Clinical Case Load AssistantAt — Karen P. Palmer, Ph.D.

Together Lily and I will be working on clinical case management for my existing psychotherapy clients age 19--80 years old, the details of which are further explained and referenced in this application.

“Lily will demonstrate her learning outcomes by…..”

1. Studying each vignette on her own and subsequently presenting either orally, or in writing, her tentative diagnoses; treatment plan; possible clinical modalities to be used; expected clinical outcomes; social-cultural issues; and personal or professional concerns including her rationales for each of these.
2. Assess any outstanding ethical, and or legal consideration per vignette.
3. Discuss any obvious transference or countertransference issues or any aspects of the therapeutic alliance that need support or attention.
4. Compile a list of her own resources to be studied for the client that might include both literature pertinent to the clinician as well as resources for the client him or herself such as: books, podcasts, videos, audio tapes, community support groups, handouts, worksheets, psychological tests and inventories, and on-line programs. To this end Lily can add any additional creative “homework” assignments she might deem as helpful that deepen the therapeutic work.

The Candidate must have:

1. Completed a minimum of one year of psychotherapy with either a Marriage and Family Therapist, or with a Clinical Psychologist.
2. A Bachelor’s Degree (or working University Major) in Psychology, or Counseling Psychology.
3. A declared interest in future licensure as a Marriage and Family therapist or as a Clinical Psychologist.
4. A declared interest in possible Private Practice once licensed.

To help Lily achieve the proposed learning outcomes I will:

1. Provide one vignette per week from my current caseload, and starting with Lily’s initial impressions explore and work together as a team to cover the afore-mentioned learning objectives as they might apply to each case.
2. Share and explain all of my charts, intake forms, client worksheets, reading lists, internet resources, community resources, client tests and inventories, and any other relevant written, visual, or auditory material that Lily might find useful.
3. Case by case give Lily thoughtful and respectful feedback on all of her opinions and rationales.
4. Discuss every undertaken concept thoroughly and attempt to answer all of Lily’s questions.
5. Apply any material from Lily’s college courses to the private practice clinical setting.

6. Allow Lily to observe client sessions with client's permission as available.

By the end of the internship Lily will be able to:

1. Identify clinical symptomology within vignettes and discussions based on a wide swath of an adult psychotherapy population ( 19—80 years old), as well as generate hypothetical diagnoses, treatment plans, and personal or community-based resources for the client(s). Name any professional, legal, ethical, abuse, gender, cultural, racial prejudices or biases that might arise during treatment.
2. Understand the elements of an initial intake interview, including the legal aspects of mandatory forms.
3. Have a working knowledge of the various treatment modalities that are considered historically effective with both the clinical presentations and the client’s personality or requests, while at the same time having a deeper knowledge of any treatment modality that may or may not work well with her own personality.
4. Discern when a clinical consultation is appropriate.
5. Have a better awareness of when some of the treatment plan involves a higher level of care, such as a medical consultation, psychotherapy specialist, group therapy, couples or family therapy, hospitalization.
6. Have a broader view of the general business scaffolding of office management in private practice, including its advantages and disadvantages as compared with group practice.
7. Be able to begin to assess her own strengths as an individual, couples, family, or group therapist.
8. Have an overview of how and when to work with insurance companies, including the moral and ethical standards inherent in those relationships.
9. Know the main components and parameters of a “Clinical Review” that an insurance company, court, or colleague might request.
10. Understand the difference between a Clinical Record and Provider Notes.
11. Become more mindful of challenging clients, including average resistance and transference issues, and how to therapeutically approach these.
12. Become more aware of her own countertransference tendencies.
13. Know some of the symptoms of compassionate therapist “burn out” and what to do about it.
14. Realize the broader scope of client confidentiality including: the ability of others to hear the client; the safety of record keeping; court-ordered records; the storage and location of client files when the therapist is out sick, on vacation, or dies; and client anonymity when the therapist might see the client out of the office.
15. Have a working knowledge of other client management concerns, such as missed or cancelled-too-late appointments; payment refusal; in-session outbursts; family or friends’ referrals; scheduling for another adult; scope of confidentiality when seeing a client both individually and as a couple/family; situations and types of clients with whom the therapist is not a good fit; danger and safety issues for the therapist; and lead time for the client when the therapist will be gone for an extended vacation, or leave the practice.
16. Acquire an initial grasp of the more specific business practices as a therapist, including: location of an office; noise abatement; fee structure for clients both with and without insurance; professional liability insurance for the provider; in-person versus telehealth issues; pro-bono clients; ethical advertising; how to begin a private practice; networking.