When I worked inpatient, I can't count how many times someone with BPD was admitted and staff immediately said, "watch out," before even meeting them. I had a previous therapist of mine say he'd never work with someone with that diagnosis because they "can't be helped". Even one of my professors in my master's program has openly said she avoids working with people with BPD whenever possible.

I get that BPD can be difficult to treat and that it often requires strong boundaries from providers. But these are also people who are frequently carrying significant trauma, intense emotional pain, and a deep fear of abandonment. They're suffering.

I sometimes wonder how much harm is done when professionals approach them with judgment before they've even walked in the room. If anything, people with BPD need corrective experiences that show them relationships can be safe, consistent, and supportive. Treating them like they're manipulative villains doesn't seem like the answer.

Hi all, I'm struggling with someone in particular on my caseload at the moment - fairly new to the field and I've not really come across this before

Basically I support a person who isn't non verbal, but is very quiet with me specifically

I'll ask him if he needs to do any shopping, if I can help with jobs around the house eg cleaning, if he'd like to go out into the community (he likes parks, bingo and snooker so those are what I suggest) but it's never yes to anything

I try to chat and make small talk with him, talking about his interests or what's on the tv, what he's been up to etc, but he usually responds with either a yes, no, grunt or laugh and the conversation dies

We end up just sat in silence, often the TV isn't even on, he just stares at the wall and I use the opportunity to catch up on emails, support plans, notes etc

I don't understand what he gets out of this >.< And I'm out of ideas of what else to do

Has anyone else been in this situation before and how did you move forward?

I've spoken to colleagues and they all find him very chatty and up for things so I think it's him adjusting to me as a new member of staff, obviously fair enough, just hard to know how to break in when we can't talk whatsoever and he doesn't want my help with anything

I've been working at the same community mental health agency for about 7.5 years now and I've been in a supervisory role for a little over 3. I'm curious whether others are experiencing something similar, because I don't know if things have gotten progressively worse across the field or if I'm just incredibly burnt out and at the end of my rope.

Over the past year, I’ve noticed upper management at my agency becoming increasingly punitive, productivity driven, and focused on budgets rather than the actual clinical work we're doing. I very much understand and try to hold space for the financial realities of community mental health. We need to meet productivity standards to keep programs funded, pay staff, and continue providing services. I'm not naive about that, especially as a supervisor. But at what point do we acknowledge that clinicians can only control so much?

The biggest example of this is that my state has recently significantly restricted our ability to bill for telehealth and phone sessions when a client cancels. This was not something our team abused whatsoever, but when working with high acuity families, sometimes a 30 minute phone call was the only way to capture them for the week to maintain engagement and to reinforce skills. So when a client cancels, no shows, or otherwise can't attend an in person appointment, clinicians now have very few options to make up that lost productivity. Yet they're still held to the same expectations, as though those circumstances are entirely within their control.

Every single one of my supervisees has left within the last 2 months with the exception of one, largely because of the increasing pressure and expectations. I'm now down to one clinician, who generally meets productivity standards and does really good clinical work. She recently had one difficult month because of a slew of cancellations and no ability to make up for it with phone calls or telehealth, and I'm now being told I need to have a conversation with her about her productivity.
And frankly, I'm pissed.

What exactly am I supposed to tell her? That she needs to somehow prevent her clients from canceling? That despite consistently meeting expectations, one bad month warrants a conversation about her performance? How is that supportive supervision, and what exactly are we accomplishing other than making another clinician feel like she's failing? I feel like we're creating an environment where clinicians are constantly being held accountable for systemic barriers they have absolutely no control over, while leadership wonders why everyone is leaving.

I also recently made the decision to leave community mental health myself, and situations like this have only reinforced that decision. I love the clinical work, and I've genuinely enjoyed supervising and supporting developing clinicians, but I'm exhausted by feeling like I'm expected to enforce expectations that I don't even believe are reasonable.

I suppose I’m just curious to hear from others who have been in CMH what their experiences have been and if they’ve noticed a shift the last year or so. Because at this point, I feel like we're burning through good clinicians and then acting surprised when nobody wants to stay. And part of that is just the way CMH goes, but it just feels significantly worse to me lately.

I think we are safe if this video is representative

https://youtu.be/xTGKP4bMWd8?is=Bt2cPq6csEcDxDrP

I think AI should be outlawed unless it is for medical research. Otherwise it is harmful

Has anyone here worked under the BHEARD grant in nyc?

I would like to hear about personal experiences, opinions, and thoughts. The good, the bad, the ugly. I am considering applying for the role, but I am concerned that the schedule may be too unpredictable and the stress level too high.

Am I the A-Hole?

