What does "supervised" look like in therapy?

[joeylittle]

Thanks for clarifying stuff, @lostforgottensoul

No, what he said was that the government gave funding for veterans with PTSD and with that is more and new EMDR training, for any therapist.

It was the "more and new" that made me leap to the assumption about it being a specific protocol for vets. A little internet research turns up that there doesn't appear to be such a thing. There is a new protocol for dealing with survivors of group trauma, and a fair amount of activity around that in your area following the PULSE shooting.

I want a real logical reason to turn down new EMDR training with would include anything new learned about EMDR and any tweeks in it.

That's very sensical. Doesn't look like the EMDR process has been altered, but I'd be really interested in knowing if it has, so hope you keep us posted.

And I remember a thread that was asking if there was a limited time a person should be in therapy and anthony said 3 or 5 yrs (I'd have to go look) and it's been 9 yrs in April and though a service dog helps I am still severely affected and still have severe symptoms impacting my abilty to function. When do I say "let's try something new"? You know?

I think this is the useful part of what you've been thinking about. My impression - and you can correct me if I'm wrong - is that your therapy has moved very slowly. It took you a long time to even talk about it, and you only tried formal trauma processing (using EMDR) once(?), but your abreaction was such that you and he did not try it again. So you've spent a large number of years not doing any formal trauma work. Sounds like, sometimes talking about the trauma, but mostly doing stabilization and work on your current life stressors and events. Correct me if I've got that wrong.

Re-committing to formal trauma processing, using any protocol really (but EMDR is the one we are talking about) would be a great next step for you.

As far as supervision with EMDR goes...it appears that supervision in EMDR training happens within the actual trainings themselves, and it's administered therapist-to-therapist, as part of the training protocol.

Supervision is not the same as consultation. Not sure if these terms are used the same in US as other countries, but the difference can be explained like this (my bolding added for emphasis):

Consultation is a collaborative relationship between two mental health professionals. The consultant values the integrity and independence of the individual who is consulting with them. It is the applicant’s client, and the applicant maintains primary responsibility for the decisions involving treatment...Consultation is not supervision. Supervision implies that the “supervisor” has primary responsibility for the client’s outcome in treatment. In many states, the supervisee can only practice under the license of the “supervisor”. The supervisor carries a legal, ethical, and clinical responsibility/liability for the supervisee.

(From Link Removed)

I also learned that EMDR certification is separate from EMDR-certified training. Anyone can practice EMDR, after completing level 1 and 2 training (which takes 6 months to a year).

To become certified, you have to complete an additional set of hours and requirements - and those include formal consultation from an EMDRIA-approved consultant.

It is not a requirement that the consultation take place live, in-session. It can occur in a conversation between the therapist and the consultant, with the consultant having access to the client's case file; however, consultants do have the right to request work samples from the therapist. Whether they do or not is up to the consultant. Work samples can take the form of video or audio recordings of sessions. Live attendance seems to be rare, but can be done, depending on the consultant's preferred method of practice.

The job of the consultant is to make sure that the therapist is utilizing EMDR to it's maximum potential, and with a degree of mastery. After a certain number of hours of consultation, plus additional hours accrued in EMDR continuing education (CE) credits, a therapist can call themselves certified.

Apparently, there has been confusion about this among therapists in the US, who have been considering themselves to be certified after completing and receiving the certificate of training. I can understand why they'd be confused...I'd probably think a certificate of training equated to a status of "certified". But, it doesn't. If I had to guess, your therapist was EMDR-trained, and was not actually certified. He's decided to take that next step and invest in becoming certified.

None of this is free, completing EMDR basic training is expensive. Becoming certified is an additional expense. So, funding that contributes towards those costs, enabling more therapists to become EMDR-certified, in order to serve the PTSD population better, would be a great opportunity for any therapist to take advantage of.

If I'm right about all this, and it's really consultation that he needs to complete, not supervision - then, you can have a very specific convo with him about how he wants to capture his work with you, in order to share it with the consultant, and what you are or are not OK with. If you click the link I gave above, to the EMDRIA consultation packet, you can see what all the release forms look like, including the one you'd sign, and they detail what your rights are as a client, and what happens to those work samples when consultation has ended.

