ACA Blog

Jill Presnell
Sep 06, 2012

The Inpatient Therapist: The mental health profession’s red-headed step child?

Several settings come to mind when one thinks of a counselor. A small, comfortably adorned private office. An even smaller, less comfortably adorned office at a school or community clinic. A somewhat chaotic family home. Or perhaps the more subdued residence of the elderly or infirmed. One of the last settings that comes to mind is that of a psychiatric inpatient unit. I mean, don’t psychiatrist and psychologists do that?

Being an interpersonal/existential recovery oriented therapist (okay, so I guess I’m eclectic) is difficult at times in the inpatient world of illness based problems and medication based responses. Providing actual psychotherapy can be viewed as not only incidental but insidious. Some doctors and nurses fear that encouraging the exploration of self vis-à-vis one’s environment will cause additional distress to an already fragile state of mind. Nurses can hold a pragmatic fear that people will be “stirred up” and become “difficult to manage.” To prevent this from occurring (and to keep costs down) individuals with bachelor’s degrees are hired to fill therapist positions. They are quickly trained in the use of worksheets and educational videos. When I began inpatient work, I was one of these individuals. Fortunately, in addition to my B.S. in psych and several years work experience, I had been actively involved in the consumer movement to infuse recovery orientation into mental health services (by the way, I hate that word “consumer.” I like client). My recovery-orientated knowledge base impelled me to move beyond worksheets (and eventually go to graduate school).

I learned quickly that inpatient therapy has become forgotten in terms of education and research. Classes on group therapy focus entirely on outpatient settings in which distress level is lower, members’ issues are more homogeneous, the number of sessions is higher, motivation tends to be higher, and I could go on and on. My own attempt to locate research and information on facilitating inpatient group therapy was equally disheartening. [I am deeply indebted to Jonathan Radcliffe, Katja Hajek, Jerome Carson and Oded Manor (2010) for their book Psychological Groupwork With Acute Psychiatric Inpatients . This book is now my primary source when leading the mandatory staff in-service on Groupwork] Higher education also offers very limited training on performing crisis assessment and treatment, particularly for individuals with severe and persistent mental illness. I want to be sure to state that the education graduate school provided offered many valuable resources from which I draw frequently. The lifetime debt I incurred was well worth it.

I requested the opportunity to blog on this topic in order to provide a forum for therapists in similar treatment positions to share their thoughts and experiences. And the inherent nature of blogging to be somewhat self-indulgent, I also plan to share my own insight and experiences to help other inpatient therapists provide effective treatment in a typically anti-therapeutic atmosphere. I will be addressing topics such as preventing burnout, inter-professional rivalries, stigma prevalence among providers, engaging the reality within psychosis and groupwork (of course). I hope you come along.



Jill Presnell is a Counselor in Northeastern Pennsylvania as well as an advocate for the provision of recovery oriented mental health services.

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