Working when experiencing your own crisis

[psychma]

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I was injured badly in a car accident 8 weeks ago. I fractured my tibial plateau, my tibia and my femur. I was out of work for many weeks and my practice fell apart. I’m scrambling to keep from going under. But I digress.

What are some tips for working when you aren’t feeling your best. I have had to cancel sessions 10 min in because of pain issues. I’m in a wheelchair and just have general problems accessing my files, printer, etc. Working feels very difficult but I’m not in a position to take more time off. Do any of you work with a chronic health condition or pain? What are some of your tips and tricks?

 

[coffee&CBT]

Such a tough situation. I can't remember if disability was mentioned on your other post about the accident/your practice. Have you filed for short term disability? It really doesn't sound like you can do your work effectively right now and need to heal.

 

[quickpsych]

It sounds like short term disability filing would be of benefit if applicable given your being injured in an accident. It's a tough situation.

Chronic health wise, I have an autoimmune disease that impacts multiple areas of my body (mostly related to spine, neck, joints but can also cause fatigue, lowered immunity, and other issues). Sometimes I push a little too hard and need to reel it in a bit, but for me I tend to seek variety in my work and more flexibility in my schedules (i.e. I no longer take jobs or work that require I show up at a set time for set hours a day. If I ever go into practice for myself I would likely cap my work to no more than a few hours a day maybe 3-4 days a week). How this might translate to private practice, I imagine it might mean reducing the number of patients you see or for now reducing the amount of time you work each day. You might also consider if switching to telehealth is feasible so you don't have to travel to your office.

But yes sounds like as other commenter said, look into short term disability. If you want to continue seeing patients in your practice it sounds like, while not ideal, you need to consider reducing the amount of work you're doing so you can work at a level and frequency that's effective for you in your current state of health.

 

[Therapist4Chnge]

1. I never book more than 4hr of F2F per day, though it’s easier in an assessment-based practice bc I can bill for record review and report writing. In your position, I’d consider contracting for some hours to do utilization review or similar bc you can make your own schedule and work when you feel up to it. Not great money, but it’ll help bring some $ in.

2. I split my days in half, and try to only see pts (or take meetings w lawyers) in a half day blocks bc if it’s a rough day, I know I only have to get through a 1/2 day and not a packed day.

3. While not really a morning person, I still try to do my client facing hours in the mornings bc I have more energy and I know I can take a break at lunch and/or run errands in the afternoon. I workout in the morning, which helps my thinking. I do a lot of my writing from 3pm-8pm, so I don’t feel bad food shopping midday on a Wednesday. I sometimes will go to the gym midday and steam or get a massage.

4. I grant myself a lot of grace. Some days just ain’t it. Instead of fighting myself to “push through” and write a report, I take breaks and try and do little things like decluttering, emptying the dishwasher, do a load of laundry, etc. I know those tasks need to get done eventually, so I do them knowing future me will appreciate the effort. Clutter is inherently stressful to me, so it’s oddly like self-care.

5. I try to pursue and foster referral sources that provide the types of work I want. I do workers comp clinical cases bc it’s steady referrals, not bc I love the work. I’d guess 90% of my “marketing” time my first year or two was spent pursuing IME work bc record review I can do at 10am or 10pm.

I know a therapy practice has more demands on F2F, but tweaking the case mix might help. I screen every referral before I accept and I decline any high acuity cases bc they can be a time and energy suck.

Hopefully some of this helps.

 

[cara susanna]

I have a chronic pain condition (endometriosis). On days that are just absolutely awful, I do the small things that help manage it. Like, wearing a portable, chargeable heating pad that I can wear underneath my clothes. I listen to music in between patients, because for some reason that helps me feel better. I take medication as I'm able. I also give myself grace and, when I am not doing notes or seeing patients, let myself scroll on my phone or read or do something pleasant. I also drink a TON of herbal tea.

If it's so bad that I am essentially not going to be effective, that is when I decide to call out. Some examples would be if I am up all night from pain and got very little sleep. Or if my pain is giving me GI issues that would make it difficult for me to stay in a therapy session for 45-60 minutes (especially on the, happily rare, occasions that I vomit from the pain). There are days I didn't call out when I probably should have, and days I called out when I probably could have pushed myself. I've learned to give myself grace in making these decisions and decide it's a pros vs. cons things as opposed to an absolute right or wrong. Also, reminding myself that my patients themselves are quite understanding and want me to be at my best, even that means their appt gets cancelled. Generally, though, I try to make it to work and tell myself that I can always leave if I need to. Sometimes that does happen, but more often than not I've found that working usually helps because it gives me something else to think about. Or, sometimes my patients cancel and I can leave early guilt-free, lol.

Overall, as a former colleague used to say, it's okay to be a B+ or even C+ therapist on some days.

 

[psychma]

There are good thoughts here. I don’t think I’m ready to go back to work really. I’m behind on documentation, I’m tired, I feel anxious. I’m not at my best. I don’t qualify for disability. I cut my caseload in half but I don’t feel it’s enough. Last night, for example, I woke up in pain at 4am. I had pain all day and was tired. I lost count of the number of times I said ummm during appointments. I’ll just have to cut back some more.

 

[Doctor Eliza]

Would doing more telehealth help?

 

[psychma]

Would doing more telehealth help?

I currently have a telehealth practice. Generally speaking it has worked for me but my wheelchair chair is uncomfortable and I have to keep my leg up in the leg rest which gets uncomfortable. I think with the pain and swelling and lack of sleep I just need to try to do less.

