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In this article, Bradley J. Muldrow, JD discusses eight important reasons therapists should consider joining consultation groups.
by Bradley J. Muldrow Staff Attorney The Therapist November/December 2020
No therapist is an island. Providing effective clinical services to patients experiencing mental health struggles, personal tragedies, and other difficult circumstances often necessitates support and input from trusted colleagues. This reality is, perhaps, clearer now than ever before as the world experiences a global pandemic that has left patients and clinicians alike feeling isolated, stressed, and emotionally drained. This article will address eight reasons why consultation group participation can help therapists navigate these challenges and increase the efficacy of their clinical work.
CAMFT Code of Ethics Rule 5.15 provides, “[w]hen appropriate, marriage and family therapists consult...in order to improve and protect the health and welfare of the client/patient.” Accordingly, consultation is more than a best practice or a helpful clinical strategy reserved for the most difficult cases. In appropriate circumstances, consultation is an ethical requirement MFTs must meet to support their patients' clinical needs.
Joining a consultation group is one of the easiest and most effective ways to meet this ethical standard. Consultation groups offer practitioners regular opportunities to discuss cases and receive the clinical feedback and guidance necessary to " improve and protect the health and welfare of [their patients]."
Practice Pointer: Looking for a consultation group? Local CAMFT chapters offer great opportunities to meet fellow clinicians who can help you identify consultation groups in your area (or work with you to start new consultation groups). To learn more about CAMFT chapter membership or find your local CAMFT chapter, visit https://www.camft.org/Membership/Chapters/Join-a-Chapter.
The rewards of serving within the mental health profession rival, if not surpass, those offered within any other field. Counseling patients each day can provide practitioners with deep senses of joy and fulfillment as they watch individuals whom they care about learn and grow in significant ways. Moreover, as states across America list mental health professionals as “essential workers” during the coronavirus pandemic, therapists can perform their work with the societal encouragement and assurance that their services are vital to the continued functioning of American life.
However, working within the mental health profession also poses challenges for practitioners. Carney and Jefferson describe one of the most significant concerns mental health counselors face as follows:
[A] key commonality of the therapeutic process centers on the counselor’s ability to attach to, care for, and separate from people in need, over and over again.1 Navigation of this intense and constant cycle of empathy and detachment can leave counselors susceptible to burnout, ineffectiveness, and incompetence.2
Participating in consultation groups can afford therapists the opportunity to mitigate the effects of this emotionally exhausting cycle and reduce the risk of burnout by processing their professional struggles in supportive environments with practitioners who have experienced the same issues. Although consultation is not a substitute for therapy, it can offer therapists helpful guidance on how to avoid common sources of stress and practice more effectively.
Additionally, consultation group participation can alleviate the feelings of isolation private practitioners often experience. Therapists who work in agencies, hospitals, schools, and other large settings tend to have extensive networks of therapist and non-therapist coworkers to connect with on professional and personal levels. However, private practitioners typically lack such sources of support and comradery within their work environments. Even in group practice settings, differing schedules can significantly reduce opportunities for officemates to meaningfully engage with one another. Consequently, some private practitioners speak with their patients daily but can go weeks or even months without interacting with other therapists.
During this pandemic, laws and health guidelines limiting physical and social interaction have rendered the task of connecting with colleagues both more important and more difficult than ever. Meeting regularly with a consultation group, even virtually, can ease the burden of isolation private practitioners commonly experience and allow them to benefit from the sense of community and support these groups are able to provide.
Although judges render verdicts and other critical decisions in the court of law, they rarely make these decisions alone. Prior to ruling on a case, a judge will typically discuss key issues presented in the case with their law clerks, question and hear arguments from attorneys representing parties to the case, and review rulings other judges have come to in similar cases. Judges are entrusted with the power to make life changing legal decisions each day, but they are not expected to do so without receiving input and guidance from other professionals within the legal community.
In the clinical realm, therapists similarly make life changing decisions on a regular basis. Clinicians are constantly faced with complex choices such as whether a patient’s symptoms support a diagnosis of ADHD or bipolar disorder, or whether a patient struggling with severe anxiety is an appropriate candidate for exposure therapy. In many instances, these decisions may not require consultation. Like a judge issuing a quick ruling on a standard evidentiary objection, therapists can rule out certain diagnoses, develop treatment plans for patients experiencing common clinical Issues, and make other routine clinical decisions without obtaining consultation. However, even the most seasoned clinicians frequently encounter issues that are best navigated with the clinical support, deliberation, and collegiality consultation groups offer.
For example, therapists are often presented with the difficult challenge of determining whether patients experiencing suicidal ideation, eating disorders, or other life-threatening clinical challenges would receive a greater benefit from continued outpatient services or higher levels of care. In such situations, a therapist’s genuine concern regarding the progression of their patient’s symptoms can be further complicated by fears of how the patient may react to the mere suggestion of receiving treatment from other providers. Discussing these challenges in consultation group meetings can allow therapists to receive clinical guidance on how to ethically and compassionately navigate these issues and relieve the feelings of stress and isolation therapists often experience when making tough treatment decisions.
