That’s a very timely and pertinent question, Rachel. Mental health services are under attack at the fed, state and local level with many mental health centers shuttered as politicians decide that tax revenue needs to be kicked up to those who need it least.
Working with people with extreme emotional disturbances is difficult: there are huge emotional demands; time demands and pressure from mental health clinics and insurance companies to end the treatment as soon as possible and kick the patient loose.
This coupled with a paucity of training, especially for those of us who know psychodynamically oriented psychotherapy with a well trained therapist and, if needed psychiatric back up for periods when medicine support for the patient is indicated, is a very, very effective treatment.
However, short term therapies are usually the only ones most insurance carriers will fund.
It’s also problematic that many people on the extreme edges of madness often don’t have the funds necessary to support intensive treatment.
However, there are some of us in private practice willing to see these people at a reduced fee, often based on a sliding scale. This, however, can be difficult especially during stormy periods during the therapy where the patient is truly captured temporarily by the underlying madness and the stress on the therapist can be extreme. It is then that we wonder what on earth are we doing this most challenging work for less than our usual fee.
That however, if the therapist has been well trained and well “therapied” him or herself and has ongoing consultation and or therapy to help the therapist with his or her normal, and not so normal, anger and desire to retaliate. Maintaining boundaries is also difficult as these patients in their desperation will not be able to end the sessions on time as the separation from the therapist is felt as catastrophic.
In short, working with people dwelling in the near suburbs of madness or living inside its city limits all too often, is very demanding, draining, & often draining & exasperating work.
Yet, those of us who do work in the vicinity of Madness, USA find the work exhilarating, often magical, and an offered journey deep into ourselves as we accompany the citizens of Madness on their journey of rage, fear, annihilation, brushes with suicide and through it all, an emerging emotional contact with the therapist who, for the most part has not given up and withdrawn, nor has s/he lashed out in fear, anger or rage.
But, instead, the patient gradually finds a therapist who can contain all those feelings of the patient until those inflamed emotions cool to warm embers and provide a space to be truly alive and connected to someone else. Maybe still damaged and sometimes fragile, but an expatriate of Madness USA.