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Tough Customers: Is It Them or Us?
By Rich Simon As therapists, many of us practice in two different worlds. In the first, we see polite, well-behaved, articulate clients with solid values. They engage fully in therapy, talk cogently about their problems, listen attentively to our responses, make reasonably good-faith efforts to follow our suggestions, and sooner or later get better. No wonder we genuinely like these people! Does This Kid Need Medication? with Ron Taffel
Meds: Myths and Realities: NP0035 – Session 3
Do you feel like you could be a more effective therapist with your younger clients? Do you find it hard to determine when interventions--psychological and pharmacological--might be needed? Join Ron Taffel and learn to identify key diagnostic signs that indicate medications could be helpful when dealing with depression, anxiety, AD/HD, and affective disorders. After the session, please let us know what you think. If you ever have any technical questions or issues, please feel free to email support@psychotherapynetworker.org.In Consultation
Peer Supervision Groups that Work
By Eleanor Counselman
Three steps that make a difference
Q: I’d like to organize a peer supervision group, but I’ve heard their failure rate is high. What do you recommend? A: Peer supervision groups provide a welcome respite from the isolation of private practice and an informal, nonevaluative setting after years of formal supervision, particularly for young therapists. They offer valuable guidance on difficult cases and tough ethical dilemmas to therapists at any level of experience. And they’re free! However, as you note, many of them fail. In my experience, careful attention to the initial contract and the ongoing group process can make a huge difference in helping them sustain their membership and thrive. Though they’re often called peer supervision groups, it would be more accurate to call them peer consultation groups. Members don’t have direct supervisory responsibility for one another’s cases: they simply offer suggestions, which members can accept or reject. They typically have four to six members who have approximately the same level of professional experience or share a specific area of interest. Members meet on a regular, usually biweekly, basis. Group consultation, with or without a leader, offers advantages over individual consultation. It includes the possibility of multiple perspectives on the same problem and the reduction of clinicians’ shame about confusions and mistakes as they share similar stories about their struggles with difficult cases. Another benefit is peer interaction, which develops one’s professional sense of self. The hall-of-mirrors effect—seeing yourself as others see you—which is so potent in therapy groups, is a major component of the supervision group experience. Nevertheless, despite the many benefits, it’s challenging to start and maintain a consultation group, particularly if it’s a leaderless one. They can fail to thrive or suffer from “task drift,” moving them away from discussing clinical material and into a form of therapy. It can be difficult to integrate new members and maintain clarity about the group’s own process. Presenting cases in supervision in any format poses obvious risks to one’s self-esteem, and group dynamics add additional risks: issues of power, competition, exposure, and shame can lead members to drop out. It’s especially challenging to manage group dynamics in leaderless groups, as it’s usually the leader’s role to remain aware of what’s happening within the group, and without a leader in charge, shame or fear of being judged may silence members. The most successful leaderless groups seem to be those in which the group members find a balance between a focus on cognitive and emotional issues—talking about cases and about the feelings that arise when seeing clients—while consciously managing the functions that a designated leader would serve. These include protecting the group contract, setting and maintaining appropriate norms, and handling gatekeeping matters, such as bringing in new members. A crucial component of maintaining an atmosphere of group safety is regular, dependable member attendance. Without this, a group will never feel like a place to take risks. Members need to be willing to bring up concerns about irregular attendance because, just as in a therapy group, member lateness and absences can indicate issues that need exploring. Chronic irregular attendance can be demoralizing and cause a group to fail. When it comes to group safety and cohesion, Woody Allen was right: 90 percent of supervision group success is about showing up. A significant issue in any supervision group is shame and the reluctance to expose oneself. To make supervision groups feel safer, therapist David Altfeld developed a model of group consultation in which all group members simply share their emotional reactions and associations to a situation being discussed, instead of one person presenting a specific case issue and everyone else giving advice as resident “experts.” This procedure levels the playing field by not allowing members to compete for the best case analysis. It leaves room for highlighting emotional issues, countertransference reactions, and parallel process. Making everyone vulnerable in this manner avoids opportunities for excessive criticism (or its counterpart, excessive niceness) and encourages emotional sharing. Another group consultation model, developed by Irish therapist Bobby Moore, focuses only on minimal case information, such as a patient’s age, length of time in therapy, and perhaps a little demographic information. Then the presenter talks about his or her thoughts, fantasies, feelings, and associations about the patient and the therapy. Group members then share their associations. Following that, the initial presenter is invited to share any further associations. Only at this point does the presenter give the facts of the case and the clinical dilemma. Finally, the group thinks together about what’s been discussed and what it indicates about the case. For those interested in the power of the collective unconscious, this is a fascinating process to experience. To succeed, a consultation group must feel safe and useful to its members. Here are a few simple principles to follow: Clarify the group structure. The group needs to agree on the frequency and length of meetings, which is best accomplished with a predictable schedule. The group needs to agree on its task and focus: is this group for any clinical issue or just for couples, or trauma, or group therapy? How much time will the group spend on “schmoozing,” and will there be one or more than one case presented each time? What will be the presentation format? While most groups use verbal presentation, some groups are now using videoclips—which makes the discussion much livelier. Agree on membership issues. How many members will the group have, and how will new members be integrated? Once a group has formed, I believe that decisions about adding more members should be a group decision. While it may be tempting to accept a request from someone who wants to join the group, a total of six members seems to be the maximum number for each member to have enough opportunities for presentations. Attend to the group process and dynamics. While groups should build in a “schmooze” or “check-in” time, there needs to be an agreed-upon limit to the socializing, so that the group doesn’t become a therapy group or a coffee klatch. Without a leader, the members themselves must monitor the group’s procedures and raise any important issues. Some groups do this ad hoc; others schedule a regular review meeting to evaluate how things are going. Leaderless peer supervision groups can help clinicians at any stage further clinical learning and combat professional isolation. They’re likeliest to succeed when the group members have a clear working agreement, maintain regular attendance, and create an environment in which both emotional and cognitive learning occurs. Eleanor Counselman, Ed.D., is a past president of the Northeastern Society for Group Psychotherapy and an assistant professor of psychiatry at Harvard Medical School. She’s published numerous articles on psychotherapy and has a private practice in Belmont, Massachusetts.
