week10a

Interview with Mary Hull

Wed, 04/26/2023

Mary Hull is a Licensed professional counselor in Virginia. I conducted this interview over the phone and this is the transcript of that phone interview.

Mary: Hi, there

Me: Hey, how you doing?

Mary: Hey. Good. How are you?

Me: Good. Thank you for doing this.

Mary: Great. My pleasure. I'm happy to help. Me: Okay, so the first question was, describe your motivation for becoming a mental health counselor.

Mary: Great. Do you want to be typing while I'm talking?

Me: So I was actually thinking, like, if you don't mind, can I record? Mary: Yeah, totally. I get it. Okay so for the first question, I think I was probably one of the lucky ones, because it very much has always been something that I wanted to do as soon as I was a little girl and realized, oh, my gosh, you get to help people analyze their problems and the human psyche and help them how to live happier lives. That sounds amazing. So it's really always been that kind of calling, and I know everyone doesn't always get a calling. And then when I was younger so, like, my elementary school best friend, her name was Roberta, the girl that was my next-door neighbor that I grew up next to my entire life, she developed schizophrenia when we were 17, and that kind of really further solidified this is really what I would like to do. But when I went to college, someone told me that 92% of people that take psychology because that was originally my major, they said that was the number one taken major. And 92% of people that took it didn't work in their field. So I thought the field was overly saturated. I guess I had assumed that it would be really difficult to find a job, which to me, it is not. And so I switched it and I switched it to communications and became a reporter in DC. Which I did not like. because I loved writing. And then I realized I did not want to do this for money. And then I went back in my late 20. Back to school and studied to become a professional counselor at that point, which was a really good thing, because if I had actually gone into the field a decade earlier, I would have been way too immature. I would not have nearly had enough life experience. I would not be a very good counselor, I don't think. So everything kind of turned out the way think it was supposed to. You are exactly where you're supposed to be kind of deal. Hopefully that answers that question.

Me: All right. Wow. That's very interesting. Were you, like, a news reporter?

Mary: Yeah, I worked in Falls Church and worked for Falls Church News Press, USA Today, and another one I can't remember as well as, like, a freelance writer, because I really had the same drive to help people. I wanted to be a reporter, and I wanted to be, like, a part of the action so I could become well informed. But that did not pan out. It was not.

Me: I can actually see that because you're so well spoken, so I can see you being a reporter.

Mary: Thanks. Yeah. I love the written word. It's great. But it also sucks because writing is so hard. Yeah. Why do have to make it so hard? But I do love the written word. I love the art.

Me: Yes. All right, so for number two, how was the profession of counseling unique within the helping professions? How does it differ from psychology or social work? Mary: Sure. So, counseling and particularly substantive counseling, marriage and family counseling, and literally professional counseling that's the name of the master's program is where you work directly with the individual. You do the interventions with them. You are standing next to them and going with them like you're not really showing them really what to do, per se. But you do walk alongside. So that's what a psychotherapist does. A psychologist is someone that does the assessments. So, if I think someone has bipolar or whatever it may be, I'll send them to a psychologist, and the psychologist runs the battery of tests to determine whether or not someone has major depressive disorder or schizophrenia. And that's like, a far more legal document if you really want to make sure that, okay, I do have this. I knew something was different. Or if you're trying to file for disability or anything along those lines, that is much more legal. That's what psychologists do. And psychiatrists are medical doctors. First, they go to medical school. They're an MD. Medical doctor, MD. And then, just like a podiatrist would go and specialize in your foot, a psychiatrist goes and specializes in in, basically, medicines of the brain, of psychology, of neurology. They don't really look at the brain like a neurologist does. But they are mostly medication prescribers. And while psychologists and psychiatrists can do counseling, they do not really usually do that because of two reasons. One, it's a different education set, both of those are doctorate levels. But two, they don't get paid anymore. They get paid more for doing the assessments and the medication. So, for them to do counseling, they'd actually get paid less. I wanted to work with the individual, and social work is also working with the individual, but it's much more working with the government programs that the individual will need to be empowered to get themselves straight. So, if you need housing assistance, if you need Snap assistance, if you need to get your easy pass reduced because you work on the other side of the bridge, you can do that. If you're trying to get other kinds of programs that are government related programs or school related programs like EAPs for your children or you are homeless and schizophrenic and you really don't know where to start, that's really where social work people begin. social workers are the ground level, and I would be referred to from a social worker. So they're really doing great work and are often overworked because of the cases that they get. You have to be pretty bad, pretty bad off that you wouldn't be able to set up your own doctor's appointments, you wouldn't be able to set up your own counseling appointments and all those kinds of things. Get to a social worker. So, a lot of times they'll work with the disabled. They'll work with homeless people that have schizophrenia. They'll work with people that have chronic major depressive disorder or substance use disorders, co-occurring disorders, and they just can't help themselves, and they don't know what to do and how to get there. Those are really good jobs, really good purpose, is all of them. Just not exactly the thing that I wanted to do.

