Performing at Your Peak as a Mental Health Clinician
I’ve often put forth the notion that if you dwell on the clients you don’t help or just drop out of treatment, over the course of a career, you’ll do a lot of dwelling.
But of course, this statement has its limitations. It’s a fact that in spite of our best efforts, we won’t see the kind of success we would have wanted in some clients; and it’s downright confounding as to why people drop out of treatment without providing appropriate notice — even in instances where treatment was delivering measurable improvement which was corroborated by the client. However, if we are not having enough successes on a consistent basis and too many clients are dropping out prematurely, we’ll soon be out of business or out of a job. So what influences peak performance as a mental health clinician, that is, treatment which is linked to client retention and engagement yielding consistently effective care?
Before delving in to this question, it’s worth clarifying that the type or form of therapy utilized has no bearing on treatment outcomes at all. It matters not whether the model employed is traditional cognitive-behavioral, dialectical, mindfulness or whatever else could be tossed into the mix, and in some instances, this applies to medication treatments as well. The best outcomes predictor with regard to mental health services relates directly to the provider of the service.
Variability among therapists abounds. As is the case in any area of healthcare, some practitioners are prone to deliver their product more consistently than others, and on balance, are more effective. So anyone in the process of deciding whether to begin psychotherapy treatment will be much better served by researching or inquiring about the professional they are contemplating seeing, rather than focusing on the treatment model employed, where the practitioner graduated from or trained, or how many credentials are strung behind their name. What then are the drivers of optimal performance as a mental health professional?
Top performing, in-demand practitioners do a variety of things. Foremost among them is keeping the client connected to treatment, because the risk of dropout increases as the length of treatment without positive benefit increases. Therefore, they consistently strive to keep people in treatment long enough to give the intervention strategies sufficient time to bear fruit or to have the client feel comfortable enough to express their dissatisfaction with how things are going. The goal is to gain as much feedback from the client as possible so that the current plan can be modified or adjusted in order to generate improvement. In this vein, top performers routinely think about the rapport they have with a client, and they examine and reexamine whether there’s agreement on treatment goals and whether the therapy process is playing out in a way that matches well with the client’s values and preferences.
The skilled clinician knows that the majority of problems in the therapy relationship can be traced to a misunderstanding of the client’s goal. As we are all so aware, many clients have NO idea what their goals are upon entering our offices, so we keep mining away to connect the dots — often discovering what the real goal is through insightful and carefully planned questioning. (Last week I had a new client tell me that his goal was to improve his work performance. I had to dig further to find out that his marriage is falling apart, and because he’s consumed by this, his work is suffering. We reached an agreement that repairing his marriage is the goal).
Astute clinicians never stand too firmly behind the accuracy of their assessment of the client’s goals, because the wrong goal paves the way to ineffectual treatment. So when treatment isn’t working, after reexamining the goal, they consider a change of setting (shifting the client from individual to group treatment or to a partial hospitalization setting, for example) and as a last resort, they contemplate referring the client to a different clinician to establish a better fit and increase the chances that the client will be helped.
The most important distinction between top tier practitioners and their more average counterparts is this: the peak performer spends considerably more time engaged in “virtual practice” outside of their day-to-day actual practice setting. They realize that merely seeing patients is not the kind of “practice” that foretells excellence at their craft, because every day work is not actually practice and the idiom “practice makes perfect” is a myth. Also, they are aware that experience does not necessarily correlate with outcome. The reason for this is that the crucial elements needed to enhance learning and growth — such as reflection time and identifying errors made during the work day — can’t be accessed when they’re caught up in the trappings of a busy day meeting with clients.
Are there specific activities that best performing practitioners utilize to engage in “virtual practice?” No, there aren’t. What they do is carefully choose the learning experience (book, seminar, podcast, etc.) that they believe will best help them improve their performance. They could care less about whether or not there are continuing education credits for the activity and understand that any form of training or skills development that isn’t applied to a select client situation is useless to them. Then they set aside some quiet time and set up a “virtual practice” scene with a client through their imagination, painting a rich picture of how the new information they’ve acquired will aid them in developing a plan for what they’ll do differently and even better the next time they’re back in the real practice trenches.
Is all this exhausting? Yes, most assuredly. Pursuing excellence always is.
Joe Wegmann is a licensed pharmacist & clinical social worker has presented psychopharmacology seminars to over 10,000 healthcare professionals in 46 states, and maintains an active psychotherapy practice specializing in the treatment of depression and anxiety. He is the author of Psychopharmacology: Straight Talk on Mental Health Medications, published by PESI, Inc.