Policies and Procedures Manual for Consultation and Referral Service

Policies and Procedures Manual
for
Consultation and Referral Service
October 2008
Center for Modern Psychoanalytic Studies
Consultation & Referral Service
16 West 10th Street
New York, NY 10011
(212) 228-6036
www.cmpstalkinghelps.org
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Directors
Fellows
ADMINISTRATION AND STAFF
Ellen Barz, Clinical
Angela Musolino, Administrative
Hubertus Raben, Milena Cornick, Monday
Charlotte Melnik, Ioanis Papavassiliu, Tuesday
Angela Musolino, Marzieh Hadavi, Jennifer Wade, Wednesday
Raúl García, Richard Sacks, Thursday
Patrice LaMariana, Friday
Adminstrative Assistant
Externs
Sarah Philipson
Barbara Goldsmith, Robin Jones
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TABLE OF CONTENTS
Administration and Staff……………………………………………………….….. ii
CERTIFICATE CANDIDACY AT THE REFERRAL SERVICE
General Information………………………………………………………………. 1
Administration…………………………………………………………………. 1
Eligibility……………………………………………………………………….. 2
Application……………………………………………………….…………….. 2
Requirement of Good Standing…………………………………..…………… 2-3
Ethics………………………………………………………………………….. 3
CLINICAL STUDIES INTERNSHIP 4
Getting Started…………………………………………………………………….. 4
Policies and Procedures……………………………………………..…………….. 4
Patient Assignment…………………………………………………………….. 5
Priority……………………………………………………………….…….. 5
Registration……………………………………………………..………….. 5
Intake Process………………………………………………………………….. 6
Minors…………………………………………………………………..….. 6
Daily schedules………………………………………………………..……….. 6
Release of Information………………………………………………………… 7
Interruption of Therapy……………………………………………………… 7
Patient-initiated…………………………………………………………….. 7
Candidate Absence or Withdrawal…………………………………………. 7
Vacation…………………………………………………………………… 7
Documentation of Clinical Process…………………………………………… 7
Patient File Forms…………………………………………………………. 7-8
Contact information……………………………………………………….. 8
Room Use…………………………………………………………………. 8
Referral Service Facilities………………………………………………………. 9
Telephone………………………………………………………………….. 9
Stationery…………………………………………………………………… 9
Room Condition……………………………………………………………. 9
Clinical Supervision……………………………………………………………….. 9
Registration…………………………………………………………………… 9-10
Advancement to Level 3, Research Candidacy…………………………………..… 10
Graduation………………………………………………………………………… 10
Private Practice……………………………………………………………………. 11
APPENDICES
Application for Certificate Candidacy………...…… 12-13
Request to begin PT 311………………………….. 14
Request to begin PT 411………………………….. 15
Intake Form………………………………………. 16
First Assessment Interview. ………………….…… 17-18
Assessment Interviews 2-5………………………… 19-20
Patient Statistical Information……………….……. 21-22
Authorization to Release Information…………..… 23
Monthly Therapist Room Use Report………..…… 24
Parental Consent Form…………………………… 25
Termination Report………………………………. 26
Summary of Experience in 311……………………. 27
Summary of Experience in 411……………………. 28
Release From Referral Service Responsibility……… 29
Monthly Private Therapist Room Use Report…….. 30
Application for Graduation……………………….. 31-40
Release for Private Practice in the Referral Service… 41
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CERTIFICATE CANDIDACY AT THE
REFERRAL SERVICE
GENERAL INFORMATION
The Consultation and Referral Service of the Center for Modern
Psychoanalytic Studies was established in 1972 as a non-profit, community-oriented
service. Its purpose is two-fold: to provide advanced candidates, as an integral part
of their training in psychoanalytic practice and research, with clinical experience in
conducting psychoanalytic therapy; and second, to offer affordable, high-quality
psychoanalytic services to the community.
The Consultation and Referral Service of the Center for Modern
Psychoanalysis (the Referral Service) is located in the lower Fifth Avenue area, at 16
West 10 th Street, in an historic townhouse. The facility, renovated in 1998, consists
of ten therapy rooms for individual, couple, and group sessions, a patient waiting
area, and garden.
The Referral Service is open Monday through Thursday 9 AM to 9 PM,
Friday 9 AM to 8 PM and Saturday 9 AM to 1 PM.
The Referral Service is closed on Sundays, New Year’s Day, Memorial Day,
Independence Day, Labor Day, Thanksgiving Day, Christmas Day, and two weeks in
the summer. The holiday and vacation schedule is posted at the beginning of each
academic year.
ADMINISTRATION
Directors
The Clinical Director is responsible for the overall clinical functioning of the
members of the Referral Service; the Administrative Director is responsible for the
overall administrative functioning. Both act as liaisons between the Referral Service
and the President of CMPS, and work collaboratively to implement Faculty Council
policies and Referral Service procedures. Biweekly informational meetings are held
between the Administrative Director of the Referral Service and the CMPS Director
to discuss facility issues. Biweekly staff meetings of Fellows and Directors are held
during the academic year to discuss and improve the training environment. These
meetings provide the opportunity to discuss clinical and advisement issues,
administrative matters, and outreach strategies. Policies and procedures are reviewed
and changed to better serve clinical and educational development. Candidates
enrolled in the program are invited to contribute to this process through meetings
with their Fellows. Problematic clinical issues and questions about patients’
suitability for therapy are resolved at these meetings. Candidates enrolled in the
program are invited to contribute to this process through meetings with their
Fellows.
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Fellows
Each Fellow is present at the Referral Service for 4½ hours on a designated
day to serve as the administrator in charge of the facility. All questions, problems and
incidents are brought to the Fellow’s attention. The Fellows also function as
academic and clinical advisors responsible for the education and clinical
development of their assigned candidates. The Fellows assess their candidates’
readiness for intakes and monitor the intake of new patients, guiding candidates in
administrative requirements and documentation. In consultation with the Directors,
the Fellows assist in assembling adequate information to evaluate the suitability for
therapy of incoming new cases identified as problematic.
Externs
Externs are generally work-study students or graduate volunteers who are
responsible to the Fellow in charge of the day and to the Directors of the Referral
Service. Their duties include the implementation of special projects, on-going desk
coverage, record keeping, processing and storing information.
Administrative Assistant
The Administrative Assistant oversees scheduling of patients, consulting
room assignments, telephone contacts and messages, and record-keeping. Intakes are
assigned according to the priority list compiled by the Fellows.
ELIGIBILITY
After a minimum of 100 hours of approved training analysis, successful
completion of the Fieldwork Program, and the pre-requisite coursework, a
matriculated CMPS student in good standing can apply for Level 2, Certificate
Candidacy, and entry into the Referral Service internship.
APPLICATION
When eligible, the student initiates the application process by submitting the
“Application for Certificate Candidacy” (pp. 12-13) to his or her academic advisor
prior to the application deadline date posted each semester. If the advisor approves
the application, the student is referred by the advisor to the Clinical Director of the
Referral Service for an interview. Final approval to register at Level 2 is determined
after the completion of this interview.
REQUIREMENTS FOR GOOD STANDING
During the certificate candidacy period, candidates must continue in an
approved PT 7 individual weekly training analysis. Any disruption in the training
analysis is to be reported to the Fellow within 24 hours. Candidates must meet all the
academic requirements attendant to their level of training (see Bulletin), maintain and
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document an individual liability insurance policy, submit all clinical and
administrative forms when due, and meet case supervision requirements.
ETHICS
Candidates are expected to conduct themselves according to the guidelines
of the Code of Conduct governing ethical behavior of candidates in training.
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CLINICAL STUDIES INTERNSHIP
GETTING STARTED
Internship begins with an assignment to a fellow. The candidate discusses
this assignment during the application interview with the Clinical Director and is
notified of the assignment by the Administrative Director prior to the beginning of
the semester. During the first year of internship, the candidate meets weekly with
the fellow for 20 minutes. During these meetings the candidate learns the
administrative aspects of working at the Referral Service, including policies,
procedures, and documentation requirements for patient and student files.
Of special importance during this first year is attention to intake procedures
and processes. When patients have been assigned and analysis begun, the candidate
presents these cases and discusses case management issues with the Fellow. In
subsequent years, the candidate and Fellow collaborate to determine the frequency
of their meetings. Both the candidate and the Fellow have the option at any time
over the course of the semester to request additional meetings beyond the agreedupon
schedule.
The Fellow acts as the academic advisor for the candidate and reviews
registration forms prior to the beginning of each semester, assessing academic
progress and current learning needs. Application to begin PT 311 Individual
Supervision of Referral Service Cases (p. 14) and PT 411 Control Analysis of a
Referral Service Case (p. 15) are submitted to the Fellow for review and approval
when the candidate becomes eligible for these advanced supervisions. The candidate
is responsible for maintaining the required academic and clinical files. Periodically
the Fellow and candidate will review all files to insure that they are up-to-date.
At the conclusion of each semester, the Fellow and candidate evaluate the
candidate’s work at the Referral Service, noting any recommendations for training in
the candidate’s official academic record.
POLICIES AND PROCEDURES
PATIENT ASSIGNMENT
Candidates in good standing are eligible to see three or more Referral Service
patients. The candidate informs the Fellow of his or her hours of availability. The
candidate regularly checks to ensure that this information is up-to-date, accurate, and
recorded on the appropriate form in the intake book.
Candidates are expected to maintain three individual analytic cases before
being assigned couples, families, children, or groups. Exceptions are made with the
approval of the Fellow Group.
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Priority
Patients are referred to candidates according to the priority level determined
by the Fellow, and by the candidate’s availability. When candidates have
demonstrated proficiency with intake procedures and patient management on their
assigned day, they may request to have additional hours on other days. Requests for
scheduling changes are discussed and mutually agreed upon by a candidate and his or
her Fellow. Morning, early afternoon, and late evening hours are available to
candidates who want additional patients on other than their assigned day. Premium
evening hours, i.e. between 4 PM and 7 PM, are reserved for students working on
their assigned day. Requests to see patients during these hours by candidates from
other days are discussed with the candidate’s Fellow and approved by the Fellow of
the alternate day.
Fellows determine priority for assignment of new intakes. Top priority is
given to candidates in the first semester of internship. Other factors considered are
the number of cases a candidate is carrying and length of time since last referral.
Registration
The prospective patient makes the initial phone contact or drop-in office
visit. A Fellow or the Administrative Assistant records the following information in
the intake book: patient’s name, address, phone number, source of referral, and
patient’s availability by day and time. The Fellow or the Administrative Assistant,
using the eligibility list, arranges an intake appointment for the patient with the next
available candidate who has hours coinciding with the patient’s. Effort is made to
effect an intake appointment at the time of the first contact. Patient requests for a
specific candidate are honored whenever possible.
During the initial contact, the patient is advised that there is a $40 fee to be
paid at the time of registration. If the patient asks about the cost of sessions, he or
she is advised that fees are arranged between the therapist and the patient. If other
questions arise during the initial contact, the patient is encouraged to discuss them
during the intake appointment.
When the patient arrives for the intake appointment, he or she is asked to fill
out the Intake Form (p. 16) at the reception area and the intake fee is collected. The
patient is then directed to the waiting area. Candidates who are expecting an intake
should be available in the therapy area a few minutes prior to the scheduled time.
The candidate collects and reviews the registration form during the intake interview.
INTAKE PROCESS
The Referral Service allows candidates one to five sessions for continuing
intake. In most cases enough information is gathered during the first interview to
allow for a determination of the disposition of the case. These decisions are made after
discussion with the fellow. If there is no further information to be obtained, the patient
and candidate may agree to work together. If there is no agreement to work together,
the candidate discusses the reasons with the Fellow so that an appropriate
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eassignment can be made. Intake sessions should be extended beyond the initial
visit when additional information is needed or suitability for therapy requires further
clarification. Establishing frequency and fee mark the end of the intake process.
