practice

One of programs I was involved in at the CU Aging Center this year was the At Home Mental Health Service program. We partner with a local social service agency for seniors to provide therapy for clients in their homes. These individuals typically have a number of physical or emotional problems that make it difficult for them to leave their homes to obtain services.

Some things I learned through my work in this program:

1) It's OK to set boundaries: For example, asking clients to put pets in another room or not to smoke during the session is not selfish or too demanding, rather it's a way for me to take care of myself in order to give my full attention to the needs of my clients.

2) Therapy goals can never be too clear: This is particularly relevant with older clients who are dealing with loneliness. Sometimes I was seen as a "visitor" coming for social reasons. While increased social contact may be helpful in and of itself this may not be the best use of a therapist's skills.

3) Good supervision is essential: Of course supervision is always necessary, but it's especially important when dealing with complex clients. It was extremely helpful to have a team of peers and more experienced clinicians to discuss cases with and a place where I could admit I had no idea of what I was doing!

4) A lot of older adults who could benefit from therapy are out of the "reach" of traditional services: Several of the clients who I worked with through this program probably would have never engaged in therapy if it meant weekly trips to a clinic to meet with a therapist.

Though challenging, my participation in the At Home program was a valuable experience in helping me to develop as a therapist.

One of my clinical rotations at the CU Aging Center this year was in the Memory Clinic. The Memory Clinic provides brief cognitive screening for individuals who may be experiencing problems with their memory. This type of testing is less extensive than a standard neuropsychological assessment and can determine whether an individual's cognitive abilities are within a "normal" range for their age, if clear cognitive impairment is present, or if further testing is indicated.

As it turns out, most of the clients who I've assessed this year have had emotional problems that were contributing to their memory difficulties, rather than dementia. This is good news in the sense that depression, anxiety, and sleep problems are potentially treatable. Other individuals were having no memory problems, but wanted a baseline measure of their functioning in case they experience a decline in the future (a current fear of thousands of baby-boomers).

If you are in the vicinity of Colorado Springs and are interested in a memory assessment, you can contact the CU Aging Center at 719-471-4884 to schedule an appointment.

As part of our clinical training at the CU Aging Center, we are required to give an "evidence-based practice" presentation to the other staff members. According to the APA, evidence-based practice in psychology is "the integration of the best available research with clinical expertise in the context of patient characteristics, culture, and preferences." That is, both research and clinical skills are used in the practice of psychotherapy. Inspired by a client with whom I worked earlier this year, I chose to discuss complicated bereavement, which is being considered for inclusion in the next edition of the DSM.

A lot of people who know me now probably wouldn't believe it, but I used to be an expert pessimist. I could ruminate on the worst aspects of any situation with the best of them. I've made several changes in my life in order to shift to a "glass half full" orientation; one of the things that helped me the most was to begin a "gratitude journal."

For the past few years, I've kept a notebook that contains lists of whatever I'm grateful for at that moment, however large ("I'm grateful for being able to visit my family at Christmas") or small ("I'm grateful for my flannel sheets"). I decided recently that I needed a practicum gratitude list. As any graduate student knows, many aspects of the practicum experience can be frustrating and annoying, but there are also many that can be appreciated. So, here's my current gratitude list for working at my practicum site:

- I'm grateful for being able to work almost exclusively with older adults and their families.

- I'm grateful for not having to search and interview for a new practicum placement every year.

- I'm grateful for having the opportunity to be involved in so many different rotations.

- I'm grateful for having a five-minute commute.

- I'm grateful for having my own desk and computer.

- I'm grateful for being able to work with bright, interesting, motivated colleagues who have similar professional interests.

The Psychological Society of the Pikes Peak Region sponsored a conference today titled "The Science of Change: Translating What Works in Therapy." Barry Duncan, Psy.D., co-director of the Institute for the Study of Therapeutic Change, challenged recent trends in the field of mental health that emphasize treatment methods over other factors responsible for psychotherapy outcome. From his years of experience as a practitioner and review of the literature, he has come to a few conclusions:

- the therapeutic alliance is more important for psychotherapy outcome than the theoretical orientation of the service provider (e.g., clients generally don't remember what brilliant techniques we use in therapy, but how well we build a relationship with them)

- evidence based treatments aren't "bad," but overemphasized in the field of mental health and should be used on a client-by-client basis (taking into consideration client characteristics, culture, and preferences)

- most of the outcome variance in psychotherapy is due to client/extratherapeutic factors (i.e., something that happens outside of the therapy hour that helps a client to change)

- therapeutic power does not come out of identifying what clients need, but in identifying their strengths and resources that can be put to use in reaching their goals (Dr. Duncan calls this "finding the heroic client," my clinical supervisor calls it "being curious")

- asking clients what they'd like to do to deal with their problems and asking for feedback on how they think they are progressing throughout therapy improves the quality and outcome of services