National Center for Effective Mental Halth Consultation
   

Defining the Consultative Stance in the Context of Relationship-Based Work

According to Johnston and Brinamen (2006), the central tenet of mental health consultation to early care and education is the "consultative stance," used to capture and describe the consultant's "way of being" in relationship-based work. At its core, this descriptor represents the belief that the ways in which people are treated influence their views of themselves, and in turn, their relationships with others. This belief reflects the psychotherapy origins of relationship-based work, which more recently has been adapted to principles of infant mental health that address infant development as well as intervention in the context of relationships.

Simply put, in blunt, bumper sticker fashion, "It's the relationship, stupid" (adapted from political slogans). This slogan captures the influential relationship process that takes place in mental health consultation.

How the consultant "is" — his or her demonstration of interest, empathy, respect and understanding — is central to successful consultation (Johnston & Brinamen 2006). Then, in what is termed a "parallel process," the positive experience of the relationship between the effective consultant and the early care and educator, influences the relationship between the early care and education provider and the children in his or her care and their families. This captures the "how" of consultation that can be hard to relay when describing the work of mental health consultation.

child readingIn addition to underpinning relationship-based work, the consultative stance also involves the mental health professional avoiding the position of the expert and resisting addressing the mental health needs of children and families alone and in lieu of those who provide regular care for the child and engage the child's family. The consultant does not "fix" the problem; instead, the consultant works collaboratively with the child's regular care providers (staff members and family members) and intervenes indirectly by building the caregivers' capacity to problem-solve and change practices.

Rather than providing direct therapy services to a child, the consultant empowers the caregivers in the child's life to become therapeutic and deliver care and interventions in the context of the child's and caregiver's everyday activities and caregiving (Hepburn et al, 2007). Therefore, the practices associated with the consultative stance lie somewhere between collaboration and direct therapy, as a collaboratively therapeutic intervention.

The consultative stance can challenge the most highly trained mental health services provider. The expertise and knowledge one acquires through a selected mental health related discipline and traditional education, training, and experience may include:

  • Knowledge of child development
  • Children's mental health
  • Family dynamics
  • The experience of group care
  • The early care and education environment
  • Group facilitation
  • Various intervention approaches/skills that are important and essential to preparation to be an early childhood mental health consultant.

However, to be effective in consultation, the mental health professional's preparation must be supplemented with:

  • Emphasis on self-awareness
  • The belief in the power of relationships
  • Respect
  • Flexibility
  • Tolerance for ambiguity
  • A commitment to understanding everyone's perspective.

These are the tools for transforming relationships through the consultative stance and affecting therapeutic change through both child and family centered as well as programmatic consultation.

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Georgetown University Center for Child and Human Development National Center for Effective Mental Health Consultation