Disappointment

I have been let down by someone I trusted again. In fact, in the last three months I’ve been let down by four separate people that I have trusted, in three different separate sets of circumstances, and two of them have been clinical psychologists. That feels like an unpleasant cluster of disappointment. In each case they made me lots of promises and didn’t deliver. I was relying on them and now have to pick up the pieces. I was assuming that my ethical values would be ones that we commonly held, but in fact each person turned out to be entirely self-serving, despite the high cost to others. In each case the other party has taken what they wanted and left me to deal with the fallout.

Being exploited by others always makes me very sad, and it erodes my faith in people. But this time it has coincided with me being physically unwell. It may even be the cause of my health problems. If so, that is something new, and something I need to address robustly and never let happen again. But as ever in real life the picture is complicated and hard to unpick.

I’ve normally been a pretty resilient person, and hardly ever take time off sick. However, the minor road traffic accident in which I was rear-ended by a lorry 18 months ago transpired to have cracked three of my teeth*. One cracked wisdom tooth was removed soon after the accident and the second patched up with a filling. However the third was a visible tooth that had already had a root canal, so it needed to be removed in a way that would allow an implant to be fitted to fill the gap. I paid for expensive specialist dental work to preserve the bone and fill the gap with collagen to encourage regrowth. Unfortunately, removal of the tooth root was harder than expected and involved half an hour of brute force, breaking off a piece of my jaw bone in the process. That led to dry socket pain. I then required bone grafts along with a pin to support the implant, and six stitches to pull my gum back together. I’m not normally anxious about dental work, but it was stressful enough to make me shake before subsequent appointments and involved several weeks of painkillers and a course of prophylactic antibiotics whilst I recovered. So I suspect I was already somewhat physically depleted.

Then the interpersonal disappointments started to compound things. After a particularly unpleasant bit of news in early December I had to go home from work due to what felt like a migraine starting. I’ve subsequently been off work for six weeks with a “severe otitis media, probably herpetic” written on my sick note. The GP was concerned it was a variant of shingles due to the blistering inside my ear, so I was prescribed antivirals as well as antibiotics, but thankfully it didn’t develop into the full shingles presentation and has just felt like a prolonged ear infection. Subjectively I’ve mainly felt like I’ve been underwater, with periods of more marked earache, dizziness, fatigue and a kind of general malaise. Driving in particular has been difficult (as acceleration and even small hills tend to trigger pain), as has going outside (perhaps due to the changes in temperature) but it has also stopped me from playing with the kids in the way I normally would (as spinning, chasing or sudden movements can bring on earache/dizziness), thrown my sleep out and confined me to the sofa for much of each day.

It seems it has also reduced my ability to weather stress, and made it express in a more physical way than I’ve ever experienced before. I’ve had stomach cramps and waves of nausea that appear when I read emails from certain people. I can’t tell how much of the overall problem is a somatic expression of stress, and how much is my resilience being depleted by physical illness and making it hard to cope with the emotional stuff. But it has been an interesting learning experience. I’ve had to stick on an out of office message and binge watch TV serials. It is a big behaviour change for me to disconnect with my work, but I have to accept my own limitations. If it is shingles, then it can do lasting damage to the facial nerves or lead to hearing loss. No contract, colleague or past employee is worth that.

So I’ve made a pledge to myself never to let this happen again. Work is going to be a smaller part of my life, and I am going to make more time for art and music and going out into nature. Within my work I’m going to follow my heart more. I will only work with people I trust, who share common goals, and a sense of fun. I’m going to focus on doing what I enjoy, and what makes me feel I am having the most impact for those who need it most. I’m not going to bend over backwards for people who wouldn’t do so for me. And I’m going to challenge my inflated sense of responsibility for others.

Maybe it comes from being the oldest child of hippy parents, but I’ve always been a person that enjoys helping others, and giving a leg up, or a treat to people around me. Whether it was spending my pocket money on sweets for my friends at school, raising money for charity, or helping someone else out, I’d always put in a little more effort than other people seemed to. When I look backwards I can recognise that sometimes this has led to other people taking advantage, and me ending up feeling exploited.

I first noticed it in an adult reflective way a long time ago. I remember helping someone with a paper they were writing for a journal submission. Their draft was really very poor, and I made a lot of changes, but they didn’t add my name or even acknowledge my input. A year or two after that I coached someone who wanted to get onto the clinical training course I was on, and let her present a small analysis we had done together on my research project data, only to find out that she had presented the whole study as her own and not credited me at all. I also got her a summer job, from which she was fired for her poor attendance and timekeeping, for which she later attempted to use me as a reference, claiming that the service had subsequently closed and omitting to mention the reason for her departure**.

