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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: Ethics  Telemental Health in the 21st Century with Marlene MaheuHandling Today's Hidden Ethical Dilemmas: NP0026 – Session 6As the final session in the “Handling Today’s Hidden Ethical Dilemmas” series, Marlene Maheu, a leader and pioneer in telehealth, will discuss how to effectively provide online therapy while maintaining ethical boundaries. She’ll explore such tools as Skype, Google, virtual self-help products, and more. 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 Law, Ethics, and Risk Management with Steven FrankelHandling Today's Hidden Ethical Dilemmas: NP0026 – Session 5During this session of “Handling Today’s Hidden Ethical Dilemmas,” you’ll have the opportunity to hear from Steven Frankel, who’s a certified clinical and forensic psychologist as well as an attorney at law. Frankel will discuss the best ways to deliberately avoid the most common ethical dilemmas in order to protect your clients and yourself. 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 The Ethics of Termination with William DohertyHandling Today's Hidden Ethical Dilemmas: NP0026 – Session 4Learn from veteran therapist William Doherty as he’ll delve into complicated ethical situations by showing video clips from the popular HBO series, “The Sopranos” and “In Treatment” to lead discussions on useful and unbeneficial ways to bring up terminations when clients are no longer benefiting from therapy. Doherty will explain the most common scenarios when termination is—or should be broached—and will go over strategies for initiating termination topic at the right time and in the right way. 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 The Therapist's Duty to Warn with Clifton MitchellHandling Today's Hidden Ethical Dilemmas: NP0026 – Session 3Join Clifton Mitchell for a practical discussion on the latest legal developments on therapists’ responsibility to handle self-injurious behavior in clients, report abuse or rape, and handle right-to-die issues. Mitchell will delve into significant legal and ethical situations and discuss practical case studies that’ll help you better understand the best ways to deal with these important issues—ethically and legally speaking—in the consulting room. 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 Ethics in the Digital Age with Ofer ZurHandling Today's Hidden Ethical Dilemmas: NP0026 – Session 2How has digital technology changed the ethical challenges practitioners face in the consulting room? Join psychologist Ofer Zur in this practical discussion of the new ethical trials that exist due to new technologies such as email, social media platforms, the Internet, cell phones, and more. Zur will break down the new issues and provide suggestions as to what therapists should do in order to best handle these ethical quandaries. 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 21st-Century Ethical Dilemmas with Mary Jo BarrettHandling Today's Hidden Ethical Dilemmas: NP0026 – Session 1Welcome to New Perspectives on Practice: Handling Today’s Hidden Ethical Dilemmas. This practical and thought-provoking series with leading experts on ethical practice will explore current ethical guidelines for therapists. The first session with Mary Jo Barrett will delve into how to reconcile boundary maintenance and will cover why peer supervision and consultation are vital to ethical therapy, plus many issues that are consistently confusing for clinicians. 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 Who Needs an Ethics Code?Some people---especially those who’ve never been in therapy---insist that the therapist is nothing more than a kind of paid friend. After all, isn’t therapy just a regularly scheduled conversation in which Party A listens sympathetically, making encouraging or consoling little noises, while Party B feels free to share the most intimate details of her life? But of course it’s a rare friendship that could tolerate such open-ended, one-sided “sharing” of our most private concerns, not to mention our uncensored thoughts and feelings. In fact, the hallmark of the therapeutic encounter is that the therapist is an expert, trained in a particular skill-set to conduct a rather odd, rarified conversation, while the client most definitely is not. Although both therapist and client enter equally and freely into an association, it’s understood that for the duration of treatment, the relationship---however “collaborative”---will also be hierarchical: the therapist will be the guide, leader, advisor, teacher, whatever, e.g., the one in charge. In effect, the client agrees, however grudgingly and fitfully, to at least attempt to unilaterally disarm and expose his vulnerability, neediness, flaws, and failings to someone who’s in no sense obliged or expected to reciprocate. What keeps this arrangement from being hugely dangerous for the client---what makes it even possible, let alone healing---isn’t just the therapist’s