Staff Perspective: Dispelling Misconceptions Around Consultation
By Rabia Mir, MPH and Lisa French, Psy.D.
The Center for Deployment Psychology (CDP) offers Evidence Based Psychotherapy (EBP) consultation in addition to many EBP training workshops. CDP often receives questions pertaining to consultation and the consultation process. Throughout the work we do at the Center, we have observed several common misconceptions regarding consultation. We hope to dispell some of the more common clinican misconceptions, while answering questions that frequently arise. In addition, we hope to provide a platform for clinicians to discuss any thoughts they may have regarding consultation.
We know that learning a new therapeutic approach and delivering it with high fidelity requires a lot of effort. One of the best ways to ensure you are delivering an EBP with high fidelity is by utilizing an EBP consultant. Consultants are key in every stage of behavioral change, from planning to sustainment. Consultants roles include coaching, teaching/reinforcing, assessment and feedback, and provision of emotional support in evidence-based skill development. Despite ample evidence supporting it, consultation is greatly underutilized with EBPs due to two main factors: logistics and misconceptions.
Logistically, there are a number of issues that pose a challenge to seeking consultation. Examples that have been shared with CDP include lack of support to receive consultation, cost and time away from direct patient care, and limited number of qualified consultants.
Logistics aside, many newly trained therapists forego consultation because they are not aware of the benefits and may even hold inaccurate ideas about what consultation means. Logistics are very difficult to change; however, misconceptions can be more easily corrected. Consider the following comments made by seasoned providers:
“Only new providers and interns need consultation on cases; I've been practicing for many years so I'm good to go!”
Many clinicians do not perceive a need for consultation in light of their vast experience. It is not uncommon to hear clinicans express that consultation is too "basic" for them. In reality, consultation, as opposed to “supervision,” is aimed at improving performance, regardless of level of experience and training. Even very experienced therapists, including the Subject Matter Experts at CDP, engage in consultation as a regular part of improving performance and preventing “drift” from the model, which occurs naturally as time passes. Consultation also provides an unbiased and fresh perspective to case conceptualization, enabling even the most experienced therapists to benefit and extend their skills.
One added benefit of seeking consultation from a qualified EBP consultant is that these consultants tend to hear about a wide variety of cases, so the consultee gets the benefit of the collective experience of the community, rather than relying solely on their own resources. Seeking consultation is also in-line with the American Psychological Association ethical guidelines that encourage consultation as a means for members to obtain the required competence.
“I get informal consultation with my peers, which is just as good as formal consultation!”
Informal consultation is often referred to as “curbside consultation” and is a common way for clinicians to get clinical questions answered. This type of advice can provide valuable adjunct to training, but it is not a substitute for the more formal and structured learning that can be obtained from formal consultation. Curbside consultation lacks continuity and input is often sought when the therapist is unsure of the next move, or needs a second opinion. Unfortunately, we are often not familiar enough with the protocol to see what we are missing. In addition, opportunities to deepen learning and improve outcomes may be missed because we wait for a problem to arise rather than proactively look at what our next steps are going to be. Informal consultation also runs the risk of the advisor not fully understanding the situation, protocol, and best practices associated with it, and consequently offering an opinion, as opposed to a valuable fact.
In formal consultation, input is a regular part of practice. Options are systematically considered and checked against the model. Not only can problems and crises be anticipated and averted, but the consultee also has more confidence to implement more difficult or less familiar aspects of the protocol with the regular support of a seasoned consultant. In addition, protocol delivery is more likely to improve over time, which leads to improved patient outcomes.
“My peers would look down on me if I were getting consultation on cases…like I don’t know what I’m doing.”
Some therapists may worry that seeking consultation reflects poorly on their skills and experience. They may believe that supervisors or peers will view them as less competent. In reality, most professionals understand the value of consultation, continuing education, and case review. In most settings, the availability of consultation is seen as a perk and a privilege. Those who have obtained regular, formal consultation are more likely to be viewed as local Subject Matter Experts by peers and supervisors. In addition, documenting consultation as part of your employment history can even be seen as a career asset.
