Perfection said:
How specific are your groups? (I.e. are the groups broadly focused like "the group of people who have some sort of problem" or narrowly broadly focused like "the compulsive collectible spoon shoplifter support group")?
Some sessions such as Emotional Intensity will be more specific to women with BPD. Most of them have good diversity and can range from 18 years (the minimum age for our program) to over 80 years. Such heterogeneity creates a good environment for different opinions and feedback for everyone.
sanabas said:
Do you apply that to all conditions, including things like bipolar & schizophrenia, or only some of them, such as borderline & depression? Do you think the view that "I can reach a point where I no longer have this condition" is realistic or constructive for all conditions?
Certainly not. Some conditions such as schizophrenia are developmentally based and are simply part of the person's make-up. If some conditions can't be "cured" or successfully coped, then it is a matter of learning to live as a person with that condition. Other conditions like depression, however, are often based in lifestyle and unsatisfactory functioning. What can be realistic and constructive for both, however, is to treat each client with the dignity he or she needs to help them live for themselves.
sanabas said:
Seems like you're buying into another misconception, that medication and better self-care are mostly an either-or scenario. Rather than replace helpful meds with better self-care, why not augment helpful meds with better self-care? Then you can try phasing out the meds later. For everyone, it's probably going to be useful to replace poor self-care with good self-care. For some, a medium-long term goal is probably replacing current meds with no meds. But good self-care is useful all by itself irrespective of meds, rather than a replacement for them.
I think medication is useful only when all other self-care strategies have been tried and don't work. For most of our clients, that's not the case--many are living with terrible sleeping schedules, eat improperly, and exercise very little if at all. That way when such strategies are tried (such as a client with bipolar who exercises constantly but can't ameliorate a manic episode), there's better information for the psychiatrists to decide how much medication to prescribe.
sanabas said:
****oo's nest was filmed in the 70s, but the ECT depicted in it is more like the 50s. And I'd still take some serious convincing to do it, having seen many people who have. Some found it really good, some not so much, and the side effects I've seen are very, very high on the list of stuff I never want to have.
Don't get me wrong, we're not jumping at the bit to taser your head at the first chance. It's always going to be a last resort simply because of that lack of certainty. That's why dosage is kept to a minimum and spaced out considerably--the doctors want to make sure that it's actually working.
sanabas said:
This happens now over here, no reason (other than funding) it couldn't happen there now too. In fact, I'm sure it does in some areas, because I've talked to people who have been involved in programs that visit people in their home. Easier to improve people's self-care if it's not always in a come & visit the hospital, clinical setting.
Our Family Wellness Program is the first of its kind to do just that. It's currently set up as a long-form study taking place over several years. Children who come from very unstable backgrounds are recommended by school nurses and social workers for assessment. From there a wide intervention on the family is implemented, from therapy with the child, therapy with the couple, and the family as a whole. Parenting classes are provided with supplemental education for the children. And there are periodic home visits from a specialized team. The early results say that it's working to some extent--the families with more consistent interventions have been shown to improve more.
sanabas said:
You work for a privately-run hospital? How's it funded? What state or federal govt-run services do the clients who come to your hospital have potential access to?
The hospital relies on a combination of insurance reimbursements and fundraising. The clients have access to any state-run services; in South Dakota, however, that doesn't mean very much. That's why it's often our job to help network them with services such as home weathering and emergency electricity.
sanabas said:
When you do group work, who else does it with you; nurses, doctor, psycholgist? What will be your focus with the clients when you start doing 1-1 stuff? Is your role to actually do things like CBT, or is it more to try and get the client doing things, help them deal with finding work, housing, etc, and hook them up with psychologist, dr, etc to work on the more treatment specific stuff?
Nurses do run groups, although the hospital is starting to shift to credentialed therapists. When I do 1:1 therapy, it will be a combination of interventions along what you describe. CBT will be often used to frame challenges like finding work and housing; the main emphasis will be on the client's immediate functioning in dysfunctional thinking and relationships. In both group and some 1:1 sessions I've also used interpersonal process theory to help keep the clients' attention on what is happening in the room--that is, how their dysfunctional thoughts and behavior play out in real-time and affect the quality of discussion.
Psychiatrists and psychologists often come downstairs to do 1:1 sessions and check up on how the medication is working.
sanabas said:
Have you had a client top themselves yet? How did you cope/how do you think you'll cope?
There's no simple panacea when either client or staff dies. I haven't seen a client complete suicide yet, but it's happened in the program before. On the staff side, however, there have been quite a few tragedies in recent months. Another therapist was killed in a car accident, followed by another death elsewhere in the hospital.
Takhisis said:
Why do you call them clients and not patients?
Both "patient" and "client" are used interchangeably throughout the hospital, depending on the level of care. In our outpatient setting, the clients are voluntarily using our groups and classes, so we prefer a term that's more encompassing of life problems. It's also a social worker thing--we just like language that's not overtly medical in tone.
Boundless said:
Do you find it hard to separate between home and working life?
At times, yes. Mental health extends to everyone, including therapists. Any personal issues I think about can always be thought through with the material we use for discussion, which can blur the lines.
Kan' Sharuminar said:
What's the most rewarding experience you've had with your work?
It's always rewarding to directly engage individuals and hear honest, genuine self-disclosure. I find it fun to be able to help guide someone at their level and slowly help them work their way through a mental labyrinth. When I'm able to give hope to people is when I think I have the greatest reward.
One rewarding experience was with a younger depressed client who was still mulling over what she could do for herself. After a couple sessions, we were able to work out goals that she wanted to do. Suddenly, this bright, happy look of relief came over her face. Maybe for the first time in a long time, she felt that someone on her side.
Another time was with an elderly woman with some dementia. In group, she remained very quiet while others gave their disclosures and stories. Once she was able to share something, though, she became very serene. After group, she told me in a very little voice that she was glad she was heard. Maybe for someone her age, it's more therapeutic to be able to have someone be there with her. Later in therapy she was more engaged by the group and actively listened.
Quackers said:
If you have an entire day full of depressed patients - don't you go home feeling depressed yourself? In other words how do you keep yourself happy when your environment can be so miserable!
It helps to work with a staff that has a good sense of humor. We frequently give each other a hard time about stupid stuff, so that help to keep the drama down. Even so, the group energy can rapidly fluctuate between sad and quiet to manic and frustrated, often between sessions. I try to stay as detached as I can while remaining genuine with clients, but it's also important for me to keep track of what stimulation is still lingering from a particularly difficult session. Eating a good amount of food between sessions and getting into a good workout after work can help.
Because clients can fluctuate so much in mood, however, it's somewhat easier to take outbursts in stride. If they're not in a good place to talk well now, something can change tomorrow, or concurrent therapy can help calm them down. When the whole point of your job is help decrease stress, that helps somewhat.
Nonetheless, there are frequent "bad days", but the first step is to simply accept them as part of the job.
