Formatting code for RichardsonSchoolPracticum
Katie Richardson
College of Arts and Sciences
School Psychology Practicum
Cayuga Medical Center: Behavioral Services Unit
Journal
6/3/10
5 hours
Today was my first day in the behavioral services unit. Dr. Kevin Field, my faculty supervisor, and resident unit psychologist, showed me around the department, and introduced me to most of the staff. Then I went to human resources to get a ppd test, as well as my photo i.d for the hospital. It was kind of scary to be locked in the BSU for the first time. Some of the nurses didn’t know who I was and I feared they thought I was a patient. Thankfully, next time I will have a key and will be able to move around the unit as I please.
I was also introduced to the unit director, social worker, assistant director, along with several other techs and nurses. So far the staff seems very friendly, knowledgeable, and eager to help patients along with one another. It is a relatively small unit with about twenty beds. The average length of stay is one week, as the BSU serves to get patients back at a stable baseline both physically and emotionally. Whether patients are sent by the emergency room due to self-injurious behavior, escorted by the police or concerned family members, most people that arrive at the BSU are in a state of severe crises. It is then the hospital’s job to get them back to a stable, functional level via counseling, various group meetings, and medication.
Week 1: 6/7 – 6/11
15 hours
I arrived at BSU in the morning, and first attended treatment team with the staff of the adult unit. At this time they discuss all the patients as a team, regarding diagnoses, treatments, medication, and discharge plans. The staff works together to help patients plan and meet their goals for discharge, provide them with resources for outside life, as well as adjust medications.
Next, I attended cognitive behavioral group therapy led by Dr. Field. There, he discussed Freud’s theory of the ego, including the observant, conscious, and subconscious. His group session was similar to our 101 class, where he was the teacher trying to help the patients understand the concepts from a psychological point of view, in the hopes that they will be better able to understand their own thoughts and actions. I was able to contribute to the conversation by helping to explain the observant ego. A patient was having trouble understanding, so I used the analogy of the mirror, where we are aware of the self, and its actions and how they affect others. Dr. Field explained to me privately that he likes to run group in more of a classroom style rather than forum. Although he gives the patients opportunity to express themselves, he feels they require the structure of an informative session.
Following group, a paranoid schizophrenic patient had an outburst. This was my first time witnessing something like that. She accused the hospital evaluator of verbally harassing her, and demanded to speak to a supervisor, a long with a press conference to speak out for all mental health patients. She then escalated in to yelling about how her father beat her every night, and raped her every Friday night. It was difficult to hear. I am not used to this environment yet, but I think I will benefit greatly in that I will learn how to be professional amongst such awful, emotional subjects, which is essential in being a psychologist.
I was allowed to help give a Rorschach test to a middle aged woman suffering from depression. I thought ink blot tests were only used in cliché movies, however the test proved to be very informative and helpful to the patient. Every card is associated with certain aspects such as authority, male/female relations, and feelings of the self. The test can be used as a psychosis diagnostic tool, or to simply help the patient understand some underlying feelings they may be having. This woman was well educated and seemed to really appreciate the exercise. The test also provided a forum for the patient to openly discuss their mental illness, as well as the thoughts and concerns that come with it.
Week 2: 6/14 – 6/18
15 hours
This week I primarily shadowed the staff of the adolescent unit at the BSU. First I attended their treatment team session. I learned a lot about different medications prescribed to patients, why, and how they work. Then, I followed the adolescent unit on their “rounds” where the entire adolescent staff: psychologist, social worker, recreational therapist, and nurses, meet with each patient individually. During these meetings they discuss the daily goals which each patient is expected to write down, the status of their discharge plan, and any incidents that might have happened the previous day. If the child acts out they are required to fill out a behavioral assessment plan, and present it to the group. They help the child to understand what happened, how they can do better next time, and how the staff can help them achieve better behavior. The adolescent patients must also follow a behavior modification plan, where they must petition to be at a certain “level”. These levels are color coded, and reflect the patients’ behavior. In order to be discharged, they must achieve the green level, which reflects appropriate, productive behavior. The patient is also required to explain why he or she should be allowed to move up.