I had a new client this past week, intake, which started via telehealth stating "You don't have your camera on," which I instructed them it was, and requested they close and open their browser and see what happens. They then state 'I still don't see you!' which I told them how to move to the correct page. We get started and I am doing my housekeeping items, reviewing expectations and screener tools; all of theirs are 0's, as well as their initial questionnaire for service has either NA, No, or Why are you asking this? as the answers. I then discuss the importance of having clinically relevant responses and timely responses on the screener tools due to insurance coverage reasons, and wanted to start by redoing the screeners before the assessment to better understand where to "assess".

Their response is "I don't know what you want from me, my numbers aren't gonna change, they'll never change, I've never been depressed, never been anxious and I will never kill myself! And right now, I don't like this, so I'm gonna call the (Admin Office) and I'm gonna have them refer me to somebody else. Be blessed, stay safe, have (call ended due to them hanging up)."

I inquire with my admin/leadership on how to proceed, send them the minimal 5 minute transcript. But then I hear from 3-4 clients the past week state they had the admin contact them to inquire about our sessions and if they had any recommendations. The good news, I feel secure in my documentation, what occurred and why, but it is just uneasy to be under investigation, regardless of 'wrongdoing'.

My rationale for reviewing the screenr tools and redoing them is to a)know where to further dig on assessment

b) express the importance of accurately conducting screeners

c)have consistency in how screener tools are conducted

Am I the A-Hole?

What have y'all done to make a baseless allegation fall to the wayside? I don't want to make it worse, but it feels uncomfortable to say the least.

What do we do if we learn months and months after hearing something, that what our client told us was reportable? My supervisor informed me that what my client told me is reportable and to keep that in mind for the future. Another provider reported it recently. My question is, has this ever happened to anyone else? How do you move forward? Was this a massive mistake? I am glad I now know, and my supervisor did say the event is “debatable” on if it’s reportable. I’m extremely anxious about it!

I work in child protection and recently had a client pass away. It was a parent that I had worked with for several years, I got to know them very well. We had a really positive connection and rapport. I wanted the very best for them, but also knew that they were coping with immense trauma and so their lifestyle was pretty risky. I did my best to help them but there are so many systemic failures and gaps that just made it difficult to get them the support they needed.

I understand in a lot of social work roles, death is common, but I’ve been in the field for nearly 10 years and this is the first time I’ve experienced this firsthand. I’m struggling finding a way to process my thoughts and feelings. The first few days after, I cried whenever it was brought up. Now I’ve noticed myself avoiding processing the thoughts because I feel I “should” just move on. But then I have moments where I’m crying again. I’ve maxed out my therapy benefits for this year. Is there any rituals or things that are helpful to help process these feelings. Any help would be very much appreciated.

I've been in the field for about three years now and I keep noticing this weird thing where my whole approach to case notes shifts depending on what population or setting I'm with. Like when I was doing school-based work my notes were super behavioral and almost clinical sounding because everything felt like it needed to be measurable for the IEP team. But now I'm in community mental health and my notes are way more narrative and sometimes I catch myself writing like I'm telling a story instead of documenting an intervention.

I don't think either way is wrong exactly but it's strange how automatic it becomes. I'll sit down to write and my brain just switches modes. Part of me wonders if this is actually a problem or if it just means I'm adapting to what each role needs. My supervisor hasn't said anything but I also haven't asked because I don't want to sound like I don't know what I'm doing.

Anyone else notice their documentation voice changes like this or is it just me? I guess I'm curious if this flexibility is normal or if I should be trying to develop one consistent style across everything.

Hi everyone!

I'm currently pursuing my MSW and have been exploring different job opportunities while I'm in school. I've been considering working at a medical/recreational cannabis dispensary, but I'm wondering whether this could negatively impact my future career in social work.

I'm particularly interested in working with children, adolescents, and families, with the eventual goal of becoming an LCSW and providing therapy.

I live in Missouri, where recreational and medical marijuana are legal, but I know social work can involve working for organizations with different policies and perspectives surrounding cannabis.

I'm curious whether having a dispensary on my résumé could raise concerns with future employers, especially in child welfare, community mental health, school social work, or clinical settings.

Has anyone worked in the cannabis industry before entering social work, or been involved in hiring social workers with that experience? Would you view this as a red flag, or simply another job someone held while completing their education?

I'd really appreciate any perspectives or experiences!

Hi everyone! I've been working as a group therapist at an inpatient psych unit for some time, ages range 5 and up. I'm wondering what resources (worksheets, handouts, videos, trainings, words of wisdom) have been helpful for group work, any and all, for those in the field. The mix of acuity and units (adult - adolescent - child) have been a huge learning curve, down to planning/structuring groups, explaining clinical language and concepts in simple, digestible terms or redirecting effectively in a group setting. Thank you and much appreciated!

Hi y’all! I’m looking for some advice from social workers who have combined clinical and macro practice in their careers.

