Internship I

March 23, 2010

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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)

THERAPEUTIC CHALLENGES

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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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TERMINATION

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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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Types of Termination

• Mutual termination

• Therapist termination

• Client termination

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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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CASE SUMMARIES

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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:

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Next Week

• Treatment Plan & Case Study, Part II due

• Topic – Integration

• Readings– Midori Hanna, 1, 3-4– Lebow– Sextion et al.

• Workshop with Brent Dunn – 11:00-1:00 in lieu of staffing