Instructors nor colleagues ever spoke to me . . . in a classroom, as a supervisor, one on one, or even in a text about therapists’  mishaps and what to do about them.  No one ever spoke about them being opportunities for learning and growth.

Instead, when errors were made, I was taught that they were embarrassments, shameful, and dangerous for any mental health professional. They were things to be talked about behind closed doors with an attorney or forgotten about and not to be discussed with clients and colleagues and under certain circumstances maybe even lied about . . . .

Then, several years back, I attended a workshop at an annual conference for the Association of Women in Psychology. The workshop focused on discussing those very things that I was taught should not be discussed . . . clinical misjudgments, errors in thinking, and client-related mishaps.  It was, for me, a practice-altering experience . . . to be in the presence of counselors, psychologists, and social workers candidly speaking about their professional and sometimes costly gaffs.  It was also a very healing experience . . . to learn that other professionals (many more experienced than me and a few quite well-known) also made mistakes . . . as we grappled together with how to responsibly and ethically admit our mistakes, make amends for our transgressions, and learn from our own misjudgments.

Ours is not the only profession that struggles with how to undo any damage that we may have caused.  Physicians are also taught to play it safe when errors are made and keep their gaffs to themselves.  However, research is increasingly showing that it is often in a client’s  best interest for medical professionals to ‘fess up and admit mistakes made.  Check out When Doctors Admit Their Mistakes and also Risk Management: Extreme Honesty May Be the Best Policy.

Here’s my point . . . . I am a better therapist when I am able and willing to tell the truth . . . the whole truth to myself, to my colleagues and to my clients.  I am a better person when I am able to tell the truth.   And, my clients deserve the best therapist that I can be . . . 100% of the time.  Until the mental health professions are able to create a culture and space in which we can take responsibility for and  learn from our own mistakes, we are not the professionals that our clients deserve.

Surely I’m not a lone voice for shedding the embarrassment over clinical misjudgment and shelving the self-imposed shame of making errors with clients.  When well-trained therapists with good intentions make choices that, in hindsight, are not the most helpful ones to our clients,  I believe it should be the standard of our professions to create a space for owning our mistakes and making amends to our clients with dignity and heartfelt regrets.

It’s time for our professional associations and our graduate institutions of learning to model healthy and appropriate ways to create spaces for dialogue and healing and forgiveness when therapists err.  It’s the right thing to do . . . for our clients, for ourselves, and for our profession. If you, like me, have ever made a mistake and felt the tug to do the right thing and yet have also felt the fear of doing the right thing, today is a good day to start the dialogue.

Tags: Choice, Continuous Learning, Dialogue, Ethics, Self Care, Standard of Care, Truth

“Fat . . . Borderline . . . Retard . . . .”

It is always shocking to me how easy it is for medical and mental health professionals to reduce their clients to less-than-desirable and less-than-accurate one dimensional labels behind closed doors.  I’ve heard excuses that range from minimizing (“oh-he-knows-I-don’t-mean-it”) to intellectualizing (“it’s just a short-hand way to refer efficiently to a particular group of symptoms).

Whatever the reason . . . ignorance, mean-spiritedness, or just plain old laziness . . . if you’ve been tempted to mock a client or speak derisively about a client behind closed doors, you might want to check out Tara Parker-Pope’s post on professionals mocking their clients. It’s one of those things that wasn’t discussed in my ethics classes  but probably should have been.  After all, if we are reducing our clients and all of their complexities to a simple one word label, it’s likely we don’t have our client’s best interest at heart.

Tags: Boundaries, Ethics, Judgment

Are you looking back to the “good ole days” when your practice was shiny and new . . . ? Remembering when your appointment book was full and you had a two week waiting list and wondering where all the clients have gone?

Well, I’m here to tell you that they are all still right here . . . right around the corner from you and they are wondering what happened to their bright and enthusiastic therapist that you used to be!  That’s right!  You heard me!  Any client will tell you that s/he would rather return to the same therapist s/he’s seen before rather than change to a new one.  They only change when they have no choice but to go elsewhere to get the help they are seeking.

If your old clients are going elsewhere for their counseling services, then it might be time for you to give your practice a facelift and that means taking a fresh look at your office, your office practices, and yourself.

