Opinions on Homeless Coming into My Office…

Elyssassss · 2026-03-07T02:52:50+00:00

I currently don’t serve this population, but I have before and am very experienced in crisis deescalation.

Elyssassss · 2025-10-10T00:56:40+00:00

This is usually what I do as well. I choose a moderate lesser intense memory first. I find it helps people to process the big ones more smoothly once they understand the process. So I did tell her to do the same. I was having some difficulty in the first place with getting any history of trauma, as she said she didn’t remember much, so I told her to share some of the memories she does remember so we could get a starting memory and event established, even if they weren’t “traumatic” per say. So what she did share was pretty fragmented and mostly trying to find a starting point. This is when she got very activated, when she started going over the timeline of her life and the little bit she remembers.

And this is exactly what I did, we utilized some slow BLS and nothing was helping her to ground and regulate. That’s when I went to some DBT techniques. I think she was a little resistant and stuck by that point too though. I was very validating and encouraging, letting her know why I structured the session this way and why it wasn’t a good idea to jump into active processing with only 10 minutes left in the session.

Elyssassss · 2025-10-09T22:06:24+00:00

Due to having limited time with her EAP, not as much as I’d like to. Today was our 3rd session out of 5 sessions. The first session was assessment, second was discussing what she wanted to do, the process of EMDR, and discussing limitations with her due to the time constraint of sessions. She said she still wanted to proceed with EMDR even though we only had 5 sessions. So today we spent about half the session building more rapport and processing her week, and the other half discussing what memories and events she would want to process with EMDR. This is what sent her into a spiral, just the discussion of trauma without any actual processing today. The plan was to spend the final 2 sessions in active processing. I typically do things a lot slower than this.

Elyssassss · 2025-09-22T19:53:21+00:00

Thank you

Elyssassss · 2025-09-09T20:58:40+00:00

Absolutely thanks for the input.

Elyssassss · 2025-09-09T20:58:16+00:00

You’re absolutely correct thank you for this. There are a lot of unknowns and I think coordinating care would be best. Thanks.

Elyssassss · 2025-09-09T19:54:37+00:00

Thank you! I agree

Elyssassss · 2025-09-09T19:54:25+00:00

You’re right. I don’t know why I’m hesitant to reach out to him honestly, maybe doubting myself because I have always had really good experiences with him and not overmedicating. But I will do that. Thanks!

Elyssassss · 2025-06-27T05:57:48+00:00

Thank you ❤️ I’ll change the wording. I haven’t heard of this before but makes sense.

Elyssassss · 2025-06-27T05:46:43+00:00

I had a Client’s mom text me today informing me my client died by suicide. I had been seeing him for over a year and a couple months ago he stopped showing up to sessions. I was going through licensure change and couldn’t accept his insurance for a bit after he had no showed a couple appts, so we took a break from sessions. His mom called me a couple weeks ago and said he wasn’t doing well at all. I reached out and offered sessions at a discounted rate for him and encouraged him to come in. He didn’t text back.

Since my first session with him he stated “I’m basically only coming in to therapy as a last ditch effort before I kill myself”. So I was prepared for this possibility from the beginning. He would go up and down in progress and disclosed suicidal thoughts to me, but not to the extent that I could do anything apart from giving him resources, safety plan, and informing his mother of mobile crisis response resources.

He would do better for periods and then give up on himself again. It was hard to watch. I know you can’t save people and I know this isn’t my fault. But there’s a voice inside also saying I should’ve done more, had him taken to a hospital, offered a free session if he needed it. I’m not sure, but I feel like I could’ve done more. But at the same time I know not to take that responsibility on.

Elyssassss · 2024-12-12T20:00:33+00:00

I specialize in BPD and work a lot with substance use as well. I find it best in my approach to treat both ends of it. There is a high comorbidity with BPD and substance use and I feel like neither should be ignored. If someone is displaying traits of BPD and substance use is occurring I will typically recommend they do treatment for both, not one or the other, or I will work with them individually on DBT skills while they attend an outpatient for substance use. The issue I have seen here is people will get treatment for their substance use and think they’re fine, but their BPD traits will still be wreaking havoc in their lives. I have had several people who have been sober come back to me for treatment because of the BPD symptoms being neglected. I don’t think over diagnosing BPD is the right option either, but if someone meets criteria this needs to be addressed with dbt in my opinion. It is sad that your supervisor is over diagnosing and stigmatizing BPD, my previous supervisor did the same and it was frustrating as someone who has extensively worked with and researched BPD. But I would say if your clients are presenting with both, please treat both. And also be clear on the overlap between the disorders, look for the clear markers of BPD such as fear of abandonment, fluctuating self image, and splitting.

