VA Mental Health Provider Venting / Problem-solving / Peer Support Thread

[deleted1038433]

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Thanks. Yes, I do have self-blame that I recognize is irrational. I do use the CPT approach to an extent. I have a history of OCD, so I try not to analyze intrusions around harm and guilt. It becomes compulsive for me. There is definitely a ton of sadness and anger working itself out. I wish I could take some time off, but I don't have the leave. I do good with being a clinician, but I am emotionally detached and distant after my work day. I don't have any current colleagues, I'd feel comfortable talking to about it. I have a couple of folks from previous work places that I've started reaching out to.

I wanted to provide an update. First - thank you so much to all of you who offered support, suggestions, and shared experiences.

When I reached out to a former colleague and friend at a different VA hospital for support after my patient died by suicide, their spouse (also a VA employee) responded from my friend's work account asking if we were having an affair. I think I addressed that concern in a kind way, but it was very upsetting to be asked that and to have to deal with that on top of everything else. I am tired of people I interact with in VA playing stupid games and not giving them stupid prizes. I am wondering what stupid prizes y'all would have awarded in this situation if "professionalism" in our field did not hold you back.

 

[cara susanna]

I wanted to provide an update. First - thank you so much to all of you who offered support, suggestions, and shared experiences.

When I reached out to a former colleague and friend at a different VA hospital for support after my patient died by suicide, their spouse (also a VA employee) responded from my friend's work account asking if we were having an affair. I think I addressed that concern in a kind way, but it was very upsetting to be asked that and to have to deal with that on top of everything else. I am tired of people I interact with in VA playing stupid games and not giving them stupid prizes. I am wondering what stupid prizes y'all would have awarded in this situation if "professionalism" in our field did not hold you back.

I'm pretty sure letting their spouse use their VA work email, even if the spouse is a fellow VA employee, is a huge violation of policy. I've seen people get fired for similar things.

 

[AcronymAllergy]

I'm pretty sure letting their spouse use their VA work email, even if the spouse is a fellow VA employee, is a huge violation of policy. I've seen people get fired for similar things.

I agree, that's a BIG no-no, for various reasons (including that patient information can be sent via email when encrypted). I would be surprised if it were not a potentially fireable offense for both parties. And there's then no telling what else the spouse may have access to.

That might be something you'd be obligated to report. Could be worth reaching out via hypothetical scenario to the information security officer. At the very least, the former colleague needs to know their spouse accessed their email. And that's without even attempting to broach what it might or might not mean RE: the relationship itself.

 

[PsyDWannabe]

I agree, that's a BIG no-no, for various reasons (including that patient information can be sent via email when encrypted). I would be surprised if it were not a potentially fireable offense for both parties. And there's then no telling what else the spouse may have access to.

That might be something you'd be obligated to report. Could be worth reaching out via hypothetical scenario to the information security officer. At the very least, the former colleague needs to know their spouse accessed their email. And that's without even attempting to broach what it might or might not mean RE: the relationship itself.

I don’t know why, but I picture him sitting right next to her as she was typing that message while staring daggers at him the entire time. Point being, I think there’s a good chance he knows, and allowed her to use his VA email. Some couple dynamics are weird.

 

[cara susanna]

I don’t know why, but I picture him sitting right next to her as she was typing that message while staring daggers at him the entire time. Point being, I think there’s a good chance he knows, and allowed her to use his VA email. Some couple dynamics are weird.

If she signed the email as herself, though, then you can't prove that he was the one writing it. Idk, I get if OP wants to just ignore it and move on though.

 

[Fan_of_Meehl]

How do you do Tracers on yourself? Why would you not do it and just say you did?

Exactly.

The requirement was, literally, simply to fire off an email once per month to the Chief stating, 'I completed my tracers on myself for the month of (X) and was at 100%.'

Sometimes I feel like I am working inside of a cartoon.

 

[Fan_of_Meehl]

I wanted to provide an update. First - thank you so much to all of you who offered support, suggestions, and shared experiences.

When I reached out to a former colleague and friend at a different VA hospital for support after my patient died by suicide, their spouse (also a VA employee) responded from my friend's work account asking if we were having an affair. I think I addressed that concern in a kind way, but it was very upsetting to be asked that and to have to deal with that on top of everything else. I am tired of people I interact with in VA playing stupid games and not giving them stupid prizes. I am wondering what stupid prizes y'all would have awarded in this situation if "professionalism" in our field did not hold you back.

