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Hey, everyone. Welcome back. Glad to be talking with you again today as always.
I have a pretty dynamic interview for you today that is I think very relevant, certainly for me, but for many of you out there as well because the topic that we are discussing is consultation, both seeking and providing [00:01:00] post-grad consultation.
Dr. Kathryn Esquer is my guest. She is a licensed psychologist and founder of the Telethearpist Network, a consultation community for the next generation of practitioners. She’s passionate about preventing burnout and isolation in the field of mental health by using relationships and consultations to stay connected, confident, and ethical in private practice.
This was a really dynamic discussion. Kathryn has done a ton of research on the theory and practice of consultation and shares a lot of that knowledge with me today.
So we cover I think are a pretty broad range of topics related to consultation. We define consultation and distinguish it from supervision. We talk about the responsibilities of both the consultant and consultee when approaching consultation. We talk about contracts and legality involved in consultation, privacy, [00:02:00] fees, any number of other things.
This is a really rich discussion and there is a lot to take away. So certainly stay tuned for this one.
Speaking of consultation, if you are an advanced practice owner, or soon to be, or hope to be an advanced practice owner, and you’d like to take your testing practice to the next level, beyond that beginner stage, I would invite you to apply for the Advanced Practice Mastermind. The next cohort is starting June 10th. You can get more information at thetestingpsychologists.com/advanced.
All right, let’s get to my conversation with Dr. Kathryn Esquer all about consultation.[00:03:00] Hey, Kathryn, welcome to the podcast.
Dr. Kathryn: Hi, Jeremy, thanks for having me.
Dr. Sharp: Of course. I feel lucky to have found you. You are doing so many amazing things here. I’m just grateful to have a little bit of your time to talk about consultation and what that might look like and how we can offer consultation.
So yeah, once again, I’ll say this a few times, but thank you so much for coming on and spending a little time with me here.
Dr. Kathryn: So flattering. Of course, I love connecting.
Dr. Sharp: Well, this is an interesting topic to talk about. I mean, obviously relevant for me as someone who provides not clinical consultation necessarily, but some, and a lot of business consultation. But there are a lot of folks out there who I think are providing clinical consultation informally or flying by the seat of their pants a little bit.[00:04:00] And I think we have a lot to talk about that could be helpful for those folks.
So I always start… I’m curious, of all things that we might talk about, why is this particular area important to you?
Dr. Kathryn: Yeah, why is the boring topic of consultation my passion? That is a great question.
Dr. Sharp: I did not say that for the record.
Dr. Kathryn: Well, so I am a pretty social person. I used to joke around in college and say that I wish there was a major in networking. I love connecting with people. I love learning from people. And that carried me through grad school and beyond. I really bonded with my graduate school peers. My postdoc position was at a university counseling center and that is a very developmental, supportive, learning environment. And I was really grateful to have those experiences. I kind of took peer consultation for granted during those times in my life.[00:05:00] My husband and I chose to move back to my very rural hometown in Pennsylvania after post-doc and when we were starting our family, I have two toddlers. I got back and I loved it. I joined a primary care group. I’m the only psychologist there. And I have a lot of people to consult with on the physical health side. I really missed that mental health consultation. And I didn’t think about it when I moved back. It was something I took for granted. And I think a lot of us might do that at points in our career. We all go to grad school and we’re all told to consult, consult, consult to the best quality control we have for our services. But post-grad, there’s nothing really holding us to it.
And so I started doing some digging and research into the world of clinical consultations and looking for my own clinical consultation group. And it really lit a fire under me when last [00:06:00] March when we had to switch to all telehealth, which I was familiar with, competent with, I was educated in. So I had a good foundation going into it, but I didn’t have those consults ready to go or lined up. And they were even harder to find when we were all online.
So, I took my passion for consultation and networking and connection and ran with it and created the clinical consultation group, the Telethearpist Network for the next generation of therapists to find their consultations. And so with that bridging going into a business endeavor involving consultations, I like to stay on top of recent literature or research, ethics with consultation, and get to know what consultation looks like across different specialties and fields.
So I find it really great because it bridges my clinical work with my social inclination. And I find that we’re not [00:07:00] talking about it as much. And so I really liked the advocacy work too.
Dr. Sharp: Sure. You touched on so many important points over the course of that explanation. I totally get it. I feel like I get so many questions and just see so much discussion online about finding consultation and what that looks like. And, Oh, it’s so hard, especially in our field or our subfield, I suppose, with testing, it seems like it is tough to find other people doing testing if you’re not in a hospital or a larger organization or something like that.
So, I think you’re right on. And it’s so true that we talk about it so much in grad school and that’s always like the first line of defense if some issue comes up, but it’s kind of hard to make that happen in the real world.
Dr. Kathryn: Absolutely. And especially this past year where we’re all working so differently, and personally so much more than I have in [00:08:00] past years clinically, that finding the time or making it easy to find those consultations is non-existent. We all know we should but it’s just difficult. Absolutely.
Dr. Sharp: Yeah. Well, I want to dig in and do some definitions and, of course, really dive into the information that you’ve gathered over the last few months or years. So, maybe we just start with some basics. So when you say consultation, what do you mean by that? What is consultation? It seems like this is a no-brainer, but I would love to hear a definition and I would particularly like to know how it’s different from supervision.
Dr. Kathryn: Slowly. So, the biggest misconception is that supervision and consultation are the same or people use the term peer supervision groups or peer consultation groups.
We need to make sure we’re using the right terms here because they are very, very different [00:09:00] in terms of legalities.
And the first is that consultants, so consultation groups, the consultees are the clinical person asking for the advice retains full control over their decisions and has the option of following, modifying, or ignoring the recommendations by their consultant or consulting group. So that means that you’re asking for advice, but it is up to you to weigh that advice and decide whether it is appropriate, relevant, and the best course of action. You retain all legalities, all ethics. You’re in the driver’s seat. So, going to the peer consultation group and asking for advice and then implementing that advice and say push comes to shove and there are questions about that action or that path you took, you cannot come back and say, well, my clinical consultation group told me to do it. So I did it. You have to have a rationale on why you did it, why you [00:10:00] waited, why it was appropriate. And so just blindly taking someone else’s advice is not okay here.
That’s the difference with consultation between supervision because supervision, the supervisee does not retain legal and ethical rights over their case. They have to follow the advice or the direction of their supervisor because the supervisor is ultimately responsible for the care or the results of the supervisee’s clinical work. So there is a direct link there.
I think that we use these terms interchangeably, and I think we need to be a little bit more purposeful and thoughtful of when we use them because peer supervision is it’s not actually… that’s not the case, right?
Dr. Sharp: That doesn’t exist.
Dr. Kathryn: We can’t have them. Yeah, that doesn’t exist. We don’t have peer supervision. Peer supervision implies that we’re on the same level or we’re peers with our supervisor. That’s not the case. It’s a hierarchal relationship. Peer consultation is actually [00:11:00] redundant because consultants are our peers. One might have more knowledge but you were on the same level and you ultimately retain responsibility for the case. And that I think is a big trip up in terms of language we use out there in the field.
Dr. Sharp: Oh, sure. Yeah. I know that I myself have mixed those up and probably used them interchangeably.
That’s a very clear and very important distinction to make. And I think that even if we ended the podcast now, that would be a very helpful thing to take away, right?
Dr. Kathryn: All right, I’m done.
Dr. Sharp: Yeah. Thanks, Kathryn. I appreciate you highlighting that. And just when I’m spending a little time kind of stalling a bit because I think that is really important actually just to let that sink in for people that consultation does not protect you in any way. It’s still on you to take [00:12:00] that information and do whatever you want with it. Yeah, go ahead.
Dr. Kathryn: I was going to say the one thing it does do is it does give you evidence that you are taking effort to provide the best care possible. You’re still responsible for your actions, but if you document your consultations, if there are questions you can say, Hey, listen, I went to this group, I decided to follow or not follow their advice, but I did seek it out. That is one thing that can help you but you still have to be held accountable. You are going to be held accountable for the end result.
Dr. Sharp: Okay. So it might bolster a case or kind of soften the blow a little bit but that’s not going to be the end-all.
Dr. Kathryn: No, nothing is bulletproof.
Dr. Sharp: Got you. Okay, that’s very important. So, when do you think is important for people to seek consultation then? Because I think post-grad, 98% of the time we’re going to be doing consultation [00:13:00] versus supervision. I would guess. I don’t know. Do you know? Are there actual statistics around that or do you have a different opinion?
Dr. Kathryn: There are no statistics. No, but I see the same thing in the field. And especially on the Telethearpist Network, we see a lot, I mean, almost the majority, unless you are a pre-licensed, you’re not going to really have that hierarchal relationship where someone else is in charge of your clinical outcomes or responsible for them.
So yes, consultation is definitely where it’s at when it post-grad, seeking help. But we need to seek, and this comes straight from the API. We need to see consultation whenever we are providing a clinical service that is beyond the boundaries of our competence or whenever we’re working with a population that is beyond the boundaries of our competence. So even though that’s a very clear-cut statement, there is a lot of interpretation in that.
What defines competence? That’s still up for debate. But largely speaking, [00:14:00] it goes off of your education, your formal education or continuing education, your supervised experience. So if you had supervision experience or your experience with working with or consulting with other professionals who have the knowledge and the expertise that you are looking to fill. So it’s not enough just to have a graduate class to define areas of competence. You really do need to seek ongoing education and consultation to be able to support that claim that you are competent in a certain, either clinical intervention, a clinical task to present your problem or a population.
Dr. Sharp: Yeah, that’s important as well. I think especially these days when there’s so much consultation available via online resources like your own, or I moderate a Facebook group of 8,000 testing psychologists. Like there’s a lot of case consultation going on. That does not equal [00:15:00] competence by any means. I appreciate you highlighting that.
Dr. Kathryn: Exactly. And the important thing is that it could be one or the other, or both. If you are seeing the most obvious distinction is you’re used to testing adults and now you’re expanded into adolescents or children or even younger, that is a pretty clear distinction of you should probably be seeking some type of consultation. You definitely should be seeking some type of consultation, continuing education around expanding your services to other populations.
