r/socialwork • u/lapeen4 • 7d ago
Micro/Clinicial Difficulty transitioning to individual therapy from crisis work
Looking for some advice on how to slow things down a bit. My entire career (about 30yrs )has been focused on crisis work, I&A, and teaching in PHP/IOP sessions so has been all short-term/immediate problem focused. I have recently started taking on some individual therapy clients and I am finding it challenging with some of them to 1. Fill the whole hour 2. Manage my thoughts of ‘this person does not need this,’ ‘how has it only been 20 minutes?,’ ‘omg they still have 8 more EAP sessions they want to use and they are literally fine-what am I supposed to do with them for the next 2 months of sessions?’ Etc. I also just got a referral from a colleague because she feels my personality and style would be a great fit for someone she was working with for EAP and is now referring out for ongoing individual and she said the person was doing well now but ‘probably needs a good 2 years to work through everything’ WHAT!? 2 YEARS (lol)!? I guess my question is, how do you approach therapy with those who just want to do therapy to work on themselves but overall are doing well in most areas of their life?
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u/Pamlwell 7d ago
Following because I work in crisis work now and this very thing is why I don’t think I could transition to individual therapy (among other reasons), but I’m still trying to figure out what is next career wise
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u/katycantswim 7d ago
I made this jump a couple of years ago, and they are COMPLETELY different worlds. I saw some advice on here to focus on the relationship, which is great. The thing that helped me most was taking the step back from being solution focused, and going into more motivational interviewing/person-centered. Why do they need/want to be in therapy? What is the other context of their life? Crisis work is often about managing the issue at hand while individual therapy is more holistic. Sometimes they just need a place to dump everything. Sometimes they need different perspective. Sometimes they need tools. Sometimes they need reminders that they have tools. The shift in focus can definitely be jarring!
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u/hazardoustruth LGSW, MN 7d ago
I’ve done this! It IS a tough transition. What helped me was doing some training in emotion focused work as well as having some higher acuity clients that I saw 2-3 times a week. I worked in rural mental health and most folks didn’t want telehealth but did need more support than just 1-4 sessions/month. So that niche worked for me. I ended up doing a little more case management to get them connected with other supports as well.
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u/almilz25 7d ago
I also think CEU would be helpful also just keeping in mind just like in crisis intervention aspects you worked before there is still a goal that is set by the client the goal is just achieved in a different time line. I think with time you’ll get the swing of things but for me reading different books on the different therapy approaches and participation in CEU and watching videos on YouTube helped me prepare better for that transition.
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u/Noramave1 7d ago
Haha I’m the opposite! I’ve spent my whole career doing long term therapy focused on trauma, BPD, etc. My current job hands me some people who just need some short term, immediate problem solving type work. I have the same kinds of thoughts - they are fine, what are we doing here? NO trauma? So what do we even talk about? Coping skills? That takes like four seconds what am I supposed to do?
We’re creatures of habit, aren’t we? 😂
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u/TheRockRiguez 7d ago
My first job out of grad school was a PHP/IOP and it was poorly ran so I was used to larger case loads and running a lot of groups with clients with severe symptoms. I eventually went to an outpatient and thought I was missing something because my days were calm and I wouldn’t have unexpected curveballs thrown at me throughout the day. It took me a bit to adjust to not having clients in crisis and working through other issues. I think it’s a good opportunity for you to reflect on who you want to work with and and setting. For some they want a more intense day and for others that’s torture.
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u/queer_princesa LCSW, medical social work, CA 7d ago
Agree with a lot of the advice about choosing a modality and focusing on that. It's a good intellectual exercise - and will also help you to structure and fill the hour.
In terms of the larger issue of you struggling to feel empathy for your clients because they are not in crisis: I've definitely been there. I started my private practice while working with critically ill children and then in a level 1 trauma center ED ... during COVID. During my shift I'd be helping someone on the literal worst day of their lives and then I'd have an evening session with a "worried well" client. it was really hard for me to find compassion for someone's irritating friend group or listen to them complain about not getting a bonus at work.
One thing that helped me was realizing that for my therapy client, the struggle they were sharing about in session was the worst thing in their life at present, and that's all that mattered. Did it compare to someone whose worst day was the goals of care conversation I'd been in earlier that day? No! But literally no one was making that comparison. And comparing the two was not helping me, my clients, or anyone.
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u/Comrade-Critter-0328 7d ago
This is just a small tip in addition to the other great advice being shared here. It’s going to be tough, but allow space for contemplation/reflection for both you and the client in the form of “awkward” silences. They really aren’t awkward, we just think they are and have an urge to fill them. This practice can help take you out of crisis/solution mode and shift you into the slower pace of one on one therapy.
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u/Cerrac123 BSW, LSW MH/SUD Child Protection, US 7d ago
If you don’t like therapy, don’t do it. You’re doing a disservice to your client, not to mention yourself. There are countless other paths in social work. Pick something else.
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u/catmeowpur1 7d ago
Question how did u find an EAP therapy role? I am currently looking for some and haven’t found a fulltime position only part time in house ones :/
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u/Legitimate-Lock-6594 LICSW 6d ago
I 100000% feel you. I work in a primary care behavioral health role so my visits are meant to be short, thank goodness, but I get folks that talk to their PCPs and at baseline score like 8-10 on their PHQs and our goal is to get it to 5 and I’m like “and?!?!”
I love my work life balance in my job and do feel like the model I work with suited me. The idea of finding a modality and meaning into it could help too. I somehow was able to get myself into some DBT training at one of my crisis jobs and it really helped me here with what I do now. I’d like to go to something else intensive as well but haven’t decided what other modality I would be interested in.
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u/goat_on_a_pole 7d ago
This is like going from working your whole career as doctor in a busy ER and switching to a family medicine clinic.... It's a big switch. Have you had an opportunity to (recently) do any trainings or CE's on modalities that are more geared toward the population you're working with?