An interaction method of teaching consultation: Role-playing

Role-playing is not a reckless undertaking for instructors or seminar participants if they follow a careful progression. First, instructors show standard techniques and how to handle awkward situations. The students first experience role-playing in the familiar role of therapist to differentiate therapy and consultation responses. Then they practice being consultants, anticipating certain pitfalls in consultation. Later, they role-play consultees and discover which consultation interventions work best. Class members gradually set up their own role-play, challenge the limits of each others' styles, and draw upon their real-life experiences in class as a model.     

A biopsychosocial approach to treating patients with affective disorders

The authors describe the development of an affective disorders consultation service that implemented a biopsychosocial model of subspecialty consultation within a university-affiliated community mental health center. They retrospectively analyzed the first 2 years of consultations, assessing the process of consultation and examining patterns of consultee inquiries and consultation recommendations. Consultants recommended combined psychopharmacologic and psychodynamic therapies for most patients and found psychodynamic psychotherapy strikingly overlooked by consultees, all of whom were psychiatrists or other mental health professionals. This evaluation documents the psychiatric consultees' deemphasis of the biopsychosocial perspective in clinical practice.     

Task accomplishment and consultation outcome

The general hypothesis that consultation outcome is related to the occurrence of certain tasks associated with each of several consultation phase areas was tested. Task accomplishment was examined in relation to both participants (consultants and consultees). The findings partly upheld the hypothesis and indicated that consultants and consultees differed in the areas that discriminated between a very successful outcome and a moderately successful outcome. These differences are discussed in terms of differential role behaviors of the consultants and the consultees.     

Effect of liaison psychiatry on attitudes toward psychiatry, rate of consultation, and psychosocial documentation

Prior literature suggested that psychiatric liaison on medical wards would produce a more positive attitude towards psychiatry, more psychosocial chart documentation, and a higher consultation request rate. Over 3 years, liaison was conducted on two medical wards, and its effect was contrasted with two control (consultation only) medical wards. Liaison activities were more favorably received by consultees than consultation alone and increased the consultation request rate, but produced no change in psychosocial documentation. Additional effectiveness of liaison activities might be achieved through direct, focused interventions, and through active involvement of senior medical faculty.     

Mental health consultation with groups

A case-seminar method of group mental health consultation is presented and differentiated from group supervision, seminar teaching, sensitivity training, and group psychotherapy. The group consultant employs roles and techniques of a teacher, a group leader, a clinician, and a communication facilitator. Analysis of the process of group consultation suggests that several phases are discernable and that each phase offers opportunities for fruitful, problem-solving discussions of the personal reaction of clients and consultees. Group discussion of consultees' reactions to and feelings about their clients and the active use of group processes by the consultant most clearly differentiate this method from Caplan's approach to mental health consultation with individual consultees.Some of the ideas expressed here were presented in papers at the American Orthopsychiatric Association, New York City, 1961 (C.D.S.); the Southeastern Psychological Association, Gatlinburg, Tenn., 1961 (C.E.); and the American Psychological Association, Los Angeles, 1964 (J.A.). We appreciate the cooperation of C. B. Davis, Director of the Consolidated Health Department of Wilmington and New Hanover County, N.C. and of Robert F. Young, Director of the Halifax County, N.C., Health Department. We are also grateful to Irving Alexander, Lloyd Borstelmann, Gerald Caplan, Louis D. Cohen, J. Edward Connors, Saul Cooper, and Norman Garmezy for stimulating discussions about consultation and to the Scripps Clinic and Research Foundation, La Jolla, California, where early drafts of this paper were written while the first author was on sabbatical leave.     

A retrospective view of school mental health consultation

General principles of mental health consultation as written about by Coleman and Maddux are enumerated. Historically, the refinement of these principles for school consultation was described in detail in the literature by Gerald Caplan and Irving Berlin. Common methods define the consultees' problems as work problems; the consultant views the consultees' difficulties as due to intrapsychic conflicts. Resolution of the consultees' difficulties requires the consultant to use methods that enhance the consultee's self-esteem and indirectly provide the consultee insight into the genesis of his or her problems. Thus, consultees are gradually better able to help the client with his or her difficulties. Training of child psychiatry residents in school consultation historically occurred in three divisions of child psychiatry. Training methods were quite similar. The history of consultation to school administrators at various levels, the issues that emerged, and methods of helping administrators to deal with these problems are elucidated. Special problems in dealing with school consultation on two American Indian reservations, especially that of gaining entrance into the school, are discussed.     