Me: So, number three was what professional license do you hold? What are the requirements for a professional licensure in your state? Mary: Yes. So, the license that I hold is an LPC, which stands for Licensed Professional Counselor, and that is a 60-credit hour master's program. Some programs are Cacrep accredited? C-A-C-R-E-P. Some programs are not Cacrep accredited. You can get licensed in your state. Still if the program is not Cacrep accredited, certain insurance companies won't take you, like TRICARE won't take you. So that is 60 credits. There is another one. That's 30 credit that they offer. But don't take that one because it doesn't work in Virginia. I know it works in other states. And I didn't know that at first. and I signed up, and I took a semester of classes I didn't need, but I got all A's, and so it bumped up my GPA. Me: Nice. Okay. Good to know.

Mary: Yeah. So you’re in 60 credit hours, and while you're in the last three semesters, you'll do a Practicum, which is like an internship. That's exactly like an internship. You're still a student, and you'll go to a practice. I emailed the owner of my practice. I was just emailing practices, hey, I'm looking for placement as a Practicum student. And you go and you basically work for them as a trainee, and that's for a semester. And then you have another two semesters. And you're working with someone who already has their license.

Me: like, you're working under them for those three semesters while you get your Practicum?

Mary: Correct. Yes. You'll actually be working underneath a licensed clinician for about three and a half years before you will ever be able to go on out on your own. So anything that you write and everything that you do, every note that you do, they read and sign off on to make sure that you're doing the right thing. And you meet with them at least weekly for an hour to go over your cases together. Some supervisors will let you have clients totally on your own. Our practice does, and then people can see those clinicians for free, but some supervisors do not. They want you to be in the room until you're further along in your schooling. So it just varies from person to person. There is a certain amount of direct hours, which means you are in the room with the client. Direct hours that you have to get. And a certain amount of indirect hours is for things like working the front desk, any administrative task, independent research that you have to do, anything that you're really learning about the profession, even billing, ethics. And for your practicum, I don't remember how many hours, but it's usually you can get them in that one semester. And then your internship usually takes two semesters. That I think is 400 hours. It might be six. Either four or 600. Okay. Yeah, I think it's 600 hours. And then you have your residency. Which is, again, just like the same thing. But it's after you graduate. And in order to become fully, fully licensed this whole time, you're still under a supervisor and your residency has to be 4000 hours totally total. But you include your 600 of internship in that. Technically, it's 3400 hours. And there are different requirements. Again, there you need a certain amount of direct, which I think is like half, close to half. Again, I'm sorry, I don't remember off the top of my head. Don't quote me on that. And the minimum amount of time you're allowed to spend on your residency is 21 months. So you can get your residency done in under two years. Me, I took two years. I took the full 24 months to kind of do it.

Me: All right. So 60 credit hours. So that's like two years, basically. And then, correct. Two more years of residency, and then you can get your license correct. Mary: Total. The whole thing is four years total. Correct. Until you practice independently. Some people have their supervisors at different practices, and they meet with them electronically. Like, we had one supervisor in Richmond. And you would sign your notes, and she would log into your platform. So she never knew any of your clients or anything like that, but she was there to provide guidance. And there are different rules for each insurance company, I think. Anthem medicaid or Optimum medicaid. I think both. If you're a resident, your supervisor can submit for insurance. You get reimbursed the insurance rate, but not for any of the other ones. I don't think that's kind of new. Like, if you have, like, regular TRICARE or regular United, I don't think they can do that. The insurance companies update their policies all the time. You just have to read what's new every year. And these are all different pay grades, so depending upon your practice, what you're paid as a practical student some people aren't paid what you're paid as an intern and what you're paid as a resident. And if you want to see those on our website, go to the portal where you would log in, and you can see the prices. Like, where you would normally log in. Yeah. And for your internship, sometimes you're not paid for that either. It depends on where you go. Me: Okay. Interesting. All right. Well, this gave me a lot of clarity. Good to know. Good to know.

Mary: But, yeah, four years is a normal amount of time to kind of wrap your head around. Me: And is there a max time? Because I know you said minimum 21 months. Is there, like, how long you could take for your residency? Mary: Like a time for that? Yes. I'm pretty sure it's four years. I don't think you're allowed to take more than four years.

Me: Okay, well, that's fair.

Mary: Yeah. Yeah. And There is only one major exam you have to take. It's your boards. And you can take that anytime during your residency, the beginning or the end. And I don't want to intimidate you, but I believe two thirds of the people fail it the first time that they take it. So it's a very weird test, and you just have to wait. You can take it again. If you fail again, you can take it again. If you fail it a third time, then they reduce you down or they'll work with you to try to figure out something else like what's going wrong here, sort of. Me: And you take that after you finish your residency? Mary: You can take it whenever you want. You can take it anytime during your residency. So if you're done with your schooling and you're just like, I just want to get it over with and get it out of the way, and you can do that. I think I studied for mine for about six months, sort of casually, but for the last month that I was going to take it, like I was studying every weekend for at least like 5 hours, probably every week for probably about five or 6 hours.

