1. What I found most interesting was found in the Grubaugh, et al. article especially in contrast to the Hunter, et al. article. In the former, the patients’ perceptions of safety in hospital facilities was frightening. The statistics that stood out the most were those of being handcuffed, as well as ” being placed in seclusion (59.6%), being put in restraints (34.0%), receiving a “take down” (i.e., subdued by physical force; 29.1%), being forced to take medications against wishes (27.0%), being strip searched (24.1%)”. Those numbers seem incomprehensibly high. I realize in this setting, we are dealing with very symptomatic patients with severe mental illness, however, seclusion, restraints and strip searching seem inhumane. I found the study on Gary to be rather promising. Instead of just following protocol, they figured out some of his mood issues might have been from medication withdrawal and they seemed to have great success in behavior modification and self-soothing through means that weren’t coercive and harsh as mentioned in the first article.
For me, the challenge to working in a psychiatric hospital seems to be the severity of symptoms and risk of harm to themselves or others, and the treatment that those require. As one of the required readings mentioned, the number one reason for hospitalization is suicide. According to another study, as referenced in my previous response, the means by which they keep patients “safe” aren’t necessarily ones that I could endorse. They also seem to follow more of a medical model of diagnose and treat (usually with medication). I think of myself as more of a “talk” therapist, rather than someone that deals in medication and/or safety patrol.
Even before I began my practicum, I saw myself in a Community Mental Health Center setting or private practice. While I know a lot more now about other options that are out there, I think that knowledge has more or less solidified the fact that I still see myself in private practice or at a CMHC. Having said that, I am open to other experiences. I simply enjoy the variety of working in the community and with several different populations as I do at my practicum. I think I would burn out much more quickly if I was stuck with one population or modality day in and day out. At my CMHC I use play therapy, do home visits with older adults, run a DV mens group as well as perform traditional individual therapy. I think my niche is just variety and I seem to have found it there.
2. First of all, ethics and legal aside, that supervisor behaved so inappropriately that he has no business negatively reviewing anyone until he takes a hard look at himself! I was getting physically agitated just watching that clip. Grrrrr. Anyhow, the counselor did not behave ethically in any sense of the word. He certainly did not follow the 4 As. I suppose he was slightlyavailable, but he did not give the trainee any attention especially not to any relevant issues. He certainly wasn’t accessible given how distracted he was during the entire session. He was anything but affable and I am seriously concerned that he isn’t even an able counselor if he runs his own sessions in this manner. In my opinion, he didn’t possess any of the skills or qualities of a good supervisor as far as listening to his trainee’s concerns, observing his counseling skills, giving him feedback on improving his counseling skills or communicating ways he was there to assist if needed. Legally, the agency may be open to lawsuits given that no one, at least not counselor D the supervisor, was gatekeeping this trainee to ensure a minimum standard of care was being provided.
If I was that trainee, I suppose I could excuse ONE session like that in hopes that maybe the supervisor was having a bad day. If it happened again, I would certainly talk directly to my supervisor about what was bothering me. I have no problem at all with stating my displeasure with the disruptions, with not sticking to relevant issues and not being provided with the appropriate guidance and direction I am entitled to. If it continued, I would document these sessions and go above my supervisor’s head and voice my concerns to their boss. My internship is where I need to practice and hone my skills in order to be the best counselor I can be. I would not allow one counselor to impede that process. At the very least, I would request another supervisor.
3. There are many ethical and legal issues that could be involved with this type of supervision. For one, both parties could be at risk for a malpractice suit because they are not ensuring their clients are receiving the best treatment possible. Asking a supervisee to perform counseling, on his own, at this early stage in his career is not ethical. In regard to the ACA Ethics Code, F.6.a, Evaluation, is being violated. This code requires that supervisors document and provide supervisees with ongoing feedback on their clinical performance, which Counselor D failed to do. Additionally, supervisors must schedule formal evaluative sessions throughout the supervisory relationship. In the video, the supervisor spends more time asking his supervisee on his opinion of the game, which is not considered a formal evaluation under any circumstance.
If I were in this position, I would document each session I had with my supervisor. I would attempt to discuss my concerns directly with my supervisor, stressing the importance that I receive the best training possible in the early stages of my career. If my supervisor did not change their behavior within the next session by allowing more time for discussion and feedback, I would consult with another coordinator to make the necessary arrangements to find a new supervisor. As a supervisee, it is my right that my sessions are free of distractions, which include eating, answering personal phone calls, and discussing trivial topics not related to my concerns in practice. Likewise, it would be my responsibility to provide feedback to my supervisor that I was not satisfied with our sessions and discuss what was unhelpful in the supervisory relationship. These steps need to be taken prior to a supervisor administering a negative evaluation.
10 hours ago
Thank you for your post about the information depicted in the Grubaugh et al. article it is very amusing to learn that many individuals who have severe mental illness encounter frightening conditions in the hospital facilities. I agree with your post that mentally ill individuals need to be offered an intervention that would help improve their mental states. Not secluding and strip searching the mentally ill patients would not improve their condition in any way as the need to be taken care off and offered the best interventions. In two instances I have also worked in a psychiatric hospital the challenges that I encountered managing and providing intervention to such individuals is controlling them not to engage in harming themselves through committing suicide. In addition to your post, I think of myself as an individual who deals with medication as I believe this would be the best intervention for the mentally ill patients. I also think that the Community Mental Health Center is the best settings where an individual can practice practicum as many individuals need medical and therapeutic intervention………
APA 442 words