In a way, Babbins-Wagner is like surgical specialists who’ve performed one kind of operation so many times that they’ve achieved a degree of mastery and success unmatched by any other colleague. Even so, this ability to specialize your way to excellence is a luxury not available to most therapists in most agencies, where “potpourri” or “mishmash” is the only kind of case load most can expect, and if agencies have their own problems in creating the kind of conditions that promote a culture of excellence, individual therapists face even more of a challenge.
Most therapists who begin their careers in agencies move on to private practice as soon as they can. At that point, they’re truly on their own—directly accountable to nobody except their clients, the law, and their own consciences. So where and how can private practitioners find a trustworthy community of their peers that will challenge them to keep growing as therapists and people?
In December 2009, the International Center for Clinical Excellence (ICCE) was launched, and since then, it has grown into the largest, global, web-based community of clinicians, researchers, administrators, and policymakers dedicated to excellence in behavioral health. Clinicians can choose to participate in any of the 100-plus forums, create their own discussion group, immerse themselves in a library of documents and how-to videos, and consult directly with peers. Membership costs nothing, and the site is free of the advertising, solicitations, and endless e-mail so typical of the web, list-serves, and other online venues. With just a few clicks, practitioners can plug into a group of like-minded clinicians whose sole reason for being on the site is to raise everyone’s performance level.
“Being a solo practitioner can be very isolating,” says Australian psychologist and ICCE member Vanessa Spiller. “Having a supportive, like-minded community in which I can ask questions and present ideas and thoughts, and have people critically review these—which I’ve done several times—has been very helpful. It’s been great to be able to access this ‘oasis’ of international expertise, providing me with a community of peers willing to critically review my work, identify some of my unquestioned assumptions, and make specific suggestions for changes I can implement and objectively evaluate the effectiveness of.” Similar sentiments are expressed by Dutch psychologist Peter Breukers. “As a solo practitioner, the ICCE gives me a safe ground to fall back on while I practice sticking my neck out, implementing new ideas, and thus continually and deliberately refining my ideas and methods.”
What seems so striking about ICCE is that it transcends its online limitations—which often reinforce anonymity and invisibility—to provide members with the same complex norms of personal connection, openness and honesty, mutual trust and support, challenge and accountability that any “land-based” community of excellence offers. There is, for example, the same emphasis on taking risks and sharing one’s mistakes, admitting when you’re having difficulty, don’t know what to do, or suspect you aren’t helping a client get better.
“Risk is the key to growth,” says Danish psychologist and ICCE Community Manager Susanne Bargmann, “Without taking a chance, venturing beyond the tried and true, nothing happens. It’s only through difficulty that you learn. It’s precisely for this reason that the members and associates continue working very hard at making the ICCE a safe place for clinicians to share openly, and be pushed and stretched.”
The ICCE community isn’t merely a resource aimed at preventing ethical and professional lapses. It’s a genuine source of friendship, support, and encouragement to those practicing a profession that’s not only lonely, but frequently characterized by real self-doubt and anxiety. “I don’t feel alone—I never feel it’s just me and the client,” says Bargmann. “I have this whole team—a network, a community of colleagues that I can access whenever I need them.” As in any other excellence-driven community of practice, the freedom the ICCE provides to openly and freely admit failure, embrace error, and make mistakes is “enormously empowering,” says Bargmann.
With thousands of practitioners using the website, including some of the world’s best-known therapists, it may be surprising to learn that the self-promotion and ego stroking that often color professional gatherings is almost entirely lacking. Also absent is the contentiousness that supplants civil conversation on so many online listservs and forums. No “my way is the best way” is tolerated. “While the various forums are monitored by ICCE trainers and associates for compliance,” says Ms. Bargmann, “the need for intervention by management has been minimal. In fact, the staff spends more time participating than policing! And there’s an ecumenical spirit and degree of curiosity, humility, and camaraderie in the interactions that’s quite inspiring and, frankly, seems organic in origin.”
Meeting the Challenge
Coming full circle, our investigation of top-performing agencies and clinicians shows that excellence requires that we look forward and have a process in place that enables continuous renewal, growth, and expansion. Complacency is the enemy. The field as a whole and practitioners in particular face a number of stark challenges in the future, not the least of which is remaining competitive, if not relevant. As the people we work with and the culture in which we all live are constantly changing, so must we. The time is now.