The benefits of clinical consultation groups

October 2023

If you believe consultation groups are boring and not especially useful, think again. We are clinical supervisors who participate in a successful consultation group that is fun and growth producing. In this article, we discuss several key benefits for the creation of consultation groups, regardless of experience or place of employment, and share our firsthand experiences. And in keeping with the spirit of consultation, we present this information in a fun, conversational format.

Why begin a consultation group?

Wendy: When I began my solo stint sharing an office suite with other therapists, I was determined to interact with them. The occasional sighting and waving a silent “hello” in between sessions were not enough for me. It turns out my colleagues wanted this too. Putting our creative heads together, we came back with several great ideas on how to remain connected for camaraderie and fun and to improve our expertise as therapists. As a result, the consultation group known as Mosh Pit was born. Why that name? For us, the word Mosh Pit means the fusion of great minds connecting in a positive and intentional manner. And yes, we do dance sometimes. We wanted a space where we could laugh, relax, celebrate, cry and focus on promoting excellence in counseling. Mosh Pit keeps us from siloing while improving our skills and judgment. Mike: The idea of consultation being a fusion of great minds is spot on. Having multiple perspectives has provided me with great case conceptualization for better client outcomes. In private practice, it can be difficult to access other clinicians, and Mosh Pit has provided me with strong friendships, support and colleagues to go to for quick consultation. This format provides a cultivated space that promotes diversity, equity and inclusion, which could be neglected in a supervisory relationship because there is an inherent power dynamic that comes from the need to evaluate supervisees for licensure requirements. Instead, consultation is evaluated on the desired goals of the participants and their own development.

How does consultation promote wellness?

Wendy: Mosh Pit is part of my wellness plan. Our group is funny and kind, and the meetings are something I look forward to rather than dread. Why? Because they are also productive. I need that laughter and wisdom. Mosh Pit participation is a priority for me, and I believe that I am a more balanced and successful therapist as a result. Mike: Wellness is integral to the person and community. No person can truly be “well” if they lack a community or are separated (whether through privilege or marginalization) from their own community. For me, it has been so beneficial to be embedded in a group of diverse clinicians who support me on a professional and personal level. As counselors, we are often so focused on supporting the growth of others that we sometimes neglect our own growth. Mosh Pit has been a paradigm shift in my understanding of wellness as a communal factor versus just “self-care.” Wellness involves finding new and creative ways to cope, relate and learn about the essential aspects of ourselves. Not only does this honor our cherished competencies and build our professional identity, but we can value the identities that intersect within us more authentically. I have found the focus on wellness has made me more genuine in my sessions and in my personal life with others. If we want to honor the client as a “whole” person versus just a list of symptoms, we must also honor that quality of life supports all aspects of a person. This is especially true for young counselors who are trying to navigate their own wellness, often while working in systems and settings that may not support them.

How does consultation help counselors professionally?

Wendy: It helps with case conceptualization. We bring our difficult and successful cases to consultation to gain insight and peer input, which leads to professional growth and better client outcomes. Discussing cases also expands our knowledge base and improves our ability to conceptualize. We have a mutual agreement that we can all learn from each other’s wisdom no matter how many years we have practiced. Another benefit is being able to discuss ethical dilemmas, which are confusing, tricky, complicated, confounding and any other adjective you want to throw in there. An emotionally safe group creates space to ask questions. Not every situation is black and white. If we are stuck, we look it up or we ask our state ethics representative for help. Mike: I have found it beneficial to have clinicians in various stages and levels of their career (from supervisors to new professionals) share their perspectives. Having more eyes on a problem promotes novel solutions. When Wendy started her consultation group, I was in my internship trying my best to conceptualize a case without letting my own imposter syndrome fester. Now that I am farther along in my professional journey, I can give others the same safe space and allow them to hone their own information gathering and treatment planning.

What factors promote a great consultation space?

Wendy: It is a given that a safe space is needed where one can share honestly and authentically. Members must commit to caring for the emotional environment in the room. As previously mentioned, we inject humor, dance, food, meditation and music, while being genuine and helpful. Naturally, member selection is key, and mutual adherence to the group’s values and standards is necessary. I am sure you can imagine participants who might be challenging. Mike: Define goals and roles. This ensures that what is brought to the group will be provided in a trauma-informed way and will honor the theory or intervention the person is seeking to improve. Structure and transparency are often the cornerstones to helping people feel comfortable in the group. However, it cannot be emphasized enough that all feedback can be accepted or rejected by the consultee. Legal and ethical concerns aside, consultation can be a democratic way to improve desired goals without the “blowback” that can occur when your supervisor has dual roles of being your developmental and administrative supervisor.

How does consultation keep counselors fresh and current?

Wendy: Ongoing learning is part of our professional standards. In our consultation groups, we teach each other new skills and help with skill improvement. We also sometimes incorporate dance or movement at the beginning, but this is not mere folly. As a certified mindful dance instructor, I know that movement can be an intervention tool for letting go of trauma, promoting joy, welcoming behavior change and decreasing anxiety. I teach my colleagues how I use movement in session with my clients. This is skill improvement in motion. We also share upcoming training opportunities and good books to read. For example, one person shared a great training on internal family systems, and several of us signed up for it. We then discussed what we learned and how we can use it in practice during our next consultation meeting. The experience deepened my understanding of the theory. Mike: Our group has different clinicians with varied theoretical expertise who share how they would conceptualize a case. This synergy has helped me with several case issues and taught me how to apply several of my own skills in a new strategic or more trauma-informed way. Wendy: We share local, state and national updates related to mental health with each other. When we learned about legislation that would expand Medicare coverage to include mental health counselors and marriage and family therapists, for example, we all wrote to our congresspeople to vote “yes” to passing that piece of legislation, which will take effect in 2024 (hooray!). With so much happening these days, it helps to have several people looking out for changes and updates so that we don’t miss anything. Mike: I remember several times learning about bills that were being introduced in my state’s legislature at Mosh Pit, and we discussed what we could do as a group to advocate for counselors and clients. Mosh Pit also provided me with the personal advocacy I needed to launch my own private practice when I moved across the state.

