intern supervision

Although the interventions and interactions delineated below are typical of interventions and interactions which might be used in therapy (depending upon the client, therapist, et cetera), cases presented are entirely fictional characters. Thus, this example may be freely utilized without concern for issues of confidentiality, as these "clients" are non-existent.

Client Name (age)	# sessions to date	client risk level	difficulty level	"stuckness" level	Fee/ Source
Marie Santini (40)	8	2	2	1	$30
Mary Richards (28)	3	4	4	2	$50
James Bond (62)	9	3	5	4	$45
Tom Piper (8)	5	5	3	3	VWA
Eb Scrooge (77)	13	3	4	3	$20
Missy Muffet (7)	5	4	3	2	DFCS
(et cetera)	-	-	-	-	-

D: Marie talked about problems with job search ("scary, intimidating"). She shared that she read the recommended section of When Love Goes Wrong and she "saw herself" reflected in the narrative. "I remembered childhood interactions...", following the reading, that clarified the abusiveness of her FOO. Homework is to continue her centering and relation exercises and journal work.

A: M is gradually moving away from denial about danger presented by her battering ex-partner, as she is able to acknowledge dysfunctional patterns of interaction in FOO, and is strengthening her sense of self, and gaining in ability to calm and cope. Self-talk is improving her ability to self-motivate (e.g., in terms of job search). Centering and relaxation, as a means of building sense of self-efficacy, are also her to build self awareness and self esteem.

P: Validated M's efforts, reflected her increasing awareness of invisibility/invalidation in FOO and in adult relationships, helped to reframe negative self-view into a more adaptive perception. Continue work to strengthen awareness, build SE and competence, increase cognitive/behavioral coping skills.

D: Conducted BDI, agreed to complete Substance Use Inventory (take home) screen for next week. We worked on communication skills fostering positive interactions and cooperation. Mary admitted that she holds in frustrations at home and office, then, when issues are unresolved, "explodes" (explains this as sharp, critical, negative affect and attitude toward others...ranges from "snippy" to rude to yelling [yells only at home]). Mary did set appointment with physician for physical to deal with breast lump.

A: Mary's BDI score indicates mild depressive state (12), which is congruent with current stressors. Sleep difficulties (minor) possibly relate to fear of cancer issues.

P: Validated M's courage for setting appointment for physical. Offered support for fears around cancer. Introduced concept of self-talk/perceptions-feelings-actions. Continue to assess for: 1. depression/bipolar disorder, and follow with referral for psych evaluation if indicated 2. for substance use issues 3. expression of anger/interpersonal coping skills

D: Tom still fidgets nervously at beginnings of session, but quickly relaxed, and stated that he likes the play room, and was afraid his mom would forget the session. Talked about sadness, was teary, about Halloween, and how it reminds him of brother's death (car accident, Tom present) last year...misses brother, feels guilt regarding helplessness. Some recent bad dreams about accident (anniversary). Asked if he could make Halloween card for brother. Asked if I would explain to Mom that he wanted to put it on the refrigerator where Alex could see it "from heaven". We role played a discussion where he talked to Mom, and I assisted. He was afraid Mom would laugh (or cry).

A: Verbally assessed level of depression (appears congruent with situation, "bad dreams" were not "night terrors").

P: Processed sadness, facilitated expression of grief about Alex's death. Probed regarding "bad dreams". Continue to build trust, work with grief, assess for on-going depression. Work on "transitional activities" for times that Mom might forget the session.

D: Worked on "scary feelings box" which she decorated with stickers, especially of cats, dogs, and teddies (which she sees as protectors against spiders). Missy was able to generate several cognitive statements with which to cope with fears and anxieties. Later, during play with dolls, she was relaxed and happy, and said "Counseling is one of my best things. It helps me feel strong."

A: Missy expresses increasing trust in the therapeutic relationship and process, verbally, in her actions and attitude, and her willingness to engage in activities such as "protective thoughts". Bright and very capable.

P: Encouraged, supported, validated. Continue to work on verbalization of fears and anxiety. Continue work with coping strategies. Introduce relaxation activities/exercises. Schedule parent session for further clarification regarding origins of spider fears/phobia.