|Hardware for Your
Equipping a clinic for training always poses challenges. Aside from structural issues like sound control or installing and placing observation windows, supervisors and observing student therapists need to be able to hear and see what is going on in therapy. Typically, they want to record sessions for future review, and they often want to be able to communicate with therapists during therapy, giving instructions or asking questions in what is called "live" supervision. Cost is generally a factor, so this article will consider hardware that strikes a balance between quality and price.
Some of the best sources for information about how to equip a training clinic will be local radio and TV stations—a public or college station may be a good place to start. Well-equipped training clinics are similar to radio or TV sound stages, so radio or TV broadcasters frequently can tell you what you need and where to get it. There are differences, though. Unless you really want to put out broadcast quality tapes, avoid too much professional broadcast equipment. There are far more important things to spend your money on than digital tape editors and multi-thousand dollar cameras.
Audio and video dealers frequently serve as consultants, usually for a fee or with the expectation of making a profit from supplying the hardware you’ll need. Use them as appropriate, but I recommend starting with the broadcasters. A great deal of information is also available on the Web from both manufacturers and retailers; several web addresses will be cited throughout this article.
Let’s assume you already have a one-way observation window installed in your therapy room. You’ll need a microphone to hear what’s going on. The most suitable for therapy are called "boundary" microphones. They’re designed to be mounted near or in a room boundary—a table, wall, ceiling, even a floor—and to pick up any sounds in the room. Typically, you’ll want mics with an omnidirectional pickup pattern, unless you know exactly where in the room your sound sources will be located. There are many manufacturers, but two of the most experienced are Crown (crownaudio.com) and Astatic (astatic.com). Crown manufactures two mics called the PZM 10 and 11, which are designed to look just like a light switch and therefore be unobtrusive in a therapy-like setting. Astatic makes a model 202 designed for the same purpose.
The most common boundary mics are electret type mics—which means they will need a power supply. Mics like the Crown PZM frequently cost less than $100, while power supplies can run another hundred dollars for a unit that can power three or more mics at once. Some electret types run on batteries or a/c power, while dynamic mics need no external power source. Talk with a consultant or salesperson about what may be best for you.
Mount mics near sitting areas, around mouth height. Remember that clients in pain often whisper and bend over when they talk. Mics can also be mounted in the ceiling—but keep them away from air ducts and flourescent lights, which are too noisy.
A mic without an amplifier and a speaker system of some kind, of course, is useless. All it does is receive sound, not disperse it. You will need an amp to boost the microphone signal to levels a speaker can make use of, and a speaker itself to hear the sound. You may also need a mic mixer if you have more than one microphone in your therapy room. Many companies, including Radio Shack, Crown, Shure (shure.com) and Peavey (peavey.com) make mixers for around $300 and up, which will handle four or more mic inputs. Most mixers also can power electret mics, so if you buy a mixer that can, you won’t need separate microphone power supplies. Amps and speakers need not be expensive; you’re not staging a rock concert. Decent public address amps from Bogen, Radio Shack, and others start at $100. Speakers can often cost under $30 dollars. There is no need to overspend.
Ok. So you can hear what you want to hear, and, with your one-way mirror, you can see what you want to see. But suppose you want to videotape sessions?
The most appropriate systems for most clinical purposes are so-called closed circuit TV systems—abbreviated to CCTV. These are used largely in security and surveillance, but are also the best systems currently available for training clinics. Cameras are small, sometimes remotely maneuverable to switch aim point or zoom in and out, and newer models, using charge-coupled devices—CCDs—can work in very low light—a plus for doing therapy using warmer floor or table lamps rather than typically harsher overhead flourescent lights. Panasonic and Sony are some of the better known manufacturers. Cameras typically come with lens, but you’ll need to choose what kind. To cover a typical therapy room you’ll want a wide-angle lens; zooms give you a choice of coverage but add to expense and aren’t necessarily worth it. Like many microphones, CCTV cameras generally require power supplies—again, costing around $100 per camera.
Remotely maneuverable video camera systems, such as those manufactured by Pelco (pelco.com), offer great control of shot angles and frames, but they also are much more expensive than non-maneuverable cameras—$1,600 as opposed to $500 just for the camera systems—and require expensive controller panels, video mixers, and usually a computer, to be of any use. Be realistic. The number of videotaped therapy sessions in which it is even possible for someone outside the room to manipulate the camera and decide whom to focus on or to zoom in on at a given point is typically very small. Set up one consultation room that way, but not all of them. Besides, you haven’t even bought a VCR yet, or talked about the possibility of viewing therapy sessions from multiple locations.
