I will always say that therapy and case management are very important to people with chronic mental illness. I feel we need someone outside ourselves and friends to be an objective supporter especially long term. Good case managers can cut through all the paperwork and arbitrary hoops to get someone services they need like medical doctors, medication for free, getting into a residential facility working with other agencies ETC.
A good therapist can move alongside the client being a compassionate and steady support through the ups and downs, especially downs of living with mental illness. Ideally this person is someone open minded, flexible, and who is humble enough to admit that they just have never experienced whatever the client is going through which would make genuine empathy more well genuine as you know that it’s coming from a place of honestly not knowing but truly wanting to be there rather than something put on as some therapy technique.
And I realize people can’t progress at times without being encouraged out of their comfort zone. I believe a good professional will get to know the person before doing this, and exactly how much pushing they can handle and how much is too much and therefore will shut the person down.
I’m a stubborn person for example. If you don’t push at all I’m likely to not do much changing. Or I will but it will take like a million years. If you push too much I totally do shut down and say I hate you and refuse to talk at all. It’s just me. To me it’s not worth having someone supposedly there to help me who’s totally not on the same page, not respecting my boundaries, life experience, triggers and just where I’m at at a certain moment. And then doesn’t respond when called on it.
I think particularly with case management but also therapy, particularly with young in the field professionals there’s a huge rush to put down concrete goals and accomplish them quickly. This could work for some people, their personalities just fit that goal directed let’s just get this done one thing after another approach. For many, including myself, the process of building a relationship first is the main goal over anything else. Because I don’t trust someone to help me work on my life who doesn’t know me.
Sadly there are some professionals who plain don’t care or it seems that way. They have a way of doing things and that’s it. They’re gonna put down whatever goals that they see fit, in the clinical language they have to use (which I hate) and then basically attempt to force the person to do this talking of nothing else or plain insisting on their way doing things if necessary to basically make their way happen.
At this one IOP program I went to of course they put goals down like right away. Somehow the main therapist got into her head that I “have poor boundaries.” This is because I have a close friend who I love more than anything, and she was going through something that really stressed me out. I had to God forbid, miss a day of their precious program. They talked about this constantly as proof that my unhealthy attachment interfered with my life I.E attendance.
They also cited my relationships to staff as poor boundaries, that I grew attached to them and then got upset if I couldn’t work with them/ they left/ ETC.
So they put this down against my wishes and totally not matching up with anything I felt was really true about me. The program was soo CBT I don’t know how I got through the couple weeks I stayed at it so I left. But these people really do believe they’re above the clients obviously. They really think they know better than the person what the person’s problems are, and what they need to do to fix it. And some people sadly are so used to people treating them this way they just allow it. They don’t know any other way. Good thing I’m not like that at all!
Another example is the whole Stephanie thing. I mean I did not need like hour lectures about why I don’t use my cane in this building. I know exactly why I don’t use the cane in this building. I’ve explained a million times why. I say I admit I’m not the best mobility girl and given the chance would do sighted guide over anything else. Even mobility teachers have said this is fine that people have a right to do what works for them and shouldn’t be hassled about it. Yes I could improve. With Edith I was walking with the cane with her with me. Unfortunately she left and then there was the whole craziness getting to Anna and now well it’s freezing cold out so no walking for me (in hot or cold weather so yeah). But I don’t need hour lectures on it.
And something else. I*will not* do something I don’t feel I need to do, either long term or in the moment no matter how much a professional wants me to do it. Because they then put me in a position of feeling like I have to do this thing just so they can check off I did it and call it progress. And that’s totally insane! That’s not helping people. It’s just boosting the professionals ego. It’s not authentic or honest and it has nothing to do with actually improving a person’s life. Unless they have something I needthat I need them around for, I.E working with blind services (shutter) to get free training/ paratransit tickets, I will not do it. And even then it would so drain me to do it.
Have a situation with a friend that really brings this home. She has physical as well as psych disabilities. She struggles with self-harm, and generally keeps herself to herself, to the point at times she doesn’t know what’s happening in her own head. So she’s been struggling along. Really not a talk therapy girl, mostly meds have been the main treatment. Well events happened where she basically has no choice but to go to therapy. She signs up for therapy yay!!
She’s working on signing up for paratransit, which I’m sure she’ll get based on her disabilities (arthritis, blood pressure/ heart concerns, in general a complex medical history where she has what I call a sensitive body). There is insurance provided transportation that takes you to appointments like programs therapy ETC.
