team supervision
CHRISTY STEIMER
Hi folks,
I'm not new to the list, but I don't think I've
ventured out of my little world and sent any messages for
a long time, so I'll give you a short intro. I'm a
clinical student here at the University of Missouri - St.
Louis doctoral program. I'm in my second semester and
stressed out just thinking about all the work I have to
do, so I'll be brief...
During our first year here at UMSL, we are
included in team supervision meetings second semester, even
though we aren't seeing clients until the summer. This
doesn't present many problems on structured teams that
have some specific "jobs" for first years - readings,
co-therapy, etc. Unfortunately or fortunately, I'm on a
team with less structure for first years, and I'm able to
forge a path for myself. This leaves me with the dubious job
of figuring out what is best for me to do with this time.
I would like to feel like I'm making some headway here on
my clinical skills. Someone out there have any concrete
suggestions for handling this situation? One thing I've
heard of others doing is "mirroring" another student
therapist. Basically this involves attending their
individual supervision for a specific client and listening
to the tapes of their sessions. Does anyone have opinions
on this approach?
Thanks in advance for any suggestions,
Christy
email me privately at: s102...@admiral.umsl.edu
if you prefer ....
Victoria McCoy
Christy--Hi. I'm unclear on some of the specifics of how supervision works at
your program. When first years mirror another therapist, is the indivudal
supervision they attend being performed by someone on staff at the University?
Or is this supervision being given in the community at the student's site? Are
clients aware that recordings of sessions are being made available for the
instruction of students other than the primary therapist? I was just wondering
about the ethical issues that might be associated with mirroring another
student's therapy work (confidentiality, informed consent, etc.).
Matthew Simpson
At 01:43 PM 1/21/98 -0600, Christy wrote:
>This leaves me with the dubious job
>of figuring out what is best for me to do with this time.
>I would like to feel like I'm making some headway here on
>my clinical skills. Someone out there have any concrete
>suggestions for handling this situation?
Excellent foresight!
Here is a skill that most interns have no clue about and they
end up looking kinda naive compared to psychiatry residents when
they start their internship - Reporting on the patient's mental
status.
In my graduate program, nobody introduced this test to me. But I
found that it was a fundamental skill that I wish I would have had
when I started my internship. If you would like to learn more about it,
it is described very well in a companion text to the DSM-IV, called
"The Clinical Interview Using DSM-IV Volume I: Fundamentals" by Othmer
and Othmer.
Another important skill is documentation of a consultation. When you are
called to a unit to do a consultation on a patient, the psychiatric folks
there aren't going to wait around more than 24 hours for your assessment
of the patient. They want your insight pronto. You have to get in there,
read the chart (about 15 minutes), see the patient (30 - 60 minutes; this
will vary, depending on the assessment requested), and then sit down with
the chart in hand and write your cunsultation into the chart BEFORE you
walk off the unit (another 15 mintues). So, if you want to get a good
leg up on what it takes to see a client while following a demanding
schedule (the documentation), practice practice practice. Start with a
paragraph stating the mental status. Continue with an outline of the
material coverred. Get used to writing things like, "The patient seemed
agitated while discussing the number of ETOH drinks/wk as evidenced by
frowning, elevated voice, and irritable reply 'You really think this is any
of your business?'" Separate your observations from your impressions.
Finish with a section providing your overall impressions, followed by
recommendations. If the patient is yours, write down the plan and the
date of the next appt.
> One thing I've
>heard of others doing is "mirroring" another student
>therapist. Basically this involves attending their
>individual supervision for a specific client and listening
>to the tapes of their sessions. Does anyone have opinions
>on this approach?
One of my favorite professors at U. Ottawa, Al Mahrer, is a world-renouned
authority on research in psychotherapy and experiential therapy. He is
a strong advocate (and if he had his way, he would require it of all students)
of doing co-therapy. That is, with your classmates, take turns being the
therapist and the client. Do therapy with each other. I found that when I
described this exercise to my internship class, they thought the whole thing
was gastly. Who in their right mind would want to violate the bounderies
of friendship and therapy by doing psychotherapy with your peers? Well, we
did it at U. Ottawa. And I found that it helped me to develop therapy skills.
I also think it decreased my defensiveness among peers.
Al Mahrer also compulsively tape records his own therapy sessions and then
reviews the tapes in exhaustive detail. This is the source of the development
of his science and his form of experiential therapy.