- What is the PSRC?
- Are all PSRC services confidential?
- Will I be recorded on video?
- Why must I fill out questionnaires?
- What other mental health/psychological services are offered on campus?
1. What is the PSRC?
The PSRC or Psychological Services and Research Centre is essentially an analogue of what a teaching hospital is to a medical school. It is an advanced training facility for graduate students in the Clinical Psychology Program at the University of Windsor. Low-cost psychological services are provided by clinical trainees under the supervision clinical psychologists from the Department of Psychology, all of whom are registered with the Ontario College of Psychologists (www.cpo.on.ca).
The mission of the PSRC is threefold:
- to provide gold standard clinical training,
- contingent on training priorities, to provide psychological services to University of Windsor students and to larger the Windsor community, and
- to generate applied research opportunities for faculty and students in the Department of Psychology.
Who is using the PSRC space?
- Every year this health clinic serves 18 academic courses & practica, involving 11 faculty members, 50 graduate students, and up to 250 patients/clients.
- Assessments involve about 3 visits, while therapy is an average of 10 visits.
- Approximately 30% of PSRC clients are students from University of Windsor
- Approximately 70% of PSRC clients are adults and children (ages 6 and up) from Windsor and Essex county, including refugees and victims of human trafficking
2. Are all PSRC services confidential?
We adhere to the professional standards of confidentiality as mandated by the College of Psychologists of Ontario. The fact that you come to the Psychological Services and Research Centre (PSRC) and the information you share with your therapist are private and confidential.
Like your family doctor, or dentist, we are required by law to keep records of your visits and these records stay at the Centre. They will not be shared with anyone else outside of your circle of care providers unless you request it. By law, we cannot reveal anything about you to anyone without your written permission, although as with your family doctor or any other health practitioner, there are a limited number of exceptions. We must report information about:
- current child abuse or serious risk of abuse.
- sexual transgressions by any other health care professional.
- a threat of clear, serious, and imminent danger to your own physical safety or if you pose a similar risk to another person.
- if ordered by a judicial court of law.
- If there is confidential review by "Quality Assurance Assessors" as may be required by the Health Disciplines Act of Ontario.
Privacy procedures related to psychological services provided in Canada are described in greater detail in the CPA brochure titled "Protecting the Privacy of Your Personal Health Information". Please feel free to contact us for further clarification and explanation of our standards of professional practice.
3. Will I be recorded on video?
What is this talk about videos?
The standard practice at the Psychological Services and Research Centre is that all psychotherapy sessions are video recorded. This means that after you first meet your therapist she or he will discuss recording the session.
Why is this part of the therapy? Who does it benefit?
Recording sessions improves the quality of your treatment. Although your therapist is a trained clinician she or he also works on your case as part of a small treatment team, which is supervised by a Registered Psychologist. Recording sessions allows your therapist to get feedback on what to work on with you in session. In the end, it means you getting the best possible treatment.
Who is on the treatment team?
Your therapist, a supervising psychologist, and usually about 4 to 5 other therapists. If you want, you can ask your therapist for a list of their exact names. Everyone on the team has signed a commitment to protecting your confidentiality.
Is this common for therapy?
Recording therapy session is often standard at many university clinics. Videos are treated with the same confidentiality as any other health record, except they are deleted as the therapy goes on, and we don’t keep any copies.
What about my privacy?
While you are a client, videos are digitally encrypted and also kept in a locked file cabinet.
Then what happens to the video?
Videos are only used to help your treatment, so usually they are deleted each week. When you finish therapy we verify that all video recordings have been completely deleted.
4. Why must I fill out questionnaires?
Why do we use routine collection of outcome and process measures at the PSRC?
Using these measures improves clinical effectiveness and clinical training. First, there is empirical support suggests clinical service is improved using process measures, such as session-by-session feedback from clients on the quality of the relationship and what they found helpful or hindering in the session. The measures also provide data for future research inquiry on psychotherapy processes and clinical training.
As opposed to much of the research that tells us that a particular treatment approach is effective overall for a particular population, the use of outcome monitoring measures, such as the Outcome Questionnaire (OQ-45), can tell us whether this current treatment delivered by a particular therapist is helpful to a given client at a certain point in time. Research tells us that, without outcome monitoring, clinicians tend to overestimate the outcomes for their own clients (Walfish et al, 2012). When therapists use routine outcome monitoring, clients enjoy higher rates of improvement and reduced rates of deterioration (Boswell, et al, 2015).
