A Therapist’s Guide to Clinical Consultation in Private Practice

Thanks to Rebecca Wong, LCSW for this guest post!

Where do you get the professional advice you really need?

Being a therapist in private practice can be isolating. You spend your workdays seeing client after client. Between sessions, you try to connect with colleagues. You might hop onto Facebook and go to one of the many groups for therapists.

Occasionally, a particular client gets under your skin during a tough session. You need to talk it out. As therapists, we hold BIG, life changing stuff for our clients. If we are going to be and do all that for them, we need someone to support process – but who?

Bring it to supervision? Post about it in a Facebook group of colleagues?

Let’s talk about consultation and how it serves a very different role than supervision. Before we get to that though, it’s important to be clear why Facebook is NOT the place to get into the details of your sessions.

Let Facebook Do What Facebook Is Meant to Do for Therapists

Facebook is great for many things: building a following, expanding your reach, finding your own voice (aka: your brand), and learning to trust your own voice as you put yourself out there.

The world’s biggest social media platform can be the place to meet your professional tribe, deepen connections with fellow therapists, and seek collegial validation and support.

It’s also a good place to seek out WHO to consult with. But when it comes time for actual case consult and those nitty gritty case details…

Not Facebook. Please just say no to social media TMI (too much information) when it comes to your caseload.

Facebook is not a secure platform. You don’t know who is reading your posts or what they are doing with the information you share. Facebook’s very ease of accessibility is exactly what makes it such an inappropriate place to share specific case details.

Concerns over the lack of confidentiality and security on social media is actually what prompted this article. Lately, there have been many explicit, overly detailed posts appearing in multiple Facebook groups from therapists who were essentially asking for consultation.

As therapists, we need to see the problem with this kind of behavior and remember that our role is to protect our clients. We are obligated to hold our clients’ best interest at heart. Not only does the indiscriminate sharing of such sensitive information betray client trust, it also damages professional credibility.

And look at it from another side. Consider the free, easy, readily accessible advice that you get when you post about that tough client…

Who is actually providing that advice? What do you know about them and their training other than the group moderator approved their group membership?

Can you really trust your professional honor and credibility to just anyone?

Seeking Advice on Facebook is Human Nature in 2015

Listen, I get it. Turning to social media for feedback is as easy as it is tempting.

It’s easy to use it as a go-to resource whenever you want to solve a problem. I recall a time I asked for some help with a tricky situation that involved a client’s string of weather related cancellations in a Facebook group. Based on what I know now about how social media can be overused and even abused by therapists, I’d be more mindful when bringing such question to the public or semi-public zone of a Facebook group again. It’s not that I gave TMI per se, but I wasn’t necessarily being thoughtful about boundaries.

On the other hand, there are times when Facebook-based feedback is like soul food. After all, I received awesome, private practice boosting feedback in ZynnyMe’s Business School Bootcamp Facebook group after and I grew.

In reality, with all the options out there for therapists seeking support, there’s no need to misuse social media for clinical or professional advice. Facebook has its merits, but we need to be mindful of what works and what does not – and what’s ethical and what isn’t.

Building relationships with colleagues with whom you can consult… Yeah, you can totally use Facebook for that

You and I both know that despite its limitations, a lot about social media is real and constructive.

All of your meaningful relationships are a reflection of who you really are – this is one of my basicConnectfulness concepts.  In the best of circumstances, Facebook is a vehicle that builds these authentic, reflective relationships. As you build an online community full of thoughtful, conscientious colleagues who are dedicated to the collective best interests you learn more about how to honor your clients, your business, your peers, and yourself.

An additional bonus: thanks to the growing list of contacts you have due  to your conscious commitment to the online world you know exactly who to call when you need to pull in a case consult.

From experience, these consultations – held somewhere secure like over a phone call, email or video chat – are as fun as they are enlightening.  These conversations deepen my clinical insights and often develop into collaborations of one sort or another. These relationships with colleagues encourage me to keep growing and evolving both personally and professionally.

Do you need supervision or consultation?

Depending on where you are in your career and what goals you’ve set for your future, you may seek out supervision, consultation, or a mixture of both (on top of that personal therapy you’re already getting, of course!).

What is supervision?

Supervision is a necessary step towards your licensure and certain certification pathways. It’s how the profession ensures that you know your stuff.

