Concerned about clinical training

[GradSchool2011]

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I am a first year grad student and have not received any type of clinical training. During practicum, I just sit and listen to the few cases that the upper year students have... I have asked my advisor whether I can shadow them, but my advisor says I do not need to worry about training yet. This would be fine, if I felt could trust my advisor. However, I know that all the students in my lab have been unhappy because of the lack of guidance. I was wondering when most people started their clinical training? And if anyone had suggestions how to improve your clinical training when your advisor tends to neglect training their students?

 

[Duck Duck Goose]

I am a first year grad student and have not received any type of clinical training. During practicum, I just sit and listen to the few cases that the upper year students have... I have asked my advisor whether I can shadow them, but my advisor says I do not need to worry about training yet. This would be fine, if I felt could trust my advisor. However, I know that all the students in my lab have been unhappy because of the lack of guidance. I was wondering when most people started their clinical training? And if anyone had suggestions how to improve your clinical training when your advisor tends to neglect training their students?

My PsyD program started 2nd year. Similar programs in my geographic area also start second year.

This kind of thing should be clear from your graduate program's materials and/or the program director.

 

[erg923]

My PsyD program started 2nd year. Similar programs in my geographic area also start second year.

This kind of thing should be clear from your graduate program's materials and/or the program director.

I agreed. It should be VERY clear when clinical training starts in your program.

I am not really a fan of this throwing students to patients in the first year thing. Cart before horse. Get your basics, THEN apply them, right?

 

[cara susanna]

Are you taking assessment courses? Is there any practical component? That's all I was doing my first year. We did sit in on a clinical intake and then give one (with someone else sitting in) our second semester, but that was it as far as seeing clients.

 

[Maedothin]

I agree with the above comments. Clinical training typically starts 2nd year. Shadowing is also, for confidentiality reasons, not commonly done. I would advise against speaking only to the 2nd-year students, since having anxiety is VERY normal in second year. Speak to a 3rd or 4th year that seems to be doing ok, and ask them how they felt in their first / second year, and what they did to overcome their nerves.

 

[AcronymAllergy]

My program typically has us begin seeing clients our first semester for assessment (therapy tends to come later unless you have prior experience), although it varies somewhat by lab/advisor. In general, it's a very "med school philosophy" mindset (i.e., watch one, do one, teach one). However, I also know from information posted here and from speaking with students in other programs that this isn't at all the norm, which tends to be that clinical work is started in the second year.

I agree with Maedothin that seeking guidance from upper-level students is probably going to be your best bet. Ask them what problems they ran into and how they went about solving them (or wish they'd gone about solving them).

What I will say is that no matter how long you wait to see a client, you're NEVER going to feel fully ready. You're going to need to essentially force yourself to take the plunge while accepting that you're going to be uncomfortable and will probably make a mistake or three. Just be honest (with yourself, your supervisor, and the client as appropriate) when this happens, learn from the mistake, and move on. And realize that this skill will improve with practice, and will be essential as you continue through your training (trust me, the nervousness and feelings of uncertainty will probably return when you start a new practicum in a different setting/with different clients, when you start internship, etc; the more ok you can be with hitting the ground running despite this nervousness, the better off you'll generally be).

 

[4410]

Most programs have an onsite clinic with clinic rooms set up for observation and sound by supervisors.. My program did not have a clinic. We have a practicum I and II, a practicum III and IV, and an Advanced Practicum. The goal is to take your assessment courses, general psychology courses, and three psychotherapy courses and begin practicum in year two. The I and II practicums is a year long and is a assessment practicum and the practicum III and IV is a year long and is a psychotherapy practicum or combined assessment/psychotherapy practicum. Advance practicum is a year long and may either be an assessment or a psychotherapy or a combined practicum.