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Tag: Attachment  Riding the Wave: Harnessing the Power of Emotion with Kathryn RheemWho’s Afraid of Couples Therapy?: NP0022 – Bonus Session 2Discover with Kathryn Rheem how to respond effectively when clients express strong feelings in session. Based on Emotionally Focused Therapy, you’ll explore attunement and how to use your own emotions to help clients move beyond attachment injuries. After the session, please let us know what you think. If you ever have any technical questions or issues, please feel free to email support@psychotherapynetworker.org. Comments Attachment Issues: Embracing Disowned Parts with Janina FisherThe 6 Most Challenging Issues in Therapy: NP0021 --- Session 5Discover how to join with self-loathing clients who are so filled with feelings of shame and worthlessness that they find little benefit from the therapeutic relationship. Janina Fisher, who lectures and writes about integrating neuroscience research and body-centered approaches into psychotherapy, guides the viewer on how to help clients heal their attachment issues and gain self-compassion and acceptance. After you hear this presentation, please take a few minutes to comment about what you found most interesting or relevant, to ask any questions you have of the presenter or your colleagues, or to share any experiences. As always, if you ever have any technical questions, please feel free to email support@psychotherapynetworker.org and our Support Team will help you. Comments NP0016, Attachment, Bonus Session, Ed TronickThank you for your participation in “The Great Attachment Debate,” which has covered a wide range of viewpoints on attachment theory and research and how the role of attachment theory in the consulting room. For our Bonus Session, “What Therapists Should Know about Human Development,” development researcher Ed Tronick will join us to discuss development, attachment, and psychotherapy. After listening, please take a few minutes to comment about what’s been most interesting to you throughout this webcast series, what stood out to you the most after this session, and ask any questions you may have. We invite you to include your name and hometown to continue creating a sense of community and to read and respond to others’ comments and questions. As always, for any technical questions, please feel free to email support@psychotherapynetworker.org and our Support Team will help you. Comments NP0016, Attachment, Session 3, Dan SiegelHow can attunement enhance brain integration and self-regulation? In this third session of The Great Attachment Debate, Dan Siegel, one of the leading proponents of integrating brain science and psychotherapy, will explore the practical applications of Attachment Theory in clinical practice, and explain the role of attunement in integration. Siegel, a prominent researcher, will shed light on interpersonal neurobiology. After participating in this session, please take a few minutes to review and engage in the Comment Board. What did you learn in this session that was new or surprising? What was most interesting or relevant to you? What questions do you have now for the presenter or other participants? Please feel free to share your thoughts, and we invite you to include your name and hometown along with your comment. If you ever have any technical questions or concerns, contact support@psychotherapynetworker.org, and someone from our Support Team will respond as soon as possible. Comments NP0016, Attachment, Session 2, Jerome KaganAre we too attached to attachment theory? In this session with leading child psychologist Jerome Kagan, you’ll get the opportunity to explore the methodology and evidence behind Attachment Theory. Then, you’ll be able to decide whether you think the research shows that temperament or attachment is more significant to human development. After hearing Kagan talk about the research and theories, please take a few minutes to engage in the Comment Board. Let us know what you think. What did you learn from this session that was new? What was most striking about this session for you? What questions do you have? We invite you to include your name and hometown along with your comment. If you ever have any technical questions, contact support@psychotherapynetworker.org. Comments NP0016, Attachment, Session 1, Alan SroufeIs Attachment Theory important to clinical practice today? Over the next few weeks, the Great Attachment Debate will present a variety of viewpoints from leading experts on the scientific foundations of Attachment Theory to answer this relevant question about its implications.
