MENTAL HEALTH CONSULTATION

· Finally, consultee-centered administrative consultation focuses on remedying difficulties among consultees that interfere with their abilities to perform their work. These problems may be the individual difficulties noted in consultee-centered case consultation or may be the result of poor leadership, authority difficulties, communication blocks, and other group problems. Table 16.1 provides a comparison of these four types of consultation.

TABLE 16-1: MENTAL HEALTH CONSULTATION

  Client-centered Case Consultation Consultee-centered Case Consultation Program-centered Administrative Consultation Consultee-centered Administrative Consultation
Focus Client-centered case consultation focuses on developing a plan that will help a specific client. Consultee-centered case consultation focuses on improvement of the consultee’s professional functioning in relation to specific cases. Program-centered administrative consultation focuses on improvement of programs or policies. Consultee-centered administrative consultation focuses on improvement of consultee’s professional functioning in relation to specific programs or policies.
Goal To advise the consultee regarding client treatment. To educate consultee using his or her problems with the client as a lever. To help develop a new program or policy or improve an existing one. To help consultee improve problem-solving skills in dealing with current organizational problems.
Example School psychologist called in to diagnose a student’s reading problem. School counselor asks for help in dealing with students’ drug-related problems. Nursing home director requests help in developing staff orientation program. Police chief asks for help in developing ongoing program to deal with interpersonal problems between veteran and new officers.
Consultant’s Role and Responsibilities Usually meets with consultee’s client to help diagnose problem. Never, or rarely, meets with consultee’s client. Meets with groups and individuals in an attempt to accurately assess problems. Meets with groups and individuals in an attempt to help them develop their problem-solving skills.
  Is responsible for assessing problem and prescribing course of action. Must be able to recognize source of consultee’s difficulties and deal with them indirectly. Is responsible for correctly assessing problem and providing a plan for administrative action. Must be able to recognize source of organizational difficulty and serve as catalyst for action by administrators.
From Brown, D., Pryzwansky, W. B., & Schulte A. C. (2006). Psychological consultation: Introduction to theory practice (6th ed., p. 32). Boston, MA: Allyn and Bacon. Copyright 2006 by Allyn and Bacon. Reprinted with permission.

Across the different types of mental health consultation, consultants consider these fundamental assumptions. Both characteristics of the consultee and the environment must be considered. Consultee’s beliefs, feelings, and attitudes impact behavior. Furthermore problems do not reside completely within the client but also at several levels within and outside of the organization. Other assumptions rest on the idea that technical expertise must be incorporated into intervention design. That belief recognizes that the norms, roles, language, and body of knowledge of the profession combine for the unique aspects of the context of the consultation. Furthermore, the responsibility for action belongs to the consultee. That practice promotes learning and generalization to other situations for the consultee. Caplan and Caplan (1999) explain that mental health consultation provides a supplement to other problem-solving mechanisms within an organization and that consultee attitudes and affect cannot be addressed directly—that would upset the working relationship in many ways (Brown et al., 2011). Sandoval (2014) has compiled an excellent volume about the application of consultee-centered consultation in schools.

Knotek and Sandoval (2003) pointed to a new definition of consultee-centered consultation that identifies the goals as a joint development of new ways to see the work problem. The process includes orderly reflection, generating hypothesis, and exchanging information. The relationship between consultant and consultee is supportive and equal. The goal of the relationship is changing the consultee’s understanding of the situation. The consultant helps the consultee think differently by using a range of techniques (Caplan & Caplan-Moskovich, 2004), with dialogue being used to explore the consultee’s view of the problem, introduce alternative viewpoints or new information, or reframing the problem to a solution focus. Nonetheless, the consultee is free to accept or reject the consultant’s ideas (Brown et al., 2011).

Another modification of mental health consultation is the ecological approach in which the consultant sees the client system as the source of difficulties between the individual’s ability and the demands of the environment (Gutkin, 2009, 2012). This approach involves three premises. The first assumption is that each setting has finite resources for maintaining and developing itself. Next, the model posits that in an adaptive environment the members have a variety of competencies. Therefore, the goal of intervention is to activate and develop resources. The ecological perspective focuses on consultation that cultivates opportunities to build competencies for self-development (Dougherty, 2013).

