Chapter 9: Consultations and Referrals
Chapter Overview
The authors discuss the roles of consultation and how they are distinct from other counseling activities.
The authors provide an explanation of the function of consultation and how it works with mental health
treatment providers. Additionally, the authors create awareness of how clients and communities are
managed in the process and how multicultural and ethical issues are incorporated and addressed.
Key Words
Consultee – Individual seeking consultation.
Primary Care – Addresses mental health issues before they become problematic.
Secondary Care – Address client needs and behaviors that are already indicative of substantial risk related
to a particular mental health concern or issue.
Tertiary Treatment – Addresses behaviors and concerns that are actively a part of a client’s life.
Multiple Choice Questions
1. Consultation is distinct from supervision in all of the following ways, EXCEPT:
a) There is an inherent hierarchy with supervision and not necessarily with consultation
b) Supervision is not triadic
c) Supervision involves a longer term relationship
d) Supervision is more developmentally focused
2. The persuasive principles of power specific to goals of consultation include:
a) Education: Legitimate; Diagnostic: Expert; Facilitative: Referent
b) Education: Expert; Diagnostic: Referent; Facilitative: Legitimate
c) Education: Expert; Diagnostic: Legitimate; Facilitative: Referent
d) Education: Legitimate; Diagnostic: Prescriptive; Facilitative: Referent
3. Dougherty’s 4-stage model is the most often used model for the consultation process. Which of
the following accurately describes the stages?
a) Diagnosis, implementation, disengagement, discharge
b) Diagnosis, implementation, evaluation, disengagement
c) Entry, diagnosis, implementation, disengagement
d) Entry, analysis, implementation, discharge
4. Which of the following is NOT a role in which a consultant typically practices?
a) Leader
b) Expert
c) Prescriber
d) Mediator
5. The primary goal and focus of family consultation is:
a) The overall functionality of the system in which the identified client operates
b) Promotion of the mental health and wellness of the identified client
c) Advocacy on behalf of the identified client
d) Assessing whether family members are the source of the identified client’s problems
6. One of the identified key presumptions that one should hold about family members when
preparing to consult with them is:
a) The systemic unit of the family is more important than the individual client
b) The family is competent
c) The family presents an opportunity to acquire additional clients for individual work
d) The family needs the counselor to take charge
7. Research suggests which of the following?
a) Increased consultation and collaboration is associated with reduced frequency for in-patient
treatment
b) Increased consultation and collaboration is associated with an increased level mistrust of the
counseling profession
c) Increased consultation and collaboration is not associated with a difference in client mental
health outcomes
d) Most physicians do not perceive their consultation interactions with counselors as positive
8. Counselors who act in the consultant-liaison role:
a) May help clients keep secrets
b) May work as proxy medical professionals, explaining what a client’s physicians are saying in
more accessible language
c) May participate in mental health trainings for medical professionals
d) May act as case workers for clients, ensuring that clients receive all of the benefits that are
available to them in the area, given their presenting concerns
9. Which of the following does NOT describe the main focus of consultation in the community?
a) Focus on systems and subsystems
b) Behavioral systems
c) Families
d) Larger social systems
10. To be effective in a community based consultation, a consultee would need to possess the
following skills:
a) Expert in the identified problem and guide in the consultation process
b) Educator in the intended intervention and evaluation process
c) Dynamic negotiating skills
d) A and B only
e) All of the above
11. Self-awareness in regard to strengths and competencies, as well as limitations, is needed to
assist counselors in understanding:
a) When to seek consultation
b) To be mindful of ethical mandates
c) Demonstrate culturally competence
d) All of the above
12. When referring clients to another treatment provider, or other supportive services, it is important
to keep in mind:
a) The way in which the client may interpret the referral and their emotional reaction to the
referral.
b) The reason for referring the client and expectations of the new provider
c) The amount of support and preparation the client may need before meeting with
d) the new service provider
e) All of the above
13. The assignment of care levels is necessary in the treatment of mental health conditions because:
a) Care level determine the degree and level of diagnosis needed for treatment of severe client
presentations
b) Care levels are standardized and allow for clinicians to use a “common language” to
communicate about client diagnostic concerns
c) Care levels allow clinicians to investigate and determine the degree and type of care needed
to treat a given client.
d) All of the above
14. The triadic relationship between consultant/consultee/client can expose the consultant in which of
the following ways?
a) Malpractice law suit from the client
b) Malpractice law suit from the consultee
c) Breach of confidentiality from client
d) All of the above
15. Which of the following actions does NOT foster ethical practice for consultation?
a) Promote self-sufficiency and independence of consultee
b) Empower consultee to set goals and interventions for treatment
c) Train consultee
d) Use expertise to set treatment goals for consultee
Activities
1. Reflecting on the needs of Sam in Case #1, identify the roles for which the consultant would use in
supporting Sam. Be sure to discuss more than one role.
