Winter 1995, Vol. 4, No. 2

The Workplace Psychiatrist's focus: Organizational, clinical-organizational or clinical interventions

By Len Sperry, M.D., Ph.D.

The tumultuous changes facing work organizations today have not only transformed the way business is done and organizations behave, they have markedly altered the nature and type of consultation needs and requests. As recently as 15 years ago, the external environment of work organizations was relatively stable. For the most part, changes--and even crises--originated primarily from within the organization. Consultation tended to be sought to aid in managing these internal planned and unplanned changes. Designing and implementing management development programs and performance appraisal systems were common organizational consultation requests then.

Today's consultation requests are different

Today, both the internal and external environments of organizations seem to be constantly changing, with crises further exacerbating the levels of stress experienced by an organization's leaders and members. A host of changes including hostile takeovers, large-scale downsizing, unprovoked violence and other crises have significantly increased the stressors associated with organizational life. Not surprisingly, consultation requests have likewise changed. Consultation is now more likely to involve re-establishing stability between internal and external environments, as well as dealing with the clinical sequelae of change and crises. Instead of being narrowly focused on management development or performance appraisal systems, consultation is more likely to focus on changing the organization's strategy, structure, culture and team functioning to increase productivity and competitive advantage while also attending to the psychological well-being of its leaders and members, including their clinical needs.

A new breed of consultant needed

While traditionally-trained management consultants and industrial-organizational psychologists may be quite adept at effecting planned change efforts in organizations, they are not clinicians. On the other hand, clinicians, particularly clinical psychiatrists, are trained to deal with crisis situations and their sequelae. As such they have much to offer organizations beyond the provision of traditional psychotherapeutic services. With an expanded vision of their role in organizational change processes and additional assessment and intervention strategies and skills, clinician-consultants can readily meet a number of the challenges modern organizations face today. At a time when many psychiatrists are seeking alternatives to traditional clinical practice, the prospects of providing consultation services to a variety of non-profit organizations, health care organizations, and family-owned businesses may be an exciting, challenging, and welcome option for psychiatrists who are willing and prepared to expand their practice options.

Approaches to interventions differ

In the past it was relatively easy to distinguish clinical from consultation work. The clinical psychiatrist primarily did psychiatric evaluations, psychotherapy, and psychopharmacotherapy, and some did couples, family and group therapy, while workplace psychiatrists usually did disability evaluations, executive consultation, or some type of team and/or organizational interventions. These traditional forms of consultation require considerable skill and experience, and can be done by non-psychiatrically-trained consultants. With the changes in the nature and type of consultation needs, these traditional organizational interventions will still be necessary and useful, but I believe that the demand for clinical-organizational interventions will increase dramatically. The diagram below illustrates the relationship of clinical, organizational, and clinical-organizational interventions.

What are clinical-organizational interventions? Clinical-organizational interventions are therapeutic or quasi-therapeutic methods for dealing with distressing or potentially distressing organizational issues or situations, or preventing them. Traditional organizational interventions, usually referred to as "organizational development" (French & Bell, l995), are most appropriately utilized in instances where modifications or changes in an organization can be planned, that is, designed, implemented, and evaluated. Two organizational interventions that are in vogue today are strategic planning and culture transformation. Clinical-organizational interventions, on the other hand, are more appropriately utilized when changes are unplanned, such as crises, or to prevent or ameliorate crises. Crisis Intervention Stress Debriefing (CISD) and "merger syndrome" consultation are two examples of clinical-organizational interventions. In brief, traditional organizational consultants utilize organizational interventions in dealing with planned change in non-crises contexts, while consultants utilizing clinical-organizational interventions are more likely to be dealing with unplanned changes, usually in crisis situations, or the prevention of crises. The table at right lists a number of organizational, clinical-organizational, and traditional clinical interventions. These organizational and clinical-organizational interventions are described in some detail in Sperry (in press). You'll note that stress disability evaluation is listed under clinical and clinical-organizational. Even though both interventions involve a similar process, they can be quite different. When the disability evaluation is complete with little or no concomitant investigation of the worker's organizational context, the evaluation is a clinical activity. However, when the evaluating psychiatrist adequately assesses the organizational context for possible determinants of the claimed disability, the intervention would be considered clinical-organizational.

By virtue of their medical training--which focuses on diagnosis and treatment--and their postgraduate training and experience, which emphasizes interventions of medical and psychosocial crises, psychiatrists are uniquely qualified, and more likely than those of other helping professions, to become expert at utilizing clinical-organizational interventions. By translating and extending their knowledge and skills in clinical psychiatry, psychiatrists should be able to develop competency in clinical-organizational interventions. Certainly, the amount of training and experience to accomplish this is considerably less than to develop competency in the organizational interventions.

References

French, W., and Bell, C. (l995), Organization Development. Behavioral Science Interventions for Organizational Improvement, Englewood Cliffs, NJ: Prentice-Hall.

Sperry, L. (in press), Corporate Therapy and Consulting. New York: Brunner/Mazel.

 
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