Consultation Skills for Mental Health Professionals

Consultation Skillsfor Mental Health Professionals

Richard W. Sears

John R. Rudisill

Carrie Mason-Sears

JOHN WILEY & SONS, INC.

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Richard W. Sears

John R. Rudisill

Carrie Mason-Sears

JOHN WILEY & SONS, INC.

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This book is printed on acid-free paper.

Copyright 2006 by John Wiley & Sons, Inc. All rights reserved.

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www.wiley.com

To Ashlyn and Jeremy,from whom we have learned so much.

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Contents

Preface ix

Acknowledgments xi

Chapter 1 Introduction 1

Part One: Individual-Level Consulting Issues 23

Chapter 2 Clinical Career Assessment and Counseling 25

Chapter 3 Organizational Context 45

Chapter 4 Leadership, Management, and Supervision 76

Chapter 5 Executive Assessment, Selection, Interviewing,and Development 114

Chapter 6 Executive Coaching andPerformance Enhancement 153

Part Two: Consulting to Small Systems 221

Chapter 7 Working with Teams and Groups 223

Chapter 8 Training and Team Building 249

Chapter 9 Diversity Issues in Consultation 270

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viii Contents

Part Three: Consulting to Large Systems 299

Chapter 10 The Nature of Organizations 301

Chapter 11 Assessment of Organizations 318

Chapter 12 Organizational Intervention 331

Part Four: Special Topics 353

Chapter 13 Practice Management 355

Chapter 14 Clinical Consultation 386

Chapter 15 Consultation Services for Special Populations 413

Chapter 16 Crisis Consultation 428

Glossary 447

References 469

Additional Reference Sources 497

Appendix 499

Author Index 515

Subject Index 527

About the Authors 533

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Preface

This book is based on the class notes for the core course on consultation for doctoralclinical psychologists created by John R. Rudisill, dean of the Wright State UniversitySchool of Professional Psychology. Our intent is to educate mental health professionalson the practical aspects of consultation. This material covers traditional mental healthconsultation models, but also focuses on consulting with organizations, which is a rap-idly growing area of the field. Regardless of which area you find most attractive (or evenif you believe you may never actively engage in formal consultation work), the diversearray of knowledge covered in this book will prove useful to all mental health clinicians.The book is organized into four parts: (1) Individual-Level Consulting Issues, (2) Con-sulting to Small Systems, (3) Consulting to Large Systems, and (4) Special Topics.

The chapters in this book cover a broad variety of consulting topics and make ampleuse of disguised case examples taken from actual practice as well as fictional scenar-ios to illustrate and enliven the concepts discussed.

Chapter 1 provides an overview of consultation, discussing definitions, differenttypes of consultation, and the fields that have contributed to the research and knowl-edge base. It reviews the settings in which consultants work and highlights the basicskills and competencies needed by consultants. Basic problem-solving skills are alsooutlined.

Part One covers issues related to consulting at the individual level. Chapter 2 coverscareer counseling. Assessment and other issues are discussed for individuals who areseeking employment, changing fields, being promoted, or simply are not happy withtheir current jobs. Chapter 3 covers concepts concerning a variety of organizationalcontexts, including job stress, burnout, and how jobs are structured. Theories of humanand work motivation are explored, as well as basic legal issues regarding employment.Chapter 4 deals with leadership, management, and supervision. Beginning with histor-ical models of leadership, the evolution of ideas about how to manage others in theworkplace is traced, culminating in a multidimensional approach to conceptualizingleadership. Important leadership skills are taught, including supportive communica-tion, dealing with difficult employees, networking, negotiation skills, organizationalpolitics, and how to deal with conflict. Chapter 5 investigates the tools and skillsneeded for executive assessment, employment selection, effective interviewing, andprofessional development. Chapter 6 covers executive coaching and performance en-hancement, a rapidly growing field in which the consultant or coach works to im-prove the executives job performance. This chapter presents a variety of strategies,including how to apply psychotherapeutic theories to a coaching situation.

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x Preface

Part Two focuses on issues involved in working with small systems, such as groupsand teams. Chapter 7 explores the nature of teams and groups (using systems theory,role theory, and group theory), how to effectively conduct a meeting, and how to facil-itate a group (which involves feedback, basic skills, methods and tools, and designingeffective facilitation). Chapter 8 discusses how to plan and conduct training and team-building sessions. Though important diversity issues are highlighted throughout thebook, Chapter 9 focuses specifically on the many diversity issues that are important inworkplace and consultation settings, including how to educate managers and how tomake the workplace more inclusive.

Part Three investigates consultation as it applies to large systems. Chapter 10 dis-cusses the nature of organizations, and covers organizational structure, terms, con-cepts, culture, change, and resistance. Chapter 11 explores assessment issues, includingthe characteristics of healthy and dysfunctional workplaces, targets and goals of assess-ment activities, and how to perform effective assessment interviews. Chapter 12 looksat intervention issues and outlines the steps in process consultation, discusses organiza-tional change and development, considerations in the use of differing consulting styles,and strategic planning.

Part Four introduces special consulting topics. Chapter 13 covers the practical is-sues of running a consulting practice, including charting, billing, and the developmentof a marketing strategy. Ethical issues are also discussed. Chapter 14 provides infor-mation on clinical consultation and explores Caplans mental health consultationmodel, behavioral and ecological models of consultation, as well as general knowledgeand skills required for successful clinical consulting. Chapter 15 covers consultationservices for special populations, including school and pediatric consultation. Anno-tated bibliographies are included for those who would like to know more about thesesettings. Chapter 16 covers crisis consultation and outlines strategies for interveningwhen organizations experience traumatic events, including critical incident stressmanagement (CISM), psychological first aid, phases of disaster recovery, how to com-municate with the media, and crisis response in school settings.

The field of mental health is changing. With nationwide budget cuts, communitymental health centers and other agencies are cutting back on the number of high-levelmental health providers they employ. Aside from the positive aspects of doing consul-tation work, consulting may become a necessity for many clinicians to provide themeans to make a decent living.

Recently, there has been a rapid expansion of research into the field of consulting.Although it is important to have an understanding of the research base, this book fo-cuses more on the practical aspects of consulting. References provided at the end ofthe book show readers where to find more details about the empirical research.

As a final caution, remember not to consult in areas for which you are not compe-tent to practice. Just as you would not work with a deaf client (even through an inter-preter) without specific training in deaf culture and issues unique to that population,you should not begin to do work in large organizational strategic planning without spe-cialized knowledge, training, and supervision. In mental health work, the clients men-tal health is at stake. In organizational consulting, the organizational health and thefinancial health of the institution and all of its employees are at stake.

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Acknowledgments

We would like to thank the many students who have stimulated our thinking andpressed for increasingly helpful ways to impart this material, especially Erika Driverand LaToya Gregory.

Also, we appreciate the support of the generous and welcoming psychologists of theAmerican Psychological Association, Division 13.

Many thanks to our diligent research team, who are doctoral students at the Schoolof Professional Psychology at Wright State University: Shelley Leiphart and BrandonKozar, for their background research and painstaking indexing work, and TriciaGiessler, Lindsey Slaughter, and Jayme Arose for finding difficult to find citations.Thanks also to Susan Foskuhl, for all of her administrative support.

Thanks also to Elfriede and Charles Sears for all of their support over the years,and to Ashlyn and Jeremy, for all those times we told them we did not have time toplay. The mentorship of Joseph Petrick in business consulting and ethics is alsogreatly appreciated. The inspiration of ninjutsu teacher Stephen K. Hayes has alsohad a profound impact.

We would also like to thank Tracey Belmont, senior editor at Wiley, Ester Mallach,editorial assistant, and all of the Wiley staff for their encouragement and support ofthis project. Special thanks also to Charlotte Saikia for her diligent editing work, andto Pam Blackmon and Nancy Land of Publications Development Company of Texas.

This material was gathered from many sources over a number of years, and althoughevery effort was made to appropriately cite material, errors are possible. The authorsapologize in advance for any such oversights, and request that we be made known ofsuch instances so that proper credit can be given in future editions of this book.