Me: And how long is that test?

Mary: I think mine was 3 hours. And it's on a computer. You go to a Pearson place and it's really kind of cool because you're sitting in the room with all these other people that are about to be like leaders of Their industries. Like, you're sitting next to people that are about to take their lawyer boards and their doctor boards, and they were talking about the different tests that they're taking, and you're taking this other test. So it's a very powerful and at the same time inspiring and intimidating feeling, like and everyone's so nervous. And then you get your results right away. As soon as you walk out, you get to see how you did, and you're like, oh, thank goodness. It's totally, totally worth it. Like, you took psychology in your bachelor's because you're fascinated by it. I can't imagine that happened for no reason, that you weren't always fascinated with people growing up and the way that the mind works. Me: All right, number four, what are your thoughts on the current labor market for counselors?

Mary: It has an amazingly bright outlook, so we are in the red. We definitely need more counselors as mental health is becoming less stigmatized. I'm rarely ever taking new clients, and almost everyone at our practice is chronically booked, and we have 25 or 26 clinicians now. My boss, I joined her in 2015. Yeah, she started the practice in 2014 team, and it was just me and her. So in seven years. Like she grew it 25 times this amount. And the insurance companies pay us very well. I think it changes a little bit from one insurance company to the other. But I think the minimum that an hour session right now is approved for is $90. And I think the maximum is $130 for an hour. And the insurance companies give you raises. There are lobbyists out there that lobby for the medical professionals to get more money, and the insurance companies’ kind of stay on par with that. So you can join a practice. They are itching for people. You can become a private practitioner. And I don't think it would be difficult for you at all to be booked to the capacity that you want to take clients at all. It's a very promising path.

Me: So you think it's like under man, basically.

Mary: Correct. So if you are thinking about going what we call we call that private pay, if you're just having people pay out of their pocket because a lot of people don't want to handle insurance companies because sometimes they're a hassle. They are part of the work that you will do will be managing billing, administrative tasks, getting credentialed through insurance companies. That's what it's called, where you basically sign a contract and you're like, I'll work with you and agree to accept $130 for my services, whereas you could be in private practice and charge $200 an hour. And there's still plenty of those people totally booked. You do have to do a little bit more self promotion if you're going to go down that path, but that's totally fine. Me: Right, okay. Good to know, all right. number five, can you describe what a normal day looks like for you as you do your job?

Mary: Yes, totally. So because I'm at a practice, I don't really deal with billing all that much. So my day spent doing administrative tasks is minimal. This would look different if you were on your own or you didn't have a billing manager. I get up and have a normal morning going to work. I only get to work about 15 minutes before my first client. So I kind of set up my office, make sure nothing's laying around or whatever it may be, and then I have my first client come in and we kind of talk about what's going on. So, you know, I say, how are you? At the very first time. The policy is meet them where they're at that day. So what's going on? Are there any crisis that we need to manage first and then sort of defer to their treatment plan in that 15 minutes? In the beginning of the morning, I'll look over my schedule and see who I have, and click on their last note. I just sort of have an update on kind of what we talked about and. Try to remember what were we working on. And then everyone has their own treatment plans, you know, like, okay, what you're sort of going to try to train the conversation to go. Like, if we are working specifically on OCD impulses, usually say, okay, well, last week we talked about this. How's that going? And then if they say it's going this way or this way, then I'll think of maybe an intervention or something or try to problem solve. Or if they're just in grief, just hold space for them and provide hope and motivation and all that sort of stuff. And then that client will come to a close. And then I'll usually have five clients in the morning, and then I have an hour lunch break where I eat lunch, and then I take a 30-minute nap.

Me: Wait, you have five clients in the morning? Mary: Yes.

Me: So an hour each? Correct?

Mary: Yes. Back-to-back. Correct.

Me: Wow, that's a lot.

Mary: Yeah, I kind of like to do it that way, but a lot of other people, they'll only do 45 minutes sessions. But because I'm doing Skill Building, like, it's not just talk therapy, like talk therapy, where is pretty much less involved, it's less directed, which it can be really good. Talk therapy is really good for psychodynamics. So where you're talking about you're growing up or grief like that's also psychodynamic. And talk therapy is really good. And we talk a lot, but there's not a lot of Skill Building, so it's more of just processing. So usually The hour is justified, but people that do 45 minutes, they'll still put clients back to back, but some people don't, and they'll get like a little break, they'll write their notes after each person. So then I'll have lunch and I take notes while we're talking. So I already have a little bit of a template of what our note is going to look like later on.

Me: Do you have any time between your clients? Or is it like not necessarily back-to-back?