Issues may arise during the intake interview or during the course of ongoing
analysis that need to be brought to the immediate attention of the Fellow. The
following problems should be brought to the immediate attention of the Fellow:
1) Potential suicidal or homicidal risks;
2) Life-threatening illness;
3) Pending legal action or court mandated therapy;
4) Child abuse and neglect issues;
5) Recent psychiatric hospitalization and psychiatric history;
6) An intuition that something is wrong in a case even if the problem cannot be
immediately defined.
The Fellow determines what further investigation or action is necessary.
When necessary, the Clinical Director of the Referral Service, the Fellow, the
Supervisor, and the candidate work together to assess the patient’s suitability for
therapy. In the event that a psychiatric consultation is indicated, the patient is so
advised. The Referral Service does not make referrals to specific psychiatric
specialists but will communicate with the patient’s selected psychiatric specialist as
needed and when the patient fills out an Authorization to Release Patient
Information form (p. 23 ).
Minors
Prospective patients under the age of eighteen may be seen at the Referral
Service only with the written consent of the parent or guardian on the Consent Form
for Treating a Child or Minor (p. 25).
DAILY SCHEDULES
Administrative issues such as changes in time, room, or day are discussed and
made with the Fellow. Only Fellows and the Administrative Assistant make entries
or changes in the daily schedule book. The candidate consults with the Clinical
Supervisor regarding the resistive aspects of a patient’s request for schedule changes.
RELEASE OF INFORMATION
Before responding in writing or by phone to requests for any information
about a patient, the candidate discusses the matter with the Fellow and the
Supervisor. The patient signs the Authorization to Release Information Form (p.
23). If information is given, one copy of the signed form is placed in the patient’s
Referral Service file, and one is sent to the person requesting information.
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INTERRUPTION OF THERAPY
Patient-Initiated
Breaks in therapy are reported verbally to the Fellow within 24 hours of the
last session and are discussed with the Clinical Supervisor. The Fellow contacts the
patient within 48 hours for administrative follow up if that is necessary. The
candidate fills out a Termination Report (p. 26) when no future appointments have
been agreed to, even if there is an expectation that the person may return to the
Referral Service at some future date.
Candidate Absence or Withdrawal
When a candidate is unavailable for sessions, the fellow is given notice. If a
short-term leave of absence is necessary, the candidate and the fellow work out a
plan for the patients.
Candidates who are planning to withdraw from the Referral Service discuss
the situation with the Fellow immediately and return their patients to the Referral
Service for transfer to another therapist. The process of informing the patients of the
candidate’s planned leave begins only after a plan has been formulated with the
Fellow, the Clinical Supervisor, and the candidate. Reassignment is determined by
the Fellow. If patients do not choose to continue therapy at the Referral Service,
they are asked to sign a Release from Responsibility form (p. 29) and to meet with a
Fellow for an exit interview.
Vacation
Candidates are encouraged to plan their vacations during the month of
August, but whenever the therapist decides to take a vacation, the Fellow is informed
in advance.
DOCUMENTATION OF CLINICAL PROCESS
Patient File Forms
In addition to the Intake form (p. 16) that the patient fills out during the
first visit, the candidate completes the Intake Information Form and First
Assessment Interview form (p. 17-18), the Ongoing Assessment form (p. 19-20),
which documents the second to fifth visits, and the Statistical Data form (p. 21-22).
The Statistical Data form can be completed over time as the information emerges in
the clinical process. All these forms are completed and placed in the patient’s
individual chart and filed in the active file cabinet at the end of the fifth
appointment. Ongoing documentation is as follows:
PT 211: Process notes for six sessions and a summary for each patient
covered in the supervision is submitted at the end of the semester to the Fellow.
Process notes are typed on 8 ½” x 11” standard white paper. The heading includes
the patient’s first name only or case number, name of candidate, name of supervisor,
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semester, and date of session. These notes are then placed in the patient’s file.
