Consultation & Competency ft. Shannon Heers

Many group practices offer clinical supervision for prelicensed therapists. Join me, Uriah Guilford, and Shannon Heers of Firelight Supervision, as we discuss this fascinating topic. Click to listen now!

In This Episode, You'll Learn:

  • The secrets to being a great clinical supervisor
  • How to improve in your supervision skills

Resources Mentioned In This Episode:

Firelight Supervision
The Productive Practice book

⬇️ Click for full episode transcript ⬇️

Uriah
Hello, Shannon. Welcome to the podcast.

Shannon
Hi, thanks, Uriah. It's so fun to be here.

Uriah
Yeah, it's really great to meet you. That's one of the things I love about doing this podcast is meeting interesting and fun people like yourself. It's just been a blast. So yeah, I appreciate you being here.

Shannon
Yes, I'm avid listener. I love it. I recommended your podcast to my admin person and I'm like, Oh, you have to listen to this one. I think they get really annoyed when I send like, No, it's episode number. That's great. I love it. I'm all about efficiency. Yeah.

Uriah
Well, and sharing tips and resources, I think, to help anybody that you're trying to help is the way to go. That's what I'm all about. Yeah, for sure. We have a fun topic today talking about the connection between consultation and competency. I said that very slowly and carefully that I didn't choke on the words. But I first would love to hear about you, just a little bit about your story and about Firelight supervision, because I know you're up to some really cool things.

Shannon
Yes. Well, I probably don't have enough time. I've been in the field a long time, so I don't want to go too deep into all the details. But basically, I've been working in the field for about 25 years. I had a long career in community mental health as a therapist, case manager, supervisor, manager, program manager. And then I had kids and decided I didn't want to do that anymore. A new management role? Yes. So moved into private practice. And then as with many therapists, my private practice got full, so I expanded to a group practice. But supervision was always a particular passion and interest of mine, partially because I've had both ends of the extreme. I've had fantastic supervisors and I've had terrible supervisors. And they have had such... The quality of my supervision has had such a impact on not only myself and myself as the team and my ability to provide good clinical work, but also my job satisfaction and my life satisfaction. I think I'm just someone who needs a lot of support. And so clinical supervision is something I actually continue to do. I still have a clinical supervisor. I still am part of a consultation group. It's just something that has been so helpful for me that I understand how it can really help keep therapists in our field for the long term. So that's a little bit about me. So I've always had clinical supervision as a service as part of my private practice. And then in the last year, year and a half, our supervision program just got so big that we had to open a separate program from our group practice called Firelight Supervision. And I'm lucky enough to have several therapists internal to my practice that are also supervisors. And then we have a couple of extra ones right now. So we have a team of six supervisors right now. And we provide clinical supervision, which is what most people tend to think of as licensure supervision before you get fully licensed. So we provide that in a few states. But the other thing we provide is clinical consultation. And that is the actual term for supervision that we use after you're licensed because you're not required to get supervision anymore. So it's much more of a collaborative case consultation process there. So one of the... Yes, so that's where we are. That's where I came from and that's what I'm doing now. I could keep talking, but I'll take it to my answers.

Uriah
I know, yeah. There's so much to tell. I do have a question for you. I'm curious, before you started your private practice, before you had kids and you had all those various roles in community mental health, what was your favorite or what did you enjoy the most during that phase of your career?

Shannon
I think supervision, I would say program development and supervision. I really loved thinking, being really creative about what are the needs right now in my program or outside of my program or within the agency, what are the needs and how can we meet those needs? And so part of that also was, okay, how can I get the right people in the right place, in the right jobs? And some of that is like you combine that and that's program development. So the supervision aspect of what are each person's strengths, and how are they using them the best and how can they develop their skills even more in the areas that they're interested in? I think that's a lot of the supervision that I was really interested in. And then the combination of those two, I think, really lend itself well to a lot of private practice therapists who are those entrepreneurial type thinkers.

Uriah
Definitely. And were you pushed towards a passion for supervision, largely because of poor experiences? Or was it like a combination of things?