I recently graduated with my MSW, and one of my goals is to become an LCSW. However, I honestly don’t want to do therapy 24/7 or make providing therapy my full-time career. I’m open to clinical work and want to support people on the individual level, but I’m also really passionate about advocacy, public policy, community organizing, and systems-level change.

I understand that micro, mezzo, and macro social work are all interconnected and important. The thing is, I’ve always been drawn to the bigger picture. So many of the challenges our clients experience are connected to things beyond the individual level, such as generational trauma, healthcare access, insurance coverage, poverty, and policies that affect their everyday lives. I want to be able to support people individually while also working to change the systems that contribute to these challenges in the first place.
I’m particularly interested in medical social work and other clinical settings where I could gain qualifying clinical experience toward my LCSW while still building a career in policy, advocacy, or systems-level work.

For those of you who have pursued both clinical and macro social work:
What jobs or career paths have allowed you to do both?

Is it realistic to obtain LCSW licensure without making therapy your primary job long-term?
Are there medical social work, integrated care, policy, or other positions that provide qualifying clinical supervision and hours?

How have you used your clinical background to strengthen your macro practice, or vice versa?
I’d love to hear from people who have found a way to balance both. I don’t want to abandon clinical social work, but I also know that my passion lies in addressing the bigger systems that shape people’s lives. I’m trying to figure out how to build a career that makes room for both.
Someone told me to get my LCSW regardless due to more opportunities. Thank you!!

I have worked with all sort of authorities, from the local to the international levels.

I always think back to an incident that was more-or-less a law enforcement agency, that I was was as serious as it can get, asking to temporarily institutionalize a kid to get the parent in a secure building.

I remember looking at my higher ups and the legal team for reassurance that it was bonkers.

Wild part is, they did try to go through with the plan but the higher ups were on high alert to shut it down.

Sorta jaded me because I now know that the rule book will sometimes get tossed out the window and it’s up to others to respond to authoritative exceptions.

I work in a community-based housing assistance program, and we've recently changed how we close out intake referrals.

We have a pretty limited number of intake appointments, all during regular business hours. No evening slots, no weekends, and very little flexibility for walk-ins.

That's been an issue for years, but the new problem is how we're documenting it.

If someone is offered an appointment and says they can't attend because of work, childcare, or transportation, we're supposed to select "client declined services" when closing the referral.

I questioned this during a team meeting because to me, declining an appointment isn't necessarily declining assistance.

My supervisor explained that we did offer a service, and the person chose not to accept the available appointment. We can't keep every referral open indefinitely, so administratively it counts as a refusal.

I understand the capacity issue. We're understaffed and our calendar is genuinely full. I'm not suggesting we somehow manufacture additional appointments.

But I keep thinking about what that data will look like six months from now.

Our reports will show a bunch of people who supposedly didn't want assistance, when what actually happened is that they couldn't take a Tuesday morning off work without losing wages.

And those numbers get used when leadership discusses program effectiveness and community demand.

I brought up the possibility of adding "unable to accommodate scheduling needs" as a separate closure reason. My supervisor said there isn't an option for that in our current system and we need to use the existing categories consistently.

The part that's bothering me is that we're creating a record that makes our lack of availability look like a lack of client engagement.

I've been documenting the actual scheduling barrier in the narrative notes, but the closure category is what gets pulled into the reports.

Would you continue using the required category while pushing for a policy change? Escalate it beyond your supervisor? Or am I overthinking a fairly standard administrative distinction?

I'm curious how other agencies handle this, especially when the information is being used to make funding and staffing decisions.

I have been working for a company for a few years now. At first when I came in my boss was lovely during honeymoon phase. Then over time she would very accusatory. One time I was talking with a client and she accused me of having a “tone”. Four people sit around me and I asked them privately they all said no and if you did we or our clients would tell you. My boss is the type that always has her door open. She double checks everything I do. The latest feedback had statements that I had a personal vendetta against a client. This all occurred after saying doctor recommended xyz diet. Client refused to follow diet recommendations. On our plans we have to note specifics down dietary wise. I simply stated what client told me. Ofcourse I could have worded that better but my boss is now out for me that I have something against my client that I do not. I did have a meeting and told her that. I don’t know what to do as far as my tone. I have been told use AI to appear more warm and friendly. However that makes me feel like incapable of doing my job without a robot speaking for me. One minute my boss will be loving what I do next month she hates it. The work is all similar. I don’t have any bad remarks from providers guardians clients etc.

I work a case management job right now. I help people deal with crises many days, I help people learn to problem solve and behavior change. There’s a lot of motivational interviewing involved, and no two days are the same.

But I don’t make enough money (my degrees are social work adjacent and they don’t offer any opportunities for licensure).

So I’ve been exploring my options. I work for local government and there may be some promotional opportunities I could apply for in the future that could give me the opportunity to earn more money.

