Has anyone worked in a VA Residential Treatment Program?

[mind_over_matter277]

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I have been a staff psychologist in a VA residential treatment program for the last 4 years. I’ve always wanted to work in this setting within the VA after completing a practicum in a SUD/Dual diagnosis VA residential program.

It’s a unique setting and I enjoy working with the veterans for sure. However, I am noticing some frustration and stress due to systemic issues. Over the last few years, several psychologists have left this setting. Most have moved to outpatient programs.

I find that there seems to be less of an influence of psychology in this setting relative to previous years. There seems to be a push for more case management and group therapy rather than individual evidence based treatment.

I also notice that there’s a lot more drama present among colleagues. It’s started to weigh down on me. I do feel maybe there’s a desire to phase out psychologists here as many positions are being replaced by master’s level clinicians.

Have you all worked in this type of setting before? Did you encounter any of these issues?

 

[Sanman]

SUD is an interesting place as not as many psychologists are trained in it and is has always had case managers and other paraprofessional involvement. There is a lot of money in intensive outpatient treatment outside the VA and with everything going on right now, I can't imagine that you are drawing the most competitive candidates for the job.

 

[Therapist4Chnge]

The residential sub abuse treatment program (at The Dom) at the VA i trained at (15yr ago) always felt a bit different, far removed from the main hospital culture and vibe. A unique fiefdom of mostly midlevels doing their own thing and on their own timeline. They say every VA is a bit different, so I’m not sure if this tracks elsewhere, but it always felt more like a commune where they practiced more hippie-dippy stuff in groups. There were a psychologist or two and a medical director, who seemed to handle acute crisis cases, but most staff felt like cardigan wearing tea/coffee drinking people who just kind of went with the flow of things in the Dom.

Residents would be at the Dom for months, and you could feel who was new and who had been there for awhile. A sub-section would rotate through the substance abuse treatment program that offered mostly group therapy over a couple of months (?). The program was pretty helpful, though some vets would just stay at the Dom afterwards, kinda like Tom Hank’s character who is stuck at the airport for months/years.

Not my jam, but the clinicians who were there all sort of found their home and stayed long term. Going back to the main hospital probably would have felt really foreign and off-putting.

 

[PsyDr]

1) If you accept a role which would never be asked of a physician, you are accepting lower status than a physician. Imagine a law firms asking their lawyers to sweep the floors. Imagine internal medicine physicians being asked to schedule the nurses. Imagine how these professionals would react to being asked to do something outside their role. Do that.
2) If your duties become increasingly menial, the ship is already sinking.

 

[mind_over_matter277]

The residential sub abuse treatment program (at The Dom) at the VA i trained at (15yr ago) always felt a bit different, far removed from the main hospital culture and vibe. A unique fiefdom of mostly midlevels doing their own thing and on their own timeline. They say every VA is a bit different, so I’m not sure if this tracks elsewhere, but it always felt more like a commune where they practiced more hippie-dippy stuff in groups. There were a psychologist or two and a medical director, who seemed to handle acute crisis cases, but most staff felt like cardigan wearing tea/coffee drinking people who just kind of went with the flow of things in the Dom.

Residents would be at the Dom for months, and you could feel who was new and who had been there for awhile. A sub-section would rotate through the substance abuse treatment program that offered mostly group therapy over a couple of months (?). The program was pretty helpful, though some vets would just stay at the Dom afterwards, kinda like Tom Hank’s character who is stuck at the airport for months/years.

Not my jam, but the clinicians who were there all sort of found their home and stayed long term. Going back to the main hospital probably would have felt really foreign and off-putting.

You are 100% accurate! This is how my current setting is. Most of the clinicians adopt the 12 step model and have a very odd view of things.

 

[mind_over_matter277]

1) If you accept a role which would never be asked of a physician, you are accepting lower status than a physician. Imagine a law firms asking their lawyers to sweep the floors. Imagine internal medicine physicians being asked to schedule the nurses. Imagine how these professionals would react to being asked to do something outside their role. Do that.
2) If your duties become increasingly menial, the ship is already sinking.

Yes, I’ve had to take on the tasks of a social worker, chaplain, peer support specialist, and addiction therapist.

 

[docloufan]

Yes, I’ve had to take on the tasks of a social worker, chaplain, peer support specialist, and addiction therapist.

would leave. now.

 

[PsyDr]

Yes, I’ve had to take on the tasks of a social worker, chaplain, peer support specialist, and addiction therapist.

You get the respect you demand. You teach people how to treat you.

It's like when agreeable psychologists tell staff to address them by their first name, and then get frustrated when staff value their own opinion at the same level as the psychologist.

 

[mind_over_matter277]

would leave. now.

Why

 

[mind_over_matter277]

would leave. now.

No, I am not ready to jump to that yet. I know it’s possible to do an internal transfer to another clinic within the facility. It appears that this has been paused for time being.