🚀 go-pugleaf

At 01:43 PM 1/21/98 -0600, Christy wrote:
>This leaves me with the dubious job
>of figuring out what is best for me to do with this time.
>I would like to feel like I'm making some headway here on
>my clinical skills.  Someone out there have any concrete
>suggestions for handling this situation?

Excellent foresight!

Here is a skill that most interns have no clue about and they
end up looking kinda naive compared to psychiatry residents when
they start their internship - Reporting on the patient's mental
status.

In my graduate program, nobody introduced this test to me.  But I
found that it was a fundamental skill that I wish I would have had
when I started my internship.  If you would like to learn more about it,
it is described very well in a companion text to the DSM-IV, called
"The Clinical Interview Using DSM-IV Volume I: Fundamentals" by Othmer
and Othmer.

Another important skill is documentation of a consultation.  When you are
called to a unit to do a consultation on a patient, the psychiatric folks
there aren't going to wait around more than 24 hours for your assessment
of the patient.  They want your insight pronto.  You have to get in there,
read the chart (about 15 minutes), see the patient (30 - 60 minutes; this
will vary, depending on the assessment requested), and then sit down with
the chart in hand and write your cunsultation into the chart BEFORE you
walk off the unit (another 15 mintues).  So, if you want to get a good
leg up on what it takes to see a client while following a demanding
schedule (the documentation), practice practice practice.  Start with a
paragraph stating the mental status.  Continue with an outline of the
material coverred.  Get used to writing things like, "The patient seemed
agitated while discussing the number of ETOH drinks/wk as evidenced by
frowning, elevated voice, and irritable reply 'You really think this is any
of your business?'" Separate your observations from your impressions.
Finish with a section providing your overall impressions, followed by
recommendations.  If the patient is yours, write down the plan and the
date of the next appt.

> One thing I've
>heard of others doing is "mirroring" another student
>therapist.  Basically this involves attending their
>individual supervision for a specific client and listening
>to the tapes of their sessions.  Does anyone have opinions
>on this approach?

One of my favorite professors at U. Ottawa, Al Mahrer, is a world-renouned
authority on research in psychotherapy and experiential therapy.  He is
a strong advocate (and if he had his way, he would require it of all students)
of doing co-therapy.  That is, with your classmates, take turns being the
therapist and the client.  Do therapy with each other.  I found that when I
described this exercise to my internship class, they thought the whole thing
was gastly.  Who in their right mind would want to violate the bounderies
of friendship and therapy by doing psychotherapy with your peers?  Well, we
did it at U. Ottawa.  And I found that it helped me to develop therapy skills.
I also think it decreased my defensiveness among peers.

Al Mahrer also compulsively tape records his own therapy sessions and then
reviews the tapes in exhaustive detail.  This is the source of the development
of his science and his form of experiential therapy.