Say, 'yes...we ARE having an affair and we can't keep our hands off of one another?'

 

[deleted1038433]

I'm pretty sure letting their spouse use their VA work email, even if the spouse is a fellow VA employee, is a huge violation of policy. I've seen people get fired for similar things.

I'm not looking to cause any professional difficulties for anyone. I am looking more for relational prizes. I was kind and addressed it conscientiously. If there were not so much pressure to be a consummate professional at all times, I could see myself responding with a screen full of vomit emojis, telling them that they seem insecure/paranoid, saying something irreverent (blowjobs don't count as cheating if there was no swallowing), pointing out that they should not be dragging me into any of their marital conflicts, etc.

 

[Fan_of_Meehl]

I'm not looking to cause any professional difficulties for anyone. I am looking more for relational prizes. I was kind and addressed it conscientiously. If there were not so much pressure to be a consummate professional at all times, I could see myself responding with a screen full of vomit emojis, telling them that they seem insecure/paranoid, saying something irreverent (blowjobs don't count as cheating if there was no swallowing), pointing out that they should not be dragging me into any of their marital conflicts, etc.

If its any consolation...the fact that this even happened at all signifies pretty clearly that things ain't exactly copacetic on their end.

 

[deleted1038433]

If its any consolation...the fact that this even happened at all signifies pretty clearly that things ain't exactly copacetic on their end.

It does at that. It is not a consolation though because I wish them well and they are friends. I think I want the VA colleagues I manage to trust a smidge to not treat me poorly. I would like to feel that it is safe to privately hold others accountable when we are close and they behave like garbage.

 

[deleted1129370]

It does at that. It is not a consolation though because I wish them well and they are friends. I think I want the VA colleagues I manage to trust a smidge to not treat me poorly. I would like to feel that it is safe to privately hold others accountable when we are close and they behave like garbage.

I hold people accountable. I'm currently holding my supervisors accountable for their crap. 🙂

 

[deleted1038433]

I hold people accountable. I'm currently holding my supervisors accountable for their crap. 🙂

I am not nearly as assertive as you. I did try debriefing with the friend's spouse, and they sort of apologized for being offensive.

 

[cara susanna]

I am not nearly as assertive as you. I did try debriefing with the friend's spouse, and they sort of apologized for being offensive.

I'm glad they apologized. It angers me that you were reaching out for support and got this response.

 

[Fan_of_Meehl]

I am not nearly as assertive as you. I did try debriefing with the friend's spouse, and they sort of apologized for being offensive.

I would ask you if the event had any impact on your beliefs about yourself, others, or the world in the following areas:

Safety
Trust
Power/Control
Intimacy
Esteem

...but, you might punch me in the face, lol.

GOD, I hate doing back-to-back-to-back-to-back-to-back trauma/CPT sessions day in, day out...day in, day out.... .....

 

[Sanman]

I would ask you if the event had any impact on your beliefs about yourself, others, or the world in the following areas:

Safety
Trust
Power/Control
Intimacy
Esteem

...but, you might punch me in the face, lol.

GOD, I hate doing back-to-back-to-back-to-back-to-back trauma/CPT sessions day in, day out...day in, day out.... .....

Just remember, you got the good pension (I think).

 

[deleted1038433]

I'm glad they apologized. It angers me that you were reaching out for support and got this response.

Thank you for saying that! It was not an effective apology. It was very much, "I'm sorry *if* I offended you or surprised you" plus a lot of defensiveness and explanation for why they felt the need to do that. I didn't think it was worth providing them feedback about how to apologize and take accountability. I'm proud of me for trying to be a good person and responding with more emotional maturity than I was receiving from them. I'm not sure if I'll be reaching out to my friend much in the future.

 

[deleted1038433]

I would ask you if the event had any impact on your beliefs about yourself, others, or the world in the following areas:

Safety
Trust
Power/Control
Intimacy
Esteem

...but, you might punch me in the face, lol.

GOD, I hate doing back-to-back-to-back-to-back-to-back trauma/CPT sessions day in, day out...day in, day out.... .....

