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Consultation to the Workplace:
Thoughts for Family Therapists*


I. Introduction

The number of organizations calling on therapists for help is increasing. I think that there are several reasons for this phenomenon: a level of trust in the therapeutic model coinciding with a growing frustration with the content experts (Hilburt-Davis and Senturia, 1995); a heightened awareness of the 'human side of business' (Kanter, 1985); and the growing number of therapists, frustrated with managed care and the changing mental health field, expanding their knowledge and practices to consult to larger systems. This article will offer some background information about the field of organization development (known as 'OD' ); how the therapeutic and consultation roles differ; and how family therapists' knowledge of systems can be a valuable contribution*.


II. Organization Development

History

OD has evolved from several roots: (1) National Training Laboratory (NTL ) and T-Groups (or sensitivity training); (2) human resources, personnel & industrial relations, including ideas about professional management practices; compensations and career paths for employees; (3) survey feedback, an orderly and formulaic method assessing the organization from the viewpoints of the employees ; (4) sociotechnical and socioclinical systems, an approach pioneered by Tavistock consultants based on the premise that an organization is both a social and technical system; (5) the group as a focus of change, including ideas about behavior (Lewin, 1958), interpersonal dynamics and learning (Argyris, 1971), psychodynamics of social defenses (Hirschorn, 1988,1993) and the group's unconscious (Bion, 1975), connecting the individual with transpersonal functioning.

Models of Intervention
.
Although there are several models described in the OD literature, most practitioners agree that the generic model of intervention looks something like this: (1) contracting for the work to be done; (2) gathering of information from the client system; (3) reporting the information back to the client in order to make an action plan; (4) collaborative planning between the change agent and the client; (5) implementation of the plan; (6) institutionalizing the change; (7) evaluation. This is often referred to as action research and is an iterative, recursive process.

III. Therapists in the Workplace

Parallels exist between the history of family systems and the history of organization development; both are relatively new fields with no one single theory, but an emerging set of assumptions. The effectiveness of each field is being examined. (Burke,1995; Pinsof and Wynne,1995). A useful way I have of conceptualizing each is that the model of organization development is practical, a way of doing; the systemic framework is theoretical, a way of thinking.


Technical Differences

In considering the similarities in working with families and the workplace family, it's important not to forget the differences. (Wynne, 1986) These vary, obviously, with the size and structure of the organization and the contact person but in general the following apply: The presenting problems in consulting work are usually around transitions, such as downsizing and mergers, crises of leadership, and lack of direction, no articulated short or long term goals. The work or tasks within the work place is to improve the bottom line and be more productive and efficient. It is not overtly around pain or suffering, only how these feelings get expressed in the work. Leaders want to hear, whether they address it overtly or not, how this will affect productivity. The contract is explicit usually specifying the 'deliverables', and an estimated cost and time for the job. The consultant works within the hierarchy and the higher up in the chain of command the contract is made, the greater the chances of success.

The professional relationship in a consultation is collegial with the motivation coming from the boss and not primarily from the relationship with the consultant. The language and vocabulary of the consultant describes interpersonal dynamics in less clinical terms. For example, assessment in place of diagnosis; issue, problem or concern in stead of symptom; old baggage instead of transference. The paper work in consultation is a major part of the work. There is an emphasis on written materials and hard copies of instructions and advice that can be left behind. I spend alot of time at the computer preparing worksheets, training manuals, and psychoeducational material for my clients.

Challenges for Therapists

  • Boundaries

    The client is a colleague; for example, at the Family Firm Institute dinner programs, it is expected that consultants will bring a client as their guests. Can you imagine as a family therapist taking a client to dinner? This requires careful boundary work on the part of the consultant. The work that therapists have done on themselves is invaluable once they get used to the change in the type of relationship.

  • Culture of Business

    The focus is on the bottom line. The work is not directly around pain but around getting the work done more effectively; creating more productive employees. The move is toward changes in observable behavior rather than changes in subjective experience. As consultants, we must remember that we are not hired as psychotherapists. The changes that are requested are not intrapsychic but are at an interactional level. It is here that systems therapists have a distinct advantage; change happens as the systems change. Intrapsychic changes may happen but only as a result of changes in the interactions, the processes, the system.

  • Giving advice

    The consultant takes a leadership position/role of the change agent . You are paid to have an opinion, to give advice. The consultant is active, direct; His/her personality is often a commodity. The expectations are that the consultant takes more responsibility than in the clinical setting for making changes happen and, then, institutionalizing them. There is a paradox in being the expert and the facilitator that can be used effectively by systems trained consultants who can move in and out of the system.

  • Information

    The consultant gathers information and makes decisions about how and what gets 'fed back' into the system. Not all information, such as personal histories, is shared with the work group or the leader. The consultant makes clear at the beginning of the work that, although all information gathered will be used in the assessment, only themes relevant to the work will be discussed and individuals' anonymity respected.

  • Marketing

    Therapists are generally terrible business people. Somehow business is a nasty word. There is no other way to get the word out that what we do really works and is essential in the work setting.


IV. Nothing is so Practical as a Good Theory

The Case

The phone call was from a physician at a local hospital and the request was for a "Retreat" since two hospitals were merging and the this section was the first to be merged. I explained that I would want to get some information; and always urge a follow-up in about 6 months. The fee was settled on and I made an appointment to talk with the Chair of the department. The work involved several information gathering formats: individual interviews, focus groups, and a questionnaire asking each person to prioritize the issues they wanted to be addressed at the Retreat. This information was feedback to the work group in a mini-seminar we called "Introduction to the Retreat".