Mary: Yeah, it's usually back-to-back, but some clients don't show up. I think the cancellation rate for therapists is between ten and 20% because we see two people weekly, and one out of nine people is probably going to be sick or they got into a car accident, they can't make it, or something had to change. So the cancellation rate is higher because we see people much more frequently than when you go in to have a physical once a year. You're more likely to keep that because I've been waiting for this appointment for six months kind of deal. And so because that's unplanned time, I plan for that unplanned time, and that's when I do my psychotherapy notes. So you take a note every time someone comes in and you'll learn what this is called. It's called a soap note. Subjective objective MSC, which is like a mental status exam. It's just a little like how do they appear? What was their mood? Are they functional? Are they congruent with their a reporting of their mood? Like, if someone says I'm depressed and then they're smiling, that's incongruent. But you always want to listen to what their report is because some people are really good at masking and what's their memory like? What's their orientation towards you? Are they reactive towards you or aggressive? Then you do all that and then what the interventions are that you used and then what the plan is or the homework is for next week and anything else. So once you get good at it, you can do these pretty quickly. But they are definitely something that you'll need to take some time, sit and think about it Just like every doctor has, kind of. Okay, so if I have a cancellation yeah, I'll finish my notes up during that time, or I'll try to get some done during my hour lunch break and then I take a nap. And then I'll have four or five clients in the afternoon. So I choose to work ten to eleven-hour shifts Monday, Tuesday, and Thursday. And then I take a half day on Wednesday, and I work from home. Monday, Tuesday, Thursday, and then a half day a half day on Wednesday, and I work from home on Wednesday. So I schedule my first client for 08:00 A.m., and that forces me to get up and get dressed and be all on and all that kind of stuff. I see them on the computer, and then I give myself a two-hour gap, and then I exercise, and I clean my house. And then I go down for another three clients and find the computer, and I get to play with my dogs in between. So it's a really jelly schedule. But I still get to see about 36 clients a week. 36, 38, which is a lot. Or other people tell me it's a lot. I do keep a lot of hours, and I think two or three other clinicians keep the same amount of hours as I do at my practice. Everybody else is kind of in that 25-client range like some people are at 18. It really depends on what you as a person can take. And then if I need to do any extra work, like be on the phone with their doctors or coordinate with other family members or type up other documents for them, then I do that Wednesday afternoon or on Friday. And I don't have to do a lot of those things. Sometimes the front desk would be the one doing those things for me, but I'll just do them because it's faster. But it's really not that much. Me: Okay, cool. All right, so for number six, what ethical and legal issues do you have to keep in mind each day? Mary: So a lot of ethical and legal issues come into play when you are dealing with children and teenagers because there are rules about confidentiality and you want to keep the safety of your client as primary. But if they're doing something that's really going to be super dangerous, you don't want to break their trust because that's super important. So you have to be really vigilant on how you handle things. Like when teenagers are doing substance use or teenagers are self-harming, you have to judge, okay, is this self-harm something that could accidentally kill them versus not? And who do we get involved and when? And most of the time you can talk to these people and like, hey, I know that you don't like that you're doing this. But also, a lot of times, parents will discover it, and they'll sort of force their way into the session. And there's a lot of collaborating with the parents, kind of, even if the teenagers don't want you to because they never want you to. But I always make it very clear to them that I am their advocate. And if I ever need to talk to Mom or dad, they will know exactly what we talked about before we talked about it. I'll ask your permission. I will never reveal anything that you have ever said in here unless it's within the confines of I truly think that you're going to kill someone or yourself or you're talking about abuse. Like, there was one client for whom there are a thousand examples of this, but I've had to call CPS (Child protective services) a couple of times because abuse was disclosed. And you can also tell people, like, you're toe in the line because on a mandated order, if you tell me this detail, then I'm going to have to report it, and that detail might be okay. Does the neighbor live on the left or the right of you or what's their name or whatever it may be? And some people will want you to do that because they want whatever the bad thing is to stop, but they don't have the power to do it themselves. But we try to really empower that person to do it themselves. That's a big one. And then you'll wind up a lot of times in custody court with minors because a lot of times they're there because their parents don't get along or complications related to the parenting and stability or anything, stuff like that. That's a big one. There's another one. The number one really is our number one ethical consideration is to do no harm. So there are limitations on a lot of the things that you would normally maybe just say to people because you don't want to harm them. And this varies from person to person, too. Some people are much more blunt than others. And DBT (Dialectical behavior therapy) specifically tells you to do something called radical genuineness, where you tell people like, hey, this is how you're affecting me, and I don't like it. I don't like how you are right now or whatever it may be. And that kind of shocks people, which is understandable because I wouldn't want to hear that. Usually, and this is going to happen to you not usually, but a lot of times people fall in love with their therapists because they love that they have a person that will listen to them and be genuine and genuinely care about them and genuinely let them be who they are around you. But it's not real love because you actually don't know your therapist, but you do know now the way that you want to be treated by someone else. So, it's very normal for people to detach from whatever unhealthy or toxic relationship they're in and attach themselves to you, which is totally normal. And then your job is then to teach them how to properly reattach to a healthy person or environment or support system. And therapists fall in love with their clients every now and then. We had one client named Margaret, and she fell in love with one of her clients, and they ran away to Utah together a couple of years ago. And I would have never guessed. It was like she was so good at her job and seemed to be so ethical. The person that reported her to the board was her client's wife.