But the populations can become more nuanced than just age, right? We can have different nationalities, different subcultures. And if that is relevant in your assessment, your battery, or the presenting problem, it is important to seek consultation around those populations.
Dr. Sharp: Right. I wonder, do you have any thoughts on when it does actually need to cross over into supervision? [00:16:00] What’s the line there when we’re trying to expand the scope of expertise or build our competence? I’m curious if there are any hard and fast or even soft and slow rules.
Dr. Kathryn: I don’t have a straightforward answer for that. I think that it really depends on your level of comfort, whether you’re comfortable assuming responsibility for the case.
I think that goes back to, are we really doing our own inner work and understanding where our strengths, weaknesses, and potential blind spots might be. And you would also get really good information about this from a clinical consultation group where they might say, Hey, you’re doing a great job, but I think you need a higher level of support here.
I hate to say it but seeking consultation around whether you should be supervised or not would be helpful. So [00:17:00] meta but there’s no way for us to know our blind spots except through that mirror that consultation provides us.
Dr. Sharp: That makes sense. I’m trying to think of it just as a personal example for myself. I have a lot of background in pediatric assessment and I sought consultation whenever it was way back when to expand into integrating more neuro-psych perspectives into the assessment and different measures and things like that. But for me personally, I would need supervision if I try to test adults at this point, especially around things like cognitive decline or dementia or organic issues and things like that.
Dr. Kathryn: Absolutely. That’s a great example. And that’s potentially something that could start off with a couple of cases being supervised and then maybe branch off. And when you’re feeling more comfortable and competent, continue working with your supervisor but in a consultant role, [00:18:00] right? You can decrease that level.
Dr. Sharp: Right. That’s a good point. I think that’s a nice segue too. Let’s talk a little bit about the types of consultation that we can pursue. What thoughts do you have there?
Dr. Kathryn: I think the most frequent one we as psychologists come in contact with is the informal, brief consultation where you are picking your colleague’s ear about a very specific question, maybe about a battery or a population, something where you maybe have general competence knowledge but you want to check yourself or you want to fill in a tiny gap. That to me is informal and one time. That is something that we do and we should be doing on a regular basis.
But there are also other more formal types of consultation arrangements where perhaps you actively seek out an expert in the field or someone who [00:19:00] is very well versed in a certain area that you want to become. Like you said, seeking out consultations when you were expanding into the neuro-psych perspective. That is more of a formal, ongoing relationship where you are building competence. You are building a skill. And that might come with some fees associated with it. I don’t think any of us would charge our colleague down the hall for our time for a 10-minute consultation, but there are paid consultation services out there. Or you could be offering your own paid consultation services if you do have expertise in a particular area and you want to work with and share that with other psychologists.
So they range on a spectrum of informal to formal, one-time versus the ongoing, and also paid versus free or reciprocal. You can also do it in group settings or individuals depending on what you’re looking for. Consultations look so different depending on what you need at that time for that case. But [00:20:00] they serve different purposes. And I like to have a variety of all of them kind of going on in my life and my practice at one time.
Dr. Sharp: That’s great. I like that kind of multi-layered option. Just from an etiquette perspective, I always recommend, if you feel like it’s going to take longer than a half-hour, you should just offer to pay for it even if it’s someone that’s relatively close to you, just from again, an etiquette perspective. And certainly, if this will be like an ongoing relationship, you should expect to pay for that and pay at least the person’s hourly clinical rate for consultation.
Dr. Kathryn: I like that barometer, a half-hour. And another option is, if you’re starting off and you can’t pay the consultation, if they’re on your level and you can offer them some consultation services, perhaps it’s reciprocal and you start forming a consultation group or partnership where you both get to benefit from it.[00:21:00] Dr. Sharp: Yeah. I like that. I just did an episode a few weeks ago about finding a consultation group. So that’s nice. I like this kind of piggybacking on that. Groups can be a great resource.
So let’s talk about how to actually find and vet a consultant. Like, let’s say you want to dive in and maybe do a more long-term or ongoing relationship with a consultant, where do you even start with that and how do you find that person? How do you vet that person and anything else?
Dr. Kathryn: Well, so first of all, I would say, even if you’re not looking for an ongoing relationship or super formal consultation, no matter when you’re asking advice or receiving advice, you need to qualify the consultant. So, Testing Psychologist Facebook group, Telethearpist Network, we have a lot of opportunities for asking for advice from our [00:22:00] peers and we get a lot when we ask. But you can’t just take that advice with a name behind it and move forward. You really do need to actually look into their experience, training, education. It is not inappropriate by any means to ask for their CV or LinkedIn. A lot of times now I know on the network, we have our LinkedIn linked to our profiles. So anyone could go on and see our CEs, see our education. But you do need to vet the advice because ultimately we’re responsible for whether we accept it or reject it or modify it.
So we need to be able to say, I did one of those three things, and here’s why I trusted their advice or disregarded their advice. And that has to do with their experience because well-meaning psychologists and colleagues could be offering their perspectives and maybe aren’t qualified to do so. And that’s up to us retaining full legal and ethical responsibility for our cases to understand that. So [00:23:00] it’s important to really look into. And as a consultant myself, I would not think twice, I would actually think highly of someone who asked me for my qualifications or why I was giving this perspective, or what made me competent enough to give that perspective.
