New counselors deserve more supervision and support

[any identifying details have been changed or removed] My first client appointment at a new job (state mental health agency) was today. I’ve been here for a couple of months ”onboarding” (mostly state-level compliance trainings, a few crash-courses at the clinic about documentation and crisis policies); most time has been spent alone, and as of a week ago, I got access to my caseload.

The first client I have is a teen with a high ACE score, who has had up to 8 state-based and private counselors, inpatient and outpatient, a broad *slew* of diagnoses in his history and actively on his chart, as well as NSSI and passive SI, and who today also announced he’s been refusing to eat but also never has an appetite and doesn’t feel hungry. I feel completely in over my head.

My gut says I need to back up and really look at and learn about the real human in front of me, but I’m in a chokehold with quality assurance requirements for billing/documentation. I am not seeing evidence in the client history or family history, previous therapy assessments/encounters, or in his presentation to support the current diagnoses in his chart aside from one neurodevelopmental diagnosis. It gives me the impression that numerous clinicians have just slung diagnosis after diagnosis at the wall to see what sticks. And I’m sure it won’t surprise anyone to know that the client has not liked past therapy experiences.

It’s a mess. But then I think, am I just being naive? Do I need to just buck up and figure it out? I just don’t know what to do. I have talked to my supervisor but he doesn’t really provide much guidance or advice for how to structure or approach the case. He also is not responsive to my concerns. Is it bad etiquette to go above his head to the director if I feel like I’m not getting the clinical support I need so I can staff the case with someone?

I feel so unprepared- and I know, I know, I am not supposed to know everything as a brand new clinician, of course— but am I not entitled to somewhat extensive supervision on this case in order to best serve this client and freaking learn how to do this? I need all the advice.