Professional Development Plan 

You are a family nurse practitioner employed in a busy primary care office. The providers in the group include one physician and three nurse practitioners. The back-office staff includes eight medical assistants who assist with patient care as well as filing, answering calls from patients, processing laboratory results, and taking prescription renewal requests from patients and pharmacies. Stephanie, a medical assistant, has worked in the practice for 10 years and is very proficient at her job. She knows almost every patient in the practice and has an excellent rapport with all of the providers.

Mrs. Smith was seen today in the office for an annual physical. Her last appointment was a year ago for the same reason. During this visit, Mrs. Smith brought an empty bottle of amoxicillin with her and asked if she could have a refill. You noted the patient’s name on the label, and the date on the bottle was 1 week ago. You also noted your name printed on the label as the prescriber. The patient admitted that she called last week concerned about her cough and spoke to Stephanie. You do not recall having discussed this patient with Stephanie nor do the other providers in the practice.

Case Study Questions:

What are the potential ethical and legal implications for each of the following practice members?
Medical assistant
Nurse Practitioner
Medical Director
Practice
What strategies would you implement to prevent further episodes of potentially illegal behavior?
What leadership qualities would you apply to effect a positive change in the practice?  Be thinking about the culture of the practice.
A scholarly resource must be used for EACH discussion question each week.

Psychoanalyst Case Narrative Examination

Instructions For Completion Of Case Narratives To Meet The Examination Requirement For Licensure In New York State

The State Board has determined that two case narratives that describe the assessment and treatment of separate clients will allow you to demonstrate a basic level of competence in applying the knowledge and skills necessary to practice psychoanalysis in New York State. You will be able to select your own cases in advance, but you will write the case narratives in a supervised, secure test center. Each narrative will be reviewed and scored by two members of the State Board or its designees to determine the thoroughness and appropriateness of your interactions with and your therapeutic approach to the treatment of a client.

The Examination

You may not bring notes, case files, or any other materials into the examination site. Prior to the examination, you should have selected a case of sufficient duration and depth to allow you to complete the seven required examination sections. Select a case that involves the treatment of an individual (rather than a couple, family, or group), and that reflects standard theoretical orientations, rather than experimental or eclectic approaches to treatment.

Your case narrative should provide sufficient evidence of treatment planning and implementation appropriate to the patient, regardless of the number of sessions.

The narrative should clearly state your theoretical orientation. The reviewers will evaluate the narrative as to whether your assessment and treatment of the patient is appropriate to that theoretical orientation.

Your case narrative must be organized according to the format of the scoring sheet used by the reviewers. Following this format increases the likelihood that you address each area in your case narrative and receive maximum credit for your narrative. Although the use of titles can suggest that the case narrative is a collection of discrete subjects, the acceptable narrative will reflect the relationship between areas (e.g., presenting problem, assessment, and treatment) in the practice of psychoanalysis. Any narrative that is not in compliance with the required computerized format will not be scored and the candidate will be notified to that effect.

Format for the Narrative

Your case narrative must demonstrate the relationships among: the presenting problems, the background material, formulation of case dynamics, a diagnostic formulation, the phases of the psychoanalytic process, an assessment of patient functioning, application of psychoanalytic theory appropriate to the case and supervisory issues. You must write the case narrative in the order and format provided on the score sheet directly on the computer. You will have three hours to write, review, and complete the narrative. When you are finished, it will be submitted electronically to the State Board for Mental Health Practitioners for scoring.

Do not include your name or any other identifying information in the case narrative. Do not use actual names of clients, supervisors or agencies; use fictitious names or initials.

Scoring the Case Narrative

Each case narrative will be reviewed and scored by two licensed professionals selected by the Department who are competent in the practice of psychoanalysis. The Department will make every effort to assign the scoring of a case narrative to a licensed psychoanalyst with the same theoretical orientation as the applicant.

The reviewer provides a score for each of the sections on the scoring sheet; these are added to produce a total score for the case narrative. A reviewer may assign zero credit, partial credit or full credit for each item on the score sheet. A total score of 75 or higher from each reviewer is required for a case narrative to be acceptable. The criteria to be used by the reviewer is detailed on the next three pages.

If your case narrative is acceptable, you will be notified that it has met the requirement for one of the two case narratives necessary for licensure.

If a case narrative receives a failing score, the applicant will receive the reviewers’ score sheets with point values assigned to the narrative. (Raters may also have written comments about narrative deficiencies in the “comments” area under each scoring section.) An applicant may choose to revise the case narrative to improve scores in the deficient areas, in which case the applicant must schedule a session with the test center; there is no additional charge for revision. A failing case narrative may only be revised one time. As the applicant may not bring materials into the test room, the applicant will be provided with a copy of the rating sheets at the test center so that he/she may again see how the narrative was rated. If an applicant wishes to submit a new case narrative, he/she must contact the test center to schedule a session and pay the required examination fee for a single case narrative.

An applicant is limited to submitting and revising two case narratives per calendar year.

Credit for a passing score on the narrative is retained until the applicant meets the requirements for licensure or the applicant withdraws the application or after five consecutive years of inactivity.

