Maintaining Emotional Wellbeing During Placement

Factors affecting the emotional wellbeing of a student

Maintaining emotional wellbeing of the student

Reporting requirements

First: Consider factors affecting emotional wellbeing of a student

There are many factors that can contribute to maintaining emotional wellbeing during a placement. Consider that overall, it is recognised that when subjective experiences are not acknowledged or validated, the impact on the individual can be quite devastating (Stolorow & Atwood, 1992, cited in Litvack, 2010, p. 237). What might seem ‘normal’ to an experienced clinician, may be confronting for a student, and needs to be acknowledged.

Consider a range of factors that affect a student’s ability to manage stress in the field placement:

The experience

Emotionally upsetting experiences can be conceptualised as a product of interrelated factors including:

The actual practice event and its subjective meaning to the student
The student’s emotional intelligence – the ability to self-regulate, the level of self-awareness, self-motivation, social awareness and social skills

The student-field instructor relationship

Can serve as either a risk or protective factor:

When the experience of negative field events was met with warm, supportive and interested field instructors, students were better able to move ahead in their learning process
The presence of a caring field instructor appeared to soften or diminish the student’s discomfort and distress about placement concerns
Where supervision is underscored by a climate of safety and trust, supervisees can develop their sense of professional identity
Students did not seek out field instructors who were perceived as unavailable or uninterested in teaching
The absence of a potentially helpful field instructor appeared to exacerbate students’ negative reactions to placement concerns

The organisational context of the practicum

Can mitigate or exacerbate student distress:

Agency policies, observations of informal styles of communication and staff tensions all have the potential to intensely affect students
The student’s ‘workplace literacy’ – the ability to understand the specific written and spoken language used by colleagues, particular jobs and tasks within that workplace and their comprehension of the ‘unwritten rules’.
When both the relationship with the field instructor and the environmental context were stressful, the total experience was perceived as highly negative.

Adapted from Litvack et al, 2010, pp.233-235; Litvack et al, 2012, p. 3; Maidment, 2013, pp. 7-11; National Association of Social Workers, 2013, p. 8)

Second: Maintaining emotional wellbeing of the student

Formal and informal supervision are primary realms for clinical educators to address the wellbeing of their students throughout a placement as well as preserve their own emotional wellbeing. Three common occurrences in supervision can pose potential risk for both student and clinical educator maintaining ‘a level head’ throughout the educational experience:

Anxiety and Power

Acceptance of anxiety and the inevitable power dynamics as a natural part of the supervisory process can make it easier for students to explore feelings of anger, defensiveness or disinterest as possible reactions to underlying anxiety by asking themselves what they might be anxious about. A clinical educator who validates these emotions and creates a safe environment characterised by respect, openness, support, trust and the provision of non-judgemental feedback, allows the student opportunity to move forward through the negative emotions.

Transference and countertransference

Often both student and clinical educator desire a successful outcome from placements and, as such, can feel pressure to perform well during supervision. The student may have experienced the unconscious phenomenon of the client’s feelings, thoughts and behaviours being transferred to them during a session. The student then brings this reaction into the supervision sessions. Countertransference refers to the thoughts and feelings experienced by a clinician towards the client, a supervisor towards their student or the student towards the supervisor. Transference and countertransference can be the root of confusing, difficult and sometimes negative interactions between supervisees and supervisors alike, blurring the boundaries of the supervisory relationship. If either of you are feeling more than would be considered therapeutic when sharing an education experience, consider the possibility of transference and countertransference. Being aware of the transference process, identifying early and openly discussing the process, enables the educator to emotionally self-regulate and lead the student through their own emotional journey.

Parallel process

Following an intense placement experience, students may become overly involved in the client’s journey. The parallel process within supervision that follows, occurs when supervisees unconsciously present themselves to the supervisor in much the same fashion that the client presented to the supervisee. It involves a series of transference-countertransference interactions. Consider asking the student to consider the following: What client am I currently discussing or reminded of? To what degree could the client be feeling similar to the way I am feeling now? Do you have any insights regarding my description of the client and how it compares to your and my feelings in this situation?

Adapted from Pearson, 2004, pp. 369-370; Centre for Addiction and Mental Health, 2008, pp. 60-63

Third: Reporting requirements

It is important that if you feel a student’s mental health is at risk or the client’s care is at risk as a result of the student’s emotional wellbeing, contacting the university placement coordinators as early as possible is vital for the correct management pathway to occur. Universities cannot generally disclose student issues but may already be aware of a particular student’s specific needs and be able to respond accordingly. For relevant professions, AHPRA has completed guidelines for mandatory reporting requirements. On the AHPRA website, it is stated that ‘The National Law requires practitioners to advise AHPRA or a National Board of ‘notifiable conduct’ by another practitioner or, in the case of a student who is undertaking clinical training, an impairment that may place the public at substantial risk of harm’. The respective university placement coordinator will be able to guide you through the process or alternatively you can contact AHPRA directly.

References

Centre for Addiction and Mental Health (2008). Clinical Supervision Handbook: A guide for clinical supervisors for addiction and Mental Health. The Office of Nursing Practice and Professional Services and the Faculty of Social Work (University of Toronto), Canada.

Litvack, A., Mishna, F., & Bogo, M. (2010). Emotional reactions of students in field education: An exploratory study. Journal of Social Work Education, 46(2), 227-243.

Litvack, A., Mishna, F., & Bogo, M. (2012). Emotional reactions of students in field education: An exploratory study. Retrieved from University of Toronto Research Institute for Evidence-Based Social Work: http://www.socialwork.utoronto.ca/Assets/Social+Work+Digital+Assets/Research/Emotional_field.pdf

Maidment, J. (2013). Getting Ready for Placement. In K. Stagnitti, A. Schoo & D. Welch (Eds.), Clinical and Fieldwork Placement in the Health Professions (2^nd ed.). South Melbourne: Oxford University Press.

National Association of Social Workers Association of Social Work Boards. (2013). Best Practice Standards in Social Work Supervision. Washington DC.

Pearson, Q. (2004). Getting the most out of clinical supervision: strategies for mental health counselling students. Journal of Mental Health Counseling, 26(4), 361-373.

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