So. I love love love my new job. But, and there is a HUGE but, there’s a little thing called “managed care” that guides every aspect of the work that I do. I know that it has been harped on and harped on throughout grad school, but working in the non-profit sector, I was able to avoid most of the ridiculousness. Now, I truly want to make a difference with these profoundly troubled kids, but my hands are tied in every aspect. I have to bill a certain amount of units per child per day, regardless of whether quality of care is affected. I have to bill pretty much every second that I am at the clinic, not taking any sort of lunch break/self care/breathing time, to make productivity (36 units a day..or for those not intimately familiar with units..roughly 9 billable hours) or I could lose my job. And we are limited even to the type of therapy we can provide. We are forced to use only cognitive behavioral therapy, which is great but not appropriate for all children and all diagnoses, but that is what Medicaid will pay for because it is intended to be a brief treatment modality (yeah right). So, I’m just a little dissatisfied at the work that I’m Doing and the level of care that I am providing to these children when I am told to focus on the numbers and doing my documentation in session and all kinds of other crap. It’s just not fair to the children. I miss private practice where I could do whatever the hell I wanted and what was actually the most appropriate and effective treatment for the individual. More than anything, I miss play therapy :(. Anyway, I guess my goal will be to just provide the best services and therapeutic environment as i can for the kids and work on building relationships regardless of what I can bill and hope that I don’t get fired! Wish me luck!