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Do You Know What You Don't Know? Consultation Helps

By Tikvah Portnoi, LICSW

One of the important services provided by the Massachusetts Chapter of NASW is consultation. When a member calls the office with a questions, answers may be provided by staff, or based on the staff assessment, the call may be referred to an NASW member who is willing to address questions. The call may be directed to someone who is the chair of a particular committee which deals with the subject of the question, or our Ethics Hotline, or it might be directed to a volunteer who is senior and experienced in many areas of social work practice. I do consultation on clinical issues.

Clinical Consultation:

Questions may be the result of insufficient information about ethical or legal requirements, a clinical dilemma or insufficient information about a particular case. For example, imagine that you are a new LICSW and working as a fee for service provider in a family agency. You are working with a child client and you also see the child’s mother on occasion. The father, separated from mother, sees the child on a court-ordered visitation schedule and, caught up in a custody battle, calls you and wants to see the child’s re-cord tomorrow before a court hearing. You are being pressured by the father for immediate response. He sounds angry. Mother says he has no right to see the record. Your supervisor in the agency is on vacation. The director can’t meet with you for several days. Do you know what you need to know? What about confidentiality? What rights does the father have? What about his anger? Do you know how volatile he is when angry? An NASW consultant can help you figure out what questions you should be asking, and help you find answers.

Now imagine that you are an experienced clinician in private practice working with a paranoid client who is about to be fired from his job because of unexplained absences. Your client, distraught, believes that his boss is being unreasonable, is picking on him for no good reason. The client leaves messages on your voice mail telling you that you have to do something to prevent the firing or he will hold you responsible for the job loss. His voice sounds threatening. At the same time, your husband is about to be laid off by a firm which is downsizing. Your high school child’s grades are slipping. Your child is withdrawn and uncommunicative. You are feeling over-whelmed. How will you handle the distraught client in the midst of your personal issues? What are the risks? Do you know what you need to know? You need to assess whether the client is posing some risk to himself or to you. You need to find the best way to work with him. A consultation with an NASW volunteer can help you think through whether there are risks, and if so what they are, and help you decide how to handle the client crisis.

Any of us can find ourselves with personal pressures which make it difficult to sort out the best management of a very difficult client. A peer group can be a good resource at such a time and NASW can help a member get involved in such a group. But a consultation can be immediate.

These are just two illustrations of the kind of dilemmas which can be resolved through consultation. Many questioners have reported their relief and thanks to our organization and particularly to our Chapter.



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National Association of Social Workers - Massachusetts Chapter
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