After the Retreat, I was asked to conduct one educational meeting about teams and communication. The four newly formed teams began their work. Two of the teams proceeded without major problems; two experienced conflict right at the start. And I was called to help them deal with the conflict. My systemic thinking was invaluable in managing the conflict and facilitating lasting changes.

  • Knowing where to look and what to do when you find it

    From a systems perspective, the consultant gathers information from all involved, takes a meta position and carefully looks at patterns and processes. I conducted individual interviews and focus groups. As one name kept coming up as the 'troublemaker', I was able to see the usefulness of this scapegoating to the department. I was not lead off the track by red herrings, could hold the multiple realities offered and understand the forces working against change. I could understand the function of the symptoms (conflict, anger and anxiety) and this lead me down the critical information paths.

  • Systems theory as change technique

    My own experience is that most consultants pay lip service to the words 'whole system' and do not understand or apply the fundamental concepts of systems but are generally referring to the whole department, section, or organization, not individuals. One consultant told me that he did 'systems work' since he worked with the whole department and not just individuals.

    I use a lot of psychoeducational and experiential material to ready a group for change and help them through it. Depending on the sophistication of the work group, I will teach about the differences between process and content, effective and congruent communication, systems terms (such as scapegoating, boundaries, symptoms vs. problems and effect of change on a system). Before this group got to the Retreat, they had a working vocabulary of these useful concepts. I think that this training accomplishes several goals: the training itself is a group process and I can give hands-on suggestions as they work on exercises and role playing; the work teams generally feel 'given to' by the larger agency; it enables them to step back and look at the process with a new lens, and gives them knowledge to use in future changes

  • Planning change: homeostatic forces

    The merger was not the choice of either department. There would be powerful homeostatic forces (resistance ) at work. The technique of reframing was useful for everyone to understand how difficult this would be, give emphasis to health, strengths, resources to empower Another effective systems concept was being able to assess who had the power and who had the control in this system. Organizational hierarchies, both formal and informal are necessary pieces of information. In this case, I was also able to understand the role that this department (sub system) had in the larger picture of the merger. Two cultures were becoming one; this process included loses and gains. There was a push- pull for change.

  • Use of Self: as a transitional object.

    The work we've done on ourselves is priceless as a consultant in being able to provide a holding environment for the consultee as it goes through the painful and exciting process of planned change and to deal with dependency issues. As the groups struggled with the integration process, I received many panicked phone calls to help with what was happening. Countertransferential material provides a wealth of information for the systems consultant, especially to feedback into the system in ways appropriate to the workplace. I was able to provide reassurance, normalization and specific tips for dealing with the difficult process. After the major part of the consultation is over, I think it is crucial to help the clients set up a container for themselves. This can be in the form of structured meetings, exercises, regular communication and/or team meetings, and helping them think in systemic ways.

  • After the action plan: what to expect

    As the new work teams were formed, the conflict in one was chronic and complex. In the other, it was new , with no complicated history. From a systems perspective, I could reframe the new conflict as anxiety being expressed in reaction to the massive and unwanted changes. This reframe helped the work group handle the conflict and establish rules for dealing with conflicts as the arise in the work team. In the other group, I help individual and the a joint meeting with the two warring parties. This conflict was long standing; simple rules of communication would not have even touched the issues, My experience as a systems therapist allowed me to see the conflict from a meta position and dig a little deeper to see where it started, what kept it going ; how to manage it; and how to affect a second order change.

V. Conclusion

Both the fields of family therapy and organization development are changing. Increasing numbers of therapists are consulting to the work place; systems thinking is finding its way into the organization development field. Systems therapists have distinct advantages in consulting to the work place. They bring special skills and a unique perspective that can deepen the work as needed to create lasting changes. The challenges for the therapist are in the nature of the work; the nature of the relationship where the rules and boundaries are different from the therapy relationship; and the culture of the business world.


*My thanks to Mary F. Whiteside for helpful comments and suggestions.

Readings:

Argyris, C. Management and Organizational Development, NY., McGraw-Hill, 1971.

Bion, W. "Selections from Experiences in Groups," in Colman and Braxton, ed. Group Relations Reader 1, London: A.K. Rice Institute, 1975.

Burke, W. Organization Development: A Process of Learning and Changing, Reading, MA: Addison-Wesley, 1994.

Hilburt-Davis, J. and P. Senturia. "Using the Process/Content Framework: Guidelines for the Content Expert", Family Business Review, VIII, 3 (Fall 1995), 189-199.

Hirschorn, L. The Workplace Within: Psychodynamics of Organizational Life, Cambridge, MA MIT Press, 1988.

Hirscholrn, L. and C. Barnett. The Psychodynamics of Organizations, Philadelphia: Temple University Press, 1993.

Kanter, R. "Managing the Human Side of Change", Management Review, 1985, 52-56.

Lewin, K. "Group Decision and Social Change," in Maccoby, Newcomb, and Hartley, eds. MY: Hold, Rinehart & Winston, 1958.

Pinsof, W> and L.Wynne, "The Efficacy of Marital and Family Therapy: An Empirical Overview, Conclusions, and Recommendations." Journal of Marital and Family Therapy, NY: Guilford, 21,4 (October 1995), 585-613.

Wynne, L. S. McDaniel, and T.Weber. Systems Consultation: A New Perspective for Family Therapy, NY: Guilford, 1986.

*Originally in AFTA Newsletter, Spring, 1996.

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