Clinical Consultation Jeffrey K. Edwards, Ed.D., LMFT Northeastern Illinois University

Definitions of Consultation Me and you talking about him or her with the purpose of some change occurring (Fall, 1995). A contractual relationship where by a person or persons (consultants) are hired to deliver services (product) to a person, group, organization, or community (consultees) for the purpose of some kind of change. The relationship is voluntary, temporary, and goal focused.

Principles of Consultation A Triadic relationship (focuses on a third party) that may be an individual, organization,or a group within an organization. It is not therapy! Consultants may be internal or external.

Principles of Consultation Internal consultants are from within the organization, and thus are responsible to the organizational leadership. External consultants are hired from outside and have responsibility only to complete the task for which they are hired. Issues of confidentiality when collecting data differ with each of these types of consultant.

Consultation changes over the years. Early on consultants were hired for direct service interventions. There may not be someone with specific skills to accomplish a task, and the consultant is responsible for doing what needs to be accomplished. (consultee is not involved in process, usually. (Serenity House – consultation/supervision/ therapy of staff) (Catholic Charities – AAMFT Clinical Supervision)

Consultation changes over the years. Consultation for a specific purpose and to train staff – Consultee is included in process. Children’s Memorial Hospital – need for training of clinical staff in supervision skills.

Consultation changes over the years. Consultant is hired to provide specific skills and training for the purpose of exploration of problems, (process consultation) and either make suggestions for, and/or implementation of interventions to deal with the problem. (Lutherbrook and racial problems)(Artistic company and productivity).

Consultation Trends – away from a “Dis - ease”model. Systemic – all parts of the system are in need of evaluation, and are affected by a) the problems that are in need of changing, and b) the intervention that may be implemented. Developmental – Individuals and Organizations pass through predictable stages. Prevention – by designing interventions that are pro-active and take into account the system and development, one can predict with some degree of accuracy what to do to prevent similar problems in the future.

Consultation Models Using the different models of psychotherapy or theories of change, consultants will modify their approach according to what they believe and how they think about the problem to be addressed, and the intervention they implement. Our theory says more about our self than it does about the consultee we serve.

Stages of Consultation Preentry – being contacted, preliminary exploration of what needs to be done (in the eyes of the consultee), explaining how consultation works, and how this particular consultant (you) will work. It is here that the role of the the relationship is first defined. Who the consultant is responsible too (sometimes a person without power is asked to contact the consultant, and this needs to be gently explored and the relationship explored).

Stages of Consultation Entry – Making contact with those in authority, and exploration of what needs to be done (in the eyes of the consultee), and then preliminary contracting for services. It is here that the role of the the relationship is fully defined. Who wants what (what are the goals), who will pay for services, who will use the consultation and for what purpose, what is to be done, the responsibility of the consultant, follow-up needs, etc. This need not happen during the initial contact, but can happen at the time of presentation of proposal for services.

Stages of Consultation Information Gathering – Needs assessment, data gathering, and permission and parameters for data gathering. Contracting specifically regarding what are the parameters, what will be done with information, how it will be used, confidentiality, roll and relationship between those who are requesting services, those who make decisions, and the consultant, and goals of intervention.

Stages of Consultation Solution searching, and intervention Determining strategies for change, discussion with consultee, agreement on the form of intervention, and follow-up. Contracting again for services, if the consultant is going to provide the intervention, or suggestions for further work and referral. A good intervention is goal oriented and measurable.

Stages of Consultation Evaluation – either by qualitative or quantitative methods. Were goals met, and to what degree, using surveys, or other means of direct observation. Based on the evaluation, either more consultation may be contracted for, referral to an appropriate source for further work, or termination may occur. Termination

Consultation Process Effective decision making requires free and open choice – Consultee (supervisee) has choice. Implementation requires Internal Commitment – consultee needs to be committed to process of change. Goal is to establish a relationship and solve problems together so they work and stay solved. Change works best when consultee feels the need, and goals and solutions are mostly their ideas. Process means examination of all data, and choice making. Collaboration works best, over that of “expert” role. Block, P. (2000). Flawless Consulting.