Enhancing CBT Consultation With Multicultural Counseling Principles

The use of multicultural principles to enhance cognitive behavioral therapy (CBT) for individuals of marginalized backgrounds has received increased attention in light of the heightened national awareness of systemic oppression and racialized violence directed towards Black, Indigenous, and People of Color. However, there has been less of a focus on applying such principles to consultation for skill development. If ethical guidelines are expected to influence the behavior of clinicians in session, guidance is needed to indicate how and where and when clinicians should receive training in implementing culturally responsive CBT. Individual reading and reflection are necessary but are not sufficient in acquiring new clinical skills. Consultation is recommended and strongly suggested when clinicians are working with new populations or delivering a new treatment, or even using a new modality. Consultation can also be useful when adopting a new approach or stance to therapy. For practicing clinicians who have not developed these skills, additional consultation can and should be used to address this gap. Moving forward, integration of cultural responsiveness into standard consultation will ensure that these skills are seen as a core competency, rather than an optional additional skill that may be (or not be) elected. This paper presents core experiences that may be integral to a CBT consultation model that aims to enhance providers’ ability to provide CBT in a way that is culturally responsive to their clients. These recommendations attend to both content and process within CBT consultation and reflect guiding assumptions for helping clinicians to develop the ability to practice CBT in a culturally responsive manner, including (a) normalizing discussions of cultural identity and oppression, (b) an emphasis on cultural self-awareness, (c) emphasizing culturally informed CBT case conceptualization, and (d) skill development in applying cultural elements to CBT interventions.     

Relative frequency of consultee lack of knowledge,skills, confidence,and objectivity in school settings

Caplan (1963, 1970) specifies consultee lack of knowledge, skills, confidence, and objectivity as the “four common reasons for the work difficulties that underlie the need for consultation” (p. 127). Although Caplan hypothesizes that the majority of consultation cases result from consultee lack of objectivity, there has been no empirical examination of the relative frequency with which consulting school psychologists encounter each type of consultee difficulty. To assess this, ten school psychology consultants rated the primary consultee problem for each consulation case they had. Contrary to Caplan's assumption, data analyses indicated that significantly more consultation cases resulted from colsultee lack of knowledge, skills, and confidence than from consultee lack of objectivity, which accounted for only 7% of the cases. These findings call into question the practical utility of psychodynamically oriented Caplanian techniques for consulting school psychologists. Because the preponderance of consultation cases develop from consultee lack of knowledge, skills, and confidence, school psychologists would be best advised to focus primarily upon the development and utilization of problem solving, behavior analysis, and sophisticated communication skills as their principal consultative strategies.     

The Impact of Childcare and Parent-Child Interactions on School Readiness and Social Skills Development for Low-Income African American Children

Low-income and African American children are at increased risk for school readiness deficits in terms of both cognitive and social development. This study examined the roles of childcare involvement and parent-child interaction quality on the development of school readiness and social skills among a low-income, minority sample of kindergarten children. Findings provide mixed evidence on the role of childcare exposure, with early entry into childcare predicting higher levels of social skills ratings and increased time per week in such settings predicting lower levels of social skills development. Childcare exposure had positive, although trend-level, relationships with other readiness-related outcomes after accounting for demographic characteristics of children and their families. Parent-child interactions characterized as structured and responsive to the child's needs and emotions were positively related to school readiness, social skills, and receptive communication skills development after accounting for demographic characteristics and childcare exposure. Implications for preventive intervention program development and the role of school psychologists in the areas of consultation and intervention are discussed.     

Supervising Consultants in Training: An Application of a Model of Supervision

In this article the author delineates a model of supervision for consultation training. The model is based on Stoltenberg and Delworth's (1987) Integrated Developmental Model of supervision of counselors and has been adapted for supervision of consultation trainees. The model describes trainee characteristics and supervision needs across three levels of development, culminating in an integrated (3i) level with developed skills across eight domains of consultation activity. Development is tracked by monitoring changes in three crucial structures: self- and other-awareness, motivation, and autonomy. Suggestions for supervision approaches for all three levels are presented, and relevant research is discussed.     

Integrating consultation and program evaluation in school psychology

Consultation approaches to providing psychological services are widely used by school psychologists. Recently, the need for school psychologists to be proficient in educational program evaluation has been recognized. The present paper discusses how school psychologists can use their existing consultation skills as an approach to program evaluation. The integration of consultation skills with evaluation results in an approach to program evaluation that is particularly useful where program goals and objectives are broad and nonspecific (as in many educational innovations). Also, the consultation approach to evaluation is easier for school psychologists to blend with their other roles in schools than the assessment-oriented evaluator role of some evaluation models. The consultation approach to evaluation is illustrated using a federally sponsored training program for school teachers and administrators.     

