Indirect Work, Consultancy, Training

This section is to give an overview of different models, different therapeutic orientations and techniques
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Indirect Work, Consultancy, Training

Post by miriam »

Clinical Psychologists are being increasingly called upon to offer more than just direct therapeutic work, as this reaches limited numbers of people. Instead, there is an increasing focus on indirect work - such as advising staff who work directly with people with mental health problems. This can take the form of supervision, consultations, training and systemic or strategic work within an organisation.

For example, I have one session in which to support the adoption service in our area. In this time I could take on 2 direct cases, and see perhaps 10-12 families per year. However, there are many more families or children about whom the social work teams would like some psychological thinking. I have therefore made a bookable diary of consultation slots. Each slot lasts just over an hour, and can be used to guide professionals in their thinking about a child or family. Sometimes the worker brings the foster parents to the consultation, and sometimes it works more like a professionals meeting. The Social Worker responsible for case-holding may attend with a therapist who is working with the child, and/or a link worker for foster or adoptive parents with whom the child is currently living, or where a potential link has been made. We then talk about the concerns about the child and their placement, the impact or potential impact on the family. I rely on other professionals observations, rather than making my own, as I don't see the child, but I can still formulate and hypothesise what might be going on, and what could be potentially useful. I also bring a knowlege of attachment theory and research, which can be helpful to share with the professionals and carers. I can also suggest some therapeutic techniques, like how to use empathy and curiosity with children who have not had attuned parenting in the early part of their life, to help them learn more from the new relationship. I acknowledge that the carers can spend more time with the child in a weekend than I can in one hour appointments over the course of a year, and that making minor changes to their understanding and behaviour can have a significant impact on the child. With the AP I supervised at that time, I have written up some examples of how the consultation slots were used, and whether staff found them useful in Clinical Psychology Forum (I think December 2005) which is available on the BPS website if anyone is interested in more detail.

Another example of indirect work would be sitting on the ASD inter-agency strategy group for our county, in which we worked together to set minimum standards for assessment and diagnosis, and in sharing information between agencies. Again, instead of using those ten sessions a year to see 30 families, the strategic work can have an impact on hundreds (although committees do seem to take more time than you expect to reach decisions, and can be politically difficult situations).

Another example would be training schools to think about mental health in their students, and how to promote resilience and social inclusion.

I'm sure that others can add examples of their indirect and consultancy work over time too, but I hope that is an interesting starter for now.

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Post by h2eau »

The child LD team I work in does a lot of consultancy and indirect work with other health professionals, educational psychology, schools, social work and care/respite providers. This is done jointly with psychiatry and it seems to work really well. There is clearly a role for psychological approaches for most of the cases we see, but there simply is not the capacity to meet that demand so we must think creatively about how to extend that capacity.

In addition to training and supervising other professionals who wish to adopt psychological approaches, consultation is a means of enhancing the work that other professionals may be very capable of undertaking. It is also a means of ensuring appropriate use of theoretically robust, evidence-based psychological interventions.

Consultation is a useful way of making the referral process more efficient. Pre-referral consultation helps ensure that the referrals received are appropriate and if they are not - they can be redirected to a service that is better able to meet the identified need.

Sometimes people wonder what the difference is between consultation and supervision as they overlap in some ways. I think about consultation as a discrete (but not necessarily one-off) opportunity to jointly discuss and reflect on an issue. This in itself may fulfil the needs of the person(s) seeking consultation as it may enable them to think about the issue in a different way and come up with their own solution. Whereas I see supervision as more of an ongoing relationship.

Consultation may also involve joint problem-solving and/or specific guidance or advice. In contrast to supervision, clinical responsibility remains with the caseholder and any advice or guidance given is not compulsory.
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