Getting Unstuck in Clinical Work: Everything You Need to Know about Case Consultation

When we feel stuck in our work, all too often we allow fears about appearing inadequate or incompetent to keep us from seeking help. However, just as our guidance can help our clients to move forward, as clinicians, asking for help when we’re stuck in our work, or when we are unsure about which way to go, can be an important part of moving toward what matters.

When Should you Hire a Consultant?

It’s always a good time to hire a consultant. Whether you’re a seasoned clinician or just starting out, the nature of the work we do and the vast diversity of the human population ensures that we will continue to encounter situations that we’re unsure about throughout our careers.

“Consultation is for everyone from beginners to experienced therapists. We all encounter places where we get stuck, or need guidance in our work,” says Robyn Walser, PhD, a clinical psychologist, trainer, and consultant who specializes in acceptance and commitment therapy (ACT).

Consultation topics can cover anything from case conceptualization and treatment planning, to ensuring that the way we conduct our intake assessments is consistent with a particular approach or model. Consultants with specific areas of expertise may also help with context-specific questions, such as how to put together court reports or how to apply an intervention with a particular population like children or teens. Many consultants also offer group consultation for treatment teams seeking to improve teamwork dynamics and morale in the service of improving care and outcomes.

There may not always be one specific issue or question address. Consultation may simply serve as an opportunity to step back and look at what is and isn’t working in your practice.

“Consultation is helpful if you’re stuck in some way and you need the perspective of a thoughtful, nonjudgmental third party who has some expertise in your area. This is especially true if you work in an isolated environment, or if you don’t feel like your colleagues are people you can be open with,” says consultant Matthew Boone, LCSW, who is a clinical social worker and trainer. 

If you’re learning a new treatment approach, pairing up with a consultant who has expertise with the model can be tremendously useful as well. Developing an ongoing consulting relationship with an experienced clinician is an excellent way to build on what conceptual understanding you may have around a particular approach, and develop a more experiential understanding that can be applied directly and flexibly in sessions.

“Early in my development as an ACT therapist I did both individual and group consultation with some experienced ACT folks, and it made an enormous difference. It was one thing to go to a workshop or read a book, and another to have that regular, concentrated time to devote to my learning and growth,” says Boone.

The consultation relationship can also provide a powerful source of moral support, which can significantly help prevent or minimize clinician burnout.

What should you look for in a consultant?

Once you’ve established that you’re ready to hire a consultant, finding the right match can be a challenge; the large volume of professionals who offer consulting services can be daunting. In addition to the basic requirements—like being sufficiently licensed for your needs and holding up-to-date credentials—you’ll want to find someone who is experienced in the modality or modalities you work with most. Ideally, your consultant should also be experienced working with similar populations, communities, and conditions as those you’re seeking help with.

Do your homework. When possible, look into the prospective consultants’ professional background, resume, and publications, if available. Pay close attention to the way they engage during initial e-mails, phone calls, and in-person meetings. If the consultant is willing, and if it’s financially viable for you, book one or two sessions before committing to a longer-term arrangement.

During your early interactions, notice if the consultant is attuned to where you are in your development, present to your specific clinical challenges, and responsive to your needs. Ask yourself the following:

  • Does the consultant give me relevant feedback? Is feedback offered with kindness and compassion?
  • Do I feel comfortable giving my own feedback if I see opportunities for growth or improved functioning within the consulting relationship?
  • Is the feedback I’m being offered clinically useful and applicable with my work? 
  • Do I trust the feedback I’m being given? Do I feel that what I’m being offered is credible?

“Look for a consultant who can walk a few steps ahead of you, nudging you in directions you might not usually go, challenging you to step outside of the familiar. If you spend time with a consultant, and you feel more flexible, present, and willing as a result, that’s a sign that it might be a good fit,” says Matthew Boone. 

What should you expect to get out of consultation?

A good consultation relationship should yield a balance of both professional and personal benefits. If you’re experiencing positive shifts in the way you interact with clients—and maybe even others in your personal life—you’ll know the consultation has been useful.

If you’re working within a particular model of therapy, your ultimate goal should be to use the model with more fluency, fluidity, flexibility, and confidence. Through consultation, you’ll ideally develop a better sense of what is and isn’t working in your current practice, as well as a keener sense of how to detect your less helpful clinical behaviors before they become patterns. Consultants may assign experiential exercises, facilitate activities geared toward diving deeper into your model of choice, review recordings of your sessions, or give feedback on how specific interventions could be implemented or improved.

Overall, consultation should heighten your awareness of your behaviors and patterns, and it should highlight how they enhance or diminish the quality of the work you do with clients.

“Good consultation doesn’t just ask you to think in new ways and try new skills. It also asks you to develop a more refined awareness of yourself as a professional. Knowing yourself more deeply—what you bring to the clinical encounter, what gets you stuck—will help you be a better therapist,” says Boone. 

As you continue to help clients examine the way their behaviors function within the contexts of their lives, it’s important that you also stay committed to investigating how your own behaviors are affecting your clients. Good case consultation should help you stay committed to asking this question in healthy and productive ways, while boosting your ability to make something meaningful of the results.

PraxisConsult is proud to offer real-time, HIPAA-compliant, peer-to-peer case consultation options. For more information about our consultants, check out our website.