Question for those of you who have worked in community mental health centers

[Childdoconeday]

How do you prepare yourself for a role where you will be treating clients with such a large range of presenting issues? I am hoping to continue to strengthen my therapy skills, and I figured I would ask you (community mental health care providers) as you all are able to treat so many different issues.

Thanks!

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[Seven_Costanza]

How do you prepare yourself for a role where you will be treating clients with such a large range of presenting issues? I am hoping to continue to strengthen my therapy skills, and I figured I would ask you (community mental health care providers) as you all are able to treat so many different issues.

Thanks!

Lots of intensive training, good supervision, and experience.

When I first started training, one thing I found helpful while working in a community clinic was taking a transdiagnostic approach. This involves targeting the common mechanisms, or psychological processes, that underlie a number of conditions (such as worry, emotion dysregulation, self-criticism), rather than focusing on the specific conditions. This is especially helpful for CBT and third wave approaches.

 

[foreverbull]

Agree! To add to the discussion, I believe that having a solid theoretical orientation to work from is important, so that rather than feeling like you address wide-ranging concerns in a piecemeal/haphazard way, you have solid grounding regardless of the presentation. Depending on your orientation, you might view issues as attachment-based/ego-based, or thought distortions, culturally-influenced, existential/spiritual crises, emotional avoidance, issues needing reinforcement or extinction, interpersonally-based, or a combination, etc. Once you feel solid in your theory (theories?), you work from your orientation and (appropriately) incorporate other interventions that are helpful, and seek additional training in areas that you’re less familiar with.

The nice thing about working in group settings is the wealth of knowledge/experience shared, so I would strongly suggest consulting as needed and making good use of the expertise of the seasoned clinicians around you.

 

[Sanman]

One of the things I would add here is that community mental health is often overwhelmed with need. Don't try to be all things to all people. Set realistic goals and work within your skillset and setting. It may be more about improving coping skills and addressing emergent/immediate needs rather than addressing longstanding, specialized concerns.

 

[Therapist4Chnge]

One of the things I would add here is that community mental health is often overwhelmed with need. Don't try to be all things to all people. Set realistic goals and work within your skillset and setting. It may be more about improving coping skills and addressing emergent/immediate needs rather than addressing longstanding, specialized concerns.

Great post. Nearly every treatment plan I design for my counselors include education about stressors, basic coping skills, and sleep hygiene. The vast majority of cases I eval have disrupted sleep, which can wreak havoc on mood and physical functioning.

While I haven’t worked in a CMHC setting, I formerly worked in public hospitals and I found that getting issues documented (typically for the social worker) so they can be addressed down the road seemed really helpful.

I also frequently did a lot of reading on cultural implications for treatment of MH and how different cultures approach healthcare and treatment. Knowing the largest immigrant populations of your City and who is being seen can be helpful; social work and/or admissions should know this information. I’d often find (or put together) a cheat sheet of useful information for other staff. Obviously the level of acculturation varies between populations, but it can be invaluable for first generation (older) immigrants who were more likely to adhere to their traditional culturally defined roles.

 

[Doctor Eliza]

Are you working at a CMH for internship or a job?

 

[Childdoconeday]

Are you working at a CMH for internship or a job?

Job. It's definitely an adjustment for me but these responses have all been very helpful

 

[MAClinician]

Also be prepared for some (many?) of your clients to have limited resources: social support, financial, access to transportation or other concrete needs, and inter generational trauma.