PhD/PsyD Supervisors with BPD (or other personality disorders)?

[Mk1000]

Perhaps, we are more in-tune with how others' behavior makes us feel in this field (some, not all of us of course). Combined with the fact that we have a framework for discussing patterns of behavior and how they make us feel, we might be more inclined to label someone as having a particular PD or other diagnosis. Taken a step further, we are in a helping profession, so we might then feel like it is our responsibility to "help" this person, or to alert others who will come into contact with him/her.

Maybe I'm about to make this way too simple. However, as someone who took a significant amount of time working in non-psychology fields prior to entering graduate school, I found that there are jerks in positions of power in all different fields. We call it BPD, others might just call it being a....well...you can fill in the blank. Either way, you will find them in most settings (psychology or not) and I think the key is learning how to work with them and not to lose sleep over their behavior.

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[smalltownpsych]

Perhaps, we are more in-tune with how others' behavior makes us feel in this field (some, not all of us of course). Combined with the fact that we have a framework for discussing patterns of behavior and how they make us feel, we might be more inclined to label someone as having a particular PD or other diagnosis. Taken a step further, we are in a helping profession, so we might then feel like it is our responsibility to "help" this person, or to alert others who will come into contact with him/her.

Maybe I'm about to make this way too simple. However, as someone who took a significant amount of time working in non-psychology fields prior to entering graduate school, I found that there are jerks in positions of power in all different fields. We call it BPD, others might just call it being a....well...you can fill in the blank. Either way, you will find them in most settings (psychology or not) and I think the key is learning how to work with them and not to lose sleep over their behavior.

Exactly. Furthermore, I think that labeling obnoxious, rude, or selfish behavior as being BPD is an insult to my patients who have the diagnosis of BPD. Being a jerk is not part of the diagnostic criteria. Is the supervisor self-harming, chronically suicidal, have intense fears of abandonment, binge drinking, experiencing transient psychotic symtpoms, dissociating? If they are just a bad supervisor then drop the diagnostic label.

 

[Mk1000]

Exactly. Furthermore, I think that labeling obnoxious, rude, or selfish behavior as being BPD is an insult to my patients who have the diagnosis of BPD. Being a jerk is not part of the diagnostic criteria. Is the supervisor self-harming, chronically suicidal, have intense fears of abandonment, binge drinking, experiencing transient psychotic symtpoms, dissociating? If they are just a bad supervisor then drop the diagnostic label.

Very good point.

 

[deleted343839]

Friends have said "you only have X days to work with him/her, suck it up" but interactions with this person unravel me and I can't focus afterward (because of the tone, underlying messages, attributions, insinuations that all occur during supervision). I repeatedly ask myself - how did this person ever come to supervise anyone?

I suspect many of us have had an unpleasant supervisory relationship at some point. I would only offer tactful, diplomatic feedback to the supervisor regarding his/her style if s/he seems genuinely open to feedback, though I'm guessing that doesn't apply in your situation and could backfire. You should share your concerns with your DCT though. If others have made similar complaints yours could be important for establishing a pattern.

From what you've shared, the offensive behaviors sound subtle and require some interpretation on your part (ie, "underlying messages" and "insinuations"). If a fellow trainee were to listen in on one of your meetings would they have the same reaction? Is the content of your discussions abusive or boundary-crossing? Is the supervisor asking something inappropriate or unethical of you? If you can't give a clear 'yes' to any of those questions, then I would be inclined to heed your friends' advice and just wash your hands of this person when you can. Of course, give feedback to the DCT (and to your fellow trainees) but focus on what the person actually says and does. Avoid speculating about other people's mental disorders in a professional context. It will never reflect well on you.

 

[smalltownpsych]

I suspect many of us have had an unpleasant supervisory relationship at some point. I would only offer tactful, diplomatic feedback to the supervisor regarding his/her style if s/he seems genuinely open to feedback, though I'm guessing that doesn't apply in your situation and could backfire. You should share your concerns with your DCT though. If others have made similar complaints yours could be important for establishing a pattern.