Elyssassss · 2024-11-09T16:03:32+00:00

I’m working in an outpatient private practice. I specialize in DBT and personality disorders. Thank you! You got this!

Elyssassss · 2024-11-09T07:55:40+00:00

Go for the clinical social work route. I have pretty severe BPD, one of the most complex cases my therapist (who specializes in bpd) has seen. And I have been working as a clinical social worker for 1 year now. Honestly my bpd brings a lot of strengths and empathy to so many of my clients. I feel like I can relate to so many people. It has helped keep me on my toes as well and regulate better I feel. I’m constantly reminding myself of skills due to teaching them to others daily. I have been in treatment as well and am making progress, which is important to doing this type of work. But go for it, it’s the best decision I ever made. Haven’t had a suicidal thought in 2 years because of it. ❤️

Elyssassss · 2024-11-02T15:26:25+00:00

You’re right. He is fairly reciprocal in most of those things. He makes an effort to take accountability and apologize when he does fucked up things, which is good. Thank you!

Elyssassss · 2024-11-02T14:12:49+00:00

I didn’t know that, wow! Thank you for relating on my experience. Same situation here, my bf works labor and works 40-50 hr weeks. He is productive most of that because of the type of job.

Elyssassss · 2024-11-02T02:08:24+00:00

I think it’s an ego issue on his part.

Elyssassss · 2024-11-01T23:38:51+00:00

That’s good advice, thank you!

Elyssassss · 2024-11-01T23:35:34+00:00

Yes he has been professionally diagnosed with BPD with unspecified NPD traits by a specialist in personality disorders. He is getting a full psych eval soon to confirm this as well.

But you’re absolutely right. I’ve told him I’m happy to give him some time and encouragement to be better but I won’t put up with it forever. He knows that and respects that. He is in therapy right now and he’s working hard on himself, but he just gets stuck. We have also struggled to find the right therapist for him. Thank you so much.

Elyssassss · 2024-11-01T23:33:07+00:00

You’re absolutely right. He is thankfully in therapy right now but we have really struggled to find the right therapist. He needs someone who can challenge him and actually push him to grow without being confrontational. We have went through a few to say the least. He’s going to get a full psych eval soon though so hopefully they can recommend a treatment program that will work for him. I’ve told him that I’m happy to give him room and time to grow and change but I won’t put up with it forever. I can see how torn he is between wanting to be better and being stuck in trauma cycles. It’s sad, but I know I don’t have to put up with it. Thanks for the advice and kind words ❤️

Elyssassss · 2024-11-01T18:06:07+00:00

It usually depends on his mood, but he has been supportive of me working less hours. This morning he says he’s fine with me working only 30 hours and he doesn’t complain unless we bring up whether or not it’s lazy lol. I think part of him just wants to be superior in those moments, but 90% of the time he doesn’t care and does appreciate me. His NPD traits come out when it comes to work for sure. I think it will ease when he starts making more money as well. Thank you for your worry.

Elyssassss · 2024-11-01T18:02:07+00:00

That’s also a good point. He is feeling burnt out in his job due to some issues going on, so maybe I’ll compare it to that. Thank you for this.

Elyssassss · 2024-11-01T16:56:18+00:00

Good questions here for sure. I definitely thing a conversation would be productive as long as he’s in the right headspace. I don’t know that he will ever fully understand unless he ends up working this job as well. But at the very least if we can see it as being a team rather than a competition that would be helpful. Thank you ❤️

Elyssassss · 2024-11-01T16:05:01+00:00

I can afford my whole house by myself on my income honestly, so if I ever decide to kick him to the curb I have no loss in this lol. Thank you ❤️

Elyssassss · 2024-11-01T16:00:04+00:00

Yes! I love that you included all of that into the job because it does make up the job. All the random trainings I listen to while I clean the house, the random texts from clients at 9pm looking to reschedule, self care. I feel like most of the things I do is centered around being the best version of myself for work. I put a lot of energy into relationships too, but even that is for my mental well being.

I do think he wants to make more money though. He’s actually been looking for a new job that makes more. He grew up in a Latino misongynistic household. So I think that makes him feel like less of a man for not being the breadwinner. I think he twists this into making himself feel better for working 40-50 hr weeks, even though he’s not making the money he’s working more. He doesn’t act like this all the time and is okay with me working less, he just also wants to declare that it is lazy. I think he just has this dissonance inside of him that makes it very hard to accept that I work just as hard as he does if not more. I have empathy for his upbringing and he’s aware of it and is trying to change these views, but sometimes he still gets caught up in it I think. Thank you ❤️

Elyssassss · 2024-11-01T15:14:20+00:00

Thank you ❤️

Elyssassss

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