The psychiatrist leads these meetings, and also attempts to get to know the patient, how he or she is doing in the BSU, which can be very stressful for some, or even comforting to others who come from horrific home lives.
There had been a significant amount of drama this week. With only one boy in the unit, the girls were fighting and instigating one another in jealousy. Their issues seemed to be those of normally adjusted as teenagers, however exponential in the fact that they are low functioning, medicated and trapped all together. Thursday’s rounds were not very therapeutically productive because they were busy handling the drama rather than focusing the patients’ personal problems, and actual reasons for being here due to an incident involving one girl slapping the boy.
I had the opportunity to assist Dr. Field in giving Bender-Gestalt Visual Motor Integration and the Wechsler Adult Intelligence Scale III to test and elderly woman for dementia. She proved to be positive, was very confused, and had trouble identifying her own family members, and the present time. This was difficult for me because my grand father suffered from dementia during most of my lifetime, and I was able to identify her before the test was even given. We didn’t make it all the way through the Wechsler III, because it was clear she was unable to identify the prompts, and to continue would have been redundant and almost cruel.
I am enjoying being able to assist with testing as I feel it is very important to the diagnostic and treatment process. I also believe it will greatly benefit me in my Assessment of the Behavioral Sciences class I will be taking in the fall, as well as increasing my ability to give them by myself in the future. I am learning how to professionally administer these tests, in a way that provides the patient with the most opportunity to express their thoughts and feelings, with as little help from the administrator as possible. It is important not to distract them or prompt them in the wrong way, as it can take away from the legitimacy of the test.
During lunch on Tuesday I was able to meet with a prescription drug salesperson who was visiting BSU. She had Dinosaur BBQ to effectively lure staff in to hear her speech. She was selling Seraqeul XR, a mood stabilizer which can be used as a sleeping aid, or as an adjunct depression treatment. It was interesting to hear how the drug worked and what studies had been done to show its effectiveness. I noted that while the drug had been numerically proved to be effective for treating depression, it had not been statistically proven. As I learned in Behavioral Statistics, to prove effectiveness statistically is extremely important, so it seemed she was selling an additional treatment that may or may not be effective.
Week 3: 6/21 – 6/25:
10 hours
I like to call this week “borderline boot camp” because the majority of the adult patients have been diagnosed with borderline personality disorder. This is my first experience with borderline patients, and I am finding them quite challenging. At times they seem completely sane, and others they are making ludicrous self destructive statements. They tend to devalue and criticize and treatment given as well as the hospital in general, while complaining that they are not receiving enough help.
All of the cognitive behavioral group sessions this week focused on borderline personality disorder, including explaining the disorder, and helping patients work through typical problems borderlines have, such as respecting boundaries and controlling feelings such as anger, frustration, and sexual impulses. It was at times difficult to keep the group focused and productive, but they did seem to learn a lot from the sessions intellectually. Two female patients today showed sad affect, and were able to discuss the major problems they are facing as they try to move forward. I had not taken abnormal psychology, so this is my first exposure to this type of patient. I am learning a great deal about this disorder, what symptoms patients show, especially narcissism/histrionic ones and how they are best treated. In general they are difficult to treat because the narcissism tends to get in the way. However I do feel we are making progress. Ultimately the goal is to get them to a place where we can ensure they will be safe from hurting themselves or others upon discharge.
Personality disorders are extremely common amongst mental health patients due to their tendency toward anti-social behavior, and it is important to learn how to best deal with such patients in a positive, productive manner. I do believe we helped several patients this week to achieve a better grasp on what is going on inside their own head and in the world around them, whether they would like to admit it or not. Keeping post-discharge patients safe from themselves and others is the ultimate goal of the hospital and I believe we achieved that. The hospital serves as a safe place where people of any mental health background can come to receive help in working through crises.
Week 4: 6/28 – 7/2
15 hours
Today (6/30) in cognitive behavioral group therapy, we discussed some topics which I had previously learned about in my Psychology of Religion class. Dr. Field explained the limbic reptilian brain which involves “The four F’s of functioning”: fight, flight, food, and fornication. He described how this basic level of functioning is relative to Freud’s theory of the Id, which is regulated by the Super Ego. I was able to elaborate on his ideas with my knowledge base from the book we read in psychology of religion: Spiritual Evolution. In this book the author surmises that humans have evolved in to the mammalian brain, whose main capacity is that of empathy. Humans’ ability to experience empathy allows us to work together, and separates us from other lower species. I was able to explain how empathy is an important concept in conjunction with the observant ego, in how we present ourselves, and our awareness of how we are interacting with others. This is an important concept in the behavioral services unit where patients often have a difficult time in social situations, relating to others, and recognizing what situations certain behaviors are appropriate in. This group was very productive and the patients seemed to grasp the concepts, although implementing them is a whole other matter. Teaching them these boundaries and how to regulate their basic drives is an essential component in preparing them for discharge in to public life.
In my fifth week of interning at the behavioral services unit, I am beginning to see patterns in the types of symptoms, as well as causes of symptoms different patients who are placed here experience. Prior to working here I was not aware of how wide-spread physical and sexual abuse is amongst children. Nor was I aware of how profoundly and consistently abuse translates in to mental health disorders and anti-social behavior. It is a rather disgusting realization to come to, however it will certainly help me to recognize abuse cases in the future, as well as analyze what seems to be the most successful treatment. Patients in this category may vary greatly in functioning levels, but all seem to experience serious repercussions which they don’t know how to handle, resulting in crisis triggering behavior.
Working here has also given me the opportunity to observe professionals in the field at work, helping me to understand where I see myself working in my future career. I have decided that I am not interested in becoming an MD psychiatrist, as I have seen their function is more that of a boss and bureaucrat than a counselor. The psychiatrists at the BSU are very knowledgeable and hard working; however it seems they have a great deal more legal responsibility and less one-on-one time spent with patients. I think that I would feel more job satisfaction from working directly with patients rather than paper work. At the BSU it seems the RNs and techs so most of the grunt work in that department, although the psychologists and social workers do spend a significant portion of time with patients. The specific task of the psychologist which differs from other positions is that he administers and scores psychological tests. I feel this would be a good occupation for me because I appreciate the scientific aspect that goes with psychological analysis, feel comfortable using my knowledge base in a group setting, and find satisfaction in personally counseling patients.
Week 5: 7/5 – 7/9
15 hours
This week was rather slow in the BSU, with only about 7 patients. I learned how to score an MMPI, and scored several. There are currently several alcoholics on the unit, mostly middle aged males. It is sad to see how alcoholism has so negatively affected their work and home life. Many are seeking treatment for the first time, mainly because their wives are sick of treating themselves. I would be interested to learn how and where alcohol affects the brain. Most alcoholic patients have severe depressive disorder and have been using alcohol to self medicate. They all seem to want to change, however the change in lifestyle is extremely difficult and they often relapse post inpatient treatment. The hospital has AA group therapy for these patients, and helps them to find rehabilitation centers that may help them. Ant abuse is also sometimes prescribed, yet only effective if taken which is in the hands of the patient.
This week, I shadowed some of the hospital discharge planners. The hospital discharge planners are key in the post in-patient process. Often patients come in because they are not receiving sufficient outpatient support. The discharge planners ally patients with appropriate support systems, from living arraignments, clinic groups, support groups, rehabilitation services, residential treatment, and financial aid. I think this piece of the BSU is possibly the most important, as it is impossible for the patient to permanently reside here. Trying to help the patient adjust to outside life is absolutely necessary. It is totally possible for mental health patients to function successfully in society; they just need the extra tools and assistance. Discharge planners spend most of their time on the phone with various agencies trying to find availability in a multitude of services based on each patients needs. Patients sometimes spend an unusual time on the BSU waiting for a bed at another facility.
Week 6: 7/12 – 7/16
10 hours
This week was relatively routine on the BSU. We only had 7 total patients on the adult unit. Many patients are experiencing relational crises in their marriages, or struggling with the loss of a job. Unemployment seems to be an ongoing theme among BSU patients, either because they receive disability or have been fired/laid off. It is obvious that unemployment causes a great deal of stress. It would be interesting to do a study to find a correlation between unemployment/economic depression and rates of clinical depression. The hospital does not directly assist with employment, but does help the patient decide what their next move might be. It seems to me, especially with chemically dependent patients, that even a part time job can give an increased sense of self-esteem as well as a productive activity worth being sober for. Many people with mental illness often have difficulty finding a job due to their poor social skills, while others are higher functioning with a consistent job/career.
The hospital is currently looking to hire a new psychiatrist. In the mean time they have had two different interim doctors. It is obvious that professionals in this field are sorely needed, and have the option of choosing where they want to work. One doctor is in a program where he is hired throughout the United States, and is able to travel as a substitute doctor. I would by highly interested in a position like this, if it did not require going to medical school. However, I would think a psychologist would have similar occupational options and opportunities.
Week 8: 7/19 – 7/23
20 hours
Mondays are always interesting as many new patients come in over the weekend. This week we seem to have many schizoaffective patients who endorse both negative and positive symptoms, ranging from paranoid to disorganized to isolation. I shadowed the recreational therapist today, and her group focused on identifying stressors, warning signs and both the positive and negative ways of coping with them. I found this group to be very helpful for patients, who are low functioning and have difficulty appropriately dealing with the stressors of every day life. I was able to help her explain the Fight or Flight response as we spoke about it in detail in both psych 101 and psychology of religion.
Anger management is also a major theme amongst groups. Patients usually have a hard time controlling their basic impulses, especially when enraged. They tend to behave immaturely, without insight, in ways that are harmful to themselves and others. Three basic concepts that Dr. Field stresses regarding anger management include, not raising your voice, not using profanity, and not physically intimidating others. Patients seem to be able to grasp these concepts but feel they don’t apply when the person they are conflicting with uses them. They have a child-like perspective on fighting and endorse physical signs of anger such as breaking things or throwing temper tantrums. These fits are generally what lands them to the BSU, when they escalate to a dangerous level. The patients’ inability to control their strong emotions is a definite, consistent indicator of mental illness or poor development. Being able to control these feelings is essential to functioning in all settings of society; therefore anger management therapy is key in preparing the patient for discharge.
What concerns me is many patients are parents to multiple children, with seemingly no normative or healthy family structure. It is easy to see why mental illness can often be hereditary and cyclical amongst families. Luckily outside agencies are notified and involved to either remove children from the home or at least keep an eye on them. However it is still rather frightening that helpless children are allowed to live in a home with such blatantly unstable adults.
Week 9: 7/26 – 7/29/10
15 hours
In my final week at the Cayuga Medical Center Behavioral Services Unit, I was surprised to find two patients who had been previously treated at the beginning of my practicum, returned. Dr. Field explained to me that they have several “all star” patients who they see several times per year. I found it odd that these people could possibly want to repeat their experience here. However, their behavior shortly after discharge proved to be inappropriate, illegal and self-destructive. One of these patients is a middle age female, who endorses negative symptoms of schizophrenia. She has little understanding of what is going on around her, little desire to improve, and minimal affect. Most staff members agree she simply needs a place to stay, which has structure and consistency.
I have learned a great deal in my 9 weeks here. I learned how to give and score several different psychological tests. I learned how to keep a poker face and professional demeanor in a chaotic, intense environment. I learned how to interact with patients in a meaningful yet professional way. I learned about many different services for the mentally ill/disabled that will be important resources for me to know as I serve the community in the future. I learned how to recognize and identify a multitude of behaviors and how they are related to various mental disorders. I learned how different treatments both medicinal and therapeutic effect and aid patients in their struggle. Most importantly I learned a lot about myself, where I see myself working in the future, m strengths and weaknesses in the field, and what is important for me to improve and learn about in the future.
All together it was an extremely educational experience that would have been impossible to gain in a classroom. This real life experience taught me a great deal about how the field of psychology, from research to practice directly effects a large portion of the general public and how important it is to continue growing in this knowledge base and it’s implementation. It has undoubtedly helped me in my career as a psychologist and will be a base of experience for future endeavors. I find the lessons I have learned here important in my personal and professional life, and am very grateful for the opportunity.
TOTAL HOURS : 120
College of Arts and Sciences
School Psychology Practicum
Cayuga Medical Center: Behavioral Services Unit
Journal
6/3/10
5 hours
Today was my first day in the behavioral services unit. Dr. Kevin Field, my faculty supervisor, and resident unit psychologist, showed me around the department, and introduced me to most of the staff. Then I went to human resources to get a ppd test, as well as my photo i.d for the hospital. It was kind of scary to be locked in the BSU for the first time. Some of the nurses didn’t know who I was and I feared they thought I was a patient. Thankfully, next time I will have a key and will be able to move around the unit as I please.
I was also introduced to the unit director, social worker, assistant director, along with several other techs and nurses. So far the staff seems very friendly, knowledgeable, and eager to help patients along with one another. It is a relatively small unit with about twenty beds. The average length of stay is one week, as the BSU serves to get patients back at a stable baseline both physically and emotionally. Whether patients are sent by the emergency room due to self-injurious behavior, escorted by the police or concerned family members, most people that arrive at the BSU are in a state of severe crises. It is then the hospital’s job to get them back to a stable, functional level via counseling, various group meetings, and medication.
Week 1: 6/7 – 6/11
15 hours
I arrived at BSU in the morning, and first attended treatment team with the staff of the adult unit. At this time they discuss all the patients as a team, regarding diagnoses, treatments, medication, and discharge plans. The staff works together to help patients plan and meet their goals for discharge, provide them with resources for outside life, as well as adjust medications.
Next, I attended cognitive behavioral group therapy led by Dr. Field. There, he discussed Freud’s theory of the ego, including the observant, conscious, and subconscious. His group session was similar to our 101 class, where he was the teacher trying to help the patients understand the concepts from a psychological point of view, in the hopes that they will be better able to understand their own thoughts and actions. I was able to contribute to the conversation by helping to explain the observant ego. A patient was having trouble understanding, so I used the analogy of the mirror, where we are aware of the self, and its actions and how they affect others. Dr. Field explained to me privately that he likes to run group in more of a classroom style rather than forum. Although he gives the patients opportunity to express themselves, he feels they require the structure of an informative session.
Following group, a paranoid schizophrenic patient had an outburst. This was my first time witnessing something like that. She accused the hospital evaluator of verbally harassing her, and demanded to speak to a supervisor, a long with a press conference to speak out for all mental health patients. She then escalated in to yelling about how her father beat her every night, and raped her every Friday night. It was difficult to hear. I am not used to this environment yet, but I think I will benefit greatly in that I will learn how to be professional amongst such awful, emotional subjects, which is essential in being a psychologist.
I was allowed to help give a Rorschach test to a middle aged woman suffering from depression. I thought ink blot tests were only used in cliché movies, however the test proved to be very informative and helpful to the patient. Every card is associated with certain aspects such as authority, male/female relations, and feelings of the self. The test can be used as a psychosis diagnostic tool, or to simply help the patient understand some underlying feelings they may be having. This woman was well educated and seemed to really appreciate the exercise. The test also provided a forum for the patient to openly discuss their mental illness, as well as the thoughts and concerns that come with it.
Week 2: 6/14 – 6/18
15 hours
This week I primarily shadowed the staff of the adolescent unit at the BSU. First I attended their treatment team session. I learned a lot about different medications prescribed to patients, why, and how they work. Then, I followed the adolescent unit on their “rounds” where the entire adolescent staff: psychologist, social worker, recreational therapist, and nurses, meet with each patient individually. During these meetings they discuss the daily goals which each patient is expected to write down, the status of their discharge plan, and any incidents that might have happened the previous day. If the child acts out they are required to fill out a behavioral assessment plan, and present it to the group. They help the child to understand what happened, how they can do better next time, and how the staff can help them achieve better behavior. The adolescent patients must also follow a behavior modification plan, where they must petition to be at a certain “level”. These levels are color coded, and reflect the patients’ behavior. In order to be discharged, they must achieve the green level, which reflects appropriate, productive behavior. The patient is also required to explain why he or she should be allowed to move up.
The psychiatrist leads these meetings, and also attempts to get to know the patient, how he or she is doing in the BSU, which can be very stressful for some, or even comforting to others who come from horrific home lives.
There had been a significant amount of drama this week. With only one boy in the unit, the girls were fighting and instigating one another in jealousy. Their issues seemed to be those of normally adjusted as teenagers, however exponential in the fact that they are low functioning, medicated and trapped all together. Thursday’s rounds were not very therapeutically productive because they were busy handling the drama rather than focusing the patients’ personal problems, and actual reasons for being here due to an incident involving one girl slapping the boy.
I had the opportunity to assist Dr. Field in giving Bender-Gestalt Visual Motor Integration and the Wechsler Adult Intelligence Scale III to test and elderly woman for dementia. She proved to be positive, was very confused, and had trouble identifying her own family members, and the present time. This was difficult for me because my grand father suffered from dementia during most of my lifetime, and I was able to identify her before the test was even given. We didn’t make it all the way through the Wechsler III, because it was clear she was unable to identify the prompts, and to continue would have been redundant and almost cruel.
I am enjoying being able to assist with testing as I feel it is very important to the diagnostic and treatment process. I also believe it will greatly benefit me in my Assessment of the Behavioral Sciences class I will be taking in the fall, as well as increasing my ability to give them by myself in the future. I am learning how to professionally administer these tests, in a way that provides the patient with the most opportunity to express their thoughts and feelings, with as little help from the administrator as possible. It is important not to distract them or prompt them in the wrong way, as it can take away from the legitimacy of the test.
During lunch on Tuesday I was able to meet with a prescription drug salesperson who was visiting BSU. She had Dinosaur BBQ to effectively lure staff in to hear her speech. She was selling Seraqeul XR, a mood stabilizer which can be used as a sleeping aid, or as an adjunct depression treatment. It was interesting to hear how the drug worked and what studies had been done to show its effectiveness. I noted that while the drug had been numerically proved to be effective for treating depression, it had not been statistically proven. As I learned in Behavioral Statistics, to prove effectiveness statistically is extremely important, so it seemed she was selling an additional treatment that may or may not be effective.
Week 3: 6/21 – 6/25:
10 hours
I like to call this week “borderline boot camp” because the majority of the adult patients have been diagnosed with borderline personality disorder. This is my first experience with borderline patients, and I am finding them quite challenging. At times they seem completely sane, and others they are making ludicrous self destructive statements. They tend to devalue and criticize and treatment given as well as the hospital in general, while complaining that they are not receiving enough help.
All of the cognitive behavioral group sessions this week focused on borderline personality disorder, including explaining the disorder, and helping patients work through typical problems borderlines have, such as respecting boundaries and controlling feelings such as anger, frustration, and sexual impulses. It was at times difficult to keep the group focused and productive, but they did seem to learn a lot from the sessions intellectually. Two female patients today showed sad affect, and were able to discuss the major problems they are facing as they try to move forward. I had not taken abnormal psychology, so this is my first exposure to this type of patient. I am learning a great deal about this disorder, what symptoms patients show, especially narcissism/histrionic ones and how they are best treated. In general they are difficult to treat because the narcissism tends to get in the way. However I do feel we are making progress. Ultimately the goal is to get them to a place where we can ensure they will be safe from hurting themselves or others upon discharge.
Personality disorders are extremely common amongst mental health patients due to their tendency toward anti-social behavior, and it is important to learn how to best deal with such patients in a positive, productive manner. I do believe we helped several patients this week to achieve a better grasp on what is going on inside their own head and in the world around them, whether they would like to admit it or not. Keeping post-discharge patients safe from themselves and others is the ultimate goal of the hospital and I believe we achieved that. The hospital serves as a safe place where people of any mental health background can come to receive help in working through crises.