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1

Chapter 1

INTRODUCTION

What exactly is consultation? Even very experienced practitioners in this field have adifficult time answering this question with precision. However, one way to define con-sultation is through consideration of the activities involved. Although the variety ofactivities makes it difficult to say what a typical day might be like, Box 1.1 shows asampling of a day in the life of a consultant in private practice.

As mental health clinicians, most of us are not particularly interested in consultationduring the early years of our career. We usually want to do therapy, most often individ-ual therapy, and are enlivened by the opportunity to intimately connect with individualsin a safe, structured environment. Consultation is sometimes neglected in mental healthprofessions because students conclude that clinical practice is the only legitimate pro-fessional expression of clinical skills. As we progress (and sometimes burn out), we

A Typical Day for a Full-Time Consultant

7:30 A.M. Have breakfast at the Racquet Club with the managing partner ofa law firm to discuss her business and personal concerns.

9:30 A.M. Work with an executive who is the victim of downsizing on ca-reer assessment.

11:00 A.M. Consult with a company concerned about a potentially violentemployee.

12:00 P.M. Put on a team-building and planning workshop with a small fi-nancial firm around the organizations future.

4:00 P.M. Meet with an owner and company president who are having dif-ficulty getting along.

5:00 P.M. Analyze a test battery from a selection candidate for an execu-tive position.

6:00 P.M. Coach a supervisor who was demoted by his company because ofhis poor people skills.

On the way home, think about the survey requested by a large social serviceagency and a consultation request by a medical practice.

Box 1.1

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2 Introduction

often begin to feel some comfort with individual therapy, and want to add increased com-plexity by seeing couples or families. From family or group therapy, the next step in ourdevelopmental mastery of complexity may be supervision or organizational consultation.

All the lessons we learn and the experience we gain from individual and grouptherapy are useful when doing consulting work. Therefore, this book begins with in-dividual interventions, moves into considerations for group interventions, and pro-gresses into principles for organizational consultation. Consultation is one of themost complex and challenging interventions a mental health provider can perform,but with that challenge comes great potential for service. We can often create majorimpact through our consultation efforts by using the important principle of leverage.As individual service providers, we are limited in the number of individuals we canhelp. By providing group therapy, we can further increase the number of individualswe help. Through consultation, however, we can ultimately help many more individu-als, especially when viewed from a systems perspective. Assisting a work supervisornot only improves the quality of work and life for the supervisor, it can foster ahealthier work environment for all the employees at that worksite. Consulting withother mental health providers about specific clinical skills (e.g., systems perspec-tives and diversity issues) can positively affect every client seen by each provider.Consulting with CEOs of large corporations can help improve the mental health ofevery employee in that organization.

Once we become more aware of the suffering in the world, we feel compelled to domore about the systems in which the suffering is perpetuated. You may feel that youhave little to offer, but what seems like common sense to you may be enlightening tothe consultee. As clinicians, we often experience this with psychotherapy clients. Whenasked later what was most helpful in therapy, clients often point out incidents that wedid not recognize as meaningful at the time and discover that the client has no recollec-tion of what we felt was the most meaningful therapeutic event. Whatever the percep-tions of either person, the end result is life-altering change.

Consultation has several unique features that may appeal to mental health profes-sionals, depending on their vocational and avocational interests. Often our clinicalclient base consists of individuals with severe psychopathology with whom it can beextremely challenging to work. Consultation clients are often highly skilled and ac-complished normal individuals who are extremely grateful for the consultants ser-vices. Consultants typically earn a relatively high fee, which is received promptly,avoiding the hassle of insurance companies and managed care forms and oversight. Onthe downside, consultation can be anxiety-provoking, tapping into our deep-seatedfears and worries about our competence. There is also a large degree of ambiguity inconsulting situationsyou may find yourself staring at the client with neither of youknowing what the other one really wants or needs. The knowledge that we have learnedand relied on in clinical situations, such as the importance of avoiding dual relation-ships, often becomes less applicable. Consultants must rely on a broad knowledge base,including fields such as business, education, and health. It also typically requires eitheran ability to market yourself well or a strong personal face validity, or presence.

We can use our past training and experiences to overcome most of these challenges(Bellman, 1990). We frequently face ambiguous moments or awkward silences in ther-apy, and ask questions or reflect the conversation to the client when in doubt (or we de-velop a comfort in using the silence therapeutically). We continuously face ethicalissues and devise a systematic framework for thinking about them. We are accustomedto being seen as an authority figure, with all the advantages and disadvantages entailed


Introduction 3

in such a perception. And those of us who have invested so much time and effort in oureducations are likely to enjoy learning new things.

Martin (1996) also encourages mental health professionals to remember the valu-able qualities we possess, which will give us confidence to do consulting work. Hedoes this by reminding us about the unique skills we have developed from our psy-chotherapy experiences:

1. You are an expert at forming and building a trusting relationship. The most significantelement of the consulting process is the client relationship. Skills that you take forgranted, like bonding, empathizing, confronting and disciplining, provide a competi-tive advantage in the consulting industry.

2. You have multidimensional training and experience. Organizational life is complex;and you will find your deeper analysis of the issues useful. The corporate client maynot see a problem as intrapsychic, as well as interpersonal, structural or systemic. Asa result, he/she will appreciate your broader perspective.

3. You are hypervigilant and tuned in to people. This makes you keenly aware of thesymbolic aspects of what you observe. Clients, particularly when recruiting execu-tives, find this ability extraordinary in preventing bad hiring decisions that literallycost millions.

4. You have conducted psychotherapy with extremely challenging cases, including border-lines and multiple personalities. As such, you have experienced firsthand the commit-ment required for healing and change. Your ability to stay in close proximity withorganizations undergoing the turbulence and pain of change will reap rewards fromyour grateful clients. Particularly artful transformation of negative transference isadmired. (p. 16)

DEFINITIONS OF CONSULTATION

The practice of consultation probably dates back to prehistoric humankind. Even be-fore the emergence of spoken language, someone more skilled at hunting could have as-sisted someone less skilled on becoming a more efficient hunter. As a serious andformal area of systematic study, however, the complex field of psychological consulta-tion based on scientific principles began in the late twentieth century.

The National Council of Schools and Programs of Professional Psychology(NCSPP) considers consultation to be a core competency in the training of psycholo-gists. Consultation is defined as A planned, collaborative interaction that is an ex-plicit intervention process based on principles and procedures found within psychologyand related disciplines in which the psychologist does not have direct control of thechange process (Bent, 1992, p. 77). For systemic competency, the NCSPP expectspsychologists to develop the capacity to use a systemic epistemology, systemic assess-ment processes, interpersonal relationship skills, and systemic intervention to assistlarger social systems and organizations.

Another definition might be that mental health consultation, especially when work-ing with organizations, is the act of applying psychological principles and understand-ing to promote the accomplishment of organizational goals. The accomplishment ofthese goals always depends on being able to mobilize the energies, dedication, team-work and synergy of its workforce. Organizations with the desire to achieve sustain-able, long-term growth and prosperity should have the development and fulfillment ofindividual growth as a part of their mission. The most precious resource of an organi-zation is its people, and understanding and being able to work with people is the most


4 Introduction

Definitions of Consultant

A consultant is a person with special knowledge, skills, and talent, who makesneeded expertise available to a client for a fee. This is perhaps the broadestdefinition of a consultant, and is applicable to any consultant in any field ofknowledge.

A consultant is someone who helps people deal with their organizational issuesand opportunities, in order to accomplish strategic directions (Widdis, 2005).This is a general business definition of consultant, perhaps best capturing thefunction of the management consultant: someone who works directly with themanagement and leadership teams in an organization to improve performance.

A consultant is an expert who charges you for looking at your watch andtelling you what time it is. Though this is said tongue-in-cheek, sometimes aconsultant may feel that he or she is receiving a lot of money for seeminglycommonsense information. However, some clients are happy to pay someonewith more expertise to oversee new projects, if only for the emotional comfortof knowing that help is close at hand should the need arise.

