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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: Anxiety  Defeating Panic with Reid WilsonTreating Anxiety: The Latest Advances: NP0025 – Session 6Join Reid Wilson as he explores a step-by-step approach that helps clients shift their relationship with panic so they can overcome their anxiety. By gradually learning to approach, exaggerate, personify, and caricature panic, the client is able override the responses that perpetuate anxiety. 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 Parents, Children, and Anxiety: Changing the Family Dance with Lynn LyonsTreating Anxiety: The Latest Advances: NP0025 – Session 5Learn the 3-step program to help parents and children deal with anxiety. Join Lynn Lyons as she teaches exercises that help normalize anxiety (de-catastrophize it), externalize it (turn the internal state into external metaphors that can be dealt with more readily), and experiment with it (find innovative, playful ways to deal with it). 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 Single-Session Cures with Anxiety Problems with Steve AndreasTreating Anxiety: The Latest Advances: NP0025 – Session 4Learn techniques drawn from Neuro-Linguistic Programming that target the auditory and visual representations that clients make. Join Steve Andreas as he brings about immediate and enduring changes in clients perceptions and feelings as they deal with anxiety. 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 Interrupting the Anxiety Cycle with Danie BeaulieuTreating Anxiety: The Latest Advances: NP0025 – Session 3Expand your understanding of the sources for different kinds of anxiety along with your repertoire of interventions. Join Danie Beaulieu as she explores what metaphors, visual images, and multisensory messages you can use to more fully engage clients and achieve greater impact than is possible with purely word-bound communication. 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 Neurobiology of Anxiety with Margaret WehrenbergTreating Anxiety: The Latest Advances: NP0025 – Session 2Learn how to clearly convey neuroscience information to clients in ways that can have a calming effect and enhance treatment effectiveness. Join Margaret Wehrenberg as she reviews how brain science has allowed therapists to match treatment to the brain structures characterizing anxiety and discusses why it is helpful for clients to have an understanding of neuroscience in treatment. 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 Motivating the Anxious Client: A Paradoxical Approach with David BurnsTreating Anxiety: The Latest Advances: NP0025 – Session 1Dramatically shorten treatment time and improve clinical effectiveness with a new powerful motivational approach to anxiety and other presenting problems. Join David Burns as he uncovers and dispels resistance to treatment and enhances collaboration between therapist and client. 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 Panicking On PurposeReid Wilson advocates intentionally triggering panic, in order to master it.An hour-long visit to an island of calm—that’s what many clients who panic hope for when they go to a therapist. But according to Reid Wilson, an expert on panic and other anxiety disorders, that’s the least beneficial thing we can provide. In fact, the safety of the consulting room makes it the ideal place for clients to intentionally trigger their panic. Then, with our support, they can move into the experience and master it. In a recent conversation—part of our upcoming webcast series on the latest advances in treating anxiety—Reid illustrates the use of practical strategies for gradual exposure through which the client always comes out on top. In this brief video clip, Reid explains how he prepares clients to “take the hit” that will allow him or her to step out of the victim position and onto the road to healing. Take just a few minutes to watch. I think you’ll find plenty you can use right away in your own work with clients who are anxious or given to panic attacks.
Reid Wilson is just one of the six innovators included in our upcoming video webcast series: Treating Anxiety: The Latest Advances. It offers a vivid look at the practical methods experts on anxiety treatment like Danie Beaulieu, Peg Wehrenberg, Steve Andreas, Lynn Lyons and David Burns have to offer that can expand your own clinical repertoire with psychotherapy’s most common presenting problem. To learn more about this exciting new webcast, click here. Want to learn more about treating anxiety and panic? Here are 3 Free articles that are popular with your peers: "Facing Our Worst Fears: Finding the Courage to Stay in the Moment" by Reid Wilson, "The Ten Best-Ever Anxiety Management Techniques" by Margaret Wehrenberg, and "Nightmind: Making Darkness Our Friend Again" by Ruben Naiman. Explore More in our FREE Popular Topic Library. You'll find lots of free articles on Anxiety, Depression, and Brain Science. Need CEs? Audio Courses available include The Anxious Brain and Ten Best-Ever Anxiety Management Techniques, both by Margaret Wehrenberg. About Reid Wilson: Reid is associate clinical professor of psychiatry at the University of North Carolina School of Medicine. He runs www.anxieties.com, the largest, free anxiety self-help site on the Internet. He’s the author of Don’t Panic: Taking Control of Anxiety Attacks and Facing Panic: Self-Help for People with Panic Attacks. Comments The Neurobiology of a Panic AttackIntegrating Brain Science into Anxiety TreatmentIn recent years, our rapidly expanding understanding of the neurobiology of anxiety has become much more than an arcane scientific disciple filled with polysyllabic terms. Therapists like Margaret Wehrenberg, who have studied closely what this new research reveals, have discovered that brain science now offers a range of practical