Week 4: 6/28 – 7/2
15 hours
Today (6/30) in cognitive behavioral group therapy, we discussed some topics which I had previously learned about in my Psychology of Religion class. Dr. Field explained the limbic reptilian brain which involves “The four F’s of functioning”: fight, flight, food, and fornication. He described how this basic level of functioning is relative to Freud’s theory of the Id, which is regulated by the Super Ego. I was able to elaborate on his ideas with my knowledge base from the book we read in psychology of religion: Spiritual Evolution. In this book the author surmises that humans have evolved in to the mammalian brain, whose main capacity is that of empathy. Humans’ ability to experience empathy allows us to work together, and separates us from other lower species. I was able to explain how empathy is an important concept in conjunction with the observant ego, in how we present ourselves, and our awareness of how we are interacting with others. This is an important concept in the behavioral services unit where patients often have a difficult time in social situations, relating to others, and recognizing what situations certain behaviors are appropriate in. This group was very productive and the patients seemed to grasp the concepts, although implementing them is a whole other matter. Teaching them these boundaries and how to regulate their basic drives is an essential component in preparing them for discharge in to public life.
In my fifth week of interning at the behavioral services unit, I am beginning to see patterns in the types of symptoms, as well as causes of symptoms different patients who are placed here experience. Prior to working here I was not aware of how wide-spread physical and sexual abuse is amongst children. Nor was I aware of how profoundly and consistently abuse translates in to mental health disorders and anti-social behavior. It is a rather disgusting realization to come to, however it will certainly help me to recognize abuse cases in the future, as well as analyze what seems to be the most successful treatment. Patients in this category may vary greatly in functioning levels, but all seem to experience serious repercussions which they don’t know how to handle, resulting in crisis triggering behavior.
Working here has also given me the opportunity to observe professionals in the field at work, helping me to understand where I see myself working in my future career. I have decided that I am not interested in becoming an MD psychiatrist, as I have seen their function is more that of a boss and bureaucrat than a counselor. The psychiatrists at the BSU are very knowledgeable and hard working; however it seems they have a great deal more legal responsibility and less one-on-one time spent with patients. I think that I would feel more job satisfaction from working directly with patients rather than paper work. At the BSU it seems the RNs and techs so most of the grunt work in that department, although the psychologists and social workers do spend a significant portion of time with patients. The specific task of the psychologist which differs from other positions is that he administers and scores psychological tests. I feel this would be a good occupation for me because I appreciate the scientific aspect that goes with psychological analysis, feel comfortable using my knowledge base in a group setting, and find satisfaction in personally counseling patients.
Week 5: 7/5 – 7/9
15 hours
This week was rather slow in the BSU, with only about 7 patients. I learned how to score an MMPI, and scored several. There are currently several alcoholics on the unit, mostly middle aged males. It is sad to see how alcoholism has so negatively affected their work and home life. Many are seeking treatment for the first time, mainly because their wives are sick of treating themselves. I would be interested to learn how and where alcohol affects the brain. Most alcoholic patients have severe depressive disorder and have been using alcohol to self medicate. They all seem to want to change, however the change in lifestyle is extremely difficult and they often relapse post inpatient treatment. The hospital has AA group therapy for these patients, and helps them to find rehabilitation centers that may help them. Ant abuse is also sometimes prescribed, yet only effective if taken which is in the hands of the patient.
This week, I shadowed some of the hospital discharge planners. The hospital discharge planners are key in the post in-patient process. Often patients come in because they are not receiving sufficient outpatient support. The discharge planners ally patients with appropriate support systems, from living arraignments, clinic groups, support groups, rehabilitation services, residential treatment, and financial aid. I think this piece of the BSU is possibly the most important, as it is impossible for the patient to permanently reside here. Trying to help the patient adjust to outside life is absolutely necessary. It is totally possible for mental health patients to function successfully in society; they just need the extra tools and assistance. Discharge planners spend most of their time on the phone with various agencies trying to find availability in a multitude of services based on each patients needs. Patients sometimes spend an unusual time on the BSU waiting for a bed at another facility.
Week 6: 7/12 – 7/16
10 hours
This week was relatively routine on the BSU. We only had 7 total patients on the adult unit. Many patients are experiencing relational crises in their marriages, or struggling with the loss of a job. Unemployment seems to be an ongoing theme among BSU patients, either because they receive disability or have been fired/laid off. It is obvious that unemployment causes a great deal of stress. It would be interesting to do a study to find a correlation between unemployment/economic depression and rates of clinical depression. The hospital does not directly assist with employment, but does help the patient decide what their next move might be. It seems to me, especially with chemically dependent patients, that even a part time job can give an increased sense of self-esteem as well as a productive activity worth being sober for. Many people with mental illness often have difficulty finding a job due to their poor social skills, while others are higher functioning with a consistent job/career.