03.20.2012 Posted In: NP0016 The Great Attachment Debate By Psychotherapy Networker
In this first session, you’ll learn the fundamentals of Attachment Theory—John Bowlby’s influence, the connection between attachment style and psychopathology, and why Attachment Theory is important to clinical practice—with leading researcher Alan Sroufe. After each session, please take a few minutes to engage in the Comment Board, an important part of our learning experience and to create a community of learning between participants. Please feel free to comment about what you’ve learned in the session, to ask any questions you may have of the presenter or your peers, or to share any relevant experiences. We invite you to include your name and hometown along with your comment. If you ever have any technical questions, contact support@psychotherapynetworker.org. Comments NP0011, Couples, Bonus 2, Kathryn RheemDiscover with Kathryn Rheem how to respond effectively when clients express strong feelings in session. Based on Emotionally Focused Therapy, you’ll explore attunement and how to use your own emotions to help clients move beyond attachment injuries.
01.25.2012 Posted In: NP0011 Who's Afraid of Couples Therapy? By Psychotherapy Networker
After the session, please take a few minutes to let us know what you think, both about this session and about the series as a whole. What stood out for you? What questions remain? We encourage you to take this opportunity to share your thoughts, questions, and revelations. Please include your name and hometown with your comments. As always, if you have any technical questions or issues, please feel free to contact support@psychotherapynetworker.org. Thank you so much for your participation during this series. Comments P004, Attachment, Session 4, David SchnarchThis session will air on Tuesday, April 26th 2011. Join David Schnarch, a leading proponent of the role of differentiation in the therapeutic process, as he discusses his perspectives on attachment and why he believes that Attachment Theory can keep clients in the role of needy children. This fourth session of “The Great Attachment Debate,” will go over the importance of differentiation in healthy development, delve into enmeshment and how it contributes to fused relationships, explain “attachment hegemony” and how it can get in the way of effective therapy, and much more. After listening to Schnarch’s presentation, we encourage you to please reflect on what you’ve learned and comment on what was most interesting to you, ask any questions you may have, and share any relevant experiences. We invite you to include your name and hometown, and to review what other participants have to say about this particular session and their webinar experiences. Comments P004, Attachment, Session 3, Dan SiegelWelcome to “The Attuned Therapist: Attachment Theory in Action,” with Dan Siegel—the third session in our newest webinar course, “The Great Attachment Debate.” As you probably know by now—if you attended the 2010 Symposium, read our March/April 2010 issue on attachment, or heard from Networker Editor Rich Simon in this webinar—a “great debate” on attachment occurred live—spontaneously—at last year’s conference. At one of Jerome Kagan’s workshops, his comments regarding attachment theory prompted Attachment Theory advocate Dan Siegel, M.D., to unexpectedly get up in front of the crowd and respond on the spot. This heated debate between two respected minds in the field sparked much discussion at the conference and afterward. In this webinar session, Siegel will discuss how Attachment Theory is integrated into his clinical approach. He’ll talk about how to use the Adult Attachment Interview in assessing clients, applying brain science in the consulting room, brain integration and how it can enhance self-regulation, and much more. Please take a few moments to comment on what you felt was most striking, most relevant, or to ask any questions you may have. We encourage you, as always, to include your name and hometown with your comments. Thank you for sharing your thoughts with this community. Comments P004, Attachment, Session 2, Jerome KaganWelcome to the second session of The Great Attachment Debate. Today’s session with renowned developmental psychologist Jerome Kagan will discuss the scientific evidence that forms the foundation of Attachment Theory, and whether we’re “too attached” to using Attachment Theory as a basis for our clinical work. He’ll go over the Strange Situation and what it measures, the roles of attachment and temperament in human development, and more. After listening to today’s session, please comment on what you felt was most relevant or interesting. The Comment Boards are a platform for both questions and discussion, and to continue fostering a sense of community, we encourage you to include your name and hometown with your comments. We thank you for your participation in this significant webinar debate, and for your sharing your thoughts. Comments P004: Attachment, Session 1, Alan SroufeWelcome to “The Great Attachment Debate”—a 6-part webinar interview series with leading experts in the field, brought together to present the scientific foundations of Attachment Theory and how it influences—or doesn’t influence—our clinical work. The series, following the March/April 2011 issue on attachment, kicks off with Alan Sroufe, Ph.D., a leading Attachment Theory researcher.
03.31.2011 Posted In: P004 New Perspectives on Practice: The Great Attachment Debate By Psychotherapy Networker
This first session will delve into what research has shown us about the effects of our early relationships. Sroufe will explore John Bowlby’s work and how it’s led to attachment research, connections between attachment style and mental health, how Attachment Theory affects the process of change in psychotherapy, and much more. After listening to Sroufe’s presentation, please take a moment to comment here and share your thoughts. The Comment Boards will be on the Networker website throughout this webinar so we can share thoughts, experiences, and any questions, creating a space for learning and community. What did you learn today that was new or interesting? Please feel free to include your name and hometown along with your comment, and make sure to check out Alan Sroufe and Daniel Siegel's feature article on attachment in the March/April issue, "The Verdict Is In." Comments |
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