Thank U, Next...Level of Care
Season 1, Episode 10
Jessica shares her story about trusting her clinical judgment and going against the recommendations of her upper management, a veteran psychiatrist, and the clinical quality team to advocate for a higher level of care for a new client. Despite the disagreement and strong pushback telling her she was wrong, she leaned into her clinical rationale and peer support to act in the patient’s best interest. She shares how she navigated this conflict with her superiors, advocated for her clinical skills, and managed her own feelings throughout it all.
You can find our more about our podcast, full transcripts, and apply to be a guest on our website!
Follow Am I a Bad Therapist on Instagram for sneak peeks, previews, and all of the latest information about the podcast!
https://www.instagram.com/abadtherapistpod/
Connect with Jessica:
www.jessicaclarktherapyservices.com
https://www.instagram.com/jessicaclarklcsw/
Connect with Kathryn:
https://www.instagram.com/teletherapist.network/
Connect with Allie:
https://www.etsy.com/shop/TheJoyofTherapy
https://www.instagram.com/thejoyoftherapy/
Episode Transcript - Thank U, Next...Level of Care
Allie Joy 00:07
Have you ever asked yourself, am I a bad therapist? Well, you're in the right place. I'm Allie Joy, a licensed professional counselor and registered art therapist.
Kathryn Esquer 00:16
And I'm Katheryn Esquer, a clinical psychologist, and this is Am I a Bad Therapist.
Allie Joy 00:22
Join us each week for stories from behind the closed therapy door.
Kathryn Esquer 00:26
You'll hear experiences that made us ask, Am I a bad therapist? iIncluding bloopers, jaw droppers, and other difficult moments that normalize the unique struggles of modern day therapists.
Allie Joy 00:39
This is a space with no experts, no gurus and no hierarchies just humans sitting in similar chairs.
Kathryn Esquer 00:46
And while we're not the gatekeepers for good and bad therapy, because we're bad therapists too, we are here to shine a light on the difficult decisions therapists face on a daily basis, and normalize that mysterious gray area of clinical practice that no one wants to talk about.
Allie Joy 01:04
Our mission on Am I a Bad Therapist is to normalize and humanize our existence as therapists. You can help us spread this message by subscribing and leaving us a review wherever you are right now. Whether that's YouTube, Apple, podcasts, Spotify, Stitcher, you know the drill.
Kathryn Esquer 01:19
You can also help us by sharing Am I a Bad Therapist with your network. Whether it's on social media, your stories, or just between colleagues, every listener helps us make a difference in this field, and will always reshare if you tag us.
Allie Joy 01:34
If you're listening to the podcast, make sure to check out our pretty faces on our YouTube channel.
Kathryn Esquer 01:38
And if you're watching us on YouTube, make sure to head over to our podcast and leave a review. You can find all of our links in the notes below.
Allie Joy 01:46
We pick a few lucky five star reviewers to shout out and invite for a 15 minute consultation with the both of us to talk about anything on your mind. From clinical work to podcasting, we're game, just make sure to leave us your name and location in the review.
Kathryn Esquer 02:02
So Allie, we're gonna talk to Jessica today about how she had to stand firm for a pretty long time. And her clinical rationale and judgment for recommending a particular higher level of care for a patient, even in the face of a veteran psychiatrist, hospital administration, and quality no a clinical quality control representative telling her that she was wrong. She had to stand firm to get her at, we'll see if her patient got what they needed.
Allie Joy 02:38
Yeah, and it can be so intimidating. I have been a part of, you know, treatment team meetings, of course, before. I've worked in hospice and things like that. And it was very similar, where we would have psychiatrists, there were doctors on our treatment team, people who had been in the field a lot longer than me. And it can be so intimidating, because of course, the work we do is valid. It's so important. We're clinically licensed. But sometimes again, when you're you know, next to this psychiatrist who has been in the field 30 years, it can be so intimidating, but Jessica handled it so well. I think you guys are going to learn so much from her story, and how she handled it and we can't wait for you to hear it.
