Internship I March 23, 2010

2 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

4 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? 5

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? 6

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? 7

TERMINATION 8

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 9

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? 10

Types of Termination Mutual termination Therapist termination Client termination 11

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 12

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 13

Unilateral Terminations Therapist-initiated –Moving/graduating/terminating employment –Problem outside of expertise –Disagreement on therapeutic goals or contract –Client dependence on therapist 14

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 15

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 16

CASE SUMMARIES

18 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

19 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:

20 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