My Keynote at Colorado Counseling Association’s 2024 Annual Conference

“How’s it going?” My close community kept checking in on me as a I prepared to give my keynote at the Colorado Counseling Association Annual Conference in Keystone the next day. “I keep crying at certain parts of my speech,” I shared. I’d already given myself a grief hangover just writing my speech, now I was doing my best to stay composed as I said it out loud. “It’s okay to cry, your message is important,” each of them said. I agreed with them and continued to prepare. When it was time, I stood in front of almost 300 members of my community and introduced them to the term confidential grief. Defined by Dr. Lena Salpietro as losing a client to suicide and not being able to talk about it, I invited the audience to apply confidential grief to all the experiences in our industry that feel secretive due to feelings of shame, guilt, and judgement from others. I named the Big Five Fears of client suicide, client death, client violence, subpoena, and grievance as examples. We got to know our shame monsters together as a group. I had chosen to share my personal and professional journey of becoming a Confidential Grief Specialist. 

To help my colleagues understand the impact of confidential grief, I took them through six impactful and painful points in my 14 years as a therapist. These were stories that weren’t public knowledge due to confidential grief, and I named them as moments of self-doubt, shame, and leadership trauma. We grieved the loss of community members to violence and clients to suicide. We shared outrage at circumstances outside our control. And this time, I didn’t cry so hard that I lost my place. Instead I carried that emotion with me as I embodied vulnerability to a group of people I felt I was just starting to know more fully. 

As the talk continued, there were invitations to laugh, cry, and connect. I shared how I’d learned from my experiences that introversion is welcome (and necessary sometimes), vulnerability in leadership is allowed, and stories eliminate isolation in our field and as humans seeking connection against burnout. We talked about how to combat confidential grief through building community, showing up fully, and creating healing spaces for ourselves and others. I introduced bread crumbs imagery as bite-sized messages of hope and healing for folks to find when they were ready. Lastly, I shared a beautiful image on screen to start and close the talk. “There are not enough words” became an anchor amidst waves of emotion that come with confidential grief, and I invited my audience to share those words with others.

After my keynote was finished, I was given the gift of my community approaching me in both in the moments after and for hours into the next day to share their stories. You felt safe to share your losses of client suicide, your leadership trauma, and how you needed the term confidential grief to feel more seen. I heard countless exclamations that having a name for your experiences (both confidential grief and leadership trauma) was encouraging you to heal from here. I’m confident in the ripple effect of collective healing that will come from this gathering of clinicians, and find myself full of gratitude and with ‘not enough words’ to express the profound effect this experience will have on me for years to come. Thank you from the bottom of my heart for the collective healing and sharing together at CCA’s annual conference, I can’t wait to hear where your journey takes you from here.

A reflection on my Keynote titled Combatting Confidential Grief, Colorado Counseling Association Annual Conference

Breaking Free of Confidential Grief

Photo by Luke Besley on Unsplash

I first discovered the term confidential grief when researching for my latest book on helping clinicians heal from client suicide. In what felt like a sign from the universe, the September edition of the Counseling Today magazine arrived, and had an article titled Counselors Share What It’s Like to Lose a Client to Suicide. I felt compelled to reach out to Dr. Lena Salpietro, one of the quoted professionals who shared the importance of validation and empathy from mental health leadership to clinicians who’d lost a client to suicide. I couldn’t agree more with her statements and I was beyond excited that not only were people talking about the life-changing experience that is losing a client to suicide, but that there was a name for the behind-closed-doors experience of grieving a client loss.

According to the original research study published in July 2023, confidential grief describes the secrecy of our pain and grief when losing a client to suicide. Out of fear, shame, and perceived judgement from our peers, mental health professionals don’t feel safe to share that they are going through grief and loss, and thus attempt to grieve in private. It also feels confidential because client matters remain confidential, which means we can’t share our experience as openly as if it was a loss from a different part of our life. All of these things add up to an experience where clinicians are suppressing their emotions, attempting to compartmentalize their grief, and could result in them leaving the field due to the lack of support.

So here I am inviting colleagues to break free from confidential grief. How do we bring client suicide into the light? How do we prepare clinicians for this life-altering experience? For folks who’ve felt comfortable sharing with me thus far, I’ve often heard that nothing prepared them for this experience. With 1 in 4 therapists predicted to lose a client to suicide in their career, this is adding another layer of pain that could be easily addressed. How do we create safe spaces for this grief? Here are a few ideas for mental health leadership:

1. Attend to the person first, professional second.

When a client dies by suicide, the first thing we focus on as mental health leaders should be the clinician standing in front of us in shock. How do we help them navigate this event with compassion? Do they want to talk about it? Do they want to sit here and experience the flood of emotions with someone they trust? Do they need us to cancel their appointments for the day so they can go home? We can offer various things that could support them in a time where they may feel frozen in place.

2. Talk about it!

Let’s normalize that clients die by suicide. Let’s talk about it in graduate school, in community mental health, in internships, and in private practice. Let’s explore it with supervisees as a possibility so they can feel more prepared. So much more healing can be accessed if we normalize the possibility of this happening within our field.

3. Create spaces for healing

Since suicide will happen for 25% of us, how do we create spaces for healing? Is it a one-on-one conversation? A support group? A journey to self-discovery? A healing retreat? The more healing spaces we can offer, the more clinicians can move towards post-traumatic growth. What spaces do you know of? What more can be added for colleagues experiencing client loss?