2. In small groups, work through the following case: You are a counselor at a rural community mental
health center. There has been an influx of clients at your center recently with issue of self-injurious
behaviors. No one in your agency has expertise in this area and the closest “expert” is one-hour away.
Identify a plan of consultation, including:
• Identification of the apices of the triad
• Type of consultation needed
• Modes of consultation needed
• Specific issues or ethical concerns for the consultant and consultee
• Consulting with physicians.
3. Please consider the process of medical consultation. Write a 1 page response paper to the following:
Dr. Hua has left a message on your phone, along with a corresponding fax which you have received, that
indicates a release of information for your client Zoe. Dr. Hua would like to consult with you on Zoe’s
treatment; he notes in his phone call that Zoe wants to be prescribed benzodiazepines, potentially
addictive medications for anxiety and panic attacks. Zoe has been in counseling with you for about four
weeks, during which time she has indicated a pattern of substance abuse, panic attacks, and insomnia.
Describe your process of consultation with Dr. Hua. What should you consider, or do, before the initial
stages of consultation? What information might you share with Dr. Hua? What are the goals that you
outline for consultation? What potential problems might arise? How would you resolve them?
4. Consulting with families.
Please consider the process of family consultation. Write a 1 page response paper to the following:
Trina has been seeing you, her mental health counselor, for about 6 months for Major Depressive
Disorder. During the course of this treatment, she has maintained weekly counseling visits and has
received medical evaluation and medication management from a psychiatrist upon your referral. Now, the
two of you feel that it is time to address her concerns that her family does not understand her diagnosis.
Please describe considerations that you need to make with Trina before consulting with her husband and
parents. Also, what potential issues might arise during this consultation? How will you address these
issues while maintaining your focus on Trina? Finally, explore how you might use information obtained
from this consultation in your continued work with Trina.
5. Consultation in the community.
For this exercise, practice taking on the role of a consultant in a community system at any level. Choose
the type of community system you will interaction with within your own community. Outline how you
would conduct the consultation from the initial meeting with the consultee and stakeholders to discuss the
presenting issues to termination of the consultation. Be sure to address each of the stages as well as
ethical and diversity considerations.
Discussion Questions
1. Consider the potential benefit of consulting with clients’ family members. Create a hypothetical case to
present, in which family consultation would be useful. As you discuss this case, explore some of the
potential risks involved, as well as how you will address them. In your discussion, incorporate new
information that you learn from family members. How will this information impact your work with the
client? Will additional referrals be necessary? How will you complete the process of consultation with
these family members, and what will be the impact on the continued counseling relationship with your
client?
2. Consultation with medical professionals can take on a number of forms. In some instances, a mental
and medical healthcare team approach to addressing a client’s needs may be warranted. Create and
explore a hypothetical case in which a team approach would most suitably meet your client’s needs. If
you were organizing this effort, how would you decide who should be involved? Describe your process
for discussing the issue with your client, approaching the potential team members, moving into the
process of consultation, and implementing your portion of the team’s plan. Please note that you will want
to maintain focus on your client’s needs throughout this process. Do any problems or concerns arise
during consultation with your team? How do you resolve these issues? What are the outcomes of this
consultation?
3. Pretend you are a consultant collaborating with a community agency that has internal turmoil between
clinicians. As a result of the negative interactions, client outcomes are decreasing, paperwork is
incomplete, and funding is being lost. Outline how you would enter a hostile system that is resistant to
change and internal authority as an external consultant.
4. Taking into account the ACA ethical code and those of other professional organizations relevant to
your intended practice and the laws that regulate the practice of professional counseling in your
jurisdiction, what type of detailed information will you share with a client for whom you need to make a
referral? What impact does the increase or decrease in level of care have on your wording?
5. With regard to the ethical, legal, and cultural considerations for consultation, how might counselors
serve to protect themselves in the role of consultant? Consultee? How do these considerations have a
trickle-down effect for clients?
Multiple Choice Questions – Answer Key