Box 1.2

important quality in skillful management and leadership. The task of the mental healthprofessional when consulting with organizations is to offer ways to accomplish goalsthat heighten productivity through the effective management of people. Box 1.2 pro-vides additional definitions of consultant.

THE TRIPARTITE NATURE OF CONSULTATION

Consultation generally involves three parties: the consultant, the consultee, and theclient. The consultee is the individual with whom the consultant works directly. Theclient is the individual or group with whom the consultee works. For consultation inclinical settings, the consultee may be a mental health provider who has little experi-ence with a particular type of client. The consultant is called in to discuss the clientsunique case factors with the consultee. In an organizational setting, a company (theclient) may hire a consultant to work with the CEO (the consultee) to enhance that per-sons managerial style.

The consultant, consultee, and client system are involved in a problem-solving pro-cess that includes relationship development, data gathering, problem identification,goal setting, strategy selection and implementation, evaluation, and often a recyclingof the process. This sequence is not necessarily linear (e.g., evaluation of how thingsare going can occur at any point during the course of consultation).

Caplan (1970), the founder of mental health consultation, originally restricted con-sultation to two professionals and their agreed-on work and firmly believed that ther-apy should never occur in a consulting relationship. This stance is generally accepted,but most mental health consultants would likely agree that the boundary between ther-apy and consultation is sometimes blurred and that it is difficult to avoid therapeuticissues when working closely with a consultee. However, it must be stressed that con-


Introduction 5

sultation is not the same as psychotherapy. In psychotherapy, the therapist works withthe clients personal issues. In consultation, the consultant works with the consultee toenhance the consultees effectiveness in a job situation or some other specific capac-ity. Although in practice, this distinction has many shades of gray, the consultantshould refer the consultee to another mental health provider should it become apparentthat psychotherapy is indicated.

The goal of consultation is to improve the consultee or client system in some way.Helping the consultee with the client system enhances the consultees knowledge,skills, and attitudes, leading to improved handling of the client system.

Another definition of consultation is tailored specifically to the field of human ser-vice (Goodstein, 1978). Dougherty (1995) characterized consultation as a process inwhich a human services professional assists a consultee with a specific work-related orcaretaking-related problem within a client system. This process helps both the consul-tee and the client system. Box 1.3 lists the core characteristics of consultation.

Unlike clinical, counseling, school, and industrial /organizational psychology, con-sulting psychology has only recently become a formally recognized area of training.Many mental health provider educational programs provide only some basic coursework,and quite a few programs do not offer any explicit consultation training. Because there isa growing interest in the field, many programs are now offering special tracks in con-sulting, sometimes in collaboration with business schools. Still, at the present time, nospecific credentials or licenses are necessary to do consulting work. Only in the last fewyears has there been postdoctoral recognition of consultation expertise, such as theAmerican Board of Professional Psychologys Diplomate in Consulting Psychology,which was first offered in 2003. The Society of Consulting Psychology, Division 13 ofthe American Psychology Association, produces a publication called Consulting Psy-chology Journal: Practice and Research. Clinical psychologists make up the largest per-centage of the Divisions membership. The career path for becoming a consultingpsychologist has not yet been clearly defined but typically has started from clinical,counseling, industrial /organizational psychology, or social psychology, with predictabledifferences in emphasis and skills. Industrial /organizational psychologists tend to bemore measurement oriented; counseling psychologists tend to be more career orientedand coaching oriented; clinical psychologists tend to be more involved with employee as-sistance programs and with troubled employees; and social psychologists tend to focuson an interpersonal and systems orientation with strong quantitative skills.

Even less clear are the roles and boundaries of competence for mental healthproviders such as counselors, social workers and psychiatric nurses, who have not beentraditionally as involved in organizational consulting. The unique training and strengthsof each discipline are likely to translate into valuable consulting niches. Practitionersfrom each field are advised to discuss these issues with their mentors.

CONSULTATION AS AN INTERDISCIPLINARY FIELD

Approximately 30 years ago, consulting psychology began to emerge from the shadowof clinical psychology. It became a truly interdisciplinary field, borrowing and inte-grating concepts, models, and research from business, organizational behavior, gen-eral systems theory, group dynamics, action research, community mental health,family systems, and social psychology, in addition to the godparent fields of clinicalpsychology, counseling psychology, social psychology, and industrial /organizationalpsychology.


6 Introduction

Core Characteristics of Consultation

1. Either the consultee or the client system may be given priority over theother at a given time, depending on the approach to consultation that istaken.

2. The consultant provides indirect service to the client system by providingdirect service to the consultee.

3. A consultant can be either separate from or part of the system in whichconsultation is to occur. Consultants who are not part of the system inwhich consultation is to occur are termed external consultants, while thosewho are part of the system are called internal consultants.

4. Participation in consultation is voluntary for all parties involved.5. Consultees are free to do whatever they wish with the consultants sugges-

tions and recommendations. They are under no obligation to follow theconsultants recommendations.

6. The relationship between the consultee and consultant is one of peerstwo equals. Although the consultation relationship is equal in terms of thepower of the consultant and consultee, it is unequal in terms of need; thatis, the consultee needs help with a problem and the consultant does not, atleast as far as the consultation relationship is concerned.

7. The consultation relationship is temporary. Depending on the type, con-sultation may range from a single session to weekly sessions for years.Whatever its length, however, the relationship is always temporarytheconsultant does not replace the consultee.

8. Consultation deals exclusively with the consultees work-related or caretaking-related problems (Herlihy & Corey, 1997). Consultation, bydefinition, only deals with the personal concerns of the consultee whenthey impact work performance. Sometimes, major personal concerns arebetter addressed in psychotherapy.

9. The consultant can take on a variety of roles in consultation, depending onthe nature of the problem, the skills of the consultee, the purpose and de-sired outcomes of consultation, and the skills of the consultant.

10. Consultation tends to be collaborative in nature; that is, consultants andconsultees work together to complement each other in solving the problemsdefined in consultation. Typically, consultants do not do for consulteeswhat consultees can do for themselves. One exception is when consulteeshave the skills but not the time to do a given task. For example, a consulteemight ask a consultant to lead an in-service workshop on substance-abusecounseling for the consultees organization, even though the consultee isskilled in that area (Bennett & Lehman, 2003).

Box 1.3

The mental health consultant can benefit from knowledge related to a broad array ofdisciplines. Following are brief descriptions of the many fields that contribute to theknowledge base of consultation.

Business: Research in the areas of business gives the consultant a background intothe processes that take place in organizations, including how organizations are struc-


Introduction 7

tured, managed, and how they survive. Such information can be important to consul-tants so that they may freely work in organizational environments, and better under-stand the reciprocal effects between organizations and individuals.

Organizational behavior: The study of individuals and groups in organizations(Schermerhorn, Hunt, & Osborn, 2000). This field draws heavily from both busi-ness and psychology research (Kolb, Rubin, & Osland, 1995; Matteson & Ivance-vich, 1993).

Human resource management: The design of formal systems in an organization toensure effective and efficient use of human talent to accomplish organizationalgoals (Mathis & Jackson, 2003).

Management: The use of organizational resources to achieve objectives throughplanning, staffing, leading, and controlling (DuBrin, 2000).

Marketing: The conception, pricing, promotion, and distribution of ideas, goods,and services to create exchanges that satisfy individual and organizational goals(American Marketing Association, 2005; Lamb, Hair, & McDaniel, 2003).

Sociology: The structure and functioning of societies. Knowledge of human behav-ior in groups is crucial to consultants who must find interventions for individualsand groups within a larger organizational and societal context.

Structural sociology: A sociological theory based on the premise that societycomes before individuals (Wordreference.com, 2005). It is the study of the vari-ous effects of structure on collective behavior.

Social psychology: The study of the influences that people have on the beliefs orbehavior of others (Aronson, 1999). Social psychology can be considered as a sub-field of both sociology and psychology.

Psychology: The study of human behavior. The science of psychology gives the con-sultant a strong background in the functioning of individuals and groups.