There are lots more ideas in my book Moving from ALERT to Acceptance: Helping Clinicians Heal from Client Suicide. This book captures ideas for clinicians wanting to heal, as well as ideas for the mental health leaders helping them with that healing. You don’t have to do this alone. I recently shared with a colleague that I identify as a Confidential Grief Specialist to therapists amidst other roles of consultant, trainer, and course creator. For years, colleagues have been sharing with me their hardships and challenges, everything from family abuse to trauma, to substance use, to client death. It’s one of the reasons I started surveying colleagues on their career experiences with Adverse Psychological Events (APEs) as mental health professionals. Although confidential grief exists because of the loss of clients to suicide, I believe this term can be expanded to cover all sorts of career-related stressors, which create the potential for burnout within our field. Adverse Psychological Events can include client suicide, client death, client violence, subpoena, and grievance. All are disruptive and painful for clinicians, all are not spoken about freely because of fear, shame, and judgement.

Let’s break free of confidential grief together. We have a name for the experience, now we can offer something different! I know there are many of us out there wanting to create a safe, empowered container for clinician healing. Let’s share what we are doing to combat confidential grief and connect soon in our efforts to support colleague healing!

The Human in the Helper: This isn’t something essential oils are going to fix.

Gabrielle shows up as vibrant, friendly, and personable, which serves her well as a mental health leader and Licensed Clinical Social Worker. She’s made quite the name for herself as an entrepreneur and consultant serving therapists and professionals around burnout and burnout prevention. With her passion, beautiful tattoos, and love of Zumba, it’s hard to believe she’s already experienced significant professional burnout in her career.

“I woke up one day and hated it,” Gabrielle shared. “My clients were no longer my ideal clients. I didn’t have the boundaries I needed. I kept hearing my own voice in my head say, ‘this is how it is.” But Gabrielle found out that things could be different. She was venting about how tired she was to a colleague in another industry one day. Their response? Sell your practice. 

“I found myself fantasizing about selling, but with the number we came up with, it didn’t seem worth the work.” At least at first. Gabrielle spoke to how she’d entered the mental health industry while working three jobs, and was subscribing to the hustle and grind culture of being a Millennial. “I believed that the harder I worked, the better it would be.” Which lead to burnout. Gabrielle recalls how she worked a job where she and her colleagues were expected to work long hours, take their work computers home, and come in on Saturdays or Sundays to get caught up.

Gabrielle then moved into private practice, rapidly growing into a group practice serving a community in need. She acknowledged that she built her business fast with the same drive of previous jobs and hadn’t worked on all of her own stuff as a person and professional. “This is what business ownership is about,” she told herself when she felt it catching up to her. Then she got the call to sell her business. “I had to ask myself, what do I want my life to look like?”

Gabrielle is a trailblazer in the mental health community by challenging the assumptions that success means a full private-pay practice or group practice ownership. “I have no regrets, this is alignment with my values,” she said of selling her practice. When asked what she wants other therapists to know, she shared, “you can create your dream life! There are so many options.” She warned against comparison to colleagues or listening to the ‘shoulds.’ She named how therapists have set high expectations for themselves, saying “we didn’t talk about the risks of burnout in school.”

When reflecting on her current roles of being a business and burnout consultant, Gabrielle shared a story of how an old job asked for self-care tools to be donated to their self-care room for employees. “This isn’t something essential oils are going to fix.” We have to agree.

To learn more about Gabrielle and how she can help colleagues and professional communities heal from burnout, visit her website at https://gabriellejulianovillani.com/

Things happen to us as humans, even as we support our clients as professional helpers. Do you have a story you want to share with the mental health community? Email us at croswaitecounselingpllc@gmail.com to learn more about The Human in the Helper Series!

Setting Up Services: Supervision versus Consultation

Photo by Magnet.me on Unsplash

When thinking about services you want to offer in your business, it’s not unusual to explore offering both consultation and supervision as part of your mental health leadership. In fact, it’s a common question I get when supporting fellow supervisors and leaders who are building their brands as professionals. So let’s take a look at the opportunities and differences between consultation and supervision as you consider offering these valuable services in your work with others.

Clinical Supervision can be defined as a licensed mental health professional supervising an unlicensed or candidate mental health professional in their therapeutic work as they pursue licensure. Some things to note:

·      Supervision must be scheduled regularly per your licensing board

·      Supervision requires contract of expectations for both supervisor and supervisee

·      Supervision comes with liability for the licensed professional taking on an unlicensed professional until they achieve their own licensure

Professional Consultation can be defined as a written and/or verbal agreement to provide insight, suggestions, and resources to a colleague who is paying for your expertise. Some things to note:

·      Consultation can be scheduled as a one-and-done or as needed basis

·      Instead of a contract, there is a written agreement about the parameters of consultation including fees, duration, and specialities the consultant can speak to.

·      Consultation, as a professional service, has reduced liability similar to paying for a product. The consumer—in this case a colleague—agrees to a fee for your knowledge and expertise to support their goals.

So how can this look different when a fellow mental health professional outreaches you?

Consultation requests may sound like:

·      Can I pick your brain about building a group private practice?

·      Can I schedule consultation with you on a client’s OCD presentation and next steps?

·      Can we find a time to talk about suicide prevention resources in Colorado?

·      I’d like to staff a case with a recent DV incident, how do I schedule with you?

Supervision requests may sound like:

·      I’m seeking a supervisor who specializes in EMDR and Play Therapy

·      I’m looking for a supervisor who can support my clinical work outside of my agency that offers admin supervision only

·      I’m searching for a LAC supervisor to sign off on my hours

·      I’ve recently graduated and am seeking a supervisor as a I start private practice

Although an evaluation of appropriateness of supervision vs. consultation is encouraged at every outreach, knowing the context of what you can offer is a valuable first step when receiving an inquiry from your community. I hope this brief exploration of the differences in what you offer under each umbrella can help you in setting up your services with confidence!