Trauma Therapists Need Consultation

I just heard another horror story of humiliation in a consult group from a new consultee. It makes me almost as furious as finding out a therapist has been sexually exploiting a client. Another breach of professional ethics by someone who should know better! Grrr!

So what is consultation supposed to do? In my less than humble opinion a good consultant shoud support clinicians to do this hard work by

• Letting them know when they do something right

• Expanding, when necessary, their view of a particular case, or clinical issue

• Teaching good clinical technique

• Sometimes, exploring their emotional response to a case, from grief to celebration

• Acknowledging when the work is hard or heart-breaking

• Noticing when the emotions they have are the projected emotions of a client: "So you're feeling helplessly stuck with this case. The therapy seems to be moving along. Is that your feeling about it or your client's feeling? The client's. So whenever you feel a different feeling with this person, than the one you came in with, you might wonder if it's the client's feeling, and then figure out your clinical response to it.

• Gently, letting consultees know when they're barking up the wrong tree.

• Supporting innovation and creativity.

• If it's a group or consultation based in a particular technique, point out when that technique is not the "drug of choice" for a particular client and suggest a technique that will work better.

• Support the consultees' confidence as they continue to grow as clinicians.

• Consult to them at or only slightly above the level of skill and knowledge that they have. This will vary from person to person. I try to use language that fits what the person already knows. If, in my EMDR consultation groups, a clinician is object relations trained, I might talk about negative and positive cognitions in term to deal with introjected material. If a consultee has a movement background, I might ask what she sees in the body stance of the person, and tie that into the EMDR lens: the AIP.

• On rare occasion, when a clinican doesn't have the stability or affect tolerance to do good therapy, gently and privately suggest a good therapist for him or her.

• Never humiliate, belittle, embarrass, single out, or triangulate a consultee, especially in a group setting. We're here to cure PTSD, not cause it.

• Make your consultation, whether individual or group, a safe place to be. We're therapists. Technique is necessary. Relationship is the context in which it works.