Consultation outcomes. The psychiatrist as consultee

The frequent coexistence of psychiatric and medical illness supports the need for excellent medical care on inpatient psychiatric services. Effective use of consultation is an important element in ensuring this care. In our study of medical-surgical consultation to an inpatient psychiatric service during a two-year period, outcome variables, such as frequency of and concordance with drug and diagnostic action recommendations, were determined and compared with similar data for psychiatric consultations to medical-surgical services. Thirty-eight percent of cases received a consultation. Patients seen by a consultant had a longer hospital stay. Twenty-seven and forty-six percent of consultantions contained a drug or a diagnostic action recommendation, respectively. The concordance of psychiatric consultees was 79% for drugs and 75% for diagnostic action recommendations. Comparison with medical-surgical consultations done by psychiatric consultants revealed important important differences and similarities.     

The mental health consultant as seen by his consultees

In this study the reactions of a group of Public Health Nurse consultees to their former consultants has been described and an initial effort made at proposing a consultuary of consultant types. The paper discusses an attempt to explore the response to mental health consultation by a group of professionals who have received consultations from 10 consultants during an 11 year period.Dr. Eisdorfer was formerly Professor of Psychiatry and Medical Psychology at Duke University, Durham, North Carolina, and Program Director of the Halifax County Community Mental Health Center (an outgrowth of the Halifax County Community Mental Health Consultation Program).     

Communication processes in school consultation

Summary This paper describes communication processes between the Community Mental Health Service of the Massachusetts Mental Health Center and the Boston public schools with regard to establishing a school consultation program, along with the difficulties encountered in obtaining sanctions for the program. Communication was hampered by stereotypes that teachers and mental health workers had of one another and by widely varying concepts of what was being requested or offered under the name of consultation. Gerald Caplan's definition of mental health consultation was the model adopted for use by the consultants in our program. The key issue in communication with school personnel appears to be the consultant's ability to establish and maintain a coordinate relationship with his consultees. Communications must be kept open with all significant authority figures in the school system in order to maintain sanction for the program. All consultants working in the same school system must communicate with one another regularly in order to keep abreast of significant system-wide issues and to learn of one another's successes and failures which may influence the progress of the program.This paper was read at the 24th Annual Meeting of the American Association of Psychiatric Services for Children, Washington, D.C., November 4, 1972.     

Ownership, responsibility and hospital care: lessons for the consultation psychiatrist

OBJECTIVE: To identify scenarios in which consultation psychiatrists encounter difficulty reconciling their clinical role with consultees' expectations and to suggest concepts that help navigate these situations. METHODS: The authors' clinical experiences are used to generate and discuss three major categories of situations that require psychiatric consultants to thoughtfully adjust the breadth and depth of their obligation to patients and consultees. RESULTS: "Occam's razor 'dulled," "Conflation of the psychosocial with the psychiatric" and "Disposition preoccupation" are proposed as the major categories leading to conflicting patient management views between consultant and consultee. Each has, at its core, a compromise of patient ownership that blurs the boundaries of the consulting psychiatrist's responsibility. CONCLUSIONS: Understanding and channeling ownership back to the consultee, while appropriately gauging and embracing one's responsibility, form a two-pronged approach to clarifying one's role in consultations.     

Telepsychiatry: psychiatric consultation through two-way television. A controlled study

Telepsychiatry (consultation carried out through 2-way interactive television) has been the object of a number of trials in the past twenty years, but to our knowledge there is no previous control study which compares CCTV and face-to-face interviews. Various aspects of the interviews carried out on CCTV were rated on a 5-point scale in questionnaires filled out by: (a) patients; (b) consultees and; (c) consultants. No significant difference was elicited with control interviews in respect to patients' diagnosis, age and sex. CCTV interview ratings by consultee and consultant were rated only slightly below those of the control group. Such findings should encourage a broader application of interactive CCTV, particularly as a complement to live consultations in distant areas.     

The Psychiatric Consultation Checklist: a structured form to improve the clarity of psychiatric consultation requests

Medical specialty consultation is requested to obtain expert review of a patient's condition. The specialist usually receives a case synopsis with pertinent positives and negatives and a specific request for assistance. In contrast, the psychiatrist often gets a statement of diagnostic speculation (e.g., "depressed") with a request to "please evaluate." Classically, the psychiatric consultant begins with open-ended empathic questioning in an attempt to redefine the written consultation question. However, given the difficulty consultees have in forming questions, and increasing time limitations, a more structured approach to obtaining data might assist both the consultee (M.D. requesting assistance) and the consultant (psychiatrist). The Psychiatric Consultation Checklist (PCC) was devised to function as a paper "expert" questioning system to provide such assistance. In a pilot study, 10 administrations of the PCC took an average of 3.6 minutes. In comparison to consultations using standard forms, more data were supplied in several categories when the PCC was used, particularly regarding patient stressors, patient behaviors of concern, and consultee speculation on psychiatric diagnostic formulation. The PCC may be used in consultation research, for assessment and education of physicians in training (regarding psychiatric issues in the medical/surgical setting), and for general clinical consultation purposes.     

