Diversity Career Stories Healthcare

Mental health counselor changes lives despite government red tape

This counselor, with 12 years of experience, tells how she was drawn into the counseling field through personal emotional hardships, and how no day is typical when dealing with the mentally ill.

What is your job title, and how many years of experience do you have in this field?
I have been working in a community mental health agency for 12 years. I was hired as a counselor in recovery services. Three years ago I became coordinator of recovery services. I found being “just” a counselor more enjoyable than being a coordinator. I had more time to spend with clients, less paperwork, and about a hundred fewer meetings per week.

The focus of my work is helping people diagnosed with severe, persistent mental illness. The people I counsel are learning to manage diagnoses such as clinical depression, bipolar disorder, schizophrenia, obsessive-compulsive and panic disorders. Many of our clients also struggle with a personality disorder, and several have a “duel diagnosis,” meaning they have substance abuse issues and a mental illness.

In this field, the word recovery expresses the idea that people with mental illness (or MI) can have meaningful, productive lives even though their symptoms persist. In our recovery program, members come to our facility one to five days per week. Each day they receive five hours of group and individual counseling, life skills training, and interaction with peers.

Would you describe the things you do on a typical day?
One of the things I love about my job is that there is no such thing as a typical day. Although we have a weekly schedule of activities, you never know what is going to come up when with a group of 25-30 people who have mental illness.

I arrive in my office about 8:00 a.m., make coffee (top priority), and tackle some paperwork. I actually know one coworker that loves doing paperwork – the rest of us just do it to get by. From nine until noon I run groups, have individual sessions, consult with colleagues, or have meetings to attend.

I enjoy eating lunch with the clients. You’d be surprised how much therapy you can sneak in while laughing with your mouth full and chatting about “stuff.” During the afternoon, I perform the same activities as in the morning. Clients go home at 3:00 p.m. Then there is time to make and return phone calls, write treatment plans, assessments, chart notes, and talk about important (and unimportant things) with coworkers.

Now, throw into that nice neat schedule, a client who admits they’ve been out of medication for three days, another who is boiling over because his or her lunch was stolen (we usually find it), one more who is in tears over something said in a group, and someone who pulls up their sleeves to reveal fresh cuts (self-injury). All of that can transpire within one hour.

On a scale of 1 to 10 how would you rate your job satisfaction? What would it take to increase that rating?
I will say 7.725.

Community mental health is becoming a managed care system. To increase that satisfaction number …the amount of paperwork required will have to return to the realm of common sense. If we say that a client took a breath, the state (Medicaid) wants proof. You can be sure I am not the only person who whines about this.

There is also the matter of salary. I took my job knowing that getting wealthy while working at a nonprofit agency is an anomaly. The salary range is below average compared to other professionals with a masters degree. New teachers have a higher starting salary than fledgling mental health counselors. Everyone knows life isn’t fair, but that doesn’t make it less annoying.

What did you learn the hard way in this job and how did that happen?
I worked with a gentleman, Ben, for the first 3 1/2 years of my counseling career. He was extremely anxious, depressed, and had social phobia. However, Ben had faith in therapy. We met weekly, and he participated in many groups I facilitated. I put hours of effort into helping him see how his distorted thoughts were the reason for most of his anxiety. Hours, I tell you.

He came into my office one morning with an ear-to-ear smile. He opened the book in his hand to a dog-eared page and read a paragraph explaining how our thoughts affect our emotions and feelings. Then he looked up and said, “I had a revelation when I read this, it explains my problem! It’s the way I think about things that triggers my anxiety. I wish you had told me.”

Now, I laugh. In that moment, I wanted to strangle him. (He’s still alive.) I realized that my efforts were not necessarily going to be rewarded with appreciation. My gems of insightfulness may not open my client’s eyes, but a stupid paragraph in a library book might. One of my supervisors had told me this job is basically to plant seeds in others. The seeds may or may not grow. If they do grow, it will be when that person is ready.