VCRs and Monitors
The two most basic pieces of video equipment you’ll want are a videotape cassette recorder—VCR—and a television monitor—what most of us call a TV. While there are hopeful noises in the equipment press about digital video recording using computer hard drives or similar media, such technology simply isn’t practical yet and won’t be for several years. Plain old VHS videotape is still the way to go. The type of equipment you’ll probably want is so-called "pro-sumer" equipment—midway between the mainstream consumer market and broadcast professionals. Such equipment has multiple inputs for several signal sources and professional cable connectors. VCRs in this class cost anywhere from $300 to $1500; good monitors can be purchased for $400 or less. Some of the best deals for such equipment (as well as for some mics and amps) can be found at online or mail order camera and electronic equipment stores, such as B&H Photo (bhphoto.com), or Northern Video Systems (northernvideo.com). Pro-sumer VCRs have modest editing capabilities while better monitors have two-tuner capacity, meaning you can watch two different signals on the same screen. In a clinical application, for example, this means you could watch a reflecting team in one window of the monitor, while watching the therapy session in another. This takes some fancy set up, which a consultant can help you with, but it can be done if your monitors are capable. It can also be clinically useful to have a monitor and VCR in each therapy room, along with the mic and camera, as I’ll talk about next.
With a well-equipped system (including a VCR, camera, mics, and monitor) in each therapy room, your therapists will be able to use the system for clinical interventions, particularly with couples. If a therapist is taping a session, for example, and the clients interact in a potentially interesting way, the therapist can stop the VCR and play back the interaction for the clients at that instant, helping them gain perspective on their behavior or clarifying details of their interaction which often are missed.
Observing from Several Locations
Let us assume that you have set up your clinic as described above, and that you also have a small staff room from which it would be nice to observe sessions, or supervisor offices from which supervisors could watch cases. How do you make that work?
Installation is typically best left to the pros—check the Yellow Pages under "Sound Systems and Equipment" or "Television Systems and Equipment"—but you should know that you can structure your clinic’s hardware so that you can receive the TV and audio signals captured by your mics and cameras in several locations at the same time, even while a session is being taped in the therapy room (or elsewhere). Video modulation is one route, which converts the TV and audio signals to the low end cable band and sends them by wire to any monitor you choose. At the training center where I work, using video modulation, we can monitor or tape any session from any (or all) of six locations, as well as tape a session in the therapy room itself. ChannelPlus (channelplus.com) makes a variety of equipment for such a purpose.
You can also use traditional video mixers to send signals to various places, but you may need to add video amplifiers to such a system, and it is likely to be more expensive than a video modulation arrangement. Three years ago, we were able to install a video modulation system at our center—exclusive of cameras, VCRs, monitors, and mics (which we already had)—for under $2000. A video mixer alone would have cost us half that, without any installation or hookup. This again is the time to seek a consultant for your particular situation. No two setups will have the same requirements.
Finally, we arrive at the common problem of live supervision: communicating with the therapist in the room. Therapist to supervisor communication is a matter of style, and different techniques have their partisans which I’ll briefly discuss. My own choice for a clinic-wide intercom is Aiphone’s TD-Z system (aiphone.com/home). It is basically a private telephone system that can serve an entire clinic with up to twelve separate handsets, and in several years of searching I’ve found nothing else similar. Remember, most intercom systems aren’t private; they’re much more like speaker phones. Unlike talking with a telephone handset unit, anyone in the room can hear what is being said. It is important to note that not all intercom units are even point to point private. Some units are basically huge party lines, even those with handsets, that let anyone who picks up any handset in the system listen to what is being said by anyone else talking on the network, whether the person speaking has dialed them or not. The TD-Z system is fully private in all these senses. Our 12 station unit cost under $2,000 for the equipment, including cabling, and I was able to install it by myself—a bit tedious, and a little grubby running cable above the ceiling panels, but not terribly difficult. It is also a system you can take with you when you move—our own clinic has moved four times in its history.
Not everyone likes using telephone-type intercoms for live supervision. Some people prefer the "Bug in the Ear" unit—basically a receiver/earpiece unit connected to a small amplifier and microphone. The supervisor speaks into the microphone and the therapist, who has the speaker in her ear, hears the supervisor immediately and directly. The chief drawback of in-the-ear units for setting up a clinic is that they are not at all useful as intercoms, since they are always "on"—but for live supervision that’s sometimes very appealing. Therapy is never interrupted by a jarring intercom buzzer and clients never know when an intervention is being offered by the person behind the glass. Some therapists hate, however, having to listen to two voices at once—the one coming through the earpiece along with the voice of their client, so again these things are matters of preference. There’s also the further drawback that unless you include a mouthpiece mic—which invariably makes the therapist look a little bit like an AT&T operator—the therapist can’t talk back. However, there’s no reason one couldn’t use both an Aiphone like intercom and a "Bug in the Ear" if one’s budget allows; each has its virtues and limitations. "Bug in the Ear" used to be a brand name, which appears to have gone out of business, but Radio Shack carries similar units. You’ll want the wired version rather than the wireless—for reasons I’ll discuss below.
