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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: Future of Psychotherapy  The Practice of ExcellenceBecoming a Smarter TherapistOnce we’re past the early stages of our training, the accumulating evidence suggests that, despite our own favorable impression of our increasing therapeutic savvy, most of us don’t improve our clinical skills. With so many smart, devoted, hard-working practitioners in the field, how could this be? In “Is Psychotherapy Getting Better?” a provocative article by Diane Cole in the March issue of the Networker, Bill Doherty observed: Read moreComments Andrew Weil and the Future of PsychotherapyThis year’s 35th-Anniversary Symposium will not only offer an up-to-the-minute perspective on the field’s recent innovations and advances, but a vision of its future. We'll be exploring how all the ferment of the moment--the exciting possibilities opened up by brain science, the growing understanding of the mind-body connection, the clinical influence of mindfulness practice, the emerging science of human performance--will shape therapeutic practice in the years to come. In his Symposium keynote address, "The Vision of Integrative Mental Health," Andrew Weil, world-famous pioneer in the development of complementary medicine, will explore the new skills and knowledge the practitioner of tomorrow will need. We interviewed him recently and here's what he had to say: 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 NP0010, Mindfulness, Session 3, Tara BrachExplore RAIN, a simple but powerful technique for directing attention to one’s inner world, with Tara Brach, a leading Western teacher of Buddhism, known for her ability to integrate psychotherapy with meditative and mindfulness practices. Understanding and learning how to implement RAIN into your clinical practice will allow you to help clients discover the thoughts, emotions, and feelings that make up their true inner experiences, and will open the door for deconditioning unconscious patterns. After the session, please take a few minutes to engage in the Comment Board and let us know your reflections. What do you think about this technique and how it might be implemented into your professional or personal life? Do you have any specific questions for the presenter 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 NP0009, Marlene Maheu, Bonus SessionAs 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. 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 what you’re thinking after participating in this ethics course and hearing perspectives on a variety of applicable topics. What do you think was most interesting or made the most sense to your practice? 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. 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 email support@psychotherapynetworker.org and they'll assist you. Comments NP007, Excellence, Bonus Session, Don MeichenbaumDon Meichenbaum, the founder of Cognitive Behavioral Modification, will lead you in this Bonus Session, “What Expert Therapists Do,” on learning how to master the core tasks of psychotherapy and how to enhance your practice and expertise using web-based training procedures. Discover how to use new computer technology as an adjunctive tool in the psychotherapeutic relationship to improve your outcome and better help your clients. We encourage you to take a few minutes after this session to comment on what you’ve learned from this presentation, and from the course as a whole. What was most striking or most relevant to you? What questions do you have? As always, if you ever have any technical issues, just email support@psychotherapynetworker.org for help! Comments The Science of Trust, John Gottman’s Keynote“Do you trust me?” What a question to propose to a significant other or a friend. Maybe they’ll respond with “Yes, of course,” but when it really comes down a situation that requires absolute trust, they won’t. John Gottman’s keynote speech, based on research published in his most recent book The Science of Trust, covered the scientific data behind trusting one another—something that’s vital to the success of a romantic relationship, and that impacts so much else in daily life. Comments Don Meichenbaum, Technology and the Future of PsychotherapyToday’s lunch with Don Meichenbaum, Ph.D., the renowned founder of Cognitive-Behavioral Therapy and current Research Director at the Melissa Institute for Violence Prevention and Treatment, was the perfect complement to Sherry Turkle’s morning’s keynote. This morning, Turkle spoke about how our relationships with technology may be harmful to our relationships with each other. Meichenbaum’s presentation, “Technology and the Future of Psychotherapy,” told the other side of the story: how our digital gadgets can be extremely helpful as part of therapy. Comments Sherry Turkle's Keynote: "Cyber Intimacy & Solitude"This morning’s keynote, “Cyber Intimacy and Cyber Solitude” with Sherry Turkle, perfectly fit the theme of this year’s Symposium, “Braving New Worlds”—and Rich Simon’s musical production of Journey’s “Don’t Stop Believin’” also appropriately fit the theme of exploration. Turkle, the director of MIT’s Initiative on Technology and Self and a clinical psychologist, spoke about the evolution of our relationships with technology, as illustrated by her extensive studies, as well as her own, changed perspectives and understanding of our beloved electronics. Comments Sherry Turkle Questions Our Love Affair with TechnologyIt turns out that we’re not the only ones talking about MIT psychologist Sherry Turkle, our Symposium keynote speaker. Her new book, Alone Together, an insightful look at our shifting relationship with technology, has gotten a lot of press recently, earning glowing reviews from both Newsweek and Time. Have you ever text messaged someone who’s in the same room or e-mailed people in your office rather talking face-to-face? While our beloved new gadgets make our lives more efficient—and entertaining—are they actually separating us, instead of connecting us? Turkle says they are. This week, she appeared on the Colbert Report to discuss it. Read moreComments The Fabulous Five WorkshopsMore than 1,200 attendees have already signed up--our largest registration ever! So this is a good time to see which Symposium topics are inspiring therapists the most. Here are the five most popular sessions so far, in reverse order: 5. Paper Tiger Paranoia: Transforming the Fearful Brain: Rick Hanson will demonstrate that, while evolution may have hard-wired us to overestimate threat--favoring chronic anxiety--we can use our own neuroplasticity to override this evolutionary heritage. Read more. 4. Treating PTSD and Complex PTSD: 101 Ways to Bolster Resilience: Amidst all the competing claims of different approaches, Donald Meichenbaum, one of the founders of psychotherapy’s “cognitive revolution,” will separate myth from reality in the treatment of trauma. Read more. 3. The Therapist Under the Microscope: “In Treatment” and the Ethical Challenge of Practice: William Doherty will use clips from the popular HBO series to illustrate the ethical complexities of modern therapeutic practice. Read more. 2. The Attuned Couple: John Gottman, famous for his groundbreaking research on everyday couples interactions, will provide a practical roadmap through even the most densely overgrown marital jungle. Read more. 1. Creating a Beautiful Mind: Symposium keynoter and poet David Whyte will lead a journey through the uncharted challenges of 21st-century life. Read more. Another workshop in particular that’s worth noting is the new The Hero’s Journey: A Special Two-Day Transformation Retreat. Come to the Symposium a day early for this newly created, two-day session. This popular workshop is filling up fast, as it'll be an unforgettable enrichment to your personal growth. Read more. Of course, as more registrations come in, these Fabulous Five could find their stars eclipsed by yet newer wonders--after all, the Symposium season is young and we have 175 different events and workshops to choose from. Just click here to explore what workshops are likeliest to float your boat. Let us know what inspires you the most about the upcoming Symposium. Sincerely, Rich Simon Comments |
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