The hospital is currently looking to hire a new psychiatrist. In the mean time they have had two different interim doctors. It is obvious that professionals in this field are sorely needed, and have the option of choosing where they want to work. One doctor is in a program where he is hired throughout the United States, and is able to travel as a substitute doctor. I would by highly interested in a position like this, if it did not require going to medical school. However, I would think a psychologist would have similar occupational options and opportunities.
Week 8: 7/19 – 7/23
20 hours
Mondays are always interesting as many new patients come in over the weekend. This week we seem to have many schizoaffective patients who endorse both negative and positive symptoms, ranging from paranoid to disorganized to isolation. I shadowed the recreational therapist today, and her group focused on identifying stressors, warning signs and both the positive and negative ways of coping with them. I found this group to be very helpful for patients, who are low functioning and have difficulty appropriately dealing with the stressors of every day life. I was able to help her explain the Fight or Flight response as we spoke about it in detail in both psych 101 and psychology of religion.
Anger management is also a major theme amongst groups. Patients usually have a hard time controlling their basic impulses, especially when enraged. They tend to behave immaturely, without insight, in ways that are harmful to themselves and others. Three basic concepts that Dr. Field stresses regarding anger management include, not raising your voice, not using profanity, and not physically intimidating others. Patients seem to be able to grasp these concepts but feel they don’t apply when the person they are conflicting with uses them. They have a child-like perspective on fighting and endorse physical signs of anger such as breaking things or throwing temper tantrums. These fits are generally what lands them to the BSU, when they escalate to a dangerous level. The patients’ inability to control their strong emotions is a definite, consistent indicator of mental illness or poor development. Being able to control these feelings is essential to functioning in all settings of society; therefore anger management therapy is key in preparing the patient for discharge.
What concerns me is many patients are parents to multiple children, with seemingly no normative or healthy family structure. It is easy to see why mental illness can often be hereditary and cyclical amongst families. Luckily outside agencies are notified and involved to either remove children from the home or at least keep an eye on them. However it is still rather frightening that helpless children are allowed to live in a home with such blatantly unstable adults.
Week 9: 7/26 – 7/29/10
15 hours
In my final week at the Cayuga Medical Center Behavioral Services Unit, I was surprised to find two patients who had been previously treated at the beginning of my practicum, returned. Dr. Field explained to me that they have several “all star” patients who they see several times per year. I found it odd that these people could possibly want to repeat their experience here. However, their behavior shortly after discharge proved to be inappropriate, illegal and self-destructive. One of these patients is a middle age female, who endorses negative symptoms of schizophrenia. She has little understanding of what is going on around her, little desire to improve, and minimal affect. Most staff members agree she simply needs a place to stay, which has structure and consistency.
I have learned a great deal in my 9 weeks here. I learned how to give and score several different psychological tests. I learned how to keep a poker face and professional demeanor in a chaotic, intense environment. I learned how to interact with patients in a meaningful yet professional way. I learned about many different services for the mentally ill/disabled that will be important resources for me to know as I serve the community in the future. I learned how to recognize and identify a multitude of behaviors and how they are related to various mental disorders. I learned how different treatments both medicinal and therapeutic effect and aid patients in their struggle. Most importantly I learned a lot about myself, where I see myself working in the future, m strengths and weaknesses in the field, and what is important for me to improve and learn about in the future.
All together it was an extremely educational experience that would have been impossible to gain in a classroom. This real life experience taught me a great deal about how the field of psychology, from research to practice directly effects a large portion of the general public and how important it is to continue growing in this knowledge base and it’s implementation. It has undoubtedly helped me in my career as a psychologist and will be a base of experience for future endeavors. I find the lessons I have learned here important in my personal and professional life, and am very grateful for the opportunity.
TOTAL HOURS : 120