Shannon
Anyone who's been in community mental health, very often if you're good at what you do, they're like, Great, let's put you into a supervisor role. Let's make you manager. Right, a manager role. I was put into a supervisor role. I wanted it, but I was put into it before I really had any clue of what I was doing. I think I was a supervisor pretty close to the first year after I became fully licensed. I liked it, but again, I didn't know what I was doing. So I had a lot of learning and development that I needed to do to become a good supervisor at that point. I definitely should not have been in that position. But again, you don't say no when they say, Hey, here's more money, more responsibility, more leadership. You don't say no to that.

Uriah
It was a steep learning curve and growth edge, most likely. But it probably helped you and motivated you to get better at that, especially because you knew that you enjoyed it and you wanted to go that direction. At some point, that clicked, right?

Shannon
Yes.

Uriah
Yes, exactly. You're making a distinction between, and it's helpful to talk about this, supervision for pre-licensed therapists and clinical consultation being post-licensure. Do you think, I think I know the answer to this, but do a lot of therapists get licensed and then completely abandon the idea of consultation and supervision? Is that common?

Shannon
Yes.

Uriah
That is unfortunate, isn't it?

Shannon
Yeah, it really is. Then they don't have anyone to talk to about tough cases or complex cases or risk issues. I think those are therapists... Because you're like, Okay, I can't afford to do it anymore. I don't have to, so therefore I can't afford to do it. And I think that is true. Yes, we're all tight for money right now, but it's also a bit short sighted because clinical consultation has such a return on investment in terms of helping you learn and develop as a therapist, that's going to help you keep your clients longer. And we all want to keep our clients longer in private practice because it's a lot easier and cheaper to keep the clients we have rather than get new clients, we know that. And clinical consultation plays such a big role on that. It can help give you confidence. It can help, of course, learn new skills. You're doing case consultation. But clinical consultation is more than just case consultation. It's learning to identify to grow as a therapist, like what's your style? Once you become licensed, your learning doesn't stop there. I'm a very different therapist now than when I was initially licensed 15 years ago. If I had stopped clinical consultation, I probably wouldn't even be a therapist anymore. So I think there's so many other things that clinical consultation can do that can help people on. But it does tend to be an investment because either it's a time investment, you got to make time to do it and to seek out people you know and trust to get that consultation on a regular basis or consistently, which is when it's most helpful, of course, or it costs money to invest in supervision or a consultation group or ongoing. Or sometimes both time and money. And that's something that sometimes we don't have a lot of.

Uriah
And when it's no longer required. I think also once we get through the licensure process, so many things have been forced upon us and have been required, whether they make sense or not. Probably like, as a field, we're probably like, No. I'm 18, I'm out of the house. Don't tell me what to do. Exactly. Kind of thing?

Shannon
Yeah. If you had a bad experience with a licensure supervisor, why would you want to put yourself in that position to get more of that? That's true.

Uriah
I'm really grateful. I don't know if this happened by accident, but I had a really wonderful experience after I got licensed. I think it was a couple of years after I got licensed, I got into this program that was locally run through a nonprofit. It was called Fostering Connections. The idea was they want to provide good quality services for free to foster and adopt children. They said, Well, if you, as a clinician, will agree to see one client for free forever or for as long as they need to be seen, we will put you in a consultation group with, I can't remember the terminology, but basically a senior clinician who's very experienced. I spent six years with this one group with a really wonderful clinician named Mervyn Meyer, and he taught me so much about attachment-focused therapy and attachment-focused family therapy. It was incredibly valuable. I'm so grateful for that program and that experience. It really made me a much better clinician, like what you were saying before.

Shannon
Well, yeah. That's a great example of that. You were licensed as a therapist, but you didn't have that specialization. You didn't have that specialized knowledge. How do you get that specialized knowledge other than just going to more formal trainings? Because you can get trained on something, but then the implementation of it and how you use it with each one of your clients in your cases, that's the biggest challenge, I think. And that's what consultation can provide you, can really help you develop your niche, your specialization areas, your interest in different clientele or modalities like you were talking about. And I think that's also something we don't have once we get licensed. That's a big part of our learning process.

Uriah
Yeah, just to me that it's never been easier to get information, obviously, and to get courses or education or not to acquire knowledge. But the application of that knowledge and how do you use it with your clients in an effective way and how do you improve over time, that's definitely missing. That's one of the things that I got from that group was, okay, now we're learning about therapy and these are some techniques and some skills you can use with kids and families. Then we would come back and talk about how did it go and what could you have done differently and all that. The applied knowledge is way more valuable.

Shannon
Yeah, it's that feedback loop. You're trying something with your client and then you're sharing that with other people and they're giving you feedback about what might work and what didn't work quite as well. So yeah, I think that's invaluable and that's an invaluable part of clinical consultation. I also think there's so much more to clinical consultation. There's the support that you need, especially if you're a solo private practice therapist like you're out there on your own. There's no one else that you can turn to. And that can feel like you have a lot of control over what you're doing, but you also don't have that safety net underneath you. Just getting support, even just having someone to say, Oh, I had a really tough day, or I felt really drained after this client. Just talking to someone who understands that can be really invaluable. I also think there's a lot of research about the supervisory relationship, and primarily the research is based on licensure supervision. But you can also have a relationship with your clinical supervisor once you're fully licensed and you're getting consultation. So that can really help mimic also or model for you as a therapist, the therapeutic relationship between you and your client and what it's like to develop that ongoing and have a long-term relationship in that way.

Uriah
That's fantastic. So let's step back and talk about that therapist isolation piece because I think that is super common. I'm thinking about one of my amazing therapists who worked with me for me for six years and then went out on his own and he's doing really great. But he's seeing like 25, 30 clients a week and he doesn't really do marketing. He doesn't really do networking. I don't know for sure, but I don't think he has dedicated time for clinical consultation. I'm like, Oh, goodness, what does he do? Because here in my group practice, we just walk down the hall or we chat with people who we work with and we say, I don't know what to do about this client. What do you think? We have meetings and all that stuff. But he doesn't have that. So what are the potential dangers of that? Yeah. What's that like? Oh, my gosh.

Shannon
Well, I don't know if you are part of any Facebook networking therapist groups, but I'm a part of a lot. I think what I see is people are trying to get their clinical consultation through Facebook, putting up a post, they're either providing, hopefully not, but most of the time providing a lot of PHI about a client, and they're saying, I need some consultation around this. And then up to 100, 200 people could answer that. And you don't know any one of those. You don't know those people. So do you really want to get your clinical consultation from someone that you don't know and trust? I mean, I don't.

Uriah
Yeah, crowdsource clinical consultation.

Shannon
Right. I mean, I think there's some great things about the therapist, Facebook community, but I think that's one thing that that's where people are getting it because it's not like you don't need it. I mean, I'm a seasoned therapist, you're a seasoned therapist, but we still could use some support with our cases. And so it's not like you don't need it. And if you're seeing 25 to 30 clients, you don't have a lot of extra time for that. But are you showing up as the same great therapist for client number one as you are for client number 30 in your week? And are you doing that week in and week out and month in and month out and year in and year out? Because we all want to have long term sustainable practices without burnout. So I think those are some of the dangers of practicing in isolation. A few other dangers that I've noticed is that therapists tend to be more likely to create ethical dilemmas or ethical violations if they're not getting any support because you just don't have anyone to talk to about it. Maybe you're blind, you're like, Oh, okay, well, I didn't realize my boundaries were not set up pretty strictly for this client until it becomes really far down the line. One of the things I didn't mention in my introduction, but I did crisis emergency work for about 10 years. So I was assessing people in emergency rooms, what level of care they needed. Did they need to people who are suicidal or drunkicidal, as we called it, or had had suicide attempts? What do they need to go inpatient, outpatient, IOP, home, residential, where do they need to go? After 10 years of it, I really knew what I was doing, but I was never allowed to make a decision about risk, about placement factors without consulting with two people, my supervisor on the shift and the prescriber or the psychiatrist on call. So it just really drummed into me. You never want to make a decision about risk on your own in isolation. One, we did it that way because the liability then is spread out between more people. The more people agree on something, the more likely it is to be the best way to go. If it's just you, you might have some blinders on. You never want to make a decision about risk. So if you have clients coming into your practice, they will come in at some point with risk issues, with suicidal thoughts, with maybe even homicidal thoughts, grave disability, you don't know. And you can't always predict when that happens. So you want to make sure that you have someone to consult with, not just someone on Facebook, but someone that you know and trust and you can access quickly. Because for those urgent and emergent cases, you don't want to wait like two or three weeks to consult with someone on that. You need some support and help right away. Those are the concerns that I see and the things that I see for people who aren't getting consultation on a regular basis.

Uriah
Definitely. Yeah, that makes sense. Thanks for sharing that. What do you think—and I'm not just asking about your business, but you can certainly talk about that—what is the easiest way for somebody who's, let's say, a licensed therapist and they realize, maybe Jim's listening to this, Hey, Jim, they realize they need some of this in their life, in their practice, rather, what's the easiest way to access that? And are there other resources? Are there other similar kinds of services out there? What do you recommend?

Shannon
Oh, my gosh. So I think you have a lot of options. People have a lot of options. I don't think you're restricted by geography anymore with all the virtual stuff that's happened. Like at Firelight Supervision, we offer virtual individual and virtual group consultation. So you can join from wherever you're at. So you're not bound... Maybe you move to a new area, or you don't know a lot of therapists in your area yet, like an online consultation group that someone else sets up for you or an online supervision that's available, that's a great option. But there are some people who are online doubt and they want to meet in person with a consultation group. And there are lots of consultation groups that pop up that are completely peer run. And some of those are great. Some of those are not so great. I think you really want to do your research. I remember being part of a peer consultation group quite a while ago, and no one was interested in discussing cases. They just wanted referrals from other people because they were trying to build their caseload.

Uriah
More networking than consultation.

Shannon
Right, which is fine and a good thing. But I was going because I really wanted clinical consultation, so that did not work for me. So there is a difference between peer-led consultation groups and supervisor-led consultation groups. I will also say with peer-led consultation groups, usually the bulk of the work ends up being on one person to get the group organized and to plan and to facilitate the meeting. And sometimes they get what they need out of the meeting. They end up being like a free supervisor. I would say there are lots of options for consultation groups in your community. You can reach out to former professors, to former colleagues, to current colleagues. I think there's a lot of options out there to get both free and paid clinical consultation. You shouldn't be limited by your location or by your network.

Uriah
That's really great. I like that. So it's probably just a Google search away, right?

Shannon
Yes, Google search away.

Uriah
Yeah, that's good. One other experience that I had that was really great is I actually got invited to join a longstanding peer consultation group years ago. I think I was in that group for four or five years, and it was a really good one. We met on a regular basis, and we did actually share a lot of referrals. And to even to this day, it's been very beneficial. But we would definitely talk about cases. It was a fun group and it became very friendly too, in the sense that we were peers, but also became friends. That was really beneficial. Definitely helps with that isolation of being in private practice.

Shannon
It does. And that happened through your long-term relationships with them. That stuff wouldn't have happened if you had just gone once or twice and you're like, Bring me referrals, or you wouldn't have gotten that same benefit. So I think that's the other benefit is getting people that you know and trust. And maybe you don't know and trust them right away, but developing that. And how do you develop that? Well, you show up. You show up, you connect with people. You become a little bit more vulnerable than maybe you're comfortable about being and saying, I'm really stuck with this client and it doesn't feel good to say that. And then other people, Oh, my gosh, I feel the same way. And then you just feel that sense of connection with people. And then you're also, as you mentioned, you're going to be much more likely to refer your clients to someone that you can say, I've met this person and they will be a great therapist for you rather than just like a random name on a website.

Uriah
I think there's a lot of value in what you're talking about in the sense that as therapists, especially licensed folks, we think that we are supposed to be the experts and that we know all the things. Of course, we do amazing work with all of our clients, and we always know what we're doing. We know the next steps and all this, but we don't. It's really hard to go into any group or to any person and say, You know what? I think I'm really blowing it with this client. What should I do? But if you're in a group that you trust and you're with them for a longer period of time, there's more freedom for being vulnerable and then getting really good guidance. Because the worst thing you can do as a professional, as a therapist, is struggle through seeing a particular client or a particular client and then just never tell anybody. Then just do really not help and not make a difference when you could. So that's definitely worth considering.

Shannon
Right. I think we all want to be good therapists. For sure. And we want not just to be good therapists, but we all want our clients to have really good outcomes, whether that's developing the ability to get boundaries or have better relationships with people or symptom reduction or work through trauma or grief, whatever it is, we want our clients to have good outcomes. And so what can we do to help with that? Well, I think clinical consultation can do a lot. It can provide you different access to different modalities, different perspectives. Oh, I never thought I would try that. That is interesting. And then maybe you develop an interest in that area. And it can also help you, I think, just feel a little bit more secure and confident in the work that you're doing. And the confidence that we have as a therapist, that will show up when you're working with the clients. Clients know if they have a confident therapist or not. I have way more confidence now than when I started a long time ago. I feel very clear that I can come in and intake and say, Yes, I absolutely can help you, and here's how I can help you. That's a good feeling. Yeah, it's and it feels really good. But I didn't always have that. I worked really hard. It's not just years of experience. I got a lot of feedback, a lot of learning, a lot of support from my own supervisor and group. I think.

Uriah
Honestly, that's one of the things that I've developed over the years that has been the most valuable is the ability to ask for help and get consultation, not just clinical consultation, but business and other kinds of consultation, even just my personal life. Maybe that just comes with maturity, but maybe when I was younger, I definitely would not tell anybody what I was struggling with. Now I tell all kinds of people, and then I get all kinds of advice and direction, and then I decide what I want to do. But it's so helpful to do that. I wanted to touch on something that you mentioned briefly, because in my mind, I can't help but be a marketing person. I'm thinking like, Well, if I was writing the sales pitch for why you need to get clinical consultation, why it's a good idea, you mentioned client retention, and I think that's really important for a number of reasons. But can you talk just a little bit about how clinical consultation can help the therapist keep their clients longer and help them more?

Shannon
Well, certainly the case consultation helps, but some other things. Some of the things that I work on with my therapists and clinical consultation, it could even be boundaries. It could even be, Hey, do you have a cancelation policy and are you holding to it? Are you providing your client with expectations about what therapy is going to look like? Are you providing treatment recommendations for them? All these little things are going to help retain your clients. I'm trying to say, I literally just came from a presentation I did on client retention. So it's so funny you asked that. I probably have to be different techniques I gave on that. Certainly scheduling ahead of time, making sure you're scheduling out 2-3 months ahead instead of just session to session. I think the biggest thing, though, that I work with my therapist on with client retention is who are your ideal clients? And you've heard this before, you're very familiar with this. But you're going to do your best work with the clients that you... With your ideal clients. And the people you do your best work with, those are the ones you're going to see coming back over and over and over again. Now, if you're meeting with someone and you're not feeling comfortable and confident and experienced and educated about what they're presenting, they're not going to continue to come back because you're not helping them as much. So I would say that would be one of the biggest things in terms of client retention.

Uriah
That's great. Yeah, working with your ideal clients. We hear about it a lot, at least in the entrepreneurial therapist space, but that can't be overstated because if you work with people who you enjoy working with and who you are passionate about helping them get the outcomes that they want, it's just good for everybody, right?

Shannon
It's so good for everyone. And maybe they'll refer new people to you to you.

Uriah
Yeah, those are the people that are most likely to tell their friends and family, right? Oh, my gosh. Shannon is so amazing. You need to go see Shannon. That's where it's at. I do love that about this career, even though I actually no longer see clients, but I love that about this career is that if you're open and you're interested, you can be constantly growing and improving as a clinician and as a person well into your 60s, 70s, 80s, right? That's pretty amazing.

Shannon
Yes, interesting. We actually get a lot of second-care therapists or therapists who have taken a big break and they're coming back into the field and just not feeling as confident. And that's really when I see clinical consultation as being very beneficial because they really do have the skills. It's just dusting them off and getting them confident in using them.

Uriah
Yeah, that's great. I love that. Good for them for plugging into those resources and getting that support. I have another question for you before we wrap things up. I'm just curious about any trends you're seeing or changes you're seeing with new therapists coming into the field, folks who are getting supervision and working towards licensure. Honestly, positive or not so positive? What are you seeing in that area?

Shannon
People coming in and working towards licensure. I am based in Colorado. I'm licensed in Colorado and Washington, but I'm based in Colorado. Every state is so different about what they allow provisionally licensed therapists to do. We are very apparently liberal in Colorado, and a pre-licensed therapist can really almost do anything as long as they're under supervision.

Uriah
I know they can run a group practice, right?

Shannon
Yes, they can.

Uriah
That's what I heard.

Shannon
Yeah. I'm seeing so many more, I would say the last several years, so I don't know if this is an actual trend, but so many more therapists, they are just graduating and they have minimal experience other than maybe just their internship and they're jumping into private practice. And there's nothing we can do about that. They just are. So my thought was, well, do I really want to be supervising these people? And my thought is, well, they're doing it anyway. Why don't they get good supervision? And there are some people that I would absolutely not recommend go into private practice right from graduating. I didn't go into private practice. I had maybe many years of experience before I did, and I still felt like that wasn't quite enough. But again, if they want to do it, I think that's great. And there are some people who really can do it. They niche down enough, they know who they're going to work with, they do have the confidence in the training, great, that's wonderful. But I think the worrying trend that I see is that people are jumping in a private practice and they have never seen a suicidal client or they don't have a referral network. So they have someone who comes in with really deep trauma and they don't have experience with that. And they're saying yes to these clients and not referring out.

Uriah
They need clients because they're new to private practice.

Shannon
They just want to build up.

Uriah
Their caseload.

Shannon
Oh, my goodness. They just want to build up their caseload. And I'm not saying you should refer out every case, they don't fit in your specialization, but there are clear cases when you really should. And so I think those are a few of the trends that I'm seeing, at least in Colorado.

Uriah
That is interesting. Yeah, new therapists are coming into the field with a lot more confidence, it seems like, which is not all bad at all, but maybe a scosh too much at times. I wonder if they are actively and proactively seeking out consultation at that point or not. I don't know. There definitely have been quite a few changes in our field over the last 5-10 years, and lots more coming down the pike too, right? Yeah.

Shannon
Yeah, it's exciting. There's such a need. I do think that there are absolutely enough clients for all the therapists out there. I do think there's such a need. And I think that's the big learning curve that people are coming out of graduate schools or agency work and saying, Well, I want to work for myself. But they just have to remember it's a business. You're providing a service, therapy, but the point of the business is to be profitable and to make money. And so we're needing to focus just as much on that as they do on their clinical growth and development.

Uriah
Definitely. Well, I'm glad that you're doing the work that you're doing because it's important and it's necessary. Well, thank you for this conversation. Super interesting. Yeah.

Shannon
Yeah, thank you. I love talking about this stuff. I could talk about it forever, so...

Uriah
Yeah. Well, this isn't a topic that we've talked about at all on this podcast in the last three years, so hey, I like it. So if people are looking for clinical consultation, supervision, and are interested in firelight supervision specifically, tell them where to find that information.

Shannon
Yes. If you just go to our website, Firelightsupervision.com, just like it sounds. And we have a lot of different services that we want to offer. So if you're fully licensed, click on the consultation tab and it'll talk about all the different options we have. We have some specialization areas, but I would say our most popular thing that people tend to want is group consultation. They just want to come in once a month or so, meet with some people that's led by a supervisor who knows how to facilitate the group and manage everyone's time, get the connections with other therapists, get the case consultation. We definitely offer a lot of different group options.

Uriah
I love it. All right. Thank you, Shannon. Appreciate it.

Shannon
Thank you, Uriah. It was a pleasure.

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