Quick note from Partners in Recovery about the work we've been doing. They can now be found on Facebook:
"Petar Sardelich, LMFT, MACII, LPT, has joined Judy McGehee, LMFT in supervising La Verne University Trainees, and Interns, in the Glendora Schools Internship Program. Since September 2009, interns, therapists and trainees have been offering 40 hours per week of probono mental health counseling and education in the community. This includes Whitcomb High School, Glendora High, Sandburg and Goodard Jr. High. Community and Parent nights have educated participants about drug and alcohol abuse, building communication between parents and teens, and in March, 2011, information regarding bullying and helping individuals in combatting this behavior. PIR is a non-profit organization where volunteer therapists and board members provide mental health services and referrals in the community."
Partners in Recovery website:
Judy McGeehee/Partners in Recovery
Showing posts with label clinical supervision. Show all posts
Showing posts with label clinical supervision. Show all posts
Sunday, January 23, 2011
Tuesday, May 25, 2010
What We Don't Get Taught
Have been lucky enough to do some clinical supervision with Judy McGehee. As I've mentioned before, she and some interns have been providing free services to their community for some time now. Some concerns I've had with other venues of supervision have come up the last couple of times we've met.
Clinical supervision, like therapy, is different things to different people. Many times it's the opportunity to "present cases", problem-solve clinical, legal, ethical issues and etc. It's also a place for us to have the opportunity to discuss or work out struggles we have as therapists- something that certainly should go on for our entire careers.
One of the things I like to do in supervision is talk about the issues that are not necessarily explicitly processed when we go to school. There's lots of these sorts of concerns... how to deal with our own feelings as therapists. Issues of responsibility- where ours are vs. where the clients' responsibilities are, how much is "enough", concerns when we're sometimes working harder than the client is (or not). Handling boundaries about parents endeavoring to influence issues discussed (or simply perspectives about them), concerns that arise in couples therapy or family therapy like one person in the "group" disclosing something that affects the others outside of the "group" proper. How to handle when a client isn't being honest about a problem or circumstance or behavior. Determining how to handle "terminations"- planned discharges, "therapeutic discharges", discharges against medical advice... sometimes when a child is "pulled" from treatment by a parent against the better judgment and suggestion of the therapist. Speaking of, there is little discussion about how to handle referrals to other types of resources or therapists. Specific methods to avoid (or deal with) "burnout". Very "nuts and bolts" concerns like documentation, treatment planning, dealing with insurance companies and such. Fee setting. What to do if a therapist runs into a client outside of the office or other milieu. How to handle when a client is "stonewalling". Handling clients that are self-medicating. My personal favorite is specific goals and underlying philosophy of our methods as therapists. There are many, many more.
It is of course really important to do case conference, have both group and individual forums for processing what is happening with specific clients or groups and the like. I find it of great import too however, to discuss the above issues. It is one thing to discuss a specific case, but I think it another to discuss what it is about that case that will come up (or has) repeatedly, in a principled manner. Would argue too that discussing issues like responsibility, boundaries, terminations, referrals etc often lead to greater resolution with clients "in the room", as well as provide a way of generalizing our knowledge and methods, thus making it a more organized and effective way of treating folk.
Am not suggesting that these things never occur. It has definitely been my experience however, that most of the above ideas are not discussed in depth, if at all. Certainly concerns of symptom ID and management, differential diagnosis, theoretical orientation and etc are of great import, but it is uncomfortable and counterintuitive to run into a circumstance that occurs frequently or that is a fundamental part of operating in our discipline (treatment planning, for example) that is largely omitted from our education.
More than anything else, I think I'm advocating for more of a focus on our underlying philosophy for employing the methods that we do as therapists. I'm not simply trying to help someone (or their parents) improve failing grades, or get someone in a relationship to be more sensitive or attentive, or even to diminish "depression". What I hope to achieve in most (most) circumstances, is to:
1. Insure safety and stability necessary to do "The Work". (absence of suicidality, abstinence from drugs, ETOH, or a behavior, have medical concerns be ruled out by a physician, insure that necessary resources to do the work are in place, etc)
2. Identify "issues"- the events (relationships, circumstances, etc) or other causes that prompt us to feel mad, sad, afraid, ashamed, and/or hurt and/or "behave" in ways we struggle with.
