Everything, Everything: Challenges in Providing Mental Health Care

Lately, I’ve been encountering some of the most emotionally challenging sessions at work. Everything that I learned about interpersonal relationships, everything about psychology–I’ve found that everything, everything, matters in shaping the therapist that I want to become. I was challenged beyond my own mental capabilities this week, and realized that I still have a long way to go before I can confidently provide the best mental health care possible. Until then, I still have everything to learn. This post is a reflection on thoughts from my current job, and the mental preparation I need while building a career in therapy. 

As a behavior therapist, I provide clinical sessions using Applied Behavioral Analysis to help improve the communication, social and learning skills of children with autism. My clients range from non-verbal children to higher functioning youth with maladaptive behavior tendencies and emotionally challenging home lives, such as military households and low-income living. Though my position primarily focuses on behavioral health, I have found that mental health and emotional wellbeing plays a huge factor in providing effective care for my clients and their families.

I see a client, “Liam”, at his middle school a few times a week, and he not only has autism, but also has severe ADHD on top of a recent diagnosis of diabetes. Keeping him on top of his schoolwork was the original reason for behavioral services, and I would sit next to him in class to keep him from falling behind. However, in recent times, not only has it become academically difficult for Liam to stay in his public school, but his emotional stress has also risen, because of a challenging home life given his parents’ impending divorce.

How could a father give up on his son because of his disabilities? I met with Liam’s mother today, and she told me that his father has waived all rights to his son after the divorce. Not only did the father reject future visitations, but he has also cancelled on weekend visits the past few weeks, last-minute every time.

“Liam told me, ‘my dad doesn’t want me anymore,'” Liam’s mother said to me. “But I told him, ‘I want you. And I will be here for you.'” 

Mom’s words left me soaking up her emotions like a sponge. Conversations with Mom only scratched the surface of what their family was going through, but I recognized an internal struggle within Liam as I worked with him during school. He’s a tough kid, always good-natured and friendly to others, despite so many barriers to living a typical life or even having a regular day at school. Despite all this, never has he voiced anything of concern to me besides classwork concerns or superficial things, and never has he claimed to be sad or need a break.

So today, he did. Today, he shut down in class. We went outside, and I probed about what was wrong to no avail. He didn’t give more than a one-word mumble to any question I would ask, even trivial ones such as “what game should we play on your iPad?”. It was here that I realized I have yet to learn the first thing about being a strong therapist, because I suddenly felt completely at a loss for what to do next. How do I handle this situation? How do I talk to him without pushing him too hard? What can I do for Liam, a boy who I’ve been helping with school for months and never witnessed have such a breakdown? I didn’t know, didn’t know, didn’t know.

After some quiet time, I eventually asked him to think about how he was feeling, and to describe that in one word.

“Liam, in one word, how do you feel right now?”

He didn’t respond at first, simply mumbling “umm…” and “hmm…” while staring blankly at his iPad. I waited, deciding it best not to break the silence.

Then he said it: “I guess…depressed.”

In that moment, it hit me like a slap in the face what a plethora of challenges therapy involves. What a wide range of skills are required to be an effective counselor, what a level of self-understanding is required to be a good provider. I couldn’t do anything for Liam if I was about to burst out in tears myself, I couldn’t do anything for Liam’s family if I myself could hardly speak with his mother without intensely channeling her pain. To become the therapist I want to be, I have to not only learn all that I can about understanding others, but I also need to learn everything that I can about my own self. How do this family’s struggles relate to my own, how do they impact me, and how I can maneuver around any personal parallels in order to focus on best helping my client? How can I best talk to Liam, who isn’t the most expressive individual, and may resist opening up emotionally? How do I, how do I, how do I?

And so I will continue to learn. Despite today being an incredibly challenging day for me as a provider, today also served as a reminder that I am in the right place, doing the right thing. Never have I doubted that I want to guide individuals through their problems, and be exactly where I was today, supporting a struggling child who needed help. I thereby resolve to learn more, to read more, to explore myself more, for the sake of Liam, and all of my future clients. I want to one day have the strength that these children show me, and be able to provide unwavering therapeutic support without my voice trembling, my heart dropping, or my mind closing up on me.

One day, I will be strong enough, to be everything that it takes. Everything, everything.

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