Well instead of just being happy that she’s going to therapy, her case worker in her so called wisdom decided she would force her to use public transportation to get there. She is disabled. She has a complete right and need for paratransit. To me there’s just no question. Yes walking will greatly improve her physical health and perhaps long term improve the physical stuff going on. But it needs to be done slowly, and to me her body is so much a puzzle that you just never know. She could just bend over and somehow twist something in her back, we don’t even know what and be in pain for weeks. Then you have a medical doctor who has no idea about pain management and like basically does nothing of any use.
So anyway. Caseworker basically put her in a position where she can’t use this medical transportation anymore. And must take the bus. Which is a block away going about a ten minute distance. Still she has to do all that, plus the stress of the new experience of therapy, and then come back home by herself. Like I said she has high blood pressure, diabeties, weird joint things going on. It’s all huge unknowns about what will happen with her body. Never mind her emotions.
As I said she usually keeps herself to herself, she’s not like me usually. Ya know if I’m upset the whole world knows it and I’m pretty demanding. People either figure it out like Mr. J, or they’re not in my life too long because I don’t like them and they don’t like me. And in the mental health world, they should know how to deal with all types of people. I’m not their friend I should be able to express myself, even if it’s not the best way because at least I did rather then cutting or keeping it in and then we can work on it. That’s Jonathan’s attitude anyway.
So she writes the caseworker a furious e-mail. Mine would have been worse. Well not only does the woman dig her heels in and not move one inch on the transportation issue she calls her out for her attitude. This really got to her my friend, and she was even crying which is huge for her! For her to be that open and let her feelings out like that was amazing. Let’s Celibrate that! Apparently caseworker doesn’t agree.
I just wish everyone had Jonathan’s mindset. No matter what someone here does, I mean they could try to knock him over, or break a computer or something. He always finds some positive or something to learn from, usually something both he and the person can do differently or know about each other from having the experience. If I were him I’d say awesome we just broke new ground! But no.
Again if this person now has to do this, which it sadly looks like she indeed has no choice, it’s just a stupid exercise. She’s doing this she’s not ready. She’s already taking a huge emotional risk with therapy and it’s just not the time, or the right way to go about it. There’s a difference between a walk a couple of times a week or once a week and having to be some place that’s new and hard, having to go and come both ways. When there’s alternatives perfectly available for that situation. Not saying they can’t get there. But I’m sorry, it has to be at least mostly on her terms. She’s the client not the caseworker. The caseworker is not the client.
So those are my thoughts. And suggestions. If you’re a new caseworker or therapist I understand the strain in balanceing what you’re trying to do with just being new, and likely trying to please a supervisor. But at least listen to the person, really listening. Genuinely listening and giving a response like I totally understand you don’t want to do this right now. This is really hard I know I’m asking a lot. But we have to work on this, how can we compromise? If you have more flexibility, as in are not necessarily in a time limet/ bound to a supervisors wishes, I’d say bring the openness and listening further. Go through it step by step. And again compromise. Don’t lecture, or try to dominate the person over to your way. Don’t make it about reaching the goal for the sake of saying you reached the goal.
Clients understand this is where many are coming from. The whole supervisor/ being trained that they need to do this. I’ve been on their side of things it’s harder than you think. That said don’t be pushed around. Try to fight back, stand your ground, calmly state your position. If calmly doesn’t work, furiously state your position. These people aren’t your friends. You shouldn’t have to walk on eggshells around them, so what if you give a little attitude. My first psychiatrist who was a great therapist said that when a person hasn’t spoke up for a long time and is learning to others are going to hear things they’re not gonna like. And the person will likely just explode the first few times. I’m biased, and maybe Jonathan is a little crazy himself. But his thing is you need to feel like you can say absolutely anything and they won’t shut you down or leave you. That could be due to my particular trauma that this is what I need to heal otherwise nothing will happen. But I happen to agree with him in general. If you can’t go off on your therapist or case manager what do they want you to do. I mean it’s a lot different going off on your family or friends. And maybe if you go off on your therapist a few times you can eventually learn how to talk to your friends without either keeping things in or going off. That’s the hope. But that can take a long time. I’m a proponent of stuff taking a long time as long as you’re moving forward. And for many, especially self-harm/ trauma survivors, they’re used to keeping everything in. And taking it out through cutting. So having “an attitude” can be the healthiest start they can have.
I think I’ve made my point sorry for the long post. I know many will disagree with me but that’s cool.