Internship I March 23, 2010. 2 Today’s Agenda Exam #2 (8:00-9:00) Break (9:00-9:15) Therapeutic...
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Transcript of Internship I March 23, 2010. 2 Today’s Agenda Exam #2 (8:00-9:00) Break (9:00-9:15) Therapeutic...
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Today’s Agenda
• Exam #2 (8:00-9:00)
• Break (9:00-9:15)
• Therapeutic challenges (9:15-10:00)
• Termination (10:00-10:30)
• Writing case summaries (10:30-10:50)
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Therapeutic Challenges
• Out-of-control children• Client leaves session• Not all requested family members attend session• Engaging unwilling family members• “Dropping a bomb” at the end of the session• Alcohol & drug use• Secrets• Interrupting and/or rambling• Dealing with sexual attraction• Transference & counter-transference• Dealing with cancellations & no-shows
Self-Supervision Questions
• Am I working harder than the clients?
• What are the negative consequences to change that my clients may be struggling with?
• Does the problem serve some positive function or purpose?
• Have I clearly assessed the client’s goals, and does the client see me as working on those goals?
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Self-Supervision Questions
• Have I sufficiently joined with the client?
• Does the client see therapy or the therapist as credible?
• Is my frustration a possible sign of my own personal issues interfering with the client’s?
• Are my reactions or responses isomorphic to the system?
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Self-Supervision Questions
• Have I appropriately balanced the responsibility for change?
• Have I identified two or three key therapeutic issues or themes, or am I trying to focus on too many things?
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Benefits of Formal Termination
• Effective way of empowering both clients & therapist
• Increases likelihood that clients will seek therapy in the future when needed
• Brings closure to the therapeutic relationship
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Questions to Ask Yourself Prior to Termination
• How satisfied are the clients with the therapeutic process?
• How effectively is the system functioning in relation to current & changing personal & systemic goals & needs?
• How appropriately are the clients interacting in relation to their situation as a family & within the community?
• Do the clients have a positive sense of identity & place in the community & feel better about who they are?
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Mutual Termination• Decision to terminate
– Successful achievement of therapeutic goals
– Clients have difficulty finding issues to discuss in therapy
– Session time is spent in nontherapeutic talk or social chatter
• Goals– To help clients consolidate gains
– To empower clients, giving them confidence to handle issues on their own
– To be sensitive to loss issues
• Termination as a process
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Unilateral Terminations
• Client-initiated– Problem is resolved – no longer a need for
therapy– Loss of momentum for coming to therapy– Obtained enough relief– Costs of continuing are too high– Dissatisfaction with therapy
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Unilateral Terminations
• Therapist-initiated– Moving/graduating/terminating employment– Problem outside of expertise– Disagreement on therapeutic goals or
contract– Client dependence on therapist
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The Termination Session• Summarize presenting problem & main events of
therapy• Predict relapses and/or coming difficulties
– Ask clients to identify conditions that will result in reappearance of problems
– Ask family to speculate on difficulties they see coming
• Ask about what was helpful/not helpful in therapy• Tell family what you gained from working with them• Remind clients that they can come back to therapy at
any time
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MFI Termination Protocol• Have a termination session with clients
• Have clients complete Therapy Evaluation Form
• Post-test clients & complete assessment supervision protocol
• Complete a Case Summary• Make sure file is up to date
• Take file to supervision & have supervisor sign Case Summary
• Keep file in drawer until graduation
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Elements of Case Summary
• Identifying information– Case number– Client name– Total number of
sessions– Date of last session– Therapist
• Presenting problem• Who attended• Diagnosis (systems)
• Diagnosis (medical) at admission– Each person in the
treatment system
• Diagnosis (medical) at termination– Each person in the
treatment system
• Evaluation of therapy• Therapy outcome• Supervisor initials
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CASE SUMMARY
CASE NUMBER:
CLIENT NAME:
TOTAL NUMBER OF SESSIONS:
DATE OF LAST SESSION:
THERAPIST:
PRESENTING PROBLEM:
WHO ATTENDED:
DIAGNOSIS (SYSTEMS):
DIAGNOSIS (MEDICAL) AT ADMISSION:
DIAGNOSIS (MEDICAL) AT TERMINATION:
EVALUATION OF THERAPY:
THERAPY OUTCOME:
SUPERVISOR INITIALS: