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Clinical psychologists?

2016

Hello,

My name is Zachary and I am a student in my second year of my Child Studies degree, majoring in Child and Youth Care Counsellor. At the beginning of this semester I began my practicum at a 6 bed group home for children ages 12 - 17.

The clients at my practicum have a wonderful advantage over my previous experiences in the field: they have on site clinicians. Not having to wait for appointments to be planned, and paper work to be filled, but to simply be able to sit down and have a bowl of cheerios with their clinician shows wonderful results. In addition to being able to speak one-on-one with the clients, the clinicians at my practicum take on a much larger, and more important role. They sit in on collaborative meetings to advocate for the children and youth that they know personally, as well as professionally, and help to build a therapeutic mileu around the client.

Whether it is the casual way with which the clinicians can approach clients, or the visible changes created by a clinician's influence is clearly beneficial. That being said, this is my question: funding aside, why do more programs, or agencies not make use of onsite clinicians? If funding IS the sole issue, why is there not federal funding to provide such a beneficial tool for all of our nation's children and youth?

Zachary
...

Hi Zachary,

You ask an important question and I am sure you will receive many opinions about this. Here is what I think:

1) Funding is often an issue, although this may vary from one setting to another. So this might be part of the reason why you don’t have more clinicians on site.

2) “Clinicians” are not very popular people in child and youth care settings. Even word “clinician” does not fit nicely with the frame of reference we hold about what children need. Psychologists are often regarded as treating disorders and dealing with dysfunction, therefore not very development or strengths-based. Often child and youth care practitioners therefore think of psychologists as representing the opposite of what they are aiming at, i.e. looking at children from a medical model rather than a developmental model. So I think the perception people hold of psychologists might prevent them from exploring this option. Of course, some disagree.

3) The perceptions that people have of psychologists as medically-orientated and clinical is often accurate, unfortunately. Therefore it is true that many clinicians would not fit very well into a child and youth care setting and that their approach would be at odds with a child and youth care way of working. Not all clinicians would be comfortable casting aside the comforts and protection that the profession affords them to venture into the real and unpredictable world where “things happen” and where the aim is to build real significant relationships with children. Of course, some would disagree.

At the end of the day, I would suggest that what makes your experience a good one is not that you have clinicians on site, but that you have the right clinicians on site. There are many different practice settings and it is important to select the right team composition that works for each individual setting. I think some settings would do better without on-site clinicians, while others may benefit tremendously.

I find it very encouraging that you share this positive experience – thank you.

Werner van der Westhuizen
South Africa
...

I think FUNDING is the sole issue.

Lorraine


Good morning,

Thank you very much for your responses. The clash of values between a clinician, and a child and youth care preferred strength based approach had not occurred to me. I suppose that I have thus far been fortunate to have encountered what you refer to as the "right clinician", and for that I am thankful.

That being said I can definitely understand how certain settings would benefit more from others, especially if they did not have the right team picked for them.

Again, thank you for your response, and for taking the time to assist me.

Zachary


Werner. I’m glad you said “some would disagree”. I am a Psychologist as well as a Certified Child and Youth Care Worker. I don’t see a conflict. I also think the discussion that’s been running about knowing the client’s history (“file”) is an important one as it blends the two approaches without conflict. If CYC’s are getting paid to provide “treatment” the “relationship” is not the only thing that matters. The relationship is USED to enhance and provide treatment, and I don’t understand how it is not relevant for CYC’s to understand exactly what “wound” (mental or emotional) the young person needs treatment for.

Lorraine

You can read the discussion about knowing the client’s history here — Eds.


I think a lot has to do with the role of the psychologist in the setting and the orientation of the psychologist.

In the 'olden days' -(hopefully not now) - the treatment team or the setting's team in general - was hierarchical. Staffing and planning meetings would be held and 'treatment plans' might well have been generated. However, the child and youth workers may not even have been present at these meetings and yet were somehow supposed to help implement these plans. If they were present, maybe they could give a report, but may not have had a real voice in the decisions made.

As well, the 'real' treatment was considered not to take place in the milieu but rather in the 1/2 hour or so of therapy with a psychologist, social worker, psychiatrist or psychiatric nurse. There could be tension between the direct care workers and these other staff members because the direct care workers got shut out of the planning, yet were supposed to implement recommendations if they were told about them at all. As well the direct care workers would comment that the children were more 'difficult' before/after the sessions.

Under the model above, the children and youth themselves might experience the milieu as fragmented and 'assembly line' - as rather than an integrated approach to their daily experience, they would rather be given an hour of this, a half an hour of that, and never the twains would meet.

Hopefully by today a much more collegial model is being implemented. If so, that is great news and if there is true teamwork I think the 'clinical' input from a psychologist can be valuable. Information and observations from the direct care workers can be invaluable to the psychologist. In other words - and as I think Werner was saying - it's all how the psychologist is integrated into the setting. Roles need to be articulated and understood by all.

As well it's the theoretical orientation of the psychologist that may be significant. A psychologist with a rigid view of boundary issues (not that it is important to be aware of them) might not be supportive of the relational aspect of child and youth work.

There are and have been quite a few clinical psychologists totally understanding of and committed to the key role of child and youth workers. Martha Mattingly was one of them.

