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

Every mental health professional needs consultation on a regular basis.  I wrote about that in my last post.  If you work in an agency or organization, it’s likely that consultation is built into the system.  However, if you have ventured out into private practice, you have to work a little harder to get your consultation needs met.

Many therapists choose to pay an individual counselor for their clinical consultation on a regular basis.  If that is what you prefer, then you can expect to pay whatever that therapist’s usual and customary hourly fee is for his / her consulting and therapeutic services.

However, here are nine benefits to creating a peer consultation group to meet your consultation needs:

1. As a solo practitioner, you remain isolated most of the day except for seeing your clients.  A peer consultation group allows you to meet some of your basic social needs.
2. It also exposes you to new / different ideas, perspectives, and energies.
3. It allows you to learn about other therapists’ business and clinical practices.
4. It may give you a broader range of professionals to refer to.
5. It exposes you to more professionals who may refer to you.
6. It exposes you indirectly to more resources in your community.
7. It can serve as a knowledge bank for clinical issues that you are not familiar with.
8. It can serve as a check point for potential ethical issues.
9. It’s free!

Have I convinced you yet of the huge benefits to participating in a peer consultation group?  In my next post, I’ll tell you How to Create a Peer Consultation Group that ROCKS!

Tags: Consultation, Ethics, Network

Back in the Day . . . .

When I was in graduate school, no one talked about the need for a professional counselor to participate in ongoing consultation post-graduation.  Instead, as I remember, we were taught that ethical therapists seek consultation when they do not know how to proceed with a particular client.  Nothing was said about seeking ongoing regular consultation at all!

The New Standard of Practice

However, times have changed and these days regular clinical consultation is increasingly considered the minimum standard of practice. Unless you are under clinical supervision (which is different than clinical consultation), every practicing mental health professional should either pay for regular i.e. ongoing individual clinical consultation or be involved in a peer consultation group.

What Consultation Can Look Like

Thankfully, I had access to clinical consultation for most of the two decades that I have been in mental health.  However, what that has looked like has varied considerably. . .

• One on one clinical consultation . . . .
• Agency-required “staffings” . . . .
• Treatment team meetings in a psychiatric hospital . . . .
• Small-group consultations that were spontaneous in format and content . . . .
• Thematically-focused peer consultation groups (where I learned how to apply solution-focused brief therapies and, in another one, clinical hypnosis) . . . .
• And, for the last two years, I have been attending a monthly peer consultation group with 6  other therapists. You can check them out here: 
  • Valerie Varan, MS, LPC,
  • Amy Maddox, MAEd., LPC,
  • Leslie Vogt, MA,
  • John Harder, LCSW, ACSW,
  • Julie Uhernik, RN, LPC, and
  • Donna Schwartz, MA, CACIII.

Peer Consultation for Tamara

A peer consultation group can look and function in a lot of different ways. My current group is a really interesting mix of backgrounds.  In addition to the varied disciplines that you can deduce from the credentials above, one of us is child-focused, one is addiction-focused, three are heavily trained in energy medicine (and the rest of us are interested and learning as we can), one works with equine therapy, one is heavily trained in Western medicine, and I practice with a dual emphasis on systemic and depth psychology.

Still not sure that you need regular, professional consultation?  In my next post, I’ll talk to you about the benefits of peer consultation groups.

Tags: Consultation, Ethics

Colette Binger of Ridott, Illinois is expanding her practice to include consulting.  She wrote in asking what should be included in her consulting contracts.

Here are the categories that I consider when I offer contractual services:

• Services to be provided including specifications / proposal, if applicable;
• Reports and presentations to be included;
• Where services will take place i.e. on client’s premises or on consultant’s premises;
• Any other special arrangements;
• Beginning date;
• Target completion date;
• Fees specified per hour / day / other – consider including maximum number of individuals to be worked with;
• Total estimated fee / cost;
• Other costs (specify what for);
• Amount of advance retainer amount;
• Specify terms for balance to be paid;
• Notes, remarks, and special provisions, if any;
• A place for consultant to sign and date; and,
• A place for client to sign and date.

After you develop your consulting contract, be sure you take your contract to an attorney for review.  (I didn’t do this and unknowingly signed a non-compete clause that was perfectly enforceable – and not in my best interest – in the state of Colorado.)

Never sign a contract that has not been reviewed by an attorney in the state where your services will be provided.

