Consultation from the consultee''s perspective

School-based and other mental health consultants are confronted with consultees who must adjust to the process of consultation by learning the parameters of the interaction. Consultees must learn how to act in this unique setting, must learn to use the consultant and the process for their own ends, and must learn about ways that they, themselves, contribute to problems which assail them. Consultation is successful to the extent that consultees come to a quick understanding of how to proceed. By being aware of what it is that the consultee must learn, the consultant may expedite the necessary insight.     

Inflammatory projective identification in fundamentalist religious and economic terrorism

Abstract

This paper contains the reflections and thoughts of the author, a psychoanalyst and consultant psychotherapist who through his work with violent patients at the Portman Clinic, and later as a specialist consultant with migrants, asylum seekers and political groups has developed some understanding of lone attackers and terrorist behaviour. He uses psychoanalytic theories such as inflammatory projective identification to understand how people can become inflamed through their experience of exploitation, economic and political hegemony, and loss of identity, so that they turn to violent evacuations into others. This violence toward the other is also reflected he says in western economic policy which has also been violent toward those who have been exploited through colonialism and more recently an unfettered market driven economy. This provides the drive to grievance and hate that can be so easily exploited by unscrupulous fundamentalist regimes.     

From exclusion to inclusion; supporting Special Educational Needs Co-ordinators to keep children in mainstream education: a qualitative psychoanalytic research project

This paper draws on my doctoral research study based on consulting work with three primary school Special Educational Needs Co-ordinators (SENCos) that took place in 2008. The study examined the interactions that arose in the consultations with the SENCos and their staff. The findings that emerged from the application of Grounded Theory research methodology showed that the consultant, the SENCos and the children for whom they were responsible all felt on the edge of school life. SENCos and their staff were subject on a daily basis to powerful projections from children who were unable to tolerate difficult feelings and they were at risk of becoming identified with these feelings. The consultant in turn was the recipient of powerful projections from the SENCos. These complex dynamics of projective identification are examined in the study. The question of how SENCos and staff can better support children on the edge of exclusion with these unregulated feeling states is discussed. It is proposed that senior management teams and policy makers are essential in putting the SENCo role more at the centre of schools, both physically and in terms of how it is perceived. The need for access to a consultant who can help SENCos to understand and process extreme feelings is recommended as a way forward.     

Deciding in the best interest of clients with dementia: the experience of public guardians

We conducted an in-depth interview study of public guardians in three local jurisdictions in the state of Maryland to explore the decision-making process utilized by court-appointed public guardians making medical and EOL care decisions on behalf of their clients with dementia. Overall, public guardians appeared to make their decisions in the context of relevant ethical principles and relevant case law and state statute, and the basis upon which they made informed decisions was dependent on their training and experience. The stated goal of public guardians is to make decisions that they believe are in the best interest of their clients. In the case of a healthcare decision, their goal is to maximize quality of life; and in the case of an EOL care decision, their goal is to minimize pain and suffering. In general, public guardians gathered information in order to identify previous preferences of their now-incapacitated clients, so that they could develop a preference profile to assist both an initial decision on whether an individual ought to have a court-appointed public guardian, and with healthcare and EOL decisions once an appointment was made. When guardians were unable to develop a preference profile for a particular client, they relied on past decisions in similar situations. Healthcare and EOL decisions were most often triggered by a recommendation by the client's healthcare provider. Once a decision-point was identified, the public guardian considered the risks and benefits of the proposed intervention in light of the client's current condition. At times the guardians reviewed informational resources such as textbooks and the Internet. In addition, most guardians sought advice from a medical consultant who is available to all public guardians in Maryland. Some guardians sought the advice of this medical consultant only when faced with more complex decisions. Guardians challenged physicians' recommendations when they believed the physicians were recommending an intervention that was not in the best interest of the client--that is, they advocated against either overtreatment or undertreatment. Ultimately, guardians took particularly difficult issues to the court and obtained a judge's opinion.     

The myths of relationship abuse

Fortunately, people are becoming more aware than they used to be of the existence of relationship abuse and are consulting ministers and pastoral counselors to help them deal with this problem. Unfortunately, several myths exist regarding relationship abuse which, if taken as fact, are counterproductive to people involved in such relationships and countertherapeutic for the ministers and pastoral counselors who are attempting to help. This article addresses four commonly held myths regarding relationship abuse and the attendant pastoral implications. is a pastoral consultant and conductor of workshops. He makes his home in Tiburon, California.     

The use of mental health professional consultants to police hostage negotiation teams

Three hundred law enforcement agencies in the United States that employ a negotiator in hostage incidents responded to a survey regarding the use of mental health professionals as consultants to the negotiation team. Thirty-nine percent of the agencies with a negotiator use a mental health professional consultant to the negotiation team. Police agencies that use a mental health professional as a consultant on negotiation techniques reported more hostage incidents ending by negotiated surrender and fewer hostage incidents ending by tactical team assault and arrest of the perpetrator. Also, police agencies that use a mental health professional as a consultant on the assessment of the perpetrator reported fewer hostage incidents resulting in the serious injury or death of a hostage. Although these results are only correlational, they raise the possibility that the use of mental health professionals as consultants to police hostage negotiation teams may decrease the risk of hostage injury and death.     

Peter Block's Flawless Consulting and the Homunculus Theory: Within Each Person Is a Perfect Consultant

Authenticity on the part of the consultant is significant to the process of consulting, according to Peter Block (1981). As the consultant acknowledges feelings and thoughts when they surface, client commitment and trust develop. By defining five phases to consulting and by detailing the work that must be completed in each phase, Block (1981) has provided a step-by-step procedure for consulting without errors.     

Organisational Consultancy, Institutional Dynamics and the Role of the Student Counsellor

The despair and uncertainty apparent in some parts of the current educational environment is likely to give rise to an increase in the occurrence of unhealthy institutional defence mechanisms. The implications of such developments for the counsellor are explored. In particular, it is argued that the latter may have to assume the role of organisational consultant and become more politically engaged within the institution, if the integrity and dignity of counselling are to survive.     

The evaluation and programming of basic learning abilities

An attempt has been made to examine some of the problems and possibilities inherent in the psychoeducational evaluation and programming of learning disabilities. The quandary presented by the traditional psychometric role of the school psychologist was resolved with the proposal that he move into the field of educational task analysis and programming as a professional educational consultant. A definition of learning disabilities was suggested and the characteristics and needs of children with such dysfunctions were delinated. A system of Basic Learning Abiities and a rationale for its justification was presented. It is hoped that such a proposal may stimulate further discussion and possible change in the challenging field of psychoeducational evaluation and programming.     

基于眼动数据的一例角色书信疗法临床案例的分析与启示

采用眼动法,探究来访者阅读去信与回信时认知信息的变化,以及新手型咨询师与来访者在阅读角色书信时认知信息的差异。结果表明,来访者阅读回信时,对去信中诱发不良情绪的部分认知因素予以回应;新手型咨询师的注视时间显著短于来访者,注视次数多于来访者,热点区域不同于来访者。结果说明,往复的角色书信可以促进来访者转变不良认知;新手型咨询师对角色书信的理解与来访者存在不同。     

Why the Sky Didn't Fall: Mobilizing Anger in Reaction to Voter ID Laws

Since 2002, 26 U.S. states have passed laws that enhance restrictions on voters who intend to register and vote. Most have been sponsored by Republican legislators and passed by states with large Republican majorities. Proponents of such identification requirements argue that they are necessary to ensure the integrity of the electoral system by reducing voter fraud. Many Democrats have cried foul, arguing these laws are motivated by crass partisanship at best, and racial bias at worst, because they disproportionately disenfranchise minorities. Surprisingly, empirical evidence for significant demobilization, either in the aggregate or among Democrats specifically, has thus far failed to materialize. We suspect strong emotional reactions to the public debate about these laws may mobilize Democrats, counterbalancing the disenfranchising effect. We find support for this conjecture in a nationally representative survey and an experiment where news frames about voter identification (ID) laws are carefully manipulated.     

Living With the AIDS Virus: A Representative Case

A human sciences, multilevel, hermeneutic approach was employed to study intensively the relevant life experiences of a 21-year-old male expert consultant who had tested positive for the AIDS virus but who was asymptomatic. The study is presented both as a methodological example of this type of research and as a contribution to understanding an important personal and social issue. Under supervision, the initiating investigator collected anamnestic, behavioral, and projective data, as well as dream reports and spontaneously produced artistic material from the expert consultant. A narrative was produced to describe the study, and the data were integrated in terms of five themes: feeling infected and infectious; facing death and dying; ambivalence; uncertainty; and secrecy. Special features of this method of research are discussed, as is its relevance to the needs and interests of professionals who work with this population.     

The clinical psychologist as program consultant: When is enough enough?