What don’t they teach in school that would have helped you?
A couple things come to mind. I wish they had warned us how utterly clueless we were going to feel sitting across from our first client. Even though I had been through a year-long internship, it is different when you are the responsible go-to person for someone. From talking to many other counselors, I discovered this is a natural part of the process for most newbies.

The second thing is this. In school you learn theory, counseling ethics and skills, how to build trust and how to help people help themselves. What no one ever said was, “To be good at this you have to relax into the skills and let your personality shine through.” I discovered over time I needed to give the work my unique imprint to be effective. It is a fine line to walk – a balance of objectivity and letting your personality sparkle. I should add that some therapists may not agree with this; but I wouldn’t go to them for help.

How did you get started in this line of work? If you could back and do it differently, what would you change
I am in this field partly because of a divorce, and also because I felt I was marking time at my former job. My husband did not want to try marriage counseling although I dragged him to three sessions of futility. When I realized the break-up was going to happen, it opened my inner Pandora’s Box, and I started individual therapy.

The therapy process captured my interest right away, and I wanted to learn more about it. From the time I started talking about going back to school for a masters, until I actually stepped foot in a classroom, was three years. I wanted to make sure I wasn’t changing professions because my therapist, Dave, had awesome blue eyes. The desire to become a counselor stayed with me, even after the inevitable crush on my therapist faded, and I went back to school.

I wouldn’t change anything, but wish I had gone on to earn my doctorate (PsyD) after getting the masters. I could go back to school now, but no longer have the drive to work and go to classes and write a lot of papers.

What is the strangest thing that ever happened to you in this job?
There are people pacing, laughing, and talking to themselves on a daily basis where I work. It takes a lot for something to be strange. Really, the strangest moments are when a client who has worn black pants and a white shirt for thirty years walks into the program one day sporting blue shirt and khakis. Or, a woman who did not speak for seven years starts a conversation during lunch. Those are the things that make my jaw drop.

Another example is Pat, a long-term client with Schizophrenia. For years, during art group, he painted pictures using black, brown, and dark blue acrylics. Usually, by the time he finished painting, all you could see was black. Then, in an otherwise ordinary art group, Pat picked up a brush and painted with bright colors. He never went back to drab.

I have run poetry writing groups at work. During one session Eve, who rarely said more than two or three words at a time, came into the group and started writing. When it was her turn to share we thought she would pass. Instead, she read the beautiful, touching poem she had just written. Talk about a stunned silence.

On a good day when things are going well, can you give an example of something that really makes you feel good?
I really enjoy running group sessions, especially when I’m in the “zone.” Facilitating an interesting, lively group that stimulates exchanges between participants gives me a counselor-high.

Sometimes good groups seem to happen spontaneously. One person says something that clicks with someone else, starting a chain reaction and getting everyone involved. During groups like that, I feel as if I’m conducting group energy. The clients are helping one another, and I am there to keep the group from disintegrating into noise.

There are also groups that shine because I am in the flow, working at the top of my game. I pick up on the subtlest cues, am sage and insightful about their issues, and …you would not believe the pearls of wisdom that fly out of my mouth. I stay humble because most of the pearls fall on the floor and are vacuumed up by the cleaning service.

When nothing seems to go right, what kind of snafus do you handle and what do you dislike the most?
Most snafus I deal with originate in my own mouth, especially on days where my neurons seem to fire in the wrong sequence. I have laughed at funny client stories that weren’t meant to be funny. I have joked around with clients and gone a micro-byte too far. Sometimes a client will come to see me after three days of despair over a comment I made in a previous group.

I really dislike times when my foot goes in my mouth so far, my inner shame-o-meter buzzes me with embarrassment. Then I need to get a grip and apologize.

The good news is that you can turn any snafu into a therapeutic learning situation. I have been a role model by apologizing for my stupidity several times. By talking through the situation with the offended party, they learn conflict management skills. You really can’t say the wrong thing as long as you use it to the client’s advantage. However, clients are people. Some of them are slow to let go of my mistakes.

