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Management versus Therapy
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Case Management versus Therapy by Richard Bermack may 2001
“When working with this population, we don’t have the luxury of just doing psychological work. Our clients need case management,” she explains. “But their material problems are so grave we endlessly address them, sometimes at the expense of their psychotherapy needs. “Our clients have acute mental illness and particularly schizophrenia. They have primary problems interrelating with people and relationships. They are isolated, they are withdrawn, they don’t know how to deal with things properly. Getting these people into relationships is a big part of the task. “So how do you move back and forth between dealing with material needs without reducing someone to those material needs and neglecting them as a person? “Now of course, everyone wants to be housed and fed. We have an absolute need to deal with that. But you have to be sensitive that people have a need to talk and be listened to. They need a kind of emotional holding. What I hear from interns very often is that clients will respond to the interns’ attempt to solve the clients’ overwhelming material needs by saying, in essence, ‘Stop trying to fix me, I want you to listen to me.’ I hear this from my own clients as well. They need to be listened to and understood. “It is important that all of the work to get someone stabilized and housed and to take care of themselves gets done in the context of improving their interrelatedness. If we just deal with the external things then we’re not doing the job, because it is the internal holding things that will matter in the end. If they don’t have the internal holding, then they are much more vulnerable to having the external environment fall apart after they leave us."
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Marilyn
Senf is a licensed psychologist and mental health clinician at Berkeley
Mental Health. She loves her work. She values being able to provide both
psychological care and material services. However, she worries that an
emphasis has been placed on the clients’ material needs to the detriment
of their deeper psychological issues.