Dear Teacher, How Can I Express the Thanks You Deserve?

I found out this week that the most amazing teacher I know is retiring, so in honor of her, and all the wonderful teachers who have touched my kids lives and so many other families’ as well, this week's blog post is for you:

Dear Amazing Teacher,

I knew I liked you the day I met you, with your welcoming smile and your warm hugs for uneasy incoming students. But I grew to LOVE you when you spoke with me at the end of the first day of school. 

“Mrs. Deuter?” You said.  “I don’t want you to be alarmed, but your son had kind-of a tough day. He didn’t eat his carefully packed lunch and he didn’t want to play or interact with the other kids at recess. I tried to nudge him to go play with the kids, but he started to cry, so I just held him on my lap. I’m sure he’ll warm up. Just thought you should know.”

We talked every day for the first two weeks of school, just to check in. Everyday he rejected lunch. Everyday you held him close at recess. He came home after school and crashed out on the couch from the exhaustion of the day. He was clearly feeling overwhelmed. You assured me he would adjust, that in twenty years of teaching, they always adjusted. So we hung in there. And then one day he hopped up and trotted off to swing at recess without looking back, and that was that.

Your gentleness and patience had gotten him through. I’m sure you might have liked to take a break for yourself during recess, maybe sneak off to the restroom, during those long two weeks. But you apparently cared more about a nervous little boy than your own personal needs.

In itself, what you had done would have been heroic, shepherding not just him, but his parents through those stressful days. But that was just the beginning. Within a few more weeks, my anxious boy began to say he loved his teacher and he loved his school. You taught him that school was a wonderland of fun. That teachers were silly and full of energy and lots and lots of hugs. And you taught him to love to read by dressing up as Russell the Farting Dog. You laid the foundation for how he would feel about school. You were safe and joyful and fabulous.

Two years later, we were blessed to have our daughter land in your classroom, too. You taught her that dancing in the morning would warm up her brain for learning. She still does that. You demonstrated that living your passions is beautiful. She wanted to be you. You told her if she really runs for president some day, you’ll definitely vote for her. She has never forgotten that.

At parent conferences, you placed your hand warmly over your heart and looked us in the eyes and said, “I love your child so much,” and you clearly meant it. I bet you said that to many, many parents over the years, and I believe it was absolutely true every time. 

Children thrive on warmth and love and every parent wants to send their child into a classroom as full of it as yours was. It was no coincidence that experienced parents requested to have their kids in your room. They wanted to benefit from your magic, have it pay dividends for years to come like it has for my family.

How does a parent thank a teacher for what you have given us? Are there even words? You exemplify the idea that teaching is a calling, a labor of love. The bonds you’ve made with my children, and countless others in all your years of teaching have been the foundation for their educational lives. You taught them how to learn, and most importantly, how to have fun doing it. Teaching really can change the world. And you changed ours for the better!

So thank you, from the bottom of my heart, and from every parent who has been honored to have a child land in your loving, giving hands. Enjoy retirement, take a bathroom break when you need one, and know what an impact you’ve made!

Grateful Parent

For Patti SampsonC

The Meaningful Life

Last week, I had a session with a struggling twenty-something. He was angry and disheartened about life. He said the values his culture taught him had proven worthless in the real world. (Young people tell me this often). He said he is unable to find hope in the world. Although a great student, he found no pleasure or usefulness in achieving. His parents told him, “Just study. You’ll feel better after you score well on the exam.” So he studied, but after the exam, he still felt lost, alone, and as though life was inherently meaningless. Same with work. He was told, “Earn a little money working in a retail store. Money will make you feel independent. Then you’ll feel better.” But work didn’t provide what he was looking for either.

He’s been searching for a life of meaning, and he doesn’t know where to look. Evening practicing his faith isn’t helping him.

We started to talk about what gives life meaning, and what he wished had been taught to him as a child. We made a list of four things he wished had been part of his upbringing, things that might guide him now in young adulthood to find meaning and build a good life.

