Ten Tips from 40 years in Clinical Practice

By Allan G. Hedberg, Ph.D.
February 18, 2011

Forty years ago, I began clinical practice after receiving the Ph.D. degree in clinical psychology from Queen’s University. The first two post-graduate years were devoted to direct service delivery while serving in a community mental health center in Minnesota. This was followed by three years of university teaching at the doctoral level while providing consultation to many community businesses and social service agencies, while maintaining a small private practice.

It was through the process of teaching, consulting and a limited private practice that I decided to focus on a full time private practice with a community psychology emphasis. The breadth of experience coming from teaching, consulting, psychotherapy, community education and a variety of other professional services provided a good lifestyle for my family and a very rewarding professional career. Patients are better served when their therapist has a deep and broad base of experience.

This broad base of experience from one or two structured clinical environments prior to settling down in a private practice office in a community of choice has definite advantages personally and professionally.

Throughout my professional career, I have come to see the advantages of the various therapeutic techniques, aids and approaches I developed and utilized with patients. They not only proved worthy of use and further development, but were helpful enough to share with other therapists.

The following ten ideas and therapy aids are offered for the benefit of other therapists, especially new graduates/professionals starting out in their professional career:

Share life experiences

  • Use selected opportunities to share your life with patients, as appropriate.
  • Patients need role models and can learn from the good traits and values a therapist possesses and passes along.
  • Patients learn from others whom they respect and this often includes their therapist.
  • Patients are encouraged to open up and share their life experiences after hearing a personal experience from their therapist.

Use community resources

  • Patients glean strength and benefit from being referred to specific community resources for additional mental health and personal growth between therapy sessions.
  • Patient benefit from the community resources they utilize over a long period of time after therapy that facilitate healing, personal development and new learning.

Visual aids, homework and handouts

  • Patients gain when they are provided a homework assignment or a “take home” handout to read on the topic or issue being discussed in therapy.
  • Patients gain from a visual presentation during therapy on a topic or therapeutic issue to help them change an undesirable behavior.

Use assertive confrontation

  • Patients are more likely to stop denying and excusing their wrongful behavior when a therapist supportively confronts them with the facts and with reasonable discussion.
  • Patients progress in therapy more quickly and fully when the therapist is empathically assertive, forthright and confrontational.

Use mottos, quotations and adages

  • Patients bring to therapy a history of personal mottos, adages and quotations that can be discussed and used as simple teaching points with therapeutic impact.
  • Patients can be assisted in relating to their past and connect with an “unspeakable” trauma event or experience by using their own mottos or adages as teaching points with long-term significant meaning.

Use quarterly mini-vacations

  • Patients understand and are sympathetic to the therapist’s need to take several mini-vacations during the year to restore the mind and body after a prolonged period of intense psychotherapy day after day.
  • Patients learn about taking care of themselves and their family as they observe their therapist take care of himself/herself.

Use e-mail communication

  • Patients can often gain and learn from critical points of behavioral change when allowed to engage in a limited but essential e-mail communication between sessions.
  • Patient’s progress can be advanced by the use of e-mail to provide feedback during the week when a patient has successfully completed an assignment or made progress on the assigned homework exercise.

Use books, leaflets, tapes, DVDs

  • Patients appreciate being given a selected paper to read or being loaned a relevant book, tape, CD or DVD to help them advance in their therapy.
  • Patients like selected topics to read about or study further on some therapeutic issue related to their problems during the weeks between sessions.

Use consultants

  • Patients may benefit from many experts with whom a therapist may consult to properly address their complex situation, especially when co-morbidity is involved.
  • Patients understand that the use of consultants is not a sign of weakness of a therapist, but rather a sign of strength and wisdom.

Use white board (black board)

  • Patients today come from a history of visual based learning. Drawing a therapeutic concept or historical lifestyle pattern on a white board is helpful and comfortable for most patents, especially younger ones.
  • Patients find the use of a white board a good tool for teaching complex ideas and theories and how their presenting problem can best be understood and improved through a course of therapy.
  • Patients like the use of the white board to explain abstract ideas or concepts and help make them concrete and applicable to the patient’s treatment plan.

I am sure every therapist has found some technique or teaching point to share with their patients to further their objectives when they came to therapy. As a profession, we need to share “what works” with each other and help each other conduct our therapy more efficiently. I offer this article as a beginning and encourage you to share your ideas and methods. We can continue to learn from each other as we did in graduate school.

Allan G. Hedberg, Ph.D., is a clinical psychologist with a practice in Fresno, Calif. He may be reached by e-mail at: allanghedberg@sbcglobal.net.

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