So, go ahead.
Dr. Sharp: Yeah. I was just going to jump in and ask, and I think you live in this world quite a bit, but the online space, how does that work in the online space where people are firing questions off the spur of the moment. How do you recommend people vet opinions they get online when they may, I mean, at least in a Facebook group, it’s maybe not even the person’s real name. How does that work?
Dr. Kathryn: Well, it might not be your favorite answer, but I would say they’re not the best situations to be asking for really serious clinical consultations. I would say, [00:24:00] if you’re not comfortable asking someone for their CV or LinkedIn profile and they’re giving you advice, why are you even entertaining their advice in the first place?
I would say make it available. And on the flip side, if you’re offering consultation advice, if you’re the consultants are answering, maybe we should start as a field being able to have a little blurb about our experiences and backgrounds and justifying why we’re we can offer this advice. It helps us back it up because if we’re out there offering advice that we really aren’t qualified to give, that’s not a good thing either. We have to think about it from both ends, asking and then also giving advice.
Dr. Sharp: Yeah, that’s such a good point. I like that quote, if you’re not comfortable asking for the CV why are you comfortable asking their advice?
Dr. Kathryn: Yeah, LinkedIn’s are great, just drop that link, and people can go. If you keep that updated, it’s a really great resource.
Dr. Sharp: That’s true. I do agree with that. There are, [00:25:00] people listening I’m sure who are going to shoot me, but Facebook communities really are not meant to be used for intensive consultation. And it’s really challenging both from a privacy standpoint and from a vetting standpoint.
Dr. Kathryn: Yeah. They are great for resources though. Perhaps you’re looking for a consultation group or a specific type of long-term formal consultation with one consultant, you can ask people to point you in the right direction and then you can vet that. Or if you need a resource to learn more. They are great for crowdsourcing. Just not the type of crowdsourcing that needs us to qualify where it’s coming from.
Dr. Sharp: Right, that’s such a good point. So are there other components of qualifying your consultants that we want to make sure and touch on?
Dr. Kathryn: Yeah. Well, before, I mentioned your consultant should be [00:26:00] qualified, educated, and experienced in both the clinical aspect that you’re seeking on and then also the population you’re working with. Having a consultant who’s really great at neuro-psych but not neuro-psych with kids, it’s not going to work. You have to make sure they’re competent on both. And then, if you are offering consultations, if you are the consultant saying, Hey, I can work with you. I can share my experience. I can share my advice, it’s important that you personally stay up to date on all of the recent literature, all of the recent CEs, make sure you know what’s going on in that particular field that you are our subject matter that you’re offering consulting services on so that you can say I’m doing this with the most accurate knowledge. I stay up to date. This is a passion of mine.
If you are offering consultations, you probably aren’t offering them on a dozen different topics especially if they’re [00:27:00] paid.
Dr. Sharp: Right. Is there anything that we need to know from the consultant side in terms of vetting consultees or is that not something that we need to worry about?
Dr. Kathryn: Well, if you think about back to your supervisor- supervisee relationship, you definitely want to look for… if it’s an ongoing formal agreement and you know you’re going to be spending a lot of time and energy with this consultee, you really want to make sure that their values align with yours, you trust them. There has to be a level of trust there. They’re open to hearing other types of perspectives and whatnot. It’s very similar to that supervisee-supervisor relationship where, again, but with different legalities and ethics, but that openness and that dialogue, but it’s more on a [00:28:00] peer level, so it actually could become more nuanced.
So there is more to navigate. So you want to make sure that you were really going to want to spend time with this person and they’re going to be open and accepting, or at least willing to challenge you too. This is a dyad. This goes back and forth. This isn’t a one-way hierarchal relationship. So you really want to think about that relationship, and also if there are any dual relationships going into that? Now, I don’t think any of us would say, well, I’m not going to give my colleague down the hall a piece of clinical advice because we have a dual relationship. In fact, dual relationships can come in handy with clinical consultation groups.
You get to know that person and maybe what their countertransference is bringing them, or you get to know them and what their skill sets are or where there might have some blind spots and the whole grand scheme of things. But you do want to make sure that there are no potential dual relationships that would prevent the consultee from [00:29:00] taking your advice or skew their perspective in any way. And also vice versa. If you have a dual relationship with the consultee that maybe it won’t allow you to see or could hinder your ability to see their case clearly, see their case subjectively, you want to make sure that those are discussed, assessed, and flushed out if needed.
Dr. Sharp: It just makes me think of the complexity here and how much consulting is. We’re really living in the gray a little bit because, again, we could be peers and it can be less formal, but we also have to maintain that objectivity, I suppose.
Dr. Kathryn: Absolutely. We are living in the grey. I love that.
Dr. Sharp: Yes, always. So let me ask you, let’s see. I was going to ask about something along those lines formalizing the relationship and [00:30:00] what that might look like.
So, you recommend a contract, right?
