Dr. Laura Kelly, PhD, NP, PMHCNS-BC
Associate Professor of Nursing at Columbia University School of Nursing
Dr. Kelly teaches Clinical Practice and Supervision in Family Therapy in the School of Nursing. This course runs in conjunction with a theory course where students learn a family systems approach. Dr. Kelly’s clinical practice course typically enrolls 15-20 students. Prior to 2020, these students worked face to face with volunteer families in need of family therapy. With the shift to remote teaching in Spring 2020, Dr. Kelly had to rethink how students could practice clinical skills in the absence of available families and in a fully remote modality. Dr. Kelly met the moment by creating a long form simulation, linking theory to practice, fostering diversity and inclusion, and embracing the remote modality. Read on to learn more about what Dr. Kelly did in her courses, what lessons and experiences she’s carrying forward, and the advice she has for other instructors at Columbia.
Create a Long Form Simulation
Part of the training of psychiatric Nurse Practitioners is that they have to be competent therapists. Students do individual group and family therapy as part of the program, including a full semester of family therapy. Before the pandemic, we found volunteer families for students to work with. Faculty in the college of nursing who have practices would put up flyers in their offices advertising for families. During Covid it was impossible to recruit families because no one was coming into the office, so no one was seeing the flyers. However, the clinical practice experience is essential to allowing the students to sit for board certification, so I had to come up with plan B.
It’s amazing that I didn’t think of it before, because it worked out so well. I created simulated families that the students worked with for the entire semester. I created three families, three different couples, using actors. The actors were scripted to some extent, but obviously we didn’t know what each individual student-therapist dyad was going to ask. Every week I would give the actors a range of responses in the direction that they should be heading, and every week I would meet with the actors to see where things went, and then script out the next session.
The students worked in pairs. Each pair of students saw their family six or seven times, and they saw them every other week. Each couple had six student dyads.
Link Theory to Practice
Anyone who does therapy has clinical supervision during which the therapist reviews cases and talks about transference and countertransference. My role in the spring semester is to do clinical supervision with the students. I’ve always done this, but I’ve never met their families and didn’t have a window into what happened in their sessions.
I don’t teach the theoretical family theory course. There is another faculty member who’s a family therapist who teaches the theory. However, I know the content covered each week. So now that I could direct the sessions, I could create a narrative that would potentially be an opening for students to use some of the techniques that they’re learning that week. It gave me way more control than a family that I didn’t know and wasn’t scripting. In the end I created and managed three different couples on three different family journeys, with six different therapy groups each week, writing the narrative each week.
I met with the actors before I met with the students for supervision, so I knew what had happened in the sessions. The students didn’t necessarily know that I knew what happened though, because it became so lifelike for the students that they forgot they weren’t working with real families. It worked so well. I’ll never do it any other way.
Foster Diversity and Inclusion
I was able to create diversity: I had a heterosexual, biracial couple; an elderly Lesbian couple; and two Gay men, one of whom was white and elderly, and the other about twenty years his junior and Latinix. So I really was able to create a lot of diversity. Next year, I think we’re going to add adult children into the scripts, because that’s not something that we haven’t tried yet. But being that these actors now know each other so well, and also know the scenario so well, I think it’ll be fun for all of us to add something.
Embrace the Remote Modality
Even now that we are back in the classroom for the didactic portion of this course, the family sessions are still done as Zoom interviews. The practice of therapy has changed because of the pandemic. We will continue to do virtual family therapy forever. It would be doing a disservice to our students if we didn’t provide them with a platform for tele-psychiatry, because they’re going to be doing it when they graduate. This is a modality in which the students have to become proficient. It will never go away.
Advice for Instructors and the Future of Teaching at Columbia
Reflect on your teaching methods.
We shouldn’t have to be in crisis to think creatively. I could have been doing this before. I’ve always been sort of an out of the box thinker. Why didn’t it occur to me sooner to do this sort of modality? One thing that had always been lacking in the clinical practice course was the opportunity for the students to clearly see the theory play out and practice with their clients, to try interventions based on what they know. Simulated scenarios really allowed for more of that, essentially because the situations were so clearly set up to create this opportunity.
I think that we can often, especially if we have been doing this a while, get stale in our teaching. We should be asking ourselves how we can provide our material in a new way, in a way that excites learners.
Spend time learning in your field.
I haven’t had family theory in a long time. I mean, I had a family theory course in graduate school. The fact that I had to create families really got me back into the theory in a way that I hadn’t been in years. My need to keep on top of things to that extent was really helpful in making sure that the students were making those connections too. It was better than when I was not creating scripts, and was just reviewing their family work each week. Since I was writing the scripts, I had to be really listening.
Embrace the new reality.
I was an early adopter of online teaching, and was fortunate enough to get a lot of education from the Center for Teaching and Learning at the school where I taught previous to teaching at Columbia. When I started teaching at Columbia, the College of Nursing had not offered any online courses and it was not an accepted method of teaching.
I think that hybrid learning, and some online learning, is a perfectly acceptable way to provide education to students. Offering potentially a hybrid option where some weeks are online, or some lectures are online and some lectures are in person, is useful. In my clinical specialty, students must become proficient in client assessment and treatment in a virtual format, so this type of teaching is not only useful, but necessary.