Our practicums are competitive in that we have to apply and interview for the practicums and we are competing with students from our program as well as other programs. I am an older student with multiple mental health licenses at the masters level, so naturally, expectations have been much higher for me at practicum sites than say a novice student with limited experiences. With my three years of practicum, I have over 2000 practicum hours that I included in my internship application with APPIC. Now if you don't get started with your practicum rotations until your third year, it may be difficult to have sufficient clinical hours to improve your selection chances during internship applications. Although, I have some 25-years or master's license experiences, internship sites do not consider this experience but rather look at my doctoral study clinical training hours.

Listen to your adviser as you need to develop a solid relationship with this person rather than second guessing their decisions. Clinical psychology values supervisor-supervisee relationships and you will be under supervision for the next four to six years during your training. Speaking from my experiences as an older student, I had major issues listening and following direction of my practicum supervisors that delayed my progress through the program. Cherish you time now in your courses and make good grades because once you begin your practicums, your time will be stretched to the limits.

Speaking on behalf of "Shadowing!" My first two years of practicum was based on weekly supervision but I saw all of the clients alone or without a supervisor observing me. My advanced practicum supervisor sat in on all of my sessions during the first semester and now during my second semester with him, I am seeing more clients without being observed. Having experienced both training models now, I really wish that my first year and second year practicum experiences were like my advanced practicum. I have learned much more in my advanced practicum than in my first two years of practicum. Supervision was not very instrumental in my professional development during my first two practicums. I've known students who had very devastating experiences during practicum rotations to the point where they quit the program or transferred to a different school.

If I was you, I would listen to your adviser and not rush things.

 

[Psychadelic2012]

My advanced practicum supervisor sat in on all of my sessions during the first semester and now during my second semester with him, I am seeing more clients without being observed.

Was this a therapy practicum? Was your supervisor actually sitting right next to you (or in the room)? Just curious. Seems strange and possibly invasive to have both an intern and a supervisor sitting in on each therapy session. Golly.

 

[GradSchool2011]

Thanks everybody for your responses. Normally, I would not question my advisor, but it is because of the level of discontent from my lab mates that has me concerned. I wasn't expecting to see clients my first-year, but I did think I would be gaining experience in assessments; most students in my program who if not already seeing clients have at least started giving assessments. I just want to make sure that I am being proactive. For some reason, I can't shake the sense that there is something I'm supposed to be doing that I'm not. Did anyone else feel like this their first-year?

 

[erg923]

That is what concerns me, is that I haven't even started to do any type of assessment.

Again, I'm not sure why your so worried? What are you worried about, precisely?

As stated already, programs vary widely on when one starts clinical exposures. Some programs (Vanderbilt?) wont even begin until the 3rd year, although that pretty rare now days. The whole first year, including through summer, was nothing but basic psychological and clinical psychological science courses in my program. All my psychopathology courses, all my courses in cognitive and affective bases of bahevaior, psychometric theory, and human development were completed before I was ever exposed to a patient. I really think thats optimal.

 

[4410]

Was this a therapy practicum? Was your supervisor actually sitting right next to you (or in the room)? Just curious. Seems strange and possibly invasive to have both an intern and a supervisor sitting in on each therapy session. Golly.

It is in a independent practice and no we are not sitting next to each other. He is sitting at his desk and the client and myself sitting in separate chairs. It is a collaborative process and he has seen these particular clients ranging from 6 to 10 years so they already have a long term relationship. In some respects, it is similar to conjoint methods of therapy. I don't necessary agree with this method but I will agree that I am leaning more by shadowing supervision model than the weekly face to face supervision model discussing clients. He works from a person centered treatment approach and my other settings were CBT treatment appraoches with primarily short-term or brief-therapy model. Since our program values broad based training, I was not able to repeat a CBT training site for my advanced practicum placement. We also see some couples and have two groups weekly using this model, and it is more of a medical school model. I do see individuals and groups alone every week now and he steps in and out during some of the sessions.

As I said, I feel that the quality of supervision is much better using this model than the prior supervision I received in my prior practicums where I had two or three supervisors and they were always having time concenrs about the supervision time required per week. When you talk later about what happened in therapy session much information is lost, whereas when the supervisor is sitting in with you in session it is more of an in vivo experience that enables relevance of the learning experience.

