Counseling Supervision 2

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    • 00:02


    • 00:15

      SHONA VAS: I am going to be meetingwith two of my psychology interns.They are both graduate students in clinical psychology,and they are in their final year of training.Within the next six months, they will both receive their PhDsin clinical psychology.So they are very advanced students

    • 00:36

      SHONA VAS [continued]: with a really well developed set of skills already.And so we're really working on refining those skillsand having them develop a sense of their own professionalclinical identity.

    • 00:51

      POOJA DAVE: Hi.

    • 00:51

      SHONA VAS: Come on in.

    • 00:52

      ANDREA KASS: Thank you.

    • 00:53

      SHONA VAS: The purpose of this supervisionis to discuss the care of the patientsthat they've seen in the last week.Sometimes we do this individually,but today we're going to meet together as a group.So each of them will present their casesand talk about how things went and where they requireassistance and what we need to do at the next session

    • 01:13

      SHONA VAS [continued]: as they move forward.It's almost Friday, so that's good.It's a very relaxed atmosphere.It's a weekly meeting.So they come in, and they will present the cases.So they'll talk about the five different peoplethat they might have seen that week.If it's a new patient and I don't know much about it,they'll present some more information

    • 01:35

      SHONA VAS [continued]: on the patient to give me some background.And then we'll just really talk about whathappened during the session.And we'll go through that process for allof their patients and come up with a planfor the next session.

    • 01:47

      ANDREA KASS: I have one patient I would love to discuss today--

    • 01:50

      SHONA VAS: OK.

    • 01:51

      ANDREA KASS: --as part of our meeting.

    • 01:52

      POOJA DAVE: And I have one too, on my roster.

    • 01:54

      SHONA VAS: OK.Is there anything else you guys wantto talk about besides patients.

    • 01:59

      ANDREA KASS: I guess it might be useful justto talk about how things have been going over the past coupleweeks in the program.

    • 02:04

      SHONA VAS: OK.Who wants to go first?

    • 02:07

      POOJA DAVE: I thought I'd bring up this patient justbecause I've been struggling a little bit with herin terms of what direction to go in.This patient is just extremely anxious in session.She has a lot of difficulty manging her anxiety whilein session, as well as identifying and describingher worries, because she talks so much it's hard to focus her.

    • 02:29

      POOJA DAVE [continued]: So whenever we get towards restructuring,it's just really hard for her to get on board,especially given her profession.She's a lawyer, and she knows how to do this stuff.She knows how to restructure.She knows how to argue.And actually, that's part of her worrying.It's a lot of arguing herself out of the worries.And so this is just a thought that I have

    • 02:50

      POOJA DAVE [continued]: and I wanted to get your opinion on this.I'm going, what if I augmented it with some acceptance basedstrategies, just to get her to learn to toleratethe negative emotions that come with anxiety?

    • 03:02

      SHONA VAS: So it sounds like she is worryingand while she knows that the worries aren't realistic,the restructuring isn't working.

    • 03:14

      POOJA DAVE: Yeah.

    • 03:15

      SHONA VAS: So she hasn't been able to tease thoseapart and see what part is based on fact,and what part is based on reality.So you are wondering if it would be more useful to actually helpher accept that worries are normal,and most people will always have worries.

    • 03:37

      SHONA VAS [continued]: You just don't want them to interferewith her life in the way that they do.

    • 03:40

      POOJA DAVE: Yeah.And so what do you think about just an acceptance basedapproach for a little bit, just gettingher to experience the worry.I mean, not so much maybe worry exposures,but general exposure to what she feelslike when she's worrying that way, justto help her make that connection.I don't know.

    • 03:58

      ANDREA KASS: That makes sense.

    • 03:59

      SHONA VAS: So I would think that before youjump to doing the acceptance based approach, what youactually need is some mindfulness and maybesome mindfulness about when are you worryingand what does that look like.

    • 04:11

      POOJA DAVE: Yeah.I think that's a good idea.

    • 04:13

      SHONA VAS: So what do you think about starting there with herand seeing how she responds to that?Because then the worrying at leastanchors her to the present even though the contentmight be future-oriented.I am less likely to tell them exactly whatto do, but to rely more on their impressionson what might be appropriate choices of action.

    • 04:36

      SHONA VAS [continued]: Because there isn't necessarily one right way to do things.So they might have some ideas already about where they'dlike to go and what direction they'd like to follow,and so we talk about pros and cons of those choices.

