In my new job I’ve switched from doing therapy with people 100% of the time do now doing 80% case management and about 20% therapy in my new role working with adults with chronic mental illnesses mostly those with psychosis of some sort, and also those with bipolar or longstanding and complex mental illness of varying sorts.
Some would call it a fall from grace other people would call it a chance to directly impact people’s lives.
The work I do now puts me squarely in the medical model as I work closely with the psychiatrists monitoring medication adherence and tolerance, as well as working together with the client on a movement to recovery in their mental illness.
One positive aspect of my job is now working more closely with Occupational Therapists at our centre who do a wonderful job of connecting people with activities, socialization and even housing. The job of the OT and case manager overlaps at times as I may be actively working on some areas that OT’s may also help with (housing for example). The OT’s run groups at some of the community mental health clubhouses and by doing this they introduce the clients to a new community support network.
Because of the short-term nature of my previous job doing therapy I did not usually refer my clients to these resources as they were not appropriate supports, or the person was independent enough to connect individually.
I miss doing therapy greatly. I have a number of clients I have offered to do therapy. For example, one client with schizophrenia (now under control with meds) and OCD. We will be working on the OCD together in therapy. This will be a new challenge for me as I have not worked with someone on OCD before and because of his also having a diagnosis of schizophrenia.
Working in therapy on this team is generally harder for a couple of reasons. Firstly my caseload is at least double and almost triple what it was before- so I am caring for more people with the same amount of time in a week- so in this model I cannot do therapy with everyone but with somewhere between 5-12 people at a time.
People come to our team because they have had a mental illness for some time; this can make therapy harder as they and those around them have accepted that this is how life is for them. Therapy can feel threatening as if to challenge the equilibrium they may have found. Most people have had case management for a long time (usually meeting once a month for a 1/2 hour) that they are accustomed to the care they have.
Other people benefit so much from medications and are well-supported by family and involved in their community (many of my clients are christians who go to church regularly) that the focus is much different; on relapse-prevention planning and re-enforcing and maintaining good support.
What I have noticed is that in some people with psychotic disorders there is a strong anxiety component. For example, a cleint may have had hallucinations and delusions in the past but they are now managed by medication but still they have significant fear and worry in their lives, and have difficulty handling difficult emotions, like shame or embarrassment.
These are the folks that I would like to do some basic therapy for anxiety. However, given their chronic nature and how negatively their mental illness has impacted their ability to function in basic areas of their life they may have a harder time engaging in traditional CBT therapy- some of them are just not interested as well.
This is the challenge ahead. I hope there will be some encouragement in undertaking this work with those who are ready and providing support to all of my clients in meeting their goals and needs wherever they are on their road towards greater wellness.