Clinical Consultation
Dr. Klafter's Clinical Office in Cincinnati OH
Approximately one-third of my professional time is devoted to consultation for psychiatrists, psychologists, psychotherapists, and other clinicians regarding diagnostic questions, impasses in psychotherapy treatment, psychopharmacologic strategy, development of advanced psychotherapy skills, and how to assess the suitability of patients for intensive psychotherapy or psychoanalysis. I also provide consultation for patients who are seeking a second opinion about diagnosis, treatment planning, or the next steps in situations where previous treatments have not produced satisfactory results.
Who can benefit from clinical consultation or supervision? Ideally, all psychotherapists should be supervised by or consult with senior colleagues. For psychoanalysts, consultation is a required aspect of professional development, where it is built into training programs for many years alongside the analyst’s personal psychoanalytic treatment. Even after training is over, consultation remains equally important throughout one’s professional career. Even though I am frequently consulted by other therapists and psychiatrists, I continue to consult with colleagues for my own growth and development as a clinician. Psychotherapists and psychoanalysts are life-long learners, and thoughtful consultation with experienced colleagues is one of the most important ways clinicians continue to refine their work over time.
What is the difference between consultation and supervision? Many clinicians use these terms interchangeably. In earlier stages of the profession, supervision was the term used to describe a therapist’s consultation with a senior colleague in order to develop new skills and or for help with a challenging case. In order to distinguish between professional relationships where the supervisor has actual authority over the supervisee, I continue to use the term supervision only when there is a formal hierarchical structure in place—for example, when a faculty member in training program supervises student therapists, or when a therapist is not yet licensed and works in a clinic under the authority of a credentialed supervisor. In other situations, where a therapist choose to seek out the help of a senior clinician, consultation should be understood as a collaborative process between colleagues who are working together to think more carefully about complex clinical problems.
Can patients seek consultations? Yes, a patient who is wishes to continue seeing the same therapist may wish to meet with another clinician to discuss questions areas of concern about his or her treatments. These consultations may involve a one-time diagnostic evaluation or may take place over time through ongoing discussion of clinical material, depending on the needs of the patient or the referring clinician. In the sections below, different types of consultation are described, including those which can be initiated by patients.
Second-Opinion Consultations for Patients and Clinicians:
No clinician should discourage a patient from obtaining a second opinion. Patients who have questions about whether their treatment is progressing as expected may wish to meet with another clinician for consultation. There may be questions about diagnosis, modality of therapy, the therapy relationship, medications being used, or other aspects of treatment. In most cases, diagnostic or second-opinion consultations are provided while a patient continues treatment with their current clinician. Ideally, the second-opinion process is collaborative with the treating clinician and supports that treatment relationship.
Diagnostic Consultations for Patients and Clinicians
complex and difficult clinical presentations
questions about personality organization, including narcissistic and borderline states
trauma, complex trauma, and dissociation
treatment-resistant depression or anxiety
questions about the suitability of psychoanalysis or intensive psychotherapy
Psychotherapy and Psychoanalytic Consultation for Therapists and Psychoanalysts:
psychotherapy and psychoanalytic treatments that appear to have reached an impasse
deepening a psychotherapy treatment toward a psychoanalytic process
transitions from supportive or manualized therapies to psychodynamic modalities
maintaining the professional frame when professional boundaries are challenged
understanding and working with transference, countertransference, enactments, and projective identification
working with resistance
working with dreams
working with patients or families who are skeptical about the benefits of psychotherapy and mental health treatments
Psychopharmacology Consultation for Physicians and other Prescribers
For psychiatrists and psychiatric nurse practitioners, consultation is available regarding patients who have failed to benefit adequately from multiple medication trials, including strategic combinations of psychotropic medications for treatment-resistant disorders, and the appropriate use of tricyclic (TCA) and monoamine oxidase inhibitor (MAOI) antidepressants. I am a member of the International MAOI Expert Group.
Cultural and Identity-Related Clinical Questions for clinicians
cultural, religious, political, gender, race, and sexuality-related factors that influence treatment
Dr. Klafter has specialized knowledge about religious beliefs, practices, and communities of devoutly religious patients, including Orthodox Jews, devout Catholics, evangelical Christians, LDS, and Muslims
Professional Development Consultation for Clinicians
decisions about pursuing advanced psychotherapy or psychoanalytic training
developing a stronger psychotherapy practice
building a more financially sustainable and stable professional practice
professional burnout