BEHAVIORAL AND COGNITIVE-BEHAVIORAL CONSULTATION

For school or mental health counselors interested in a more structured model of consultation, behavioral consultation may be appealing. This approach to consultation requires a deep understanding of behavioral theory and practice, especially Bandura’s social learning theory (Bandura, 1977). The foundation of behavioral consultation is that behavior is observable and can be modified through the use of learning principles.

Kratochwill, Elliott, and Callan-Stoiber (2002) outlined behavioral consultation and therapy as the application of systems theory and principles of learning a problem-solving process. The consultant gathers information from the consultee and then defines the problem in concrete, behavioral terms, as well as identifying the environmental conditions that maintain it. The consultant tries to help the consultee solve the problem by changing either the client’s or consultee’s behavior or the system in which the client and the consultee exist. Dougherty (2013) and Scott, Royal, and Kissinger (2015) detail the sequence of behavioral consultation as follows:

· 1. Problem identification: After a detailed analysis is performed, the problem is formulated in succinct, behavioral terms.

· 2. Problem analysis: A functional analysis of the problem is studied within its framework; antecedents and consequences are identified as well as task demands (cognitive, time, educational, and others).

· 3. Selection of a target behavior: The focus of the consultation is chosen.

· 4. Behavior objectives: Specific goals of the intervention are generated.

· 5. Plan design and implementation: A behavioral plan is developed and applied.

· 6. Evaluation of the behavioral change program: Measurement of behavioral outcomes in relation to goals established occurs.

The guiding principles of this model are the scientific perspective of using evidence-based practices, an orientation to the present, and the use of behavior change processes of operant conditioning—reinforcement, punishment, and shaping of behavior. Interventions begin with the agreement of consultant and consultee on a behavioral objective with one of three broad goals—reducing inappropriate behavior, increasing appropriate behavior, or eliminating an identified behavior. Consultant and consultee collaborate to change behavior. Intervention strategies, such as those described by social learning theory and cognitivebehavioral theory, also can be applied in the consultative setting to address either the antecedent or the consequence of the identified behavior. The choice of the intervention would be based on the one best suited to the knowledge, skills, and goals of the consultee (Scott et al., 2015).

MacLeod, Jones, Somers, and Havey (2001) have investigated the effectiveness of school-based behavioral consultation. Their findings support the importance of consultant skills and the quality of consultation in generating successful outcomes. Wagner (2008) identified behavioral consultation as one of the two most common methods to work with parents. The consultant promotes behavior change by closely examining the environmental antecedents and consequences of the child’s actions. Parents learn to observe and monitor the behaviors also and then apply behavioral techniques to modify the actions. Operant conditioning, which includes the use of positive reinforcement, punishment, and extinction, is the technique parents are taught. Danforth (1998) provided a Behavior Management Flow Chart, which gives parents a step-by-step decision-making process to respond to their child’s behavior.

Brown, Pryzwansky, and Schulte (2006) have developed general interview guidelines for behavioral noncrisis and crisis consulting. The consultant in a noncrisis situation (developmental interview) focuses on the following tasks:

· 1. Establishing clear general objectives

· 2. Reaching agreement with the consultee in the relationship between general objectives and more specific ones

· 3. Generating clearly defined, prioritized performance objectives with the consultee

· 4. Deciding how accomplishment of performance objectives will be assessed and recorded

· 5. Deciding on follow-up meetings

In a crisis or problem-centered interview, the outline focuses on the following tasks:

· 1. Identifying and describing problematic behavior(s) by collecting data from several sources concerning the nature of the problem

· 2. Determining the conditions under which these behaviors occur, their antecedents, and their consequences; the consultant and consultee analyze either the setting or interpersonal factors that contribute to the problem or the client’s skill deficits

· 3. Deciding on assessment procedures; the consultant and consultee design a plan to deal with the problem by identifying objectives, selecting behavioral interventions, considering barriers to overcome, and evaluating progress

· 4. Scheduling future meetings (Brown et al., 2006, pp. 52–53)

MacLeod et al. (2001) conclude that intervention planning was positively correlated to student outcome. A step-by-step plan, adhering to the treatment plan, and the comparison of baseline and treatment data all related to student behavioral change.

