I was called in to meet with the psychiatrist with one of my clients the other day and we were discussing her symptomology. I had done the assessment on this client, and because Medicaid wants a diagnosis pretty much minute one, I had given her the diagnosis of major depressive disorder. First off, let me say that I did so because I think it was the least restrictive one I could have given her. Secondly, I could probably write an entire blog about my feelings about Medicaid and the way it runs, but that is a battle for another day. Anyway, when I got into the room with the psychiatrist and all three of us started talking, it was very clear that the client exhibited much more bipolar II symptomology rather than atypical depression. What I had considered as triggers for bad behaviors were indeed triggers, but they were more than likely triggers for her manic episodes. It was important to make the right distinction because medication choice relies heavily on whether or not she is depressed versus bipolar. So, I was incredibly thankful that the psychiatrist had caught the things I missed.
Why do I give you this example? Because had my client NOT gone to see the psychiatrist she would have been misdiagnosed by me and the approach I would have used, while addressing the same behaviors, may not have been as effective for her. As many of you know if you read this blog, I am an in home therapist and it’s a pretty lonely endeavor. I don’t have colleagues that I interact with on a regular basis and a lot of times I question whether or not that is a good thing. This example shows why it isn’t necessarily the best option out there. For those of you out there that are private practitioners I ask you, how do you get your second opinions? Who do you run your theories and perceptions by as a check in?
In the 2005 Code of Ethics it became fairly obvious that ACA supported the idea of consultation. I remember joking with my ethics professor that it seemed one should consult for every case and his response was simple…”if there is ever any doubt, consult, it’s what a reasonable counselor would do”. The concept of reasonable counselor stuck with me because I actually began to question whether or not on average “reasonable” counselors consulted regularly. I think it is incredibly easy to get lost in the shuffle as a private practitioner to not have a resource to go to in times of doubt and maybe it’s just easier to rationalize a decision when that doubt isn’t a big one. I have a feeling we all would consult on the big cases, but what about the ones like my client who seemed to fit depressive symptomology and yet there were things out of place, but not too far out of place for me to think otherwise. How easy is it to fall into a pattern and not question ourselves?
I know for me that I try to challenge myself and my preconceptions, but when that consultation experience comes up, it is like someone has turned on the brightest light in the room and I see things differently because I’ve interacted with a different viewpoint. Consultation is good for helping us try to figure out sticky situations, but I argue that it’s much more than that. I’d argue that consultation is good for the wellness of ourselves as professionals. We need other viewpoints to challenge us and to keep us on our toes, we need to keep up to date with literature but also up to date with how people are interpreting what is out there. By consulting on a regular basis, we allow ourselves the freedom from routine. We allow ourselves the ability to look beyond what we “know” to see what “is and can be”. The power of consultation is not finding someone who agrees with you, it’s finding someone who can offer you a different perspective that allows you to know you got it right.
Michelle E. Wade is a counselor and doctoral student focusing on in-home therapy and technology in counseling.