Me: Can't you get arrested for that, or no?

Mary: That is a good question. I don't know if it's criminal. I don't think you can be fined. Criminally license taken away? I'm assuming so. Utah has weird laws so she would not have. There was an investigation that the board puts on, but she didn't do anything criminal. But yeah, her license was removed. And there are certain things where you're never allowed to get your license back versus, you're suspended or whatever it may be. So you have to be very careful that your life is fulfilled and that you're pouring into your life as much where you're not getting any of that emotional needs met by the client. So everything that you're really saying and doing is for the benefit of the other person. Which is really weird sometimes because if someone's addicted to heroin and you're like, you shouldn't be addicted to heroin, that's actually not going to be the benefit of the other person because they've heard that 10,000 times. It's like, how do I motivate this person to stop doing heroin without telling them to do so?

Me: Wow. Okay. All right. So for number seven, how does understanding and respecting multiculturalism help you as a counselor? Mary: Okay. So the cool part about becoming a reporter before and taking communication and there is a lot of cultural learning that comes with that. So probably, to be honest, there's not enough that comes with our professional teaching, but it doesn't come to some, but probably not enough, to be honest. But there's a lot of information gathering that you need to use when you're in the room with somebody. That helps them too; when they can explain their family culture, it helps them to articulate their own understanding of the rules of their culture, which increases your emotional intelligence and that increases your ability to regulate your emotions. But you very much have to come from any kind of nonjudgmental stance at all, even if it's something that you totally, totally, totally not agree with. And a lot of people don't want to work with certain populations. Like, if a pedophile came into your office, you can say, no, I don't want to work with this population. Well, my family has a history of incest or whatever it may be, and it's been passed down, and I watched my grandfather rape my cousin. And these are little stories. And if you want to be able to try to help the worst parts of these cultures that can be so enriching, you have to be non-judgmental. And people have a sense of justice. They're born with it. You can see it from a very young age, at the age of two and three. They know when something's not fair or something's wrong or something doesn't feel right to them. And again, within the legal confines of what is considered abuse or not. But the more that you can really educate yourself on a particular type of culture, the better you're going to be able to help. A lot of black women, for example, get a bad rep because they are viewed as being loud or unruly or untamed or whatever it may be. This is before the “Karen” population sort of came along, but there was a study that was done where they asked they asked black women, then they asked white women, what does it mean to talk? Right? And white women said, well, you are polite, you take turns, you're conscientious of the other person's feelings. Whereas black women said you're honest, you speak truthfully, you speak from the heart, you're direct. And so they use just a different kind of way of speaking. And so you do have to if you didn't know that and you're like you have this other kind of bias in the back of your mind, you're going to judge them. So you pay attention to things like their communication styles and you have to mimic it. Like the way that if I have a New Yorker right in my office and they're like, I don't want to this is too fluffy. You know how to stay yourself but match the things that they are going to hear well. And once they actually truly trust you, that's when you can really start providing feedback. Hey, I've noticed that when you say stuff like this every time you kind of come in and you're talking like this happen, it doesn't go well. What do you think it is that is perpetuating this idea and depending upon that person depends upon how much they really want to get involved in changing that dialogue. Some people are very involved in changing, like the LGBTQ dialogue or the BLM (black lives matter) dialogue, whereas other people are silent partners that are the followers, which is not a bad thing. It's not bad to be a follower. In order for leaders to be leaders, you have to have followers. So you gauge them and you may be very passionate about like this is unfair or whatever it may be or what this is doing is wrong or personally, but you can't tell other people kind of to do that. And different cultures have different beliefs just in like I think I can't remember the name of the disorder, but Japanese people think that their bones are made of glass and they're going to break like that's something that's like historical. cultural fear or that their penis is going to be flung off their body and, like, float away. I've never encountered any of those clients, but you'll learn about some of those when you study the DSM-5. But a lot of people also want to see not everybody. Again, not everybody but want to see someone that they can identify with, because it's really difficult to really, truly feel like you can trust someone until you know that person has gone through what you've gone through. And that's fine. That's good. That's okay. That's what you're going to need to feel safe. That's just fine. A lot of people that have been sexually traumatized, they want a client who has also been raped or have been through that kind of thing. If you've been in the military and you've had to face someone where you've killed somebody, you want a clinician who's also been there so they truly, truly get you, helps you feel understood. And it's a major component in catharsis. I don't know if that answers the question, but a lot of education, like asking self education, subjective education, as well as objective education okay, I don't understand this. Let me Google it. Let me research, let me look for articles. And you have to be aware enough, and you can add your own stuff in there if you really want to give your opinion. If they're asking you for it. You can be authentic and genuine. You don't have to lie. But I've got a bunch of clients that are diehard Biden fans, and I've got several clients also that are diehard Trump fan. And however they want to talk and express and whatever it may be, you're still part of that unconditional positive regard, supportive reflection category. But again, you do not have to work with those populations if you don't want to. You can definitely say no, I can't. I have children. It makes me sick to my stomach to be in the same room as a pedophile. But that means that they're not getting a lot of qualified help, and they don't. Me: so, number eight, how have you engaged in advocacy, parentheses, for clients, for the profession? If so, what did that involve? And how did it go?

