Practicum Internship Lessons

A practicum is kind of like a residency. An internship where you do actual therapy work supervised by more experienced people who sign off on all your work. My practicum internship was hard. One of the hardest times of my life. But not because of the clients. Below is a reflection from the middle of my internship:

I look forward to most of the interactions with the clients. I like the kids (most of them) and I like their parents (most of them). I actually love the kids, it’s like my heart is made of velcro and almost all of them stick onto me. Not all, but most. I’m excited to meet each one and hear the story, try to put the puzzle together with the clues they share and the ones they hold back.

I like being the person who hears their complaints and their skewed versions of their lives. I know it will be very different from their parents’ versions, and their teachers’ versions. I like being the one who listens as if what they say is true. I also like gently pointing out their doublespeak, their evasive tactics and the holes in their stories.

I like making the really sad ones smile. Even getting them to furrow their brow feels like entre with some of them; the ones whose affects are flattened or who can hardly hold their heads up. It turns out that many of the things that make me awkward with adults, actually work pretty well with troubled kids. I am often impulsive, irreverent and weird. I have no poker face and other people’s emotions get under my skin quickly.

I wish I could draw people a picture of these kids and what I like about them. I find the boys especially easy to fall for. When I meet them, I want to hug them and hold their faces in my hands. What I do is shake their hands and look them in the eye. If they have a good handshake, I compliment it and ask them who taught them how to shake hands like a gentleman (even if their girls). If it’s a terrible handshake I make a mental note of that.

What they do is break my heart. The kids I see are on the troubled end of the spectrum. Somehow they’ve gotten onto the radar of the The County. Could be because the school social worker is worried about the mental health of a kid. Could be that their probation or parole Officer thinks there’s more to a kid’s truancy, shoplifting or assaultive behavior than just badness. Might be that a Child Protective Services worker meets the kid and family and believes there’s a mental health problem with the kid. Every once a while, it’s a parent who is desperate to get mental health attention for their kid and doesn’t know where else to turn.

The other big way I meet kids is if they, or their parents, or their school calls the children’s crisis line. For example if a kid at school says he or she wants to kill him or herself, they might call the crisis line to assess the suicide risk for the kid. I go out on crisis calls sometimes, even though my main job is to do diagnostic assessments on kids who are not in crisis at the moment. Often the crisis line will refer a kid for a diagnostic assessment and referral for services.

Often, there’s something wrong with the kid. I see lots of kids with anxiety, lots with depression (they’re best friends, anxiety and depression). I see kids with PTSD and kids who are grieving and can’t move through it without help. I see kids who are stressed out, who have personality disorders and kids who are just pissed off. I see kids who are low functioning intellectually, in low functioning families, in a world that is fast moving and tends to prey on the easy marks.

Some are, for whatever reason, just rotten or naughty. They are making their families miserable and they are unwilling or unable to behave and stay out of trouble. Some have lost multiple friends to gunshots, jail, heart failure, car accidents. Stupid bullshit to have to deal with when you’re 17. Two the kids had lost multiple friends in the previous year. And by lost I mean either to death or to incarceration.

Many of them have problems with drugs and alcohol. Almost none of those kids are ready to stop using substances that seem to tame their biggest demons, but sap their motivation, kill their ability to tell the truth and cause them to hurt themselves people who care about them.

One of my kids doesn’t sleep well. His apartment has rats and bedbugs and they wake him or scare him. Many of my kids have serious mental illness in their families. One kid is really worried about growing up to have schizophrenia. She has family members on both sides who are schizophrenic. Lots of them are unsure where and with whom they will live in six months. Christ! Of course they’re troubled.


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