Devices Never to Use as Intercoms
Baby monitors. Many clinics use them, inviting lawsuits. They are essentially localized broadcast radio devices; most people with infants have heard stories of people who heard the baby next door crying (or the couple next door arguing) on their own baby monitor or cell phone, or sometimes even on their radio. Baby monitors are cheap, but a malpractice lawsuit isn’t, and it raises everyone’s liability insurance rates.
Wireless mics, intercoms, and cordless and cellular phone—radio broadcast devices again. Remember Prince Charles’s infamous intercepted phone call to Camilla Parker Bowles, or Newt Gingrinch’s intercepted cell phone call dissing Bill Clinton when he was supposed to be making nice with him. There are people who really do regularly scan the airwaves to intercept and record embarrassing transmissions. If you think it can’t happen, talk to Chuck.
Used microphones, mixers, and even cameras can frequently be found at quite reasonable prices; for half or less than new equipment. They can also sometimes be found at institutional equipment auctions for very low prices. There’s no shame in taking hand-me downs, as long as they work. When the hot clinic uptown or maybe the local TV or radio station is upgrading, ask what they’re doing with their old stuff. We’ve gotten many good pieces of equipment gratis this way. Good deals for used hardware can also sometimes be found on the web. Just enter the type of equipment you want in a search engine, and you may find a great bargain.
Abuse and Confidentiality
Useful as the equipment I’ve talked about here is, it’s also easy to abuse. Equipment that lets supervisors monitor therapy at the flick of a switch can invite Big Brother into the clinic. No system is complete without a clear policy for its use and limits that everyone on staff understands. At our own center, while everyone knows that anyone on staff might be watching anyone else work—including students watching supervisors—everyone understands it is proper to ask beforehand. Supervisors, of course, have a duty to observe, but we still expect them normally to ask before turning on the monitor. Supervision does not mean anonymous random spying.
Clients obviously must be informed about monitoring and what the limits of it are. In some circumstances it may be appropriate to offer them the right to refuse observation, though in most training situations the obligation to monitor in some form is mandatory, and should be specified as such before treatment begins to anyone who seeks services.
Therapists and supervisors must also be prepared for the unexpected: it is not unheard of for a clinician to be observing a case and suddenly see a family friend sitting in the client’s seat. Clinicians should be instructed in advance to excuse themselves in such circumstances in order to avoid conflicts of interest or the exploitation of other relationships.
Lastly, videotapes and other recording products must be treated with the same care as all other clinical materials. Clients need to know if tapes will be erased after treatment or kept like regular records, and whether or not, like other clinical records, clients may obtain copies of them. We have had more than one client request a copy of a tape of a therapy session the client found particularly valuable, and we have acceded to such requests.
Although the devices and techniques I’ve mentioned here can be quite useful, they can also be dangerous. Every year, people are electrocuted by microphones whose cables have been shorted with a/c lines, or by plugging the wrong connector into an electrical power socket. Cable insulation can fray, poorly mounted microphones and cameras can drop from above, and coffee cups placed thoughtlessly atop amplifiers can spill into them with serious consequences. Nothing compensates for thoughtlessness.
Particularly for family therapists working with children, the safety of an installation needs to be viewed from a child’s perspective as well as an adult’s. Get down on the floor at toddler or infant height and see what is chewable, pullable, or snaggable, especially current carrying conductors. An adult will usually survive a 120-volt shock with no more than some minor pain, while a 2 year old ’s heart could stop.
This is of course no more than a very quick sketch of training clinic set up for effective supervision and education. I haven’t even touched on the questions of soundproofing and masking, installing observation windows, or presentation quality videotaping and editing. But at least now you should have some idea of basic topics involved and some acquaintance with types of equipment and terms so you can shop and design knowledgeably.
Used with proper care for ethics and safety, a well executed monitoring and recording system can be an invaluable asset to any clinical agency. Just because we’re therapists doesn’t mean we have to turn everything over to technocrats.
Scott Johnson, Ph.D., is an AAMFT Approved Supervisor and received his doctorate in MFT from Virginia Tech, where he is Associate Professor and Clinical Training Director. He has been interested in audio and video devices since building a tube amplifier from a kit when he was 12.