Wednesday, March 28, 2007

The Nurse and Psychotherapy

Having lived with depression all my adult life---and possibly childhood, as well---I am not one to beat around the bush when it comes to talking about mental illness, psychotherapy, and antidepressants, even when the subject is myself. It's one of my missions in life to normalize conversation around these issues, to take away the stigma, making it easier to be forthright about such matters, even in "polite company".

So, yes, I'm in psychotherapy again, after a three-year hiatus. The last time it was precipitated by the murder of a friend and the resultant acute post-traumatic stress. Now, work and career, chronic illness, pain, and life in the nursing fast-lane made me place the call. Insurance companies make choosing a therapist easier in one respect---one must choose from those providers listed on the comany's website, thus winnowing down the astronomical number of choices (especially in our area where you can't throw a stone without hitting a therapist of some kind on the head.)

That said, my brief game of telephone-tag with a number of local providers yielded an initial "acquaintance appointment" a few weeks ago with one of these individuals, but within five minutes of sitting on that comfy couch I knew that I had chosen well. Perhaps it was chance, perhaps not, but the happy result is a new therapeutic relationship of which I am on the receiving---rather than the giving---end.

On the work front, today's slog through the trenches of inner-city nursing yielded an intervention with a suicidal patient with a personality disorder who, twenty-two months sober, feels his life is at an end due to isolation and loneliness, refusing any help or psychiatric evaluation. This was coupled with a new patient with End Stage Liver Disease (ESLD) who's home with hospice care, drinking himself to death, mentally and physically taxing his 70-year-old caregiver who is quite ill herself. Add to the mix a young paraplegic with what appears to be a raging urinary tract infection, possible acute kidney failure, and a staunch refusal to go to the ER even though she can't produce enough urine to culture. Yikes.

So, the intrepid and exhausted nurse sits himself in the therapist's office at the end of the day and examines his proverbial navel. The conclusion is that a great deal more self-examination is in order, not to mention self-care, rest, and plans for further means of self-protection and healing in a world gone mad.

A nurse and psychotherapy go together like cheese and crackers, cereal and milk, culture and sensitivity. What took me so long?
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