The purpose is to guide mental health professionals in exploring consultation
as an extension of primary treatment efforts as well as an alternative to the traditional
therapeutic approach. A main premise being that the additional skills
necessary to provide effective consultation are built upon a professional’s solid foundation
of clinical knowledge and expertise.
As a mental health provider, you may intend to expand your current practice to offer
additional services or plan to develop a new program to address the concerns in your
community. Others may simply wish to hone their existing skills in working with those
providers with whom they already collaborate regarding ongoing clients. It is likely
that most mental health professionals have already been involved in consultation without
necessarily having any formal training or instruction specific to that area. These
situations are likely to have been brief sidebars or “hallway consults” as a professional
courtesy to colleagues in your clinic or via a telephone call for advice from another
provider in the community. Such clinical consultation opportunities are most likely to
arise when a mental health professional, through additional training and experience, is
requested to share his or her more advanced understanding of particular diagnoses or
disabilities, stages of development, specialized treatment methods, alternative
lifestyles, and so on.
The demands for alternative or specialized services are increasing such that it is
time for the creation of more structured systematic training in consultation for mental health professionals. While many graduate programs in school psychology offer specific
training on the skills needed for consultation, there continue to be few courses in
other areas of psychology and human service fields. In a survey exploring the adequacy
of preservice training, Constenbader, Swartz, and Petrix (1992) found that 61% of
school psychologists who responded received one semester or less of formal training in
consultation. School psychologists are the most likely to have consultation as a major
part of their professional expectations, yet as much as 25% had no training on any
model of consultation. The amount of training in most graduate school programs
specifically addressing consultation skills that is available to other psychologists, social
workers, and counselors is likely to be much less.
Before reviewing the foundations of independent consultation as a different approach
to meeting mental health needs, we explore how a therapist may incorporate
consultative skills to their treatment repertoire. The steps in which a clinician becomes
a consultant is most likely to occur through a process of experiences which are not
often addressed in other resources on mental health consultation. Since we have established
that limited coursework is available to train providers formally on general mental
health consultation, much of the necessary professional development must be
guided by the mental health provider’s personal efforts. For those who are seeking a
career in a specialized field of consultation (e.g., pediatric psychology, behavioral
health), there are opportunities at pre- and postdoctoral levels to pursue formal clinical
training. In any case, experience is always the education most crucial in fostering
the emergence of a well-rounded and confident consultative perspective.
Presuming that times really have changed, mental health providers can no longer
offer therapeutic services in a vacuum addressing isolated aspects of the individual
who presents with mental health concerns. Because of the intensity and diversity of
client needs and the growing evidence-based links between health, rehabilitation, and
mental health, our scope of practice is already evolving. More professional programs
are offering courses and training opportunities in psychopharmacology, developmental
disabilities and autism, and psychological aspects of health issues; preparing the mental
health provider with the knowledge base needed for effective collaboration with
other experts in human services. Psychologists, social workers, and counselors are developing
conceptually integrated ties with other professional disciplines. It has become
much more typical in the past 20 to 30 years to find mental health professionals playing
a vital role on a wide variety of inpatient and outpatient medical treatment teams
and leading primary intervention programs in pediatric or behavioral health care centers.
Thus, it follows that our therapeutic approach toward assessment, diagnosis, treatment,
and connection with community supports in all settings, should demonstrate our
acceptance and pursuit of a holistic perspective.
At its core, “Consultation involves sharing information and ideas; coordinating and
comparing observations, providing a sounding board; and developing tentative hypotheses
for action. The emphasis is on equal relationships developed through collaboration
and joint planning” (Dinkmeyer & Carlson, 2001, p. 13). As mental health
professionals, we have information about the general psychological dynamics that
apply to individuals in a wide variety of situations. To make this information more useful
to other professionals and benefit the client, it is beneficial to be broadly informed
about the realm of services of different disciplines. As the previous definition suggests,
the consultative relationship is intended to be collegial. Part of the art of consultation
is creating a workable rapport in which consultants present themselves as
knowledgeable and confident while not coming across as all knowing or condescending.
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