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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: Couples Therapy  NP0011, Couples, Session 1, Ellyn Bader and Peter PearsonWelcome to our latest New Perspectives on Practice series, “Who’s Afraid of Couples Therapy?” This exciting series, based on our November/December 2011 issue on the topic, will explore the challenges of couples work, discuss how therapists can become more comfortable doing effective work with couples, and much more.
11.29.2011 Posted In: NP0011 Who's Afraid of Couples Therapy? By Psychotherapy Networker
What are the most effective strategies in working with couples? How can therapists structure therapy—particularly in the early sessions—so that couples leave with a sense of hope, rather than frustration? Can working with individuals who have serious issues in their relationships actually be detrimental to them? Find out the answers to these questions and much more. In this first session with expert couples therapists Ellyn Bader and Peter Pearson, the creators of the Developmental Model of Couples Therapy, you’ll find out why clinicians often avoid working with couples and how you can better prepare yourself for couples therapy work. Throughout the series, a Comment Board after each session will be available. The Comment Boards are a way for participants to share thoughts and reflections about what was most interesting 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 thought and to continue the conversation sparked by each session. After listening to this first session, please just take a few minutes to share what you think. What was most striking about this session? 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 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 NP006, Couples, Bonus Session, John GottmanAs the final, bonus session in the Couples Therapy: Today and Tomorrow series, John Gottman, renowned for his breakthrough research on marriage and parenting, will explore how couples can be there for each other, despite inevitable difficulties and differences. Gottman will cover the core skills in the three primary contexts of a couple’s relationship, methods to help couples develop attunement skills, ways to interrupt destructive relational cycles, and more. 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 series in its entirety, and how you feel after participating in this couples therapy course and hearing such diverse perspectives. What do you think was most interesting or made the most sense? What questions remain for you? Do you have any relevant experiences to share? We encourage you to comment on this session and about the series as a whole, as this kind of engagement and participation is central to deeper learning and understanding. Thank you for your participation, and we hope you come away from this course with a better sense of where the couples therapy field is and where it might be going in the future. Comments NP006, Couples, Session 4, Sue JohnsonWelcome to Session 4 of Couples Therapy Today and Tomorrow with Sue Johnson, the originator of Emotionally Focused Couples Therapy (EFT). In this session, Johnson will explore the basic principles of EFT, the most empirically validated approach to couples work. Johnson will discuss how attachment theory informs the dynamics of couples’ issues, how to develop a systematic treatment plan to intervene with couples, how to restore a sense of calm in couples relationships, and how to interrupt destructive cycles in relationships. We encourage you to participate in the Comment Board as a forum to reflect on what you’ve learned and to share any relevant experiences with couples therapy, discuss what was most interesting to you, and ask any questions you may have. Thank you for your participation and for your comments, as the Comment Boards are an extremely important part of the webcast experience.
Comments NP006, Couples, 3, Harville HendrixWelcome to Session 3 of Couples Therapy: Today and Tomorrow with Harville Hendrix. In this session, Hendrix, the co-developer of Imago Relationship Theory and the co-founder of Imago Relationship International, will delve into the basic principles of the Imago approach to authentic connection between couples. Hendrix will discuss how to help the resistance to love that was founded in childhood experiences, how to help partners learn to heal wounds from each other’s childhoods, the basic skills of mirroring and empathy, and how couples can validate each other—even when they disagree. We encourage you to use the Comment Boards as a vehicle for reflection and discussion with each other and with the presenters, to bring up any relevant thoughts or questions. What was most striking to you about this session? Comments NP006, Couples, Session 2, Terry RealWelcome to the second session in Couples Therapy Today and Tomorrow—“The New Rules of 21st-Century Marriage: Toughness, Truth, and Tenderness” with relationship and gender expert Terry Real. In this session, he’ll discuss how to help couples develop the skills necessary to achieve the high level of connection and emotional intimacy that many desire. He’ll go over how to deal with the differences between what men and women bring to relationships, how to identify that strategies that disrupt relationships, how to present blunt truths, and much more. We encourage you to use the Comment Board as a way to engage with each other and the presenters in this course, to share what you felt was most interesting, to ask any questions you may have, and to reflect on what you’ve learned. What was most relevant for you in this session with Terry Real? Comments NP006, Couples, Session 1, William DohertyWelcome to the relaunched series of New Perspectives on Practice: Couples Therapy Today and Tomorrow. This practical, nuts-and-bolts first session with William Doherty, a seasoned couples therapist, will explore the most common mistakes therapists make in treating couples, and will provide strategies for how to avoid making these errors. Doherty will go over the most common obstacles to effective couples therapy, how to best structure couples’ sessions, how not to undermine a couple’s commitment, and much more. In the inaugural series, course participants used the Comment Boards as a way to share what they thought was most relevant or interesting from the sessions, and to ask questions of the presenters and of each other. It often led to back-and-forth discussions between course participants and presenters. We invite you to use the Comment Boards in the same way, after each session and after completing the course. What was most striking about this session with William Doherty? Did this session bring up any similar experiences? Any questions? We encourage everyone to use the Comment Boards as a forum for reflection, thoughts, and questions. Thanks so much for your participation, and welcome to this extremely relevant and lively series! 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 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 Page 2 of 2 |
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