“I will not become proficient in the little time I have available for consultation.”
It is not unusual for clinicians to feel discouraged if they have limited time available to fully learn and be proficient in EBP protocols. Perhaps they have tried implementing EBPs in the past and encountered roadblocks. This may have been due to administrative challenges, such as high workload, travel, and competing priorities, or lack of available consultants at the time they were trained.
Change can indeed be frustrating if progress is slow and learners can become disengaged if support is scarce. Learning a new treatment does indeed require an added investment of time and effort on the part of both the clinician and the consultant. However, learning an EBP brings added value to clinical work. The additional investment pays strong dividends in terms of job satisfaction and client outcomes, and as new learning takes hold, frustration and doubt are replaced by optimism and confidence. In addition, as clinicians become more seasoned, they become resources for others at the local level, even as they continue to seek consultation.
“Other people don’t know that much more than I do, so consultation wouldn’t be helpful.”
Clinicians have access to the same books, manuals, articles, and other information as consultants do, so it may be tempting to rely on those resources instead of formal consultation. Reliance on reference material fails to make use of the objectivity that a set of fresh eyes can provide. More importantly, in a setting where time is at a premium, most clinicians do not have time to read through the plethora of books and articles searching for answers. Consultants have specialized training and it is their mission to stay on top of the latest literature and new developments in their area of expertise. They can offer real-time information, which in turn can save clinicians both time and energy.
We would like to have a discussion with you about consultation, including additional misconceptions you or a peer may have regarding consultation. Are there ideas you have for CDP to improve how we offer EBP consultation? What would increase your own utilization of consultation? As we, as a Center, work on increasing access and utilization of consultation to clinicians, we would like to hear suggestions on how you think this can occur. Likewise, if you have received formal consultation, we would appreciate hearing about your experience.
Lisa French, Psy.D., is the Assistant Director of Military Training Programs at the CDP and Rabia Mir, M.P.H., is a Subject Matter Expert in Dissemination and Implementation Sciences at the CDP.
References/Bibliography:
American Psychological Association. (2002). Ethical principles of psychologists and code of conduct. Retrieved from http://www.apa.org/ethics/code2002.html.
Bond, G.R., Becker, D.R., Drake R.E., Rapp, C.A., Meisler, N., Lehman, A.F., Bell, M.D., & Blyler, C.R. (2001). Implementing supported employment as an evidence-based practice. Psychiatr Serv, 52, 313–322.
Fixsen, D.L., Naoom, S.F., Blase, K.A., Friedman, R.M., & Wallace, F. (2005). Implementation research: A synthesis of the literature. Tampa, FL: University of South Florida, Louis de la Parte Florida Mental Health Institute, The National Implementation Research Network.
Kavanagh, D.J., Spence, S.H., Strong, J., Wilson, J., Sturk, H., & Crow, N. (2003). Supervision practices in allied mental health: Relationships of supervision characteristics and perceived impact and job satisfaction. Mental Health Services Research, 5, 187-195.
Lyon, A.R., Stirman, S W., Kerns, S E.U., & Bruns, E.J. (2011). Developing the mental health workforce: Review and application of training approaches from multiple disciplines. Administration and Policy in Mental Health and Mental Health Services Research, 38, 238–253.
Marks, S. U. & Gersten, R. (1998). Engagement and disengagement between special and general educators: An application of Miles and Huberman's cross-case analysis. Learning Disabilities Quarterly, 21, 34-56.
McCormick, K.M. & Brennan, S. (2001). Mentoring the new professional in interdisciplinary early childhood education: The Kentucky Teacher Internship Program. T EAR CHILD, 21(3), 131-144.
National Association of Social Workers. (2008). Code of ethics from the national association of social workers. Retrieved from http://www.socialworkers.org/practice/clinical/csw0703b.pdf
Showers, B. & Joyce, B. (1996). The Evolution of Peer Coaching. Educational Leadership, 53(6), 12-16.