PT 311: A case summary of each patient is submitted to the Fellow at the
end of each semester. The patient’s summary is typed on 8 ½” x 11” standard white
paper, a separate sheet for each patient. The heading includes the patient’s first name
only and case number, name of candidate, name of supervisor, and the semester.
PT 411: A case summary of each patient is submitted to the Fellow at the
end of each semester. The patient’s summary is typed on 8 ½” x 11” standard white
paper, a separate sheet for each patient. The heading includes the patient’s first name
only and case number, name of candidate, name of supervisor, and the semester.
Contact Information
Each candidate at the Referral Service fills out a Rolodex card. This card is
kept in the Fellows office to facilitate access to candidate and patient information.
The Rolodex card includes:
(a) Candidate’s name, address, home, and work telephone numbers. It is
important that candidates designate which phone numbers are private and which
may be given to patients.
(b) Names, addresses, telephone numbers, and case numbers of all Referral
Service patients with their starting and terminating dates. Candidates are responsible
for entering all information in the file as new referrals are received and as cases
terminate.
Room Use
The laboratory course fee covers room rental for three referred patient hours
per week. A room rental fee of $10.00 per hour is charged to therapists with more
than three patient hours per week. The room is rented by the month; the candidate is
responsible for payment whether or not the room is used. The Monthly Therapist
Room Use Report (p. 24) is completed and signed by the candidate after the last
session of the month is conducted. The forms are submitted to the Fellow. These
forms also document the number of contact hours, both direct and indirect, that the
candidate has accrued and becomes part of the candidate’s education and experience
requirement for subsequent licensing.
Referral service candidates who possess a valid New York State license to
conduct psychotherapy may see private cases at the Referral Service during available
hours for a room rental fee of $15.00 per hour. Rental fees for groups are $20.00 for
a 90-minute session. Arrangements to see private practice patients are discussed with
the candidate’s Fellow and the Administrative Director. Room fees for private cases
are paid at the beginning of the month. A Monthly Private Therapist Room Use
Form (p. 30) should be completed and signed by the therapist and is given to the
CMPS Director with the appropriate payment.
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REFERRAL SERVICE FACILITIES
Telephone
The office telephone may be used to call patients who are late for an
appointment. When clinically appropriate, candidates provide their own phone
numbers to their patients so that the candidates can be reached directly. Candidates’
phone numbers are never given to patients before the intake process is completed.
Since the efficacy of telephone sessions is still in the experimental phase and
Referral Service candidates are being trained to work in the physical presence of a
patient who is lying on the couch, telephone sessions with Referral Service patients
are not permitted.
Stationery
Candidates may use Referral Service stationery only after discussion with and
the agreement of their Fellow.
Room Condition
Consulting rooms are left in good condition after sessions, with furniture
restored to original positions and used napkins thrown away. The last candidate to
use the room each day is responsible for turning off all lights, unplugging room
heaters, and generally noting that the room is left in an orderly condition. Doors are
left open when the room is not in use, and the Therapist Not in Session sign is
posted on the door. Candidates report any problem in room condition or other
therapy area to the Fellow on duty. If a Fellow is not available, a note is left in the
Fellow’s mailbox. If the problem requires urgent attention, CMPS office staff are
notified.
CLINICAL SUPERVISION
REQUIREMENTS
Faculty supervisors guide the training of the candidates. Every Referral
Service case must have an approved supervisor who is responsible for the clinical
management of the case.
PT 211 Each section covers a maximum of three cases.
PT 311 Candidates who wish to begin PT 311 supervision submit a written
application (p. 14) to their Fellow. Generally, one session of supervision covers four
patient hours.
PT 411. Candidates who wish to begin a PT 411 supervision submit a written
application to their Fellow (p. 15). It is recommended that candidates have worked
with at least one Referral Service case for a period of one year prior to beginning PT
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411 with an approved Control Analyst. PT 411 may be carried concurrently with or
following one year of PT 311.