When a friend of a friend (I’ll call her Jo) sent me an email about being suicidal a few years ago, I cancelled a day of work to go and take her to A&E, and spent 24 hours getting her to attend and waiting for various services. Over the next fortnight I helped Jo sort out problems with her rented accommodation and to get a settlement from her job instead of being dismissed. After a second depressive incident a few weeks later, I brought her back to my house for the weekend rather than leave her alone and unsupported, a visit that subsequently extended to a six week stay.

I tried to be a supportive friend. I got Jo a new job within my network and a week later I agreed to be guarantor on the lease for a lovely flat. However the next day after a clash of opinions with a colleague she decided to quit the job. That left her no means to pay the rent, which would therefore have fallen to me, so I withdrew from being guarantor and the flat fell through. Jo was upset that I prevented her leasing the flat she wanted, but concluded that she would continue live in my house, rent-free, until something else came up. I felt that as well as not being the right choice for our family, this would have been enabling her dependence. There were various problematic incidents, but I still agonised before saying she had to leave and helping her move in with a family member instead. I took another day off and drove a 5 hour return trip to take her and her possessions to a new location. Despite all the efforts I put in, Jo remains angry at me for the perceived rejection and feels that I let her down. She periodically tries to shame me in our social group for “abandoning a vulnerable mentally ill woman”. For me it was all cost and given there was no benefit to Jo it was actually a lose-lose situation, but I did not recognise that until long after it was obvious to everyone else around me.

More recently it has been colleagues and collaborators who have let me down. I’d consider that par for the course if I was unreliable myself, but I don’t think that is the case. I always try to treat people as I would want to be treated myself, and to be really clear about the contract between us (whether that is a literal written agreement or an implicit verbal arrangement). I tend to assume that anyone who has the same profession or client group as me will have the same ethics and the same drive to do the right thing as I do. I always assume that people will care about the quality of the service, prioritise what is in the best interests of clients and keep their word, because that is what I would do in their shoes. Sadly, it seems that is not the case, and lots of other people prioritise their self-interest over anything else.

I don’t think I have unrealistic expectations. If someone signs a contract with me then I expect them to honour it. If someone agrees in writing to deliver a particular piece of work, be it training or clinical work, I expect them to turn up and do that work on the date they agreed. If someone agrees to take on clinical responsibility for some of our clients, I expect them to provide a good quality clinical service for those people rather than nothing at all. If someone agrees to purchase our services for a particular period of time, I expect us to have to deliver those services and for them to pay for them. If someone agrees to buy something from me and I deliver it to them, I expect payment. It doesn’t seem a huge leap of faith to me. Yet somehow these very simple expectations are too much for some people.

I’ve spent too many words justifying why, but I am disappointed by that. And, whether by coincidence or causality, I have been physically unwell in the immediate aftermath. But I am not the kind of person that just rolls over. I might be a sucker and go beyond the call of duty to be helpful when I can, but I don’t let people play me for a fool. I have a very strong sense of fair play and once people cross the line, then I feel obligated to do something about that. Just as I am a demanding consumer who will assert my rights for a refund or compensation when things go wrong (and gave Regus merry hell a few months ago for their terrible service with the office I was going to rent), so I will also take action to ensure that professionals honour their obligations. The way I see it is that many people don’t have the resources to address problems (be that intellectual, time, financial or personal) so those of us that do need to help put the checks and balances into the system.

So my plan is three-fold. Firstly I will address each issue head on and reach a resolution. And secondly I will make plans for the future that mean I am not put in the same circumstances again, gather better allies and do more of what I enjoy. I’ve already got a good team around me and lots of irons in the fire for new projects, and I have had helpful legal and practical advice from a number of sources. So it will all pan out in time. However my top priority is to get well again. And that involves the foreign concept of taking time out to rest. For a workaholic that might be the toughest part of all this!

*I don’t believe this to be a common result of an RTA, but I have brittle teeth due to tetracycline damage as an infant

**I didn’t feel able to provide such a reference, and gave them the contact details of the service instead.

Reflecting back

I’ve been archiving the files for a lot of my past court work this week. I moved office base and I don’t want to be cluttering up my new space with lots of old case information I don’t need any more, when it can be securely stored and eventually shredded. So far I’ve boxed up the files for 115 family court cases for which I completed an assessment and wrote a report, leaving only records that have been updated since the start of 2013 in my filing cabinet. As I check that each of the newer cases has been completed and invoiced, I will put those into storage too, and use my filing space for other things. It is another step in letting go of my role as an expert witness, and the huge weight of responsibility and emotional demand that entails.