Specifically, supervision focuses on how you manage the clinical work you do with clients. It’s a space to explore and deepen your understanding, education, and refine your clinical mind. The goal is to review your work with clients, enhance your professional development, instill ethical boundaries, and ensure that you are providing your clients with the best possible care.

It’s in supervision that you learn how to differentiate your “gut feelings” from “indigestion.”

I have to thank an early supervisor of mine, Les Gallo-Silver, LCSW-R, for that analogy. My gut feelings are amongst the most valuable tools in my clinical bag of tricks.

Thanks to Les’s advice, I’ve always sought supervisors who could help me value, trust, and hone my own intuition. I know that being tuned into the NOW and being fully present is what helps me manage my most demanding, difficult cases.

What is consultation?

There are different kinds of consultation: informal conversations between friendly professionals; ongoing, formalized dialogs with other therapists; and even calling on experts from other fields.

Consultation is always an opportunity for further growth — clinically, business-wise, or both. Consultation involves a collaborative discussion rather than the straight up offering and receiving of advice.

Often, consultation takes you beyond what you can achieve with your supervisor alone.  Topics you wish to consult about might be outside of your supervisor’s competency zone. A consultant can also be the person who can help you with branding and marketing and all that stuff they don’t yet teach you in your masters/PhD programs.

The main difference between supervision and clinical consultation has to do with your relationship. Your supervisor is/was ultimately responsible for the overall quality of care you provided to all of your clients. Consultants, on the other hand, are offer their expertise in a particular area and are excellent resources for tricky cases and situations.

There is a need for more consultation in our field.

Too often, clinicians are going to the wrong place for professional advice for all different aspects of clinical work and business. Or, therapists are so afraid of looking like they don’t have it all together that they don’t get help at all.

I’m suggesting that everyone needs to consider consultation, if not in an ongoing relationship, then at least on an ad hoc basis. It’s key that you ensure you’ve always got someone to talk to when new or difficult situations arise.

Why? Because the stuff you’ve always done won’t be the thing to get you to that new place where you want to go. Simply stated: you need help. (We all do.)

What keeps you (and yes, all of us) from getting help? Fear.

Fear isolates you. A fear of inadequacy or a fear that you’re doing something wrong keeps you from connecting with people who can help. The fear keeps you from taking actions that help your clients, your practice, and yourself.

And, when you try to do it all alone you end up learning the hard way: as relational beings, sustained learning and growth refuse to occur in a vacuum.

Consultation saves you from the stress of both TMI and isolation. And, it gives you real, actionable advice to deal with the initial problems that had you seeking advice or losing sleep in the first place,

Consultation helps you through the little freak outs and struggles with internal “ick” because it’s supporting you through each key period of growth and expansion that trigger your panic.

For this article alone, I consulted with my dear friend and colleague Robyn D’Angelo, my practice consultant Jo Muirhead, and my friend and writing coach, Marisa Goudy. I even knocked it around with my husband, in therapy, and supervision too. At this stage in my business I understand that a guest post like this can be important enough that it’s worth involving many members of my professional support team.

On the purely clinical side, I recently, consulted with Dr. Lily Zehner, a therapist specializing in sex, intimacy, and relationships. She helped me sort through my intuitive responses to a recent client and offered guidance on how to proceed. I’ll likely also reach out to a past supervisor to help me with this case because, when I process collaboratively, my work is richer. I serve my clients better. We all grow.

Consultation helps with the jigsaw puzzle of YOU. It enables you to see how all the pieces, both personal and professional, fit together – or don’t.

If you are ready for a little oomph in managing your own humanness and honing the skill of being a connectful therapist –bringing more of your YOUness into your work in order to transform your practice, relationships & life, I’d love to help.  Come visit me and learn about the consultation services I provide fellow professionals like you.

Rebecca is a relationship therapist and professional consultant in private practice in New York’s Hudson Valley where she lives with her husband, two children, and a few four legged mischief makers. Her evolving relational theory is called Connectfulness and she uses this approach to help her clients and colleagues understand, manage, and value their own humanity as a tool to connect to themselves and all of the important people in their lives. She believes that our relationships are reflections of who we really are and every interaction is an opportunity for evolution. Every day she embraces life as a beautiful, messy, serendipitous adventure!