By Rabia Mir, MPH and Lisa French, Psy.D.
The Center for Deployment Psychology (CDP) offers Evidence Based Psychotherapy (EBP) consultation in addition to many EBP training workshops. CDP often receives questions pertaining to consultation and the consultation process. Throughout the work we do at the Center, we have observed several common misconceptions regarding consultation. We hope to dispell some of the more common clinican misconceptions, while answering questions that frequently arise. In addition, we hope to provide a platform for clinicians to discuss any thoughts they may have regarding consultation.
We know that learning a new therapeutic approach and delivering it with high fidelity requires a lot of effort. One of the best ways to ensure you are delivering an EBP with high fidelity is by utilizing an EBP consultant. Consultants are key in every stage of behavioral change, from planning to sustainment. Consultants roles include coaching, teaching/reinforcing, assessment and feedback, and provision of emotional support in evidence-based skill development. Despite ample evidence supporting it, consultation is greatly underutilized with EBPs due to two main factors: logistics and misconceptions.
Logistically, there are a number of issues that pose a challenge to seeking consultation. Examples that have been shared with CDP include lack of support to receive consultation, cost and time away from direct patient care, and limited number of qualified consultants.
Logistics aside, many newly trained therapists forego consultation because they are not aware of the benefits and may even hold inaccurate ideas about what consultation means. Logistics are very difficult to change; however, misconceptions can be more easily corrected. Consider the following comments made by seasoned providers:
“Only new providers and interns need consultation on cases; I've been practicing for many years so I'm good to go!”
Many clinicians do not perceive a need for consultation in light of their vast experience. It is not uncommon to hear clinicans express that consultation is too "basic" for them. In reality, consultation, as opposed to “supervision,” is aimed at improving performance, regardless of level of experience and training. Even very experienced therapists, including the Subject Matter Experts at CDP, engage in consultation as a regular part of improving performance and preventing “drift” from the model, which occurs naturally as time passes. Consultation also provides an unbiased and fresh perspective to case conceptualization, enabling even the most experienced therapists to benefit and extend their skills.
One added benefit of seeking consultation from a qualified EBP consultant is that these consultants tend to hear about a wide variety of cases, so the consultee gets the benefit of the collective experience of the community, rather than relying solely on their own resources. Seeking consultation is also in-line with the American Psychological Association ethical guidelines that encourage consultation as a means for members to obtain the required competence.
“I get informal consultation with my peers, which is just as good as formal consultation!”
Informal consultation is often referred to as “curbside consultation” and is a common way for clinicians to get clinical questions answered. This type of advice can provide valuable adjunct to training, but it is not a substitute for the more formal and structured learning that can be obtained from formal consultation. Curbside consultation lacks continuity and input is often sought when the therapist is unsure of the next move, or needs a second opinion. Unfortunately, we are often not familiar enough with the protocol to see what we are missing. In addition, opportunities to deepen learning and improve outcomes may be missed because we wait for a problem to arise rather than proactively look at what our next steps are going to be. Informal consultation also runs the risk of the advisor not fully understanding the situation, protocol, and best practices associated with it, and consequently offering an opinion, as opposed to a valuable fact.
In formal consultation, input is a regular part of practice. Options are systematically considered and checked against the model. Not only can problems and crises be anticipated and averted, but the consultee also has more confidence to implement more difficult or less familiar aspects of the protocol with the regular support of a seasoned consultant. In addition, protocol delivery is more likely to improve over time, which leads to improved patient outcomes.
“My peers would look down on me if I were getting consultation on cases…like I don’t know what I’m doing.”
Some therapists may worry that seeking consultation reflects poorly on their skills and experience. They may believe that supervisors or peers will view them as less competent. In reality, most professionals understand the value of consultation, continuing education, and case review. In most settings, the availability of consultation is seen as a perk and a privilege. Those who have obtained regular, formal consultation are more likely to be viewed as local Subject Matter Experts by peers and supervisors. In addition, documenting consultation as part of your employment history can even be seen as a career asset.