As I put each case away, I added the family names to an index in order that I could locate them if it is ever required. I am supposed to keep files for seven years, or until the child is 21, so they stay with me a long time. As I record the names I realise I can remember the stories of many of the families, and I wondered how they were doing now. There were lots of traumas in those stories, that I heard and described in my reports, and felt in my bones. Many parents whose own childhoods meant that they couldn’t parent in a safe and nurturing way. Many of them dealt a hand full of adversity, who had no resources to cope with the stresses of their chaotic lives. Over and over again I saw children who were harmed by the care they were given, both in the children I had to assess, and in the histories of their parents and grandparents. Themes repeating across two or more generations.

It has always felt terribly sad that in order to give their children a chance at a better life, the courts have to intervene in ways that further wound the parents. But an expert’s job is to advise on what is best for the child, and sadly that is often contradictory with what is in the best interest of their parent. And I hope that I have always kept what would be best for the child paramount in my thinking, but whilst holding some compassion for the other family members. I think about the cases where I didn’t do the story justice, and the courts made decisions that I didn’t agree with. I worry about the cases where greater experience or new knowledge from the literature would have given me a slightly different perspective. I think about times I was threatened, or parents refused to talk to me, or I was cross-examined for five hours straight. Then I remember a time when a parent I assessed approaching me after I gave evidence, and feeling wary she was going to be angry that I recommended her child was removed. Instead she said thank you to me. “You were the only person I’ve met in all this that was always honest with me, and understood how I got here. I can see why you said what you did about me, and I think you are right that he will do better being adopted”. I’m still blown away by that. What an amazing gift to give me at a time that was so painful for her. I hope that she got the therapy she needed to put that reflection, empathy and kindness into practise in her life, and get out of the run of destructive relationships that had dominated her life.

I put the files into the box and lock them away. I am glad to let them go. It isn’t just physical space they take up, but mental space. Being an expert witness for the family court is a tough job. The hourly rates might seem high, but there are other ways to earn the same without the emotional burden. There have been pros and cons for me. I’m a different person now than I was when I began doing that work. I’m more observant and analytical, better able to ask the right questions, to deal with uncertainties, and to spot inconsistencies and triangulate sources. There have been rewarding moments too. I have had a lot of positive feedback about the quality of my assessments and evidence, and thanks for the impact of my work. But I’m also more cynical and I’ve seen a very dark side to the world. I’m more aware of the risks, and of how prevalent maltreatment and poor care are, even in our supposedly developed nation. I think I’m less trusting of people as a result of doing this type of work, and my norms for what levels of problems require professional help have shifted towards the more severe end of the spectrum, making me less sympathetic to people who feel very disadvantaged by more minor difficulties. I’ve also acquired the bad habits of work that has a strong pattern of boom-and-bust in demand – working through the night to make deadlines, putting in 80 hour weeks to meet demand, and generally taking on too much to leave enough of myself for other tasks and life outside work. It has also shown me that I can be a total control freak about the standards of work contributed by other members of my team, because my own standards are meticulous and I take this type of work – that can change the course of people’s lives – particularly seriously.

Letting go of court work is difficult, because it glitters. There is always demand, and it is nice to feel needed and held in high regard by other professionals. It feels as if you have genuine influence in the legal process (and I generally hold the UK justice system and public law professionals in high regard). The pay, although much reduced since legal aid cuts, still seems somehow more attractive as an hourly rate than the reality should be (given you can’t charge for much of the time these cases actually take, nor for administrative support such as typing or arranging appointments, nor for venues or materials it actually works out to be less than I make from other activities like therapy, training or consulting). It also has the kind of attraction of rubber-necking at a car-crash, as the cases each have their own grim story, are more complex than most clinical cases seen in secondary and tertiary tiers of service provision, and are often both acute and chronic in nature. I find it hard to say no when my skills are needed. But I must learn to delegate this work to others, or to decline, because I want to have my time and emotional energy back for other things.

And so it is good to archive my files, and to catch up with my invoicing, and to clear the decks of old ways of working to allow myself space for the new. It feels like putting down rocks I have been carrying for a long time….

Bump!

Its been a while since I wrote a blog entry, so this is a catch-up to the little chain of events that took up my summer.

On 24th June I was driving from work to do an assessment in the community, when I gave way at a roundabout. Unfortunately the lorry behind me didn’t stop, and went into the back of me. I got jolted forward in my seatbelt, but walked out physically unscathed to find that you could hardly see the impact on the car either. Thankfully the lorry driver was lovely about it; concerned and apologetic and we exchanged details. I was right near the VW dealership where I bought the car, so I got them to check it was roadworthy and went on to my appointment about an hour late. The garage explained that cars are very well protected against straight on collisions, and the bumper would have absorbed most of the impact by crumpling inside, so it was later replaced by my insurance. Likewise I was fine on the outside, but things on the inside started to show the impact in unexpected ways, both physically and psychologically.

