COUNSELING PRACTICUM CHRONICLE, Part 1:

Spring Semester 2008 has begun at Avila University, and I’m planning on writing a chronicle of one class, the Practicum in Counseling Psychology, for this semester.

Some background information: The Practicum course for psychologists and counselors is very much a bridge course between course work and the internship (in which, often for the first time, students have the responsibility and privilege of working with “real people, with real problems, in a real clinic”). In Practicum, students take a first run at using theories and interventions they have learned about in class, mostly from textbooks, and applying them to the live clinical situation. In most cases, students are not given specific training in a particular theory of psychotherapy, or in a set of interventions (other than “essential counseling skills”), but rather are given free rein to “choose a theory” and apply it, as best they can, with coaching and supervision from the practicum instructor. Accordingly, in any given Practicum class, you are likely to see students who are claiming allegiance to several different theories and methods of psychotherapy: psychodynamic, gestalt, adlerian, existential, cognitive, cognitive-behavioral, and so forth. Each of them is expected to do his or her best to figure out how to effectively apply the theory to practice.

This typical Practicum situation is what I was exposed to when I underwent my own training. I found it lacking in many ways, and my sense that it could be improved only intensified as I became a professor in a counseling psychology graduate program. The problem lies in the crucial difference between teaching someone “about” something, and teaching someone “how to do” something. In other professions, this distinction is thoroughly honored. In medicine, students generally have two years of pre-clinical book work, plus labs, before they begin to be taught and shown how to actually “do” things with patients. In law, students have nearly all of their three years of training in theoretical book work; but afterwards, if they are becoming trial lawyers, there is a strong tradition in which young lawyers are shown how to try a case (they go to trial as “second chair” assistants), and then they are closely supervised and assisted by experienced trial lawyers, as they try their first cases in the courtrooms.

One way to appreciate the difference between the “teaching about” and “teaching how to” approaches is to think about teaching someone to play golf, or to do surgery. These are skills that certainly have theoretical components: you can think about, and read about, the physics and mechanics and techniques involved in the golf swing; and the anatomy, physiology, and techniques of surgery. But they also have a large “doing” component. Nobody ever became competent at golf or surgery by reading about it, thinking about it, or being told about it. You simply have to DO it, in order to be ABLE to do it, and you need someone to demonstrate it, and SHOW YOU HOW to do it.

My first career was as a trial lawyer, and having been thoroughly and effectively trained in that profession by way of a “show me how, and then watch me and help me as I try to do it” approach, I have always felt that this approach would greatly improve the training of counselors and psychotherapists of all types.

Accordingly, when I became Practicum Director, I re-designed the Practicum Course. I developed a curriculum called Mindfulness In Action, in which students are directly taught a limited number of interventions that are (a) effective with a wide variety of presenting problems; (b) supported in the peer-reviewed, mainstream literature; and (c) consistent with most theoretical orientations in psychotherapy. In addition to “essential counseling skills” (listening skills, rapport building, etc.), students are trained in the use of mindfulness-based interventions, and values-based behavioral activation, with their clients. The Practicum instructors not only teach the theory behind, and empirical support for these interventions, but also model the interventions (showing "how it is done"), and supervise the students as they practice doing the interventions with each other, in the classroom, under supervision, before using them with clients.

This semester will be our fourth semester using this curriculum. The response has been extremely positive, both from the students who complete the course, and from the practice clients who serve as volunteers for our practicum students. [See my earlier post in this blog, dated November 5, 2007:

http://crimlawdoc.blogspot.com/2007/11/this-past-weekend-i-presented-talk-at.html

about a presentation I gave about our approach.] We have also heard very strong positive feedback from internship supervisors at clinical placements in the community, who tell us that our students are much better prepared for internship than many of the counseling and counseling psych students who come from other universities.

So we are off and running again with Practicum. First class session was Thursday, January 17. I am teaching the course with Matt Arnet, MSCP, LPC, who is well-trained in these methods and very ably teaches them. We have a total of 10 students in our (combined) two sections. In our first class, we gave an introduction to the course, its methods and rationale(s), and Matt led the class in a guided body scan meditation. For this week, homework will include daily practice of the body scan, with daily journaling about that experience; and some reading (and writing about) three journal articles that discuss mindfulness and mindfulness-based interventions in psychotherapy.