Hilarious! I did have a bout of "Maybe I don't deserve support or friendship, it is not safe to tell anybody I work with about how much I am suffering, maybe I'm just a terrible person, etc." but I was able to reframe that.

I foresee this becoming a go-to example when introducing/reviewing cognitive restructuring. One of my go-to examples has always been the generic, "someone you know well walks by you and does not acknowledge you when you say hello. How might you interpret that?" Now I could use "you reach out to a close friend for support following a traumatic event. Their spouse messages you back, and asks if you two have had an affair. What might you think?" I think that is a level of passive-aggressiveness I can stand behind.

 

[cara susanna]

I would ask you if the event had any impact on your beliefs about yourself, others, or the world in the following areas:

Safety
Trust
Power/Control
Intimacy
Esteem

...but, you might punch me in the face, lol.

GOD, I hate doing back-to-back-to-back-to-back-to-back trauma/CPT sessions day in, day out...day in, day out.... .....

I want to remind you that CPT is intended only for Criterion A events and will not be effective when used to treat the above incident that, while distressing and upsetting, does not constitute Criterion A.

(note: I am trying to be funny)

 

[cara susanna]

Hilarious! I did have a bout of "Maybe I don't deserve support or friendship, it is not safe to tell anybody I work with about how much I am suffering, maybe I'm just a terrible person, etc." but I was able to reframe that.

I foresee this becoming a go-to example when introducing/reviewing cognitive restructuring. One of my go-to examples has always been the generic, "someone you know well walks by you and does not acknowledge you when you say hello. How might you interpret that?" Now I could use "you reach out to a close friend for support following a traumatic event. Their spouse messages you back, and asks if you two have had an affair. What might you think?" I think that is a level of passive-aggressiveness I can stand behind.

I'm curious about what the neutral interpretation would be for that. The spouse was having a bad day? The spouse is concerned about the marriage in general? Lol

 

[futureapppsy2]

I'm curious about what the neutral interpretation would be for that. The spouse was having a bad day? The spouse is concerned about the marriage in general? Lol

The spouse temporarily thought that the OP was Ariana Grande? 😉

 

[PsyDWannabe]

The spouse temporarily thought that the OP was Ariana Grande? 😉

I am crying laughing lol

 

[erg923]

Bizarre turn of events here. Geez.

I'm usually a snitches get snitches kinda guy, but who know what else this dude is seeing on her emails or doing in general? Wouldn't report it but would certainly distance myself from this person for a while due to spouse behavior.

 

[deleted1038433]

I am crying laughing lol

Same! Y'all are awesome. I appreciate this forum so much.

The neutral interpretation for me in the moment was "my friend's spouse is in emotional distress. I want to help because I care about my friend and their marriage. I will reassure the spouse, let my friend know, and sort out my own thoughts and feelings later on."

Also:
-"I got this, I am good at helping damoiseaus/damsels in distress"
-"I will look back on this as a funny misunderstanding one day"
-"My spouse is going to laugh so hard about this"

 

[deleted1129370]

Same! Y'all are awesome. I appreciate this forum so much.

The neutral interpretation for me in the moment was "my friend's spouse is in emotional distress. I want to help because I care about my friend and their marriage. I will reassure the spouse, let my friend know, and sort out my own thoughts and feelings later on."

Also:
-"I got this, I am good at helping damoiseaus/damsels in distress"
-"I will look back on this as a funny misunderstanding one day"
-"My spouse is going to laugh so hard about this"

Eh...my psychologist hat is taken off at 6PM. It's okay to let people do what they do. You know who you are, and who value you. they may not really deserve you as a friend. That drama they are experiencing is between them and their marriage psychologist.

 

[cara susanna]

Sign #123 that I've worked in the VA too long:

I was texting someone about her appt to get an IUD and almost wrote "IED"

 

[Sanman]

Sign #123 that I've worked in the VA too long:

I was texting someone about her appt to get an IUD and almost wrote "IED"

So, I won't be surprised when the Feds swarm your office looking for terrorists.

 

[Fan_of_Meehl]

Sign #123 that I've worked in the VA too long:

I was texting someone about her appt to get an IUD and almost wrote "IED"

Understandable mistake.

To be brutally accurate...an IED is also an effective means of birth control.

I've also been working too long at VA.

 

[PsychPhDone]

My Teams isn't working and I've never been more productive.