Kathryn Esquer 03:13
Absolutely. And before we do just a friendly reminder that everything we say here is for entertainment purposes and is not a substitute for therapy, ethical guidance, or those invaluable clinical consultations.
Allie Joy 03:25
All right, and this is episode number 10 of Am I a Bad Therapist? Let's get into it.
Kathryn Esquer 03:36
Well, Hi, Jessica. Thanks for joining us on the podcast.
Jessica Clark 03:42
Good morning. So happy to be here.
Kathryn Esquer 03:45
And I know that we originally connected on the Teletherapist Network. But now we're going to talk about, before we talk about why you're a bad therapist, because we're all bad therapists. Why don't you share a little bit about yourself your practice how you got to where you're at in your career right now?
Jessica Clark 04:01
Yeah, of course. So my name is Jessica and I'm a licensed clinical social worker. I've been in the field of mental health for about almost 13 years now, which sounds kind of like a long time. But I started out working with youth and families. I really enjoyed that peace and like foster care group home. And then I worked in like the adoption realm, which is a little non clinical, and I wanted to get back into the clinical piece. So I did actually get involved with corrections and adult mental health at that point. And so it just kind of was a segue into private practice. I was super excited to be my own boss. So here I am being my own boss. And my current practice is all online just because of everything going on with the pandemic and I meet with adults over telehealth and going over things like anxiety life transitions and boundaries, learning how to say no those types of things. I get a lot of clients with needing some help with things like that. So that's where I'm at today.
Allie Joy 05:03
Yeah, that's awesome. Well, so what is the story that you're going to share with us today that made you ask yourself, Am I a bad therapist?
Jessica Clark 05:08
Yeah, so it was when I was first getting back into like, the, the adult mental health piece, you know, I've been working with kids and families for so long, and it's a different dynamic. And I thought, Oh, my goodness, am I a bad therapist? Like, I cannot figure out if this client, you know, patient needs, what level of care they need, because I thought I had it down. And then I was questioned, and we weren't sure. And so it's like, wow, do I really not know how to judge like clinical judgment anymore? Do I not know how to diagnose? Do I not know how to assess what is happening? So that was like, am I a bad therapist? What's going on here?
Allie Joy 05:46
Oh, my gosh. So tell us more about the setting you were in when that was happening?
Jessica Clark 05:51
It was a group setting that has multiple levels of care, sometimes at different facilities, but kind of an overall program, the highest level, we'd refer out to like, you know, the State Hospital, which they didn't usually take a whole lot of our patients or if they did go, they didn't stay too long, they stabilize fairly quickly. We had one particular patient every now and then we get a patient that would be there for quite a while. And so we'd step them down from the state hospital through our programs, just to make sure that they had enough support to stabilize and not have a whole lot of support, kind of like from an intensive inpatient all the way to like an outpatient, we take them through that. Typically, that's what would happen.
Kathryn Esquer 06:36
So tell us about this particular situation with the client, how, you know, you said you thought you knew what level of care they needed, but then somehow that was questioned. So tell us what, how you made, what went into your clinical decision making and then what was questioned about it.
Jessica Clark 06:55
This particular patient was a little unique, and that there, they had no history of mental health that we were all aware of, however, they ended up at the state hospital, and then were discharged to the lowest level of care in our program. And it was startling, I had, you know, everyone from staff or anyone who looked at the intake going, how do they get here, like what's happening? Mental health, you need to get involved. So we did, the therapist got involved in was the same to me. So I looked it over and everything I thought, wow, this poor patient really decompensated quickly and so much that they kept him for quite a while. And we were trying to figure it out with my colleague, who was kind of our interim supervisor, like, is this really, could they really function here, and we looked at everything. And I was doing kind of like a record review on suicide risk, and all of that, and just what the patient had reported to everyone else, and it seemed like wow they really need kind of a little bit more support than we could offer here. And so I said, Okay, let me meet with him, see how they're doing, see how it's going and patient presented really well, they finally kind of stabilized but they were still really anxious. And that was what led to the state hospitalization was the anxiety went so severe. So we were thinking, my opinion, the level of anxiety in a particular environment that they were going to have to function in were not a good next, and it would put the patient at risk, just to have the same thing happen again. And I asked my other colleagues who had been in the environment lot longer, like, am I overreacting am I too risk adverse? And they're like, no, no, this patient's not going to do well, here. They need to go up a level of care, and then maybe they can come back down. So I was like, Great, all right. And I put it in the treatment plan ready to go and I get to the treatment team meeting. And they're like, no, he's fine. He can just stay. All the other team members were like, No, I think we can help him here. I don't know if he needs to go. And at that point, I was like, Oh, what do I do?
Kathryn Esquer 08:55
That is the boy do what Yeah, what do you do? So tell us before we get into what do you do? Tell us about who made up this treatment team, what, what backgrounds, what level of experience I'm trying to see, trying to give us some insight into why this discrepancy might exist in his level of care recommendation.
Jessica Clark 09:15
Typically, our treatment teams have like our local manager, like leadership, let's say like our program directors, psychiatrist, myself, and usually another like psychologist or social worker who operated as you know, the therapist, and so the the people that did not agree, were psychiatry and are actually our management that was above my local facility, from afar, so they sent a representative who's like in quality management who came in as a part of the treatment team. So they've all they were all mental health. They'd all been in that system, that kind of environment for a period of time. They all had experience there. Nobody was brand new to that environment,
Allie Joy 10:02
And I'm curious if you're able to, can you speak to the different levels of care? Like what was the lowest was the lowest outpatient? Was there PHP, like, what were the different levels, you know, that were being discussed.
Jessica Clark 10:12
The lowest level was considered like an outpatient, that they pretty much did not check in very often it was, you know, not even once a week, the way that program was set up, we saw them maybe monthly or every 90 days, because it was a very low level outpatient where it was just maybe some minor maintenance, if they needed anything above that they went to like an enhanced outpatient, or they were seeing weekly with groups. And then above that they would typically, that was the only other kind of option other than if they went into crisis, or to be referred out. So there was only like three levels of care there. And they kind of had a range of what they could provide. So a lot of patients who really had severe symptoms going on, they would end up in the enhanced outpatient program, because they got group support and that individual support. Where I was at currently, in my program, we didn't have that we had groups once in a while. But really, they were just like a check in every so often just to make sure they were able to use their skills, and they're doing all right and not kind of decompensating into crisis.
Allie Joy 11:21
Wow. Yeah. So even when I was wondering that with the detail it does make it seem so surprising that a patient would come from hospitalization, going right into that recommendation of like, not even weekly, that is surprising off the bat. But then like you said, You did all that work, you did the record review you discussed with your colleagues. And then there's still that push back, that piece is just so interesting to me, that they really are sticking with like going from hospitalization to maybe once a month check in that seems definitely not enough to me.
Kathryn Esquer 11:54
Big jump, big jump.
Jessica Clark 11:55
Big jump, and I thought, Wow, this in this patient hadn't been in this kind of environment anyway, ever. And so this was all new to them. They were super overwhelmed, just navigating socially, everything else. And they have a history of also being pretty impulsive and just seeing what happened. And they're like, yeah, if I see something lying around a pill, I'm just gonna pop it see what happened. So it's like, oh, no, they need a lot more support and eyes on them. But something like that, they need some help. And it was, apparently our upper management, let's say in our regional level was somehow for some reason, part of this particular discharge planning for this patient at the state hospital. But what was interesting is the state hospital therapist, who also did not want to say they didn't recommend the lowest level of care, they recommended our step down program. And they were overruled.
Kathryn Esquer 12:54
Overrulled by who?
Jessica Clark 12:57
Our regional people, so they said, you know, we know our program. They don't need that. But thanks for the recommendation, essentially. And so that was when I was like, Okay, I'm not maybe I'm not such a bad therapist when I finally got more of the records from them. Because I didn't mention earlier, we weren't given the original discharge paperwork from the state hospital, we could only see their brief time with us before they were elevated. And we saw what happened during treatment. But when we finally got a hold of the actual discharge summary treatment recommendations, which what we were looking for, it was in alignment with what I saw, not what the other team members had thought who were in disagreement with me.
Kathryn Esquer 13:43
So the management kind of had the ultimate decision making here.
Jessica Clark 13:47
They did. And they explained why. And I could see their their view. However, I still was going back to the risk factors that I was assessing, and the totality of the whole person in the environment. I was like, I just don't think maybe they could do well for a while. But I wasn't in the business of just seeing how it goes and letting somebody sort of see if they're just gonna wobble and fall over, you know, fail in a program. I didn't want to see that happen to my patient.
Allie Joy 14:18
Of course. So it sounds like you're at a meeting with, you know, the treatment team. You're saying no, I think it needs a higher level of care. They're still saying no. What happens next, either in that meeting, or afterwards?
Jessica Clark 14:35
They did say that. So what happened next was I was holding fast on no, I don't agree with that. And my colleagues who also you know, I had consulted with that were in the meeting agreed with me. And so the treatment team was divided essentially. So their suggestion was, why don't we all meet with the patient so the psychiatrist wanted to meet with me and the patient and they'll convince the patient that they can stay, because the patient also wanted to go to a different level of care, which wasn't typical, most of them wanted to be at the lowest level, they had a lot more freedom of movement and all these kinds of other things. So it was unusual that the patient wanted to go, and I explained what would be the next level of care. And there's this huge sigh of relief for the patient, like, Oh, that would be so awesome. You know, and they're just this relief on their face, it was genuine, it wasn't anything trying to get anything else, they really were in distress. And they also verbalized in the treatment team meeting, because they were part of it, they didn't want to stay at the current level of care. So the next step was to meet with the psychiatrist and the patient, and also with quality management of the patient separately, both with the intention to convince the patient to stay, to say that they wanted to stay.
Kathryn Esquer 15:54
Wow. And you as the patient's therapist had to sit back and watch this happen?
Jessica Clark 16:00
It was yeah, I was in the room with them. And I told the patient ahead of time, we'd be meeting with them. And that, you know, I still don't agree with them, I still support what we discussed. And so the patient was a great advocate for themselves and did not kind of waver. And I don't know, I couldn't say if that was me or just them, but I was there. And when it got to the point where I felt like the patient was really being pushed, I did kind of step in and say they've already let you know that this is where they're at. And kind of mediated in the sense of, we see the psychiatrists' point of view and appreciate the offer the help thing kind of with quality management was appreciate that you're noticing the patient strengths and their adaptability to things however, the patient's pretty clear, they don't want to leave. And so they would again, ask the patient and the patient was very firm, no, I don't want to stay at this level of care, I need more help. So both meetings, the patient held firm with what they felt they needed. And they would kind of look to me and I give them the kind of the what do you want to say that the affirmation kind of the firm Yes, you're fine.
Allie Joy 17:17
Wow I can't imagine what would have happened though, if the client didn't have that ability to advocate for themselves? Because I imagine, like you're saying they're very anxious, they're in distress. They just got out of hospitalization. I'm so impressed with their ability to say that, but I can't help but think what would have happened if they could not do that for themselves?
Kathryn Esquer 17:37
Let's pause here for a quick ad break.
Allie Joy 17:39
Are you looking to incorporate more creativity into your clinical practice, but don't know where to start? As a registered Art Therapist, it truly believed that every clinician can utilize creativity in what they do. I absolutely love offering consultation and supervision to share with clinicians how to ethically incorporate therapeutic artmaking into their clinical practice. I focus on easy and simple interventions with very little prep work for you and your clients. Visit www.ccxs.care to learn more.
Kathryn Esquer 18:10
By the way, the number one support for those of us asking ourselves and I'm a therapist, our clinical consultation groups. If you don't have one yet, join us on the tele therapist network for unlimited peer consultation groups, including a lot of different specialty groups, like clinicians of color, LGBTQ plus couples counseling, EMDR
Allie Joy 18:31
and of course creativity in the clinical room hosted by me, Allie,
Kathryn Esquer 18:35
plus masterclasses media leads and everything else you need for an ethical, modern clinical practice. Join us at teletherapistnetwork.com
Allie Joy 18:47
And now back to the show.
Jessica Clark 18:52
Yeah, I was really worried about that. Because sometimes patients do just kind of placate because they get uncomfortable and they want to get out of the room. Or they question themselves and this particular patient did have pretty good self awareness that was partly why everyone else thought they were so functional those that disagreed with me thought they'll be fine look how where they are like how they understand things they're getting it they don't need this but I disagreed. Self awareness or not they still were had a lot going on as far as mental health needs.
Kathryn Esquer 19:23
What was that like for you? I know you did have colleagues supporting you in your in your decision clinical decision making but what was it like for you to stand firm on your recommendation for treatment level against the psychiatrist, administration? What do you say clinical quality control like this feels like a big a big firm stance that might have been difficult at times. So what was it like for you?
Jessica Clark 19:46
It was a little scary actually. Like I wasn't sure you know, I was like, am I a bad therapist? Am I just missing something because you know, they have different degrees and experience than me maybe I'm you know off base but I think that consulting and getting the opinions of those that I knew were in alignment with patient first kind of thinking. I thought, No, I'm not wrong in this. And so I was a little nervous, I wasn't sure, you know, what would be happened? Am I going to lose my job if I push this? Am I gonna, you know, we sort of, you know, transferred somewhere else like, is this just going to wash over, you know, blow over and no big deal? Like I didn't know what the repercussions if any would be. So I was really nervous about that. But I couldn't like ethically and myself go well everything we've learned just says you need to support the clinical rationale. And I thought, well, you know, the worst case scenario is the patient goes to the next level of care. And maybe that they assess that that program and say, Oh, he doesn't need it. But I wanted to keep my patient safe. And so that kind of helped me going. But it was really scary. It was really intimidating, being in a meeting with other people questioning my judgment, questioning my recommendation, and essentially telling me, you need to agree with we need to be united front, and you need to agree with everybody else. I was kind of like shocked and speechless and a little nervous.
Kathryn Esquer 21:14
How did you get through that? i It sounds like peer support was a huge piece. But I'm I'm super impressed, especially because you mentioned that this was during a the beginning of a transition in your career. So it doesn't seem like you're at this place very long. So you know, not having tenure of years behind you with these people. And you're coming in somewhat new and having to be quite firm, because you know that it's about patient first and patient safety. So what what did you lean on? How did you get through this difficult time?
Jessica Clark 21:50
I did lean on peer support, I did lean on my experience and would go over in my mind okay, what is my own internal, like warning signs? What are the warning bells saying? And I tried to be very specific and articulate my concerns because a lot of times, the clinicians in that environment would know like, Okay, this just isn't gonna work. But people would have a hard time explaining why. And so I think I leaned on just the rationale piece. Like what would any other reasonable clinician say, and kind of brainstorm that way. But the biggest piece, honestly, was the peer support. And my actual direct supervisor was in agreement with me. So it was the management above them that did not, but my, my local management was in agreement with me, and they had said, we'll back your recommendation. So I think the consulting was a huge piece pulling other people in and not just kind of operating like I'm this little island by myself, really is what I leaned on is like, I cannot do this alone. And so I shared my concerns, and my rationale, my political, you know, kind of assessment pieces with my management, my peers. So every bit I kind of got everyone involved, kind of that diffusion of responsibility, you could say, was what I leaned on to, so just the peer support, and I guess, sharing the responsibility pulling other people in. So it wasn't just me, you know, feeling like I was against all these other individuals,
Kathryn Esquer 23:26
You actively went out and sought that. That's excellent.
Allie Joy 23:29
Yeah, I'm curious if you can speak to this. Was this typical for this like, regional person? Like, were they always the first line of recommendation? Or was there something else? Again, if you can speak to of why they were the one who made that decision initially, like from the hospital, and why it went against what the hospital had recommended? Was that typical?
Jessica Clark 23:52
It wasn't typical, that's why it was so confusing at first, because that wasn't typical for them, to my knowledge, to be involved. And so I'd asked other people who had been there longer since, you know, I hadn't been there that long. It says this typical, and they said, No, I mean, typically, we always went, you know, our programs always went by whatever the recommendation was from the state hospital, we never question that we're like, okay, great. And this is where we transfer them to. It was really unusual. Now, I think there was some ongoing partnership and trying to alleviate, you know, over, like inappropriate referrals, things like that, you know, medical necessity, appropriateness, appropriate level of care, those kinds of things that they were trying to make sure people got the right care was what they needed. And there wasn't like the mismatch of referrals. So I don't know if they were involved just to make sure that we weren't kind of inappropriately referring or anything like that, but it was they usually weren't involved at that level, because they were usually out doing other things. So I still don't know why they were there.
Allie Joy 24:59
Yeah, I No, my mind is racing. I'm like, was there audits that happened? Like, did they get flagged for having too many people in higher level of cares? We don't know. But it just I agree. It seems like there was some other piece that made this situation so unique. But But then, you know, at the detriment potentially to the client, so that, you know, of course gets tricky. Now, what was the resolution? Did the client get to go to the higher level of care?
Jessica Clark 25:26
After much back and forth multiple meetings with the patient, yes, they did. They got to go to the level of care that they agreed to that I'd recommended that the rest of my team has an agreement with, and we ultimately followed the state hospitals recommendation.
Allie Joy 25:47
Wow, well, good job to you and your colleagues for making that happen.
Jessica Clark 25:53
Yeah, they did. I think we still weren't sure it still was the you know, there was much, you know, frustration from the others. I think the psychiatrists did eventually say, Okay, I understand. But I still think we could have helped them here. So our working relationship wasn't damaged after that, because I explained to them separately, really what my concern was, and my fears, and they said, Okay, I can see that, I still think we would be a great team to help him here. And I said, Oh, I appreciate that. But I really didn't want to risk that for the patient's sake I'm not going to experiment on what we can or can't do at this level. So I didn't ever hear anything directly, again, from Quality Management, or the people, you know, above them, because I did learn that quality management person had essentially told me, I'm here to tell you to follow the regionals recommendation, not state hospital. And I didn't. Which is hard not to do. But we didn't really interact after that, and just kind of moved on, you know, I kept a professional attitude if I saw them later, it was still Hi, how are you? Those kinds of things. And if they needed other things from me, I always provided data or, you know, participated in anything else if they sent referrals over or anything like that, cecause they did occasionally. But yeah, so it was pretty, it was intense there for a while to say the least.
Kathryn Esquer 27:24
I would absolutely describe it as intense and intense internally too, right? Question yourself, seeking support. Did this situation shape you as a clinician? And if so, how or what did it shape?
Jessica Clark 27:40
So it really, it really helped me become more confident in myself as a therapist, because I always didn't want to be that overly confident person that miss things, you know, for their patients. And it really helped me hone in my clinical assessments and like interviewing skills, and what to look for in record reviews, it really helped to me kind of hone in who I was as a therapist and how to go about that. And it really did teach me that consulting, collaboration is huge. So it's talked about a lot, and everyone says that, but what does that look like? How do you go about that? And so really, just engaging others, and not just trying to do it all on your own? It really helped me realize that, okay, I'm not a bad therapist if I have to ask for help. Because, you know, if I can't, I should be able to figure it out. Right? I'm the licensed person, but asking others for for help in that sense. And being vulnerable, like, hey, I'm not sure if I'm missing something. Am I getting this right? That was a huge piece. So I felt like I grew a lot out of that. For sure.
Allie Joy 28:49
Yeah. I'm curious to ask, did anything like this happen again, with the whole like, regional because I know there again, there's, it's common to have some discussion or maybe mild disagreement on a treatment team, right. It's the purpose of the team. But again, this one seems so intense did anything like this happened again to you when you were there?
Jessica Clark 29:10
It did a little bit but in a different situation. Sometimes that the teams would get a little reactive of sending people to a higher level of care that didn't need to go necessarily, that there's times where we could work through what was what was going on. And so that did happen in a kind of the reverse situation one other time, but not at the regional involved. As long as I was there, I never experienced an involvement from them like that. Like I said, it was unusual and I didn't, they didn't really happen again. We didn't get too many referrals from the state hospital directly like that. And it helps that once we checked, you know, we did continuity of care and we collaborated with the next the Harlow care treatment team we all know You know, talk to each other. And they agreed with my recommendation and this state hospital recommendation. So it was almost as if it was quietly just kind of pushed to the side and not talked about, again, as far as I know, from like the regional standpoint.
Allie Joy 30:16
Wow. Oh, my goodness. Okay. And if there was another clinician who was experiencing something like this, what would you say to them? What advice would you give if they again felt like they were in a very similar situation to what you described to us?
Jessica Clark 30:29
I think, for them for anyone else that may come across this because I'm sure it has, and it will for therapists to really as much as they can get a hold of the records for the client, you know, the record review is a big piece and look at other treatment recommendations or how they functioned in the other setting. And what were the key things the goals and you know, the things that they needed to work on? And what did it look like when they did achieve it? That was the big thing that I looked at for this patient. And then also really their their clinical assessment. Sometimes we get a little rushed, because people's caseloads can be high. But if you get a particular patient, it doesn't hurt to go back over it and really read the DSM, like, what is standing out to you? What is the concern? Something's like not sitting? Well, what is that, put it into words, I would say really hone in on the clinical rationale for things because that's what everyone's asked for, like in treatment team meetings, like, how did you come to this, you know, recommendation, or this conclusion kind of thing. And being able to articulate that, taking the time to go over that. And really even pointing out the exact things in the DSM, because I did that a little bit with this client. And this patient, I should say, and it did help. The other thing I would suggest is collaboration, and consulting. And so the the biggest piece around that is consulting with people who have experience in what you're asking about, and that also have the patient safety in mind. There's always the assumption there. But there are some people, unfortunately, who will just kind of concede to management or anyone else. And so you do need to kind of keep in mind who you're consulting with, that can sound a bit harsh. But I think that's the reality of things as well, because that was the reality in the setting I was in. And so I consulted with people that had familiarity with the programs, the level of care and assessing for that, knowing that they would give me an objective point of view saying you're, you're too reactive, you're too risk adverse, or actually, you're on point with this one, from what you're telling me. And they had other great questions to ask or to consider. And they listened to both sides. So like, okay, I can see that, why they're thinking that this patient be okay here. But this is kind of the key risk factors that are the tipping point that we typically, you know, go with, essentially, and so having people that are also willing to stick firm to that to in knowing where they stand and where they're at. I would always say consultant anyway. Regardless, maybe you don't know them that well, you're new that place, or you haven't had to ask those questions. Always consult though, with anyone else, whether it's a colleague, management, whoever, even, you know, I've talked with psychiatry separately, and not without like an audience, so to speak, it's the treatment team or the patient present. So we could just talk freely as colleagues, and that works out really well, too.
Kathryn Esquer 33:36
I couldn't agree more excellent pieces of advice, get really solid on the data, use your intuition to inform the data, and then seek those consultations with quality. And then also, you know, you wanted to get a breadth of consultations with this particular experience too, right?
Jessica Clark 33:56
Yeah. And so I asked different, you know, colleagues and supervisors that are involved in different things as much as I could. Now some people don't have that kind of available. But generally, I find it helpful to at least consult with a colleague who does the same kind of direct work. And from a supervisor or program manager point of view, I think, is really helpful too, because they, they can help kind of with the risk factors or the operational needs of a program that sometimes we're not aware of, like, oh, actually, we could accommodate and do A, B and C, or no, we can't accommodate and do A, B and C and so they can also help with that of what's possible in the program. So that's why I think management is so helpful. And that was it was helpful to me too, is that they knew that we couldn't accommodate this patient in that way. Like other programs that could potentially they could have stayed but with our particular but we want to say like millieu and things that we had to offer. We couldn't support this patient. With the we we tried to flex the program as much as well. possible and we just cut it. And so that would be the other piece is see what what's possible? And could this happen in this way? Could we make it happen and keep the patient safe? So I don't know if that kind of ties in makes sense. But yeah, that was the other thing too.
Kathryn Esquer 35:16
Be open to creative possibilities, creative referrals. Absolutely be open to other perspectives while also stay in firm to your own clinical rationale and clinical judgment, making sure they fit not fitting the rationale to the proposed solution. Yeah.
Jessica Clark 35:33
Yeah. Which is hard to do. It's tricky. It feels kind of scary. Like I said, I thought it was bad therapist, maybe I'm missing something am I too, you know, too new to this, am I doing not know what I'm doing? Do I not have enough training to figure this out, you know, all that was running through my head as well. So it was not easy to stand firm. But I, when my patient really wanted that and that was they were very certain this is what I needed a lot, it was actually much easier for me to stick with it too, because I was doing what was in the best interest of my patient. And that helped me also stick firm with it. And so collaborate with your patient, be open with them, it can feel scary to talk about things and like what if they say no, or they get upset, they need to be involved, they need to be a part of a treatment planning process. So that would be the last thing I would emphasize is please talk to your patient about things. They you know, it's much better if they have buy in and understanding what's happening to the best that they can. Because that did help with this patient a lot.
Allie Joy 36:34
Yes, sound advice, everything you said I agree with completely. And I truly commend you for handling the situation so well. And being such a wonderful advocate for yourself and for your client. So I'm so happy you brought this story to the podcast, I'm sure that so many listeners are going to benefit from hearing you talk about this. And just again, thank you so much. But before we let you go, where can people find you if they want to connect outside of the podcast?
Jessica Clark 37:01
So I am on the network. And so other therapists can reach me there. But otherwise, people can find me, you know, online, I have my website JessicaClarktherapyservices.com. And the probably the easiest place to find me also is like Zen Care, therapy den, just to kind of connect.
Allie Joy 37:21
And do you have a therapy instagram too, I can't remember if I saw that or not.
Jessica Clark 37:27
There'll be Instagram. Sorry, does that? Yeah, yeah, I do. So it's just Jessica Clark LCSW. So pretty easy to find on there. And love to connect don't mind sharing my story or giving feedback to others. I love kind of mentoring piece too. And even just providing that moral support if people need it, or be open to that too.
Kathryn Esquer 37:49
And we will link everything in the show notes below for those of you wanting to connect with Jessica and Jessica, thank you so much for joining us. And I'm sure you Allie and I will connect more on the network later. But thank you.
Allie Joy 38:02
Thank you.
Jessica Clark 38:03
Yeah, thanks for having me.
Kathryn Esquer 38:09
And that's it. The OG bad therapists Alan pattern are signing off for the week.
Allie Joy 38:15
Make sure to subscribe and leave us a review. We pick a few lucky five server viewers to shout out and invite for a 15 minute consultation with the both of us to talk about anything on your mind. From clinical work to podcasting we're game. Just make sure to leave us your name and location in the review.
Kathryn Esquer 38:31
And are you a bad therapist and want to join us on the show? Go to abadtherapist.com and tell us your story.
Allie Joy 38:40
Our podcast is produced and edited by my amazing husband Austin Joy. He also created the music for our intro and outro you can find this song along with many others on any music platform under the artist air for effect. And if you're a bad therapist, starting your own podcast, contact Austin for his full suite of podcast and sound production services. You can find him on Instagram at Air for Effect.
Kathryn Esquer 39:04
And don't forget, we're all bad therapists.