and even considered that career path once upon a time. (Y’all, I really was going to get an MEd in Elementary Education and work with the little ones. I love the energy of the kiddos who want to ask me the weirdest questions in the universe. We love that for them.)

To say that sometimes my heart fluctuates between: “Be an elementary school teacher and read books all day in silly theatrics” and “Become an addictions counselor with special emphases in trauma and dissociative disorders and accomplish amazing research” is perhaps the duality of woman in the grandest sense of the universe.

I often think back to why those were my favorite topics. I mean the counselor dream. Um, to pick knowing how to convince people who are scared to open up to not be scared of being scared combined with someone who knows about what people do when they’re the most scared and the most afraid of the world around them and even themselves? That’s a hot combination, especially given the progression of all of those.

Addictions are not always a trauma thing. Sometimes they’re just coping with bad experiences that are not necessarily trauma but could still have needed better skills to cope with. There’s also the biological. I often see addictions as a socially acceptable maladaptive self-harm coping skill. And yes, that’s blunt. But I also take the harm reduction methods to addictions, which is so much more effective when doing the real therapy over not. At least teaching harm reduction and then addictive levels of self-medication versus effective levels of self-medication put me in a much clearer space to effectively level with some clients. I may be a kindergarden teacher like human, but I know the signs and symptoms of drug addiction and overdose signs. [I was nerdy in school and loved medical stuff – the (often groaned over and disliked) units in school on the medical symptoms and biochemical reactions of drug overdoses were my favorite and like no one else got excited. Such a shame. (I would not survive an MD; never considered it much past one remark that I would make a great psychiatrist. Well, yeah… Yeah…)]

And then some people there was trauma, which was why I realized the addictions population deserves clinical staff who understand trauma. When you’re the most scared and I know that self-medication of a substance (even of one you have an addictive tendency toward) when having a severe panic attack is way better to discuss the effectiveness of than shame for implications on sobriety of. Maybe understanding that people deserve to be heard for their hurt and not shamed for how they were hurting was an overlap that believing in harm reduction helped me in. Because I never believed people turned to doing things seemingly unneeded by some unless there was a reason so logical to them that it would make some reasonable sense.

My underlying belief is that people always act logically to them, and even if it makes no sense to anyone else, they do it if it makes sense to them. Rationally is a different question, and sometimes that’s where I fall that the understanding “dissociation” is a key element in my focus. Because sometimes it’s not that we don’t think it makes sense but it’s that we know we can’t think rationally. I understand a lot of dissociation to describe the complex reality of experiencing multiple complex traumas so severe that being triggered into that space illicits the memory of becoming that person. It can also be a little less severe, but that’s the most integrated presentation, and it’s pretty interesting and comes up a lot in settings where people can’t get validated very easily.

I like the clients who almost don’t know that they don’t know what they know. That’s the space of the client who I help. It’s the client we describe as being “stuck” in therapy. The one who are so close to getting the words out but can’t. The ones who need a gentle reminder that being stuck is okay. Because sometimes we need to breathe and unwind from all of the chaos in our daily overwhelm. I don’t even mind the clients who scream; it’s cool, be mad you’re here. I think that’s great. Love a good vent sesh.

Sometimes, people don’t really get the concept of meeting people where they are at.

For me, this has always meant the process of allowing the client to choose when and where to guide the breakthroughs and lulls in sessions. I let the client tell me when they can or cannot handle more insight or information. It’s totally okay to need to breathe.

I don’t think I’m someone more amazing than I am.

I don’t think I got lucky in getting a clinical role that valued my expertise.

I remember back in 2021, my first experience in the clinical world.

I worked at this place we’ll call “Company A” that was an addictions rehabilitation residential facility. This meant the clients often would come from a hospital or sometimes a jail/prison and then to us. They would live in a house with 24/7 staff once an intake was completed. The houses tended to be separated by gender and were capped based on house size and a logical amount of beds that could be accomodated in the rooms.

Company A hired me to perform assessments. I was confused. I could not have been clearer to them that I didn’t have any prior clinical experience. I explained several times through that I volunteered in recovery ministry and was in school for clinical mental health. I was clear that I was not a counselor and just someone who followed a pre-written guidebook full of questions and listened to answers. Still, the CEO of the company hired me to perform assessments. I later came to understand why she hired me on.

My direct supervisor “Ray” went to show me how to do an assessment. He brought in the client and had my clinical supervisor sitting beside me. He pulled up the three or four different required insurance papers and gave the client fifteen minutes. He then asked the client to leave. He expressed that all assessments should be that quick and that fifteen minutes is sufficient time to gather the information needed. He did not provide any further instruction on guidelines, procedures, deadlines, or types of reporting.

I admittedly needed at least two to three hours to get through each assessment. Honestly, some of the clients were still coming down from a pretty severe high. I couldn’t force them to override their biology. I also wanted to catch all of their diagnoses. And Ray was furious at me when I would produce reports full of detailed information and specific diagnoses with reasonable proof. He would say my job was to provide only the diagnosis that was previously given to them and the questions were less important. But then he would say that too little information would be completely useless to him. I could not win.

It ended up being that Ray was bullying me for being a compent clinican. I cannot promise that every diagnosis I made was perfect. But I can promise that every diagnosis was written down with the best clinical judgement and with my clinical impression of the answers to their assessment. To me, that was the job at hand. I was trained for fifteen minutes on a task often given to people well into their career path in clinical health.