Clinical: The evaluation, diagnosis, and treatment of individuals with psychologicaldisorders, as well as treatment of less severe behavioral and emotional problems.Clinical psychologists typically perform psychological testing, interview clients,and provide group or individual psychotherapy (Weiten, Stalling, & Wasden, 1998).

Counseling: Overlaps with clinical psychology. Specialists in both areas engage insimilar activitiesinterviewing, testing, and providing therapy. Counseling psy-chologists tend to focus more on enhancing normal functioning or providing assis-tance with everyday problems of moderate severity, often specializing in family,marital, or career counseling (Weiten et al., 1998).

Industrial-organizational (IO): The development and application of psychologicaltheory and methodology to problems of organizations and individuals and groupsin organizational settings (American Psychological Association, 1981; Jewell,1998).

Organizational health: The application of the principles of health psychology inorganizational settings (Klarreich, 1998). Health psychology is the scientificstudy of behaviors that relate to health enhancement, disease prevention, and re-habilitation (Brannon & Feist, 1997).

Community: The branch of applied psychology that is concerned with modifyingboth the individual and the structure of the social system to produce optimalbenefits for both society and the individual. Community psychologists are primar-ily interested in preventing maladaptive behavior (Gladding & Newsome, 2004;


8 Introduction

Goodspeed, 1998; J. A. Lewis, Lewis, Daniels, & DAndrea, 1998; Sarason &Sarason, 1996).

Psychiatry: A branch of medicine that recognizes the impact of physiologicalfunctioning and health on an individuals performance in group and organiza-tional settings.

Administrative: Deals with the challenge of delivery system configuration and in-tegrated service delivery in the behavioral health system. Areas of study includeorganizational theories, leadership requirements, planning models, informationsystem solutions, models of program evaluation, quality management, and train-ing and human resource development (Talbott & Hales, 2001).

Consultation-liaison (C-L): The subspecialty of psychiatry concerned with med-ically and surgically ill patients (Academy of Psychosomatic Medicine, 1992).The C-L consultant has an extensive clinical understanding of physical /neurolog-ical disorders and their relation to abnormal illness behavior. The C-L consultantis a diagnostician, who teases apart and formulates the patients multiaxial disor-ders, and develops treatment plans. The C-L consultant also knows psychothera-peutic and psychopharmacological interventions as well as the wide-rangingmedicolegal aspects of psychiatric and medical illness and hospitalization. Thepsychiatric physician, by virtue of professional stature and knowledge, can super-vise a multidisciplinary team (Academy of Psychosomatic Medicine, 1998).Viewed separately, liaison work involves developing the skills of other staff in as-sessment and management of psychological problems, whereas consultation workassumes that the other staff already possess these skills and need a greater depthof expertise (Gelder, Gath, Mayou, & Cowen, 1996; Stoudemire & Fogel, 1993).

WHY CONSULTATION IS IMPORTANT FOR MENTALHEALTH PRACTITIONERS

Private practitioners have felt increasingly squeezed financially after the growth of themanaged care industry. To find out how practitioners were dealing with this, StevenWalfish (2001) surveyed psychologists and asked them to identify activities in their in-dependent practice that fall outside the purview of managed care. A total of 180 specificactivities were identified and were rationally grouped into 10 categories: (1) businesspsychology, (2) consultation to organizations, (3) fee-for-service, (4) forensic psychol-ogy, (5) group therapy, (6) health psychology, (7) psychoeducational services, (8) ser-vices to government, (9) teaching and supervision, and (10) miscellaneous. Several ofthese options are related to the core competency of consultation.

Although consultation can be considered a separate practice specialty, it encom-passes an important set of skills that support a clinical practice, such as the ability towork more effectively with parents, agencies, colleagues, and community groups.

Consultation skills are important for every mental health practitioner in performingthe following activities:

Addressing community needs and fostering social betterment

Advocating for underserved populations

Programming interventions, especially primary prevention interventions

Working with multidisciplinary teams


Introduction 9

All mental health professionals need to understand systems and organizations be-cause their work is done and their time is spent in a systems context (family, office,hospital, clinic, university). The mental health provider and the clients that are serveddo not operate in a vacuum.

As the managed care model, the industrialization, and the commoditization of men-tal health services continue, clinical providers will need more markets and new ser-vices to ensure their financial survival and a medium for the creative application andgrowth of their skills (Ackley, 1997). They may also work directly with organizationsto provide capitation and other traditional services. Capitation is an agreement with anorganization to provide mental health services to a set number of employees for a setfee for a set period of time. Organizations are increasingly looking to mental healthproviders for improvements in their operating efficiency (and therefore, bottom-lineprofits). According to an article from the Journal of Management (Danna & Griffin,1999), U.S. industry loses approximately 550 million working days annually to ab-senteeism, with an estimated 54% of these absences being stress-related. Estimatesplace the annual cost at more than $43 billion (p. 377). As experts in stress manage-ment, mental health clinicians can directly help the performance of organizations andimprove the work environments of individuals, thus contributing to the prevention ofmental illnesses.

Another important reason for learning about organizational factors is that manymental health professionals eventually become supervisors and managers, usuallywithout adequate training. Knowledge of consultation skills will help prepare practi-tioners for potential leadership and management roles.

HOW DOES CONSULTATION DIFFER FROMOTHER COMPETENCIES?

Consultation is a complex competency that overlaps with all the other aspects of mentalhealth practice: management, supervision, therapy, assessment, diversity/relationship,research/basic science. The development of consultation skills involves integratingthese various specialty areas. However, one must keep in mind important differences inhow these areas of competency are applied in consultation:

Management: A manager is directly responsible for the work of subordinates. Aconsultant is not directly responsible for the work results, but works indirectlythrough others.

Supervision: A supervisor exercises authority over the supervisee and holds eval-uation power. Consultants typically have a peer relationship with the clientthough the client pays the consultant for his or her time, the relationship is ideallyone of colleagues mutually working to solve a problem.

Therapy: In psychotherapy, the clinician helps clients directly. In consultation,clients are helped indirectly, through the medium of the consultee. The consultantis not contracted to do therapy, although therapeutic skills are important in theconsulting relationship. Consultants may also find themselves doing therapy forthe organization as a whole through systems intervention.

Assessment: When performing psychological assessments, the clinician mustoften make diagnoses based on limited information, usually provided only by the


10 Introduction

individual being assessed and any empirical data in the individuals record. In con-sultation, it becomes much more crucial to assess the broader influences on a com-plex system of many interacting variables. This usually involves gathering datafrom a variety of sources through interviews, questionnaires, and other techniques.

Diversity/relationship: Diversity issues, neglected in the mental health field untilrecently, are becoming increasingly recognized as crucial to efficacious therapeu-tic interventions. These are also important considerations for consultants. Con-sulting builds on this competency in designing accurate assessments and effectiveinterventions that consider diversity issues within an organization.

Research /basic science: Research skills and the basic ideas of the scientificmethod are important for the clinician to understand in order to develop and usethe most effective assessment and intervention tools. Likewise, these skills areimportant to accurately assess and intervene in an organization without beingswayed by potential biases. However, these skills constitute only a subset of thebackground knowledge needed for effective consultation.

CHARACTERISTICS OF THE PLAYERS IN ANORGANIZATIONAL SETTING

Only in the past 25 years or so have social scientists done much detailed, systematicstudy on how organizations work. Special areas of study such as organizational be-havior, which combines the fields of business and the social sciences, are becomingvery popular. Consulting psychologists working with businesses are known as corpo-rate, business, or organizational psychologists. Community psychology involves work-ing with nonprofit agencies.

Though mental health professionals possess many skills that they can leverage in anorganizational setting or consulting situation, it is important to understand the majordifferences between clients in the business world and in the helping professions.