1.    Material things and achievements are equally hollow. 
We all know that material things can’t provide happiness. But what about achievements? Achievement continues to be encouraged and touted as a meaningful part of life. While achievement can provide some satisfaction if the end goal is truly something important, achievement just for the sake of winning is fools gold for most young people. 
Rather than being told to study and earn high grades or to run for class office and win, he wished he had been taught to love learning and to lead as a way of doing his part for the group, not just trying to win.

2.    Work only feels meaningful when it helps someone.
Working in a retail store can feel meaningful, but not because he was earning money. The real value of the work was found in providing a useful service to customers. Connecting with people. Being a resource. 
Rather than “get a job and you’ll have money,” he wished he had known to look for a way to serve his fellow man.

3.    Have relationships that are real, genuine, and true.
Trying to win all the time led to isolation. Peers were the enemy, not a source of connection or support. Now as a young adult, there’s no skillset for connecting and trusting others. 
Rather than pushing past peers to get ahead, he wished he had been taught to find true friends, to seek out genuine, “real” relationships and connect with others in an honest and vulnerable way.

4.    A quiet life is enough.
Fighting for A’s and admission to the best university was very distracting and hectic. There was always something “urgent” to worry about: a big project, a college admissions essay.
Rather than fighting and struggling to sift through all the noise, he wished he had just experienced more moments of quiet and appreciated the value of those.

I thought this was an insightful list. As we raise kids and prepare them for adult lives, we may be steering them toward feelings of isolation and meaninglessness when we value academic or financial gain. 

What do you think?

Mom: A Performance Review

Today is the day after Mother’s Day, and I feel like yesterday I was handed a kind of performance review of the job I’m doing. Anyone who regularly reads this blog probably knows that I believe the job of a parent is very important to all kids' long-term psychological wellbeing. I want to do the best job possible.

So how am I doing?

My two elementary school children brought home projects from school. (The middle-schooler just wrote a quick note, I imagine prompted by Dad, saying, “Thanks for being an awesome mom.”) Both younger kids, 3rd and 5th graders, were asked to fill in the blanks with the best things about Mom. These were traditional Mother’s Day school projects, designed by teachers who surely wanted Moms to feel loved and appreciated. I was pleased to see my children had written items like: “My mom always listens to me.” And “My Mom thinks everyone should be treated equal. She will be happiest when everyone in the world gets treated that way.” Top marks on those. But “My mom’s favorite hobby is… napping.” Really? I’m not sure that’s a fair representation of my day-to-day parenting productivity. Well, at least it didn’t say staring at her iPhone…

Maybe children aren’t the most qualified to write parents’ job performance reviews. After all, don’t many kids, especially younger ones, just believe their own family is normal, or even great? They describe what they see, without fully understanding the implications. (We’ve all seen the internet memes of kids who have drawn a picture with the caption, “My Mommy likes… drinking WINE!”) 

And of course teens aren’t much more helpful in reviewing performance. It can be hard to get teens to express any viewpoint at all about their families. (Although “awesome,” while not very descriptive, still seems pretty positive.) Teens have more to say when they have a complaint, but is their feedback objective? If we rely on our teenagers to tell us how well we are parenting, we might all conclude that we are the strictest, most controlling people on the planet. “Do you know that I’m the only kid in my grade who doesn’t have a laptop?” (Doubtful). 

Young adult children won’t be much help, either. They may be frustrated about the parents’ ability or inability to help support them, or homesick, or drudging through a long list of emotions about their childhood, trying to understand who they are and where they come from. By the time adult children can give objective, helpful feedback, the parents’ most important roles have likely concluded.

So, if kids can’t evaluate our job performance as parents, who can? Because heaven knows we need some honest feedback. Otherwise how can we improve?

Perhaps we each have to assess our own performance as parents. It’s impossible to be objective, but at least we can try to honestly note our biases. Here’s a simple 12 item job performance checklist for parents:

1. Are my kids getting all their basic needs met?

2. If I’m having trouble being a parent, am I asking for help?

3. Am I living by my values and adhering to them as often as possible?

4. Do my kids know with certainty that they are loved and cherished?

5. Am I tuning in to my kids often enough?

6. Am I here for my kids, or just for me?

7. Am I managing my automatic reactions so that I can be more reasonable when I’m tired, frustrated, or just having a bad day?