Mary: Yes, that's a really good question. So this is also, again, it's very case-by-case changes from person to person. The DBT particularly does not want you advocating and substitution of the client advocating for themselves. So you are not to treat any of your clients with kid gloves like they are incompetent or anything along those lines. So really, it's only after they've showed many times where they cannot do things or get productively things done, where I will do things with them. So we will call their medication manager together, we will talk to their lawyer together, we will be on line with their disability attorney together, or we will be filing their taxes together. So this is kind of a thing that happens a lot with people that are depressed, that have abolition. What is abolition, as the inability to get even small tasks done. And other people will call them lazy. This is also a thing that happens well with ADHD, because they just need another body next to them. It's called body doubling. So you're really not doing anything for people until they've basically proven that they can't do it for themselves, and then you're doing it with them. You're never really doing it for them unless truly some abuse has actually occurred. And I had one client and her in-home counselor. So I love in home. I did in home for two years. How different people respond differently, but it's very helpful. It's very similar to social work. And so often, if a client of mine fits, I'll try to get them an in home worker. We'll fill out the paperwork together. If they can't do it. I'll even call my clients at home if they don't show up. And I'm like, hey, do you want to have a phone session today? It depends on who they are. If I know they're in a deep depression and suicidal kind of deal, we'll call them. Like, if they're just not showing up kind of deal. But I had one client, and her in-home counselor took her to lunch, which was really sweet, right? And she paid for it, but she had an alcoholic drink. And the reason that my client's disabled was because she was hit by a drunk driver. And she didn't have one. She had two, and she wasn't going to report her. And so I had to report her to the board, but I called her first to try to tell her what was going on, and then I called her supervisor, and you only have a certain amount of time to report these things when you find out. I think it's 24 hours. And nobody had called me back, so I reported her to the board, and she left the profession. And I feel really bad. You don't ever really want to report any of your professionals because you're on the same team. And I talked to her before. We're working with this client for several months together, but my client wouldn't do it on her own. She didn't have the assertiveness to make that happen. And I felt bad that she liked this girl, but she can't do that. That's a big no.

Me: So the client came to you about the therapist, basically. So you advocated for the client?

Mary: Correct. And I reported the therapist to the board and advocacy here. So this would be very similar to, like, a CPS phone call from a parent who's doing some kind of abuse or neglect. It's good to know what constitutes those things. We have it hanging up in our kitchen. What is considered abuse and neglect in the state of Virginia? It's not a major part, but it's definitely there, like, a good amount. And usually, as people get better, they become more self-advocating. So if you lead a horse to water, sometimes you got to do that, but they will drink the more that they feel like they are building mastery. It just takes a long time sometimes.

Me: Okay. Wow. That must have been really hard for you to do. But it's the right thing.

Mary: I felt so bad. I know, right?

Me: Yeah. All right, so number nine. So this was kind of like it's kind of similar to a normal day , I guess. But what do you do to maintain self-care and wellness?

