TakeAway: Seeking supervision with a professional clinician is wise when working with clients living with mental health conditions.

At some point in your career, you may work with clients living with a mental health condition. Depression and anxiety are two of the most common mental health conditions, but there are also phobias, schizophrenia, obsessive-compulsive disorder, eating disorders, addictions, developmental disorders, psychoses, and neurocognitive disorders that a person may have had since birth, has due to a traumatic brain injury, or has as a result of many other causes. There are special considerations when working with clients living with a mental health condition.

The clients may not divulge this information during the intake process. Because mental health conditions are so prevalent, you may consider asking every client, “Do you have any other health issues that aren’t listed on the intake form?” Some may be forthcoming with additional information while others may not.  

Years ago, I worked with a young man who had suffered a severe brain injury in a car accident that also left him with some physical injuries. His mother brought him to the session because he could no longer drive. During our first session, I noticed him constantly watching the clock. When he came for the second session, he had memorized exactly what the first massage was like. He would stare intently at the clock and say, “It’s time for you to do my arm (leg, neck, etc.) now.” He did not want me to vary the routine from the first massage. 

Once, I escorted him into the room and instructed him to undress to his comfort level and get under the sheets. When I knocked on the door and asked if he was ready, he told me to come in. He was standing up, getting ready to urinate on the wall. I told him calmly and without anger that this was inappropriate, handed him a robe, and escorted him to the bathroom. He had no malicious intent; he just no longer understood that this was not appropriate behavior. 

When we work with clients who live with a mental health condition, it can be helpful to expect the unexpected. That could mean anything from an emotional release, a panic attack, unfounded anger, or something like the above incident. Every mental health condition is unique to the individual, so the struggles and lived experiences will change from one client to the next. We may not know how to respond, but remaining patient and calm and seeking supervision from a clinical social worker or psychologist can be helpful to us and, consequently, to the client.