Outside the Office

• Take a look at the appearance of your building.  Has it fallen into disrepair?  Does it need trim work or to be repainted?
• Is the landscaping well-tended?
• Is the parking for your clients easily accessible and is the lot well-lit?  Does it feel safe?
• Are the windows clean?

Inside the Office

• Inside the office, take a look at the paint on the walls.  Is it dingy?
• Is the carpet dirty or stained?
• How does your office smell?
• Is the lighting warm and welcoming?
• Is your office well-insulated for privacy?
• Is the temperature in your office comfortable?

Office Practices

• Does your office staff greet your returning clients as warmly as they greet your new clients?
• Is your staff well-trained on respecting clients’ privacy?
• Are you records safely locked away out of sight so that clients do not see information about other clients?

Self Check

• Are you taking care of yourself outside of the office?  Eating and exercising?  Getting enough rest?  Attending to your personal relationships?
• Are you arriving at the office in time to get settled in and appear calm and focused when your clients arrive? Or are you rushing in harried at the last minute?
• Are you scheduling your clients far enough apart that you have time to attend to phone calls, go to the bathroom, and complete your notes in between appointments?
• Do you have a plan for continuing your professional competency and are you following it? Are you continuing to learn new and interesting things to help you in your clinical work?

These are useful things to discuss with your peer consultation group.  A fresh pair of eyes can help you identify areas that need a bit of a facelift.  And, that, in turn, may help you re-engage some of those wayward clients.

Can you think of other areas in your practice that may need a facelift?  If so, I hope you will let me know!

Tags: Location, Office, Records & Documentation, Self Care

Now that you know that you need to engage in clinical consultation on a regular basis and you know how to put your own peer consultation group together, do you know what is supposed to happen during your meeting with your consultation group? You actually have lots of options but my point is that you need to plan ahead of time how you want your meetings to proceed.  Otherwise, it can end up looking more like a clinical coffee klatch than clinical consultation.

Start with the end in mind. Consider what you want to accomplish at your meetings.  Do you want feedback from your peers?  Do you want to learn about a  particular theory or methodology?  Do you want to formally staff cases?  Are you looking for resources for a particular client?  All of these are possible but you’ll need to structure your meetings accordingly.

It’s about you and your performance. Clinical consultation is an opportunity for you to seek and receive feedback about your performance from other professionals that you respect.  Give some thought to how you (and the others in your group) want to receive that feedback.  Is the culture of your consultation group such that unsolicited feedback is acceptable?  Do you need to be invited to provide difficult feedback before you actually do so?  Some might say that by virtue of simply being in a consultation group, that all feedback is welcome.  However, unless stated up front (and again as new professionals join you), you will need to state it if that is the case.  This is especially important for those who are not familiar with the use of consultation groups.

Present clinical cases professionally. If you are going to focus on formally staffing cases (and even if you are not), you may find it helpful to agree upon a structure for presenting your cases to your group.  There is no one “right” way but agreeing ahead of time will make sure everyone is covering the basics.

Share the time. One of the decisions to be made is how will you share the time you have allotted for your consultation group. Does everyone get a chance to share?  Or, are a select few participants assigned to present cases?  You don’t want to simply “wing it” only to discover that no one or everyone wants to talk.

Decide on the structure of your meetings. Do you want to allow time for a “check in?”  Do you want to jump right in to clinical discussion?  Do you want time to to share resources and events?  By deciding and agreeing on this ahead of time, you will avoid your meeting turning into a social hour.

These are some of the considerations we took into account while creating our consultation group.    Can you think of other things that might be helpful?

Tags: Consultation, Ethics

I’ve told you that every mental health professional needs regular consultation and I’ve told you about the benefits of peer consultation groups.  Today I’m going to tell you how to put together a peer consultation group that ROCKS! Here are some things for you to consider as you put your own peer consultation group together.

