It is not uncommon to have 7 minutes to meet with a psychiatrist for medication—and that may be the only treatment obtained. This model certainly means that it is strictly symptom management. And a psychiatrist cannot require a person to go to counseling as a condition of medication. I do notice that PCPs today are more actively encouraging patients to invest in counseling where their stories may actually have a forum.
I remember watching black and white clips of treatment at AMHI which contributed to the 1990 AMHI Consent Decree which “required the State to establish and maintain a comprehensive mental health system responsive to individual needs.” So I think that that decree created a huge step toward the principles advocated for in this course. There’s much more to do, but there are also dramatic gains to recognize in the past 30 years.
I have learned to not take notes when counseling. I personally have concluded that note-taking in a session may be code for “I won’t remember your story” or “now I have some material on you” . . . . I worry that note taking could contribute to re-traumatization.
I strongly encourage my supervisees to follow my example of how I complete an Assessment. Our form has 12 pages and dozens of very sensitive questions. I never have my computer open and I do not interview the client nor ask hardly any questions. I listen and listen. I can complete a very good Assessment because the client almost always will tell me everything that I need to for CPSA. And if something gets missed, I might gently inquire in a later session. But I have seen some providers actually proceed with an interrogation which I think is not best practice for trauma survivors.