A Survey of Consultation Training as a Part of Counselor Education Programs

A survey was devised to obtain feedback from counselor educators throughout the country regarding the teaching of consultation skills in their master's degree programs. This survey was mailed to 410 counselor education departments, with the request that the faculty member most closely associated with teaching consultation at the master's level respond. Usable survey forms were returned by 144 programs. A phone follow-up survey of selected nonrespondents substantiated the indicated findings. Reported survey results indicate the extent to which counselor education programs include training in consultation skills, the number of students involved, and the emphasis placed on various consultation skills.     

Issues in the treatment of depressed children

Basic research into the cognitive, behavioral, familial, and physiological disturbances associated with depressive disorders during childhood is reviewed. Implications for the development of a treatment program are discussed and a comprehensive treatment model is proposed. The proposed model includes intervention strategies for the child, parents, family, and school. The child component consists of intervention strategies for the affective, cognitive, behavioral, and physiological disturbances that are evident from the existing research. The parent training component is designed to address disturbances in parenting due to cognitive disturbances and skills deficits. The family therapy component emphasizes changing interaction patterns that communicate schema-consistent maladaptive interactions. A school consultation component is proposed in which school personnel support the skills training through prompting use of the skills and reinforcement of the use of the coping skills.     

The “Hidden” Technology of Effective Parent Consultation: A Guided Participation Model for Promoting Change in Families

Parenting interventions based on social learning principles are amongst the most effective interventions available to prevent and manage social, emotional and behavioral problems in children and adolescents. The most successful programs employ active skills training methods (modeling, rehearsal, practice, feedback and homework) to teach new parenting skills. However, effective parent consultation also involves a broader range of interpersonal and process skills such as building a collaborative relationship, facilitating parent receptivity to new ideas or skills, managing within session resistance, and important micro skills associated with clinical tasks such as promoting parents self-regulation, independent problem solving and autonomy. This paper aims to articulate the “hidden” technology of effective parent consultation and identify implications for research on mechanisms of change in parenting interventions and practitioner training.     

The Importance of Interpersonal Skills in Consultee-Centered Consultation: A Review

This review explores the empirical research on the importance of interpersonal communication skills in consultation. Studies have found consultants' facilitative characteristics, along with an appropriate use of verbal and nonverbal skills, to be important in the consultation process. Because of the state of the research literature, however, the need for more studies on verbal and nonverbal communication skills is suggested.     

The Counselor as Consultant in the Collaborative School

A collaborative work environment has been consistently cited as a characteristic of schools that effectively respond to the diverse needs of students. Because of their role and related skills, counselors seem uniquely positioned to have a significant impact on the development or enhancement of team structures and staff relationships within a collaborative school. Educational collaboration and its relationship to school consultation as a structured planning, decision-making, and problem-solving process is described. Characteristics of a collaborative school and its organizational structures are identified. Roles and related skills the counselor can use in providing leadership in developing and implementing collaborative teams in the school are articulated.     

The effects of two conditions of client-centered consultation on student teacher problem descriptions and remedial plans

Nineteen trained consultants implemented two conditions of client-centered consultation and a control condition with 42 student teacher subjects. The dependent measures were skills in describing classroom problems and generating appropriate remedial plans. Both conditions of consultation were effective in improving problem identification skills. Consultation with observation seemed to be related to a faster improvement than was consultation with no observation. Skills in developing remedial plans were not affected by treatment.     

Examining the Efficacy of School-Based Consultation: Recommendations for Improving Outcomes

SUMMARY

Schools are faced with the difficult task of educating students who present diverse learning and behavioral challenges. To meet student needs, schools tap the expertise of a variety of specialists who provide services through “pull-out” programs or consultation to general educators. Unfortunately, neither strategy has proved effective to date with respect to children and youth who present significant social behavior problems. A brief review of the literature points to the shortcomings as linked to multiple treatments with varying outcomes and inconsistent implementation of best practices. One option to address the challenges schools face in light of ineffective practices to date is the development of school-wide systems of positive behavior support (PBS). Effective implementation of school-wide systems of PBS will require moving the consultation process from individual cases to working with teams of educators. Key skills and possible measurement strategies to develop and sustain school-wide consultation efforts are discussed.     

Use It or Lose It: Post-workshop Reflection Enhances Learning and Utilization of CBT Skills

Many therapists attend 1- or 2-day workshops as part of their continuing professional development. Recent literature has suggested that workshops are largely ineffective unless followed up by consultation or supervision. However, not all therapists have this option, and the question remains whether there are ways to potentiate workshop learning in the absence of follow-up consultation. This study tested the hypothesis that creating opportunities to reflect in the weeks following a workshop would enhance learning and utilization of skills. Two groups of practitioners, who attended the same 2-day CBT skills workshop in successive years, were compared: a training-as-usual group and a reflection group. The reflection group completed reflection worksheets at the end of each workshop day and were instructed to complete follow-up reflection worksheets at 1, 4 and 8 weeks post-workshop. Ten weeks after the workshop, the reflection group reported enhanced use of new skills with clients and a trend towards increased awareness of workshop learning. Further analysis revealed that group differences were almost entirely linked to use of follow-up reflection worksheets. Those participants in the reflection group who used follow-up reflection worksheets reported far greater awareness and use of skills than those who did not. Reminder emails had the predicted effect of increasing the use of the reflection worksheets; twice as many participants in the email reminder group used the reflection sheets compared with the nonreminder group. The results suggest that the relatively simple strategy of introducing reflection worksheets to workshop handouts, and sending reminder emails may significantly enhanced learning and utilization of workshop skills.     