• Mix it up.  Diversity in the composition of your consultation group matters.  It keep things interesting and increases the likelihood that biases are not overlooked. Those differences can help you stretch beyond your usual thinking and outside of your typical comfort zone.
• Consider safety.  You are going to be talking about your strengths and your weaknesses in a consultation group.  Although the discussion will most often be structured around your clients, the purpose of your consultation group is to expand and support your choices and your behaviors in therapy.  As such, you are going to have your own blind spots and vulnerabilities pointed out and talked about.  It’s important to choose colleagues that you can learn to trust.
• Similarity matters.  If the individuals in your group are too different from you in their disciplines, ethics, or processes, you may find that there is no sense of safety in which to discuss your own vulnerabilities.
• Expertise matters, too.  Look for colleagues that know more than you in at least one or two areas so that you can trust their feedback when you need it.
• Plan on mentoring. Including colleagues who know less than you in a particular area allows you an opportunity to mentor others in the field.  Take advantage the mentoring that you can provide and take advantage of the mentoring that you can receive!
• Size of group. Just like in group therapy, I think 7-9 is optimal.  This affords for someone to miss a group and you still have a group.  And, it’s not so many that you get overlooked in the group.
• Stable composition. A consultation group functions best when the composition remains stable.  In my current group, we must unanimously vote someone in  before they can join us.
• Frequency of meetings. I prefer peer consultation groups that meet on a regular schedule.  Mine meets monthly.  Of course, we are free to consult by phone in between our regularly scheduled meetings.
• Attendance. Sketchy attendance at peer consultation groups can sabotage your group.  When forming your consultation group, set the expectation for a commitment to attend each month.  Obviously exceptions will crop up in anyone’s schedule.  However, consistent attendance and full participation will go a long way toward building trust and confidence in your group.

So now that you know what I consider to be important when putting your consultation group together, drop me a note below and tell me about yours.  Did I miss any important elements?  Is yours decidedly different?

Tags: Consultation, Diversity, Ethics, Expertise, Mentor

2010 Open Enrollment for the 6th Annual Series

Let me, Tamara Suttle, show you how to get all the clients you want in this 18 hour series in Parker, Colorado.  This small group coaching series is spread over 12 sessions from July 9, 2010 through March 22, 2011.  Here’s what you’ll get:

• Innovative and customized information to help you build referral sources to get and keep clients
• Allows you to set aside time only to focus on your private practice growth and future goals
• Creates opportunities for you to develop practice allies with your colleagues
• Access ongoing mentoring by Tamara throughout the entire series
• Receive personal email feedback from Tamara.

Download all the details here.

Tags: Work with Tamara

If you are starting to think about your own clinical supervision, then you will appreciate this article written by music therapist and singer / songwriter, Roia Rafieyan.  In it she discusses what clinical supervision is and some common misconceptions. (And, while you’re at it, take some time to wander around her blogs and website.  She is a woman who writes and sings from the heart.)

Tags: Creative Arts Therapy, Expectations & Misconceptions

"Oriang" by Amin Choc

Andrea from Anchorage, Alaska wrote in . . .

I will be looking for an internship and practicum site in July and I’m not feeling very confident about the process . . . .

Why would an agency want to bother with a student who knows so little and has no experience?”

I get questions like this every semester and thought it might be useful to address this here so that others can read it, too.

Andrea, here’s what I know about why agencies, hospitals, and group practices want  you . . . .

Interns tend to be full of energy, optimism, and enthusiasm. Who wouldn’t want those qualities on site when the staff is likely to deal with addiction, abuse, illness, and death?

Interns see with “fresh” eyes. It is easy after being in the trenches of mental health for a while to become complacent and sloppy.  Teaching  / supervising you helps us stay sharp.

Interns are cost-effective. This is particularly important for non-profit agencies and organizations who survive on a “shoestring” budget.  These agencies often take great pride in being a training ground for new professionals – knowing that you will be lured away to more lucrative positions in a few short years.
Interns are often open to new information and new ways of doing things. Because of this, they are often more malleable to the culture and policies of a new placement – more so than those of us who have done things “our way” for a long period of time.

Interns that excel in their internships and practicums make great employees. Many sites for internships and practicums have a high rate of employee turnover.  If you stand out in your placements, it is likely that you will then become an obvious candidate for those newly opened positions.

If you have been in the position of hiring / supervising interns and practicum student, I hope you’ll drop in here and leave a few words of encouragement and advice to those just beginning their jouney in the mental health professions!

Tags: Internship / Practicum

My oops . . . . I forgot to tell you that I would be co-presenting a workshop, “The In’s and Out’s of Private Practice”  with Colorado mental health attorney, Denis Lane, on Friday, February 26th at the request of the Colorado Counseling Association.

