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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: Great Attachment Debate  NP0016, Attachment, Session 6, Allan SchoreThank you for attending this final session of “The Great Attachment Debate.” We hope you’ll come away from this course with a better understanding of attachment research and an awareness of the range of viewpoints about attachment theory and the consulting room. During this session with Allan Schore, one of the leaders of the neuropsychology movement, he’ll delve into how affect and psychobiological change are significant in the therapy process. He’ll cover intersubjectivity and how understanding it can help us in our work, how to help clients develop a body-based relationship unconscious, and much more. After listening to the course, please take a few minutes to comment about what was most interesting to you about this session, and to reflect on the course in its entirety. What was most relevant to you in your practice and everyday life? What questions remain for you? Thank you all for your participation in this series, and for taking the time to share your thoughts. 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, Session 5, Sue JohnsonHow is Attachment Theory relevant to effectively couples therapy? Learn with Sue Johnson how understanding and working with attachment relationships will help therapists deepen their emotional presence and work with clients’ emotional reactivity in session. Johnson, one of the originators of Emotionally Focused Couples Therapy, will explore the principles of this empirically validated treatment and how to apply Attachment Theory in therapy. After this session, please take a few minutes to engage in the Comment Board and let us know what you think about using this method with couples and whether you think Attachment Theory is applicable in couples therapy. What was new or most striking about this presentation? What questions did this bring up for you? 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 4, David SchnarchAre there any downsides to basing clinical treatment on Attachment Theory? In this session, discover why David Schnarch, a leading advocate of differentiation in the therapy process, believes that Attachment Theory keeps clients functioning as needy children. Schnarch will discuss how to use confrontation as an effective therapeutic approach. After this session, please take a few minutes to engage in the Comment Board and let us know what you think about using this strategy with clients. What was most relevant about this presentation? What questions did this bring up for you? 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 NP0008, Attachment, Session 5, Sue JohnsonHow is Attachment Theory relevant to effectively couples therapy? Learn with Sue Johnson how understanding and working with attachment relationships will help therapists deepen their emotional presence and work with clients’ emotional reactivity in session. Johnson, one of the originators of Emotionally Focused Couples Therapy, will explore the principles of this empirically validated treatment and how to apply Attachment Theory in therapy. After this session, please take a few minutes to engage in the Comment Board and let us know what you think about using this method with couples and whether you think Attachment Theory is applicable in couples therapy. What was new or most striking about this presentation? What questions did this bring up for you? 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 NP0008, Attachment, Session 4, David SchnarchAre there any downsides to basing clinical treatment on Attachment Theory? In this session, discover why David Schnarch, a leading advocate of differentiation in the therapy process, believes that Attachment Theory keeps clients functioning as needy children. Schnarch will discuss how to use confrontation as an effective therapeutic approach. After this session with Schnarch, please take a few minutes to engage in the Comment Board and let us know what you think about using this strategy with clients. What was most relevant about this presentation? What questions did this bring up for you? 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 P004, Attachment, Session 6, Allan SchoreThank you for attending this final session of “The Great Attachment Debate.” We hope you’ll come away from this course with a better understanding of attachment research and an awareness of the range of viewpoints about attachment theory and the consulting room.
05.05.2011 Posted In: P004 New Perspectives on Practice: The Great Attachment Debate By Psychotherapy Networker
During this session with Allan Schore, one of the leaders of the neuropsychology movement, he’ll delve into how affect and psychobiological change are significant in the therapy process. He’ll cover intersubjectivity and how understanding it can help us in our work, how to help clients develop a body-based relationship unconscious, and much more. After listening to the course, please take a few minutes to comment about what was most interesting to you about this session, and to reflect on the course in its entirety. What was most relevant to you in your practice and everyday life? What questions remain for you? Thank you all for your participation in this series, and for taking the time to share your thoughts. Comments P004, Attachment, Bonus Session, Ed TronickThank you for your participation in our New Perspectives on Practice Series, “The Great Attachment Debate.” These six sessions will cover 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 most interesting to you so far throughout this webinar series, what stood out to you the most after Ed Tronick’s Bonus Session, and to 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. Comments P004, Attachment, Session 5, Sue JohnsonSue Johnson, one of the originators of Emotionally Focused Couples Therapy (EFT) will discuss, in today’s session, how Attachment Theory can help clinicians conduct effective therapy, particularly in couples work. She’ll cover how to use an understanding of Attachment Therapy to enhance emotional presence with clients, how to work with clients’ emotions during therapy, how therapists’ own attachment relationships can affect the therapeutic process, and much more. After listening to this session, “Attachment Patterns in Couples Relationships,” please take a few minutes to reflect on what you’ve learned so far in this webinar, to ask any questions you may have, or what you thought was most interesting and relevant. We invite you to include your name and hometown and to respond to other participants’ comments and questions, as always. 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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