From what you've shared, the offensive behaviors sound subtle and require some interpretation on your part (ie, "underlying messages" and "insinuations"). If a fellow trainee were to listen in on one of your meetings would they have the same reaction? Is the content of your discussions abusive or boundary-crossing? Is the supervisor asking something inappropriate or unethical of you? If you can't give a clear 'yes' to any of those questions, then I would be inclined to heed your friends' advice and just wash your hands of this person when you can. Of course, give feedback to the DCT (and to your fellow trainees) but focus on what the person actually says and does. Avoid speculating about other people's mental disorders in a professional context. It will never reflect well on you.

This is a key point that is good for us to remember as psychologists in all of our professional communications. It is one thing for us to consider and explore all of the possible interpretations and meanings of communications and behaviors in the therapy room, supervision, or case consultation, but much of the time it is important to stick with "just the fact's ma'am". All too often, I hear other treatment professionals openly speculating their opinion about a patient and stating it as though it were a fact. "That patient did that (behavior we don't like) because they are manipulative, non-compliant, BPD, ethnic group, ______ fill in the blank."

One of the most useful tools is to always think about whether I could explain and support with facts what I am doing or saying on the witness stand in court. This also means I am comfortable with patients reading my notes or reports, too. I can report all types of negative facts and they can't really argue with them much even if they don't like them, but when I put in my value judgement or opinion - watch out. Fortunately, I am pretty good at avoiding that and have mainly seen other providers get into trouble for injecting their opinion and value judgments everywhere.

 

[futureapppsy2]

This is a key point that is good for us to remember as psychologists in all of our professional communications. It is one thing for us to consider and explore all of the possible interpretations and meanings of communications and behaviors in the therapy room, supervision, or case consultation, but much of the time it is important to stick with "just the fact's ma'am". All too often, I hear other treatment professionals openly speculating their opinion about a patient and stating it as though it were a fact. "That patient did that (behavior we don't like) because they are manipulative, non-compliant, BPD, ethnic group, ______ fill in the blank."

One of the most useful tools is to always think about whether I could explain and support with facts what I am doing or saying on the witness stand in court. This also means I am comfortable with patients reading my notes or reports, too. I can report all types of negative facts and they can't really argue with them much even if they don't like them, but when I put in my value judgement or opinion - watch out. Fortunately, I am pretty good at avoiding that and have mainly seen other providers get into trouble for injecting their opinion and value judgments everywhere.

How does this co-occur with theoterically driven case conceptualization? For example, saying that a client is castrophizing as evidenced by X, or that they are doing Y because it is reinforcing via Z function, that A is a result of B type of attachment pattern, etc? Those are, to a degree, judgments that extend beyond merely stating facts, yet ideally we are supposed to operate from theoretically-driven frameworks.

 

[smalltownpsych]

How does this co-occur with theoterically driven case conceptualization? For example, saying that a client is castrophizing as evidenced by X, or that they are doing Y because it is reinforcing via Z function, that A is a result of B type of attachment pattern, etc? Those are, to a degree, judgments that extend beyond merely stating facts, yet ideally we are supposed to operate from theoretically-driven frameworks.

Yes. That is why I made the distinction re: treatment and supervision. I was thinking of case conceptualization. Too many people make too many leaps in their inferences is what I am cautioning against. Or using one isolated piece of data, This type of critical evidence based thinking is part of our skill set that comes from our research and assessment training. I can speculate with the best of them, and in my reports I catch myself doing that and then rein it back in.

 

[psych844]

Yes. That is why I made the distinction re: treatment and supervision. I was thinking of case conceptualization. Too many people make too many leaps in their inferences is what I am cautioning against. Or using one isolated piece of data, This type of critical evidence based thinking is part of our skill set that comes from our research and assessment training. I can speculate with the best of them, and in my reports I catch myself doing that and then rein it back in.

