Tensions Between Rules, Regulations And Clinical Work Essay
The regulations governing the STCF have a profound impact on my clinical work with clients. Engagement and alliance formation is quite difficult because clients are mandated for treatment. There are many obstacles attempting to establish a therapeutic alliance with clients who are involuntarily committed. The intrapsychic and interpersonal dimensions are filled with a variety of conflicts. The level of acuity on a unit with involuntarily committed individuals is very high. The intrapsychic conflicts include suicidal or homicidal ideations and psychosis. interpersonal dimensions include engaging with clients who are resistant to treatment and feel they are being “forced” to be hospitalized and receive inpatient treatment. interpersonal dimensions include engaging with clients who are resistant to treatment and feel they are being “forced” to be hospitalized and receive inpatient treatment.
Involuntary clients/patients usually appear in civil commitment hearings. These “court” hearings happen bi-weekly on Wednesdays. The treating psychiatrist testifies that patient requires more treatment. If the client decides to appear at the hearing he or she witnesses their treating doctor telling a judge that they have poor insight and are danger to themselves or others.
I think this is severely damaging to the therapeutic alliance. I understand it is legal and procedural necessity but clinically it seems to pose a challenge to the…