It Is Not Good For Man To Be Alone

This isn't going to be some religious post, or reflection on the creation story in Genesis. This is more of a personal reflection on why I was so miserable while I was working from home on policies and procedures.

Let me start at the prison, though.

I recently started working at Jefferson City Correctional Center, the maximum security prison in Jefferson City, MO. It's really frustrating right now. I've spent two days there, and have not been able really to get started because I don't yet have access to the state computer system or documentation system to review records and create therapy notes. So right now I'm spending a lot of time sitting around, twittling my thumbs, and wondering when something interesting is going to happen.

Tonight is one of those sleepless nights that I have every couple of weeks. Just can't seem to sleep. I was laying in bed thinking about how frustrating it is, when I realized the reason I'm frustrated right now is the same reason I was so miserable when I was working from home on the policies and procedures. I crave the therapeutic relationship that exists when I engage with people who are hurting. In every altruistic offer, there is a hint of selfishness. It is part of our fallen nature. Would Blessed Theresa of Calcutta have been who she was if she didn't believe she could get to heaven? Maybe eventually we overcome that and do the work of God out of pure love, with no thought of reward. That's not where I am.

I have always wanted to help people. I have also felt compelled in my career, for some reason, to work with those with whom no one else wants to work. I find myself drawn to the jobs to which others go because they just need a job. Those are the ones I want to do. Even when I was young, I didn't mind cleaning the toilets in the seminary.

I began in the addiction/mental health profession working in an adolescent rehab unit in Columbia, MO. It was ok. But when I learned that there was an opening in the community psychiatric rehabilation program, working with those who had severe, chronic mental illness, like severe schizophrenia, severe bipolar or depression, severe anxiety disorders, that was for me. Working with those that others feel are hopeless causes. Then I learned of the opportunity to work with opioid addicts on methadone. That was for me, too. Working with those whose dependence on illicit substances had become so severe that their brains literally could no longer function without the presence of that substance, which is provided in controlled doses so that they do not get high but are able to live normal lives. The stigma against these people's physical dependency on opioids and the treatment with methadone makes these addicts in medication assisted treatment the black sheep of the recovery family. These were the ones with whom I wanted to work: the ones that were rejected even by other recovering addicts (not all those in recovery reject those who need medication assistance).

Now here I am working in the prison, working with people whose mental illness is so severe that they committed a crime that was so serious that they now have to be secured in the highest level of prison facility available and in the highest level of security within that prison. It seems altruistic, but it's really not. I'm drawn to this. I crave the relationship that can be built with these men. I do it because it is fulfilling to me. Sometimes it's entertaining, which I have had to curb these first two days on the job. For example, I sat in on an involuntary medication hearing with a patient with severe schizophrenia. He started the meeting by protesting that he should not be there because he is in fact a Supreme Court judge. He then asked if his Petitioner Hardin was going to be there, who was his other half. You see, Petitioner Hardin needs to have a say in whether or not this gentleman receives medications, because Petitioner Hardin is his other half, and Petitioner Hardin may have an allergic reaction to the medication this inmate is given. At one point during the hearing, this inmate mentioned that he is the nuclear holocaust. He also mentioned that he is the one responsible for escorting people to heaven.

The interview piece of this involuntary medication hearing concluded with this inmate asking the panel, "Is there something wrong with me?" It took every ounce of self restraint I could muster not to respond, "Yes, you're crazier than an outhouse rat." I didn't though, because I'm new.

Scientific study and research demonstrates over and over again that the number one factor in a person's mental health improvement is not technique or theoretical approach or the skill level of the counselor or even the readiness or ability of the person in treatment. The number one factor in a person's mental health improvement is the relationship that exists between the one receiving care and the one providing it.

Different theoretical approaches of counseling have stumbled across this, even if those developing that approach did not have the empirical evidence of this that we have today. Rogers's Person Centered Approach discusses the need for radical authenticity in the care provider and radical acceptance of the patient. Both of these ideas revolve around the idea of relationship, and have become foundational to every counseling theory that has developed since Carl Rogers developed this philosophy. Transactional Analysis goes even further by stating that a person's problem really isn't within the person, but exists in the interpersonal transactions that take place between people. In other words, if a problem exists, it exists in the relationship between people. Motivational Interviewing states emphatically that if a patient in counseling is resistant to change, the resistance is not centered in the individual patient or client, but occurs because of a complication in the relationship between the care provider and the patient.

My own personal theoretical foundation for working with people draws from Victor Frankl's Logotherapy. This has to do with meaning making. The words we use to define ourselves have meaning, whether that word is father, mother, son, daughter, brother, sister, friend, employee, employer, boss. Whatever word we use to describe ourselves has a meaning for us, and we live out in our actions that meaning. I am a father based on the way I define that word. I am husband based on how I define that word. The other piece of this, though, is that all of these words imply relationships. To say I am husband means that I am in a relationship with a wife. To say I am a father means that I am in some kind of relationship with my children. The same is true for son (relationship with parent), employee (relationship with employer), friend (relationship with other friends). I act out my definitions of those words. Conflicts arise when the way I define myself in a relationship or define another in a relationship does not match the other's definition of me or definition of the other's self. In other words, when Lesley and I argue, it is because I have a definition of what it means for me to be husband and for her to be wife and she has a definition of what it means for me to be husband and her to be wife, and our definitions are not matching up. The point is, the relationship is key to these definitions.

The relationship is key. That's why I got into this work, and that's why I've been so frustrated. Staying at home working on Policy and Procedure did not allow me to engage in that relationship with those who are hurting emotionally or psychologically. I wrote policies and procedures...alone...at my kitchen table. That sucked. I wasn't able to engage people in therapeutic relationships.

I've been at my new job in the prison for 2 days now, and haven't been able to start engaging these men, building relationships with them. I'm hungering for that, craving it really. It's really frustrating that I haven't been able really to get started doing my work yet.

I don't know why I have this innate desire to build relationships with these type of people (currently men in the prison) who are nuttier than squirrel poop. It's just there. Maybe it's because so many others have rejected them, even family and friends. Don't get me wrong, if these men have been rejected, it is for good reason. They have committed heinous crimes. But then, I've committed heinous sins. Maybe the reason I want to reach out to them is karma, pay back for those that reached out to me when I felt the most unlovable. Maybe I want to build relationships with them because they have no one else who even wants to understand them.

Maybe I need to feel that salvation is real. Maybe God is calling me to love the ones who are most unlovable. Blessed Theresa began by hugging a leper. I won't be hugging any bat-dung crazy killers, but I will spend time with them and treat them with respect and dignity and unconditional love. The severely mentally ill men in segregation in a level 5 prison are America's lepers. I'm no Mother Theresa, but maybe building relationships with them, relationships that hold the potential for their healing, will make me a better Jamie Smith.