Interesting. But do you then often then find yourself not being able to say much?

This is one of my concerns when I was alluding to the idea that it seems despite the long training time, we still don't know much, and often there seems to be speculation or a lack of clarity. (or at least an analysis that would be made by a layperson)

 

[smalltownpsych]

Interesting. But do you then often then find yourself not being able to say much?

This is one of my concerns when I was alluding to the idea that it seems despite the long training time, we still don't know much, and often there seems to be speculation or a lack of clarity. (or at least an analysis that would be made by a layperson)

It is often preferable to not say much and to limit what I say to what is grounded in scientific evidence and observable data. As a psychologist I am a trained observer and that will yield plenty of data.
"Patient was casually dressed for interview, wearing jeans and t-shirt. Hygiene appeared poor as evidenced by soiled jeans and unkempt hair. Patient appeared anxious as evidenced by leg bouncing, fidgeting, and biting on nails. Eye contact was poor and patient looked at the ground through much of the interview. Patient denied experiencing auditory hallucinations, but at times appeared to be attending to internal stimuli as evidenced by suddenly cocking and turning his head as though he had heard a noise although the room was quiet."

That is some pretty standard language for mental status observations and I am making some inferences from the data but what I am admonishing against is when that is taken much further. Would this patient meet the diagnostic criteria for Schizophrenia or an anxiety disorder? Would this patient need to be hospitalized? Are they obviously "off of their meds"? I would probably be able to answer those questions after a complete diagnostic interview and collateral info, as well, but I would definitely need more data than this. However, I have seen others state those conclusions with even less info than what I presented. Also, notice that I didn't state my opinion as to why he appeared anxious.

I would also quote the patient somewhere in the report because they might say, "I am really nervous because I relapsed and don't want to go to jail." or "I am nervous because I am awkward around people I don't know" or "I'm nervous because the government knows that I know about their plan to substitute key people with fakes."

A pet peeve of mine is when a supervisee says I think the patient was worried about X, Y, or Z and I ask what did the patient say they were worried about and the supervisee didn't ask the question, but was going off their own assumption.

 

[psych844]

It is often preferable to not say much and to limit what I say to what is grounded in scientific evidence and observable data. As a psychologist I am a trained observer and that will yield plenty of data.
"Patient was casually dressed for interview, wearing jeans and t-shirt. Hygiene appeared poor as evidenced by soiled jeans and unkempt hair. Patient appeared anxious as evidenced by leg bouncing, fidgeting, and biting on nails. Eye contact was poor and patient looked at the ground through much of the interview. Patient denied experiencing auditory hallucinations, but at times appeared to be attending to internal stimuli as evidenced by suddenly cocking and turning his head as though he had heard a noise although the room was quiet."

That is some pretty standard language for mental status observations and I am making some inferences from the data but what I am admonishing against is when that is taken much further. Would this patient meet the diagnostic criteria for Schizophrenia or an anxiety disorder? Would this patient need to be hospitalized? Are they obviously "off of their meds"? I would probably be able to answer those questions after a complete diagnostic interview and collateral info, as well, but I would definitely need more data than this. However, I have seen others state those conclusions with even less info than what I presented. Also, notice that I didn't state my opinion as to why he appeared anxious.

I would also quote the patient somewhere in the report because they might say, "I am really nervous because I relapsed and don't want to go to jail." or "I am nervous because I am awkward around people I don't know" or "I'm nervous because the government knows that I know about their plan to substitute key people with fakes."

A pet peeve of mine is when a supervisee says I think the patient was worried about X, Y, or Z and I ask what did the patient say they were worried about and the supervisee didn't ask the question, but was going off their own assumption.

But isn't fidgeting common? not making eye contact?

Also, isn't there too much reliance on what a patient says? how can we trust what every person says?

 

[WisNeuro]

You use different sources of information, in context. Behavior obs, chart notes, patient self-report, assessment results, etc. Fidgeting to the degree described and no eye contact during clinical interview are not that common, really. And no, we don't always trust what a person says, which is why we use multiple sources of information in an evaluative context.