 

[MCParent]

I currently have a telehealth practice. Generally speaking it has worked for me but my wheelchair chair is uncomfortable and I have to keep my leg up in the leg rest which gets uncomfortable. I think with the pain and swelling and lack of sleep I just need to try to do less.

Not that this is going to help your current situation. But I hope that at least cognitively you’re able to recognize that the problem isn’t you, it’s a social, economic, and medical system that is forcing you to have to return to work while barely starting your recovery from a major accident while also dealing with the insane legal stuff you mentioned in another thread. Not that, again, that recognition is tradeable for mortgage payments.

 

[psychma]

Not that this is going to help your current situation. But I hope that at least cognitively you’re able to recognize that the problem isn’t you, it’s a social, economic, and medical system that is forcing you to have to return to work while barely starting your recovery from a major accident while also dealing with the insane legal stuff you mentioned in another thread. Not that, again, that recognition is tradeable for mortgage payments.

I feel like everything about this is unfair, but when I sit in it, I end up throwing a pity party. It’s easy to do. I’m stuck in the cold basement and am isolated all day. Client interaction is not socialization. My husband works long hours and I talk to him about 5 min a day. That is a whole can of worms not worth opening. I’m in a wheelchair, my leg is swollen and painful, my foot is swollen and purple and I’ve lost sensation in parts of it. The medical system is a mess. I can’t get care. It’s really outrageous. The legal stuff? I’m just ignoring it at this point. The family of the drunk driver is posting stuff about me all over Facebook trying to make me look bad. I just take a screen shot, send it to my attorney, and forget about it. So really, this is just all ridiculous. It is no wonder that I’m behind on documentation and am struggling to be at my best. I find myself using more feedback informed sessions to talk about what worked, what didn’t, and provide an overview of our next steps. This is helping me figure out whether I am meeting needs the best way I know how. The only reasonable thing is to reduce my load yet again at a time when my business is faltering due to not having had an income for 6 weeks and seeing new referrals, not having insurance, and not having business saving. Look at me having this pity party right here. Time to listen to some nic music and read a book.

 

[PsyDr]

1) If I accept that the symptoms are going to be present, regardless of what I do, I find that work often distracts me from symptoms and such. I'll ask myself, "If I am going to hurt, do I want to hurt in bed with nothing to distract me, or do I want to hurt while doing something?". This doesn't work for impairments. Often, I find work to be a great distraction from things. Emotionally, my population really puts things into perspective (e.g., after treating someone with terminal brain cancer or SMI... suddenly my problems are not that bad). Physically, aside from impairment, it usually helps.
2) Personally, I find great comfort in acceptance of the situation (i.e., quit fighting it, or telling myself that something should not be). If it gets bad, I like to consider the likely length of the situation (e.g., "This thing sucks. Looking at the science, it is going to suck for a month or so.
3) Create a new schedule, and be more strict with said schedule (e.g., "I cannot do that."; "I can't take patient phone calls or emails right now, but I can schedule you for an appointment"; etc).
5) You can still get a lot done, if you're open to flexibility. Alternative work schedule (e.g., At $100/hr, 3hrs/day, X 7 days/week=$110k/yr).
4) I was curious about the assumption: is work actually bad for you? So I did some self CBT, looked at the literature, and then considered what the trend would look like on the long term. Hint: there's a lot of stuff with orthopedics, MS, etc.

https://cardinal-management.co.uk/wp-content/uploads/2016/04/Burton-Waddell-is-work-good-for-you.pdf

 

[smalltownpsych]

It’s fine to have a pity party when you are going through something like this. You are right that no one can do anything about it. Radical acceptance is hard when things really do suck. I always laugh at the overly optimistic perspective of some young people who haven’t had to deal with really tough stuff especially if they start preaching some positive affirmation crap coming from that naive perspective. Don’t be too hard on yourself and it does sound like the strategy you’re employing in therapy makes sense. During this time of emotional difficulty relying on more practical and logistical approaches can be helpful. If I’m not up for it or the patient isn’t then we can do psycho education or relationship building. Some of my patients feel that therapy should only be “work” and talking about problems, but when dealing with more significant issues, that isn’t always advisable as some days we just won’t be up to it and that’s ok.

 

[cara susanna]

Yeah, I think it's a little different in OP's situation. The pain is more acute and, I assume, they will heal and improve over time. For people with chronic conditions that aren't going away, I can't just be like 'well, I'll take time off until I feel better" because this is something I'll be dealing with my entire life.

 

[psychma]

It’s fine to have a pity party when you are going through something like this. You are right that no one can do anything about it. Radical acceptance is hard when things really do suck. I always laugh at the overly optimistic perspective of some young people who haven’t had to deal with really tough stuff especially if they start preaching some positive affirmation crap coming from that naive perspective. Don’t be too hard on yourself and it does sound like the strategy you’re employing in therapy makes sense. During this time of emotional difficulty relying on more practical and logistical approaches can be helpful. If I’m not up for it or the patient isn’t then we can do psycho education or relationship building. Some of my patients feel that therapy should only be “work” and talking about problems, but when dealing with more significant issues, that isn’t always advisable as some days we just won’t be up to it and that’s ok.

That’s a good idea to add in some psychoeducation. I’ve been trying to deepen my practice in curiosity so that I’m really listening and not focusing on my discomfort. It has seemed to help. Interestingly, I find myself becoming more honest than usual. Perhaps it is grouchiness at the chronic pain and the poor sleep, but I’ve been able to harness to a point that most people seem to appreciate it.