Emily and Dr. Haskins by Behrens and Carozza

Let us consider Dr. Haskins. During Emily’s clinical year, Dr. H as her supervisor had a dual burden: to teach and guide Emily as a student clinician, but also to bear in mind the needs of the clients assigned to Emily. Dr. Haskins sought out information to help Emily in this clinical year.

To be considered are the following factors:

Dr. H was new to the college and Emily had been enrolled for eight years, having extended the time in order to complete a double major and maintain a full time job.

At the start of their work together, Dr. H had asked Emily if she had ever been identified as a special needs student and whether Emily wanted to pursue such a diagnosis, since this would have led to course modifications in terms of workload and time allotted. Emily had reported only sketchy details about her condition and had refused to pursue any special accommodations at the college

Dr. H consulted senior faculty. Emily’s advisor emphasized the student’s excellent grades and high motivation. The only indication of any academic concern was a C+ grade Emily received in a pre-clinical course taught by an adjunct instructor. A C+, however, was a passing grade and allowed Emily to move forward. The advisor had looked upon the C+ as an anomaly in Emily’s record. Dr. H. found no record of any counseling or support for Emily.

Dr. H’s position was difficult—for herself, for her fragile student clinician, and for the many clients who were expecting to begin services. Dr. H didn’t know these clients, having recently recruited them for intake on her own and acting as the supervising clinician, working directly with the clients and families while hoping to help them, train the student, and serve as a demonstration teacher to the new undergraduates whose education was also taking place simultaneously with Emily.

Dr. H could see that the behavior pattern of Emily was evident to these other students who had taken classes with Emily. It undermined the confidence Emily had in herself. Dr. H worked diligently to align herself with the student’s goals and perceptions so that Emily could use her as a role model.

The senior faculty were observing and caring as to the situation, although they were not directly involved in any efforts to find a resolution for it.

Dr. H made the clients aware of the “newness” of the student clinic experience, and they helped by being willing to accept the situation as a dual-learning project. The children who were clients, however, were the least understanding of this model, as the student clinician was unable to modify her behavior according to their language and behavioral needs. It was clear that Emily’s anxiety increased her tendency for dysfluent behavior. Disruptive children became more disruptive. Distracted children could not be sustained. Frequently, parents had to be called in to monitor behaviors that Emily could not cope with alone, even after substantial supervisory input. The result was that there were few if any independently delivered pediatric contacts.

Dr. H noted that adult clients were able to better adjust to Emily’s atypical interpersonal style and, with Dr. H monitoring all of her sessions at the start, Emily was eventually able to deliver some sessions independently. More complex cases were not assigned to Emily, and the clinic caseload size had to be curtailed for the semester. Both Emily and Dr. H were relieved when the required hours component of the course were completed. Emily was capable of writing essentially timely notes; however, final reports were rambling and not targeted enough for even pre-professional work.

Dr. H took all of Emily’s work into consideration and determined that a D grade best reflected the skills Emily had gained during the clinical experience.

Questions

1. Was Emily’s clinical supervisor right to pass her with a D grade?
2. How could the Clinical Psychology program be restructured to predict problems that students might encounter in the clinical setting before their clinical year?
3. (This final question requires outside research and is possible as a homework question.) What strategies might people with Asperger’s Syndrome use to improve their pragmatic skills?

Copyright © 1999–2008 by the National Center for Case Study Teaching in Science.  Please see our usage guidelines, which outline our policy concerning permissible reproduction of this work.