Sometimes it occurs to me that the only person who thought I did anything wrong was Ray, as he was making a big deal out of things not accurate. He was getting the brunt of trying to haze me. And I realize, often addictions counseling doesn’t allow for healthy management styles or working environments. The CEO was a woman who may have known how to make money, but she didn’t understand quality healthcare. And I eventually left the role because I was “inexperienced” but really, Ray meant that I was meant to do a job that wasn’t just about pushing people through a money machine.

Then in 2022, I gathered up the courage to try again.

“Company B” was a lot better. They were more of a counseling agency, which didn’t mean the greatest promise of management, but did mean that there was a greater chance they could provide me the ability to grow professionally without the fear of an inappropriate assignment of roles and tasks. I was able to be paid more fairly, which was really nice. I was respected more. My supervisors understood that I didn’t mind standing up for myself and they were going to back me up that it’s my right to expect not to be bullied by clients.

I remember my first few clients were so funny.

They looked at this kindergarden teacher looking human and almost seemed afraid that their trauma was going to scare me. I later developed a technique. I couldn’t get around my visual appearance. But I can define my rules of therapy:

• I will not work harder than you, the client.
• If you don’t tell me, I can’t know about it.
• Therapy is client-led; I cannot do the work for you.
• I am here to be a therapist and do not fix people.
• Mental health is a journey and it is not linear.
• If you can’t make a session, tell me first. Please.

And those were it. Everything else was up for discussion, really.

My supervisor was so funny, she goes, “Your clients really seem to like you. You’re getting really positive responses from all of them.” I guess she didn’t realize that my strategy of showing up as someone who was strong enough to define my role and show my expertise as a therapist by being willing to follow up my “rules” with the question, simply stated as, “So what would you like me to know about you? How would you tell me?” was actually realy effective for a lot of clients of all ages, genders, and diverse traits.

And I didn’t really tell her, because it never occurred to me to.

Supervision seemed a need to talk about the things were I needed to get help where I was stuck. Get the professional advice and experience. And it was really nice.

My time at Company B only ended because I got an illness and ran into some medical discrimination in getting a proper diagnosis in a timely fashion. I unfortunately ran into a further issue with concluding a school had a promise that was unrealistic and ultimately this was not what I needed to realize in the midst of my job being both contingent on pursuing a degree and also in jeopardy because my illness was being ridiculed. I never did ask for the job back. Not because I thought I couldn’t get it, but because I knew it would be unethical to take a job I wouldn’t be obtaining the education for. And even though the plan still was to, restarting a program presented new issues entirely.

I pulled myself together in the midst of trauma therapy.

I went back into a program, this time an MSW program whose goals seemed more aligned with me and who I was. I knew the school was much more honest.

Then, in mental health, I found “Company C” was offering a clinical internship for MSW students. Company C asked me to meet with their hiring manager at their new location, which was under construction and soon to open. I admit I was very hesitant, because the building seemed to be someone else’s and the hiring manager seemed not to be completely trustworthy or knowledgable of things that were really involved.

For instance, I told the hiring manager that since he expected me to essentially be their main clinical staff, I would need a supervisor – it was ethical and a requirement of any reasonable facility and program. I also stated several times through that twenty-five to thirty hours a week is more than reasonable for a full-time clinican. My salary was based on this understanding. I negotiated that I was to be hired at a clinical rate. He seemed to be unfamiliar with everything I had been telling him. I was completely shocked.

The site manager was atrocious.

“Dave” treated everyone horribly. I started to create one of the most amazing treatment programs for addictions, substance use, and common co-occuring disorders. I presented discussion questions and allowed journaling time as well as group discussions that were intended as ways to share rather than help one another. That was my goal. People helping each other isn’t always the best course when knowing what you need is sometimes the harder question to first resolve, answer, and figure out.

Dave liked all of my work. He enjoyed and was impressed by the many deliverables presented to and created for him. When it came time for my paycheck, which I was assured was coming (and I had filled out the hourly timesheet and the direct deposit information on the appropriate sites), Dave disappeared. He threw a hissy fit at me that I was not hired to do the work I was doing and I should not be asking for pay congruent to the work performed and asked of me. I stood up for myself and said, “Well, I never would have taken the job if the hiring manager was honest about the salary that is paid.”

I left without hesitation.

I slowly began getting more and more depressed.

I was processing trauma and getting really sad that my dream career – that I often proved to be really amazing at – came at the expense of awful bosses. It was not that the job was stressful, hard, or overwhelming. The hard element is poor management and even just management who doesn’t understand that therapy isn’t scalable and clients don’t just talk for an hour even if they like their therapist. It’s management who care more about the bottom line and billing than quality of care or if the client is being helped.

Therapy isn’t about making the client cater to the business.

Therapy is about making therapy what the client needs.

It often means being willing to make a lot of mistakes.

It often means being willing to admit when we are wrong.

I will be wrong more times than right. I will definitely stump myself sometimes when meaning to help. And I will grow, and learn, and rethink how to do things. Because therapy isn’t about trying the same way every time. It’s about seeing if a different method will be the thing that transforms the lives of the person asking for help.

I believe in people’s willingness to change.

And sometimes I wish I wasn’t so hopeful that they were.

Here’s to my future in addiction studies, trauma studies, and dissociative disorders research, as well as research on treatment and intervention efficiacies of all.

XOXO,

Dorothy B.