Consultants who use the cognitive-behavioral consultation approach also rely on collaboration and shared problem solving. Those consultants believe that both internal and external factors influence behavior. Antecedents to behavior may be complicated by cognitive, environmental, biological, and cultural factors. They concur that behavior has a purpose but caution that a person may not immediately know that actual purpose.

In cognitive-behavioral consultation, the consultee identifies the problem behavior or the absence of an expected behavior. The problem identification moves into a detailed description of observable, measurable behavior. A functional behavioral assessment involves identifying the cognitive, emotional, and contextual data that might be used to help select appropriate interventions. Scatter plots might be used for tracing behavior as well as personal interviews and other means of compiling a complete picture of the behavior. Chosen intervention should be simple and nonintrusive and closely monitored for effectiveness. Observing and assessing the impact of the intervention focuses on the accuracy and efficacy of the treatment (Scott et al., 2015).

SOLUTION-FOCUSED CONSULTEE-CENTERED CONSULTATION

The models presented earlier are based on a philosophy known as modernist. That knowledge base assumes that reality is a knowable, objective reality. Those philosophers contend that only the scientific method of research identifies and verifies new knowledge. In addition, they presume that human behavior can be measured and quantified in meaningful ways. Cause-and-effect relationships exist and are discoverable through appropriate research methods. Accordingly, the context in which people exist are considered either neutral or unimportant.

On the other hand, social constructivism, a postmodern philosophy, is based on the premise that a person cannot be separated from context, people must be studied in their environments. These theorists repudiate the idea that cause-and-effect relationships can be inferred and that the only legitimate source of knowledge about a person is the subjective frame of reference of that individual. Finally, these thinkers propose that the acquisition of knowledge occurs through social interaction.

This approach to consultation borrows significantly from the work of Steve de Shazer (1985) and his wife Insoo Kim Berg that was discussed in Chapter 10. In this approach to consultation, consultant works to understand how or what the consultee identifies as the problem and potential solution. Using brief solution-focused interventions, such as finding exceptions, the miracle question, scaling questions, and understanding the clients’ stories based on their perceptions, the consultant structures the process mirroring the therapeutic one.

During the first session, the consultant helps the consultee reframe the problem in manageable ways. The strengths of the consultee are identified and the consultant may distinguish themselves as coaches or facilitators of the problem-solving process. Problem identification begins with the question “what can I do for you today?” which quickly moves to forming a goal as well as scaling the problem. Solution-finding starts when the problem is identified and continues as consultant and consultee consider what has been tried and how that action has worked previously—exceptions to the problem help the dyad build a way to another outcome to the problem. Kahn (2000) presents a case study of this model used with a teacher in a middle school.

PROCESS CONSULTATION

Edward Schein (1999) has proposed a model of consultation he labels process consultation. He considers this approach to consultation as a skill. He emphasizes the interest in how things happen between people rather than what is actually done. More specifically, he defines process consultation as a “set of activities on the part of the consultant which help the (consultee) to perceive, understand, and act upon process events which occur in the (consultee’s) environment” (Schein, 1988, p. 11).

This type of consultation focuses on the ways problems are solved and on the system in which the problems occur. The consultant and consultee examine six different areas: (1) communication patterns, (2) group member roles, (3) group problem solving and decision making, (4) group norms and growth, (5) leadership and authority, and (6) intergroup cooperation and competition. The consultant may operate as a catalyst in helping the consultee find a solution or as a facilitator who aids the consultee through a problem-solving process (Dougherty, 2013).

Harrison (2004) explains three strategic goals of process consultation. The first is to encourage a situation in which the client will ask for help. The next is to diagnose or create a situation so that information will surface and people understand better what is happening. The third goal is to build a team or create an environment in which the client will take responsibility for the problem and the solution. To accomplish these broad goals, Schein (1999) outlines these principles that can guide any consultation approach:

· 1. Constantly try to be helpful.

· 2. Stay in touch with reality by being alert to what is going on with you, with the situation, and in the consultee and client system.

"Is this question part of your assignment? We can help"

ORDER NOW