3. Process those issues in a way that diminishes, transforms, and/or (almost) eliminates them and subsequently behaviors, choicemaking, or perspectives that might contribute to these issues in an ongoing way.
4. Provide a "body of material" (patient education, referral sources, resources etc) that enables the client to be able to do these things without the therapist.
5. Insure that the client has sufficient resources (support groups, family, friends, etc) that support the work and use of that material in an ongoing way.
These are an oversimplification, but I think they go beyond simply "resolving a problem", eliminating a behavior and etc. Much of the inner workings of these ideas don't get processed as much as I'd hope while we're being educated about our discipline, but again, of course this philosophy likely exists in many of our "theoretical orientations". In my sense of things, the presence of such a philosophy doesn't go far enough- we as individual therapists need to have a grasp of our own sense of these things to make them as effective as possible.
Would say further that none of this is supported unless part of our own supervision is about dealing with our own experience both as a therapist, and a person outside of therapy. My ability to problem-solve many of the issues "not discussed" above is diminished by not having the opportunity to explore these things as part of our own clinical supervision. The largest of these things for me are the underlying treatment philosophy, and the effectiveness and grace that I deal with my own life- including my life as a therapist.
Clinical supervision, like therapy, is different things to different people. Many times it's the opportunity to "present cases", problem-solve clinical, legal, ethical issues and etc. It's also a place for us to have the opportunity to discuss or work out struggles we have as therapists- something that certainly should go on for our entire careers.
One of the things I like to do in supervision is talk about the issues that are not necessarily explicitly processed when we go to school. There's lots of these sorts of concerns... how to deal with our own feelings as therapists. Issues of responsibility- where ours are vs. where the clients' responsibilities are, how much is "enough", concerns when we're sometimes working harder than the client is (or not). Handling boundaries about parents endeavoring to influence issues discussed (or simply perspectives about them), concerns that arise in couples therapy or family therapy like one person in the "group" disclosing something that affects the others outside of the "group" proper. How to handle when a client isn't being honest about a problem or circumstance or behavior. Determining how to handle "terminations"- planned discharges, "therapeutic discharges", discharges against medical advice... sometimes when a child is "pulled" from treatment by a parent against the better judgment and suggestion of the therapist. Speaking of, there is little discussion about how to handle referrals to other types of resources or therapists. Specific methods to avoid (or deal with) "burnout". Very "nuts and bolts" concerns like documentation, treatment planning, dealing with insurance companies and such. Fee setting. What to do if a therapist runs into a client outside of the office or other milieu. How to handle when a client is "stonewalling". Handling clients that are self-medicating. My personal favorite is specific goals and underlying philosophy of our methods as therapists. There are many, many more.
It is of course really important to do case conference, have both group and individual forums for processing what is happening with specific clients or groups and the like. I find it of great import too however, to discuss the above issues. It is one thing to discuss a specific case, but I think it another to discuss what it is about that case that will come up (or has) repeatedly, in a principled manner. Would argue too that discussing issues like responsibility, boundaries, terminations, referrals etc often lead to greater resolution with clients "in the room", as well as provide a way of generalizing our knowledge and methods, thus making it a more organized and effective way of treating folk.
Am not suggesting that these things never occur. It has definitely been my experience however, that most of the above ideas are not discussed in depth, if at all. Certainly concerns of symptom ID and management, differential diagnosis, theoretical orientation and etc are of great import, but it is uncomfortable and counterintuitive to run into a circumstance that occurs frequently or that is a fundamental part of operating in our discipline (treatment planning, for example) that is largely omitted from our education.
More than anything else, I think I'm advocating for more of a focus on our underlying philosophy for employing the methods that we do as therapists. I'm not simply trying to help someone (or their parents) improve failing grades, or get someone in a relationship to be more sensitive or attentive, or even to diminish "depression". What I hope to achieve in most (most) circumstances, is to:
1. Insure safety and stability necessary to do "The Work". (absence of suicidality, abstinence from drugs, ETOH, or a behavior, have medical concerns be ruled out by a physician, insure that necessary resources to do the work are in place, etc)
2. Identify "issues"- the events (relationships, circumstances, etc) or other causes that prompt us to feel mad, sad, afraid, ashamed, and/or hurt and/or "behave" in ways we struggle with.
