Understanding The Complications Of Clinical Work

Throughout my bachelor’s in clinical and counseling psychology and even more so in my graduate program for mental health counseling it seemed that the Diagnostic and Statistical Manual of Mental Disorders (DSM) was the end all and be all when it comes to diagnoses. I am now in the process of going for licensure in the Commonwealth of Virginia. I have started my 3, 400 hour residency under the licensure supervision of Anthony Lea, LPC. In our supervision meetings we have started to go back through the DSM starting with the introduction into the manual (that I never recalled reading or discussing in my graduate program).

What lesson have I pulled out from this process so far? There is a section in the very first few paragraphs that calls clinicians to remember that the DSM is not a comprehensive dictionary of disorders. In the “Use of the Manual” section  it highlights that “The symptoms contained in the respective diagnostic criteria sets do not constitute comprehensive definitions of underlying disorders, which encompass cognitive, emotional, behavioral, and physiological processes that are far more complex than can be described in these brief summaries. Rather, they are intended to summarize characteristic syndromes of signs and symptoms that point to an underlying disorder with a characteristic developmental history, biological and environmental risk factors, neuropsychological and physiological correlates, and typical clinical course.”

The key word that stood out to me was to “summarize” and prior to that “do not constitute comprehensive definitions” meaning that there is information and disorders beyond the DSM that a clinician will encounter in practice. I personally found this to be a revelation because over the course of my first year at Blackwater Outdoor Experiences we have worked with individuals who have had mental health disorder symptomatology that has not fallen directly under the diagnostic criteria of the DSM such as Nonverbal Learning Disability, and Processing Disorder. These two disorders specifically have affected a good portion of the clients I have been working with; there have been significant differences in their neuropsychological abilities that have caused them to struggle in academic, social, vocational, and familial settings. In most cases it was these neurodevelopmental or neurocognitive disorders specifically that were significant underlying factors for the development of the clients’ social anxiety, depression, low self-esteem, and substance use disorder.

Needless to say; my job just started feeling a lot more technical.

One could say that reality set in. At the same time I believe that the processes that I learned as a graduate student and now as a clinician in the field have allowed me to gain a better understanding of exactly how to parse through the information my clients present in order to help identify effectively what is the underlying struggle for them. I invite my clients on a journey with me on a therapeutic investigation to gather the clinical evidence we need to correctly identify these underlying struggles. Human behavior comes in a variety of personalities, emotions, actions, communication styles, and coping skills. The challenge as a clinician is to be able to understand that variety and recognize when an individual is dealing with a regular life stressor, trauma, or have a mental disorder.

How do you figure that out? That’s a topic for another day.

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Counseling Style: It’s not just Theory

Counseling style; a term used to describe how a therapist interacts with their clients in order to facilitate change. If you are just starting out as a therapist like myself you may have ran into the debate of:

I align with this theory so I should try and do more of that theory but the more I try I feel less like myself.

Aligning with a theory is one thing (theoretical orientation) but counseling style is taking your counseling skills of attending, theoretical knowledge, and human development knowledge and mixing blending it with your own personality. Sounds like a simple concept huh? The process of blending takes more effort and self-awareness than it may seem.

The most effective way to develop your counseling style is by regularly analyzing recordings of yourself in practice or real life sessions so that you can discuss them with a supervisor. The conversation that takes place between you and your supervisor is where a lot of your learning will come from other than through self-assessment.

Self-assessment of one’s interest in and motivation for receiving supervision is a logical first step in preparing for the supervision experience. Given that supervised counseling experience is required to obtain a degree and license, formal supervision is essentially a mandated, involuntary requirement. MHC practicum students need to ask themselves the degree to which they consider supervision to be an opportunity for learning, an inconvenience, a restriction, or an imposition (Pearson, 2004).

When thinking about this self-assessment it is important to consider what characteristics are considered to be required to be an effective therapist. Pearson (2004) lists what supervisors’ rated as being the most important student attributes:

  • demonstrates willingness to grow;
  • takes responsibility for consequences of own behavior;
  • actively participates in supervision sessions;
  • demonstrates respect and appreciation for individual differences;
  • and demonstrates understanding of own personal dynamics as they relate to therapy and supervision

By effectively working on these characteristics to improve you supervision experience and self-reflection a therapist is able to improve their counseling skills and develop their counseling style more effectively.

As I work to develop my own counseling style I am taking into account that I am an introvert that appreciates slow, and methodical thinking. I may not be as spontaneous in my conversation as others but I appreciate putting a thought process and structure behind my interventions. At the same time however it is important to remember that a therapy session is a conversation with your client. Does the conversation style you exhibiting fit your personality or are you trying to change some of your ingrained personality traits?

In a recent reflection paper I pointed out that I wanted to be more active in my sessions. My supervisor came back with a similar question to the one that I just posed. From that experience I was able to reflect and realize that as a counseling student I have been shown many different counseling styles that integrate theory and therapist personality. The challenge now and for the rest of my career will be to develop the style into something that fits my personality and is effective in helping my clients. The process of developing our counseling style begins when we start learning about how to be a therapist – from that point on we will be changing our style as we change ourselves and one thing we know as counselors is that development crosses the lifespan.

When evaluating  your counseling style think about the following:

  • What are your strengths as an individual?
  • What are your biggest personality strengths?
  • What is your theoretical orientation?
  • How does your personality match up with your theoretical orientation?
  • What is keeping your from being an effective therapist?
  • What makes you an effective therapist?

In the mental health field we talk about strengths and weaknesses and how they can help us in treatment. The challenge in developing our counseling style is realizing what are own strengths and gifts are so that we can use them to create the best results in therapy. In order to achieve this however, we need to accept the areas in which we do not excel.

Continue reading “Counseling Style: It’s not just Theory”