    • 04:51

      ANDREA KASS: So this patient is a mid 30s Caucasian femalewho is also going through a fertility treatment.And has a history of depression, so we'rereally working on some relapse prevention skillspartly through building social support and also assertiveness.And the actual issue that I would like to bring upis that she's done a really nice job actually building

    • 05:12

      ANDREA KASS [continued]: her skills and demonstrating good use of skillsacross multiple environments.And I try to really reinforce that with herand it's been positive.She's been missing a lot of sessions at the last minute,or in advance.But every other week, there's something coming up--or every other session.And my concern is that it's not been demonstratinga consistent approach to treatment.

    • 05:33

      ANDREA KASS [continued]: And so I'd like to address it.I think it would be important to address in some capacity.But I also know she has this really big life event goingon where she's getting these treatmentsand has these doctor's appointmentsthat are also not-- she doesn't have the mostflexibility to schedule them.So I want to be really sensitive to thatand reinforce why coming weekly is

    • 05:54

      ANDREA KASS [continued]: going to be very beneficial for her skills and continueddevelopment.

    • 05:58

      SHONA VAS: So it sounds like there might be a few reasonswhy she isn't coming regularly, right?

    • 06:02

      ANDREA KASS: Yep.

    • 06:03

      SHONA VAS: So I would say that you firstwant to start with talking with her about what she thinksis going on with her frequent cancellations.I certainly wouldn't do this on the phone.I would try and have an appointment with herand have her come in and see if you can look at this together.

    • 06:20

      ANDREA KASS: Yeah.

    • 06:21

      SHONA VAS: Do you feel like you havea plan for moving forward with her, then?

    • 06:24

      ANDREA KASS: Yeah.I think this is going to work well, so thank you.

    • 06:27

      POOJA DAVE: All right.I think--

    • 06:28

      ANDREA KASS: That's all I have.

    • 06:29

      POOJA DAVE: Yeah, it's good.

    • 06:30

      SHONA VAS: OK.

    • 06:31

      POOJA DAVE: Thank you.

    • 06:31

      ANDREA KASS: Thank you.

    • 06:31

      SHONA VAS: All right.Let me know if you need anything else between now and next week.

    • 06:34

      ANDREA KASS: Yeah.And we'll keep you posted [INAUDIBLE].

    • 06:37

      SHONA VAS: OK.Sounds good.

    • 06:38

      ANDREA KASS: Good supervision is reallypredicated on knowing where your trainee is at,so what level he or she is trained at.So what I loved about today's supervisionis that Dr. Vas really recognizesthat we're advanced trainees and really catersher level of understanding of the patientsand what we want to work on at that level.

    • 06:59

      ANDREA KASS [continued]: So when I was first starting off,I think good supervision really goes more piece by piecethroughout the session, where you would have listenedto the patient's tape and then helping that training therapistto navigate what would come next and howmight be different ways of phrasing it.And I think at this point, Dr. Vasis aware we're past that level.

    • 07:19

      ANDREA KASS [continued]: So really catering to more long term treatmentgoals, case conceptualization, and thinking more stronglyabout pitfalls or areas where you feel a little more stuck.The other thing that I've really valued about good supervisionis when the supervisor provides examplesfrom his or her own clinical workto help inform some of the work that I'm doing.

    • 07:42

      ANDREA KASS [continued]: It also gives novel ways of saying something to a patient,or thinking about other examples of waysthat I could phrase something new to a patient or differentways of thinking about where the patient's at.And so I really value that aspect of supervision.

    • 07:57

      POOJA DAVE: Supervision is integral to howyou develop as a therapist.And so therefore it can be really keyinto what you're going to look like in your sessionswith your patients, as well as howyou're going to think about yourself as a supervisor.I also think I've been really luckyto have the benefit of multiple supervisorsfrom varying theoretical orientation,

    • 08:19

      POOJA DAVE [continued]: and that's helped me be a more flexible therapist.And I can think about cases in a number of different ways, whichI think is so important because a one size fits all approach isreally quite unrealistic when you have a patient thatwalks in.Learning to be flexible is really important.And so I think supervision allows you that flexibility.

    • 08:39

      SHONA VAS: I'd like to think that the relationship isa positive one, and that they feel that they can tell mewhat they really struggle with and where they would mostneed my help.The nature of supervision is inherently fraught,because you have to admit your weaknesses to your supervisorand then be evaluated by your supervisor.So it's hard to talk about what you're struggling with when you

    • 09:03

      SHONA VAS [continued]: know that that person could potentially give youa bad evaluation.But admitting your weaknesses is an inherent piece of learning.[MUSIC PLAYING]

Counseling Supervision 2

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In a clinical supervision session, Prof. Shona Vas helps students plan to address specific issues with their patients. Vas and her two students then reflect on the supervision process.

SAGE Video In Practice
Counseling Supervision 2

In a clinical supervision session, Prof. Shona Vas helps students plan to address specific issues with their patients. Vas and her two students then reflect on the supervision process.

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