The Bittersweet Goodbye is Real

Since I came back to work part time on 11/05/2025, I've been working knowing that at the far end my last day seeing clients would be Tuesday 12/02/2025 and staff (me and another LCP) would spend 3 days discharging clients, counting up IT and office equipment, finally locking the doors on Friday 12/05/25.

Last week I emailed all of my clients who haven't scheduled to see me from 11/06/25 to 12/02/25, checking if they wanted to schedule another couple of sessions or if they wanted me to discharge and close their file, which is the option the vast majority of clients took. So I spend a good amount of time last week discharging them and closing files.

Each client discharge brought to mind the awkwardness of their Intake session, "ah-ha" moments I was privileged to witness in sessions, and memories of tragedies shared and successes achieved. I teared up as I looked over most of the names on my client list. I wish I could take dozens of them with me, but I can't. I'm moving into a position that's not focused on outpatient therapy.

For me the good news is that I've already found a full time position at a local 74 bed inpatient hospital, completing Intake assessments, treatment planning, and discharge planning for both mental health and detox patients, in addition to providing individual, family and group sessions, and floating over to offer PHP and IOP 1:1 sessions, processing and psychoeducational groups. 

My last day at my current gig is Monday 12/01/25. My new gig starts 12/15/25. I've never taken any time off between job changes, but given my own mental health struggles, the objectively fucked-up way the termination of my current position has been handled, and my need for time to process all of it, I feel entitled to have ten days off between,

Whenever I get a new client I go into Facebook and try to locate them and block them. When working at a prison, this was literally for my own safety.  With middle school and high school kids this was purely for privacy boundaries and I've continued that practice for many years since. I'm well aware of the Wisconsin Department of  Health Services and best practices of not contacting or accepting contact from former clients for at least two years after the end of the professional relationship. Two years is a long time to be motivated to search for someone and start social contact with them, which is the point of that limitation. As much as I care about my clients now, in two years will they even be interested in any contact from me, and me from them?

I hope I've offered the best care I could to my clients. I want all of them to succeed, whatever that looks like for them, and if I played any role in that coming to fruition, I am humbled, I hope I've made a difference. I hope I've compassionately prompted change.

I continue to and always will hope....

                                                                

…and then there’s this…

After my therapy session but before my ninth and final acute Ketamine session on Friday, October 31, 2025, I responded to a voicemail from a Vice President in my organizational hierarchy. She bluntly told me that the “large national insurance company that owns the outpatient agency” I transferred to from a remote home-based position in November 2024 has made the decision, based on “multiple considerations” (corporate speak for “these outpatient clinics are not making a profit or at least not a large enough profit”) so all of these agencies will close permanently on Friday, December 5, 2025.

There are three agencies in Wisconsin that are closing: in De Pere where I work full time, in Appleton where we have a prescribing nurse practitioner, and the Oshkosh office where two clinicians were recently hired.

Granted, it was/somewhat still is a cluster fuck where I work. Because there are only two full-time LPCs in the office we have no admin support on site.  We started out with one, but she was let go “due to down-sizing” shortly after January 1, 2025. So that leaves A LOT of shit for the two of us to do. Because I’ve been at the De Pere location the longest, the toiletry supply/carpet cleaning company thinks I’m in some sort of managerial role and their sales rep regularly calls me or stops into the office unexpectedly and thinks talking with me will result in additional services we will purchase from them. The last time he called me, I finally told him, “Dude, I am not a decision maker here. I’m a therapist, that’s it. Here is my director’s email address. She’s based on the south side of Chicago. Good luck.”

One of the situations I hate most about any employment environment is having to fix another department’s mistakes. We have a “central scheduling department” whose location is completely unknown to me. When new hires are going through the on-boarding process, we submit our schedules to a different department that creates our schedule which includes our preferences such as not working with telehealth clients, not working with couples and/or families via telehealth, the age range of clients’ counselors feel comfortable working with and that sort of thing. Then the mystical schedulers who receive calls from new clients are supposed to follow the clinician-created availability…but sometimes they don’t.

And if a new Intake gets scheduled outside of the parameters I’ve provided, it’s up to me to contact these clients and explain why I can’t see them and provide them with next steps, so they are seen by a clinician who meets their scheduling preferences.

That drives me ABSOLUTELY CRAZY.

I have enough work to do and spending time talking with clients, apologizing profusely for a mistake I DID NOT make, but I am held responsible for fixing makes me want to scream.

 

There is a process to make the schedulers aware of such “mistakes”, but I swear it’s a 12 step process that I don’t have time to complete.

These are some examples of how I got burned out at work, only to be compiled by home stressors, that led to my recent FMLA for Ketamine therapy. I have gained significant insight into what leads up to burn out for me and am starting to better manage my perfectionism, maladaptive beliefs that I am independent to the point that “I don’t need any help or support” to get through life while increasing my insight that I didn’t get this far in life without the help and support of family and friends, and that I do the best I can with the information/skills/resources available to me at the time.

This is a much more balanced way of living, which I’ve secretly craved for so long that sometimes I have to double check the validity/reality that I can truly live this way.