Executives

Business executives, whether in a corporate or nonprofit setting, are responsible for thesurvival of the organization. Hence, their primary attitude toward people in their organi-zation involves seeing them as tools to meet organizational goals. Executives work to de-velop the skills of visioning ( leading), motivating (selling), monitoring, and rewarding(management), as well as their individualized specialty technical skills (e.g., accounting,finance, human resources, information systems, operations management, project man-agement, or strategic planning; Applegate, Austin, & McFarlan, 2003; Baker & Baker,1998; Brigham & Ehrhardt, 2002; Chase, Aquilano, & Jacobs, 2001; F. David, 2001;Mathis & Jackson, 2003; Meredith & Mantel, 2003; Stickney & Weil, 2000). The per-formance of most executives is measured (either by their bosses or by the companystockholders) in terms of their bottom-line outcomes, and hence their main emphasis ison monetary profit.

Mental Health Providers

Most clinicians primary attitude involves helping people maximize their humanpotential. Clinicians work to develop the skills of conceptualizing, listening with the

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third ear (empathy), understanding, accepting, and intervening. Hence, the cliniciansmain emphasis is on helping people (Corey, 1991).

Organizational Psychologists and Counselors

For organizational psychologists and counselors, the primary attitude toward peopleinvolves maximizing human potential to meet organizational goals, by helping organi-zations deal effectively with their employees. This requires rapport building, problemsolving, analyzing systems, and influencing others to implement interventions. Hence,they emphasize both process and people (Gallessich, 1982; Harrison, 2004; Rothwell,Sullivan, & McLean, 1995).

The inherent role conflicts among these differing attitudes and emphases suggestseveral implications for consultation:

As clinicians, we tend to treat individuals within the system as clients or patients.

As consultants, we tend to accept individual pathology and focus on the systemand its structure, which involves the organizations norms, rules, policies, culture,and climate.

Businesses exist to provide a return on investment to shareholders. Nonprofit andgovernment agencies exist to accomplish a nonmonetary mission, such as helpingpeople. These purposes can sometimes conflict. What is being recognized moreand more today, however, is that most of the time, what is good for the individualis also good for the organization. The relationship between process and peopleand profit is complementary. When employees are treated fairly and work in anenvironment wherein they feel respected and valued, they will treat customersfairly, and the customers will continue to do business with that company.

CONSULTATION SETTINGS

Consultation can take place in any organizational or work setting. What follows aresome of the most common settings where mental health professionals engage in consul-tation work.

Community Agencies

Because community agencies operate through government funding or on a nonprofitbasis, they usually cannot afford to hire a full-time advanced-level mental health pro-fessional. Such agencies include child welfare departments, social service agencies,and mental health centers. Consultants may be called on to help staff therapists dealwith problems they are having with one or more clients in their caseload, provide train-ing for work with diverse clients, or perform psychological assessments.

Educational Institutions

School systems may have special needs that their guidance counselors or schoolpsychologists cannot meet. A consultant may perform such services as working with

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12 Introduction

a schoolteacher to improve classroom management techniques, consulting with aspecial-education teacher about a student who has Aspergers syndrome, or provid-ing didactic sessions for school counselors in family systems theory.

Legal System

Courts and prisons frequently ask mental health professionals to provide diagnostic as-sessments, therapeutic interventions, and program evaluations. For example, a clini-cian may be called on to diagnose the reasons for high turnover in a prison staff.

Health Care Systems

Mental health consultants are increasingly playing varied roles in medical settings. Aconsultant may assist the staff of a multispecialty medical practice in identifying itsmajor work concerns and then assist in designing a strategic plan for overcomingthose concerns.

Organizations

Consultants can be useful in both for-profit and nonprofit organizations. Properlytrained mental health professionals can assist an organization with long-range strate-gic planning, short-range business planning, and executive selection and development.As an example, a consultant may help a human resources director develop and evaluatean employee satisfaction survey.

Government

The number and variety of government agencies that can profitably use a mental healthconsultant is continually growing. A consultant can perform evaluations and interven-tions at the local, state, and federal level. A consultant could assist a job corps centerstaff in increasing its morale, or could assist a Head Start program in evaluating itsparent training program.

Private Practice

Mental health providers who work alone or in a small group in private practice set-tings may feel isolated from their colleagues and from the frontiers of the mentalhealth fields. These clinicians may need outside consultants to provide training in spe-cific interventions for special populations or may provide in-service training for doingconsultation work.

TYPES OF CONSULTATION

There are many types of consultation, depending on the setting and the desired goals.These types are not mutually exclusive. Consultants may choose to specialize in a spe-cific type, may work in some or all of the following areas, or may creatively developunique practice niches.

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Clinical Consultation

Clinical consultation is the area that is most familiar to mental health professionals. Itmight include an initial session with a client to determine suitability for working withthe therapist, a referral from another department for an assessment of someone elsestherapy client, a session with a colleague to share special expertise, or a session withparents when treating a child.

Mental Health Consultation

Mental health consultation involves the prevention of mental health problems. TheCommunity Mental Health Centers Act of 1963 required mental health centers thatreceived federal monies to implement programs of consultation with other agenciesand professionals in their communities. Mental health professionals were generallynot trained in this capacity, and the community often resented their advice (Brown,Pryzwansky, & Schulte, 2001).

Caplan (1970) was a pioneer in the field of mental health consultation. He concep-tualized the role of the mental health consultant as one who helps other professionalswork more effectively with their clients around four key areas:

1. Lack of knowledge: The consultee may simply not have the knowledge base to un-derstand the problem at hand. The consultant serves the role of teacher, provid-ing education and information resources to the consultee.

2. Lack of skill: The consultee may not have the therapeutic skills to deal with theclients presenting issues. The consultant serves the role of teacher, enhancingthe consultees skills through discussing what-if scenarios, demonstrations,and role-play.

3. Lack of confidence: Often, the consultee may be performing very well, but is deal-ing with a complicated case or has little experience with the interventions beingused. The consultant may simply need to provide support and reassurance that theconsultee is doing well, and may offer some minor suggestions for improvement.

4. Lack of objectivity: When working with clients on material of an intimate andpersonal nature, it may be difficult for the therapist to remain objective, partic-ularly if the topics are bringing up unresolved issues for the therapist. The con-sultant can provide a fresh perspective for the consultee, relatively free of thecomplications of transference and countertransference.

Behavioral Consultation

Bergan (1977) developed a consultation model based on the principles of behavioralpsychology. Harrison (2004, pp. 189190) nicely summarizes the characteristics of be-havioral consultation approaches:

Behavioral consultation approaches are indirect services and usually are focused oncases and clients even when conducted in organizational settings (Dougherty, 1995;Gallessich, 1982; Keller, 1981).

Behavioral consultation approaches are most often used to problem-solve as well asenhance consultee competence (Bergan & Kratochwill, 1990; Mannino, Trickett,Shore, Kidder, & Levin, 1986; Vernberg & Reppucci, 1986).

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The goals of most behavioral approaches are to alter the clients behaviors, to changethe consultees behaviors, and to produce changes in organizations (Brown, Pryzwan-sky, & Schulte, 2001).

The length of the consulting relationship varies from minutes to months (Bergan &Kratochwill, 1990; Brown, Pryzwansky, & Schulte, 2001; Myrick, 1987).

In all cases, consultants should have a degree of expert knowledge in learning principlesand utilize social learning theory and behavioral technology principles to design, imple-ment, and assess interventions (Bergan & Kratochwill, 1990; Gallessich, 1982; Vern-berg & Reppucci, 1986).

The consultant /consultee relationship ranges from collegial to the consultant havingsome control in the relationship (Bergan & Kratochwill, 1990; Myrick, 1977).

The consultants major role ranges from facilitator (Myrick, 1977) to expert who im-parts psychological information and principles to consultees (Bergan, 1977; Bergan &Kratochwill, 1990).

A primary task of the consultant ranges from helping the consultee problem solve(Myrick, 1977) to enhancing the probability that the consultee will accept the consul-tants recommendations (Bergan, 1977; Bergan & Kratochwill, 1990).

In behavioral consultation approaches, the client or consultee goals or both need to bedefined in behavioral terms (Bergan, 1977; Bergan & Kratochwill, 1990; Dougherty,1990; Gallessich, 1982; Myrick, 1977).