8. Am I guiding my kids in a direction I think they need to go (rather than just letting them wander aimlessly)?

9. Am I letting go enough, so they figure things out for themselves?

10. Am I communicating clearly so they understand me?

11. Am I teaching them necessary skills they will need for future stages of life?

12. Do my kids seem okay, and if not, am I figuring out how to help?

There are probably many more items a parent could use to assess job performance. What would you add?

Urgent Care for Mental Health?

When I first heard about the concept of an urgent care clinic for mental health, I thought it couldn’t work. What about the importance of the treatment relationship? Isn’t that the key to good clinical care? And besides, I had heard that the few urgent clinics that exist around the country have patients coming in and waiting 4 hours, or sometimes all day, just to be seen. Wouldn’t any mental health urgent care fill up, leaving the same access to care problems that existed before its inception?

At the same time, access to psychiatric services is becoming more and more difficult. The typical scenario for people seeking mental health care services in my community progresses as follows: 
1.    An unexpected crisis hits, so the individual in crisis seeks care at an emergency room or medical urgent care. A doctor or PA assesses the patient and may recommend hospitalization, but usually not. (Mental health hospitals provide care for a few days when necessary for safety. If there is not a safety concern, hospitalization is usually not the best option). The doctor/PA perhaps prescribes a Xanax like medication (probably not the best treatment for he problem, but available in the ER) and recommends ongoing care with a psychiatrist, but doesn’t know anyone who is taking new patients.
2.    The patient, hopefully stable enough to wait, calls around town and finds out very few psychiatrists accept her insurance, and many of those who do take her plan have full practices. She finally finds someone and schedules an appointment with psychiatrist’s office, but will have to wait 4 months for the initial evaluation.
3.    Uncertain she can wait 4 months; she reluctantly goes to her primary care physician (to whom she had not wanted to disclose the psychiatric problem, because she felt ashamed). The PCP starts a medication, but both he and the patient feel uncertain that they understand the problem fully and both would prefer the opinion of a specialist, which they must wait 120 days to hear.
4.    When she does finally meet with the psychiatrist, she finds that this person is not a good fit for her needs. He’s a specialist in PTSD and mostly treats veterans with medications only. He has 10-15 minute appointments. The patient is a 50-year-old woman with depression, and she wanted longer sessions with her doctor. 10 minutes is not enough time to get her concerns heard. She also preferred to see a female psychiatrist, but couldn’t find one who was taking new patients.

If, however, the patient above can seek care from a mental health urgent care center, the scenario can look quite different.
1.    A crisis hits and the patient seeks care at a same day appointment. She is assessed by a team consisting of a therapist and psychiatrist, and a treatment plan is developed which includes both short term psychotherapy and starting an antidepressant. She may also be referred to a group for psychotherapy.
2.    As part of the treatment plan, a long term strategy is developed for the patient’s continued care. Her choices for care include returning to primary care to maintain treatment once her symptoms are stable, having the mental health urgent care center facilitate an appropriate referral to a psychiatrist who provides the services she needs, or waiting on a waiting list with a community provider while the MHUC provides bridge care in the interim.
3.    The MHUC stabilizes the patient, decreases emergency room and hospital utilization, and offers a screening process for the patient so she can land in the right place for care.

And what about the 4-hour wait times? I think the answer is that we need more than just a few of these specialized urgent care centers to provide the necessary services. The problem has been that only a few small clinics offered walk-in assessments for mental health. Many of these clinics were state funded, and had limited budgets. When the clinic budget was used up, the walk-in services began to clog up and drop in quality. 

The answer will be to offer more options for walk-in care. To keep pace with the demand, the number of providers will have to increase over time. By returning patients to primary care when possible, using counseling professionals to fill in gaps, and focusing on the acute phase of treatment, I believe this can be achieved. Psychiatrists can offer consultation at the onset of an illness, and then allow other professionals to continue the plan later. Urgent care centers may be the best way to deliver specialty care in other fields as well (like orthopedics and internal medicine diagnostics), so that brief periods of consultation can then be followed by longer term follow-up in primary care.