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Dr. Kathryn: Yeah, it’s a little bit less formal than a contract. It’s a consultation agreement. Basically, I think it’s similar to informed consent with a lot less legalities tied to it. It really just clarifies the rights and responsibilities of each party including perhaps the duration of the proposed consultation agreement, any fees, any termination, qualifications, and it really just helps set each party off on the same foot, right?
That level of transparency is now there between the two parties. Again, this isn’t something for informal brief consultations. This is something where perhaps fees are involved, perhaps you’re expecting an ongoing relationship, and it really helps each party know where [00:32:00] their limits lie. This consultation agreement should also clarify the distinction between supervision and consultation so that both parties know the consultee routines, all legal rights to their case. Again, it’s not necessary in every situation, but it can help the relationship grow and make the most out of your consultation arrangement, whatever that might be.
Dr. Sharp: Sure. Now, is there any legal requirement for an agreement here or is this just kind of best practice recommendation?
Dr. Kathryn: Yeah. There’s no legal requirement. It’s a best practice. It helps. Like anything, we want to have full transparency, we want to make sure we’re all on the same page. It’s a best practice for the consultee as well as the consultant. This agreement doesn’t favor one party or the other. It favors the relationship as a whole.
Dr. Sharp: Sure. That makes sense. I thought of something from our discussion just a few minutes ago [00:33:00] around relationships and qualifying your consultant or consultee and so forth. And something that I do and I know some peers do is, if you’re looking into an ongoing consulting relationship that you can, I mean, I do like a complimentary 20 or 30 minutes phone call just to check out the fit and explain the approach and get a sense of what that person might be looking forward to try and suss out the relationship and whether it’s going to work between the two of us. So that is something to consider as well.
Dr. Kathryn: Absolutely. I think that that 20-minute investment is well worth the assessment of fit and expectations.
Dr. Sharp: Sure. So, let’s see. What else? Let’s talk about confidentiality and privacy. How do those come into play in consultation?
Dr. Kathryn: Sure. So APA [00:34:00] actually in their code allows us for consultation without a release of information by the patient as long as we didn’t exchange identifiable patient information. Now, however, again, we know we have to balance both our APA requirements with our local licensing laws. So make sure you check with your jurisdiction to see if that is applicable.
A lot of us include permission to consult with qualified periods in our informed consent to assessment or to psychotherapy. And if you do do that, make sure that you discuss what that means with the client. I’m a big proponent of discussing the informed consent and making sure everyone understands that in real-world language with examples as opposed to just signing the document. Just to make sure that you explained that you would be seeking consultation with a qualified peer, no PHI is going to be released, and if it is, it’s the minimum amount necessary. So make sure you check with your laws to make sure either you have the [00:35:00] correct documentation in your informed consent or that you’re meeting all the requirements.
But in terms of how to conduct the consultation, confidentiality is important. So if you’re doing it in person, you do need to make sure you’re in a confidential space. I treat consultations to the highest level of HIPAA compliancy. So I just take it all the way to the top and I try and make sure every consultation group I run, actually, all are HIPAA compliant. I’m using HIPAA compliant technology or HIPAA compliant spaces like that. We all know Google Meet, professional Zoom, Doxy.me. We all have those in our back pocket over this past year, but use those for clinical consultations. It just helps keep it to a higher standard. Even if you’re not disclosing specific PHI, I just think there’s no harm in taking that extra layer of protection.
And if you do [00:36:00] have… Oh, go ahead.
Dr. Sharp: I was just going to say that makes sense. I’m glad that you highlighted that.
Dr. Kathryn: Yeah. And if you do have to disclose PHI, it keeps it that much more protected. But when you can protect that PHI, don’t release it unless you need it for the consult in which case that is appropriate. But not all the PHI, just the necessary pieces needed for the consult.
Dr, Sharp: Yeah. I was going to ask a question around that when you say we don’t need a release from the patient or the client to engage in consultation unless certain information is shared. Are there any guidelines around what that might entail? What qualifies as personal information?
Dr. Kathryn: Well, any identifiable patient information. So anything that could identify your patient. Again, that’s all gray space open to interpretation. But I [00:37:00] would say if you go by Protected Health Information, so names, dates of birth, anything that would really if you’re getting consultation in your community, and there’s only one sheriff, and you’re talking about how he’s a sheriff in your community, that’s clearly gonna identify him. So identifiable occupations, anything like that. It’s important to be respectful, wanting to protect their confidentiality while trying to serve them the best. And that’s why APA states that we can do this, but it is important to check with your local jurisdiction laws, your state laws.
Dr. Sharp: That sounds great. I’m not sure if you know the folks from Person-Centered Tech, they maintain a pretty great database of local guidelines.
Dr. Kathryn: Their interactive map is my favorite.
Dr. Sharp: Yes, absolutely. I’ll make sure to put that in the show notes for people. [00:38:00] But it’s interesting. This comes up a lot again in our group.
I know I brought that up a few times, but it’s a very relevant example in my life. So, the other day an example came up where someone posted, “I’m wondering about dyslexia in an 8-year old.” There were some comments around, “Hey, that’s a little too much information to share.” And we had a little bit of a debate about whether it is or isn’t. And I’m not asking you to make that call, but just trying to dig into what is actually identifiable information.