Research has consistently shown the importance of the therapeutic alliance in psychotherapy (e.g., Castonguay et al, 2006) and at the PSRC we use the Working Alliance Inventory to measure this. Research has repeatedly shown that therapist and client views of the alliance diverge, particularly early on in therapy (Horvath & Bedi, 2002). Similarly, we use the Helpful Aspects of Therapy (HAT) scale to get client input on what they found most useful in a given session and this has been valuable for trainee’s at all levels. The Session Evaluation Questionnaire (SEQ) provides information on clients’ overall rating of the session, as well as on two different dimensions – (a) depth - powerful and valuable versus weak and worthless and (b) smoothness - relaxed and comfortable versus tense and distressing, as well as on two dimensions of their post-session mood (positivity and arousal).
What are Benefits of Incorporating these Measures into Clinical work and it’s Supervision?
Incorporating measures like these into clinical practice and its supervision can be help in monitoring both client welfare and progress, as well as in assisting trainees in developing their of clinical competencies.
The OQ-45 provides a valuable tool for supervisors to monitor client symptoms and progress. Supervisors and Therapists can each independently log on to the system, and view outcome data for all clients being seen under their care (instructions for how to log onto the system and view the information are available). The on-line system graphs client progress session-by-session, while a report on the most recent session highlights any critical items client’s may have responded to (i.e., about suicidal ideation or other risk factors) and notes subscales (symptom distress, interpersonal relations, and social role). Based on a combination of symptom levels and trajectories, the OQ-45 system also is able to estimate the likelihood of treatment failure or a client dropping out. All clinicians will benefit from knowing that research has shown these predictions to be significantly more accurate than clinical judgements alone. The report shows this prediction using an “alert status.” A yellow or red alert may reflect the client suffering a recent major life stressor, or it may be a signal the risk of some negative treatment outcome. When supervisors or therapists see these alerts they should have a discussion about it as soon as possible. Jointly examining the other process measures for that client will also be of assistance in understanding the alert. The type of information available from the OQ provides supervisors and therapists with an easily accessible way of monitoring progress in therapy, and managing potential risks, and guidance for when supervisees may require extra assistance or direction.
Information from both outcome and process measures will also be helpful in assisting therapists in the development of their clinical competencies. Conducting therapy in a manner that incorporates the use of client input on process and outcomes is an important clinical competency itself, and supervisors are expected to assist in this. Having client feedback on the quality of the relationship can help therapists validate their in-session sense of the relationship and also offers supervisors insight into the treatment relationships or management of ruptures under their care. The WAI subscales provides specific information on agreement on (a) tasks, (b) goals, and (c) the relational bond.
Looking at changes in process measures such as the WAI, HAT, or SEQ early in therapy or after significant events such as presenting a conceptualization to the client, or trying new interventions, can offer systematic feedback for both the supervisor and the supervisee. Information from these three process measures is available to supervisors through fluid surveys. It is not quite as user friendly as the OQ information (e.g., no graphs of session-by-session progress), but it can be downloaded either as a pdf file (easier to read) or as a CSV file if you wish to calculate subscores or do other work with the data. Supervisors will need to forward the information form fluid survey to their supervisees.
What might the future hold with the use of outcome and process measures at the PSRC?
We are hoping to make the use of outcome and process measures a seamless process – where we will get feedback from supervisors, student therapists, and their clients, and adjust our measurement approach in response to this feedback. Clinician’s working at the PSRC wil be interested in knowing that our measurement protocol is part of a Practice Research Network, which means we are administering the same measures decided collaboratively with several other clinics (including at York University, McGill University, Veteran’s Services in Ottawa, among others). However, ultimately the usefulness to you is a key factor. We invite your input on the value of these different measures, and if you suggest changes. Finally, anonymized data is available to students or faculty for research projects. Studies that aim to improve training and/or clinical services at the PSRC are given priority.
5. What other mental health/psychological services are offered on campus?
Student Counselling Centre (SCC)
The Student Counselling Centre was originally developed as an off-shoot of the PSRC because the PSRC is unable to provide drop-in or crisis intervention. In contrast, while the primary mandates of PSRC is training and research, the primary mandate of SCC is service provision to students. Supervisors at PSRC teach academic courses while SCC staff offer service. Triage procedures operate differently between the two centres: the PSRC focuses on academic training, SCC on service. While the PSRC offers service to patient groups as determined by training needs and limited by academic terms, the SCC offers service to meet on-campus needs year-round. Additionally, the academic unit of Psychology through FAHSS financially supports 2 clinicians to help staff SCC and all student clinicians at SCC are first trained at the PSRC.