In my therapy session on 11/07/25, I suddenly came up with this concept of “Kristine 2.0” which involves getting in touch with core beliefs and values that can propel my life forward, which will likely involve cutting off some of my previous beliefs and values that served me at the time, but are no longer useful or effective.

Despite the nervousness and support of my husband, parents, and siblings, to name a few, I feel good about taking some time in December to keep exploring my beliefs and values, keeping what I need and leaving the rest. The last three Holiday seasons have ranged from totally shitty to barely tolerable at best. I want this season to be filled with hope, love and peace, and I truly believe I can make it so.

Phoenix Rising

Here I Go Again...

 

WARNING: This blog includes descriptions of self-harming behaviors, please take that into consideration before you continue reading and especially if you choose to leave a comment.

Here’s an AI generated definition of treatment resistant depression:

Treatment-resistant depression (TRD) is the lack of response to at least two different, adequate antidepressant treatments for major depressive disorder, meaning the symptoms don't improve or only partially improve after taking the medications for sufficient time and dosage. While there isn't a universally agreed-upon official definition, the condition is identified by the failure to achieve adequate improvement with standard treatments and requires further investigation to find an effective course of action. 

I’ve had a major depressive disorder since I was roughly 22 years old. I’ve had treatment resistant depression since roughly 2006 when I had a 12-treatment course of ECT (electro-convulsive therapy), generally known as “shock therapy.” I had 2 weeks of ECT on a Monday-Wednesday-Friday schedule, then 2 weeks on a Tuesday-Thursday schedule, finally I had 2 weeks of weekly treatments on Wednesdays.

By the 5^th week Mark had to carry me from the car into our house after treatments because my head hurt literally beyond description, I was weak, I had unending vomiting on treatment days, and I could barely sip water and eat 6 saltine crackers throughout the course of the treatment days.

During the last 2 weeks of treatments, I attended the wedding of one of my best friends and I remember none of it. Thank God we have pictures so at least I could see the lovely bride and groom, their flowers, and my other friends in attendance.

In early October 2023 my depression symptoms were worsening. I spent weekly sessions with my psychiatrist trying an addition of another antidepressant, reported no improvement, that med was discontinued and another antidepressant was added, yet again I reported no improvement, and my symptoms were still worsening. Finally, I did some online research and found oral Ketamine treatment for treatment resistant depression. Costs were all out of pocket, I had to provide medical information, have an online interview with the prescriber for medical clearance, meet with a “guide”, and document my intentions pre-treatment and what I got “out of the medication session” to discuss with my guide.

I had a 6-treatment weekly course of 800mcg (I’m not sure how they measure the doses, it could be micrograms, milligrams, I don’t really know) but after week 4 I started feeling a shit ton less depressed and that continued for about 18 months. Which brings me to late summer/early fall 2025.

My shrink and I have gone back and forth over the years discussing if I may have bipolar disorder, which as of my last appointment with him on August 4, 2025, I’m not diagnosed with. I agree with that…there are times when my depression was so severe, I would have given anything for a smidge of hypomania, which never happened.

By mid-September this year I started feeling overwhelmed, anxious, and once again worsening depression. I believed I was an independent woman who ought to be able to manage my emotions without any help or support outside of my therapist and my shrink. I said nothing to anyone except for them about how I was spiraling down, down, down.

I couldn’t wait for my psychiatrist to tinker with my meds or take weekly doses of oral Ketamine through the previous online organization I had previously used and received significant relief. I needed help NOW.

On September 21^st I found a local provider of IV Ketamine, 6 total sessions on a Monday-Wednesday-Friday schedule for 2 weeks starting October 13^th. They use an app where I complete daily mood ratings, journal, have access to an online community, and PHQ-9 depression assessments.

This is my entry for Friday October 10^th:

I had a breakdown. I slammed my hands against the bathroom counter while sitting down in front of the shower and slammed my head against it a few times. Then I laid down on the bath mat and cried. I took the scissors and cut off my hair. No idea what I was doing, I just kept cutting and cutting until 80 percent of it was gone. I can’t look in a mirror to see my ugly face and what I’m sure is my ugly hair. I am useless, I am a burden. I can’t stand myself.

I had my first IV Ketamine session on Monday, October 13^th. As of today (10/23/25) I’ve had 5 sessions. I was originally scheduled for 6 sessions, but after talking with my provider she recommended 8 sessions, so my last medication session is now Wednesday, October 29^th. My anticipated return to work date on a part time schedule is Tuesday, November 4^th. I’m receiving short term disability, 60% of my regular salary, which is enough to get us through.

My “mood trend” scores have gone from 3 on a 1/10 scale on 10/05/25 to 7/10 on 10/23/25 which is a clinically significant increase in mood. I have another week and a half before this part of my medication journey concludes. We’ll see where I go from here.