The consultation requirement for certification is 20 hours. Up to 10 of those hours can be in a small group (a few therapists meeting at the same time with a single consultant), and a minimum of 10 hours must be 1-on-1 (therapist to consultant).

(Hopefully this is all interesting to someone else but me...)

 

[Suzetig]

There's a definite difference in the UK in terms of supervision. The supervision that Ts undergo here is much more a collaboration of two professionals (or more if it's a peer supervision group). The T retains full responsibility for their clinical work and their clients wellbeing, progress etc. The only time that is different if where the T is in training in which case they have more regular supervision and the supervisor is responsible for ensuring the T is working within their level of competence and that their work is ethical.

Ts here are expected to have supervision throughout the whole of their career where I know elsewhere it stops being a requirement for fully qualified Ts.

Yes, the whole emdr thing is interesting to me too

 

[lostforgottensoul]

A little internet research turns up that there doesn't appear to be such a thing. There is a new protocol for dealing with survivors of group trauma, and a fair amount of activity around that in your area following the PULSE shooting.

I dunno. I couldn't find anything either but he was specific to say "even under this administration". He's not a Trump fan. So unsure what he's referencing. The way I understood him was that it was more funding towards EMDR (or maybe PTSD in general) because of veterans. But maybe he is understanding wrong. I dunno.

If I had to guess, your therapist was EMDR-trained, and was not actually certified. He's decided to take that next step and invest in becoming certified.

Probably. He was specific, referencing my own will for networking certifications and being more marketable. I knew he was EMDR trained and didn't realize there was a difference in trained and certified. He never told me he was EMDR certified so that's my own assumptions I think.

If I'm right about all this, and it's really consultation that he needs to complete, not supervision

But he actually said "supervision" so now I'm super confused. He never made me think he wouldn't be the one to call the shots or anything. He knows me too well to even mention that to me. Ugh, that only hightens my anxiety about it all but it is good to know i was right about needing to sign stuff. I haven't read the link yet but will and thanks for all the info. Will have more to bring him next week. I have a feeling the entire 45 mins will be of me asking about this and getting all of the specifics.

My impression - and you can correct me if I'm wrong - is that your therapy has moved very slowly. It took you a long time to even talk about it, and you only tried formal trauma processing (using EMDR) once(?), but your abreaction was such that you and he did not try it again. So you've spent a large number of years not doing any formal trauma work. Sounds like, sometimes talking about the trauma, but mostly doing stabilization and work on your current life stressors and events. Correct me if I've got that wrong.

No, we've done trauma work. I mean, I don't know if it's formal or not or even has a name but we've done a lot of work one on one with my trauma with a ton of homework for the week. I did have a lot of stablization to do too, that's true. But a lot of work with the trauma itself too. I think he's had to get creative a lot too. But def slow. And, I guess I am at a place (maybe a fork in the road?) and asking myself am I ready to try EMDR again. When is it time to try it again or something else in general? But, yes, we only did EMDR once.

Doesn't look like the EMDR process has been altered, but I'd be really interested in knowing if it has, so hope you keep us posted.

I def will! Thanks again for all the info!

Man! I thought I would be OK with a video running in the session

Oh, he knows me WAY better then that. I'd probably take the camera and throw it at him knowing me. I wouldn't sign consent to a video anyway and you better believe I will be getting every detail down to the words before signing my name to anything. So this may take up several sessions. Maybe right up to this training of his lol.

 

[joeylittle]

The way I understood him was that it was more funding towards EMDR (or maybe PTSD in general) because of veterans. But maybe he is understanding wrong. I dunno.

Oh - there is. Trump signed an order to increase funding towards veteran rehab. That's the funding he would have been referencing. I was just clarifying that there is not anything that is a "new" kind of EMDR, designed for vets, that's all.

I have a feeling the entire 45 mins will be of me asking about this and getting all of the specifics.

Honestly - don't waste your session. That would be a waste.

But he actually said "supervision" so now I'm super confused.

Well, he could have been calling it supervision because he thought that would be easier to understand. But yes - supervision, as a clinical term, means something very different from consultation.

I mean, I don't know if it's formal or not or even has a name but we've done a lot of work one on one with my trauma with a ton of homework for the week.