Criteria For Rating The Case Narrative

For candidate use in organizing and writing the case narrative to satisfy the examination requirement for licensure as a psychoanalyst.

The passing score is 75. The point value of each numbered criterion in the sections below appears in parentheses at the end of each criterion. Structure your case narrative exactly as the sections appear below in order.

Section I: Identifying Data & Description of Patient (10 points)

In this section, the applicant should:

1. Describe the initial contact and any resistances to it (1)
2. Describe the initial appointment and any resistance to it (1)
3. Include referral source and referral condition if unusual (1)
4. Include descriptive characteristics (age, ethnic background, physical appearance and body language, employment history, educational background, living circumstances) (2)
5. Include pertinent medical and psychotherapeutic history (2)
6. Clarify contracts regarding length, frequency and fee of sessions (1)
7. Show understanding of dynamics of resistance in any of these contracts (1)
8. Present the material with clarity, relevance, and appropriate language (1)

Section I maximum score = 10

Section II: Presenting Problem (10 points)

In this section, the applicant should:

1. Adequately describe the presenting problem as the patient perceived it (2)
2. Demonstrate a psychoanalytic understanding of the patient’s presenting problem (3)
3. Psychoanalytically define what a presenting problem is (a reason or excuse to enter treatment; a symptom; a metaphor; resistance; symbol, etc.) (2)
4. Relate background information to presenting problem (2)
5. Present the material with clarity, relevance, and appropriate language (1)

Section II maximum score = 10

Section III: Background Material and Social History (12 points)

In this section, the applicant should:

1. Adequately present a description of the patient’s psychological and sexual history and understanding of himself (childhood shyness, aggression, loneliness, popularity, modes of functioning and adapting) (4)
2. Include patient’s recollections of significant events, memories, traumas, developmental milestones (2)
3. Include patient’s descriptions of and interactions with mother, father, siblings, other important people of childhood (2)
4. Include any conceptions of relations between past functioning and present circumstances (3)
5. Present the material with clarity, relevance, and appropriate language (1)

Section III maximum score = 12

Section IV: Diagnostic Understanding and Formulation (18 points)

In this section, the applicant should:

1. Include assessment of defenses and autonomous functioning in the diagnostic process (2)
2. Include assessment of self and object manifestations and intra-psychic issues in the diagnostic process (2)
3. Integrate background material into diagnostic understanding (2)
4. Integrate presenting problem into diagnostic understanding (2)
5. Demonstrate understanding of the therapeutic relationship as part of the diagnostic process (1)
6. Present interventions between patient and analyst and patient’s responses to interventions (2)
7. Demonstrate understanding of environmental/social issues in diagnostic process (2)
8. Formulate a diagnosis and present a rationale consistent with supporting evidence and theory (4)
9. Present the material with clarity, relevance, and appropriate language (1)

Section IV maximum score = 18

Section V: Initial Phases of Psychoanalytic Process (22 points)

In this section, the applicant should:

1. Include descriptions of therapeutic relationship between analyst and patient: typical interactions and control issues concerning fees, use of couch, free association, lateness, missed sessions, etc. (2)
2. Demonstrate an understanding of psychoanalytic interventions (interpretations, communications, and interactions) and provide examples of such interventions, including the rationale for their use (4)
3. Demonstrate recognition of resistance and provide examples (3)
4. Demonstrate recognition of transference and provide examples (3)
5. Demonstrate recognition of defense mechanisms and provide examples (3)
6. Demonstrate recognition of counter-transference with the analytic process and provide examples (4)
7. Demonstrate the use of dreams to further the analytic process (2)
8. Present the material with clarity, relevance, and appropriate language (1)

Section V maximum score = 22

Section VI: Later Developing Phases of Psychoanalytic Process (16 points)

In this section, the applicant should:

1. Include descriptions of shifts, changes, or deepening of transference relationships (3)
2. Include descriptions of how the continuing/deepening of transference relationship was facilitated through analyst’s interventions and communications (3)
3. Demonstrate evidence (or lack of) of patient’s emotional growth, changes that have occurred in patient and patient’s life as a result of analysis (2)
4. Demonstrate evidence (or lack of) of patient’s strengthened ego functioning and reality testing (2)
5. Provide an understanding of major themes appearing in the therapy (object constancy, narcissistic injury, obsessive/compulsive tendencies, depression, etc.) (3)
6. Provide a rationale for continuation or termination of analysis (2)
7. Present the material with clarity, relevance, and appropriate language (1)

Section VI maximum score = 16

Section VII: Supervisory Issues (12 points)

In this section, the applicant should:

1. Demonstrate an understanding of the use of clinical supervision (2)
2. Clearly identify supervisory issues pertinent to the case (2)
3. Adequately convey the supervisor’s guidance with respect to resistance and transference issues (2)
4. Convey understanding of the supervisor’s explanation of counter-transference issues and what the applicant has learned about them (3)
5. Demonstrate implementation of the supervisor’s recommendations in the analysis (2)
6. Present the material with clarity, relevance, and appropriate language (1)

Section VII maximum score = 12

Final Score

The pass point is 75. A score of 75 or higher is a passing score and shall be considered satisfaction of the examination requirement for licensure as a psychoanalyst in New York State