Client-centered advocacy is an important aspect of the counseling profession. Identifying appropriate support resources and services for patients in need can significantly benefit the healing and growth they experience in therapy. However, given the diverse array of social, medical, safety, and other needs that can impact patients’ mental health, many therapists struggle to locate appropriate services that address these needs.
Consultation groups can offer therapists facing this challenge the opportunity to consult on their patients’ advocacy and support needs. For instance, a therapist seeking resources for a minor patient with a disability whose parents primarily speak Spanish may receive referrals to bilingual special education advocates from a consultation group member who works with Spanish-speaking families. Similarly, consultation group colleagues who work with high-risk patients and health plans may have valuable advice for a therapist looking to persuade a patient’s insurance company to cover the patient’s admittance to an intensive outpatient program or pre-hospitalization program.
To successfully defend against a professional negligence lawsuit, a therapist must demonstrate that they “use[d] the level of skill, knowledge, and care in diagnosis and treatment that other reasonably careful [therapists] would use in the same or similar circumstances.”3 Additionally, the BBS is authorized to take disciplinary action against providers who engage in gross negligence or incompetence in the provision of services,4 or intentionally or recklessly cause physical or emotional harm to patients.5 For these reasons, it is imperative that therapists act diligently to provide legally compliant, ethical, clinically effective services to each of their patients. Discussing more complex cases during consultation group meetings is a great way for therapists to demonstrate that their services meet these requirements should their conduct be evaluated during civil litigation, BBS disciplinary hearings, or other legal proceedings.
For instance, consider a therapist who is unsure whether it is more clinically appropriate to continue providing outpatient services to a patient struggling with self-harming behaviors or transition the patient to a higher level of care. By seeking guidance from a consultation group on this subject, the therapist will have an easier time demonstrating that they acted as a “reasonably careful” therapist would in coming to an appropriate treatment decision. Additionally, obtaining such consultation would help the therapist show that they acted diligently to identify the appropriate level of care for their patient rather than making a snap-judgment or “going with their gut.” Should therapists face legal or disciplinary actions, consultation group participation can help demonstrate the propriety of their clinical judgments and decisions.
Practice Pointer: As the adage goes, “if it was not documented, it did not happen.” Consultation group participation can only help therapists in legal proceedings if therapists document the guidance they received from their consultation groups.
Did you know that two new laws impacting California therapists went into effect this past July? As of July 1, 2020, AB 630 requires licensed and unlicensed psychotherapists to provide current and future patients with notice of where they can file complaints regarding the psychotherapists’ practices.6 As of that same date, AB 2138 prohibits the BBS from denying or revoking licenses due to most criminal convictions occurring more than seven years ago.7 Additionally, since the beginning of the COVID-19 crisis, there have been innumerable changes to local, state, and federal laws governing telehealth, HIPAA, insurance reimbursement, supervision, and other matters paramount to the practice of marriage and family therapy.8
Keeping up with this torrent of legislative and regulatory changes can be challenging for even the most scrupulous practitioners. Consultation group participation is a great way for therapists to stay current on new and forthcoming laws impacting psychotherapists. CAMFT staff attorneys regularly field calls from members who have questions about law changes their colleagues discussed during consultation group meetings. Sometimes it takes a village, or at least a few helpful consultation group colleagues, to stay up to date on one’s legal and ethical responsibilities.
Consultation groups also offer valuable opportunities to meet and connect with other practitioners. Such opportunities may be appealing to clinicians who are interested in receiving more referrals, joining or forming group practices, or exploring other potential business endeavors. Additionally, participating in consultation groups can help therapists develop relationships with providers who can offer temporary therapy or supervision services to their patients and supervisees when illness, vacation, and other circumstances demand.
When helping their patients navigate the emotional fallout of job loss, health complications, and other painful life circumstances, therapists often encourage their patients to connect with others within supportive communities as a means of facilitating healing and resilience. Given the clinical challenges, compassion fatigue, and ethical dilemmas psychotherapists routinely manage, clinicians clearly have a lot to gain from engaging with supportive communities as well. Consultation groups provide the clinical development opportunities, professional support, and social connection therapists need to avoid burnout and practice more effectively.
1 See Consultation for Mental Health Counselors: Opportunities and Guidelines for Private Practice (Carney and Jefferson 2014)(citing Skovolt, 2005). 2 See Consultation for Mental Health Counselors: Opportunities and Guidelines for Private Practice (Carney and Jefferson 2014)(citing Skovolt, 2005; Skovholt & Trotter-Mathison, 2010). 3 See California Jury Instructions, Section 501, Standard of Care for Health Care Professionals 4 See Business and Professions Code Section 4982(d) 5 See Business and Professions Code Section 4982(i) 6 See the BBS’ Frequently Asked Questions (FAQ) resource on AB 630. 7 See the BBS’ FAQ on AB 2138. 8 See CAMFT’s COVID-19 Resources page for up to date guidance on these legal and regulatory changes, as well as other important topics (e.g. considerations for offering in-person therapy, self-care resources for therapists, etc.). CAMFT also provides important updates on these topics on its Facebook page.