 

[Fan_of_Meehl]

My Teams isn't working and I've never been more productive.

I hate Teams. People abuse it all the time. Sending non-urgent messages during your sessions when they should send these via email.

 

[Pragma]

My Teams isn't working and I've never been more productive.

I have a feeling that this holds true even outside of VA settings!

 

[cara susanna]

Our AC isn't working and I have given up on even trying to appear productive.

 

[Fan_of_Meehl]

Our AC isn't working and I have given up on even trying to appear productive.

Avoiding heatstroke by any means necessary would probably be the most productive thing you could do under those circumstances.

Have someone run down to the nearest Dollar General and bring back a baby pool and fill it with water and put your bare feet in it.

Throw in some popsicles.

Sheesh.

Gotta be an OSHA violation.

 

[WisNeuro]

Avoiding heatstroke by any means necessary would probably be the most productive thing you could do under those circumstances.

Have someone run down to the nearest Dollar General and bring back a baby pool and fill it with water and put your bare feet in it.

Throw in some popsicles.

Sheesh.

Gotta be an OSHA violation.

🙂

 

[deleted1129370]

I will be going on a trip to Europe/Mediterranean to celebrate my 10 year wedding anniversary in late August, but I am thinking I will be leaving my VA job when I get back in mid-September. My private practice is pretty steady - I have 13 patients on my caseload, I am paid consistently with my insurances I take. Everything operationally is smooth with my practice. I would just need to add about 12-14 more patients so I have a bit of a buffer and can account for some (rare) no shows/cancellations. My biggest fears of making this leap are:

1. No more benefits
2. No more paid time off
3. What if I hit a "dry spell" with referrals/patients cancelling?
4. Paying taxes for my business

 

[Sanman]

Our AC isn't working and I have given up on even trying to appear productive.

If the AC is not working, neither am I.

 

[Fan_of_Meehl]

If the AC is not working, neither am I.

'Sorry boss...somehow the prospect of me and my psychotherapy client sitting together hyperventilating and sweating profusely on the edge of heatstroke/delirium strikes me not only as profoundly unlikely to be conducive to productive psychotherapy but also just a bit...improper...'

 

[deleted1038433]

I will be going on a trip to Europe/Mediterranean to celebrate my 10 year wedding anniversary in late August, but I am thinking I will be leaving my VA job when I get back in mid-September. My private practice is pretty steady - I have 13 patients on my caseload, I am paid consistently with my insurances I take. Everything operationally is smooth with my practice. I would just need to add about 12-14 more patients so I have a bit of a buffer and can account for some (rare) no shows/cancellations. My biggest fears of making this leap are:

1. No more benefits
2. No more paid time off
3. What if I hit a "dry spell" with referrals/patients cancelling?
4. Paying taxes for my business

 

[deleted1129370]

I took the first step today. I finally started to type up my resignation letter on VA letterhead. I am taking my time with it so I can list out my reasons in a way that doesn't completely burn too many bridges, but captures the essence behind my decision. I think I am in a place where I can do my private practice full time and will take this big leap.

 

[Sanman]

I took the first step today. I finally started to type up my resignation letter on VA letterhead. I am taking my time with it so I can list out my reasons in a way that doesn't completely burn too many bridges, but captures the essence behind my decision. I think I am in a place where I can do my private practice full time and will take this big leap.

Take your time. While I am sure they will not care about the reasons, definitely draft a copy that vents about all the problems (just don't send that one in).

 

[Sanman]

So, after spending this morning prepping for my new intake....no show. Call the numbers listed in the chart...disconnected. Call the next of kin....disconnected. This guy really wants to ghost me!

 

[cara susanna]

So, after spending this morning prepping for my new intake....no show. Call the numbers listed in the chart...disconnected. Call the next of kin....disconnected. This guy really wants to ghost me!

Send a letter and call it a day? Lol

 

[Sanman]

Send a letter and call it a day? Lol

I'll do a follow up call in a week or so and then send a letter if necessary. 1st of the month and my bet is someone forgot to pay the cell phone bill on the family plan. Besides, letters are annoying when you are remote.

 

[AcronymAllergy]

I'll do a follow up call in a week or so and then send a letter if necessary. 1st of the month and my bet is someone forgot to pay the cell phone bill on the family plan. Besides, letters are annoying when you are remote.

