I. Purpose
The clinical case presentation provides an opportunity for therapist-presenters to demonstrate their clinical work, to receive peer consultation from other participants along with supervision from the facilitator. It also gives peer-therapists the opportunity to provide consultation, to practice their proto-supervisory skills and to learn about therapeutic problems, crises, impasses, conflicts, and approaches with cases that are not their own.
Examples of topics within the context of the case presentation include:
- Diagnostic Issues
- Issues of therapeutic frame and boundaries
- "Fit" between client and treatment approach
- Therapeutic crisis or impasses
- Transference and counter transference illustrations and dilemmas
- Culture-specific clinical issues and treatment modifactions
- Stage of treatment (e.g., termination) issues
II. Written hand-out
A detailed case description should is written and distributed to all group members a week prior to the scheduled presentation day. The write-up needs to cover the following (in any order):
- Reason for referral and presenting problem
- Description of the client (physical, behavioral & social)
- Brief pertinent life history
- History of presenting problem and past treatment history
- DSM-IV Diagnosis on all five axis (including secondary diagnosis and rule-outs)
- Clinical Case Formulation (from any chosen theoretical orientation)
- Cultural Case Formulation (using the DSM-IV guidelines for cultural formation)
- Brief treatment summary and course of treatment
- Observations on transference/counter transference dynamics in the case
- Clinical concerns or issues the presenting therapist would like/would wish to address
III. Clinical Case Conferences
Typed process notes of at least one recent psychotherapy hour (as close to verbatim as possible) are distributed to all participants on the day of the presentation. The notes are presented to the group and discussed in detail (in the light of the case data, clinical and cultural formulation and the issues the presenter asks to address.)
IV. Clinical Case Conferences
At the RAMS Outpatient Clinic, we have several ongoing Case Conferences, each with a different focus and a different audience:
The monthly Child Youth and Family Clinical Case Conference is conducted during the Wednesday Staff In-Service Trainings (9:10-10:30 on the last Wednesday of the month) and includes interns, trainees, outpatient child therapists and school-based clinical staff. The Director of Children, Youth & Family Services and the Director of Training oversee this conference.
The monthly Adult Clinical Case Conference is conducted as a Staff In-Service Training (10:30-12:00 on the first Wednesday of the month) and involves interns, trainees, and the staff of the Adult Outpatient Clinic. The Director of the Adult Outpatient Clinic and the Director of Training oversee this conference.
Both In-Service Case Conferences usually involve an external discussant who moderates the discussion. Typically, the discussants represent psychodynamic/psychoanalytic approach to therapy, however, depending on the nature of the case and requests of the presenter, other arrangements can be made. RAMS clinicians take turn presenting their cases and each pre-doctoral intern is expected to present at least one adult and one child case in this format. For practicum trainees, such presentations are optional, but highly encouraged.
The Intern and Trainee Clinical Case Conference (10:20-11:50 every Tuesday in the second semester; during the first semester, the Intern and Trainee Seminar is run as a didactic clinical training and a seminar on cultural self-awareness in clinical settings). This conference is overseen by the Director of Training and involves practicum trainees and predoctoral interns only; there are no external discussants. Predoctoral interns are expected not only to present their own cases to the group, but also to use this case conference as an opportunity to practice their proto-supervisory skills and to serve as co-facilitators; towards the end of the training year each of them has a chance to facilitate one session of the case conference on their own.To download the format for a case presentation write-up that is utilized in the Intern and Trainee Clinical Case Conference, please click here.
For the current and past schedules of the In-service Child and Adult Case Conferences, please click here.
V. Presentation
Usually, presentations start with questions from the group about the pertinent needs that are to be clarified about the write-up. Then the presenter takes about 10 minutes to present the case and any additional relevant information/material since the write-up was completed. The purpose here is to help the group better understand what it is like for the therapist to work with this particular client, rather than merely to go over the written text. The group then asks any questions desired for additional information. Next, the therapist presents process notes from a recent session. The following group discussion focuses mainly on the presenter's stated concerns. In addition, the Director of Training may ask the conference to focus on a particular clinical issue.
For more information about our case conferences, click here.
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