The wisdom and benefit of clinical consultation

This post is part of a series for practicing metal health professionals.

My Clinical Challenge

A while back I found myself in a very stuck place with a client who had made a fair bit of progress, then the therapy seemed to stall. He was insisting that the only cure for his ongoing ailments was to be in a romantic relationship and eventually to get married, and I found myself insisting that there was more to life than romance.

I worked to explore his perspective and invited him to consider mine. We continued to struggle, but I wanted to figure this out. I had a good relationship with this client, who I’ll call Dan. I felt if we could hang in there a resolution would arrive. But a few more sessions passed and we remained at an impasse.

Dan and I spoke about how stuck we were. Each of us held valid ideas and we could both see why the other felt and thought the way they did. But this understanding didn’t change our gridlock. We needed help.

The psychologist consulting with me on a regular basis was already aware of the case and was both thoughtful and concerned about how stuck the client and I seemed to be. She had been working with me to find a path forward.

What happened next in this process reaches beyond a typical supervision, but points squarely to its purpose and value. I should note, that I am therapist who has been in practice for over 20 years. I “know” my way around a therapy room, so to speak. Being open and curious to feedback, being willing to risk not knowing after these many years, saved the therapy with this client.

With the client’s permission, my supervisor attended part of a therapy session and observed me and the client, live, in our frozen exchange. I was whisked back to my graduate school years and found myself appreciating her presence and knowledge. She saw something we had not seen. The interplay between the client and me – romance is the only solution, there is more to being alive than romance – had stolen our hope. Each of us was locked into a position of seeing only our solution as a hopeful one, and in so doing, had taken hope away from the other.

We did as the supervisor suggested and turned back toward hope and possibility, to working on dreams of the future while remaining grounded in the present. We were free, our path forward revealed. We began to focus on what it meant to have hope for a life that was full of meaningful and loving relationships. We explored hope for marriage and children and how one might engage in values linked to these important life areas even if they never came to pass…while holding onto the hope that they would.

My Clinical Wisdom

This was an unusual supervisory experience for me, given the number of years since I had been in graduate training, when live supervision was part of the process. It made me wonder why this kind of supervision stops after graduate training. As I reflect on my years of clinical work, I can think of at least a dozen times I could have benefited from a supervisor’s input.

I find having an experienced clinician pay close attention to my therapeutic work liberating. That’s why I’m a strong advocate for supervisory consultation. However, I’ve observed that once licensed, many clinicians find themselves so busy that supervision gets left behind.

Granted, making time for supervision in an already full schedule is challenging, but participating in supervision and consultation practice is vital if we are to give clients the best of what we have to offer.

One reason I view supervision as essential has to do with human fallibility. I can’t know everything, and I can’t be everything to every client. Sharing my work with another clinician in the service of helping clients simply feels wise.

Another reason is “therapeutic drift”– the slow and unconscious wandering away from theory and science in therapeutic practice. Simply staying in touch with the latest psychological literature is challenging for many clinicians. Supervision and consultation can assist in stemming this drift.

My Clinical Benefits (and hopefully yours)

Supervision is the place where theory meets practice. It provides therapists with the opportunity to sharpen their clinical skills and gain insight into the therapeutic relationship and process. Supervision also provides the opportunity to analyze and conceptualize a case as well as explore the latest developments in the field. It’s a place to reflect on your work, get direction, and look at things from a different perspective. And sharing your therapeutic work and experience with another clinical professional is part of ensuring client safety and progress.

Supervision reminds therapists of the complexity of human experience and keeps us in touch with the social, cultural, and individual differences that make each of our clients unique. Indeed, with respect to my impasse with Dan, supervision helped me to reconnect with his background.

Dan was from a culture where getting married was highly prized and held as a social and personal value. It represented the status of his family and the need for each child in the family to find a worthy partner. Although I had acknowledged these issues early in therapy, I had lost sight of them in my desire to see Dan succeed, marriage or no marriage. My return to acknowledging this important aspect of his background was essential and I was glad to do it. It strengthened our therapeutic bond and grew my compassion for his situation.

Supervision also gives me a place to consider my emotions in therapy and reflect on my values and what it is that I hope for in my work with my clients. It’s a place to invite personal challenge and explore reactions, notice stuck points, and examine whether I am remaining theoretically consistent. It’s a place where I can be vulnerable, something I routinely ask of my clients, thus leveling the playing field (I will not ask the client to do something I’m not willing to do myself).

Ultimately, supervision promotes personal and professional development. It can assist a seasoned therapist in following hope instead of being stuck in a particular view. It’s a collaborative process that is designed to monitor a client’s care and well-being. Surely, there is wisdom and benefit in that.

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DISCLAIMER
The content of this blog is not intended to be a substitute for professional medical advice, diagnosis, or treatment.

ABOUT THE AUTHOR
Robyn D. Walser, Ph.D. is co-author of Learning ACT: An Acceptance and Commitment Therapy Skills Training Manual for Therapists and The Mindful Couple: How Acceptance and Mindfulness Can Lead You to the Love You Want. She has also co-authored two additional books on ACT focused on trauma and spirituality. She currently serves as Co-Director of the Bay Area Trauma Recovery Center and Director of TL Consultation Services. She maintains an international training, consulting, and therapy practice.

By Robyn D. Walser, PhD

13 of April 2018 - 6 min read

Mental health treatment