​There is a standard opener in most settings I find myself in these days, a variation of “things are so hard right now!” With the current convergence of social, political and physical upheaval, folks are tired. We search each other’s Zoom faces for connection, validation, engagement. We drop encouraging comments in the chat box or click an icon to indicate we love what we heard. Maybe someone asks the check-in question “what’s something good in your life right now?” and we search our memories for a meaningful answer. For some it is more time with a partner, for others a walk outside after work. Almost every casual conversation I have with coworkers and friends these days ends with an exchange of favorite podcasts and TV shows. We are desperate for a way to fill our free time and trying hard to come up with ways to help each other do that too. In these unprecedented circumstances of whatever week we are in, we are looking for something to help us feel good.

Recently Julie Kim brought a resource to our clinical supervisor team, an infographic from the Genesis Healing Institute that opened my eyes to another way to consider how we navigate this year.  The concept is Transformative Healing, and the ideas presented on this graphic filled me with a new sense of hope and courage. At best, this offers a roadmap that helps guide us through the stages of reckoning and healing that this unprecedented time presents to us.  At it is simplest, it is a beautiful collection of affirmations that capture so much of what many of us are feeling and exploring right now. I share the graphic with you here and invite you to consider:

It might be helpful to think of this as ‘less as a roadmap, more like a cycle,’ such as the stages of grief. We may go through these stages in and out of order each time we are presented with a new 2020 challenge.  My hope is that you find this thought-provoking and that it offers you a new way to consider how you can survive (and thrive!?) during this unprecedented time. 
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In solidarity,
Emily Marsh

​  From Wikipedia’s description of clinical supervision: 

So much of what our school-based therapists do is not visible to others.  Recently a colleague asked, “What do you do in [group] supervision, actually?”  Great question!  
 
In individual supervision, the clinician typically brings areas they are struggling with in their work or successes they’d like to share.  They check in about required paperwork needs, professional development goals and the logistics of the work, and spend most of the time talking about their caseload, ethical issues and intervention plans. Supervisors are always listening for risk and safety issues for clients and making sure that the clinician is monitoring their clients’ safety in addition to their treatment goals. The relationship between supervisor and supervisee is attended to, discussed, and feedback is invited in both directions to enhance the quality of the relationship.
 
In a group supervision, up to eight therapists gather to learn from one another.  With eight therapists and only two hours, we rarely have enough time to get to everyone’s clients, so the group prioritizes together how to use their time. The therapists identify themes in their work and talk through strategies for understanding their clients and responding to them.  Every school year, each of our therapists spends between three and four hours across several groups to do a deep dive into their work with a chosen client.  Their colleagues listen, ask questions and offer reflections to help move the therapist forward in their work. At times we read and discuss articles, watch videos or welcome a trainer into the group supervision to further develop clinical practice.  Supervisors are always monitoring for safety concerns and making sure clients are always getting the best care. Experiential supervisions are some of my favorites -- that’s when we bring in interventions like play therapy techniques or art therapy activities and we try them out together.
 
Once our therapists achieve licensure (usually they’re required to have had at least 3000 hours of supervised experience before taking their exam), we continue using a similar supervision model to support their growth. In All-In!, our licensed therapists have the option of joining a “consultation group” instead of continuing in a supervision group.  The consultation group is peer-led and gives licensed clinicians the chance to practice facilitating group supervision and supporting one another.  For those who are interested in becoming clinical supervisors themselves, this consultation group is a chance to practice clinical leadership.
 
The goal of clinical supervision is to not only enhance and develop therapists’ clinical skills but also to further their professional development. 
 
Thanks for reading!

In All In, growth-mindset is part of our culture. In individual and group supervision, we are constantly discussing personal and professional growth opportunities as a result of this work.
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As we wrapped up 2019, the Behavioral Strands Leadership Team hosted a Seneca Career Fair. The objective of the career fair was to provide the Behavioral Team, specifically our Student Support Assistants an opportunity to meet, actively engage with, and learn from their fellow Senecans about various career tracks held within Seneca Family of Agencies. On the panel of participants were an array of representatives for positions including, but not limited to:

• Academic Intervention Specialist
• Assistant Director of Implementation
• Clinical Intervention Specialist
• Director of Operations
• Director is School Partnership
• DESI (Data, Evaluation, and Strategic Initiatives) Project Manager
• Program Assistant
• School Psychologist
• School Psychologist Intern
• TBS (Therapeutic Behavioral Services) Clinician
• UE (Unconditional Education) Coach 
• and much more!

It was a magical event, and the plan is to host this type of engagement activity on an annual basis. 

As we enter into 2020, “Stay Interviews" have begun. We use this interview format  to inquire about plans and professional development goals for next school year. The majority of our All-In Student Support Assistants are motivated to pursue higher learning opportunities, with the hope of staying with or returning to Seneca as a Teacher, Therapist, or Data Evaluator. Additionally, many of our Student Support Assistants have followed up with Career Fair representatives to further discuss their goals and plans for moving in that direction, which is AWESOME!!

​So, be on the lookout for our amazing Behavioral Team. They have some aspiring teachers and therapists on the rise. Some are looking forward to starting grad school Fall 2020 and others are exploring potential Universities for Fall 2021. As Eric Thomas said, “When you find your why, you find a way to make it happen.” 

There is an age-old question clinicians hear all the time – “What do you DO with the kids in your office?”  A clinician typically takes a gulp and wonders…what AM I doing?  PLAYING?!?!?
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Over the years, I have decidedly used play therapy as the primary model of working with kids in therapy.  Play therapy is tricky to explain, since it can look a lot like simple play.  A client and a therapist can be deep in the throes of a storyline that involves different races of dinosaurs battling each other to the death, spies who turn out to be counterspies (who turn out to be counterspies), and babies who require care but are also very annoying.  Or a client can play Uno for several weeks, always changing the rules so that they win at the very end after a long, drawn out game.  Or a client tells lie after lie, spills toys carelessly, and asks to open every drawer in the therapy office, saying they will never come back for therapy.  Some of this looks like fun, boisterous play and some can be more coy and mischievous acts.

In play therapy, it doesn’t matter so much what the actions may be.  We are playing.  What makes it a therapeutic intervention is how the clinician responds to the client and how the space and time is held intentionally.  I found a straightforward infograph that highlights what the difference is between play therapy and play.  I use this often, in supervisions and as a reminder to myself.

The use of play therapy is based on the belief that the child is processing things through  play.  The idea is that play is never without important meaning, nor is any play by chance or without aim.  Children use play to communicate, think through things, experience new situations, and inform their internal working models – the way they understand the world around them and their place in that world.  The second important aspect of play therapy is the adult relationship.  The experience of having an adult who has suspended judgement, is not moralizing or trying to formally teach, while remaining curious to allow the child to figure things out, control the story, or try different personas is a special interaction in therapy.  If both pieces- free play and a holding adult relationship- are present, play therapy presents limitless ways for kids to experience disconfirming stances.  “Disconfirming stances” are ways that we can support someone to have a new experience of themselves and the world, a chance to shift their internal working model if it’s become stuck or has resulted in unhealthy beliefs and behaviors. These disconfirming stances can be broad – like one client who witnessed severe violence in his family and arrived at the conclusion through play that love does not require you to destroy yourself to prove your love- or it can be very specific like the client who wanted to see different ways of playing games to make and keep friends.
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Play therapy is a fantasy place, where adults don’t have to push an overt agenda, hold to a list of action steps, or make sure to check for understanding from the child. It takes a lot of intention to not take the invitation to focus on how to correct or change a child’s behavior especially with the emphasis on teaching more observable behaviors like classic coping skills.  But the processing of the underlying needs of problematic behaviors is an important aspect of treatment that needs to be addressed for lasting health and strength.  Play therapy offers a space where these underlying needs (questions about what happened to them, what their self-identity is, what the rules of relationships are) can be addressed to support shifts in internal working models that inform our behaviors over time. This is, in essence, the process of changing from within.

In our school partnerships we have an opportunity to use multi-tiered supports as well as multi-leveled clinical interventions to address entrenched problematic behaviors.  In a world that values the effectiveness of CBT and skills based programs, please don’t forget to consider play therapy as an effective intervention that can give a new avenue for our students and clients to play with the prospect of change amidst limitless possibilities.

Throughout my adolescent and adult life, one aspect of my career journey has remained the same: I have always enjoyed working with children. When I was a child, this goal would have translated to a single, recognizable career identity, likely "A Teacher" or perhaps "A Nurse.” It was only as an adult that I discovered the many different avenues one can take to working with children – and since then I have tried on several of them.

My first job, for instance, was working for a children's play place (similar to the more recognizable icon of Chuck E. Cheese's.) I wasn’t a teacher, and I wasn’t a nurse, but I was working with kids. Yet even at the time I knew that this was a temporary role, a “stepping stone” so to speak. Looking back, I would say that my career journey really began with the two jobs I held in college, working in research labs – first studying language and cognition, and subsequently attachment. Instead of supervising children, I was studying them – a new role, with new responsibilities, and a much broader range of required skills.

Since then, I have been a special education aide, earned a Master’s in Fine Arts, taught classes on social justice & creative writing through an arts and education non-profit, set up side-gigs making art, transcribing audio, and substitute teaching, and most recently interned at my first MFT site placement with East Bay Agency for Children. Now here I am, working as a clinical intern with Seneca’s All-In program, and in May I will finish my master’s program and begin working towards licensure as a marriage and family therapist.

In some ways, I see MFT licensure as a “finish line,” establishing the career path that – at least as of now – I expect to follow long-term. Yet I still struggle sometimes with the questions “What do you do?” and “What do you want to be?” At twenty-nine years old, I have already “been” many things. Each of these roles has prompted me to strengthen new skills, tackle new problems, and take on new perspectives – contributing far more, in my opinion, to my sense of who I am than any particular job title. I try to keep this in mind when working with my clients, who also cannot be defined by any one role or aspect of their identities. And if anyone asks “What do you do?” Well, I listen, learn, try my best to be of service. “What do you want to be?” Empathetic, kind, and perhaps most importantly, flexible enough that, no matter what role I find myself in, I can continue to grow as an individual. 

The project began with an awareness of her limitations as a single provider at the school.  Using our Social Emotional Screener tool,  Marianne gathered emotional and behavioral data on every student at Achieve and was able to see trends and needs across grades, classrooms, and individual students.  But how could Marianne find the time in her week to provide the myriad of group services the students there would most benefit from? Her answer: she couldn’t do it on her own.  Marianne realized she needed more adults to provide groups and that she could share her expertise with them as a coach and mentor.  She put together a presentation on the basics of running a group, and solicited interest from her school administration and staff community.
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She then met with a group of interested EFC staff which included PE teachers, assistant principals, and other staff on site to provide them with a training on the basics of running a social skills group.  Sitting down with each adult individually, Marianne was able to learn more about what types of issues, students and age groups they were most excited to work with. She was intentional around supporting them to feel more connected to the work by getting to know what their values were and what they were most interested in.

Next, Marianne revisited the data from her Social Emotional Screeners.  She made sure to assign facilitators to grade levels and group topics that would resonate for them.  Tailoring activities to the topics of the groups was another way that Marianne supported the adults with their new initiative. And they were off!!  

Midway through the first group cycle, Marianne brought her team of adults together to provide problem-solving, consultation and connection.  She also started getting input from the team on what they’d like to do for their next cycle in order to keep the momentum going on their new tier 2 initiative.

The PSC-35 shows us how the family is viewing the child and is a way of tracking their perspective over time. The fact that caregivers complete this evidence-based form on a regular cycle may also reinforce for them how important their voice is in our work. Despite the fact that I’m often asking our clinicians to take more on, when faced with a change in requirements it does me wonders to take a moment to pause and simply take a deep breath. Breathing a bit more thoughtfully stops me from jumping down the assumption rabbit hole of negativity. I quickly find myself motivated and inspired to understand and actually dive into it a bit deeper and find the value in how it highlights and adds to the amazing work our clinicians already do.  
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If you’d like to know more, please visit: https://www.massgeneral.org/psychiatry/services/psc_home.aspx
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Blog Post Written by: 
Rachel Murray, Clinical Supervisor 

Blog Post Written by: 
Emily Marsh, Director of Clinical Intervention 

Blog post written by:
Emily Marsh, Director of Clinical Intervention Services