Not Going It Alone: Peer Consultation Groups

by Communications Staff

November 17, 2005 — When Fran Grossman, PhD, was treating a very challenging client several years ago, she wasn't sure she could continue the therapy.

"I was treating a client who was very smart, and very damaged by past experiences," says Grossman. "This client verbally attacked me on a regular basis."

Grossman turned to her peer consultation group for help. She discussed the situation with her colleagues in the group, and received the support and the answers she needed to maintain a dialogue with her client.

"I used the group to help me continue talking with [the client] and not simply to flee," says Grossman.

Peer consultation groups provide a forum for practitioners to meet informally with peers and colleagues to discuss clinical and practice issues in a supportive and confidential setting. Many practitioners like Grossman report that participating in such a group is an important professional activity for finding support and exchanging information about practice and therapy.

This article discusses how practitioners can benefit from participation in a peer consultation group, various forms the groups can take, and additional considerations related to peer consultation.

• Membership. It is important for practitioners to feel comfortable with the members of the group, including the members' range of experience and theoretical orientation.

• Structure. It is also important for practitioners to feel comfortable with a group's structure. Some groups have a more formal structure; they may, for example, devote each meeting to a prepared presentation of a case by one member of the group. Other groups are more informal, allowing group members to share information and anecdotes spontaneously. In addition, some groups have a recognized group leader, while others do not.

• Content. Some groups invite members to discuss a range of issues, including personal issues or practice management issues, while others restrict discussions to clinical matters. "In some groups, members feel free to talk about themselves-their own stresses, temptations, impairments," says Oraker, who notes that some practitioners appreciate this extra level of support.

• Size. The size of a peer consultation group can influence the dynamics of the group. Typically, in a small group, practitioners have more opportunities to contribute to discussions, while larger groups can offer participants more perspectives and feedback.

• Schedule. Some groups meet regularly on an established schedule, while others convene on an "as needed" basis. For example, Oraker is a member of one group that meets every other week, another group that meets semi-regularly, and a third group that only convenes when one of the members calls a meeting. Some groups meet for an hour, and others — especially those that meet less frequently — meet for longer periods of time.

Whatever form a peer consultation group takes, a common consideration among all the groups is confidentiality. The APA Ethical Principles of Psychologists and Code of Conduct (2002) states in Standard 4.06 that when consulting with colleagues, psychologists may not disclose confidential information that could lead to the identification of a client without the client's prior consent, unless disclosure cannot be avoided. In addition, the code says that psychologists may "disclose information only to the extent necessary to achieve the purposes of the consultation."

Another important consideration is recognizing the limits of peer consultation, which is not a substitute for all forms of professional support a practitioner may need. Practitioners must recognize when an issue raised in the group may require further consultation with an outside expert, notes Grossman.