Case Studies

A therapist consulted with me about an 11-year-old boy in a recently divorced family who had engaged in inappropriate sexual behavior toward younger siblings—and later, toward a peer at a sleepover. CPS had already been involved, and all children were in therapy, but the treating clinician felt stuck: limited rapport, unclear worldview, and growing safety concerns.

We clarified three key priorities:
✔ A psychosexual evaluation to assess risk and guide next steps
✔ A home safety protocol (including no sleepovers) created in collaboration with the mother’s therapist
✔ A nuanced understanding that age 11 is a critical window—young enough for redirection, but old enough to require serious clinical planning

The therapist left with a clear path forward, grounded in development, trauma theory, and practical safety steps.

A group practice offered both traditional therapy and in-house case management—but therapists weren’t referring clients to the case management team. Instead, they were spending valuable therapy time on tasks like helping clients fill out forms or navigate services—often missing critical supports and limiting the depth of clinical work.

Frustration grew across the clinic. Leadership saw the need. Case managers were underused. Therapists felt unsure or resistant.

In consultation, we brought all key voices to the table and uncovered the root issue: this wasn’t a one-training fix—it was a systems and communication problem. Together, we:

✔ Identified therapist concerns around autonomy and client continuity
✔ Clarified the scope and value of professional case management
✔ Facilitated ongoing dialogue between therapists, case managers, and leadership
✔ Developed a 5-point referral strategy that respected clinical judgment and organizational structure

The result? A plan that restored clarity, saved therapists time, and ensured high-needs clients got the layered support they deserved.

An experienced supervisor reached out for support—not because she needed help training a clinician, but because she was stuck balancing support vs. accountability.

Her supervisee chronically avoided clinical documentation. Notes were delayed by weeks, and when submitted, read more like casual check-ins than professional records. Even after trying every supportive strategy—co-writing notes, scheduling admin time—nothing stuck.

The supervisor didn’t want to throw him under the bus, but she was also accountable to the clinic’s standards and facing pressure to bring the issue to HR.

In our consultation, we:
✔ Reviewed the clinic’s policies and clarified what truly crossed a line
✔ Helped her define her own supervision metrics and boundaries
✔ Created a framework for transparent documentation of her supervisory efforts
✔ Outlined how and when to escalate to HR with integrity and fairness

This gave the supervisor a clear, values-aligned path forward—supporting her clinician as far as ethically appropriate, while honoring the clinic’s responsibility to quality care and risk management.

A thriving group practice was in a paradox: they had more clients than they could handle—but couldn’t attract or retain the right clinicians to meet the demand. Less experienced therapists struggled to retain clients, and seasoned clinicians often left to launch their own practices. On top of that, the practice kept getting referrals for specialized issues (like sexual addiction) that they weren’t equipped to support.

The leadership team knew they had something valuable—but they couldn’t seem to grow in the right direction.

In our consultation, we explored layered, actionable solutions:
✔ Upskilling from within: Guided existing staff toward specialty areas that aligned with both personal clinical identity and organizational need
✔ Rethinking recruitment: Identified ways to bring in more seasoned clinicians at reduced rates in exchange for steady referrals and flexible part-time arrangements
✔ Using data to drive direction: Analyzed client intake trends to forecast hiring needs and adjust service offerings accordingly

The outcome? A clearer plan to build capacity with intention—grounded in what clients were asking for, what therapists wanted to grow into, and what the clinic could sustainably support.

A young adult client came into a clinic with early-onset psychosis—but was denied access to the region’s RAISE program due to a history of autism and ADHD. At just 20, he had already been hospitalized multiple times and couldn’t maintain stability outside of inpatient care.

The clinic brought me in to help them reimagine how to support him when no formal program would.

Together, we:
✔ Assembled a multidisciplinary care team—including a psychiatrist, therapist, nutritionist, and family liaison—to create wraparound support
✔ Designed a clear, stage-based recovery framework with measurable goals (e.g., medication adherence, three daily functional tasks, and emotional self-monitoring)
✔ Initiated regular family meetings to ensure treatment aligned with the client’s own life goals
✔ Identified and navigated external supports to transition him toward sustained recovery

The result? He stabilized—no further hospitalizations, improved medication management, increased independence, and a family finally supported in a way that worked.