[rambler2014]

If there are mental health professionals on this board, I would appreciate some advice!

I recently accepted a job working in a crisis center. I'm a counseling and development student. My position is to, more or less, tide over a mixed group of adults (with various issues severely affecting their lives) from Friday to Monday when they can reconnect with counselors and social workers. I do some group; mostly affirmations and light coping skills with a general focus. I also check in with each person and just overall enforce the rules of the facility.

I'm particularly having problems expressing any kind of authority. I'm new and the consumers are not. I had four days of observation and now I work 12 hour shifts alone whereas before there was no one to do this job and there's resistance to having structured weekends. There seems a delicate balance of applying enough pressure to enforce the rules while not going so far as to exacerbate anxiety or authority issues in the consumers and having to call a more experienced person in on their days off.

A new job takes some time to get accustomed to, but I don't feel I'm being incredibly effective and I don't have experience to fall back on. Any tips for a mental health worker seeking to get more comfortable and develop the necessary skills to do this kind of work for life???

[kaliope]

hi rambler
im a social worker. I think your confidence will grow as you continue to work with your clients. I think the act rule would work in this situation. a-accept feelings, c-communicate the rule, t-target a positive choice. so when the client is breaking the rule or out of line you accept their feelings...I know you like to ........ then you communicate the rule...but the rule is...then you target a positive choice...how about you... for kids it would sound like this..i know you like to have fun, but the rule is you have to finish your homework before video games. why don't you complete your homework and then you can play games for the rest of the night. so you are accepting that they want to do something that makes them feel good, communicating the rule to them, and then redirecting them to do something that will hopefully get both your needs met. welcome to psych central. you will find that we have several forums where you can post about your concerns and receive feedback from other members. you will get a lot of support here. again, welcome

[Perna]

I think humor and "Help me out here, John, would you. . .?" could help. For me, the interaction with the other person, the one with authority over me is the big thing and I respond best when they "help" me or go along with me, etc. If you want them to do something, modelling what you want them to do, doing it "with" them while talking to them personally might help? If things get a bit too tense, a little distraction/misdirection while you turn down the volume of the TV ("Wouldn't it be nice if we had a set of earphones for the TV so it wouldn't disturb others? Why don't you suggest that to Suzie Counselor on Monday when she comes in") where there is a tie-in to others and the person's relationship with others may work? If it is not an action, but a principle, reminding the person of their responsibilities and relationships ("It's lights out every night at 10:00, John, you know that, don't you?. . .") and stating it in a matter-of-fact way with a pause while they hear/look at you, or even waiting afterwards for a response/acknowledgement from them that it is so, that takes any personal issue out of it; it is not you trying to be authoritative but just "the rules" that everyone, even you know and accept.

I've only worked with the developmentally disabled (and know what I like for myself :-) so don't know if these would work in a crisis center, especially if there is anger, fear, acting out of any sort. I was helping teach group/individual courses the students were taking because they chose to.

Another thing that really helped me is paying attention when you see/hear other counselors interacting with clients, see what they say/do and how they handle things if you can. I use to eavesdrop on my coworker talking on the phone to her elderly mother because I admired her so "copied" what she did/said with my own. Good listening skills and repetition of what I was saying/wanted when she didn't "get it" or got distracted helped there.

[bluecloud]

Yeah, developing rapport takes time. I think at this point focusing on developing on-going rapport is the way to go. They are currently resistant to change, so you've to earn their respect and trust before they can accept anything new.

One way to do it is letting your consumers run the group. Let them talk about how they feel about structured weekends, have them set up rules in the group while you still retain some control in the group by letting them know that setting rules up for XYZ reasons and these reasons are solely for the benefits of their well being (basically create a reason that can be shared by everyone in the group and have them believed in the significance of having rules). And if they don't want rules then have them talk about what's it like to have/not have rules, and during which you can validate their feelings and just let them know that you are here to listen.

[Strive4health]

I worked in mental health for a while, and all I can say for my experience is it did more damage than good. It made me more depressed because I learned people aren't really about action and solving problems.

[(JD)]

I have mixed ideas on this.
You say you're having difficulty expressing authority.
Expressing authority... everyone knows you are officially in charge right, and that you do have the "power" to take away privileges or whatever, right? IMO you don't have to express it at all: it's a given. Once you build your confidence, even a direct challenge won't shake you. It's why people who really do know something don't bother arguing with someone who doesn't.

I absolutely agree with pointing to the "rule" and making sure when someone pushes the limit that the admonition isn't coming because of you, but because of the rule. (This is taught to parents so they sit down and make rules with their children and then it's the rule the child broke, not the parent's waivering wish.) But along with the "rule" there needs to be a resulting "punishment" (Sorry, I know there are more professional words but I'm in a pain flare.)

So at that point, once all know the rule and the result of breaking that rule, it's out of your hands and you are not the ogre---it was their choice to break the rule, and the rule includes the punishment. (Oh I hate that word!)

Don't go too fast. It's so common to want to implement everything right now because it's "needed" but as you said, this is something they haven't had in a while (or ever?) so go much more slowly than you first planned. Make a timeline of slow progress and then you'll feel less frustration at the slowness?