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• How to Handle Non-Compete Clauses (freelanceswitch.com)

Tags: Consultation, Contract, Non-Compete Clauses

Carla read my post here and wrote in asking:

What do you do when as a result of finding out that you are a counselor, your church now wants you to provide counseling services to members of the congregation? Or the fact that you have taught classes at ministry events, and as a result some of the participants want to come see you?”

"Nice, Small Church" by Speediakal

How flattering!  But, here are 9 things that I consider before deciding whether or not to see members of my own church . . . .

1. Size matters.  I have found that it is difficult to be active in a church whose congregation numbers only 200 and still maintain my privacy.  That, in turn, colors my professional relationship with my client.  He knows more about me (and I know more him) than is always best.  If, on the other hand, my congregation numbers 1000, then it may be relatively easy for me to maintain my privacy and to minimize personal interactions outside of the counseling office.
2. I consider how I will handle it if I discover that my client is sexually or romantically involved with one of the leaders in my church (who happens to be married).  As far fetched as that may sound to you, it is not all that uncommon and it may very well change how you feel about your church home.  It did for me.  And, that’s before my client AND my church leader both wanted to vent to me, wanted me to choose sides, and then wanted me to publicly condone their behaviors to others!
3. I also consider how my own unforeseen weaknesses / foibles in my personal or church life (challenges in relationships, lapses in judgement, my own spiritual practices, etc.) might negatively impact my relationship with my client . . . .  Unanticipated exposure of those things can actually color what happens in my church and with my client.
4. I also consider the possibility that my partner / spouse / friend / child / sibling / parent may want to befriend my client.  That’s a mess in and of itself! And, what will I do if I believe (from my  clinical work) that the relationships with my client might not be good for my loved one?
5. I’ve had clients catch me before I could dash off from church services to “catch me up” on the latest chapter of their weekend disaster.  Do I want to do therapy in the parking lot?  Do I want to act disinterested?  Or, do I want to dread seeing that client every time I enter the church door?
6. I also have to consider if / how I am going to interact with my clients when I see them.  Am I going to speak to my clients when I see them at church?  Am I going to ignore them?  What if my new client sits down beside me on the pew?  Wants to hug me?  Asks me to take communion with her — or just “conveniently” times it so that it happens that way?
7. What if I sign up for a church dinner club and get assigned to the one that my client attends?  Am I going to explain to the host why I had to leave abruptly when my client showed up?  Am I just going to let the host think I’ve lost my mind?  (Yep, that’s exactly what I did as I ran out the back door.)
8. What if I agree to host a Bible study and my client shows up . . . or his wife . . . or someone who eventually becomes his spouse?  Am I really going to ask my client to leave because there’s a dual relationship if he stays?
9. Sometimes clients can be possessive of their therapists (and you won’t always know this ahead of time).  I’ve had Client A  show up “hurt” or mad at his therapy appointment because he had seen me talking to someone else at church.

OK, so I could go on and on . . . . My point is this . . . .  While much of this can make for great grist for the clinical work that you do with a client, do you really REALLY want to contaminate your personal life (and the lives of your loved ones), your spiritual home, and your professional life with this stuff?  Just think about it and, if you do, consult, consult, consult.

Can you think of other questions / situations / concerns to consider before jumping in to provide therapy within your own religious community?

Tags: Boundaries, Consultation, Ethics, Policies and Protocols, Reputation

The Basics of Clinical Supervision

Lately, I’ve found myself in a lot of conversations about clinical supervision.  If you’re getting ready to graduate from your clinical program in one of the mental health professions, it’s time to start thinking about your own clinical supervision.

Prior to obtaining your license as a professional counselor, social worker, or psychologist, you will be required to obtain 1500-4000 hours under clinical supervision.   If you are fortunate enough to work in an agency, hospital, or school, it is likely that your employer will provide clinical supervision for you on site at no expense to you.  If that’s the case, consider it a benefit of the job.

However, if following graduate school you attempt to go directly into private practice (as is the option in some states) or end up working for an employer that does not provide your clinical supervision, then you will need to find a supervisor and pay for supervision on your own.  (Look for 10 Questions You Must Ask Your Potential Supervisor next week to learn more about how to find a great supervisor.)

"Money Jar" by Automania / Mike

Supervision and Money

I’m not sure why but not one of my professors in graduate school ever thought to talk with us about those additional costs that we would incur following graduation.  So . . . let me break the news to you. . . .