How do you structure a successful consultation group?

Wendy: Quick answer: like any other group. We conduct Mosh Pit in a nonhierarchical way, meaning there is no one person who supervises or assumes direct responsibility for care. This structure allows us to participate as learners and experts depending on the situation. And the advice we receive isn’t a directive; we can accept or reject it as we see fit. Mike: We fuse the client-centered and consultee-centered approach from Gerald Caplan and Ruth Caplan’s 1993 model of consultation. We target the client and the group members, allowing for growth, prescriptive help and education. This format encourages diversity, equity and inclusion. Wendy: Logistically, we meet once a month for two hours, and the group size varies from six to eight people depending on scheduling issues. We meet in person and sometimes on Zoom because some members are in various parts of the state. We usually begin by playing a song. No one is pressured to dance or move, but some of us do to create some energy and fun. We then move into a wellness check-in with one another. After that, we discuss cases, counseling news, laws pertaining to counseling and advocacy, ethical dilemmas in practice, and upcoming trainings. We do not have a set agenda, but members bring in discussion questions for one another to drive the conversation. As it comes up, we dive into ethics, skill building, research, referral information, latest legislative updates and so on. The fact that we are all like-minded helps our success. We have shared goals. We agreed on what we wanted from Mosh Pit before we started the group. We were fortunate that we naturally adopted a set of attitudes that created a safe space for sharing. For those starting their own groups, I recommend that you write down a clear set of attitudes that contribute to safe sharing (such as “we can all learn from one another”) and look for colleagues who have the personality and willingness to adopt those attitudes. I also encourage you to look for diversity in expertise, in years practiced, and in culture, race and ethnicity. Mike: Have set rules and expectations of members. For example, what are the rules surrounding participation? How often and how long do you want to meet? Do members need to show up on time and be ready to go? Or can they come in late? What are the personality traits and qualities you are looking for in a group member? It’s also important to decide how long the meetings should last and determine the best group size so everyone has an equal amount of time for their consultation needs. All group formatting will have a storming phase, where new participants test and clarify boundaries with each other, and a norming phase, or the resolution of conflicts and integration of strengths and differences for the overall group dynamic. Planning for your group and having these conversations initially can avoid confusion and relationship breaches should they arise.

How do you ensure confidentiality?

Wendy: As far as professionalism goes, we make sure to keep our clients’ names and identifiable information confidential. If we need to change or alter information to keep the client’s identity private, we do so. In a small community, we might know the person that the other therapist is counseling. Although we joke and laugh in consultation, we are professional when it comes to discussing cases. As stated earlier, our approach is client centered and consultee centered. That is serious business. Our growth and our clients’ best interests are of utmost importance. In the state of Ohio, we must practice consultation with a best-practice model while maintaining our ethical standards. If you provide consultation for someone outside of your state, we advise you to be aware of their state laws around consultation practices. Mike: Remember, informed consent for all parties is the best ethical practice. To be involved in Mosh Pit, all participants must consent to clearly defined roles and agreements. We use a form that participants read and sign before entering the group so that they can learn about the process and make informed choices. Establishing informed consent is important because the consultees must be clear with their desired goals and agree to openly receive feedback from the group members with the understanding that the consultees can accept or reject any feedback given. Depending on the state, group participants may also need to notify their clients they are receiving consultation. Although Ohio does not require a professional disclosure statement, I notify my clients in writing that I seek professional consultation from colleagues in the field, at my practice and among groups such as Mosh Pit for the purposes of improving their care.

And don’t forget to keep documentation of your consultation feedback, how you safeguard client welfare and what ethical decision-making steps you have taken. If you follow these steps, then you will be providing the best legal and ethical care for your clients and yourself.

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We hope you enjoyed this brief conversation on our dynamic consultation group and the way we make it both fun and impactful. Remember, this is just one example of how to structure a consultation group. We encourage you to use your own creativity in creating your own group, but also make sure you do it in a way that honors best practices and allows you to build something that works for you.

 

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Wendy Nathan is a licensed clinical counselor supervisor in Ohio and has been practicing since 1990. In 2021, she was awarded Supervisor of the Year by the University of Toledo’s counseling program and Counselor of the Year by the Ohio Counseling Association. She is also a wellness coach and mindful dance instructor, and her book, The Portable Supervisor: The Go-to Guide for Students and New Therapists, will launch in fall 2023. She and Desposito recently began a new consulting business called Mosh Pit. It is a therapist consultation business that provides individual and group consultation opportunities for counselors. Contact her at moshpitconsultation@gmail.com. Michael Desposito is a licensed professional clinical counselor supervisor, a certified dialectical behavior therapist and an adjunct professor at a local university in Canton, Ohio. He has worked and served in the mental health field for the past 10 years; has provided over 30 presentations at national, state and local venues; and has published on affirmative therapy and wellness topics. He recently started the therapist consultation business Mosh Pit with Nathan. Contact him at moshpitconsultation@gmail.com. Counseling Today reviews unsolicited articles written by American Counseling Association members. Learn more about our writing guidelines and submission process at ct.counseling.org/author-guidelines.

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