And don't forget the overall goal: keeping the patients from digressing during the weekend between their sessions etc. I could see how just having new rules implemented would tend to make them uncomfortable and perhaps invalidated (like they aren't behaving and now need you to tell them how to act?)

Plus, they might be accustomed to having free time as well... and while structured days are good for most, they also need free time...be sure they plan that into the weekend too. But even freetime requires we all continue good self care---all humans need to do that, so they need to know that as well.

Rely upon the therapists etc to give you feedback as to what is working and what isn't... I'm sure their patients will give them an earful! Plus, with an actual timeline of when to implement each part of plan, you can have it at staff conference if necessary.

Now breathe. Keep the patients alive and you've succeeded the most.

[amandalouise]

Originally Posted by rambler2014

If there are mental health professionals on this board, I would appreciate some advice!

I recently accepted a job working in a crisis center. I'm a counseling and development student. My position is to, more or less, tide over a mixed group of adults (with various issues severely affecting their lives) from Friday to Monday when they can reconnect with counselors and social workers. I do some group; mostly affirmations and light coping skills with a general focus. I also check in with each person and just overall enforce the rules of the facility.

I'm particularly having problems expressing any kind of authority. I'm new and the consumers are not. I had four days of observation and now I work 12 hour shifts alone whereas before there was no one to do this job and there's resistance to having structured weekends. There seems a delicate balance of applying enough pressure to enforce the rules while not going so far as to exacerbate anxiety or authority issues in the consumers and having to call a more experienced person in on their days off.

A new job takes some time to get accustomed to, but I don't feel I'm being incredibly effective and I don't have experience to fall back on. Any tips for a mental health worker seeking to get more comfortable and develop the necessary skills to do this kind of work for life???

here in the city we deal with all kinds of issues, from drugs and alcohol to crimes like rape and domestic violence, and all types of mental disorders.

when we have groups we treat our clients like the adults they are, not like children that must constantly be reminded, or punished. we all go in to the groups with a definite plan, how that plan is going to be discussed and we leave very little spare time where someone who may be high, drunk or impaired by their mental problem to derail the group or cause problems.

the first session is always handout of the rules...basic common courtesy stuff..no drugs, alcohol or weapons, keep profanity to a minimum (hey we live in a major city where even a child is not free from seeing profanity style graffiti, songs.... or hearing or on occasion using profanity so we dont bother with saying none at all, who hasnt at one time or another said oh....

anyway my point is we make the rules fit the type of people we have while at the same time keeping everyone safe.

we dont even spend a lot of time reviewing the rules. we just open the class with ok lets get the formal BS out of the way first thing, here are the rules they are pretty self explainitory, if theres something on there that you dont understand see me after group. this group is ....today we will be talking about.... (this is with the educational groups)

with the support groups we go in welcome everyone with the rules hand out and again state what the group is for so that everyone in the room is in the right place at the right time. them we let things flow naturally. our support type groups are where anyone can talk about anything on the subject that we are there to meet about, everyone is free to come and go as they please, no one is forced to attend the groups. we assume everyone there is there because they want to be and should a problem arise where it seems like someone doesnt want to be there or is there to pick a fight with other members we check in with them right then an there about why they are there and whether they really want to be there or not, you know kind of like here on psych central the rule is if theres a post that is triggering you, you have the options to protect yourself by not taking part in the discussion or even reading that post. we treat our clients like that, if they dont like something someone has said they have the choice of leaving or staying and trying to understand that everyone has their own points of view and not everyone is going to like everything that goes on in the group.

even though we are a major city (NY) we dont get trouble with adults trying to go against authority, because we dont treat them like ok everyone Im the boss and you will do things my way or else....we treat them like adults..introduce a topic, give room for discussion but bring the discussion back on topic where needed...

example today was the support group on domestic violence. everyone came in.we introduced ourselves. I handed out copies of the rules to the new people then the discussion started. at one point the discussion went in the wrong direction, one victims abuser was black and another member in the group got offended by the victim using a different word...I calmly stated I understood that member did not like that word due to her race but in this room everyone has the right to name their abuser even if its the abusers race. that the member who objected would not want others in the room to dictate what she stated about her own situation. she can leave if the conversation was too much for her to handle due to the language being used if she wanted to. then I asked the first person to please continue. the woman who objected left then came back.

when you are the one running a group you cant lord over adults. the minute someone turns 18 here in america that gives an adult automatic rights....one of those rights by the ADA is that people with mental problems have the right to be treated just like other non mentally ill people....I wouldnt constantly tell my neighbor they were doing something wrong and punish them if they did something wrong. I may tell them , hey I dont like what you said or did. but I would respect that they control their self and all I control is me.

[CheryCross]

I work in a residential care home for learning disabled and mentally ill people. I agree with you about getting the right balance of firm but fair. The people I work with can be extremely volatile, if they don't like the way I have spoken to them or enforced a rule then I will be at risk of being verbally or more likely physically attacked.

They take advantage of the fact that I am new. They are very sensitive to my disposition and will exploit any sign of weakness.

While this is different to your work, it is similar in that you need to hold yourself with confidence all the time. Even if I feel like crap, I need to go in appearing to be perfectly well. I think of it as acting in a play. After an hour I start to actually feel the way I am acting.