A couple weekends ago, while at my favorite breakfast place with my family, I somehow heard the conversation going on at the table next to me. I say “somehow” because if you’ve ever gone to breakfast with a 1.5 year old, a 4 year old, and a partner you like to talk to in a restaurant that has a line before it opens, you know eavesdropping isn’t an easy thing to do.
It appeared that these two people were having some sort of clinical conversation. While I didn’t hear diagnoses, I did hear a ton about the client’s family of origin, the struggles the man was having with her motivation, and the interventions suggested by his colleague.
Was I able to identify the client based on the description? No. But if her best friend or ex-partner was sitting in my seat, they would have been able to.
The social media version of this happens a lot in the Facebook group, too. It feels like a safe place to have the conversation since we’re all healers. Sometimes the initial posts are well crafted with confidentiality in mind, but as folks comment needing more clarification in order to be more helpful, it becomes TMI.
Here’s the truth: None of us know what to do or say clinically 100% of the time. We all need support forever if we really want to continue to grow as clinicians. Luckily there are tons of avenues for that.
But here’s the really important gentle center of it: the things our clients tell us are precious to them. Extremely private and often shameful. Discussing it in public, whether that’s real life public or Facebook public isn’t the best way to get support. Most of us have been clients and the idea of one of my past therapists talking cavalierly about something it took months for me to divulge is horrifying.
So here’s how to talk about clients in different contexts:
Have a blurb in your informed consent about seeking supervision or consultation.
Have a consultation group where you are mindful of the way you present your struggles clients.
The way we ask people to request help with a client in the facebook group is other-clinician based or skills-based. So, “Hey, does anyone have experience with antenatal depression with some complex situation stuff going on? If so, can we hop on the phone?” or “I need some support around some DBT skills implementation. Can anyone hop on the phone to talk me through a client situation I’m having a hard time getting a handle on?” Then it’s my hope that you protect the client’s non-relevant information as you discuss what you need to to get the help you seek.
Want to vent or bitch about your clients sometimes? Of course you do, you’re human. First, I suggest some urge surfing. It’s rarely actually beneficial. If you decide it is necessary to do this (to get help, clear out counter-transference, etc.) be very careful about protecting the clients’ specifics and do your best to be fair to their situation. Own what’s yours (in my experience as a clinician and as a supervisor, the first place to look is your own feeling of helplessness or fear of incompetence). And vent to one person, preferably a supervisor. Not a consultation group. Not a Facebook group. One trusted colleague who will have no idea who this client could be and will give you what you need. What you need in this situation isn’t “Yeah, that client is a nightmare.” even if that’s what you want. What you need is someone to talk you through how you can show up for that client.
We get to do this amazing, beautiful, powerful thing. In the day-to-day we can forget how important and fragile the trust we’re given is. Please remember this week. And please be gentle with yourself if you’ve forgotten sometimes.
Who’s your go to for hard clinical situations? A supervisor? Consult group? Therapist BFF? Let us know in the comments.
Allison Puryear is an LCSW with a nearly diagnosable obsession with business development. She has started practices in three different states and wants you to know that building a private practice is shockingly doable when you have a plan and support. After retiring her individual consultation services, she opened the Abundance Party, where you can get practice-building help for the cost of a copay. You can download a free private practice checklist to make sure you have your ducks in a row, get weekly private practice tips, listen to the podcast, hop into the free Facebook Group. Allison is all about helping you gain the confidence and tools you need to succeed.