How stressful is your job, and are you able to maintain a comfortable or healthy work-life balance?
When you work in an all day program as I do, you are always “on” because things can change so quickly. I enjoy this constant simmer of activity, so being with the clients is stressful in a good way. The stress level in general has risen over the past 4 years because of constant policy changes due to our state budget deficit.

I use some of my vacation time to create long weekends. It allows me to regularly enjoy activities I like, such as writing poetry, reading, and doing nothing. A perfect balance for me would be a four day work week, every week. Come to think of it, three days would be even better, but back to reality.

What is a rough salary range for the position you hold? Are you paid enough considering your responsibilities
I mentioned earlier the pay scale in community mental health is low in comparison to other professionals with comparable education. I support myself and 3 spoiled cats. Discretionary money is limited, but by living simply I’ve made it work. Since I was promoted, finances are less of a concern.

A starting salary for an entry level counselor, without a license, can be anywhere from $14 – $25 per hour. Right now a licensed counselor will find offers from $23,000 – $35,000 per year in nonprofit agencies, depending on experience. That is not a lot of money if you have auto and student loan payments on top of other expenses.

Middle management positions, like mine, pay in the $36,000 – $55,000 range. These numbers are derived from positions that are currently being advertised online, and from the shared experience of other licensed counselors.

What is the most rewarding moment you’ve experienced in the position? Of all the things you’ve done at work, what are you most proud of?
It is more accurate to say that I have had many small rewarding moments. Sometimes a client will say, “That was a great group, I got a lot out of it,” or a client will come in early and make a pot of coffee for me. Several times the people on my case load have given me a birthday card they made, loaded with short passages about how stupendous I am, and to give me a hard time about getting older.

My favorite reward? Those moments when I see the light bulb turn on in someone’s mind. I’m witnessing the birth of an insight or awareness that up until then eluded him or her. The look of wonder on his or her face is priceless.

It’s hard to think of one thing I am most proud of. It might be the day one client was experiencing explosive diarrhea, and I resisted the urge to call in a HAZMAT team.

What is the most challenging moment you’ve experienced in this position? What would you prefer to forget?

It is emotionally challenging to put someone into a psych hospital against their will. Even if they are clearly a danger to themselves or others, it’s an unpleasant task. None of us like calling 911 and petitioning for a commitment while the client is begging us not to. It feels as if you are betraying them even though need help. One of my clients, Terry, became so aggressive when the paramedics arrived, it took all three of them, and a policeman, to strap her down. Usually, it is not that dramatic, but it’s always uncomfortable.

The most challenging experience is when a client takes his or her life. I’ve experienced it 4 times in 12 years. When a client commits suicide, I use all the cognitive skills I have taught others, to avoid the pit of guilt and mud hole of what-ifs. The reality is, when someone really wants to die they do not give others an opportunity to prevent it. Every therapist knows the warning signs but sometimes there are none.

I can’t think of anything I’d prefer to forget except the times I had to carry out a treatment intervention I did not agree with. It’s hard to tell someone, “You’re suspended from the program for a week because you had sex in the bathroom with Susie,” if you don’t believe it is an effective consequence. And yes, that did happen.

What education and skills do you need to get hired and succeed in this field?
To be a licensed mental health counselor, a masters degree is required. Most agencies expect their employees to be licensed, or eligible to take the required exam. States have different requirements for obtaining a license. My license gives me the authority to sign treatment plans and assessments, bill insurance companies, and to supervise others. To keep my license, I’m required to take continuing education courses a few times each year.

The counselors where I work each bring different strengths and skills to the table. I am not a good practical problem solver, but one of my coworkers is, so we compliment each other. However, we all posses an ability to keep going without frequent accolades, to set aside personal interests and agendas to mirror others, and have average or better emotional management skills. Oh, we’re all able to empathize, and have a working sense of humor.

