Embracing the Client Consultation

Note & Disclaimer: This post was adapted from an assignment I submitted as part of my journey to earn my Doctorate in Marriage and Family Therapy. It was originally designed as a podcast episode, but writing and blogging are near and dear to my heart, so it has been slightly revised to reflect this format.

Today, we’re diving into an exciting opportunity for MFTs and other systemic therapists—systems consultation. Some clinicians may recognize this by other names – initial consultation, chemistry calls, discovery calls, et cetera. Over the past several years, I’ve observed increased debate among mental health practitioners about the value of consultations to both the client and the clinician. Whether you already utilize consultations or if you’re trying to understand why other clinicians willingly part with their time and expertise for free, I think you’ll appreciate looking at consultations from a new angle. 

Defining Systems Consultation

Let’s start by defining systems consultation. In the most basic sense, systems consultation involves assessing and facilitating change within organizational, community, or institutional systems. Unlike traditional psychotherapy, which focuses on individual distress, marriage and family therapy addresses the broader systemic dynamics and patterns impacting intra- and interpersonal functioning. For many MFTs, initial contact with a potential new client, couple, or family spans approximately 15 minutes. It is typically focused on what the client highlights as the area of primary concern. In those 15 minutes, the clinician juggles not only their professional elevator pitch to market themselves effectively to the client, but they must also be able to develop a strong working case conceptualization to guide their assessment of their scope of competence and willingness to work with the client. In that moment, the MFT becomes a consultant as they rapidly assess the broadest (yet ironically narrowest) view of roles, structures, and processes impacting the caller. The clinician can choose to say, “I think we’d be a great fit. When do you want to start therapy?” 

Or, they can say, “Have you tried this instead?”

How Consultation Differs from Therapy

So, how do systems consultation differ from traditional marriage and family therapy? Both emphasize structural and process-oriented change. As MFTs, we’re systems thinkers at heart. This systemic orientation is an epistemological shift from our predecessors, who focused on identified patients and were consumed by symptomology within the context of the medical model. While consultations are not new to the mental health field by any means, and have an important role in helping potential clients exercise agency and autonomy in healthcare decision-making, systems consultations represents a fundamental internal shift in the field of MFT. It requires us all to consider the necessity of therapy. 

Naturally, as MFTs we want to help people, but therapy is not always the right answer. Sometimes issues are resolved by leveraging other resources. 

An excellent clinical supervisor of mine, Dr. Bill Sieber, use to say, “We’re trying to work ourselves out of a job.” That therapeutic aphorism has been a beacon throughout my career, yet more recently I’ve begun asking myself, “What would happen if I stopped trying to work myself into a job?” Meaning, what if I stopped selling myself to clients as the expert and instead offered a consultation that would empower clients to leverage all available resources, strengths, and social supports at their disposal? 

If we think of therapy as an epistemological approach, meaning we justify the application of therapy to relational problems because we inherently believe in its power and its necessity – we cloud and crowd out other options, other opportunities. But if we approach our initial contact with potential new clients as consultants, we can provide insight into systemic functioning and a new way of socially constructing meaning, problem-solving, and connection. We can equip individuals, couples, and families with new ways of thinking, being, and doing in a way that may kindle long-term change without ever having scheduled a session. All in the span of just 15 minutes. 

Why MFTs Are Uniquely Positioned for Systems Consultation

Marriage and family therapists are especially well-suited for systems consultation due to our training in systemic thinking. We’re skilled at rapidly identifying patterns, relational dynamics, and feedback loops within systems. Our ability to conceptualize change holistically allows us to see both individual and relational factors that may bring about structural and functional change. Let’s look at a very straightforward example: 

A marriage and family therapist sets up a phone call with parents of a five-year-old girl who is wetting the bed every night and has tantrums around going to the bathroom. They’re concerned the child is acting out, which they fear will only get worse once the child starts kindergarten in the fall. Instead of scheduling the family for an intake appointment, the clinician refers the parents to a pediatrician. The clinician, or consultant, explains it’s important to rule out underlying medical causes for the enuresis instead of jumping to psychological conclusions or assuming the child has a budding behavioral problem. The family calls the therapist back a week later to thank them, stating that the child developed a urinary tract infection due to improper wiping techniques. The issue was resolved with prescription medication and age-appropriate educational materials for the whole family. The pediatrician also sponsored a support group for new parents out of their office, which the parents decided to join. They no longer feel the need for therapy, but plan to keep the clinician’s contact information on hand for providing a successful consultation that brought rapid relief to all members of the family system and connected them to previously unknown community support. 

I think it’s important to note here that this free 15-minute consultation also saved the family from having to pay the clinician’s hefty diagnostic evaluation fee, not to mention the time they saved filling out paperwork to enter into a contracted professional relationship, driving to the intake appointment, and meeting with the clinician for anywhere from one to two hours to receive the same information. While the clinician might have benefitted from the extra funds, they now can focus their time and efforts on sessions with established clients and catching up on documentation. A welcome additional benefit is the money coming into the practice resulting from high praise by the family and pediatrician, resulting in greater credibility and referrals within their local community. 

Other areas where MFTs can offer systems consultations include healthcare, education, and advocacy. Within these systems, we can work with leaders, administrators, and staff to provide professional insights on structural and functional issues affecting outcomes such as health behaviors across the lifespan, school engagement, and multidisciplinary case management. Systems consultation is a powerful tool for helping other professionals think holistically about how to deliver community services without engaging in a traditional therapeutic relationship. 

Predicted Benefits of Systems Consultation

By expanding our mindset around systems consultations, MFTs can benefit from professional growth and diversification, increase income potential, take pleasure in having a broader impact on their community, and welcome opportunities for collaboration and networking with other professionals. From a systemic perspective, this shift in thinking about how and why MFTs offer systems consultations can have a profoundly preventative impact by instilling systems thinking into the community itself, encouraging engagement across professions, and maximizing the use of the many wonderful resources and connections that often imbue the areas where we live with vibrancy. 

So, what’s the takeaway? Systems consultation is not just an extension of therapy; it’s a powerful avenue for MFTs to amplify their impact, address systemic challenges, and innovate solutions. It’s also a way for us to take a step down from the expert pedestal and welcome other resources, professionals, and especially client strengths and insights into the problem-solving space. In so many ways, systems consultations align with our goal as MFTs to offer brief, solution-focused approaches to issues clients bring forward.