“Doctor” – Patient Interaction, more substantial and authentic than college

March 3, 2012 at 9:53 PM

“Doctor” – Patient Interaction, more substantial and authentic than college


Lauren Donohoe QC ’11 &’13 and Jim Stellar


Lauren and I have written before about the dynamic of being an undergraduate researcher in a speech/audiology laboratory and how it can be like a family that encourages the intellectual development of the student.  Well her undergraduate career worked so well for her that she got into the very competitive Master’s program at the same department, stayed, and now has a few clients for whom she functions as an apprentice speech-language pathologist.  In a conversation, we were struck by the potential difference to the student experience of patient/client interaction that comes as a volunteer vs. professional.  So, we decided to write again, but this time focusing on the tonal qualities of the differences in the interaction and what lessons it might teach us about professional encounters for students in experiential education.


Lauren, let’s start with your describing first the experience you had with the kid you had in summer camp where you volunteered.  Particularly, could you discuss what the separation that occurred at the end of the encounter taught you about the nature of your interaction? 


When I first heard that the summer camp was for children with autism, I did not know what to expect and was nervous as autism is a disorder characterized by challenges in engaging with others.  The child I was paired with (G.) was nonverbal so I did not know how things would go and hoped that he would like me.  After spending three days with him and forming a friendship and a special bond that will always stay in my heart, I had to say good-bye to my new friend.  His father told me on my last day that no one had ever connected with him the way that I had.  When I was leaving camp that day, G. was focused on his DVD player so we never got to say an “official” good-bye.  I think that added to the emotions I felt in the car ride home from Manhattan.  I was sad to leave G., worried about how he would fair not having me by his side for the remainder of the camp, and praying that his future would be filled with relationships like the one we formed.


Thanks.  Now, let’s hear the other side of this contrast we set up.  What is the nature/depth of your association with your current patients in the speech clinic and how does it differ?


Professionalism is one of the first words that comes to my mind as a graduate student.  There is also the awareness that there are eyes on you all the time.  As much as I respect those two notions, it is impossible not to form relationships with your clients over the course of three months.  I wanted so badly for my clients to succeed and the first sign of progress made me want to do back-flips because I was so happy for them.  It is also a very special feeling to know that I was a part of their progress.  This relationship differs from the one I had with G. at camp because there was much more one-on-one time with G. and we did whatever he wanted.  As a graduate clinician, there are always other people in sessions with you; supervisors, other students, or the clients’ relative(s).  Also, as much as we do what the client wants, there is still a focus on achieving their goals.  This is not to say that I did not feel sad after my last sessions with them.  I think about how they will fair in the future without me, just like with G.      


I see.  What I hear you saying is that the necessary supervision that you must receive in the clinic actually (and naturally) blocks a bit of the one-on-one relationship you were able to develop at the summer camp.  That may interfere with the development of the client in the clinic seeing you as an independent professional.  Of course, as you progress in your training, there is always the prospect of greater independence and you are on a track now to become that professional in under 2 years when you graduate again, this time with a Master’s degree.


Once I graduate, I will need to begin my Clinical Fellowship Year (CFY), which is where I will work with clients but under a supervisor.  At this point, my supervisor is less of a “boss,” and more of a mentor, someone who will help me bridge the gap between my academic experience and becoming an independent provider of therapeutic services.  I appreciate that a CFY is a requirement because it can only add to my knowledge and experience.  The thought of having someone guide me in the right direction is comforting.  I value the opportunity to have such an involvement with a therapist who is more experienced than myself.  I plan on learning everything I can from such a person, as I have tried to do with my supervisors as a graduate student.  The one thing I always keep in the back of my mind is that after my CFY, it is expected that I handle situations on my own.  I am confident that all of the knowledge I will have gained from my supervisors will assist me in my interactions with clients and their families. 


JS often uses the words “substantial and authentic” to refer to the experiences that can produce the greatest growth.  He got this from interactions with the Law School at his previous institution where he was part of a group drafting the experiential component of the strategic plan for the university.  Moot Court, while powerful and consciously imitating the judicial atmosphere was thought by the law professor with whom he was discussing to be not authentic (it was in the Law School) and not substantial (it happened in a day, although there was preparation time required).  By contrast working on a 4 month cooperative education experience in a law clinic was thought to be both substantial and authentic because the clients came to see the law students as virtually their lawyer even thought a certified lawyer was in the clinic.  The ratio of clients to lawyers was such that the law student had to function that way even if she/he could not represent in court. 


We notice how that the experience of LD above fits with this point.  We also note that this is “other lobe of the brain” thinking as this part of a person notices when the experience is a bit more vs. a bit less real.  The closer one comes to real the more powerful the student engagement.   There is a controversy over internships today (and even a book on the subject), particularly about those that are unpaid – where the intern really just gets coffee or stuffs envelopes or the like.  The best internships are those where the employer and the student forget (temporarily) that the student must someday return to college and thus form that substantial and authentic relationship. Graduate professional training programs are more substantial and authentic than undergraduate college programs.  College needs to do more to imitate them so as to produce growth in its undergraduates.  One does not grow a new brain area between 20 as a junior and 22 as graduate student.  So, it is all about crafting the circumstances where the undergraduate can be really engaged…and learn at a very high rate.


Anterior cingulate cortex and cortical re-representation of limbic processes of emotional conflict

Leave a Reply