Do you have to print and mail your own no-show letters rather than asking an MSA handle it? If so, I thought my VA was bad for pawning off administrative tasks to clinicians, but wow.

 

[Sanman]

Do you have to print and mail your own no-show letters rather than asking an MSA handle it? If so, I thought my VA was bad for pawning off administrative tasks to clinicians, but wow.

Our program does not have adequate MSA support and won't anytime soon (or ever).

 

[PsychPhDone]

Do you have to print and mail your own no-show letters rather than asking an MSA handle it? If so, I thought my VA was bad for pawning off administrative tasks to clinicians, but wow.

We have a note title that when you sign the note, it automatically prints somewhere and is mailed for us. It's amazing.

 

[AcronymAllergy]

Our program does not have adequate MSA support and won't anytime soon (or ever).

Oof. We thought it was a herculean victory to actually get MSA support in rescheduling the no-shows properly. If I'd had to print and mail my own letters as well, I might've lost my mind (seems like such a small thing, but eesh).

Then again, if they want to pay you $70/hour to print and mail letters...

 

[Sanman]

Oof. We thought it was a herculean victory to actually get MSA support in rescheduling the no-shows properly. If I'd had to print and mail my own letters as well, I might've lost my mind (seems like such a small thing, but eesh).

Then again, if they want to pay you $70/hour to print and mail letters...

In HBPC, I don't really mail letters often. I usually just let the primary care team know to hound them if there are going to be visiting.

But yeah, it's their time so whatever they want. If they want a highly overqualified and overpaid MSA that is fine with me.

 

[Fan_of_Meehl]

Oof. We thought it was a herculean victory to actually get MSA support in rescheduling the no-shows properly. If I'd had to print and mail my own letters as well, I might've lost my mind (seems like such a small thing, but eesh).

Then again, if they want to pay you $70/hour to print and mail letters...

That's the VA way, for you. Spend $70/hr paying a PhD-level clinician to be forced to type/print/mail no-show letters (after making all the no-show phone calls) whilst paying three $30/hr untrained(clinically) 'auditor' employees to harass that single PhD clinician about failing to tick off one out of forty little documentation tasks during his past week of therapy appointments because he was too gosh darned busy making all the routine no-show phone calls for $70/hr and printing/mailing no-show followup letters.

Meanwhile, the clinic MSA complains about the PhD clinician printing off the necessary copies of the CPT protocol handouts/worksheets for the onslaught of new CPT cases because he is holding up the copier for her and making her have to wait (when she, as one of two secretaries, should probably be making those photocopies for him anyway if we were a sane organization with any competition rather than an insane organization holding taxpayers hostage and setting hay-bale-sized mounds of $100 bills on fire just because we can).

 

[deleted1129370]

That's the VA way, for you. Spend $70/hr paying a PhD-level clinician to be forced to type/print/mail no-show letters (after making all the no-show phone calls) whilst paying three $30/hr untrained(clinically) 'auditor' employees to harass that single PhD clinician about failing to tick off one out of forty little documentation tasks during his past week of therapy appointments because he was too gosh darned busy making all the routine no-show phone calls for $70/hr and printing/mailing no-show followup letters.

Meanwhile, the clinic MSA complains about the PhD clinician printing off the necessary copies of the CPT protocol handouts/worksheets for the onslaught of new CPT cases because he is holding up the copier for her and making her have to wait (when she, as one of two secretaries, should probably be making those photocopies for him anyway if we were a sane organization with any competition rather than an insane organization holding taxpayers hostage and setting hay-bale-sized mounds of $100 bills on fire just because we can).

Come October 27th, this stuff will no longer be my problem 🙂

 

[ccpsych16]

Meanwhile, the clinic MSA complains about the PhD clinician printing off the necessary copies of the CPT protocol handouts/worksheets for the onslaught of new CPT cases because he is holding up the copier for her and making her have to wait (when she, as one of two secretaries, should probably be making those photocopies for him anyway if we were a sane organization with any competition rather than an insane organization holding taxpayers hostage and setting hay-bale-sized mounds of $100 bills on fire just because we can).

I thought I wrote this at first 😂 We got complaints about this too and were told to use other printers in different areas of the clinic or limit to ~10-15 pages at a time (yeah right…). I have a compressed tour, so I just print everything when everyone else is gone.