What has been most stressful in your clinical work with clients?

[DrGachet]

Here are some suggestions but you can add your own:

1. Paperwork/insurance forms/rules, regulations, policies.

2. Client characteristics (basics like people of a certain age, gender, those with language difficulties, but also multiple health problems, drug addiction, Cluster B personality disorders, schizophrenia, suicidal....).

3. Your own issues and countertransference (depths of helplessness or rage in client triggers something unmanageable in you).

4. Safety issues with potentially dangerous clients.

5. Uncertainty of the effectiveness or practicality of the treatment or accuracy of your assessment.

6. Time pressures.

7. Caseload

8. Coworkers and supervisor.

9. Lack of control over so many things in client's life.

10. Fatigue (sitting there reading body language, doing assessments, and writing up reports can be draining.)

11. General dissatisfaction with psychology as a science or worldview.

I'm just brainstorming here so excuse me if some of these are over the top. For me personally, it would have to be countertransference to enraged patients, lack of control over things in patient's life (stop going back to the abusive relationship dammit! Do the goddammed CBT exercises already!), and a supervisor with a god-complex.

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[KillerDiller]

For me the most stressful thing has been dealing with clients who I am not able to hospitalize, but who are still clearly acute and are in danger for various reasons. It is hard to let them walk out the door knowing they are not going to take me up on the outside resources I offered and knowing they probably aren't coming back. "I just needed to vent, I'm fine." No, you're not.

These stressors are closely followed by fatigue and scheduling issues. I hate running around to numerous sites around the city to fulfill all my roles, and I also hate that sometimes I am scheduled to see 5-6 clients back to back. It can get overwhelming fast.

 

[BSWdavid]

For me, the most stressful experiences tend to relate to paperwork, managed care, and case load average. Additionally, handling client no shows, appt. cancellations, etc. is quite a challenge and is exacerbated by Axis II characteristics.

 

[Ollie123]

A number of things come to mind. Though I keep in mind I'm probably atypical in that I could be perfectly happy never doing clinical work in the first place and would almost always prefer being behind the scenes writing grants/papers/reports/etc.

1) Lack of control over other treatments being provided. This is primarily a grad school thing and I suspect would be different in a professional setting where I would have more power (though I guess not necessarily in a team-based hospital setting...), but I think the modal practice in this field is placebo and it is infuriating. I always considered my clinical skills lacking until I saw what actually passes for treatment.

2) Borderline PD and borderline characteristics (this relates to the above - I am uncomfortable enough doing therapy without the intense "SAVE ME!!!!" aspects that go along with treating that population).

3) General dissatisfaction with psychology as a whole (some of the time - this one comes and goes but after spending most of the last 2 days trying to de-crapify data that is probably going to be insignificant anyways, this is one of those times..). This is more on the science-side (unfortunate, given it is what I want to do) but a part of me believes it is all BS, lack of attention to details means any study that hasn't been replicated at least a dozen times was completely invalid, and systems like peer-review are in no way capable of catching these sorts of errors as journals don't even want to see that level of reporting. Part of this is my own neurotic perfectionism, but it has left me somewhat embittered about the field as a whole on many days and wondering if I'm not better suited to some sort of math or engineering field where I get the impression people care more about making sure things are done right than the average psychology researcher. Then again, the grass is always greener....

 

[DrGachet]

3) General dissatisfaction with psychology as a whole (some of the time - this one comes and goes but after spending most of the last 2 days trying to de-crapify data that is probably going to be insignificant anyways, this is one of those times..). This is more on the science-side (unfortunate, given it is what I want to do) but a part of me believes it is all BS, lack of attention to details means any study that hasn't been replicated at least a dozen times was completely invalid, and systems like peer-review are in no way capable of catching these sorts of errors as journals don't even want to see that level of reporting. Part of this is my own neurotic perfectionism, but it has left me somewhat embittered about the field as a whole on many days and wondering if I'm not better suited to some sort of math or engineering field where I get the impression people care more about making sure things are done right than the average psychology researcher. Then again, the grass is always greener....

Yeah, this is a problem for me too. That's why I'm happy in the middle, as pure clinical work is too draining and pure research is too much of a reminder of how the sausage is made.

I mean look at the paradigm shifts in psychiatry. From Freudian to biological psychiatry! That's a huge change in worldview. We have no formulae like hard sciences. Between armchair speculations of old (more philosophical in nature), oversimplified empiricism of radical behaviorism, weak ass null testing, Big Pharma, turf wars...I have no idea how much of what we believe in, is considered "truth" in any shape or form. But I often tell myself--and I'm not interested if I'm right since no way in hell am I gonna change fields at this point with all that I have invested in this (cognitive dissonance everyone!)--that ALL fields fall way short of my romantic notions of perfection and truth.

 

[medical geek5]

hey maybe rivi needs to pay the client(LOL)

 

[DrGachet]

Thanks Rivi for your candid post. It takes courage to come out and say it like that. I wish we could all share things without fear of what others would think of us...or what we would think of ourselves, having admitted the many dissapointments and frustrations we try to forget. Even on an anonymous forum it can be difficult.

-Being the only male staff on the intake unit, knowing that if anything goes down I am going to have to get my hands dirty

This made me laugh. I've been in a similar situation. There was no escaping it.

 

[cara susanna]

I'm really early in my training, so for me the most frustrating part is the no-shows, reschedulings, and cancellations. I need hours here!

 

[DrGachet]

I'm really early in my training, so for me the most frustrating part is the no-shows, reschedulings, and cancellations. I need hours here!

I hear you. It gets better.