What would you tell a friend considering you’re line of work?
If my friend had the luxury of time, I would suggest volunteering at a mental health facility to experience working with the chronically mentally ill. I would tell him or her to consider their material desires and if the income opportunities are equal to the lifestyle they want.

I would say, “In this field, you will impact peoples lives for the better, and you will feel extremely frustrated with slow progress, or no progress. You may clearly see what a client needs to do in order to reach their treatment goals. They may disagree and do what they think is best. You might work with a diamond in the rough – one that is still basically a piece of coal – but one day will get a job, have friends, and be fun to talk to.”

How much vacation do you take? Is it enough?
For 7 years, I earned 3 paid-time-off (PTO) days per month for vacation and sick days. I stayed healthy, so had just enough vacation time. Now I earn five days PTO per month. It gives me plenty of hours off.

In the past five years, I never used all my available vacation time. I can carry 70 hours into the next year, and until recently the agency “bought back” unused PTO time, up to a certain amount. I often saved some hours for the buy back and used the extra money to pay my car insurance and buy toys for my cats.

Are there any common misunderstandings you want to correct about what you do?
Everyone that spends time volunteering or working in our program says the same thing, “The clients are just people, I don’t know why I thought they weren’t.” People with mental illness, even those with Schizophrenia, are all unique individuals. Most of them have a great sense of humor, express empathy and compassion toward others, and just want to be loved and appreciated. Most of them hope to be “normal.” I keep telling them that I’ve never met anyone normal.

Though their problems are severe, a counselor develops a relationship with recovery clients as they do with higher functioning people coming for an hour of therapy. Our clients are expected to learn skills and practice living more independently. It’s a place where they are taught, encouraged, and challenged. If I am doing a good job, my clients do not always like me.

Progress is measured by infrequent baby steps (most of the time). Alice taking a shower two times a week instead of one is a major accomplishment. Someone with social phobia and anxiety saying one sentence during a group can be a milestone. For other clients, walking away from someone they are angry with is reason enough for fireworks.

Does this job move your heart? If not, what does?
The clients I work with have often moved my heart. At times, I have felt a powerful tenderness or affection for one or more of them. What they share is sometimes heart wrenching, yet …the clients are fun and delightful to work with. They have different problems than I do, and a harder time functioning in this world, but I consider them equals.

I can give you an example of a time a client touched my heart. Tom had Schizophrenia. He developed symptoms at age 23 and since then lives with family. Even with strong medication his symptoms are profound. He was in my office one morning and started telling me about the years before his diagnosis. Tom had graduated high school, become a licensed pilot and had his own profitable vending machine company.

What brought tears to my eyes was his clear recollection of what he was like then, compared to what he is able to accomplish today. His eyes lit up when he talked about flying and how proud he was to have his own business. Then his face dropped and he shrugged his shoulders. He was saying, “Now look at me.”

If you could write your own ticket, what would you like to be doing in five years?
I would like to be living in a tree house just off a beach, writing poetry, and snorkeling.

Let me add that if I have the means to live that way I will use some of it to set up supported housing for people with chronic mental illness. The housing would look and feel like a home. No institutions or bare apartments. The people living there would share responsibilities. Some homes would have professionals living on site.

This would address several problems that people with mental illness face, such as finding affordable housing. It would help them feel less like second-class citizens and relieve some of the stigma they feel. For many, it would provide a family life that they may not otherwise have. They would hopefully feel accepted and safe.

Is there anything unique about your situation that readers should know when considering your experiences or accomplishments?
Six years ago, I set up a private part time practice to provide individual outpatient counseling. Unfortunately, meeting with four to six individual clients in a row drove me crazy. It takes a different set of traits to do that kind of therapy than to do what is done in recovery services. I am saying this because there are many different niches for counselors to fit into. One you may adore while another may seem worse than having a root canal.

I don’t think anyone knows what recovery services will look like even two years from now. At some point the changes will settle down, maybe for several years, then change will come again. I do know that the need for these services will persist, as will the incredible spirit of people contending with mental illness in a society that does not want to see them.