“What if my patient doesn't get better?”
“What if I mess up my metaphors?”
“What if my patient dissociates?”
“What if….?” questions come up frequently as we instruct or consult on evidence-based psychotherapies (EBPs). You probably recall imagining all of the worst-case scenarios when you were first learning a new treatment. Even seasoned clinicians still find themselves asking “what if…?” questions while delivering treatment. And more than once I’ve found myself faced with that scenario that I’ve been dreading for years and suddenly have to figure out “What do I do now?”
In Season 4 of the CDP Practical for Your Practice Podcast, we’re facing those fears head on and asking our guests to do the same. In Episode 2, we introduce our “EBP Confessionals” segment, which we will carry through the rest of the season. On this episode, our CDP Subject Matter Experts and podcast co-hosts share the lessons that they’ve learned when the unexpected happened in session.
While the idea for this EBP Confessionals segment initially arose out of questions received during training and consultation, I admit I am personally invested in hearing and sharing our EBP missteps. I’ve been working as a trainer and consultant for nine years now and my sense is that our audience and consultees learn as much from my missteps as they do from my expertise. Possibly more. My cohost, Dr. Kevin Holloway, puts it best: “You go to these workshops and you watch these videos where all the videos are perfect, and the therapist was wonderful and they did everything right. And there's this feeling like, ‘maybe I'm not going to be that good at it.’ Yeah, I mean, it doesn't always go right even for people who do this all the time.”
Thinking about my early clinical training, supervisors explicitly asked me to share my fears and mistakes. While I recall it being an anxiety-provoking experience, I also recall the relief in knowing that someone else was responsible for helping me fix those mistakes. Somehow, that openness seems to decrease as we become more experienced. I’ve been thinking about why that is. I keep coming back to the pressure I’ve felt to be a competent expert and to portray confidence to patients and colleagues, especially when I was a newly licensed psychologist. I was highly motivated to keep my errors and insecurities private unless a truly dangerous or unethical scenario evolved.
Now with more-years-than-I-care-to-admit worth of experience, I again find it liberating to share my missteps. I’ve learned some of my most valuable lessons by responding to those missteps, from recognizing that I can’t be an expert in everything, to the fact that patients are much more forgiving of my imperfections than I am. Through commiseration with my trusted colleagues, I’ve also learned that I am not alone with any of my fears. Most of the fears I have seem universal and talking about them shrinks their intensity. As my other co-host, Dr. Jenna Ermold said, “ It's so hard to … worry alone and come out of it in a good place if you're not bouncing that off someone.”
Mulling this over brings me to the same conclusion I always end up at: consultation is invaluable. I have been fortunate to have compassionate and skilled colleagues throughout my career, with whom I could commiserate and receive well-intentioned feedback. This has been true both of my peers and of more seasoned colleagues. And I can say that I’ve often learned from their fears and mistakes as well, perhaps more than I learned from their successes.
I hope you’ll tune into Season 4, Episode 2 of our Practical for Practice Podcast to hear some ways that we’ve misstepped and recovered (sometimes even incorporating Seinfeld references). And tune into all of our upcoming episodes, where we’ll ask each guest to share their own “EBP Confessional” as well. I think you’ll find that you’re not alone with your “what if….?” questions.
The opinions in CDP Staff Perspective blogs are solely those of the author and do not necessarily reflect the opinion of the Uniformed Services University of the Health Science or the Department of Defense.
Carin Lefkowitz, Psy.D., is a clinical psychologist and Senior Military Behavioral Health Psychologist at the Center for Deployment Psychology (CDP) at the Uniformed Services University of the Health Sciences in Bethesda, Maryland.