Most approaches emphasize direct observation techniques (Keller, 1981) and focus onpresent, current inf luences on overt behavior (Bergan, 1977; Doughterty, 1990; Myrick,1977).

In most cases, the interventions and evaluations lend themselves to empirical testing(Bergan, 1977; Bergan & Kratochwill, 1990; Mannino et al., 1986; Vernberg & Rep-pucci, 1986).

Consultation-Liaison

Consultation-liaison work refers to a mental health professional in a hospital settingwho consults with medical professionals on psychological matters. The liaison workswith other disciplines (e.g., medicine, nursing, and social work) to detect, treat, refer,or some combination of these three, those patients who have mental health or stress-related issues, especially those that affect their medical treatment. The liaison mayalso work with the patients family or support system for such things as emotional sup-port. The liaison also works on improving the overall medical care system, and mayconduct research on the interaction of medical and psychiatric comorbidity (Rundell& Wise, 1999).

Program Consultation

In program consultation, a mental health professional provides services to a key figurein an agency or organization for the purposes of assisting in the planning of a new pro-gram, evaluating and revising an existing program, or in dealing with the factors thataffect a current program (e.g., a community mental health center may wish to begin anadolescent substance abuse program, but not have any experience with starting or run-ning such a program). The primary goal is to provide an organization with the techni-cal assistance it requires to have successful programs and to accomplish its mission(Dougherty, 1995; Harrison, 2004).

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Introduction 15

Community Consultation or Organizing (Advocacy)

Advocacy for the community entails getting involved in the community to create posi-tive change for everyone, especially for the underserved. Advocacy is for those whowant to change the world from what it is to what they believe it should be (Alinsky,1969, 1971). Mental health professionals are especially well-suited to understand thepsychological consequences of oppression and low socioeconomic status.

Organizational Consultation or Development

Organizational development (OD) is the application of behavioral science knowledge ina long-range effort to improve an organizations ability to cope with change in its ex-ternal environment and increase its problem-solving capabilities (Cummings & Worley,1993; Golembiewski, 1993).

Massarik and Pei-Carpenter (2002) offer the following working definition of OD:

In the context of continuing natural change at all interrelated levels of environment, so-ciety, organization, group, and individual, with focus on specified client systems, ODengages people within and among human systems (organizations) in activities (interven-tions) intended to bring about positive change for specifiable clients and stakeholdersand directed toward improvement of the human conditionguided by humane valuesby means of significant application of knowledge rooted in the social and behavioral sci-ences. (p. 2)

The National Center for Organizational Development, which is an internal consulta-tion branch for the entire Veterans Health Administration (VHA), describes its ser-vices as including executive coaching, leadership development and assessment, teambuilding, strategic planning, large and small group facilitation, work redesign, surveydesign and analysis, and psychoeducational interventions. Schein (1969) first intro-duced the idea of Process Consultation, which he defines as a set of activities on theconsultants part that are aimed at helping clients understand their internal and exter-nal environments better so that they can act on the process events that occur (p. 34).

THE ROLE OF THE CONSULTANT

The roles taken on by consultants are unlike those of most clinicians, though there maybe some similarities to therapists traditional roles. Consultants focus on the empower-ment of others. Just as in therapy, consultants do not want their clients to become de-pendent on them, but seek to replace themselves so that clients can continue to growwhen their consultant is not around. Hence, the consultant is really a servant, helpingothers to achieve their goals. The consultant is not a manager or an employee, but useslateral relationships to accomplish goals. This requires a tolerance for ambiguity, andrequires negotiation skills (since it is easier to terminate a consultant than it is to ter-minate a subordinate). The consultant must respect the organizations culture andmust learn to work within that framework to effect lasting change.

SKILLS OF THE CONSULTANT

There are three major skills areas for consultants: technical skills, interpersonal skills,and consulting skills. Technical skills comprise an area of expertise. If you have 30

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16 Introduction

years of experience in managing inpatient hospital units, then you can probably consultwith developing inpatient programs on how to run their units efficiently. If you are anewly licensed mental health professional, you may be considered an expert on groupdynamics, stress management, or mental health issues (assuming you have had the nec-essary training to work with organizations in these areas).

Interpersonal skills are also important for consultants. These are skills that most cli-nicians work on diligently in the course of their training, and they are accustomed toworking to improve these skills in their clients. As a consultant, it is especially impor-tant to understand the client context and to be able to make and sustain relationships byjoining with the client and building rapport. Important areas of knowledge include anin-depth understanding of assertiveness, supportiveness, confrontation, listening, man-agement style, and group process.

Finally, consultants must possess skills specific to consulting, which is the majorfocus of this book. There are five basic phases of consulting: entry and contracting;discovery and dialogue; feedback and the decision to act; engagement and implementa-tion; and extension, recycle, or termination (Block, 2000; Block & Markowitz, 2001).Entry involves making a connection with the client or organization, and contracting in-volves negotiating wants, coping with mixed motivations, dealing with concerns aboutexposure and the loss of control, as well as contracting for the work to be done. Dis-covery and dialogue are analogous to assessment and diagnosis. They involve surfacinglayers of analysis, dealing with political climate, resisting the urge for complete data,and seeing the interview as an intervention. Feedback and decision making involve fun-neling data, identifying and working with different forms of resistance, presentingpersonal and organizational data, running group meetings, focusing on here-and-nowchoices, and not taking things personally. At this point, the consultant must decide ifthe work needs to be continued, reconceptualized, or terminated.

One of the best compliments a consultant can receive is to be thought of as a personwho asks good questions. Asking questions allows consultees to think out loud, tosolve their own problems, and to become invested in potential solutions. It is a key skillfor consultants. Caplan (1970; Caplan & Caplan, 1993) maintains that the consulteesproblem-solving capabilities can be influenced by the consultants questions. As men-tal health clinicians, we work to become comfortable avoiding direct suggestions abouthow clients should handle their problems. We know that advice-giving (except in suchinstances as crisis intervention) is a lose-lose proposition: If we give good advice, theclient becomes dependent on us; and if we give bad advice, the client is harmed and ter-minates therapy.

Box 1.4 contains a checklist of the diverse competencies necessary for consul-tation work.

CONSULTING CORE COMPETENCY DOMAINS

The American Psychological Associations Division of Consulting Psychology (2002)has suggested incorporating the following consulting core competency areas into train-ing programs for consultants. The areas are divided into three levels:

1. Primarily Individual-Level Core Competencies: Individual assessment for purposes of career and vocational assessment Individual assessment for purposes of employee selection or development Job analysis for purposes of individual assessment

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Introduction 17

Checklist of Consultant Competencies

Personal and Interpersonal Effectiveness

1. Self-knowledge: Awareness of the values and beliefs that influence the wayone works.

2. Self-awareness: Awareness of ones own emotional responses to situationsand people, especially patterns.

3. Active listening: Attending to the content and process level in communication.4. Self-expression: Ability to express ones own thoughts, ideas, and feelings

clearly.5. Relationship-building: Building open, collaborative relationships. Exchang-

ing feedback in constructive ways.6. Conf lict-handling: Valuing and exploring differences. Ability to challenge

without alienating.7. Personal and professional limits: Awareness of the limit of ones own com-

petencies. Willingness to ask for help.

Qualities of a Change Agent

1. Tolerance of ambiguity: Ability to live with uncertainty and complexitywithout stress. Tolerate incompleteness.

2. Maintaining a long-term perspective: Helping clients identify and articulatedesired futures.

3. Maintaining a wide perspective: Not drawing boundaries tightly.4. Understanding the nature of change: Developing an intellectual and experi-

ential understanding of how and why people change.5. Facilitating change: Encouraging widespread participation in the design and

implementation of change.

Consulting Skills

1. Contracting: Clarifying mutual expectations and responsibilities.2. Data collection: Choosing appropriate methods of gathering information

that will help to address the issues and concerns of the client.3. Diagnosis: Having a range of frameworks and models for understanding indi-

viduals, groups, and organizations. Encouraging joint diagnosis with clients.4. Design: Being creative and purposeful in designing interventions. Being

willing to redesign on the spot.5. Closure: Disengaging well from the project. Avoiding mutual dependency.

