I'm delivering therapy as an AP. How autonomous should I be?

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I'm delivering therapy as an AP. How autonomous should I be?

Post by miriam » Sat Apr 07, 2007 1:44 am

An assistant psychologist should never have to make treatment decisions themselves, the responsibility for that should always rest on the supervisor. It might be possible, if only suitable cases were identified from the MDT meeting, for you to do the initial assessment yourself, then discuss it with a supervisor to make a treatment plan. However, this relies on knowing enough about the case at the point of allocation to you to ensure that it is not too complex to be held by an assistant, and I know that a lot of our referrals are quite ambiguous and it would be hard to make a good judgement about who should take on the case until you meet the people involved (although this has improved since the Nurse Therapists started screening non-priority cases).

If you feel that a case is too complicated for you, then you should be able to discuss that in supervision and establish a care plan you are happier with - perhaps another member of the MDT can co-work the case, or your supervisor sit in on one session in every four, or perhaps you can discuss it very fully in supervision and come up with a joint formulation and treatment plan that makes it more maneagable? It would seem only reasonable to be able to ask your supervisor to support you in the MDT meeting, as they are the one with clinical responsibility for your case work.

You also need to ensure that your caseload is manageable, and that your job also includes time for personal development, reading, and plenty of supervision (minimum one hour per week if you are full time). You might wish to read the BPS documents on the role of the AP, and discuss them at supervision.

Out of interest I did a short AP post supervised by a psychologist who was originally an Ed Psych, though he had done many years in Child Guidance and was functionally pretty clinical. The only difficulty with the post, and I say this with the benefit of hindsight, was that I think there was an expectation that I do things beyond the competence or remit of an AP. I think this was because I was their first AP and was funded with monies that had previously been used as part of a post for a qualified clinical psychologist. As such I was expected to complete assessments, interpret the results and come up with treatment plans, and do teaching to trainee social workers, and contribute to court reports, all with minimal supervision. I really enjoyed the post, but if I hadn't had previous experience with psychometric assessments, and access to other sources of supervision, it could easily have been a bad experience.

However, I think that is a risk with all AP work, and was not due to the orientation or training of the supervisor. With any AP it is difficult to balance stretching the experience of a person keen to learn anything and everything, whilst ensuring they are supported and not asked to exceed their remit. It is a very steep growth curve from psy graduate to AP to trainee to qualified CP, and it doesn't end there. My job still presents me with increasing expectations and new challenges every week!! Its hard work, but its also something I love about it.

See my blog at http://clinpsyeye.wordpress.com

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