There may always be a place for traditional one-on-one, face-to-face psychotherapy directed toward ameliorating impaired mental health and life functioning but meanwhile the field of mental health service delivery is increasingly in the middle of paradigm changes. Forces driving this change include success of masters’ level trained mental health services providers entering the marketplace as well as deleterious effects of changes in reimbursement rates and healthcare policies – each of which are under significant pressures for further reductions currently.

Consultation—both in terms of providing expert assessment and intervention and consulting to improve the effectiveness and efficaciousness of individuals and teams in settings of service delivery are expanding in scope and importance (see Lowman, 2016). With such work, many ethical issues can arise and many of these have high complexity given the number of parties involved as direct or indirect services recipients and the effects on others and the context in which these individuals or the team function (Lowman & Cooper, 2017).

In the last several decades, increased emphasis on strengths-based approaches building on what a client does well and latent abilities rather than on trying to fix areas of concern (e.g. Kashdan & Ciarrochi, 2013). This approach has been particularly embraced in consulting (Foster & Lloyd, 2007). As psychotherapists confront the growing need for therapy traditional services coupled with the reality of attacks on the health care delivery system, especially for mental health services, diversification of services provided may be a wise competitive strategy — one that serves patients and clients in different ways.

Consultation goes against the grain of how many individually-focused therapists were trained.  This is because many accredited programs in psychology minimally cover, if at all, approaches to assessment and intervention that move beyond the one-on-one assessment and intervention skills. However, much of what stymies the more effective delivery of mental health services is the old-fashioned, stodgy barrier-laden systems controlling access and the purse strings for mental health service delivery along with resistance to innovation.

Problematic behavior is often embedded in a social system. To change the behavior, it is necessary to change the dynamics of the system. This requires learning about organizations and the systems in which they are embedded.

Awareness of ethical issues that can arise when operating in this systems manner is also critical. Indeed, the concept of individual – group -organizational (IGO) levels is an essential construct in consulting psychology. Consulting psychologists need to be able to understand and work within the individual, team, and systems levels to be effective in consulting roles. They must learn how to develop relationships that juggle these levels in terms of relationship-building, assessment, and intervention. And they must effectively manage multiple relationships, complex confidentiality dilemmas, practicing in newly developing areas and potential conflicts of interest.

Types of Ethical Issues in Consulting

A few of the types of ethical issues that can arise in doing this kind of work include the following:

• A psychologist-coach agrees to work with an individual employee about work-related concerns in addressing his difficulties in getting along with his supervisor. The differential diagnosis includes fit with job (how well suited is she to the job she is currently holding), fit with supervisor, and fit with co-workers. The consulting psychologist, with the permission of the individual client, met with the individual client’s supervisor. Performance concerns and a question of motivation were raised. The coaching was being paid for by the company as part of an ongoing program. To whom do the consulting psychologist’s primary loyalties lie? How can the psychologist help the individual coachee contextualize the information obtained?
• A supervisor contracts with a consulting psychologist to assess an individual whose performance has been declining. The individual was 55 years old and has been grieving the loss of his spouse of 30 years who died last year. The individual had been performing well on the job in times past and was a reliable worker but in the last year or so there seemed to be a falling off of his work performance. He was granted a compassionate leave after his spouse’s death but that was six months ago. The assessee was cooperative with the psychologist who learned that the individual had been in treatment for depression but there had been little focus on the problematic work situation. The psychologist recommended a work-focused coaching intervention but had not gotten permission to speak with the current mental health provider and had little information about the course of the care.
• A supervisor consulted with the company’s psychologist about an employee who was displaying flare-ups of temper. It turns out that the individual was in treatment with the psychologist as part of the institution’s employee assistance program (EAP). The psychologist did not want to reveal that the client was already in her care and did not want to indicate to the individual client that her supervisor had expressed concerns about her behavior.

These three examples suggest both the opportunities that exist to address meaningful and important issues and the challenges of maintaining ethical boundaries. Lowman and Cooper (2018) reviewed the three levels in which consultants must be prepared to work (individual, group, and organizations) and illustrated both general ethical principles that apply to this work and aspects that are unique to this type of work. They also addressed issues of consultation tele-practice and organizational ethics.

More generally, psychotherapists, we argue, need to expand their understanding of peoples’ lives to consider the role of work and non-family life as it relates to the challenges that bring them into care. They must also learn that, if they are to be other than passive responders to the forces that will otherwise determine how and whether they are reimbursed for their services, they need to re-think and re-define their professional roles to truly address person in context interactions and engaging in diverse professional activities that benefit all parties involved.

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Stewart E. Cooper, PhD, ABPP

My diverse professional background in psychotherapy practice, education, supervision, and research have worked synergistically with each element enhancing the others. For many years, I served as the Director of Counseling Services (which eventually included a Counseling Center plus separate Substance Abuse, Sexual Assault and Suicide Prevention units) at Valparaiso University in NW Indiana. During this time, I was also a faculty member in the Department of Psychology teaching in their accredited master’s mental health counseling program where I served two stints as its Program Chair. Based on my teaching, service, and scholarship, I was promoted to Full Professor. I have authored/edited 5 books, 10 book chapters, and 80 refereed journal articles. Within APA Governance, I have served as the Chair of the Board of Professional Affairs, Chair of the Membership Board, a member of its Policy and Planning Board and as co-creator and member of its Committee for the Advancement of General Applied Psychology. I also served two terms on its Council of Representatives and was an At-Large Member of the APA Board of Directors. Additionally, I was President of the Society for Consulting Psychology (APA Division 13) and am President-Elect for the Society for the Advancement of Psychotherapy (APA Division 29). Licensed as a HSPP in Arizona and in Indiana with Board Certification in both Counseling and Organizational Psychology, I am currently expanding Life Enrichment Associates, a solo clinical and consultation practice which I developed in 1982.