Dr. Kathryn: I think that we need to be cognizant and how we’re sharing it. If we’re sharing it to an 8,000 member group, that’s different than sharing it to a 12 person private consultation group or one peer. So perhaps we do need to be more cognizant of the pieces of information because on Facebook, we can see where they’re located. [00:39:00] it’s not just an 8-year old with dyslexia. It’s an 8-year old with dyslexia seeing this identifiable therapist or psychologist online. So I think we need to be a little bit more cognizant. Whether that breaches it, I don’t think so, but I think it’s worth a discussion.
Dr. Sharp: Yeah, sure, I agree. That’s always worth a discussion. Right.
So let’s see. What else? Oh yeah, documentation. You mentioned documentation a little bit ago as part of the deal here. So what are the responsibilities for documentation on both sides, the consultant and the consultee?
Dr. Kathryn: So there are no legal requirements. However, why wouldn’t you document it if you’re seeking it out? So there are different setups you can have, whether it’s passing or a very brief consultation with a group or a colleague, perhaps you document that in that specific client’s chart or client’s [00:40:00] documentation that you sought advice or consultation from this peer at this time, and here’s what this peer recommended, and I am choosing to accept, modify, or reject their advice. If you don’t document it, it didn’t happen as we know. So, if you’re seeking it out, you might as well document it. That’s an important part of our ethical responsibilities as clinicians.
Now, if you’re seeking ongoing formal, maybe trying to increase the competency, expand your services, maybe you keep your own consultation chart where you document what each session works on, what the questions were asked, what you think of them, whether you reject, accept or modify them, that could be its own chart in itself, your own consultation chart if you’re working on one major competency or population.
So you also want to treat these documentations exactly like you treat clinical documentations. Again, I tend to error on the highest standard of privacy and confidentiality. so [00:41:00] I store and retain and dispose of these consultation records just like other clinical documentation in my practice.
Dr. Sharp: Yeah, that makes sense. That’s nice to just reinforce that. We know just document everything, but that extends here as well.
Let’s switch and talk a little bit more about things from the consultant side. So I mentioned, I know there are a lot of us who want to offer clinical consultation or maybe are offering clinical consultation, but there are some considerations there, certainly. And so I’m curious, for those of us who might want to do that, where do we start and what are some things we need to be mindful of before we offer paid consultation?
Dr. Kathryn: Well, first I think paid consultations are a wonderful additional revenue stream for psychologists. I think [00:42:00] we all have at least one area that we are an expert in or that we are passionate about and love staying up to date on and reading literature and consulting with our own peers about. For me, it’s it’s consultation and rural mental health. Look to your clinical passions and say, is this something that would really energize me and I would love to be able to help others increase their competencies around?
I think it’s a great and underutilized area of our practice that we can do. And it’s serving our field in general.
So the first thing is to again, make sure you stay up to date on it. Make sure that you are following the research, you are taking the trainings, you are checking your own biases and your own blind spots in this area because the first mindset shift of a consultant is to be able to say, I don’t know. Even if you are [00:43:00] a self, not even self, objectifiable expert in a certain area, you still don’t know everything. And so you have to be comfortable being able to refer that consultee out or direct them in a different direction if they’re asking questions that you are not competent in.
One of the biggest things that comes up in this area is competencies within laws or ethics outside of the consultant’s jurisdiction. So if I’m working with a… I’m in Pennsylvania, I’m working with a client in Kentucky, I am not familiar or competent in their state licensing or ethical laws that they are held to. And so if there comes a question about mandated reporting and child abuse, that is something where I’m going to either refer them out to a consultant in their area who can help them or in their state that can help them navigate that dilemma or that ethical consideration, or I’m going to help them find that person myself.
So you really have to be cognizant of [00:44:00] all the gray areas of the case and when one becomes pretty large and it’s beyond the scope of your competence, you got to be okay referring out.
Dr. Sharp: Sure. That makes sense. What about the way that we approach consultation? Are there any kind of tried-and-true formats or procedures or anything like that?
Dr. Kathryn: Yeah. Well, when we approached consultations like you said earlier, we really want to find the goodness of fit. Find the good fit because our interpersonal skills as consultants, especially if we’re offering paid consultations really come into play here. So, accepting any consultee that calls you up and was willing to pay you might not be the best approach because we need to be able to work with our consultees, to be able to create that safe supportive environment, build [00:45:00] that really solid rapport so that we can give difficult feedback and help them see from different perspectives.
I can relate to as a consultee. Sometimes they see consultation when I am an anxious wreck or super distressed over a particular case. And the best consultants I find are the ones who are able to help me process that emotion and help me see clearly despite that or through that emotion. So when we’re consultants, especially paid consultations, the consultee’s emotions come into play in the relationship and in their clinical judgments. And we need to acknowledge that and play ball with that.
So having that goodness of fit is really important. And that can look different depending on your different styles. But I think we all have come to know what we work best in. And so developing a 20-minute consulting interview type situation that can help you get a feel for if [00:46:00] there’s going to be a good working relationship there, and really if you can help them rather than if they’re willing to pay you. It’s it’s about that part too.
So there’s a lot of mindset shifts with consulting because even though we’re coming in with more knowledge than what the consultee is looking for, we do as consultants have to acknowledge and embrace that we have limited control over that clinical case. We are not legally or ethically responsible for the outcomes. Now, we should hold ourselves to a high ethical standard of providing the best consultation possible, but the consultee doesn’t have to accept our advice or our perspectives. And they might go in the face of it at times even when we are very clear.
So, it’s important to respect the final decision that the consultee makes. I like to use the phrase, “This is what I would do now.” We might not do this in other clinical work, but in the consulting relationship, [00:47:00] this helps us respect that they retain final judgment and authority over the case.
And it’s interesting because, in the same breath where we don’t have a responsibility to the clinical outcomes, we are also not mandated reporters of substandard care. And that’s a delicate balance when we are consultants. So substandard care, well, again, it’s a grey definition, it’s not the best care, but it’s not also not impaired care. So it’s that gray zone in between harm and in between the best care or the best practice. We’ve not mandated reporters, but with using our relationship with the consultee and that rapport and that safe space, we as consultants should take steps to reduce potential harm to clients.
So working with the consultee, referring for additional training, encouraging the consultee to refer that client [00:48:00] out, really helping protect that client. We do have a responsibility in that area. But until we can qualify the practitioner as impaired as defined by your state licensing laws, we’re not required or mandated to report substandard care. And that’s a difficult thing for consultants to sit with.
Dr. Sharp: Absolutely. Yeah, that really peaked my interest. You probably saw my face get a little more complicated when you were talking about that. I’m really thinking through this. So, how do you approach thinking through the difference between substandard care and practicing outside the scope of expertise? To my understanding, that is something that we at least would approach a clinician about according to the ethics code, if we feel someone’s practicing outside the scope of their [00:49:00] expertise, we would have a conversation about that. So I’m curious how you might sort through the difference between substandard care consultee.
Dr. Kathryn: I completely agree with you. When we see a practitioner that we’re aware of practicing outside of their scope putting in a client in a potentially harmful situation, any kind of ethical questions, we do approach that clinician first. And that would come up in consultation. But the difference is that there are state definitions on what impaired practitioners are and what qualifies for that just like there are definitions of what is child abuse in each state. And different states have different nuances to their laws.
So unfortunately, I’m going to have to say, you really have to check with your state laws and seek consultation if you are a consultant in a situation trying to distinguish between substandard care [00:50:00] and impaired practitioners. And your state board should be able to help you with that.
Dr. Sharp: That’s fair. In some ways that does make it a little more concrete that looking for impairment feels easier to identify than just substandard care. I’m just thinking that if we’re in this relationship with a consultee, then I have trouble with that word for some reason, that we’re already sort of talking with them about their scope of expertise and that kind of covers that base. But it is an interesting question to think through.
Dr. Kathryn: It is. And I think that when you do your goodness of fit discussion, when you’re qualifying the consultee from the consultant standpoint, those are some things you should be looking into. Are they practicing outside of their scope in many areas and they’re just [00:51:00] looking for consulting about this particular area? Like, how are their ethics, how are their insight, how are their judgment calls? You can flush that out a little bit at the beginning as well because substandard care is such a gray term in general because I work in a very rural area and we do not have a lot of clinicians in my area. And in effect, all of the clinicians in my area are booked till July and beyond. So, what is substandard care event? What does it look like in that particular community?
I know that when I was practicing in an urban area, I had a lot of specialists that I could refer to, not so much in my current area or with current insurances. So, there are a lot of different things in terms of what it is. Iit’s not just substandard care is below best practice. That’s not the case. We have to take into consideration all the other factors. The clients [00:52:00] means, the clients population, where they’re located, the availability of resources. There’s a ton of literature out there on how to operate different avenues of how to operate in that gray zone when there are things being… our hands are tied in some situations.
Dr. Sharp: Right. Just like everything, there are nuances. And that our job is to think through these nuances and do our best.
That’s a really important distinction as well though. I’m glad that you said that because I think people rightfully and good-naturedly most of the time are on the lookout for folks who may be practicing outside of their scope of expertise, but sometimes that gets misdirected and turns into policing.
Dr. Kathryn: Yeah. And I mean, do we know everything about the [00:53:00] situation? Who are we to make that judgment call?
Dr. Sharp: Right, exactly. So, yeah, I appreciate you talking through that a little bit. I know we veered away from consultation just to a bit but that’s an important topic, I think, what our responsibility might be in those situations.
Dr. Kathryn: If we all turn that energy inward, we could all, instead of looking outward and trying to catch other people, why don’t we turn it inward and try and improve ourselves and try and catch ourselves in practicing or upping our competency is where we need to up them. That mentality turned inward could be across many areas of our world right now, but particularly in that.
Dr. Sharp: Agreed. Well, let’s touch on, I’m not sure what your thoughts might be on this, but logistics, fee setting I’m really curious when you’re doing paid consultation, if you have thoughts or found kind of a standard for [00:54:00] where people set their fees and how to determine that.