Mary: So. Ah, yes. Well, I'm probably figuring out the schedule is helpful. I could probably work a full day on Wednesday, but it's just so nice not having to. But because I do DBT, and I'm the active person at our practice that does it, and I'm the one that runs group and all that kind of stuff. I'm on suicide watch pretty much 24 hours whenever a group is running. And so people will call me, and I'm really glad that they call me. That is exactly what I want them to do. They'll call me or text me. And what I figured out is that in that state of crisis, I'm great, I'm good, I'm fine. I got it. Let's do it. All right. Yes. You're being skillful. However, about two to three days later, I start to get really snippy and snappy, and I think that's, like, when everything is stabilized, and everyone's okay, and if they need to be hospitalized, they're there, and they're safe for a little while, at least. So once your body realizes kind of that danger has passed, it will relax, and then the reality of it sort of sets in. And then I would start getting really kind of nippy and feeling stressed out and overwhelmed, and I couldn't really figure out why, but I figured out this is after paying attention to my own pattern. So you're constantly kind of doing therapy on yourself. And I realized what I need to do is essentially drive around. I've learned it takes me about an hour and a half, and I just need to talk to myself. Like, I just have to say everything out loud, and I have a full blown conversation with myself. I park in front of the ocean, and I look at the water. Sometimes I'll walk on the beach. It doesn't work if I just say it in my head. I have to say it out loud, and that alleviates a lot of whatever that backed-up stress is. And then I talk to myself. Like the internal family system stuff. I treat myself as fairly as I possibly can. I have a lot of interest outside of work, but I love my job, so it doesn't feel terrible. And people that usually go into this profession already have high levels of tolerance. That's why I can work with the populations that I've got, and different people are just different. Like, one of the girls that I love to refer people to, her name is Alyssa. She's super sensitive, and so I'll send people that I know need to have a very gentle approach to her. But her tolerance is much lower. That's why she can't be on call. That's totally fine. That's good. You just have to know, where your line is, and sometimes that line will change, and then that's okay. You'll change. But it might take a couple of months for you to figure out, like, a schedule or a specialty to change from. And I have a lot of hobbies at home. I like to garden. I have saltwater fish tanks. I do competitive dog training. And I walk with my mom once a week and chat with her kind of. I say a lot of loving words to a lot of other people. My mom has this quote that she made up and she says, the more love you give, the more you can give. My husband and I, we really fawn over each other. Like, I found an amazing man. Are we perfect? No. Do we fight every now and then? Sure. But they're very diplomatic and understanding and loving and forgiving fights. So cultivating the kind of relationship that you want. Yes. Thinking about that person when they're not around, like, containing yourself when you're with them in a good way, I don't know if that helped answer for sure. Me: Cool. All right, so just going back a little because you said you have hobbies at home. Do you like to garden? You said salt water.

Mary: Yeah, I have saltwater tanks, so I raise saltwater fish and coral. And that's a lot of learning. So you're learning about an ecosystem. So a lot of my hobbies involve some sort of other education nation. So we were supposed to sign up for pottery classes this week, but I didn't get around to it. It’s a lot of work to maintain an ecosystem where you're responsible for the living, breathing, like, literally, the breath that this thing takes. And so it's kind of fun and fascinating. So I know when I'm in a funk because I've been watching too much TV, but when I have good well-being and I have this in my phone, I literally wrote a list when I feel, well, what am I doing? And then, okay, what do I need to do in order to feel better? Because I'm feeling like I'm in a funk. All right, well, let me go ahead and put on a tutorial about how to, I don't know, paint Van Gogh Starry Night. Improving yourself and building mastery is incredibly stimulating for me, and it really helps to motivate me and get me out of a funk, even if I'm just googling, like how to motivate yourself. I'll watch videos on that. And this is really that piece of advice. Is it the last question? Or maybe it's the second to last question. It says, what's the greatest piece of advice that you can give?

Me: Yeah.

Mary: So this is what it is. Like, you will encounter people that you have no idea what to do with, and you are going to feel inadequate, get very comfortable with that feeling, but that inadequacy is showing you that you need to improve yourself in some way, shape or form. So self-education like I had one client that came in and I don't know if I told you in session and he was in a cult and I was like I know nothing on how to help you. I have the standard, I don't specialize in this at all. So first I tried to find someone that did and nobody really did in our area and then so I threw myself so that was my weekend and did I have to say goodbye to the other things that I maybe wanted to do that weekend? Yes, but this was the thing that was really necessary for me to have good well-being, which was to be a good clinician. And so now I can help my client when they come in at least a little bit better than before, because there's no one else I can refer them to. There's no practice. There wasn't anyone else I could find. And so I spent the weekend really throwing myself into that kind of education and literature. And that will happen to you a lot until you really kind of truly get a lot of skills under your belt, because a lot of your practical learning is going to happen in your residency after you've graduated. And this is really how to do CBT, really how to talk so you're not threatening to others, because if you come off as threatening, they're going to shut down. The more that you have those resources that you've already stockpiled, the quicker you'll be able to refer to them. But you're still going to come across things that you just don't know constantly. And that's okay because that's also what's really interesting, because you might get bored of one particular kind of population, and you're like, I would like, or maybe something comes up in your life and you want to get better at that thing you're like. I'd like to start taking clients about this, too. Once you've gone through your own training and gone to your own therapist, I went to go see my therapist this morning about my family. Go see your therapist about the stuff that you want to do. That would be my piece of advice, is when you will feel inadequate, that's okay. That's fine. That's normal. It's actually showing you that you're not arrogant. That's good. Embrace that feeling and then listen to it. What am I going to do? What do I need to do to help this person? I need to better myself right now.

Me: Okay. All right. I guess it was the same. What's the best piece of advice you can give me as a counselor and training? So you said you won't encounter people whom you will have no idea what to do with, and you will feel inadequate, and that's okay. That will show you that you are not arrogant. Yes. Is that correct? Okay. And basically, it will teach you to better yourself, and you will be able to help your client better, right? Okay.

Mary: Yes. Correct.

Me: This is our last question. So, what are your future career goals in the mental health sector? Mary: Well, my long-term goal has been for a very long time and still is to have a care facility on a farm. And I told my boss that the very first interview that we did, and I love my boss. She is a true mentor. She, I think, is an amazing asset to the community and our values align. Fantastically. She just purchased 13 acres of land out in Pungo, Virginia and I talked to her about being a mutual investor in this farm. So they're seeing if they can do zoning for agricultural and commercial there, and then she's thinking about building.