Création d’une consultation psychiatrique ouverte aux préparationnaires du 5e et du 6e arrondissement de Paris : retour d’activité sur l’année 2017–2018

Part of the French post-secondary education system is the Classes Préparatoires aux Grandes Écoles (High School Preparatory Classes) which consists of two intensive years (or three years sometimes) to pass the entrance examination of the Grandes Écoles. Grandes Écoles are highly selective, elite, and prestigious institutions [10]. The difficulties for these students are a higher stress (succeed the entrance examination), lack of time (all their time is dedicated to studies). The access to public psychiatric health system depends on where you live. Due to their schedule, they spend most of their time in the high school and they can’t consult in the psychological centre whom they depend [9]. In these conditions, in December 2017, public psychiatric care of the 5th and 6th districts of Paris created a psychiatric consultation in one high school opened to the students in Classes Preparatoires which signed a convention with the psychiatric ward.ObjectivesThis study aims to debrief the activity and the student profiles in the first year of this consultation.Patients and methodsThe patients are composed of students registered in Classes Préparatoires from the 5th and 6th district of Paris and who came to the psychiatric consultation, aged from 16 to 19 years old and referred by school nurses, school doctors, psychiatric ward or student himself. Retrospective study based on the activity of the consultation and medical files of psychiatrics consultations between December 2017 and July 2018.ResultsFifteen students consulted with a mean of 5.2 ± 2.9 consultations per students, eleven of them were oriented by school nurses. Eleven students benefited from a regular follow-up or an “in case of need” consultation. Five students had already received a psychotropic drug before the consultation; at the end of the year, ten of them received medication. The most prescribed category of medication are antidepressants and anxiolytics with seven patients apiece. The most represented disorders are a major depressive disorder (41%), adaptative disorder (29%), anxiety disorder (12%). Four students stopped their studies in the high school during the academic year. Two students needed to be hospitalized in the psychiatric ward of the district, they continued their education in their high school after hospitalization.ConclusionThe consultation for the Classes Préparatoires aux Grandes Écoles allowed an access to a psychiatric offer next to the place those students spend most of their time, without going to an emergency structure and with a shorter waiting time compared to the psychological centre in public health system. This consultation enables the evaluation, the follow-up and the orientation of the students, including the hospitalization when it is needed but also to sustain some students in their studies. In views of requesting a psychotherapy and the usual waiting time in the psychotherapeutic centre for students which already exist, there is important need to provide increased resources for these students.     

Psychiatric consultation for the geriatric population in the general hospital.

The first part of this paper is based on a study by the author in 1975--1976. The conclusions were that liaison psychiatry with geriatric patients differs from that with other age groups in the following ways: (1) referrals occur primarily when behavior becomes disturbing; (2) organic causes are often overrated but psychological and social causes and functional disorders are underestimated; (3) psychopharmaceutical agents and vasodilators are overused, while psychotherapy and other forms of treatment are underutilized. Attitudes towards consultations among these patients, their families and consultees do not differ from those of younger groups. Liaison psychiatry with a situation-oriented approach is well suited to the needs of all concerned. Review of the psychosomatic parameters of aging is summarized as a basis of the proposed psychosomatic differential model for management.     

An Examination of Behavioral Rehearsal During Consultation as a Predictor of Training Outcomes

The training literature suggests that ongoing support following initial therapist training enhances training outcomes, yet little is known about what occurs during ongoing support and what accounts for its effectiveness. The present study examined consultation sessions provided to 99 clinicians following training in cognitive-behavioral therapy for youth anxiety. Recorded consultation sessions (N = 104) were coded for content and consultative methods. It was hypothesized that behavioral rehearsal (an active learning technique) would predict therapist adherence, skill, self-efficacy, and satisfaction at post-consultation. Regression analyses found no significant relation, however, clinician involvement during consultation sessions positively moderated the relationship between behavioral rehearsals and skill. Implications, limitations, and future directions are discussed.     

Consultation and group process with indigenous neighborhood workers

This paper describes a group experience with neighborhood workers in a black, ghetto community action program, with a white psychiatrist as group leader. It focuses on the definition of the task of consultation, derivation of mutually agreed upon goals, evolution of the group, and issues dealt with during the experience. Excerpts are presented to illustrate what the neighborhood workers themselves found relevant from the sessions. Finally, the meetings are discussed from the point of view of white professional consultation to a black community agency, and aspects of group dynamics are considered.     

A college credit model of in-school consultation: A functional behavioral training program

Classes and workshops for teachers in mental health principles and techniques are abundant but rarely have they been taken directly to the teachers' school or classroom. The program discussed is a pilot study combining the didactic structure and credit of a college seminar with the immediate relevance, support, and training of a traditional in-school consultation. Teachers were trained in the implementation of functional-behavioral intervention skills. Evaluative data collected from attitudinal questionnaires received from the teachers and records obtained from teacher implemented interventions support the effectiveness of this model in training teachers as therapeutic change agents in their classrooms.