 

[Duck Duck Goose]

As I said, I feel that the quality of supervision is much better using this model than the prior supervision I received in my prior practicums where I had two or three supervisors and they were always having time concenrs about the supervision time required per week. When you talk later about what happened in therapy session much information is lost, whereas when the supervisor is sitting in with you in session it is more of an in vivo experience that enables relevance of the learning experience.

How are clients chosen for the dual sessions? Do they volunteer and consent or are they selected by the supervisor/you and then consent?

 

[4410]

How are clients chosen for the dual sessions? Do they volunteer and consent or are they selected by the supervisor/you and then consent?

We have to give informed consent indicating that I am a student. I am working under the psychologist license so he may sit in on sessions at his discretion. It is his independent practice and I am his supervisee, so I cannot tell him that he is not welcome to sit in the sessions. One of my prior supervisors had a system where she would listen in to sessions via telephone intercom systems during some points of the practicum rotation. My supervisor has about 25 clients he sees on a weekly basic and I am seeing and/or sitting in on 10 of his clients and co-leading two groups per week. I do not see or participate with the other 15 clients he sees. I do intakes and assessments, sometimes alone and sometimes with him present.

 

[psychgirl77]

Was this a therapy practicum? Was your supervisor actually sitting right next to you (or in the room)? Just curious. Seems strange and possibly invasive to have both an intern and a supervisor sitting in on each therapy session. Golly.

I am starting a CBT practicum soon and my supervisor will be sitting in on the sessions. Is this really uncommon?

 

[AcronymAllergy]

I am starting a CBT practicum soon and my supervisor will be sitting in on the sessions. Is this really uncommon?

I'm honestly not sure, but my take was that sitting in (when it occurred) was more common with groups, while remote supervision (e.g., via audio/video recording) was more common with individual clients.

This mostly relates to therapy, though. For intakes/interviews, sitting in was the only way I was ever supervised, and this was across multiple practicum sites and internship rotations.

 

[wigflip]

I am not really a fan of this throwing students to patients in the first year thing. Cart before horse. Get your basics, THEN apply them, right?

Seems logical to me. A bit off-topic, but this is one of the reasons I decided my MSW program was actually spelled B-S. Zero skills taught before we were thrown into working with clients fourth week of the term. I concluded that if I don't really need to actually know anything to do the work, I don't actually need to pay exorbitant amounts of money to get the credential 😡

 

[zensouth]

Seems logical to me. A bit off-topic, but this is one of the reasons I decided my MSW program was actually spelled B-S. Zero skills taught before we were thrown into working with clients fourth week of the term. I concluded that if I don't really need to actually know anything to do the work, I don't actually need to pay exorbitant amounts of money to get the credential 😡

+1

Made my day with that one.

 

[Duck Duck Goose]

I'm honestly not sure, but my take was that sitting in (when it occurred) was more common with groups, while remote supervision (e.g., via audio/video recording) was more common with individual clients.

This mostly relates to therapy, though. For intakes/interviews, sitting in was the only way I was ever supervised, and this was across multiple practicum sites and internship rotations.

I have had a supervisor sit in on one therapy session and, truth be told, it was because I was way out of my element and had no skills to handle the surprising situation the client presented in intake. So the supervisor helped facilitate a conversation with the client and the client's parents due to possible safety concerns (I had to convey how completely incompetent I felt to handle the situation before my supervisor asked if I wanted us both to do it). Other than that, I've audio and video taped clients (with their consent) for supervision. I've co-led groups with other clinicians but not my supervisor. And my supervisor sat in on 1 of 2 assessment feedback sessions.

If I were a client, I would act very differently in therapy with my old therapist and a new one than I would in therapy with just a new therapist or just my old therapist. I wonder if this person's supervisor is using the position to get more material out of long term clients... Otherwise, it seems very strange that someone else would be in the room and/or go in and out during the session/treatment.