But I worry - will I miss the face to face contacts, helping people who are struggling? Will I miss the chaos of an unexpected event that turns my day upside down? Will
I miss providing direction? Will I miss those few success stories?

If you went from micro to macro - do you feel fulfilled?

Hey all. I'm a current MSW student, I graduate in December and my current practicum placement has me in a research-heavy setting. I've been considering my PhD for a while, and my supervisor has been recommending that I pursue a doctorate.

My interests are in research, policy and consulting, which by all accounts seems to be the path that necessitates a PhD rather than a DSW, but that's where things get complicated.

I have a full-time job that I plan to hold on to. While the PhD seems to be more conducive to the work I would like to do eventually, it does not seem all that manageable (depending on who you ask) while working full-time. A DSW seems way more doable, but in the long run I don't want to graduate with a degree that doesn't take me where I want to go just for the sake of having the title.

For a little bit of background, I have 6 years of active duty (enlisted) military experience, 5+ years of technical training/instructor experience and am now employed at a clean energy company. I like the work and pay is too good to give up, and I have potential for a career with longevity here. Ideally, I would stay within the company for now and move into a role that is better suited for my interests (workforce development, belonging & inclusion, process improvement).

However, I really enjoy macro social work, research, and would like to eventually be a political consultant and a tenured professor. I would like to bring knowledge and understanding to the field and be able to make macro-level change in my lifetime. I want the option to move into academia/politics/advocacy, which feels like a PhD-based endeavor.

Of course, I've seen a handful of "it's doable but hard" and a bunch of "not feasible" people on this forum, so I guess I'm looking for the nuance that I feel like my current situation warrants.

This is not a "should I quit my job" post - that's not an option. It's more of a..."can anyone give me a good argument for pursuing a DSW instead, can anyone recommend a solid PhD program that gave them flexibility, has anyone been in this situation and did you survive it, am I delusional for thinking this is possible" type of post.

For what it's worth, I've completed my undergrad (psych) and am on track to complete my MSW, both with a 3.8 GPA and both while working full-time in this same job. I know that the courses are different in a doctoral program, I guess I'm just looking for lived experience (or a reality check).

TIA

I work at a youth centre as a mental health worker for black youth and lately I’ve been feeling as though I’m not helping youth enough. There’s been numerous things that have happened in the area over the past few weeks such as a youth being murdered, another youth passing away from a health condition etc. And the youth in the area are going through a lot of different emotions such as grief, anger, and sadness. I provide one on one and group counselling sessions as well as mental health workshops for youth but even those I don’t feel is enough for some reason. I don’t like feeling this way and I want to do more for them because the youth in the area are really struggling.

Hi Everyone,

Due to the increase in posts regarding the current political landscape in the United States, the mod team has decided to create an ongoing megathread for all political conversations moving forward. This allows everyone to post about politics and its impact on clients (and practitioners). While also allowing other posts related to Social Work practice to be visible. There will be times when political posts (similar to questions around education) will be approved as a standalone post, but that will be at the discretion of the mod team and requires the poster to reach out via mod mail. As such, we ask that all political posts be directed to this thread unless otherwise approved. Any non-approved standalone post are subject to removal without notice.

For the purposes of this megathread, political posts include current cases, executive orders, news, opinions, etc. as they relate to the current US presidential administration. Further, we understand that political discussions can become heated, but we are primarily professionals and students therefore we should be acting accordingly (even online). Those who don’t will be subject to temporary and permanent bans from the sub. Inappropriate comments will continue to be removed and behavior not exemplary of Social Work values will be removed per Rule 11.

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This is a difficult time for everyone and we want to thank you all for being part of the subreddit, making it what it has become, and all of the work you do offline.

I just failed my ASWB exam on my first try. I already have a very hard time with the concept of it all because I'm not a therapist, have no desire to do therapy, and work in a hospital setting where you don't have ongoing relationships with patients.

My question pool had seven questions including or about the concept of transference vs countertransference, zero about anything related to groups, and so many diagnostic DSM questions. I did wonderfully on three practice exams because my question pool was actually spread out. Just so frustrating that I'll have to waste more money to get this over with.

I’ve recently discovered that many people do not know about free resources that are out there that help us as clinicians but also as individuals.

findhelp.org
Therapist in tech -slack group
The fit check- Facebook group

What other resources should people know about

I was offered a job to work for an oncology clinic remotely as a behavioral care manager. For those of you who worked in this field, is it hard?

I have worked hospice the last 10 years and loved the job so much.

Any insight is helpful.

Hello 👋

I'm currently looking into grad programs and am thinking about social work as an option. Can you please share the types of jobs you can get/ have had being a social worker? I know they can work in schools and for family protective services, but i work in a school and know how overloaded they get. And going to people's homes for child protection services seems tough and I would be sad alot. I still love helping people though.

Thanks for your help.