Finding your Way: The Importance of a Clinical Pathway

Can you remember the last time you got that stuck feeling with a client in the middle of a session? Your chest tightens and a sense of incompetence rises and throws you off track completely. It takes time to pull yourself together and even more time to get your conversation with your client back in some sort of direction. So, how do you avoid this happening? You might get supervision around the issue with the client, or have intervision with peers where you share your experience, or even engage in more learning to get more information so that you will feel more competent. But it keeps happening. 

Lack of Direction 

But what if it is more about being lost than being stuck? When we explore where clinicians are getting stuck, it is quite surprising what we find. Clinicians get stuck a lot, it’s not always in the same places and it’s not only with particular clients, it can happen anywhere with any client. So the issue is broader than getting stuck, it’s more about navigation. You are navigating without a map, often unsure where you are and which direction to take next. You probably ask yourself “What do I do next?” over and over again. But should it be this way? Shouldn’t there be a guiding pathway that provides structure while still allowing for client differences?

The Power of a Pathway

A clinical pathway shows you how to keep your feet moving in the right direction, but the speed of your steps and where you pause are unique to each client. Instead of beginning each new client and session not knowing where it will go, you could have a structured roadmap that ensures consistency whilst allowing for necessary adaptations. Imagine it a bit like a runway that is lit up in front of you. You want to be able to see those lights from a distance and you want to know you’re going in the right direction long before you see the lights. 

As the different parts of PBBT as a full therapy regime were being pieced together, we felt it was important not to be driven by specific in-session exchanges, although they are important. Instead, we focused on the skills of setting up the context of sessions and what the agenda for each session should be, and in doing so we developed the PBBT Clinical Pathway - a clear overarching structure for therapy. In PBBT, clinicians can look up to the clinical pathway at any point and navigate their place with a client. Even if your dialog with a client becomes entangled, the pathway lights will pinpoint where you’re supposed to be and help redirect your dialog to achieve what that session aimed to do. This gives clinicians reassurance and confidence above and beyond what is happening at any point with a client. 

Think about the navigational pathway in PBBT like the yellow brick road from the Wizard of Oz. Your job is to ensure that your feet stay on the yellow brick road and don’t wander too far away from it because it is there to guide you and keep you going in the direction you want. If the yellow brick road is well built and soundly laid, as it is in PBBT, it will keep you on the right track with every client.