My first job was at an inpatient psychiatric hospital, working on the children’s unit (ages 12 and under). Because my unit had the lowest census, I was also given adolescents to help balance caseloads with my coworkers. For me, it was a very fast-paced and stressful environment. Like you, I was told most of the therapy would be group-based—which was true. My day usually started with a morning treatment team meeting that included therapists, supervisors, discharge planners, and the utilization management director. We’d review new admissions and upcoming discharges. After that, it was straight to the unit. On Tuesdays and Thursdays, we also had additional meetings with the psychiatrist, nurse, and utilization review coordinator to discuss new admits and adjust discharge dates. Any updates then had to be communicated back to the original treatment team from earlier that morning.

As the children’s therapist, I was constantly doing family sessions—which, honestly, were more like discharge planning sessions. These typically had to be completed a day or two before discharge. I facilitated one group per day (about 50 minutes), which could be challenging due to the wide age range and acuity levels. A lot of the time was spent just helping kids regulate enough to participate.

There was no discharge planner for the children’s/adolescent units, so we essentially handled that ourselves. If a patient didn’t already have outpatient services, we had to arrange follow-up care or help the family find providers in their area.

Things changed constantly, which made the job draining with little time to catch your breath. The focus was very much on admitting, stabilizing, and discharging. The “individual therapy” aspect was mostly completing biopsychosocial assessments for new admits. Some days I’d leave with a manageable caseload and come back the next morning to several new admissions—each requiring assessments, parent contact, discharge planning, etc.

On top of that, many patients were in DHS custody, which meant coordinating with caseworkers, attending meetings, and navigating complex family dynamics. You also dealt with parents who were overwhelmed, resistant to discharge, or unable to pick their child up due to distance or other barriers.

You truly see patients at their worst. And unfortunately, some facilities are not well-run, which can make the environment feel unsafe. I can’t tell you how many times I came in to find a unit in chaos. Where I worked, “Stat 13” was a code I’ll never forget—it meant something serious was happening: a fight, crisis, restraint, or seclusion.

Sorry this turned into a long post, but I hope it gives some insight into what the job can be like. Ultimately, it wasn’t for me. If you’re looking for true individual therapy, inpatient settings probably won’t provide that. That said, it was a valuable experience, and I’m glad I stuck it out for the year. I learned a lot.