I am maybe not a professional who gets the right to speak on behalf of clinicians. I was triggered heavily by a case manager who told me I did not hold clinical training or degree experience. She was rude and offensive. This is not a call out to her.

My last post was a call out to unethical behavior and ways we can advocate for ourselves, that demonstrate our clinical ability to maintain composure while being accountable and firm.

My school was very kind and said they were proud of me and impressed I knew to leave. I found that a true clinical experience values the students wishes over the compliance requirements to get hours.

My clinical perspective is really different than most therapists who hold master’s degrees.

I own up to this, and I don’t want to offend master’s level clinicians, as I don’t think they are bad or ill trained at their level or role.

We cannot know what we aren’t made aware of.

My diagnostic profile is really – let’s say – finessed in that I don’t put up with poorly trained or supervised clinicians. I have mostly really liked PsyD or LPC who are in private practice, where the modality was leaning toward expressive or Gestalt.

I don’t think this is something most clients would be able to say in their first few sessions – that they can tell if a clinician is unskilled.

My neurodivergence is often mistaken for an inability to recognize when I’m being taken advantage of, and I’m often finding ways to stand up to those in clinical spaces.

I recently expressed to a clinical site that I use a Gestalt framework within DBT and CBT, as well as Gottman and IFS interventions. I’m sure there was a better way to say this. But the fact did stand that my clinical experience was respected.

In my clinical perspective, I find client feedback and challenging to be very productive. Relational therapy (often being a professional friend) can only be used to build rapport or when there is a moment where we must respect the client over a clinical need/desire to make more progress.

Clinical work is really hard.

I expressed it to a supervisor I hope to once day work with by saying, “True clinical work challenges the part of us that wants to fight those we want to help.” I said this to a supervisor not because we were in a situation of fight, but because I realized then I was going to turn her down for the time being and wanted to remind her that I was not looking to be persuaded at the moment.

I don’t think this was the wrong answer.

Ultimately, the supervisor said that she hopes our paths cross again in the future.

I find responding as our authentic self allows us to give a positive outlook to employers while maintaining the truth to clinical work.

My perspective on clinical work is also that we allow ourselves to see if the supervisor is willing to learn from us and respect who we are.

I am not asking clients to know my personal information or business. That’s not appropriate.

I am asking that supervisors have enough knowledge to respect when I am saying things from a genuine place of clinical interest and from a place of genuine interest or inquiry.

I often like clinical work because true clinical work is where the supervisor listens to the needs of their clinical staff. In case management, it’s maybe not this way, which may be why I haven’t been successful in that domain.

I have performed clinical assessments, diagnostic evaluations, and therapy sessions. My documentation was written with creative flow, sure, and my QA/QC person loved it. I learned fast where to integrate in a sentence or two about what I was doing and what was or wasn’t important.

When I gently tell case managers that I have a different clinical perspective than them, what I am gently saying is that they are being clinically incorrect or unethical in their position.

Many master’s level therapists are trained case managers. This is not me saying case management is not essential or a skill that takes years of training and hard work.

Rather, clinical work is not case management.

Case management is not technically giving transferable skills into clinical work.

In case management, many of the functions are to listen, document, solve, and advocate.

In clinical work, it is to listen, document, challenge, listen, document, inquire, challenge, learn, understand, and even pose questions about the view presented. It is important to see the difference.

Relational therapists are trained case managers.

I don’t think they are going to do harm.

They just aren’t doing clinical therapy.

They may not understand the difference, and it may be really hard to explain the difference, as there can be a very strong connection in the field of keeping on people who aren’t the most ethical.

Clinical ethics are so different.

The way we gather consent is different.

The way we supervise is different.

Even the way we stand up for ourselves is different.

Clinical work asks us to consider if the client’s needs are more important than our need to make them feel better. Because the need is sometimes not what is being said, or felt, but what isn’t said.

I have taken interviews for jobs I knew I wouldn’t be able to take on at the moment.

I wanted a chance to interview the supervisor.

In a setting where it was not stressful on me.

Maybe it’s hard for them, too.

I see it.

Clinical work is challenging.

I did not lie about where I was at or what my intentions were, just that I wanted to see if the jobs could be a good fit for future placements.

Maybe that’s non traditional.

Yet, I learned from my mistakes.

Interview the supervisor ahead of time.

Get the chance to ask the questions about the site, the work, and the field they are in.

My difference in clinical practice than some is a matter of personal ethics.

I believe that misrepresentation of a role or organization is unethical. Some may disagree, and I’m willing to accept that’s a grey area. To me, what’s clinical is clinical, and my ethics are that clinical work cannot come at the expense of a client.

If the work is also not clinical in scope, I don’t react want to be in the role.

I like helping people grow and change. But just being a good listener is not ethical clinical practice.

XOXO,

Dorothy B