skill, but the nature of the ethical contract underlying the therapeutic relationship itself. It’s precisely the client’s deep-seated knowledge that this relationship is defined and bound all around by firm ethical rules of conduct that frees him from the ordinary internal and social strictures that often make emotional healing impossible. We may like to think that as good-hearted, moral, upright, caring people, we don’t really need formal codes of ethics. After all, we aren’t going to rob our clients, sleep with them, gossip about them, manipulate them for our own advantage. In fact, we’d never hurt anybody . . . intentionally. But there’s the rub. Nowadays, personal and social boundaries have become so loose and blurry that it’s possible to transgress them without even realizing it. In the salad days of psychoanalysis, professional ethics---particularly those having to do with boundaries, dual relationships, confidentiality, and so forth---were largely in synch with the times. Even up into the 1960s and ’70s, we lived in a relatively buttoned-up culture in which clear demarcations between the personal, the social, and the professional were the norm. Today, all those old notions have pretty much gone out the window. The seductive informality of our times has transformed even our most basic ideas of when our “office” hours end and where therapy takes place. A few months ago, attending a psychotherapy conference held at a seaside resort town, I was hanging out by the pool with an old therapist buddy who refused a second glass of wine because he said he had to get on the phone for a therapy session. Indeed, therapy now takes place regularly via Skype, cell phone, e-mail, and even in little therapy smidgens via texting. Do I hear the sound of Freud & Co. collectively rolling over in their graves? In the rebroadcast of our acclaimed webcast, Handling Today’s Hidden Ethical Dilemmas, starting September 17, six of our field’s clearest thinkers demonstrate that formal codes of ethics are far more than an antiquated set of rules, periodically reviewed in mind-numbing CE trainings so we can meet our licensing requirements. Instead, they are what makes psychotherapy as we know it possible. In fact, it might be said that whenever we conduct a therapy session, whether in person, on the phone, or in cyberspace, those rules are always implicitly present---our tacit ally and cotherapist---insuring that whatever therapeutic space is being created is truly a safe haven in a world in which circles of emotional safety and protection are in exceedingly short supply. Want to know more about Ethics? Check out these two free articles from the July/August 2012 issue, "Ethics Today and Yesterday" by Mary Jo Barrett and "Therapist Self-Disclosure" by Janine Roberts. Looking for quick CEs? Take the online magazine quiz, "Ethics In The Digital Age". Comments NP0017, Ethics, Session 6, Marlene MaheuAs the final session in the “Handling Today’s Hidden Ethical Dilemmas” series, Marlene Maheu, a leader and pioneer in telehealth, will discuss how to effectively provide online therapy while maintaining ethical boundaries. She’ll explore such tools as Skype, Google, virtual self-help products, and more.
03.09.2012 Posted In: NP0017 Handling Today's Hidden Ethical Dilemmas By Psychotherapy Networker
After this presentation, please take a few minutes to reflect on what was striking to you about this particular session, how it fits in with the entire series, and your thoughts after participating in this course and hearing perspectives on a variety of applicable topics. What do you think was most interesting or relevant to your practice? What questions remain for you? We encourage you to comment on this session and about the series as a whole, as this kind of deeper engagement is vital to learning and understanding. Thank you for your participation, and we hope you come away from this course with a clearer vision of how to handle challenging ethics issues. If you have any technical questions, please feel free to contact support@psychotherapynetworker.org. Thanks for your participation. Comments NP0017, Ethics, Session 5, Steven FrankelDuring this session of “Handling Today’s Hidden Ethical Dilemmas,” you’ll have the opportunity to hear from Steven Frankel, who’s a certified clinical and forensic psychologist as well as an attorney at law. Frankel will discuss the best ways to deliberately avoid the most common ethical dilemmas in order to protect your clients and yourself. After the session, please take a few minutes to engage in the Comment Board and share your reflections with the presenter and other participants. What was most striking to you about this presentation? Do you have any questions related to this material? We invite you to share your thoughts, questions, and ideas, as well as including your name and hometown with your comments. If you ever have any technical questions, please feel free to contact support@psychotherapynetworker.org. Thanks for your participation. Comments