My 9-5 Job

In everyday life, I don't often talk to people about my work.  It just feels complicated, like it's too hard to explain and people would never really understand.  Going into graduate school I never pictured myself in the setting in which I currently work, in fact, I don't even think I knew it existed.  I'd mentioned my motivation for going to grad school in an earlier post: I wanted to help children who were having emotional/behavioral problems due to abuse and neglect.  Once getting to grad school I realized that the majority of the entry level positions for expressive therapists in the Chicagoland area were in inpatient psych (psychiatric) settings.  So after graduating and struggling to find work in the field for a year, that's where I found myself, inpatient psych.  It's been almost a year since I started working as a therapist at a small neighborhood hospital which provides health services to low-income families.  I work on the hospital's small (24 bed and 12 bed) inpatient psych units, adult and geriatric, no pediatric psych unit at my hospital.

If you all are anything like I was prior to entering the field, most of your understanding of "mental institutions" has been through Hollywood and movies.  You know One Flew Over the Cuckoo's Nest and Girl, Interrupted, etc.  There are definitely aspects of those movies that are somewhat reminiscent of what my job is like.  There is always at least one extremely interesting character on the unit that keeps things highly entertaining.  There are occasionally restraints, but there are no straight jackets and we try to keep them restrained as short a time as possible.  People don't exactly line up at a window to get their medications, however the reality is that medications are pushed and most people spend the first couple of days of their hospital stay in a daze as they adjust to their meds.  And yes, there are psychotherapy groups where the patients sit around talking and confronting one another on their stuff but those are usually pretty rare and hard to facilitate.

Gone are the days of people being carted off to the insane asylum when they have some kind of mental break.  Psych hospitalizations are typically only five to seven days at my hospital.  People have barely enough time to be minimally stabilized on medications before being discharged back into the community.  And as I said before, the first 3 days of that week long stay is spent sleeping and the next 3 days is spent counting the hours till they can get out of there.

People come into our hospital for all different reasons and there are people of all different functioning levels, backgrounds, and race.  In order to be admitted, they must have a psychiatric diagnosis though often just  for labelling and insurance compensation purposes.  We have people ranging from our "frequent fliers," those that come in often with whom we are well acquainted, to first timers who have never experienced a setting anything like this.  We have people that are homeless knowing all the right things to say to get them a bed and 3 meals for the week.  We have individuals that are drug addicts who used all their public assistance money on substances and need medications to curb the withdrawal symptoms until they get their next check (also knowing the right things to say to get hospitalized).  We have patients that are severely depressed and have attempted suicide.  We have all ranges of schizophrenia, from people with acute psychosis who are in catatonic states to high functioning individuals who have auditory hallucinations that they can tell you about rationally.  We have people with bi-polar disorder, severe anxiety, delusions, and paranoia.  We have sex offenders, ex-cons, prostitutes, people that have been shot in the head, and people like you and me.  All individuals with individual life stories and individual problems.  My job is to hear, understand, and have compassion for those stories.

As you can imagine, there's not a whole lot of therapy that can happen in a week long hospital stay.  We as therapists, meet with each of the patients to do their assessment within the first 72 hours of their hospital stay.  Meanwhile, the patients also meet briefly with their psychiatrist, their nurses monitor their medications, the social worker meets with them to discuss their discharge plan, and we have Mental Health Counselors on the floor who provide for their daily needs.  Often times, they refuse to meet with us therapists and have no interest in any kind of therapy.  So that may be the only interaction I have with a patient. 

My primary role is leading groups.  I have to take all those people who have completely different problems and come from completely different walks of life and somehow make them a cohesive group.  We try and do at least one talk/process/psychotherapy group a day where we discuss what brought them into the hospital, how they can stay out of the hospital, and encourage them to seek therapy after they get out.  But getting a bunch of people so different to connect means we must be creative with our therapeutic methods.  We utilize music, art, and if I'm lucky, dance and movement to help patients understand and connect with one another.  Then I go sit behind a computer and chart about it.

So that's my job in a nutshell.  I lead groups, I occasionally meet with individual patients, I chart on my interactions, I go to meetings, try to get along with all my crazy coworkers, and hope that at the end of the day that I have made at least one small snippet of difference in at least one patient's life.


Check out some movies about mental illness.