Dr. Kathryn: Great question. Again, that depends on your practice. I would say, I would not set your fee differently than your hourly fee. And in terms of testing specifically, that consultation fee might go up because you are spending that entire hour or half-hour with that consultee as opposed to having the flexibility to do things on your own time. So consider your hourly fee. And then I would say that as a good starting base.
And don’t charge less than you’re worth because we don’t want to breed resentment or being taken advantage of or giving ourselves away for free. So it’s important to also if you’re having that formal agreement in that consultation agreement to have a cancellation policy or a no-show policy, the consultee, are they responsible for [00:55:00] that consulting session or do you do packages where perhaps you offer six months of ongoing consultations with a minimum or a maximum number for a set price? And if that is the case, then you need to be okay with that gray area of where it might fluctuate to. Or the time commitment might fluctuate. It might be less, it might be more. So really knowing what really pushes your buttons in terms of clients can help you set up a really great consultation agreement that works for you and is very clear for the consultee.
Dr. Sharp: I like that. I like that you mentioned the no-show and cancellation policy. I don’t know that. I certainly don’t think about that a whole lot in my consultation. I feel like we’ve covered a lot of ground. This is an action-packed hour. I’m guessing that it’s got people’s wheels turning about either how to find or [00:56:00] offer consultation.
There’s a ton of great info in here.
So is there anything else? Any parting thoughts? Anything that we maybe didn’t touch on that you wanted to make sure to highlight for folks in this arena?
Dr. Kathryn: Yeah, just in general, I think we should all be seeking out higher-quality consultations as opposed to calling very de-identified interactions online as consultations. I think we should be a little bit more cognizant of that because having regular face-to-face consultations or over-the-phone consultations with peers, not only helps boost our clinical skills and our services to our clients, but it also really helps prevent burnout especially in this day and age.
So, it’s a great investment in not only your practice but yourself as a person. As a psychologist, I have found tremendous benefit [00:57:00] over the years in my consultation groups and the support I get both clinically and personally.
Dr. Sharp: Yeah, totally agree. I feel like my consultation groups over the years have saved my career and my sanity. They’ve been so valuable.
Dr. Kathryn: Absolutely.
Dr. Sharp: Well, I really appreciate you coming on. We didn’t even really jump into your work with the Telethearpist Network which is a whole other thing that you have going on that’s pretty awesome. Do you want to say just a little bit about that?
Dr. Kathryn: Sure. So my love of consultations led me to create the Telethearpist Network, which is an online consultation community.
And we do a lot of different stuff. But most significantly, we do live weekly consultations, daily discussions, we do monthly masterclasses to teach us the business end and also a monthly book club so [00:58:00] that we can all build real relationships with people. We have a lot of live events, a lot of video events. So that we can build those relationships with our peers, know where the advice is coming from, know each other pretty well, and also fill the gaps of graduate school that maybe we missed out on, or wasn’t relevant back when we got educated, and boost our confidence in our clinical skills.
So, it’s where I’m at most often. I love it there. It is my tribe. We’re a pretty small group, but we are accepting new psychologist members for a limited time. And I’d love to give your audience some discounts to help ease the burden of finding their consultation community, if that’s okay with you, Jeremy?
Dr. Sharp: Yeah, definitely. We’ll put that code in the show notes. You said it’s “TestingPsych”, right?
Dr. Kathryn: Yeah, if you just use “TestingPsych”, you get 50% off your first month at teletherapistsnetwork.com. And you can find me on [00:59:00] Instagram over @teletherapists.network if you have any questions. I love connecting. Again, I wish networking was a major, but I found a way to make it part of my career.
Dr. Sharp: I love that. Well, thanks again, Kathryn. This was a great conversation. Just fun to talk through something that could be really boring, but you liven it up for us. I appreciate that.
Dr. Kathryn: Well, thank you. It’s one of my favorite topics. Thanks, Jeremy.
Dr. Sharp: Yes, take care.
Dr. Kathryn: Bye.
Dr. Sharp: All right, everybody. Thank you for listening to this episode. I hope you enjoyed it. Hope you took some notes. There are a number of resources in the show notes, including that 50% off code. If you are interested in joining the Teletherapist Network and checking that out, a code is “TestingPsych” and the link is in the show notes.
Like I said at the beginning, if you’re an advanced practice owner and would like to take your practice to the next level through group [01:00:00] coaching and accountability, there is a small group cohort starting June 10th. This will be the 4th or 5th cohort of the advanced practice mastermind over the years. And it is just amazing to see what people do in these groups. So if that sounds interesting to you and you’d like some accountability and support to grow your practice, you can get more information at thetestingpsychologist.com/advanced.
All right, take care. We’ll talk to you next time.
The information contained in this podcast and on The Testing Psychologists website is intended for informational and educational purposes only. Nothing in this podcast or on the website is intended to be a substitute for [01:01:00] professional, psychological, psychiatric, or medical advice, diagnosis, or treatment. Please note that no doctor-patient relationship is formed here. And similarly, no supervisory or consultative relationship is formed between the host or guests of this podcast and listeners of this podcast. If you need the qualified advice of any mental health practitioner or medical provider, please seek one in your area. Similarly, if you need supervision on clinical matters, please find a supervisor with expertise that fits your needs.