tools that can make work with anxious clients much more efficient and effective. In a recent conversation—part of our upcoming webcast series on the latest advances in treating anxiety—Margaret offered both an eye-opening look at the neuroanatomy of a panic attack and a highly practical discussion of how that can lead to more effective clinical interventions. In this brief video clip, Margaret shows how she begins work with new clients—learning about their current strategies for dealing with anxiety, providing education about the neurobiology underlying their emotional state, and beginning to structure treatment. Just in the few minutes of the interview, you’ll find plenty that you apply directly in your own work with anxious clients. Margaret Werenberg is just one of the six innovators included in our upcoming video webcast series: Treating Anxiety: The Latest Advances. It offers a vivid look at the practical methods experts on anxiety treatment like Reid Wilson, Danie Beaulieu, Steve Andreas, Lynn Lyons and David Burns have to offer that can expand your own clinical repertoire with psychotherapy’s most common presenting problem. To learn more about this exciting new webcast, click here. Want to learn more about treating anxiety and panic? Here are 3 Free articles that are popular with your peers: "The Ten Best-Ever Anxiety Management Techniques", by Margaret Wehrenberg, "Confronting the New Anxiety: How Therapists Can Help Today’s Fearful Kids" by Ron Taffel, and "The Anxious Client Reconsidered: Getting Beyond Symptoms to Deeper Change" by Graham Campbell. Explore More in our FREE Popular Topic Library. You'll find lots of free articles on Anxiety, Depression, and Brain Science. Need CEs? Audio Courses available include The Anxious Brain and Ten Best-Ever Anxiety Management Techniques, both by Margaret Wehrenberg. About Margaret Wehrenberg: Specializing in anxiety treatment, Margaret uses a holistic approach for symptom management. She’s the author of The 10 Best-Ever Anxiety Management Techniques and, most recently, The 10 Best-Ever Depression Management Techniques. Comments Treating Anxiety: The Key is MotivationDavid Burns on the Paradox of ResistanceAccording to renowned expert on anxiety David Burns, far and away the biggest barrier to treating it successfully-- sometimes even in a single session-- is recognizing how many clients covertly hold onto their symptoms, even when they restrict their lives and seem to cause them enormous distress. That's because, deep down, they believe that their anxiety protects them more than it disrupts their lives. Add to that the fact that so much anxiety treatment involves some form of exposure to the very thing that causes them so much discomfort, clients have pretty compelling reasons to resist the onerous process of transforming their anxiety. That’s why the drop-out rates for anxiety treatment are so high. Recently David has discovered that through a method that directly addresses the perceived perils of change in the very first session of therapy, he was able to forge an entirely different kind of collaborative alliance with client from the get-go. He began to see results beyond anything he had previously achieved in his long and distinguished career. The key was not starting the process of treatment before the client was truly ready to begin. In this clip, David tells the memorable tale of a case that pivoted dramatically on what he calls this “paradoxical agenda-setting.” David is just one of the six innovators included in our upcoming video webcast series on Treating Anxiety: The Latest Advances. It offers a vivid look at the practical methods experts on anxiety treatment like Reid Wilson, Danie Beaulieu, Steve Andreas, Lynn Lyons and Margaret Wehrenberg have to offer that can expand your own clinical repertoire with psychotherapy’s most common presenting problem. To learn more about this exciting new webcast, click here. To learn more about the latest developments in understanding anxiety, its roots in our neurophysiology and practical methods for effective treatment, check out these free articles: "10 Best Ever Anxiety Management Techniques" by Margaret Wehrenberg and "The Language of the Nervous System" by Laurie Leitch and Elaine Miller-Karas. Comments MC0003, Beyond Pills, Michael YapkoWelcome to this intensive Master Class series, “Beyond Pills: Effective Psychotherapy with Depressive Clients.” This popular, illuminating series features internationally recognized expert, Michael Yapko, known for his work in the strategic treatment of depression. Throughout the series, you’ll learn about the latest, significant research in effectively helping depressed clients—without antidepressant medications.
12.08.2011 Posted In: MC0003 Beyond Pills: Effective Psychotherapy with Depressive Clients By Psychotherapy Networker
These four sessions will cover such topics as why medicalizing depression has worsened the problem, reasons to be cautious about antidepressants, using hypnosis, mindfulness, and homework as part of experiential treatment, social factors as related to depression, and much more. In the second session, you’ll be able to watch this kind of treatment in action, with a video clip of Mike, a depressed and anxious client. The fourth session includes a question-and-answer session with Yapko to allow you to further incorporate this knowledge into practice. Throughout this series, this Comment Board will be available as a way for you all to share thoughts and reflections about what was most thought-provoking and to ask questions of the presenter and of each other. We invite and encourage you to use this Comment Board as a forum for learning. Between sessions, please just take a few minutes to share what you think. What did you think was most interesting or relevant? 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 |
© 2013 Psychotherapy Networker