Placements

Odysseus

Hi all,

I was wondering if anybody here has had some experience of this from either side of the fence as a psychotherapist or a therapist in training. I used to take a few students a year and supervise their work but in my current position which I have been in for the seven years they weren't knee on it. However, the mood has changed and we are now being asked to supervise students, I am happy with this as I think the Addiction Services have alot to offer students, there are high levels of comorbidity as well as horrfic personal history; so I think student would gain some significant experience.

However, my problem is that the student in question is being told by the course provider that they are to observe sessions with me. I have also been informed that this is becoming common practice, I'm appalled.

I done some CBCS training last year and had huge issues with videoing sessions, I found it highly intrusive. It didn't bother me on a skills levels but rather as it was the intrusiveness and it created a false session in my opinion. The big thing is I feel is I would be letting my client down, I'm there to provide and protect the session.

Now I know some therapies do similar stuff, family therapy and one way mirrors, CBT and taped sessions, however this onservation thing is new on me. Anyone any experience of this?

*Simone*

Hi, can't say I've any experience sitting in on psychotherapy sessions, but as part of my placement I was allowed sit in on some patient assessments, where psychometric tests were being performed. Now the patient had to give their full consent first, and if the Clinical Psychologist felt it wasn't appropriate they would tell me "not this one" or whatever. But as long as both the patient and clinical psychologist were happy with it, I could sit quietly and observe at the back.

But I would imagine psychotherapy sessions would be very different. They're clearly far more personal and intimate than just observing someone complete a psychometric test. But perhaps if you're patient feels 100% comfortable with it then it might be ok...?

krankykitty

In my own psychotherapy training there's never been a suggestion of sitting in to observe someone elses session. From what I can imagine, for both therapist and client it must add in another dimension all right, one I don't think I'd be too comfortable with if I were the client in the situation, but hey, everyone's different.
If it were me being asked to have my session observed (as therapist) I think I'd have to seriously weigh it up, particularly taking into consideration what I know about the client and what it could possibly bring up for them. And also what it would do to the working relationship, especially trust..

Odysseus

Cheers for the responses, it new to me too, however, I talked to my supervisor about it who agrees with me, however, her enquires suggested this was becoming a popular request. I had already made my mind up on it and that's NO, I just don't think its apporpriate. If it was the only way the placement can happen then I feel sorry for the student but I'm not prepared to supervise.

However, as I'm out of the supervising game a few years I'm interested in peoples thoughts around it.

krankykitty

It strikes me as a kind of pointless exercise - not all therapists are the same, or use exactly the same approach, as indeed not every client would benefit from the same approach. So you'd be effectively showing the student how YOU work as opposed to them gaining a sense of how they'd work.
I could probably see the point of it for something methodical like the psychometric testing *Simone* mentioned but not for psychotherapy.

What course is it the students are doing? (if it's OK to mention...)

JuliusCaesar

In CBT, we allow students to observe sessions with the clients consent. Patients often do allow it and are ok with it. If they show hesitation, we say ok, fair enough, there is no pressure on the client at all - because we know about 60% do agree. It's no more intrusive than having 6 medical students observe a medical procedure - and patients agree because they know why it's done. I've video'd sessions myself for use in supervision, usually with the camera focussed on me and the back of the client's head. We also record sessions to give the client to take home. We have an alliance to work co-operatively with the client in CBT so we never withhold information/knowledge relevant to the treatment, and we have to have a good therapeutic relationship with our clients too.

Gibs

Anecdotally, from talking to colleagues over the years, it seems to be pretty common (at least in clinical psychology training) for trainees to observe their supervisor in action, particularly early on in their placement. I think it depends on the therapeutic approach one takes and I would suspect the idea of having sessions observed is more welcomed by some schools of therapeutic thought than others.

From the perspective of the client, as other posters have pointed out, observation of a session should only happen with the consent of the client. I find it can be accepted more easily if the proposed observation is explained to the client in terms of its teaching function and the emphasis is placed on the idea that the trainee is focusing more on what the therapist is saying and doing, in order to learn the process of therapy

From the perspective of the trainee it is probably one of the most valuable experiences they get on placement. By observing the supervisor, they get to see how therapy actually occurs in a real setting, with a real person, something that I think can be of great help in terms of bridging the gap between what it says in the research about how therapy/assessment/interventions are done and how real therapists/psychologists do their work. There is often a huge difference between the version of therapy in the books/literature and how it is actually put into practice with a real, live person whose difficulties are often 'messier' and less amenable to straightforward assessment/intervention/psychotherapy.

From the perspective of the supervisor, I think, depending on your therapeutic approach, that being observed by your trainee can be very helpful in order to develop a good working relationship. I would go further and say that being videotaped/audiotaped is extremely useful (not to mention often humbling and excruciating!!) as it allows you to get feedback on your own performance and the difference between how you think you are coming across to the client and how you are actually coming across as revealed by the camera/audiotape.

I know that these views are not shared by all disciplines or psychotherapeutic approaches, but I think if all parties are agreeable, it can be very useful and not harmful as far as I can see. Perhaps others feel differently about it in terms of the impact on the client?

Odysseus

Thanks for all the replies, I met with my Senior and told her that I not prepared to stand over the observation side of things, however, when the student is ready to see clients individually I have no problem with supervising them. She wasn't too pleased but you have to stand over your own ethics.

@ KrankyKitty I honestly can't remember the course name but it is a psychotherapy course.

@ JuliusCaesar I done a few taped sessions for a CBCS course I did last last year, video pointed at me and with written consent of course. Personally I disliked it as did other psychoanalytic therapists on the course. I am familar with the comparsion of medical treatment and as was pointed out I think psychotherapeutic interventions are one of the few professions where this does not happen, but then again I'm against it but it was a personal opinion and of course is influenced by my training.

@Gibs, its a difficult one for me as personally I feel quite strong about it, but I agree with you if all parties are consenting I have no problem. I trained psychoanalytically, however, I'm not a nazi. I have worked very well with therapists from other apporaches of the years [I think inanyway;)], I very open to other approaches working for people I just don't work that way. I'm also agree that taped sessions as well as observation could be a very useful training tool.

Thanks again for all the replies, I know my own position on the topic but was interested in other peoples opinions.

Spartan09

I'm a Clinical Psychologist and regularly take clinical students on placement. What I find is important is the stage at which the student joins the supervisior in the work. I tend to bring students in for observation from the beginning rather than potentially and most likely disrupt the dynamics of the therapeutic relationship by bringing them in mid-therapy. I also find it ok to allow students to observe with clients that I have a long established relationship with around specific topics of concern/discussion rather that for more exploratory type psychotherapy. I remember from my own training finding observations of supervisors invaluable in understanding the dynamics of therapeutic engagement, and the chance afterwards to reflect with the supervisor on what happened in the session. With my own students sometimes they, in processing it afterwards will come up with some interesting observations / reflections that I may not have thought about at the time.