Reframing The View

I like to reframe things.  Why not? Life is full of experiences we’d rather avoid–pelvic exams, traffic, canned asparagus, Andrew Dice Clay–so learning to take a different view of an unpleasant experience is essential if we’re going to grow and progress in spite of our circumstances.

Enter Dolores.  Dolores called me up last week.  Dolores is a “certified social worker” who works for our insurance company.  Let me rephrase that, Dolores is a certified social worker who, according to a close friend, works for Satan’s left testicle.  When Grace was in the hospital our insurance company harassed her treating psychiatrist on a daily basis, and they forced her early release.  Her psychiatrist wanted her there another three to five days, but our insurance company refused to cover her inpatient treatment.  This is very typical.  So, the next time someone goes postal in a shopping mall and it’s revealed on CNN that said maniac was mentally ill and untreated, you’ll know one of the primary reasons why–insurance companies.  They loathe paying for treatment.  It’s also why many of us call them ‘Satan’s left testicle’.  I digress…

I picked up my phone and there was this voice which I can only describe as Marge Simpson’s sister, Selma Bouvier, except with a distinct Kentucky twang:

“Hello, this is Dolores.  I’m from United Behavioral Health.  I’m a certified social worker.  I’d like to talk about aftercare.  So, let’s get started.  We’re going to talk about what’s needed now, but first I’d like to get into the reasons for admission so tell me what was going on at the time of admission.”

That was it.  There was no “How are you? How is Grace?”  She didn’t even use Grace’s name.  She just went for it.  I was shocked.

Here’s one of the silver linings of this journey I’ve taken with Grace.  I’ve learned assertiveness.  I used to be a doormat.  I used to apologize for breathing.  “I’m sorry! I’m sorry! I’m sorry!” No more of that! These people will talk you into a corner if you let them, and it takes a certain brand of firmness to deal with them.  Not rudeness because it’s important to know how to be collaborative when necessary.  Firm politeness.  Dolores, however, was a different creature.

“Dolores, who are you calling about? Are you calling about one of my children?”

“Oh, uh, yes.  I’m calling about Grace.  Let’s get started on her aftercare.  So, she’s taking Lamictal.”

“Dolores, we need to stop.  Do you realize that you have not asked me one question? You have not asked how Grace is doing? You have not asked how I am doing? You have not asked if this is a a good time to call? You are representing the insurance company that bounced my daughter from the hospital against her treating psychiatrist’s orders.  So, from where I’m sitting, there might be a conflict of interest in my talking to you.  I have aftercare lined up.  Grace has profound needs.  Don’t you have her file in front of you? If you know her medications, then you know her diagnosis.  Have you even read her file? Have you looked at her date of birth? You can’t simply call up a family who’s been through what we have and behave this way.  You’re a social worker! You ought to know better!”

Dolores was silent.  Dolores tried to speak, but she could only stutter.  I waited.

“I’m sorry.  I…I should have introduced myself properly.  I’m not affiliated with that part of your insurance company.  I really am a resource for you.  I went about this all wrong.  I’m sorry.  Really.  I….I don’t know what to say.  I’ll give you my number, and if you need any help, then please don’t hesitate to call me.  Now that I’m looking at her file I can see she’s received some pretty big interventions, and I can’t imagine what you and your family have been through.  I…here’s my number.  If you need me…”

I took her number, and I have it.  I doubt I will use it.  We have almost too much aftercare lined up.  It’s ridiculous.  What I have observed in the mental healthcare community is a lot of burn-out in clinicians.  Many people have been doing this work for a long time, and they forget how to treat people.  Dolores sounded like she’s one step away from retirement which tells me that she’s seen a lot.  Maybe too much.  Empathy burn-out is not uncommon, and that’s why it’s so important that we learn how to advocate for ourselves.  Some people either forget how to treat others, or they find their little patch of influence within the kingdom of mental healthcare and rule it with an iron fist.  This is where you’ll find your Nurse Ratcheds.  Oddly, they dwell in the medical records department, too.  You’ll recognize them by their love of the ROR–release of records.

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“You want those records? Sign this…and this…and this…and give me your left retina. We need it for future scans.”

All this is to say that you can reframe all your experiences with your special children and loved ones.  It is rare to find a person who comes by self-advocacy naturally.  We learn it experientially, and you will have myriad experiences to learn it once you have a child or loved one with special needs.  It might seem like a burden, but, if you reframe it, it can become a privilege.

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7 thoughts on “Reframing The View

  1. My master’s thesis focused on compassion fatigue, or secondary traumatic stress disorder (which is not recognized in the DMS, but is alive and well, as you have experienced).

    Good for you for assertively and firmly stating your situation to Dolores, and setting the expectation of how you wanted to be interacted with. So few of us set that expecation with professionals, or even our families, friends and associates. You did Dolores a favor with your interaction. You reminded her there are different and perhaps better approaches to speaking with someone who has a child with deep and profound special needs. Especially if the company she is working for dictates much of what treatment for that child will look like if the parents must rely on medical insurance to pay for said treatment.

    • Oh, that’s right! Your thesis! Well, hopefully, Dolores will straighten up and fly right…or go to therapy herself for a much needed break.

      • Erm, that should have been DSM, not DMS. Not sure what the DMS is. LOL! Dolores will definitely either take a step back and reengage with compassion and thoughtful intent, or she will burn out. Therapy for those in the helping professions is important! We can all lose our perspective.

  2. Sometimes I wonder whether I’m making the world a better place when I attempt to do things like you did with Dolores. It never seems to work out so well for me, even when I think I’m being reasonable and I’m not crossing the jerk/asshole line.

    • Well, I wasn’t trying to make the world a better place in my interaction with Dolores. I wasn’t being altruistic. I was giving Dolores boundaries because she clearly needed them. A certified social worker cannot behave that way. Maybe she had compassion fatigue. Maybe she’s just burned out. Maybe Dolores just doesn’t like her job. Whatever the case, Dolores needed to be reminded that a social worker is supposed to be compassionate…not entitled, and if she’s working for the insurance company that denied Grace services? She really needs to make those connections BEFORE she calls someone and brazenly starts interrogating them. If I came off like a jerk, then I really don’t care. That’s probably progress for me seeing as how I usually apologize for sneezing…

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