Social Work Internship: 2nd Week

The other day I completed my second week at a mental health outpatient clinic at a New York hospital and I am feeling so grateful for this placement. Not only am I getting the clinical experience that I craved, excellent supervision and various training opportunities, but the overall feeling at this internship is one of order and organization and an overall set-up to provide a terrific learning experience for their social work (and psychology) interns.

One of the topics covered this week were the Health Insurance Portability and Accountability Act (HIPAA) rules. These are the rules that essentially protect the privacy of patients and what one needs to do to ensure patient privacy such as shredding any documents with patient information, not discussing any patient information in an area where that information may be overheard etc. For more information, please visit the U.S. Department of Health and Human Services.

In addition to the HIPAA lecture, there were other internal trainings provided so that I could start inputting progress notes on the hospital's secure online record system after seeing a patient. This was not as straightforward a process as you might think because every thing requires security and authorization plus training. In any case, I'm finally in, so to speak and starting to get acclimated to the various procedures.

In terms of actual clinical work, I saw three patients; one from last week as well as two new patients. I also sat in on two additional supportive type groups for women.

This week also included submitting my first process recording to my supervisor. A process recording is essentially a verbatim record of the conversation that a patient and social worker intern had with each other (to the best of the intern's recollection) in one column. The subsequent columns may vary according to to your particular supervisor's style.

My supervisor wanted the second column to reflect any transference and counter-transference feelings that I noted and the third column to contain observations that I made with regard to my patients' moods, behaviors and defenses. The final fourth column was to be left blank for my supervisor to provide her feedback.

For those of you who are unfamiliar with the terms of transference, counter-transference and defenses, a brief explanation will follow. In this context, transference feelings refer to those that the patients are feeling towards the practitioner. Often patients react to the practitioner as they did with a parent or a significant other person in their lives with whom they have an unresolved conflict.

The more similar a clinician is to the parent or other important person with whom the patient has had unsatisfactory or unresolved issues from childhood, the more likely and intense the transference will be.
Similarly, counter-transference refers to those unconscious feelings, behaviors, thoughts and reactions that get triggered in the clinician in therapy and/or towards the client.

Unresolved issues from the practitioner's life may evolve as a counter-transference. The therapist’s job is to remain neutral; counter-transference can be damaging if not properly managed. Hence the clinician's need for good supervision and/or therapy so as to ensure awareness of own counter-transference so that her or his emotional process is not interfering with the client's process.

Defenses refer to the coping mechanisms that people employ when facing difficult situations. These include: displacement, sublimation, projection, rationalization, denial, repression, withdrawal and reaction-formation. While we all use them when troubled, we usually are able to reach a point when we may face our problems and need not rely so heavily on our defenses to protect us.

Back to the assignment, it was a bit difficult for me because it was my first time at completing a process recording with this particular type of analysis. In any case, I gave it my best shot and handed it in. While Dr E's plan was to review it with me on Thursday, she gave it to me on Wednesday with her feedback to photocopy so that we would both have copies in hand during supervision the following day.

After photocopying it, I started reading her comments. There were so many...and my initial automatic thought was I must have done an awful first process recording for her to have so much feedback. Dr E came by my office and noted that I had started looking over her comments.

She then proceeded to explain some of her comments even though this hadn't been supervision time and I guess she could see in my face that internally I was feeling bad. She very kindly asked me what was going on and I ended up sharing with her one negative comment that my father had made when I was a teenager.

While I knew intellectually that my father had only said that negative comment out of sheer frustration that he was unable to explain something to me that I had asked him for help in, the negative remark he had made somehow was still with me and those feelings I had then got triggered when I saw my process recording with so much feedback.

This, by the way, is an illustration of transference; I was assuming that my supervisor at that point in time was thinking of me the way my father had thought of me or spoken to me in anger/frustration.

My supervisor responded in a very kind way to me and told me that her typical style of supervising is not to provide a lot of praise till the end of one's internship when one has shown a lot of growth. She has found this to be most effective in terms of motivating social work interns to continually work on improving their work etc.

She then went on to say that she thought that I had done a very good first clinical process recording and thought I was doing a very good job. She explained that the feedback she provided was just to help me improve and learn etc.

Dr E is such a kind and supportive supervisor. I need to learn to manage my leftover childhood issue with my father so as not to misinterpret her feedback. Thankfully, I can be open and upfront with Dr E and this, in turn, will assist me in this process.

As always, please feel free to share your thoughts and comments. I really appreciate them :)

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