Treating Bartleby: The Challenge of a Goal Oriented Approach In Community Practice

No Reviews - Be the first

Length: 21 minutes

Julie Kipp, PhD, LCSW

Contemporary psychiatric treatment settings with oversight by government agencies or insurance companies require that we set measurable goals with achievable objectives for our clients/consumers/service users.  Yet many people with mental illness experience difficulty forming goals, or as the title character in Herman Melville's 1856 novella, Bartleby the Scrivener, says about everything, "I would prefer not to."  Perhaps these clients are not motivated secondary to psychotic disorders, or seriously depressed.  Some, for cultural, diagnostic, or personal reasons may just not buy into the greater society's extreme emphasis on going somewhere and getting ahead.  We have a commitment to these clients, while carrying the responsibility of proving that our work is justified by the standards of our overseeing bodies.  Otherwise we lose the opportunity to help these vulnerable people.

In this paper the presenter reports on the change at her agency from a day treatment model to a goal oriented recovery model: the PROS (Personalized Recovery Oriented Services) model being rolled out in New York State.  For some clients the change will be most welcome:  they have goals and are motivated.  Even clients with goals which seem unrealistic to clinicians can find a place in this model.  However, this paper explores several issues which can arise when dealing with: clients who have difficulty with goal setting; clients who have given up hope and have settled for their career as a psychiatric patient; clients overwhelmed by psychotic symptoms; and a client who resembles the Scrivener himself.

Produced By: