What to do when the help needs help.

HiRes

I really enjoy being in private practice. I’ve appreciated the freedom and ability to be creative that comes with being self-employed. Having the ability to make more money is a huge positive and can be best achieved by growing your practice. However, don’t be deluded by the all of the positives. There are inherent difficulties that one must be aware of.
Over time my practice has grown, although there were times when I was reluctant to the increase in business and adding other professionals. I’m acutely aware that growth sometimes means, increased headaches, stress and uncomfortable issues to manage. But one of my greatest professional struggles is in learning how to manage mental health professionals with mental health challenges. Let’s face it, most of us go into this profession in an attempt to better understand, resolve, or be distracted by our own personal issues. Unfortunately, if we don’t have a good handle on our ‘stuff’, it comes spilling out and at times can be unsightly. I’m a huge believer that all, not some, but ALL mental health professionals should seek personal therapy or engage in some form of insight oriented awareness. If we truly believe in the process, we should be open to how we can personally benefit from it.
Often, in a group practice you’ll see an unresolved family of origin issue, surface among therapists. You’ll see therapists complain of feeling, left out, not being treated fairly, feeling like others are getting preferential treatment. It’s important that as a supervisor, to not diminish a person’s reality before assuming the roots originate from a childhood experience. What I’ve found eventually surfaces are, experiences the therapist felt growing up in the family or origin rather than being based in reality.
Therapists who have an unrealistic expectations and a strong sense of entitlement is another concern. These are the people who expect to receive, with little to no expectations of their own responsibility. I try to impress upon therapists who work in my practice, what their roles and responsibilities are before they join the practice. For example, when interviewing a prospective therapist, I stress the importance of them participating in increasing their referrals. I’ve encountered therapists who believe it is the practice owner’s sole responsibility for increasing referrals. I’ve also supervised fee for service therapists who believe they should be paid regardless of whether the practice has been reimbursed for services.

There are innocuous issues that therapists bring to practice that are less difficult to manage, but can be frustrating, if not dealt with openly. This includes therapists with attention deficit disorder, chronic disorganization or those who over commit. I find that coaching these individuals is extremely effective and often, they’re open to guidance on how to manage themselves and their responsibilities.
Therapists with significant, untreated mental health disorders or substance abuse presents many challenges to a supervisor. I’ve seen therapists engage in dangerous, unethical, illegal behavior, that is often the result of untreated issues. Often, personality disorders will contribute to destructive behaviors and it must be dealt with swiftly by the supervisor. It might mean making a report to the licensing board and/or alerting the police. Recently, in Delaware, there was a pediatrician who had significant mental illness. Many medical and other professionals were aware of, or suspected his problems were severe and impacting his patients. Sadly, it was revealed that he had tortured and sexually abused many of his young patients. This is abhorrent and even more detestable is that, there were later admissions by other professionals who suspected the sexual abuse was going on. The lesson for all of us, is to speak up, meet head on and do not act as a complicit partner with someone who is not well. Your clinical and professional judgment must take precedence to any personal or professional alliances.
I strongly believe that as managers and supervisors, our role is not limited to clinical supervision. Often times, we have to provide professional counsel to fellow therapists that involves recommending them to seek professional help. It is not the most comfortable position to be in, but it comes with the job. We will also serve as ‘ad hoc’ professional coaches, guiding other therapists to being the best they can be. It is also important to make sure that as a supervisor, you are attending to your needs and managing your own issues. We’re not immune to having issues and should never be above professional reproof or help. Ultimately, we are better serving our clients by ensuring that those who are providing services are performing optimally.