Memories of Arches and Canyons

 I recently came across some notes I'd written during the trip to southeast Utah Mark and I took in early September 2012:

There is "something" about these red rocks, dry earth, and striated cliffs that is calling to a very primordial part of my soul. I sense that my soul has  known this place long before it took its current refuge  inside of me. Maybe my soul is hearing that "something" calling out to it, calling, "remember me, old friend? Wasn't it you who was here, helping to carve out these cliffs in the rushing, frigid water? Wasn't it you who was here, helping to heave great slabs of earth skyward, exposing this rock below? And wasn't it you, old friend, who was here, again in the rushing river, this time flowing away from the land, leaving nothing behind but sand and a few scrubby bushes? Wasn't it you who flew high overhead, seeing all of your work, calling it good, then leaving just as mysteriously and as silently as you came?"

The sky here is a shade of blue that I don't have the words to describe. My best is, "If God has eyes, and they are blue, this is the shade of blue they would be." 

It is so singularly clear and crisp, yet warm and inviting; it's the color that welcomes one to sit, to stay and to bathe in its light. It's impossible to be angry surrounded by this color of blue because it softens everything inside of each of us, urging us to flow in the sense of awe, laugh, be kind, and appreciate this awe, because far too soon this color will shift into a much colder attitude and appearance.

Laying on my back, floating with the natural rhythm of the Colorado River, I submerged my head enough for my ears to feel like I was melting in the river, my body slowly seeping into that cool, flat water. There were two spots along the river where there was absolute silence, the only exception being Rachael our river guide, rowing and moving the water out of our way at one spot and the other being when she pushed us through the water, not even the oars in their sockets made any noise, it was the river water that accompanied us that barely made us aware of where we were. 

This is what I still hold in my heart of the desert. 

August

 

August reminds us to go to that park, grill steaks, brats, and burgers along with fresh corn on the cob.

 August pushes toward one more time at the beach, community swimming pools, and running through sprinklers in the front yard.

 It’s when summer camps end, adolescent memories for a lifetime are made. The excitement of buying new “back to school” clothes, shoes, notebooks, markers, pens and pencils – depending on your grade, a new multi-function calculator, protractors and compasses. An FYI here: I graduated from high school in 1989, I know, I know, I’m entering my crone phase of life, but I’m not sure how all of the newest technology fits into this.

 If you are starting your senior year in high school, you likely had your senior pictures taken earlier this summer and start exchanging them with your closest friends first.

 August gives us at least one or two weekends for camping at the county park, one or two chances to swim in the lake, get ice cream from the camp ground store, finally summon up the courage to swim out to the sandbar and stand up in the water only mid-thigh high.

It’s one more chance to hear the woodpeckers battling tree bark, mourning doves cooing at sunset, which is noticeably earlier than it was at graduation in early June.

August weekends become the way of counting down the number of kids hanging out at High Cliff on bright Sunday afternoons
who start floating away, the only thing left is their impression in the dewy grass.

                                                      

                         

A Story of Connection

Recently my Director at work sent out an email asking if any of the clinicians had a brief story of "success, breakthrough, or knowing when a client connected to you (as a clinician)." This is a true experience that I provided to her.

I saw this client for the first time on March 11, 2025. On his clinical intake form the reason he was seeking individual counseling was listed as “Grief/Bereavement; Mood disorders”. Ok, pretty typical I thought.

He sat down on my office couch and said, “I’m not really here for grief counseling. I received an OWI charge last summer and I feel like everyone in the world knows about it. This will absolutely ruin my relationships in the community, relationships I’ve spent years developing. I can’t get away from the shame of it.” He had become tearful.

 I handed him a box of Kleenex and said, “Are you up for a brief allegory or story of someone I know very well who was in a situation similar to yours?” He nodded yes. I told him about a 23-year-old young woman, much older now, who was dealing with addiction issues when she was 23, couldn’t make eye contact with strangers passing in the mall because she believed she was wearing a big scarlet A that the entire world could see and therefore judged her by. I continued, years went on, she spent time in and out of treatment, but she finally got it. The shame was gone. She could see a happy, successful future for herself for the first time in years.

He asked, “What happened to her, do you know?” And I said, “You’re looking at her.”

From my office couch he fell to his knees and sobbed like a child longing for acceptance, respect, and understanding.

He continues therapy with me and has made a shit-ton progress from that first visit. Recently he told me, “Kristine, if you hadn’t shared with me what you did on that first visit, I don’t know if I would have made it, I really don’t.” I smiled and said, “Well, it’s in the past where it belongs.”

Wisdom of the Old South

 This is what I’ve learned since arriving in Savannah on Thursday May 8th:

Go out there

Go to where the grass turns into a tarnished gold 

and the tree stands 

languishing and weary with the weight of itself 

Go to where the meadow ends and 

the living things are nearly gone and 

where there seems nowhere else left to go 

and then keep going.

Just a little beyond the lost trace 

of a trail, keep going 

just a little bit further than it makes sense to.

Keep going just a little past that place 

you had decided was the farthest you could go.

And then watch as your unfathomably inextinuishable

hope rises,

hungry and wild, once more.

While most of the time she was in good spirits,

on occasion it all turned to one great desert.

At these times, she would find a need 

to call upon the moon dragon 

and go off,

reminding herself of all the magic in the world.