NP0017, Ethics, Session 4, William DohertyLearn from veteran therapist William Doherty as he’ll delve into complicated ethical situations by showing video clips from the popular HBO series, “The Sopranos” and “In Treatment” to lead discussions on useful and unbeneficial ways to bring up terminations when clients are no longer benefiting from therapy. Doherty will explain the most common scenarios when termination is—or should be broached—and will go over strategies for initiating termination topic at the right time and in the right way. After the session, please take a few minutes to let us know what you think. What did Doherty discuss that was new to you? What was most interesting or relevant? We invite you to share your thoughts, questions, and revelations, as well as including your name and hometown with your comments. Comments NP0017, Ethics, Session 3, Clifton MitchellJoin Clifton Mitchell for a practical discussion on the latest legal developments on therapists’ responsibility to handle self-injurious behavior in clients, report abuse or rape, and handle right-to-die issues. Mitchell will delve into significant legal and ethical situations and discuss practical case studies that’ll help you better understand the best ways to deal with these important issues—ethically and legally speaking—in the consulting room. After the session, please take a few minutes to engage in the Comment Board and let us know what you think. What did Mitchell discuss that was new to you? Do you have any specific questions for the presenter or your peers? We invite you to share your thoughts, questions, and revelations, as well as including your name and hometown with your comments. If you have any technical questions, please feel free to contact support@psychotherapynetworker.org. Thanks for your participation. Comments NP0017, Ethics, Session 2, Ofer ZurHow has digital technology changed the ethical challenges practitioners face in the consulting room? Join psychologist Ofer Zur in this practical discussion of the new ethical trials that exist due to new technologies such as email, social media platforms, the Internet, cell phones, and more. Zur will break down the new issues and provide suggestions as to what therapists should do in order to best handle these ethical quandaries. After the session, please take a few minutes to engage in the Comment Board and let us know what you thought. What did Zur bring up that was new to you? Do you think there are any other ethical dilemmas brought up by new technologies that weren’t mentioned in this presentation? Do you have any specific questions for Zur or for your peers? We invite you to share your thoughts, questions, and revelations, as well as including your name and hometown with your comments. If you have any technical questions, please feel free to contact support@psychotherapynetworker.org. Thanks for your participation. Comments NP0017, Ethics, Session 1, Mary Jo BarrettWelcome to New Perspectives on Practice: Handling Today’s Hidden Ethical Dilemmas. This practical and thought-provoking series with leading experts on ethical practice will explore current ethical guidelines for therapists. The first session with Mary Jo Barrett will delve into how to reconcile boundary maintenance and will cover why peer supervision and consultation are vital to ethical therapy, plus many issues that are consistently confusing for clinicians. After each session, there will be Comment Boards available as a way for participants to share what was most interesting or relevant from the sessions, and to ask questions of the presenters and of each other. We invite you to utilize these Comment Boards as a forum for thought and discussion after each session and after completing the course. What was most striking about this session with Mary Jo Barrett? Do you have any similar, relevant experiences? Did this bring up any questions for you? Thanks so much for your participation, and welcome to this important and lively series! If you have any technical questions or issues, please feel free to email support@psychotherapynetworker.org. Comments What’s Hot in Psychotherapy Today: The Symposium Top 5Curious about the presenters and approaches attracting the most attention at this year’s Symposium? Here’s your chance to find out. In addition, with the early registration deadline just around the corner (February 6th), now’s a good time to consider workshop choices. You can peruse the Symposium program a number of easy ways—online, via our digital brochure, or in print—but we wanted to let you know about the workshops people seem most excited about so far. In reverse order, the 5 top workshops to date are: Comments NP0012, Ethics, Bonus Session, Marlene MaheuAs the final, bonus session in the “Handling Today’s Hidden Ethical Dilemmas” series, Marlene Maheu, a leader and pioneer in telehealth, will discuss how to effectively provide online therapy while maintaining ethical boundaries. She’ll explore such tools as Skype, Google, virtual self-help products, and more.