Physically I got a typical pattern of whiplash injury – pain in my neck and left shoulder, tightness in my left arm and a restricted range of movement, stiffness in my back, headaches and disrupted sleep. I also got bruxism, the tendency to clench or grind your teeth, particularly during sleep. I’ve had similar physical symptoms from previous road traffic accidents (I’ve been hit several times before, 3 of which caused whiplash, but I’ve never had an at fault accident in 200,000+ miles since I bought my first car at age 20). But the psychological symptoms were new.

The first thing I noticed was that my concentration was completely shot. I couldn’t sequence tasks into the right order, sustain my attention or gather my thoughts enough to write coherently. I more anxious, had an increased startle reaction to loud noises and weird scary dreams. I had to work hard to keep my mind on mundane tasks like driving, so I didn’t wander out of my lane on a quiet motorway and was attentive to the speed limit (although driving was limited anyway due to the pain in my shoulder and arm). I couldn’t draw together and reflect on the different information in my court reports, feel confident about my conclusions and present them effectively in a report, so I had to be signed off sick for a month – something I have never done before. However the weighty nature of doing expert witness work for the family court means that I had no other option, it wouldn’t have been ethical to have submitted poor work to inform the court’s decisions on such life-changing matters.

To compound things I started getting severe pain in my tooth and jaw. The dentist was initially unable to identify the source, but eventually found a crack in my wisdom tooth. He tried to fill this, but it caused me levels of pain that I have never experienced before (even in childbirth). A few days later they tried to remove the tooth but had to abort the attempt midway, due to an infection in my jaw. I spent the following week on antibiotics and analgesics, wavering between debilitating pain and a pleasant but unproductive codeine-induced haze. I was reminded how debilitating chronic pain can be, especially as I became more tolerant to codeine and had to alternate with ibuprofen to gain relief. I also found out that dental pain falls in the gaps between the out of hours services (the emergency dentist said “see your dentist on Monday, nothing we can do except let the antibiotics do their stuff, but see your GP if over the counter painkillers are not enough” whilst the walk in clinic said they couldn’t prescribe for dental pain). And to add insult to injury I got a speeding ticket for doing 36 mph on my way to the clinic. The tooth was removed the day before we flew to Scotland for our good friends’ wedding, and once there, I immediately started to feel better. On my return I was able to complete the delayed court reports and start to catch up with my email, albeit with limited intervals on the computer.

Now I feel like I’m getting back to normal. I can’t go weightlifting at the gym, my sleep isn’t 100% and I’m still very stiff on waking or if I do anything physical like playing with the kids or trying to pull a few weeds in the garden, but I feel like myself again psychologically. I can concentrate and plan to levels typical for me, and it has been an interesting experience to reflect upon. Taking time out of work was difficult for me, because it challenges both my expectations of myself as a perfectionist and workaholic, the level of input/control I’ve been able to have over my business, and my reputation as a reliable provider of services. The up side has been spending more time at home with the kids over the summer holidays, taking time to relax and being forced to think about self-care a bit more than usual. I am very lucky that my husband had just left his job and was able to postpone his freelance work and take on a lot of the domestic tasks, otherwise I don’t think that I’d have managed nearly as well.

As a self employed person, taking time off work also lost me a lot of money, but it was difficult to see this as a loss I had no control over rather than me being self-indulgent. Even though I was told that I could claim from the lorry driver’s insurance for lost earnings I was still loathe to make a claim. Of course I had to contact my insurer, as the car bumper was structurally compromised and needed replacement, and my insurance company in turn set other wheels in motion. I genuinely loathe the personal injury claim industry from the speculative cold-calls and TV marketing to drum up trade to the impact on premiums and the motivation to malinger. I hate to be part of it. Yet I watch helplessly from the sidelines as the leaches of the insurance industry cream off maximum profit to take forward my claim, from the hire car whilst mine was in for repair (for more than twice the price of just walking into the local hire shop), to the paralegals at the ambulance-chasing law firm charging an obscene hourly rate for their cut-and-paste letters and calls. Yesterday I had my medical interview/examination with a very nice doctor who took 16 minutes to complete his assessment. Certainly an interesting contrast to the detailed day of interviews and assessments of each person I do for the family court!

So, its been an interesting summer. Despite the hiatus there is a lot I want to write about.