The Cost of Not Knowing & How Consultation Pays Down the Debt

There is a quiet cost many of us carry as clinicians—the cost of not knowing. There is no way to know everything or have an answer for everything in our work.  However for those of us working with complex trauma, attachment injury, and dissociation the cost can be heavy. It’s the cost of not always knowing what to do next, how to respond, or how to stay grounded and attuned when the work feels heavy, slow, or unclear.

This cost doesn’t show up on a balance sheet, but we feel it:
in the sessions we replay on the drive home,
in the moments of self-doubt,
in the way we carry work home with us from time to time.

For many of us, investing in clinical consultation has been one of the most meaningful ways we’ve learned to pay that cost down—not by finding perfect answers, but by widening the field of support, perspective, and relational safety around our work.

Keeping Stamina for the Journey

Research tells us that treatment for clients with complex trauma is lengthy and can span years. This reality asks something different of us as clinicians. It asks for endurance, humility, and the ability to stay present in long arcs of healing that are rarely linear.

Consultation does not “solve” our clients’ problems—and it isn’t meant to. What it does offer is support in navigating both doing the work and the being with our clients:

• Supporting clinical conceptualization and meaning-making
• Refining micro-skills and clinical interventions
• Understanding stuck points and reenactments
• Attending to relational repair
• Making sense of countertransference and somatic responses
• Staying regulated, curious, and compassionate over time

In our own careers, consultation has helped us approach clients with greater steadiness and clarity. Consultation has helped our clinical work become smoother, more attuned, and more sustainable.

Another Brain, Another Set of Eyes

Working with clients who carry complex trauma histories often requires us to hold multiple layers at once: nervous system states, attachment dynamics, dissociative processes, and the relational field unfolding in real time. No matter how skilled or experienced we are, there will always be moments where one perspective simply isn’t enough.

Consultation offers another brain.  Another set of eyes.  Another nervous system in the room.  And in group consultation, this expands exponentially.

Rather than holding clinical uncertainty in isolation, group consultation allows us to access many minds, many lenses, and many ways of understanding what might be happening beneath the surface. Someone may notice a subtle attachment rupture. Another may reflect a dissociative process. Another may name something relational you felt but couldn’t yet articulate.

Together, these perspectives broaden the clinical landscape—and reminds us that we are not alone in the work.

Many Perspectives

Many of us engage in multiple forms of consultation because each offers something unique:

• Group consultation brings collective wisdom, normalization, and rich clinical dialogue
• Peer consultation offers mutuality and shared language
• Individual consultation allows for depth, specificity, and focused reflection

None of these replace the others. Together, they form a web of support that holds both the clinician and the work itself.

Consultation is Self Care

At its core, investing in consultation is an ethical choice. It says:

I don’t have to know everything to do this work well.
My clients deserve more than my best guess in isolation.
I am allowed to be supported, too.

When we invest in consultation, we are not admitting inadequacy—we are honoring the complexity of the work and the humanity of everyone involved.

An Invitation

We currently have five remaining spaces in our clinical group consultation offering for clinicians working with complex trauma, attachment injury, and dissociation.

This group is designed to be:

• Relational and supportive
• Clinically rigorous
• Grounded in both skill-building and reflective practice
• A place where uncertainty is welcomed, not shamed

If you’ve been carrying the intellectual and emotional cost of this work on your own, we invite you to consider whether now is the time to invest differently.

👉 Learn more and reserve a spot here:
Click here to join

You don’t have to do this work alone—and you were never meant to.

We would love to hear from you.

Nicole & Jill

References

Courtois, C. A., & Ford, J. D. (2016). Treatment of complex trauma: A sequenced, relationship-based approach. Guilford Press.

Figley, C. R. (2002). Compassion fatigue: Psychotherapists’ chronic lack of self-care. Journal of Clinical Psychology, 58(11), 1433–1441. https://doi.org/10.1002/jclp.10090

Knight, C. (2018). Trauma-informed supervision: Historical antecedents, current practice, and future directions. The Clinical Supervisor, 37(1), 7–37. https://doi.org/10.1080/07325223.2018.1440707

Norcross, J. C., & Lambert, M. J. (2019). Psychotherapy relationships that work III. Psychotherapy, 56(4), 423–430. https://doi.org/10.1037/pst0000233

Schön, D. A. (1983). The reflective practitioner: How professionals think in action. Basic Books.

Skovholt, T. M., & Trotter-Mathison, M. (2016). The resilient practitioner: Burnout prevention and self-care strategies for counselors, therapists, teachers, and health professionals (3rd ed.). Routledge.

van der Kolk, B. A. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma. Viking.

Watkins, C. E. (2011). Does psychotherapy supervision contribute to patient outcomes? Considering 30 years of research. The Clinical Supervisor, 30(2), 235–256. https://doi.org/10.1080/07325223.2011.619417