 

[psych844]

You use different sources of information, in context. Behavior obs, chart notes, patient self-report, assessment results, etc. Fidgeting to the degree described and no eye contact during clinical interview are not that common, really. And no, we don't always trust what a person says, which is why we use multiple sources of information in an evaluative context.

chart notes?

but aren't assessment tools often not used?

 

[smalltownpsych]

But isn't fidgeting common? not making eye contact?

Also, isn't there too much reliance on what a patient says? how can we trust what every person says?

I never said that they weren't common, but I did describe the degree. You are overinterpreting. Wisneuro is saying that it is not common in interviews to that degree and I would agree with that assessment.

 

[WisNeuro]

chart notes?

but aren't assessment tools often not used?

The medical chart. In VA's and AMC's, we use EMR. Wealth of historical information. I use assessment tools daily, but then again, it's my job.

 

[psych844]

The medical chart. In VA's and AMC's, we use EMR. Wealth of historical information. I use assessment tools daily, but then again, it's my job.

When you say assessment tools do you mean instruments like MMPI? or everything together? (observation, chart, interview, etc0

 

[WisNeuro]

WAIS, WMS, BNT, COWAT, MMPI, D-KEFS, HVLT, BVMT, DRS, MoCA, and so on, and so on.

 

[psych844]

WAIS, WMS, BNT, COWAT, MMPI, D-KEFS, HVLT, BVMT, DRS, MoCA, and so on, and so on.

But there are many psychologists that don't use those tools, correct?

 

[WisNeuro]

But there are many psychologists that don't use those tools, correct?

That is correct. Psychology is a fairly broad field, with many sub specialties. Each sub specialty has its own methods, instruments, etc.

 

[smalltownpsych]

But there are many psychologists that don't use those tools, correct?

We use them when they are indicated. I don't need to give my patient who is struggling with social anxiety to take an MMPI to tell me they have social anxiety. When a parent says that their kid is struggling in school, I'll give them a WISC, WIAT, maybe have the parents and teachers fill out some behavioral inventories and make my own observations of their behavior.

 

[psych844]

We use them when they are indicated. I don't need to give my patient who is struggling with social anxiety to take an MMPI to tell me they have social anxiety. When a parent says that their kid is struggling in school, I'll give them a WISC, WIAT, maybe have the parents and teachers fill out some behavioral inventories and make my own observations of their behavior.

Maybe that is what has colored my impression a bit. I have quite a few people in my life who have dealt with anxiety and had it diagnosed. In one case it was literally a 45min consultation, where even the questions asked seemed mostly administrative, but a diagnosis was given.

 

[WisNeuro]

Maybe that is what has colored my impression a bit. I have quite a few people in my life who have dealt with anxiety and had it diagnosed. In one case it was literally a 45min consultation, where even the questions asked seemed mostly administrative, but a diagnosis was given.

45 minutes is plenty of time to diagnose anxiety in a lot of cases. Tough to say what went on in a therapy/consultation session when you only have one side of the story though.

 

[smalltownpsych]

Maybe that is what has colored my impression a bit. I have quite a few people in my life who have dealt with anxiety and had it diagnosed. In one case it was literally a 45min consultation, where even the questions asked seemed mostly administrative, but a diagnosis was given.

Much of the time I don't even talk to the patient about diagnosis as it is often not useful. Patients are coming to me to alleviate their symptoms and telling them they meet criteria for Adjustment Disorder with Anxiety doesn't add anything more than a label. The only reason we use some of the labels is so the patient can get treatment covered by insurance. The whole concept of mental illness using the medical model based on physical illness and pathogens doesn't really work. The diagnostic system we use is based on clusters of symptoms rather than causes which is counter to the medical model of disease. Again, these limitations of the current state of our science argue for more expertise and training rather than less. especially argues for the importance of a strong empirical/research foundation in our education so we can critically assess these factors.