Box 1.4

Executive and individual coaching Individual-level intervention for job- and career-related problems

2. Primarily Group-Level Core Competencies: Assessment of functional and dysfunctional group behavior Assessment and development of teams Creating group-level teams in organizations (e.g., self-directed work groups) Intergroup assessment and intervention

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18 Introduction

Group boundary assessment and intervention Identity group (racial, gender, ethnic) management in the organizational context

3. Primarily Organizational /Systemic-Level Core Competencies: Organizational diagnosis including systemic assessment of the entire organiza-

tion or large component parts of the organization Attitude, climate, and satisfaction surveys Evaluation of corporate management philosophy, organizational culture and

nature of systemic stressors Work flow and project planning activities Identification of aggregate performance measures Assessment of organizational values and management practices Organizational-level interventions Change management of organizational systems (p. 776)

INTERNAL VERSUS EXTERNAL CONSULTANTS

As evidenced by the foregoing, there are many types of consulting work, and manykinds of professionals who may call themselves consultants. We can divide consultantsinto two broad categories: internal and external.

An internal consultant provides consulting services within the organization. An in-ternal consultant is a direct employee of the organization, and usually works within orin collaboration with the human resources department.

An external consultant provides consulting services on a contractual basis and isbrought into the organization for a specific purpose. As a person with presumed objec-tivity and special expertise, a consultant does not have direct responsibility for goalachievement. External consultants are used when sufficient time, people power, objec-tivity, or competence is lacking within the organization to solve the problem or con-cern at hand. Because of this, external consultants hold a marginal role for thelong-term operations of the organization and are generally under contract for a spe-cific, time-limited purpose. Table 1.1 shows the advantages and disadvantages of inter-nal and external consultants.

ELEMENTS OF THE CONSULTANT-CONSULTEE INTERACTION

The quality of the interactions with consultees is crucial to the success of consultation,just as the quality of interactions with clients is crucial to success in therapy.

Gallup (1998) listed several qualities that characterize a good consulting relation-ship: a workable rapport, compatible problem-solving style, integrity, open communi-cations, clear goals, and reasonable outcome measures. Successful consultants have thefollowing four characteristics:

1. Responsibility: Consultants should assume all the responsibility in their ownthinking, but must also work to build a sense of responsibility in the consultee toresolve the challenges being faced.

2. Feelings: As mental health providers, consultants know the power of emotions,and the importance of managing the consultees feelings as well as the consul-tants own reactions.

3. Trust: To build trust, consultants must always deliver on what they promise. Thismeans being careful about what they promise, and being quick to admit when

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Table 1.1 Internal versus External Consultants

Internal Consultants

Advantages Disadvantages

Knows the system (formally and informally)and how to use it.

Knows the language and how to express ideasin an acceptable way.

May know key people and how to inf luencethem.

May have a well-established network of contacts.

May already have a lot of information aboutthe problem.

Can work unobtrusively at times.

Is well placed to seize opportunities.

Is less likely to be expected to provide instantsolutions than the external consultant.

Can keep in close touch with the long-termconsequences of a project.

May have difficulty establishing visibilityand credibility.

Has a history, such as past failures, old alle-giances, that may get in the way of success.

May be too much a part of the systemnotsufficiently detached.

May be part of the problem.

May be perceived to be too much a part ofthe system, thus limiting trust.

May feel wary of confronting superiors,especially senior managers.

May be subject to political /hierarchical pressures.

May have limited room to maneuver becauseof tight role definitions.

May not be able to refuse.

External Consultants

Advantages Disadvantages

Is more likely to be seen as outside the poli-tics of the organization.

People more likely to be open.

People more willing to listen to and hear anoutsider.

Can bring new perspectives and freshinsights.

Can more easily provide contacts with otherorganizations.

Can become an important communicationchannel, especially upward.

Likely to have high visibility because ofheightened expectations.

Can more easily be direct and confronting.

Has freedom to turn down an assignment.

May be put on a pedestal, leading to defer-ence/resentment /disillusionment.

May need a lot of time to discover how thesystem really works.

May only see part of the problem.

Leaves at the end of a project and may notsee the long-term results.

May use ideas that are too different from theorganizations current way of thinking.

Source: A Consultancy Approach for Trainers and Developers, second edition, by K. Phillips and P.Shaw, 1998, Brookfield, VT: Gower.

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trouble develops in delivering those promises. Sometimes the difference be-tween success and failure is strong follow-through.

4. The right of consultants to their own needs: Consultants must be aware of theirown desires and needs for acceptance, inclusion, validation, access to the com-pany, and support from management, and must recognize how these desires willinfluence their work.

THE CLASSICAL PROBLEM-SOLVING SEQUENCE

As a consultant, you will frequently be called on to solve problems. Some may arguethat consultation can be defined as problem solving. In many instances, your clientswill have repeatedly attempted and failed to solve the problems they are currently fac-ing. Bringing in an outside, objective perspective can be helpful in re-conceptualizingthe situation. A simple device, the classical problem-solving sequence, can assistclients in systematically dealing with the problems at hand, and will give them thetools to more effectively work with future challenges.

How thoroughly the problem-solving sequence is conducted depends on the com-plexity of the problem, the seriousness of the issues involved, the amount of time avail-able, and the potential consequences of any decisions made. However, the same sixproblem-solving steps are useful whether the consultant is assisting in the developmentof a treatment plan for a consultees deaf client or helping to manage the merger of twogiant corporations.

The first step is to define the problem. Although at first this appears to be the eas-iest step, in practice, the presenting problems often are fuzzy and ill-defined. Consul-tees may know that something is not right, but may not know precisely what is goingon within the organization or client system. In addition, even if they know they aredissatisfied with the current state of affairs, they may not have identified what theend goal should be. Just as in individual psychotherapy, a thorough assessment of cur-rent functioning and clarification of how things would be different if the consulteecould wave a magic wand can often be a major intervention in and of itself.The formulation of a succinct goal statement will guide the rest of the problem-solvingprocess.

The second step is to identify alternative solutions. The consultee and the consultantcan brainstorm various possible solutions to the identified problem; they also can con-duct research and discuss the situation with others to develop a list of possibilities. Atthis stage, it is important not to prematurely filter out ideas, but to generate as manyideas as possible. Even if an idea initially sounds untenable, it may spark other, moreplausible ideas.

The third step is to weigh the consequences of alternative solutions. The implica-tions of each solution should now be examined. What are the short-term and long-term costs? Who else will this affect? How feasible is each solution? What timefactors are involved?

The fourth step is to implement the decision. As clinicians know, this step can bedifficult. Making a choice involves many factors, and there is often a great deal of am-biguity. The most difficult decisions are those that preclude other possibilities. Peoplesometimes procrastinate in making choices so that they will not have to face the conse-quences of the decision, even if they know it is the best decision in the long run. Theconsultant should be supportive during this stage, but must always allow the consultee

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The Classical Problem-Solving Sequence

1. Define the problem.2. Identify alternative solutions.3. Weigh the consequences of alternative solutions.4. Implement the decision.5. Evaluate the consequences of the decision.6. Redefine the problem and restart the problem-solving sequence.

Box 1.5

to make the final decision, since the consultee must feel invested in the decision and isthe one who bears the burden of the consequences.

The fifth step is to evaluate the consequences of the decision. Once the decision hasbeen implemented, the results should be monitored and evaluated. Are the desired re-sults being achieved? Quantitative results are best if possible. Instead of asking ifmorale has improved, the consultant could determine if employee absences have de-creased. Instead of asking if the mental health client has improved, the consultantcould determine if the client has had fewer return visits to the emergency room. Sub-jective measures are also important, but results that can be measured (e.g., by using astandardized or individualized survey instrument) provide justification for charging afee for services.