Do you mind if I ask, what did that work look like?

So this may take up several sessions. Maybe right up to this training of his lol.

I know you're joking, but I do seriously want to say again, don't let this take up your session time. I still think it's pretty simple - ask him what form the 'supervision' would take, and what the end results for him would be (if you want to know about why he's doing it). And then, I'd suggest shifting the convo over to the idea of re-starting EMDR, with or without being part of his request.

 

[Suzetig]

So this may take up several sessions. Maybe right up to this training of his lol.

As @joeylittle says, his request is a fairly common one. Please don't wast your time and money spending time on it - as for a bit more info and make your decision, then let it rest. If you can't let it rest it's probably a sign you've made the wrong decision so change it but don't over think and over discuss something that's really quite straightforward.

I know you were joking somewhat but it's very easy to use something like this to avoid doing the work we need to (remember avoidance is a PTSD symptom), try not to get caught in a loop with it.

 

[lostforgottensoul]

Do you mind if I ask, what did that work look like?

It looked like a lot of different things but I guess the formal name for it is psychotherapy. Also a lot of exposure therapy. When I first entered therapy I was terrified of a ton of everyday things and situations so we did a lot of that. Also a lot of CBT centered around the cult's beliefs and thoughts. But he also did the "court room" like thing I descrbe and just a lot of different things trying to get me to see it as abuse. I can be more detailed later today of you would like for me to.

ETA: Oh, also, researching. Cults in general and a ton of different things. He used that a lot. My homework was often times research and many times it looked a lot like a child's homework. Then he would use that in therapy and we'd discuss it.

Honestly - don't waste your session. That would be a waste.

Oh, I won't. I was just joking. I doubt if it will take up half the session to get all the details. I think my anxiety is now higher about it is all. I am also curious if EMDR has changed due to this training or if its just him being trained vs certified and i imagine if it has changed it could take a bit to decribe to me how. But normally he gives me a website or search keywords instead of explain. If its found online that is.

 

[lostforgottensoul]

Doesn't look like the EMDR process has been altered, but I'd be really interested in knowing if it has, so hope you keep us posted.

No, it hasn't. But it is being applied to other mental disorders (or I believe he said being looked at being applied to other mental disorders) and so he said the protocals would be different depending on the application. But the actual EMDR itself and how it is done hasn't changed.

It is not a requirement that the consultation take place live, in-session. It can occur in a conversation between the therapist and the consultant, with the consultant having access to the client's case file; however, consultants do have the right to request work samples from the therapist. Whether they do or not is up to the consultant. Work samples can take the form of video or audio recordings of sessions. Live attendance seems to be rare, but can be done, depending on the consultant's preferred method of practice.

So, he said 10 hrs of supervision is for a student new to EMDR. He said it was consultation and he said it wasn't required but if it were done it would basically be no names, no personal details about who i am. And he is actually using a few patients, with consent, as a case study. That's what he was talking about. In last weeks session he did say "supervision" but he misapplied the word really. He wants to simply do more with me and with EMDR.

Another thing he says (which has me a tad worried but just a tad) is he is looking at, in 3 yrs he said, breaking off from this office and renting out a location by himself and working part time doing only EMDR. So, he's looking to be able to do that. He's 61 I believe (though he looks 40) so that makes sense. Has me a tad worried about what if I am not ready to completely leave therapy in 3 yrs. He'd either do only EMDR with me or refer me out but that worries me. But again, just a tad as he did say 3 yrs. Not in 3 months. So, yeah.

Also, the funding for the military from the government was just that. More funding to the VA for veterans to have them see a therapist faster. The VA doesn't have enough therapists so they are contracting out that work to non-VA therapists. My therapist already sees a number of veterans but he said that they are looking for certification 1 and he is actually getting 1 and 2. 1 this weekend and 2 the weekend closer to March. So he is setting himself up to get more veteran patients. Thats where the government funding came in. So it has really nothing to do with EMDR specifically, just to help veterans see therapists faster. Having EMDR certification 1 and 2 makes him more marketable for that.

I told him I was ok being a case study as long as there are no names and I don't have to be there. But no person in the room and no taping being done. Whew!