12.20.2011 Posted In: NP0012 Handling Today's Hidden Ethical Dilemmas By Psychotherapy Networker
After this presentation, please take a few minutes to reflect on what was striking to you about this particular session, how it fits in with the entire series, and your thoughts after participating in this course and hearing perspectives on a variety of applicable topics. What do you think was most interesting or relevant to your practice? What questions remain for you? We encourage you to comment on this session and about the series as a whole, as this kind of deeper engagement is vital to learning and understanding. Thank you for your participation, and we hope you come away from this course with a clearer vision of how to handle challenging ethics issues. Comments NP0012, Ethics, Session 5, Steven FrankelToday’s session with Steven Frankel will delve into how to avoid the most common ethical pitfalls and how to handle the most common ethical—and legal—issues. He’ll discuss role conflicts and deviations, boundary crossings and violations, and the three axioms of ethical responsibility. After the session, please take a few minutes to let us know what you think. What did the presenter discuss that was new to you? What was most interesting or relevant? We invite you to share your thoughts, questions, and revelations, as well as including your name and hometown with your comments. If you have any technical questions, please feel free to contact support@psychotherapynetworker.org. Thanks for your participation. Comments NP0012, Ethics, Session 4, William DohertyLearn from veteran therapist William Doherty as he’ll delve into complicated ethical situations by showing video clips from the popular HBO series, “The Sopranos” and “In Treatment” to lead discussions on useful and unbeneficial ways to bring up terminations when clients are no longer benefiting from therapy. Doherty will explain the most common scenarios when termination is—or should be broached—and will go over strategies for initiating termination topic at the right time and in the right way. After the session, please take a few minutes to let us know what you think. What did Doherty discuss that was new to you? What was most interesting or relevant? We invite you to share your thoughts, questions, and revelations, as well as including your name and hometown with your comments. If you have any technical questions, please feel free to contact support@psychotherapynetworker.org. Thanks for your participation. Comments NP0012, Ethics, Session 3, Clifton MitchellJoin expert Clifton Mitchell for a practical discussion on the latest legal developments on therapists’ responsibility to handle self-injurious behavior in clients, report abuse or rape, and handle right-to-die issues. Mitchell will cover significant legal and ethical situations and discuss practical case studies that’ll help you better understand the best ways to deal with these important issues—both ethically and legally—in the consulting room. After the session, please take a few minutes to let us know what you think. What did Mitchell bring up that was most relevant or interesting to you? Do you have any specific questions for the presenter or your peers? We invite you to share your thoughts, questions, and revelations, as well as including your name and hometown with your comments. If you have any technical questions, please feel free to contact support@psychotherapynetworker.org. Thanks for your participation. Comments NP0012, Ethics, Session 2, Ofer ZurHow has digital technology changed the ethical challenges therapists face with clients every day? Join psychologist Ofer Zur in this practical discussion of the new ethical trials that have been brought up due to 21st-century technologies such as email, social media platforms, the Internet, cell phones, and more. Zur will break down these new dilemmas and provide suggestions as to what clinicians should do to effectively handle these ethical quandaries. After the session, please take a few minutes to engage in the Comment Board and let us know what you thought. What did Zur bring up that was new to you? In your opinion, are there any other ethical dilemmas that exist because of new technologies that weren’t mentioned in this presentation? Do you have any questions for the presenter or participants? Comments NP0012, Ethics, Session 1, Mary Jo BarrettWelcome to the New Perspectives on Practice series, “Handling Today’s Hidden Ethical Dilemmas.” In this popular series with leading experts on ethical practice, you’ll gain a practical and illuminating look at ethical guidelines for therapists in the 21st century.
12.02.2011 Posted In: NP0012 Handling Today's Hidden Ethical Dilemmas By Psychotherapy Networker
This first session with Mary Jo Barrett, the founder and director of the Center for Contextual Change, will give you real-world examples of how to maintain boundaries even in the most challenging situations with clients. Learn why engaging in peer supervision and consultation are vital to conducting ethical therapy, and delve into many issues that are consistently confusing for clinicians. Throughout this series, a Comment Board will be available after each session. These Comment Boards are a way for participants to share thoughts and reflections about what was most thought-provoking and to ask questions of the presenters and of each other. We invite and encourage you to use these Comment Boards as a forum for learning. After listening to this first session, please just take a few minutes to share what you think. What was most interesting about this presentation? What questions do you have? Thank you so much for your participation, and welcome to this relevant and important series. If you ever have any technical questions or issues, please feel free to email support@psychotherapynetworker.org. Comments Page 1 of 2 |
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