My session was called Business Planning for Your Private Practice.  Below are some of the observations made by  participants:

• “I really needed this information and the networking was an added bonus.  Thank you!”
• “Totally worth my traveling 5 hours from Western Nebraska!  Thanks!”
• “Wonderful information shared. Informative.”
• Thank you! This was well worth the effort to attend!”
• “Loved Tamara’s presentation.  Would’ve been happy to hear more / longer.”
• ” Both presenters were extremely knowledgeable and passionate about the topic. It was even better than anticipated!”
• “Tamara was warm and inspiring.  She enabled me to set future goals for my practice.”
• “Tamara was extremely informative!”
• “The most valuable thing Tamara presented, for me was the idea of facing my fears regarding claiming my niche.  Her presentation was a big push towards making a commitment / articulating that.”

Thanks so much to all of you who were able to attend!  You were a terrific group to work with!

And, for those of you who were unable to attend, over the next few weeks I will try to post on some of the most salient points here in my blog so that you, too, can begin to develop (or tweak) a business plan for your private practice.

Tags: Testamonials

Earlier this month, I was asked to speak to a group of new professionals interning at Aurora Mental Health Center.  The topic was on why it’s important to join your state and national professional associations.  Just in case you are hesitating, here are 23 reasons that I believe you should join your professional associations today.

1. This is your number one career development tool.
2. This is how mental health professionals get things done.
3. Often there are special resources available to you.
4. This is where you go to learn how to be a professional.
5. This is how you stay informed about your profession’s standards of practice.
6. This is where you learn about professional trends and mandated changes in practice.
7. This is where you can build relationships and expand your network.
8. This is where you get continuing education at affordable prices via conferences, workshops, and forums.
9. Often those continuing education opportunities include a free breakfast, lunch or dinner.
10. This is how you protect and promote your own profession.
11. This is where you increase others awareness of your practice or your employer’s visibility in the community.
12. Student memberships are often reduced or no fee.
13. There are always opportunities here to give back to / build up your profession by your volunteer efforts within the organization.
14. There are often opportunities for community service.
15. This is where you go to stretch your own thinking and stay creative in your work.
16. This is where you learn what others in your profession are doing.
17. This is where you can easily establish yourself as a leader.
18. This organization may choose to sponsor your work, research, or workshop.
19. Many organizations offer members free listings and links on their websites.
20. This is who negotiates for the best and most affordable liability insurance.
21. This is where you get free advice on ethics issues.
22. Many organizations offer job placement services.
23. This will allow you to know other professionals to consult with and refer to (and vice versa) as your needs dictate.

I’m sure there are more benefits / reasons to join.  Can you tell me why you’ve joined your professional associations?

Tags: Ethics, Relationships, Workshop

offers free training on ”Best Practices in Critical Incident Response in the Workplace – Online.”

If you would like to learn more about this offer, you can do so by clicking here.

Tags: Best Practices, Free

I just discovered a free source for professional development (no CEU’s) at

"Podcast Subscribe" by Derrickkwa

CounselorAudioSource.net .  This website offers free weekly podcasts on topics primarily of clinical interest to counselors.

Additionally, if you would like to expand your resume to include your own podcasts on topics relevant to counselors, you can check out their guidelines and suggestions for contributing here.

Do you know of other free resources for the professional development of counselors and allied health professionals?  If so, please let us know!

Tags: Free, Podcast, Resume

Before you even decide where you are going to locate your office,

"Mr. Zip, 1966" by Roadsidepictures

you need to conduct market research on possible locations. 

One way to begin that process is to learn about the demographics of different zip codes in your area.

Check out ZipSkinny to help you start your own market research because location matters.

Tags: Demographics, Location, Market Research, Office

Marketing and the Ethics of Advertising is a free 60 minute teleconference offered by CPH and Associates.  Take advantage of this free opportunity to learn.

Tags: Advertising, Free, Teleconference

As 2010 gets under way, I hope you’re planning for your professional development needs.  I am excited to say that will be attending (not presenting at) the annual conference of the Association for Women in Psychology February 11-14, 2010 in Portland, Oregon.  AWP is a terrific professional organization open to all mental health students and professionals.

If you are also planning to attend this conference,  I hope you’ll take a moment to let me know so that we can meet face to face and possibly share a bite to eat together!

Tags: Professional Association, Professional Development