Me: Wow. Nice.

Mary: Yeah. So, this would theoretically be like horticultural and animal training, maybe like farm residential care treatment facility type. There's a couple of different ones and I found them in the United States and I need to go visit them, but I have not gotten a chance to yet. But the hope is to be out working in the fields and basically doing therapy alongside of people. So it's like nature therapy. And there's something very cathartic about touching dirt. And nature has a natural order to it. And one of the big problems with our current care system is someone in Virginia that just has, like, major depressive disorder. There isn't any residential care treatment facilities for them to go to. Like, if you have Medicaid, you have to go to a hospital, which is acute care, which are designed to keep you alive. They're not therapeutic environments, or you have to have an eating disorder. They have residential cares for those, but not for people that are just regular. They need deeper therapy. They need more intensive therapy than just weekly. And there are a couple of partial hospitalization programs, but not for a lot of people. Like, there are a lot of people that don't qualify. So we're hopefully filling the gap. There's a lot of people that are put on substances for pain, and they get hooked on it, and there's absolutely no program to get them off of it. And I know it's outlawed in a couple of states, but one of the things like to go through withdrawals or try to get off these really intense psychedelics or whatever it may be, the psychopharmacological medicines in Russia, they put people in a coma and they go through all these terrible opiate withdrawals while they're sedated and so they can wake up. And not the thing that’s keeping them hooked on substances or the military. There's not really a whole lot of intern programs where you can be reintroduced back into society when you actually have PTSD coming back over from the military. Like. You just kind of lose that brotherhood. So transition programs don't really exist. So I'm not entirely sure which population would be the one we would work with, but there are plenty of holes that we would like to fill, so hopefully that will come to fruition one of these days. I have a timeline. I'm 38 now. The timeline is for it to launch in 40, 42, which is four years from now, and we got the property, so we're slowly plugging on. I tell you. I used to be a farmer. Do you know I lived on a Buddhist farm in Hawaii? There’s kind of that integration of natural healing and traditional healing and modern psychology. I have a colleague and she doesn't even have an office. She meets people at a park in the woods, and they walk for an hour, and so she's like, unless it's like a hurricane, people will show up in the rain, asleep, the snow, and she's like, you have the natural aromatherapy. It just feels so good to just move your body outside. So she doesn't even have office and no overhead or anything like that.

Mary: Yeah. Have you thought about what population you want to work with? Me: So I don't know. I go back and forth. I'm like maybe I want to get into family therapy, but I also feel like I want to get into the same field that helped me. So like trauma therapy and DBT, I'm very interested in that. So basically I want to follow in your footsteps.

Mary: well, that makes totally sense. Like who better to be a therapist for that stuff than you, really? Me: Right, I know. It helped me and I'm like I feel like I want to go the next step now and learn more, and I don't know, probably help somebody else how it helps me.

Mary: Yeah, that's a wonderful way to heal the whole world. Good done anywhere is good done everywhere. And this is why AA works. AA works because when you help others, you help yourself. And it's the same thing for psychology. If it didn't feel good to help other people, we wouldn't do it. Me: Yeah, it's so true. It's so true.

Mary: And it's a wonderful purpose to have. And you can start one and then you can continue to accumulate knowledge and move over to another one. So you can really theoretically do both. Couples are great, families are great. They are tougher because you're dealing with more than one person, but they are more rewarding because of that. So the successes are more thrilling because it's like, yeah, a whole group of people doing great and cheering everything on and making progress, but it is harder because it's a whole group, you know what I mean? Me: Yeah. Yeah. Okay. So I guess that was all.

Mary: I think you'd be a great therapist. I think you have a wonderful conscientiousness about you.

Me: It makes me nervous because I feel like I'm still in therapy myself and I'm still like a work in progress. So sometimes I feel what makes me qualified. Because even though I know I've been on this journey, I for some reason, just still feel like I still have such a long way to go until I see myself as the person that I want to be. Or like, not saying I've healed or I'm going to arrive to a place because I don't know if I'll ever feel like I've arrived. But I just feel like I'm a long way from there. So it makes me feel intimidated because I'm like, I don't know, how can I help other people when I still need help?

Mary: Yeah, I think you're exactly where you need to be. Because everything that you just said, that inadequacy feeling, that's what you're feeling, that humility, and that even what you just said. This is a journey that may never and that is a very true statement, like, in my experience also, which can be great, because that means the mystery gets to continue. That means you get to continue to use your curiosity and grow. Like, how boring would it be if you ever truly arrived?

Me: Yeah, true. That's true. Well, thank you so much for that.

Mary: Yes, thank you for picking me. Let me know if you have any other questions. I'd be happy to answer them. And good luck. I'm happy to be here for you.