Working Creatively in Mental Health Case Management

As mentioned in a previous post, I have been working in the area of case management for the past 6 months, with some therapy with a handful of clients- for example with a caseload of 50-60 client I may do more regular therapy with 5-10 of them.

There is a movement to adopt “recovery” oriented language and outlook but to date I have seen only glimpses of it in case management, but when things get tough (hospitalizations, etc) this language of looking at someone’s strengths, good reasons for their actions and own abilities gets thrown out the window in lieu of mechanisms of control.

In times of crisis and challenge it seems more common to start the see the client as problematic in our conversations together as professionals. For example very often people are described in the following ways: “she is very dependent”. “she is non-compliant” “requires redirection frequently”. This paternalistic lingo evolves in part by being a “manager”, rather than a therapist or a supporter.

It has become rarer now since becoming a case manager that I share with my colleagues with amazement of accomplishments that my clients have made or the amazing insight that they arrived at in session that day. Even if they are doing well it may also be attributed to the role of medication, which may be true in part, but also denies the client the victory of their own self-accomplishment.

As a case manager I spend so much time on medication refills and psychiatrist appointments that it seems like a big switch of gears to put on a therapeutic lens in each conversation. Many other professionals try to assure me that this is too much to expectof myself. However, I yearn to give the same attention and curious wonder to my clients I only see half an hour per month (or more frequently when medication changes are being made or person is unwell) as those I see every two weeks for therapy.

Part of this is beginning to think creatively, more visually and outside the box. I would like to dream to find new ways to engage their strengths and goals. This involves taking the time in each conversation to wonder out loud with someone about the future, about the ideas, about what is going well in their lives.

I have tried to have the lenten practice praying for my clients as I see them. I would also like to take time, even 15 minutes a day to think openly and creatively about one of my clients and think and plan a way forward. A therapist I used to work with used to set aside a day a month to plan and think about the work she was doing with her clients. In my work a blank calendar would definitely not go unnoticed, so a little bit integrated in would be the best strategy.

I’m curious to here about strategies of working creatively with long-term and chronic clients that you have used as a fellow therapist or ideas you may have from those outside the field. For those in mental health and case management how have you managed to refocus on recovery and strengths. Please share!!!

Happiness is…

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I recently attended a workshop by a well-known local psychologist on the topic of CBT and mindfulness. He mentioned that from talking to clients he has found that most people are searching to for “happiness”. For example we toll away at jobs that we do not enjoy for the end result of retiring comfortably and being “happy”. Of course, these culturally prescribed routes rarely produce happiness and sometimes people find they are the opposite of happy even while pursuing happiness. Depression is widespread in our culture(and among those who follow Jesus) and is characterized by hopelessness and lack of will to live and isolation/withdrawl from relationships.

For those who follow Christ I wondered if we too are aiming for happiness? The teachings of Jesus surprisingly do not seem to advocate for the goal of happiness and when happiness is spoken off it appears in an upside-down manner. For example in the beatitudes (Matthew 5:1-12) Jesus speaks of being blessed or in some translations “happy” when we are poor, mourn, meek, merciful and persecuted. It seems that happiness, instead of a goal, is a by-product of a lifestyle of both weakness and righteousness. In all of this we are called to “rejoice and be glad, because great is your reward in heaven…” (Matthew 5:12). Somehow we are supposed rejoice- celebrate – an action- not a mood stated- with the challenges in this present life with the insight and hope that God will reward us in heaven.

I have been meditating and memorizing Philippians 4:4-13 for the last month. Philippians was written by Paul from prison to the community in Philippi. He too is advocating a joyful/happy action “Rejoice in the Lord always I will say it again Rejoice”. It is in this passage that he explains that he has learned to be content in any and every situation (Philippians 4:11). This goes counter to our cultural “quest” for happiness through the usual route.

However, unlike mindfulness which aims to find inner peace through the moment Paul emphasizes that we are content in the Lord, who strengthens us. We rely on God’s strength to renew us and give us the “peace of God, which transcends all understanding”.

Being and feeling happy is cherished for a reason- it renews our spirit, we can keep on going in this hard challenging world. Can followers of Christ really hope to be happy? What can we say to clients who hope to be happy? Is it even an achievable goal?