One of the most influential roles clinical psychologists play in health care settings is as consultant to medical colleagues. The psychologist consultant typically approaches either clinical or programmatic questions intending to tap both empirical research and clinical judgment perspectives in trying to answer them. This paper describes a specific “program consultation case,” a not atypical consultation situation in which graduate medical education directors asked for advice about their residency training program. The purpose is to use this example to generate ideas and provoke discussion about such consultation processes and their usefulness in the health care training and service delivery world. The psychologist may be faced with questions that have meaningful implications beyond the specific consultation. What if the concerns being posed by this particular program are concerns which have been raised before, have been researched before, and have generated reasonable suggestions, conclusions, and strategies for improvement? And what if no one has paid attention, so that the questions are being raised again? When empirical and clinical data consistently combine to identify problems within health-related training or service delivery systems, and when suggestions or alternatives for their solutions have been presented and, also presumably, ignored, what does the clinical psychologist consultant do next?     

Potential roles of the medical ethicist in the clinical setting

The medical ethicist is a fairly recent addition to the clinical setting. The following four potential roles of the clinical ethicist are identified and discussed: consultant in difficult cases, educator of health care providers, counselor for health care providers and finally patient advocate to protect the interests of patients. While the various roles may sometimes overlap, the roles of educator and counselor are viewed as being more congruent with the education and training of medical ethicists than are the roles of consultant and patient advocate.     

寻求专业性心理帮助的预测因素研究的综述

在日常生活中,一些人在产生了自己难以解决的心理问题时,不寻求专业性心理帮助,以致使心理问题变得更加严重,这一问题已经引起了国内外不少学者的关注。他们运用各种问卷和访谈的方式,从分析求助者个人心理特点入手,并通过跨文化研究,揭示了人格特质和社会文化对心理求助的预测作用以及与心理咨询工作者有关的因素。该文概述并讨论了国内外关于此课题的研究成果,以期为我国的心理健康教育提供有价值的资料。     

Evaluation of outcome in school consultation

To further understanding regarding how content of change, degree of change, and initial level of functioning influence consultants' evaluation of consulation outcome, 14 mental health consultants completed a questionnaire. For each of the 18 prepost consultation ratings on the questionnaire (2 context × 3 degrees of change × 3 initial levels = 18), consultants rated the success of consultation and the degree to which they would like to have been the consultant. Analysis of variance results for both dependent measures indicate main effects for degree of change and initial level. Neither main effects for content nor interaction effects are indicated. It appears that consultants perceive consultation as more successful with and prefer working with consultees who improve the most and who function at a higher initial level.     

Is There a Role for Publication Consultants and How Should Their Contribution be Recognized?

When a scientific paper, dissertation or thesis is published the author(s) have a duty to report who has contributed to the work. This recognition can take several forms such as authorship, relevant acknowledgments and by citing previous work. There is a growing industry where publication consultants will work with authors, research groups or even institutions to help get their work published, or help submit their dissertation/thesis. This help can range from proof reading, data collection, analysis (including statistics), helping with the literature review and identifying suitable journals/conferences. In this opinion article we question whether these external services are required, given that institutions should provide this support and that experienced researchers should be qualified to carry out these activities. If these services are used, we argue that their use should at least be made transparent either by the consultant being an author on the paper, or by being acknowledged on the paper, dissertation or thesis. We also argue that publication consultants should provide an annual return that details the papers, dissertations and thesis that they have consulted on.     

Intensive family intervention in a community consultation framework

This article describes a form of mental health consultation to community workers who have reached a state of crisis in their work with unmotivated, multi-problem families. The central part of the consultation is a therapeutic intervention that draws on principles of time extension and network intervention. The consultant sees the family together with its community workers in a one-time, intensive meeting of up to six hours duration. This meeting is divided into three phases, aimed at achieving respectively (1) structural, (2) emotional, and (3) cognitive imbalancing of the family system. This creates a new situation, which hopefully will enable the community workers and the family to move out of the crisis in which they had become stuck.     

Conservation Withdrawal vs. Depression in Medically Ill Patients: Rorschach Case Study

The psychological consultant in a general hospital may be asked to evaluate physically ill patients who present ambiguous clinical symptomatology. The differential diagnoses of depression from the normal (conservation-withdrawal) reaction to stress is particularly difficult. A case study is presented illustrating the Rorschach test findings of a patient who appeared depressed upon initial clinical examination, but who illustrates conservation-withdrawal, an adaptive nonpathological stress reaction.