“I will not become proficient in the little time I have available for consultation.”
It is not unusual for clinicians to feel discouraged if they have limited time available to fully learn and be proficient in EBP protocols. Perhaps they have tried implementing EBPs in the past and encountered roadblocks. This may have been due to administrative challenges, such as high workload, travel, and competing priorities, or lack of available consultants at the time they were trained.
Change can indeed be frustrating if progress is slow and learners can become disengaged if support is scarce. Learning a new treatment does indeed require an added investment of time and effort on the part of both the clinician and the consultant. However, learning an EBP brings added value to clinical work. The additional investment pays strong dividends in terms of job satisfaction and client outcomes, and as new learning takes hold, frustration and doubt are replaced by optimism and confidence. In addition, as clinicians become more seasoned, they become resources for others at the local level, even as they continue to seek consultation.
“Other people don’t know that much more than I do, so consultation wouldn’t be helpful.”
Clinicians have access to the same books, manuals, articles, and other information as consultants do, so it may be tempting to rely on those resources instead of formal consultation. Reliance on reference material fails to make use of the objectivity that a set of fresh eyes can provide. More importantly, in a setting where time is at a premium, most clinicians do not have time to read through the plethora of books and articles searching for answers. Consultants have specialized training and it is their mission to stay on top of the latest literature and new developments in their area of expertise. They can offer real-time information, which in turn can save clinicians both time and energy.
We would like to have a discussion with you about consultation, including additional misconceptions you or a peer may have regarding consultation. Are there ideas you have for CDP to improve how we offer EBP consultation? What would increase your own utilization of consultation? As we, as a Center, work on increasing access and utilization of consultation to clinicians, we would like to hear suggestions on how you think this can occur. Likewise, if you have received formal consultation, we would appreciate hearing about your experience.
Lisa French, Psy.D., is the Assistant Director of Military Training Programs at the CDP and Rabia Mir, M.P.H., is a Subject Matter Expert in Dissemination and Implementation Sciences at the CDP.
References/Bibliography:
American Psychological Association. (2002). Ethical principles of psychologists and code of conduct. Retrieved from http://www.apa.org/ethics/code2002.html.
Bond, G.R., Becker, D.R., Drake R.E., Rapp, C.A., Meisler, N., Lehman, A.F., Bell, M.D., & Blyler, C.R. (2001). Implementing supported employment as an evidence-based practice. Psychiatr Serv, 52, 313–322.
Fixsen, D.L., Naoom, S.F., Blase, K.A., Friedman, R.M., & Wallace, F. (2005). Implementation research: A synthesis of the literature. Tampa, FL: University of South Florida, Louis de la Parte Florida Mental Health Institute, The National Implementation Research Network.
Kavanagh, D.J., Spence, S.H., Strong, J., Wilson, J., Sturk, H., & Crow, N. (2003). Supervision practices in allied mental health: Relationships of supervision characteristics and perceived impact and job satisfaction. Mental Health Services Research, 5, 187-195.
Lyon, A.R., Stirman, S W., Kerns, S E.U., & Bruns, E.J. (2011). Developing the mental health workforce: Review and application of training approaches from multiple disciplines. Administration and Policy in Mental Health and Mental Health Services Research, 38, 238–253.
Marks, S. U. & Gersten, R. (1998). Engagement and disengagement between special and general educators: An application of Miles and Huberman's cross-case analysis. Learning Disabilities Quarterly, 21, 34-56.
McCormick, K.M. & Brennan, S. (2001). Mentoring the new professional in interdisciplinary early childhood education: The Kentucky Teacher Internship Program. T EAR CHILD, 21(3), 131-144.
National Association of Social Workers. (2008). Code of ethics from the national association of social workers. Retrieved from http://www.socialworkers.org/practice/clinical/csw0703b.pdf
Showers, B. & Joyce, B. (1996). The Evolution of Peer Coaching. Educational Leadership, 53(6), 12-16.