The final step is to redefine the problem and restart the problem-solving sequence.Complex problems are seldom fully resolved with a single perfect solution. Even if youwere to arrive at a perfect solution, environments that are internal and external to theorganization or client may change with time. You must monitor the situation to see ifnew problems have arisen, or if the old problem still exists in other forms. Then youcan move once again through the entire problem-solving sequence. This general se-quence, which is used frequently in consulting, is shown in Box 1.5.

Consulting can be thought of as helping people solve their own problems, and psy-chological consulting can be thought of as solving people problems. Eventually, thisprocess becomes internalized, just as experienced clinicians no longer need to meticu-lously follow a rigid list of assessment steps for every diagnosis. Although this se-quence serves as a guide, many influences affect a persons problem-solving ability(DuBrin, 2000), and mental health professionals should be well suited to deal with theeffects of psychological and contextual factors.

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PART ONE

INDIVIDUAL-LEVELCONSULTING ISSUES

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Chapter 2

CLINICAL CAREER ASSESSMENTAND COUNSELING

We begin our exploration of consulting techniques by looking at interventions at the in-dividual level. This chapter investigates individual personality variables and how theyrelate to the differing demands of the workplace. This information is valuable to youngmen and women who approach the consultant seeking advice about suitable careers. Itis also valuable for people who are interested in changing careers or who are havingdifficulties with their current careers but are not sure why. The topics in this chapterwill be useful to mental health professionals whether they are engaged in formal con-sultation in organizational settings or are simply assisting their therapy clients withcareer counseling (Savickas & Walsh, 1996).

The information in this chapter is also valuable for consultants who enter organiza-tions for what may ostensibly be a systems-level change. Consultants who can identifypersonality and work styles will be able to design interventions that are more likely tobe well received and implemented. They are also more likely to detect mismatches be-tween individual styles and performance expectations. Knowing the workers strengthsand weaknesses, the consultant can make recommendations that optimize the function-ing and satisfaction of the employees within a given system.

Career counseling should involve several interviews with the client. Sperry (1996)describes five phases for this process:

1. An intake interview in which the career counselor or consultant and worker estab-lishes a working relationship such that some working hypotheses about the workersneeds and well-being can be formulated.

2. A phase involving what might be called problem definition in which the workersmajor concerns are made more explicit than in the initial interview, and a priorityorder of these concerns is established.

3. An assessment phase that involves some more or less systematic appraisal of theworkers attributes that seem to be most closely related to the defined problem orproblems. This assessment can be done using interview methods or might involve arather extensive variety of psychological tests and inventories (Lowman, 1991). Fur-thermore, the assessment phase can include work simulation or job sample tasks andtechniques.

4. The feedback phase in which the consultant reports back to the worker the results andthe potential meaning of the previous phases, particularly the assessment phase.

5. Finally, an implementation phase in which the workers main responsibility is tomake decisions pertinent to putting into action, in appropriate ways, some of themajor information and attitudes gleaned from the previous four phases. (p. 106)

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26 Individual-Level Consulting Issues

The consultant should encourage individuals to try out new careers before investinga lot of time in preparing for them. This may be best achieved through interviews, shad-owing, internships, or even part-time work in the career field (Boldt, 1999).

When helping individuals with career choices, it is important to assess and integratethree domains: occupational interests, abilities, and work-related personality charac-teristics (Lowman, 1991). When a client comes to you and asks for help with careerchoices, exploration of the clients interests is a good place to begin (Watkins & Camp-bell, 2000).

HOLLANDS HEXAGONAL MODEL OF INTERESTS

Psychologist John L. Holland used factor analysis with the empirical findings on voca-tional interests to create a theory of six basic occupational personality types: Realistic,Investigative, Artistic, Social, Enterprising, and Conventional, as shown in Figure 2.1(Gottfredson & Holland, 1996; Holland, 1966; Lowman, 1991).

Those types closest to each other are more similar, whereas dissimilar types aremost distant from each other. That is, adjacent types share more commonalities thando those that are opposite one another.

For career assessments, an individual takes a written test that produces a classifica-tion based on the initial letters of the top three type scores. The Holland VocationalTypes are commonly measured by several existing assessment instruments: the Self-Directed Search (Holland, 1994; Spokane & Catalano, 2000), the Vocational Prefer-ence Inventory (Holland, 1985; Lowman, 1991), the Career Assessment Inventory(Johansson, 2002), and the Strong Interest Inventory (Hansen, 2000; Harmon, Hansen,Borgen, & Hammer, 1994). Most occupations have associated code types that charac-terize the typical worker in that position. The prototypical manager would be ESC(Enterprising, Social, and Conventional, with the highest score listed first). Engineersmight typically be IRC, IRE, RIC, or RIE. Small differences in code types can makebig differences in interests. People with consistent codes (codes with types that are

Figure 2.1 Hollands six occupational personality types.

Realistic Investigative

ArtisticConventional

Enterprising Social

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Clinical Career Assessment and Counseling 27

next to each other on the diagram, which means they are somewhat similar) will havean easier time finding a career match because doing any one job effectively usually re-quires similar qualities. If their occupational type code does not match that which istraditional for individuals in their chosen career, they will tend to approach job tasks ina discrepant manner, leading to career frustration, both personally and professionally.People tend to do a good job in selecting their own careers, which is probably related togenetics (their predispositions) and reinforcement (if they dont enjoy a particular job,they seek out another one). Values are an implicit part of interests. To make the best ca-reer decisions, people need exposure to a variety of careers that match their interests.

Needless to say, these classification codes are to be used as tools. No one particu-lar client will neatly fit into any one category. As always, be careful to avoid pigeon-holing clients.

Though not as accurate as a full written assessment, you can do a quick self-assessment by writing down the six types on a piece of paper (especially after readingmore about them in this chapter). Mark your primary interest, second strongest inter-est, and third strongest interest. You can then mark the area in which you have theleast interest.

Here are the typical occupational types for mental health professionals:

SAI or SIA Counselor, clinical or counseling psychologist, clinician

SAE Social worker, counselor

ISA Research psychologist

SEC Teacher

S versus I The scientist /practitioner dilemma

What occupational code type best describes you? You can work in the mental healthfield with any code type, but if your occupational code type is very different from thetypical ones, you may find yourself doing things in a different way from many of yourcolleagues, perhaps feeling as though you are swimming upstream from time to time.

When assessing clients, have them explain what their typical interests and activitiesare, instead of simply having them choose from the list of six. Ask them what kinds ofthings they most enjoyed in the past, and what they most long for in the present and fu-ture. Ask them to recall occasions when they felt most alive, most content, and whichof their work activities cause time to fly by.

If you get a flat profile (the client doesnt really have any interests that stand outabove the others) or a high profile (all or most interests are rated highly), the clinicianshould consider the possibility of psychopathology. People with serious mental healthconcerns should prioritize psychological treatment over career assessment, as it will bedifficult for them to truly reflect on interests when they are overwhelmed with dailystressors. This is especially true if they have low profiles suggesting depression and/orburnout. Work must first be done in psychotherapy to build motivation and hope withinthe client.

Some people have not had enough experience to define their interests. In this case,mutual exploration between the consultant and consultee may be helpful. Although youshould avoid overt dissuasion of the consultees thoughts about career possibilities (itis fortunate that the Wright brothers did not seek career consultation before inventinga means for practical f light), you should encourage people to do things that make sensein terms of their abilities and talents.

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28 Individual-Level Consulting Issues

HOLLAND THEMES

Following are brief descriptions of the six Holland types (Harmon et al., 1994; Low-man, 1991; Prince & Heiser, 2000).

Realistic

People who score high in this area exhibit an emphasis on doing and things (e.g., build-ing, repairing, working outdoors, mechanical interests).

Realistic individuals tend to be employed in occupations such as the military, engi-neering (some types), skilled trades, and work with mechanical objects. Jobs couldrange from simple blue-collar work to highly skilled work as an airline pilot. Typically,individuals who score high in the Realistic category graduate from high school and getjobs instead of long-term careers.

Realistic people often have superior physical abilities and express a preference forthe concrete, for tangible things, and for the real world. They take what is given andhave difficulty when the job isnt there (when unemplo

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Consultation Skills for Mental Health Professionals