Tag Archives: Clinician

Having Difficult Conversations with Colleagues

I’m seeing a heterosexual couple in couples therapy, and a colleague at my agency is seeing the wife individually. Last week my colleague made a critical comment about the husband and questioned how helpful couples therapy could be. She said this in front of several of our peers, and I didn’t respond because I was shocked and hurt. I think I need to say something to her, because her negative view of the couples therapy will undermine the wife’s participation. There is a lot of conflict in the relationship but they have both expressed a commitment to work it out and stay together.

This is my second blog on the topic of having difficult conversations. It may be helpful to read the prior blog about client conversations if you didn’t do so already. This situation with your colleague is an example of difficult conversations that can arise when we share cases or consult with colleagues about our work. Growing into the role of clinician means developing skills to talk with colleagues as well as clients about uncomfortable issues and areas of conflict. You’ve already made an important first step in deciding that you need to talk with your colleague rather than avoiding a challenging interaction. I would agree that having a disagreement between the individual and couples therapists can be harmful to the client, and I would add that it can also be informative to both the individual and the couple therapy.

I would suggest that you engage in personal reflection before you approach your colleague. It is important to identify 1) the nature of the conflict or difficulty you are experiencing with your colleague, 2) assumptions you may be making about the reasons for the conflict, and 3) the desired outcome of a conversation. During this process, it may be helpful to consult with another trusted colleague or your supervisor to sort through your feelings and hear some alternative explanations or outcomes you may not have considered.

When you reflect on the nature of the conflict, identify the content or issues of disagreement as well as the emotions associated with the conflict. In this instance, you mention shock and hurt, but you may notice other emotions that have arisen since then. If you find that the issue and associated emotions are similar to interactions that have been a struggle in your personal life, it may be helpful to take this to your own therapy as well as getting supervision and consultation.

After you feel clear about the conflict itself, reflect on the assumptions you have about why your colleague made this remark. Usually an emotionally charged interaction leads us to develop explanations for our hurt or angry feelings, and these explanations often include criticism and judgment of yourself or the other person. For example, you may wonder whether your colleague doubts your skill as a couples therapist or whether she has a bias in favor of separation for couples in conflict. Consider other explanations as well, possibly with the help of your supervisor, therapist, or colleagues. One possibility is that the wife is describing her view of and feelings about her husband and marriage differently in her individual therapy than in the couples therapy. This would mean that you and your colleague are holding two disparate parts of the wife’s experience that she hasn’t reconciled.

Third, identify the outcome you desire for your conversation. There are a number of possible outcomes when approaching a colleague about a difficult interaction: expressing your point of view, engaging your colleague in understanding your difference of opinion, and sharing your view of possible reasons for your differences in perspectives are a few. Make sure that the outcome you identify is something that is focused on your communication and is collaborative in nature. A desired outcome of changing your colleague’s point of view establishes a more adversarial tone and is likely to lead to a deterioration of your collaboration rather than strengthening it. If you have difficulty identifying your desired outcome, check with your supervisor, therapist, or another trusted colleague who can maintain neutrality.

Once you have moved through these steps in understanding the interaction with your colleague, you are ready to plan a conversation with her. I would recommend letting her know you’d like to talk and planning a specific time and plan for the conversation. You’re more likely to achieve your desired outcome if both of you have set time aside and if your colleague knows what you want to talk about. Make sure you describe the purpose of the conversation in neutral terms by saying something like “I’d like to talk further about our work with X and the questions you raised last week about the couples therapy.” Follow that statement with some suggested times and a private location where you can talk without disturbance. When you come to the designated time and place, you may benefit from having a clear opening statement about your reason for wanting to have the conversation, setting the tone as positive, curious, and collaborative. An example of an opening statement in your situation might be “I was surprised to hear what you said last week about X’s husband and the couple therapy. I’d like to compare our perspectives to see if we can make sure the two therapies are beneficial to her.” The preparation you have done will enable you to listen to your colleague’s point of view, express yours, and work to establish common ground in understanding your client.

I hope you find these suggestions helpful in addressing difficult conversations with colleagues in your clinical work. Please email me with comments, questions, or suggestions for future blog topics.

Self Care in Work Habits

Iimg-article-are-you-too-stressed-out’m in my second year of practicum placement and I feel really burned out. What can I do to keep going in this career without constantly feeling depleted by my work with clients?

Your concern is a universal one for clinicians. We tend to enter this field with a predisposition for caregiving others and neglecting ourselves. The emotional demands of doing psychotherapy with highly distressed individuals and families are intense and most of us reach the limits of our previously developed coping strategies during our training. This is a good time to create new routines and habits that will serve you throughout your career.

In this blog, I will suggest some general strategies that will help to build your emotional reserves and detach in a healthy way from the intensity of clinical work. The next blog will address more specific ways to attend to your physical, mental and emotional health. I recommend that you choose one or two small steps to try out first, see if they are helpful, modify them if necessary, then build on those after you have had some success. You will probably find it hard in the beginning to give attention to yourself, as you go against longstanding patterns. Be gentle with your expectations and remember that you can always start again if you slip back into old habits.

It will be easier to sustain your physical and emotional energy if you build in breaks for yourself, both on a daily basis and throughout the training year. Look at your daily routine and schedule one or two breaks if you have a full day at your placement. Use your break to eat a meal or snack, take a walk, read or watch something unrelated to your work, or talk to a colleague. Turning your attention away from your work for a period of 15 minutes to an hour will enable you to be more engaged when you return to it. If you have classes and clinical work in the same day, give yourself some transition time in addition to your commute.

Another aspect of your routine to examine is the structure of your day. It is helpful to alternate more and less demanding tasks throughout the day. Consider taking an hour to work on paperwork or do some research into resources for a particular client to break up your client hours. If you have several particularly complex or challenging clients, schedule them on different days or at different times of the day so you have other work or less challenging clients between them.

Clinicians often have a very hard time taking a vacation from clinical work. Because of our pattern of caregiving, we often feel as though we must be available at all times. We don’t feel comfortable having someone else provide coverage. However, we cannot maintain our own equilibrium if we never take a break to restore ourselves. Throughout the training year, take vacation time as it is permitted at your agency and have a colleague provide coverage for your clients so you can be free of responsibility and preoccupation. It is tempting to check voice mail or email when you’re away from the office but you will benefit more from your time off if you fully detach. Keep in mind that taking a vacation means being away from the office and not having any client contact for at least a week. Taking short periods of a few long weekends will not allow you to truly rebuild your reserves and return feeling restored.

I hope you can use these tips for developing some work habits that counter your feelings of depletion. The next blog will continue on this topic, addressing specific ways to care for your physical, mental and emotional well-being. Please email me with comments, questions or suggestions for future blog topics.