One of the many reasons you may want to start out working for an agency that provides your clinical supervision is that it can be expensive if you have to pay for it on your own. If you are paying out of pocket, you should expect to pay whatever a typical clinical hour costs in your geographic area.

I charge the UCR – usual and customary rates – for those working on the Front Range in Colorado.  My fees are $100 – $125 / hour for individual counseling  and $60 / hour for group counseling.  I charge the same rates / hour for clinical supervision and you will find that most reputable supervisors charge based on their hourly clinical rate as well.

Too Expensive

If  you find those rates to be objectionable, you have a right to understand why these are actually reasonable fees and that good supervisors are not simply gouging you for “easy  money” (as one new graduate noted this week on a discussion list).  Here are some things to consider . . . .

• The professional standard for clinical supervision has shifted in recent years.  Your clinical supervisor is now expected (and in many cases, required) to obtain formal training in clinical supervision at her own expense.  In the State of Texas, that requirement is a minimum of 40 hours plus ongoing continuing education in the area of supervision.
• Your clinical supervisor is legally and ethically responsible for each and every client that you come in contact with.  S/he is also responsible for every decision that you do / do not make and every action that you do / do not take.  That’s a LOT of additional responsibility.
• Your supervisor is responsible for reading every bit of your initial client assessments, progress notes, all correspondence, and termination paperwork and providing feedback as needed.  That’s a LOT of time.
• Your clinical supervisor will typically meet with you on a weekly basis for 1-2 years.  That’s additional time out of her schedule every week s/he could be using to see a client and earn her hourly fee.
• During your weekly meeting with your clinical supervisor, s/he is required to essentially develop your abilities as a mental health professional.  Her roles will alternate between teacher, mentor, consultant and evaluator.
• For every hour that your clinical supervisor spends with you, s/he is most likely spending another hour in preparation — completing paperwork, refining a plan to help develop you as a counselor, gathering materials, reviewing literature to meet your unique needs and interests.  That’s MORE TIME.
• Your clinical supervisor remains on call for you 24 hours / day.
• And, long after you have completed your hours of clinical supervision, s/he remains liable for all those decisions you made while under supervision.  Assuming you are seeing 20-30 clients / week while your supervisor is also seeing that many clients / week, her choice to supervise you, in effect, doubles her risk of being sued.

I’m sure there are other risks / costs involved in being a clinical supervisor.  If you can think of them, please share them with us here so that new graduates will have a clearer understanding of why fees are set the way they are.

And, if you are a new or soon-to-be-new graduate who is considering clinical supervision, let me know if any of this is new information for you.

Tags: Clinical Supervision / Consultation, Consultation, Fee, On Call, Paperwork, UCR

This is part of an episodic series, The Therapist’s Networking Guide.
To see the previous post in this series, click here.

On Monday, in the The Therapist’s Networking Guide I talked about the difference between strategic and shotgun networking.  Today, I want to stress that networking includes much more than just showing up at a monthly meeting with your business cards in one hand and your other hand outstretched (asking for business).  If that’s your idea of networking, you may want to re-think your understanding.

Real networking . . .. strategic networking is much more effective when it is about you creating and extending an ever-expanding circle of contacts that may have the ability to refer clients / referrals to you, provide resources to inform you, share ideas to inspire you and information to support you.

Here’s the beginning of a list of the many ways you can begin to build / expand your network:

• Attending meetings and workshops.
• Keep up with what is going on in your field.
• Share your services and skills by volunteering in your community.
• Join a leads or networking group.
• Mentor new professionals.
• Seek out professionals who are interested in building reciprocal referring relationships.
• Gather information about other professionals, clinics, and treatment facilities that can support you now and in the future.
• Offer classes related to your professional interests.
• Refer clients (when appropriate) to allied health professionals.
• Get involved in your civic / religious community.
• Collaborate on projects.
• Join an on line community -  a discussion list, a blog community, or other social media.
• Stay connected to former employers and college instructors.
• Create / join a consultation group.
• Exchange resources with other professionals.
• Serve on committees.
• Meet colleagues for coffee or lunch.

These are just a few of the many ways that you can start to grow your network.  Can you help me expand this list?  What is it that you are doing to create / expand your professional network?  And, what is it that you can commit to start doing today to increase your circle of contacts?

The next post in this episodic series is The Therapist’s Networking Guide:  Are You Helping Your Network Take Care Of You?

Tags: Consultation, Network