Karen


Hi Lorraine,

I actually agree with you – I don’t see a conflict either. However, many people do see a conflict – or perhaps I should say it is their experience that there is a conflict. I am picking up on that. I think that different settings also operate very differently. I have encountered very strong opinions about “clinicians” in a CYC context, and often there is the hierarchical aspects that Karen refers to. I don’t see that there needs to be a conflict, but I think often there is one – perhaps not because the conflict is inherent in the roles, but perhaps more because of people’s own experiences and viewpoints. I guess in the end my comment goes more to how those professional relationships are experienced and managed. Hope this makes sense.

Werner

Hi!

I too am a clinical psychologist….as are many of our CYC colleagues! When I worked in residential care, my role was to support front line workers, not by seeing kids or using a medical model, but by being available to meet and consult as an external person with some relevant expertise.

Many of “us” are strength based, and strongly committed to the field! Thank you colleagues for saying so.

Varda


Just a quick reminder that psychology is not a monolithic discipline. Like CYC it has lots of edges. Some psychological approaches and theoretical orientation I have found mesh nicely with the approaches I have taken to CYC work (phenomenological, critical, feminist, existential, transpersonal, Lacanian, postmodern among others) while others are a bit more challenging. I have taught for many years in psychology departments and have found many of my colleagues in psychology to be great collaborators and co-thinkers about CYC practice including Ian Parker, Erica Burman, Chris Aanstoos, Koreen Malone and Kathleen Skott-Myhre among others.

Hans Skott-Myhre


Sorry Lorraine but I would suggest that a relationship is not something to be USED in the course of treatment. If there’s anything that so-called “treatment” has to offer it would be to support a healthy, caring and loving relationship. To repeat my well worn cliche – all our problems are created in relationships and can only be resolved in relationship. Personally I think it’s time we put “treatment” back where it belongs – on the psychiatric wards.

Gerry Fewster


I’m with you Werner.

Lorraine
...

Hi everyone, 

This is a very important and stimulating conversation. Here are my thoughts: 

I have come to learn that without thinking critically, we are at risk of becoming static and egotistical about our practice.  

We have to be careful when we say things like, 'psychologists do not have a developmental or relational approach with young people'. We would not have a developmental view of CYC work without the significant contributions from psychologists such as Erik Erickson, John Bowlby and Abraham Maslow. Therefore, CYC practice cannot proclaim this as our approach alone, especially in comparison to psychology! 

Admittedly, I used to take pride in a distinct CYC approach in comparison to other fields. Now I realize that the dichotomous comparison of a strength-based approach vs. a medical, deficit-based approach is not entirely helpful when we use it to boast our profession against others. The incredible work in positive psychology (Dr. Martin Seligman –  psychologist) and resilience theory (Dr. Michael Unger – Social Worker) has actually helped to shape the CYC strength-based approach. Strength-based approaches are not unique to CYC. 

Finally, I am still grappling with the difference between 'using' our relationship and 'being in' relationship with young people in CYC practice. I agree with Gerry that we have to be careful when we say we are 'using' it to treat a young person. However, I also agree with Lorraine that we must 'use' our relationship intentionally to enhance treatment of 'wounds'. If we simply focus on the relationship, without considering the ultimate goals of therapy, then we are not helping. In this sense, I see 'use' as a way to describe our intent with a relational approach. We also have to look toward collaborative approaches in treatment. Although I am not a fan of the word 'clinician' for our field, I see nothing wrong with this term for other professions. For some young people, clinical therapy, enhanced by the relational approach of a CYC, may be just what the doctor ordered!

 Respectfully, 

Nancy
...

Nancy.  I am in love with the way you phrased what I believe the greatest gift of love we can give our children and young people:  “clinical therapy enhanced by the relational approach”.  BOTH are Child and Youth Care Practice. 

Lorraine
...

Nancy,

Hi. Although it appears that you have already grappled with (past tense – the grappling is over), here are a few additional thoughts.

First to deal with the semantics around “treatment,” let’s use the term “betterment.” Young people, whether self-referred, court-ordered, or through some other mechanism, only come into contact with CYCs in order to make something better. That is, the initial step in the relationship, or the reason for it, is betterment. Even if, from the youth’s point of view, making things better means getting out of a “treatment” program or institution they find aversive (stupid, waste of time, etc.). So from the beginning, both the young person and the CYC expect to “use” the relationship to get somewhere better, that is, use of the relationship is built into the reality of the situation. For a CYC to not use the relationship would be to ignore reality and basically cheat the young person.

From my point of view, the issue of using the relationship is a dead issue – it’s been grappled to the ground. The real issues have to do with how to use the relationship, to whose betterment, with whom (given the main topic of this thread), etc.

Dennis McDermott
...

Nancy.. thank you so much for this well thought out response. I have been trying to put into words my thoughts and feelings.. and then I read this...

Gillian Thibedeau
...

Any time Gillian,

Lorraine - I admire your work very much and am thrilled by your compliment.

Dennis- I love the term "betterment"!! Thank you for taking the time to respond with such and eloquent new term to add to my CYC vocabulary!

Respectfully,

Nancy

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