Candidates engaged in research for a final project are expected to continue in
PT 411 until the completion of the project. In general, the ratio of one session of
supervision to four patient sessions satisfies the requirement. Any exception to this
frequency must be approved by the candidate’s Fellow in order for the hours to
receive credit.
DOCUMENTATION
PT 311. At the end of each semester of internship, candidates summarize the
supervisory experience and its relationship to their clinical work. The evaluation
form (p. 27) is submitted to the supervisor for approval and signature and then to
the Fellow by the end of the semester.
PT 411. A summary (p. 28) is submitted to the Control Analyst for approval
and signature and then to the Fellow by the end of the semester.
ADVANCEMENT TO LEVEL 3, RESEARCH
CANDIDACY
Advancement to Research Candidacy is based on an assessment of the
candidate’s clinical and academic work. The minimum requirements include
successful completion of required coursework (see bulletin), 25 hours of PT 411
Control Analysis, sufficient experience analyzing three patients to demonstrate
understanding of resistance, transference and countertransference, and the
recommendation of the candidate’s Fellow to schedule a clinical presentation. The
purpose of this presentation is to further assess the candidate’s clinical skills to
identify areas of clinical practice that the candidate and faculty determine are
essential to ready the candidate for graduation and independent practice. Three
patients are presented in the allotted 45 minutes.
After the clinical presentation, the candidate discusses the recommendations
of the faculty with the Fellow. The candidate is then eligible to register for the
research and advanced clinical courses listed in the bulletin as reserved for Research
Candidates.
GRADUATION
When the candidate’s research paper has been officially approved by all of
the committee members, the candidate prepares and submits an application for
graduation (pp. 31-40) to his or her Fellow for review. The Fellow signs the
application and forwards it to the Director of Advisement for final review. The
Director of Advisement arranges an interview with the candidate, approves the
application, and schedules an oral presentation by the candidate before the Faculty.
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Successful presentation before the Faculty marks the official graduation date of the
candidate.
RELEASE OF PATIENTS FROM THE REFERRAL SERVICE
Prior to graduation, the candidate and the Fellow will discuss procedures for
leaving the Referral Service, specifically referring those patients who wish to remain
Referral Service patients to other candidates in training and preparing those patients
who wish to enter the private practice of the graduating candidate. New York State
law requires that all persons conducting psychoanalysis or psychotherapy in New
York State must possess a valid license. In order for patients to be released from the
Referral Service to a graduate for private practice, documentation of a license or a
limited permit is required. Before the Referral Service can release a patient into a
candidate’s private practice, the patient must sign a release form (p. 29), which is
then given to the Fellow by the candidate. Once the Fellow signs the release form,
the patient can be moved to private practice. If the graduate wants to continue to see
patients in private practice on the premises under the procedures governing
graduates, the patient must sign a release form (p. 41) and follow the procedures
listed in the following section of the manual.
PRIVATE PRACTICE FOR GRADUATES AND
OTHER PROFESSIONALS
Private practice cases may be seen at the Referral Service facility during nonprime
time hours. Prime time hours between 4 PM and 8 PM are reserved for
students at the Referral Service and are therefore not available for private practice
rental. Practitioners wishing to secure space for private practice must contact the
Administrative Director of the Referral Service who will determine if space is
available. If space is available, the Administrative Director will approve the usage and
notify the fellow of the day and the CMPS Director. Private practice therapists must
be licensed in the State of New York to deliver psychotherapy or psychoanalysis and
must provide a copy of their license, current registration, and proof of malpractice
coverage prior to using Referral Service space. Reservations are made on a monthly
basis and therapists are responsible for payment on a monthly basis. The rental
agreement is limited to the specified room and time contracted by the month. The
fee is $60.00 per month for a 4-week month, $75 for a 5-week month. Fees are
payable by check at the beginning of each month. A Monthly Private Therapist
Room Use Report (p. 30) signed by the therapist accompanies the check and is given
to the CMPS Director. Rooms are available on the hour or half-hour. Rooms are to
be vacated five minutes before the next appointment and left in good condition.
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