3. Process those issues in a way that diminishes, transforms, and/or (almost) eliminates them and subsequently behaviors, choicemaking, or perspectives that might contribute to these issues in an ongoing way.
4. Provide a "body of material" (patient education, referral sources, resources etc) that enables the client to be able to do these things without the therapist.
5. Insure that the client has sufficient resources (support groups, family, friends, etc) that support the work and use of that material in an ongoing way.
These are an oversimplification, but I think they go beyond simply "resolving a problem", eliminating a behavior and etc. Much of the inner workings of these ideas don't get processed as much as I'd hope while we're being educated about our discipline, but again, of course this philosophy likely exists in many of our "theoretical orientations". In my sense of things, the presence of such a philosophy doesn't go far enough- we as individual therapists need to have a grasp of our own sense of these things to make them as effective as possible.
Would say further that none of this is supported unless part of our own supervision is about dealing with our own experience both as a therapist, and a person outside of therapy. My ability to problem-solve many of the issues "not discussed" above is diminished by not having the opportunity to explore these things as part of our own clinical supervision. The largest of these things for me are the underlying treatment philosophy, and the effectiveness and grace that I deal with my own life- including my life as a therapist.
Tuesday, April 27, 2010
Speaking of Service...
My friend and colleague Judy McGehee MA, LMFT (www.mcgeheepartners.org) along with Ted Aaselund LMFT have been providing clinical supervision (completing hours for graduation and/or eventual licensure) for a great group of interns and trainees at Judy's office in Glendora, California. They have been providing sometimes up to 40 hours of services to local schools with these Masters level folk to students and families who might not get these services at all otherwise.
I have been truly humbled by the work of these people, and lucky to get to participate in part of the supervision. We have been discussing the obvious concerns about professional standards, law and ethics concerns, types of interventions, philosophy, differential diagnosis, addiction, depression, abuse and etc. What has been so remarkable though is the intensity of the losses and difficulties these students and families have had, but equally, the grace and commitment of the interns and Judy insuring that these folk get taken care of.
It appears now that eventually, on top of the individual services that are being provided to the educational institutions, students, and families, there may be an opportunity for a multi-family group therapy at low cost for these individuals. This is such a great service, but sadly, there is no funding available for this to happen (space may be made available at a school). Of course I can't discuss the details but, there have been some huge losses for these families that they are getting little support for treating from a public standpoint, the responsibility of both the service and the internship being largely on the shoulders of Judy and the interns, a little on Ted and I (as we didn't take this on from the beginning). The families served aren't just getting low-level services- they are getting truly insightful, wise, professional services thanks to the good heartedness of the people involved.
Providing clinical supervision is such an important part of what I'm lucky enough to get to do. It means much to me that I'm in a place where I'm not just empowered to help people, but that I am empowered to help people, who can further be of service to others. What I do, I hope, matters a great deal, and the opportunity to share some of that with other people who might further use some of that to help yet other people is amazing.
I have been truly humbled by the work of these people, and lucky to get to participate in part of the supervision. We have been discussing the obvious concerns about professional standards, law and ethics concerns, types of interventions, philosophy, differential diagnosis, addiction, depression, abuse and etc. What has been so remarkable though is the intensity of the losses and difficulties these students and families have had, but equally, the grace and commitment of the interns and Judy insuring that these folk get taken care of.
It appears now that eventually, on top of the individual services that are being provided to the educational institutions, students, and families, there may be an opportunity for a multi-family group therapy at low cost for these individuals. This is such a great service, but sadly, there is no funding available for this to happen (space may be made available at a school). Of course I can't discuss the details but, there have been some huge losses for these families that they are getting little support for treating from a public standpoint, the responsibility of both the service and the internship being largely on the shoulders of Judy and the interns, a little on Ted and I (as we didn't take this on from the beginning). The families served aren't just getting low-level services- they are getting truly insightful, wise, professional services thanks to the good heartedness of the people involved.
Providing clinical supervision is such an important part of what I'm lucky enough to get to do. It means much to me that I'm in a place where I'm not just empowered to help people, but that I am empowered to help people, who can further be of service to others. What I do, I hope, matters a great deal, and the opportunity to share some of that with other people who might further use some of that to help yet other people is amazing.
Subscribe to:
Posts (Atom)
