A reader sent in this question last week:
How much consultation do I need to stay on track?
This colleague is on the verge of being licensed and so, for the first time, will get to choose how much consultation she wants rather than having it dictated to her by the licensing board. Exciting times!
The question of hiring a consultant once you’re licensed as a therapist seems, in my circles at least, to be a fraught topic. After all, the brass ring of licensure was so hard won, and required years of being underpaid and, sometimes, smothered with supervision (or starved by inadequate/incompetent supervision… it happens, sadly).
It’s understandable to feel on one level like, “Hey, I’m a grown-up now! I don’t need anyone telling me what to do!” It’s the equivalent of a teenager going off to college away from home, full of hope and optimism about how independent they’re going to be. Your governing body has just told you, “We think you’re competent to practice on your own now.” And having had to squeeze in two, three, or four hours of supervision every week to a packed intern’s schedule can sour us on investing that much time and money into consultation, especially once we don’t HAVE to anymore.
What I’ve heard from colleagues in the first several years after licensure, though, is that sooner or later there comes a wish for more consultation. Of course, this can ebb and flow, and that seems natural. It might feel great to have minimal consultation for a while right after being licensed. My advice is to let yourself pay attention to those feelings. If you decide you want to fly unassisted for a while, go for it. And if/when a feeling comes creeping in that you could use some more support or psychic space for your clinical work, it doesn’t mean you’re a failure or that you’re screwing up. It means you’re ready to be taking something in again, in a way you haven’t had room to for a while.
“Staying on Track”?
The second part of the question is curious to me: “stay on track.” Stay on track with what? Some people finish up their prelicensure hours with 3 or more hours of individual supervision each week. Going down to less than once a week from that can feel like a real leap. Maybe there’s a fear that not being interested in consultation means you’re not interested in learning how to do your job better.
It’s my strong opinion (I have a lot of those!) that good therapists are always learning. We learn first by doing–by sitting with our clients–and we also learn by talking about our work with colleagues, hearing new perspectives, and fanning the sparks of curiosity that awaken in us as we deepen into our careers.
What kind of consultation should you get?
There are three primary modes of ongoing consultation: individual (where you pay a consultant to work with you 1:1); facilitated group (where you pay a facilitator to join an ongoing or timelimited group they run, often focused on a specific issue, population, or orientation); and peer group (generally unpaid, where a group of colleagues meets regularly to discuss clinical issues; these can also be focused in nature on a specific topic/orientation, or more general).
Peer consultation is another option: think one-on-one coffee dates with a colleague (hopefully in one of your offices to protect confidentiality) where you pick each other’s brains about cases. In my experience, this is a wonderful resource, but rarely an ongoing regular arrangement.
I’ll outline the pros and cons of the first three options below.
Pros: You get individualized, focused attention on your cases and questions from a consultant you’ve chosen. Individual consultation can feel the most supportive, and the safest, for those who are newly transitioning out of prelicensure. Sometimes it’s also easier to be vulnerable with your questions and doubts in a space like this. Choosing a consultant with a lot of experience, expertise, and authority can make for a sense of having solid ground to stand on, especially if your caseload is feeling a bit overwhelming. If you find yourself gravitating in this direction, I’d encourage you to trust that urge and allow yourself to be supported.
Another pro is that it can be a bit easier to figure out scheduling than with groups, especially since meetings are generally an hour rather than 1.5 or 2 hours. You may also be able to arrange consultations more flexibly than the other options, for instance a couple of times a month or as needed.
Cons: The major con here is cost. Individual consultation is the most expensive of consultation options. And because the relational stakes can feel higher, a solid consultation relationship requires a lot of trust. For some people, entering a relationship like this can feel like a gamble, not unlike starting with a new therapist.
Peer Group Consultation
Pros: Once we transition into private practice from agency or training settings, the opportunity for an accessible, convenient exchange of ideas and support around our clinical work wanes dramatically. Peer group consultation can be a beautiful way to fill this gap. It’s a wonderful way to build a close-knit community of colleagues who can also refer to each other. Some peer groups last for decades. One of my favorite things about peer group consultation is that you can start your own group with a simple email out to professional community listservs, and set it up however it suits you (and your groupmates) in terms of the structure of your time together, how often you meet, an what topics you’re focusing on.
Oh yes, and it’s free!
Cons: In order for a peer group to work, ideally everyone in the group (or a core of folks) is committed to continuing it. Peer groups can easily fizzle out, especially if unspoken group dynamics are creating friction. If you want it to work, make sure to choose groupmates who can be consistent and committed.
The other con some people experience is the lack of a leader or authority figure in the group. If you’re in a place of wishing for more top-down learning, a peer consult group is not going to scratch that itch.
Facilitated Group Consultation
Pros: A facilitated group can be a happy medium for some people between individual consultation and peer groups. There’s an “expert” in the room who’s creating the structure, and there are also multiple minds in the room who can provide insight. The community-building (and referral networking) factor is present here too. Peer groups can also allow you to access the mind of the facilitator for less than the cost of individual consultation.
Cons: You won’t get to choose who you’re in group with, so it may turn out that the chemistry of the group doesn’t suit you. Sometimes it can feel difficult to get what you came to the group for or the amount or kind of attention you want for your cases, and it may start to feel like what you’re getting is not worth the time and money you’re spending on being there. Sometimes guilt about disrupting a small group with our absence or departure, along with the risk of damaging our relationship with the facilitator, can keep us in groups like this for too long and begin to make us feel resentful. I encourage you to be aware of this possibility as you enter a facilitated group and make an agreement with yourself beforehand about what you’ll do if you realize you aren’t getting what you need or want.
Personally, I’ve tried out all of these modes over the past year. They truly serve different functions, all have incredible value when done well, and I encourage you to try out what you’re drawn to.
And whatever you do, don’t let yourself be crushed by the weight of carrying your private practice clients all by yourself. We are human beings; we need community. And as therapists, we need extra support while doing this intense, important work. Take care of your humanity and your career, and get as much consultation as you’re craving. Trust that hunger.