An Integrative Approach to Teaching Dreamwork in Group Supervision

Dreams can be an important part of the counseling process to increase clients’ awareness of potentially unfinished business. We present an approach to teaching dreamwork in group supervision that is designed to assist supervisees’ integration of dreamwork techniques into their client consultation and to contribute to further development of advanced counseling skills.     

Enhancing Consultee Problem-Solving Skills in Consultative Interactions

Selected empirical research on consultative problem solving is reviewed. Although there is general support for the effectiveness of consultation in resolving a variety of presenting problems and in improving consultees' skills for solving future problems, there is a need for additional methods to facilitate the process. Direct training of consultees in behavior management, communication, and consultation process skills is advocated as one means of attaining this goal.     

Reducing the Risk for Preschool Expulsion: Mental Health Consultation for Young Children with Challenging Behaviors

Increasing numbers of young children are being expelled from child care settings because of their problem behavior. Access to mental health consultation is related to lower rates of expulsion, but additional data are needed to document the pathways through which mental health consultation reduces the risk of expulsion. We report on outcomes from a 4-year project designed to reduce the number of children expelled for problem behavior in a large suburban county in Maryland. Two master’s-level professionals provided behavioral consultation to child care providers who identified nearly 200 children at imminent risk for expulsion. Child care providers rated children’s social skills and problem behaviors at referral and discharge using the Preschool Kindergarten Behavior Scales and the Brief Infant Toddler Social Emotional Assessment. Statistically significant increases in social skills and reductions in problem behaviors were seen for children who received individualized consultation. More than three-quarters of the children who were at risk for expulsion were able to be maintained in their current child care placement; of those that changed placements, only half (n = 13) were removed involuntarily. These findings provide additional support for mental health consultation as a promising strategy to reduce the risk for expulsion for young children with problem behaviors.     

Consultation: A New Strategy For CETA

Program changes inherent in the CETA concept have markedly decreased the effectiveness of previous program management and liaison strategies. Some reasons for this decrease and a new set of skills for working at the interface between prime sponsors and subcontractors and/or the regional offices are presented. These skills, formulated within a consultation model and based on solid behavioral strategies, are one way to increase CETA program effectiveness.     

Effects of behavioral and medical models of consultation on teacher expectancies and instruction of a hypothetical child

Sixty first- and second-grade teachers were randomly assigned to one of four conditions representing variations in consultation where they were required to teach a hypothetical child to add. The first condition involved face-to-face behavioral consultation in which the consultant cued a teacher to verbalize antecedent and consequent conditions that might affect learning and prompted the teacher to specify the kinds of capabilities that the child would need in order to master the academic task targeted for instruction. In the second type of behavioral consultation, face-to-face consultation was augmented by a task analysis report specifying prerequisite skills. The third type, medical model consultation, involved face-to-face consultation focusing on temporally remote environmental circumstances accompanied by a traditional psychological report specifying that the child was of low ability. The control group was asked general questions about the school. Results suggested that behavioral consultation with task analysis was associated with significantly more teaching success than was control, medical model, and behavioral consultation without task analysis. Moreover, behavioral consultation without task analysis was better than medical model consultation. Implications for psychoeducational assessment are discussed within the context of teacher expectations and instruction.     

An “issue-focused” model for mental health consultation with groups of teachers

This paper presents and evaluates a model for group mental health consultation with teachers in which sessions are organized around mental health issues rather than cases. The rationale and advantages of the model are explicated and compared with other models of group consultation and group work with teachers. The model incorporates a heavy emphasis on educational preventive measures and is designed to simultaneously satisfy a wide range of consultee needs and to reduce anxiety and defensiveness. Consultant's preparations for the group sessions are highlighted so as to maximize their contribution to the participants' level of involvement, knowledge, skills, confidence, and objectivity. The different roles of the consultant during the session and the variety of techniques employed are described as they relate to group processes and consultation needs. Specific guidelines for the organization of consultation groups and training of group consultants are offered. Evaluation data based on feedback from participants in ten groups are included.     

Training District Personnel as Peer Consultants and Inservice Leaders: Implementation and Evaluation of a Training Program

For several years, Furman University has offered training for special educators to develop skills as peer inservice providers and as peer consultants to general education personnel. By means of a personnel preparation grant, School Initiated Teacher Education (SITE) Outreach, 61 special education teachers, speech therapists, and curriculum specialists have been involved in a series of three graduate level courses designed to address development of skills in inservice content and presentation and peer consultation. Evaluation data were collected to determine the impact of the training program, perceived benefits to the participants, and the receptiveness of the participating school districts in terms of the incorporation of peer inservice and consultation activities into the ongoing instructional program.