Lifelong Friendships Are Real

My father stood at the foot of his lifelong friend and fellow veterans coffin, waiting silently for him to be lowered into a final place of rest, within view of my parent's headstone, straightening his 78 year old spine as best he could and saluting for 45 minutes before Butch, my dad's best friend since middle school in Shawano, was lowered into the semi-frozen earth.

Butch graduated from Shawano High School three years before my dad; they were on the school's baseball team with another student who was actively recruited by the Cincinnati Reds, but graduated from UW-Whitewater and joined Price Waterhouse in Milwaukee with my dad instead.

Dad has a solid group of "guy friends" from Shawano, together they deer hunted, goose hunted, and flew into remote Canada for a week of fishing each summer.

I too have strong friendships from junior high and high school. I have attended services for few of their parents (which is a blessing), yet I wonder who will attend when it's my mother or father services are held for.

Untitled

Every day,

            dark

Every thought,

            dark

Every feeling, 

            dark.

            No energy                                                                                                         motivation

                   movement from my bed.

    
                  

Every distraction,                        

            dark

Every ask,

            dark

Every look,

            dark.

            No joy

                  potential

                  movement in my brain.

Every touch,

            burning

Every question,

            ignored

Every demand,

            pointless.

            No interest

                  color

                  hope.

I Quit my Fucking Job and Couldn't be Happier

Yes, it's true: I quit my job (technically not until Monday 02/23/26) and I couldn't be happier!!

I have been told ad nauseum to never quit a job unless you had another one lined up, but in this case, my job was creating so much stress, distress, and overall decreased satisfaction in my life that I had to get out of there before I became a patient there.

UHC/Optum/Sherman Counseling closed all of the outpatient agencies in the state effective 12/08/25 and I got another job at a free standing psychiatric hospital which is a level of care I had no experience working in. The salary they offered made my jaw drop and I immediately accepted.

Here's the deal with inpatient psych care from my humble experience:

There is no "typical" day

The only tasks scheduled are daily groups with the expectation of facilitating and documenting two groups per day 

Any given day at a hospital can include 4-19 admissions; multiple AMA (against medical advice) discharges, involuntary admissions with virtual court which can lead to 90-day orders for patients to remain admitted until the staff psychiatrist deems a patient no longer a harm to themself and/or others with court ordered meds which will be administered by a shot in your ass if you won't take them orally

Severely psychotic patients who will scream for hours on end something like "HELP ME!! SOMEONE HELP ME!! HELP ME!!" And it's not because they are receiving substandard care, it's because they have lost touch with reality and will be given PRN Haldol, Benadryl or possibly Thorazine by a shot in the ass to get them to calm the fuck down and sleep for between 8-10 hours

There are patients such as the one described above who cannot benefit from the inpatient level of care provided and are transferred to one of the state psychiatric hospitals - Winnebago Mental Health Institute outside of Oshkosh or Mendota State Hospital in Madison.

New admissions must have their psychosocial assessment and Treatment Plan with therapy goals completed and routed to the assigned staff psychiatrist, nursing staff, and assigned case manager within 72 hours from admission

If you complete a patient's "intake" as outlined above that patient becomes part of your caseload with the expectation of meeting with them every other day for general updates which you are expected to provide in every morning's Treatment Team meeting with staff psychiatrists, other inpatient therapists, case managers, recreation therapists, nursing staff, and utilization review staff who will tell you what the patient's last covered day by insurance is at that point and that they need a "criteria" note to indicate that the patient needs additional time at this level of care which will be part of the documentation submitted to the insurance company to gain approval for additional days at the inpatient level of care

Patients admitted for alcohol or other substance use detox have an average length of stay of 3-5 days. What beneficial therapy they are going to receive in that amount of time is beyond me.

Mental health patient have an average length of stay between 7-10 days. As primarily an outpatient therapist, what coping skills or insight into what led to their admission they can gain in that short time again baffles me

I am clearly meant to be an outpatient therapist. I want to connect with my patients, establish clear goals and work toward them with my patients, and if we get off track, I want to steer them back on the path of reaching their goals. I cannot do the work for them, however I will provide all of my training, knowledge, and experience to walk that path with them and support them during times of crisis and times of success.

That's who I am. 

                                                           😱                                                                                             

 

So This is Christmas...

This is a lyric from the song "Happy Christmas (War is Over)" that sadly strikes me as very relevant this particular holiday season:

And so this is Christmas

For weak and for strong

For rich and the poor ones

The world is so wrong

I've heard this song as often as any other and they all sort of mesh together at some point, but for this blog I read all of the lyrics and realized this is really an anti-war anthem more than a traditional Christmas carol. Regardless, it's the "The world is so wrong" line that grabbed me.

Without doubt there are many things "wrong" in our world, but as the political pendulum swings as it always does, I want to post what I wrote on the back of our photo Christmas cards this year.

I feel I've been pretty open about my mental health and work struggles this year, but I don't want to believe that the world is so wrong. Has it been my best year ever? No, but honestly I struggle to remember an entire year that didn't include disappointment, loss, or pain. Sure, maybe when I was six or seven years old the world seemed stable and consistent, but I know for sure that the Christmas of 1976 was unsettling because that was the first Christmas with my youngest sibling, my brother who's six years younger than I am. Being the oldest of the Porath clan, I've heard stories about how I pouted when my younger sister was born and the world didn't revolve around just me anymore. 

So I'm pretty sure there has always been disappointment, loss, or pain in any given year. When you're a little kid these setbacks are age-appropriate, at least I hope they are for others reading this. At age 54, the disappointment, loss, and pain feel SO MUCH MORE intense than the tantrums I threw when I was six and naturally so. If I still threw tantrums at this age, that would be really fucking weird. 

Bringing this all together, I'm trying to say that life is not fair, shit happens, and as we mature, the unfairness and shit mature with us. At age seven I wasn't worried about car insurance, now at age fifty-four, sometimes I am. I came to terms with the birth of my siblings decades ago, love them to death and am thrilled they are a part of my life. 

My intent for 2026 is to manage the challenges that will undoubtedly happen, not make mountains out of mole-hills, and reach out for help when I need it. 2025 showed me how much I need to lean on others which I have fought against so hard I burned out. I was a pile of smoking embers as summer waned but I got  help and I need to keep up that momentum. That will help me find peace, joy, and to take better care of myself (I have a terrible habit of working harder than my patients and that has stopped since I started my new job as an inpatient therapist at a free standing psych hospital).

I will close with this lyric from the same song I've been yammering about:

And so this is Christmas
I hope you have fun
The near and the dear one
The old and the young

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.