Book review essay:
Corporate Therapy and Consulting

By C. Donald Williams, M.D.
Len Sperry has produced a remarkable work in Corporate Therapy and Consulting. His goal is to help clinicians translate their clinical skills into an organizational setting. To accomplish this, he outlines the history of Organizational Consultation, and in lucid terms describes both the evolution of styles and thought within each branch, and ends with current developments in the field as a whole. The book is extremely current, and addresses external stresses such as downsizing, mergers, and layoffs, without sacrificing historical perspective. Corporate Therapy and Consulting is valuable both to new consultants and experienced practitioners facing new challenges.

    The book is divided into nine chapters. The first two chapters describe the practice of corporate consulting and therapy and how to prepare to practice in this arena. Chapters on organizational dynamics, organizational diagnosis, organizational interventions, and clinical-organizational interventions follow. Lastly, there are chapters on executive dynamics, executive consulting, psychotherapy, and coaching, and consultation with health care organizations.

    Harry Levinson, Ph.D., one of the first psychologists to work in the field of organizational diagnosis, states in the Foreword:

"Corporate Therapy and Consulting not only delineates steps clinicians should take as they begin as organizational consultants, it also sets those steps in the context of organizational methods and practices. It is therefore simultaneously integrative. Thus, it is a first: A fundamental resource for clinicians who turn their sights and organizations and their insights into organizational and individual advantage. This is the text with which organizational consultants will start and that will guide them in a simple, direct, and systematic way, to an expanding literature that is congenial with their clinical orientation and experience. As they become more experienced, they will return to it repeatedly to broaden their horizons and as a point of departure for their own teaching and writing."

    In Chapter One, Dr. Sperry provides an historical overview of what corporate consultation has been and what it is becoming. He describes the "terminology of change," and underlines how commonplace continuous internal and external change are in today's business environment. As he observes, "In the early 1970s I was never asked to consult on such problems as an employee stalking another employee, a hostile takeover, or an unexpected mass layoff of middle managers… [Now] hostile takeovers, large scale downsizing, unprovoked violence, and other crises have significantly increased the stresses associated with organizational life. Not surprisingly, consultation requests have likewise changed." Clinically trained psychiatrists deal with crisis situations and this training can allow us to go beyond the more narrowly-focused organizational development consultation offered by non-clinically trained O.D. specialists.

    The "Taxonomy of Organizational, Clinical-Organizational, and Clinical Interventions by Individual, Team, and Organization," forms the book's outline. The psychiatric clinician will find the familiar procedures under the clinical interventions heading; they include Psychotherapy, Psychiatric Evaluation, Psychopharmacotherapy, Psychiatric Disability Evaluation, Couples Therapy, Family Therapy, Group Therapy, and Milieu Therapy. These anchors provide a heuristically valuable set of correlations for the clinical-organizational interventions and organizational interventions which are listed side by side. Creating an original map of concepts is a formidable task, and requires an inside-out knowledge of the subtleties of information being organized. Professor Sperry performs a signal service to all those seeking to expand their understanding by providing such a lucid conceptual framework.

    Specific examples which will be useful to the aspiring consultant are provided in abundance. Training opportunities, differences in the role between a traditional clinician and a consultant, and a clear, practical description of five different levels of involvement in consultation organizations are discussed. I found I had no difficulty matching my current practice to "Clinical Practice with a Specialized Interest in Work Issues." Readers will find that they fit within one of the five categories which range from "Clinical Practice with Sensitivity to Work Issues" all the way to "Full Time Internal Corporate Consultation."

    Practical suggestions for increasing involvement and visibility as a consultant are presented. Clinical knowledge that is applicable as well as clinical knowledge or habits that must be set aside are discussed in detail. An example of the latter is this admonition: "Finally, the propensity to conduct therapy must be reined. It is proper to engage in therapeutic talk with corporate individuals, but it is usually inappropriate to conduct formal therapy with them while one is engaged as an internal or external consultant." Such insight develops only as the result of significant professional experience.

    Less familiar to most traditionally trained clinicians is the information provided in the following three chapters, namely Organizational Dynamics, Organizational Diagnosis, and Organizational Interventions. One challenge for the aspiring consultant is to familiarize himself or herself with a new lexicon describing work place organizations, subsystems, and their interrelationships. Through the use of diagrams as well as brief but effective references to relevant literature, the author introduces the neophyte reader to the world of business and the way it functions. By means of simple direct language connected to examples, unfamiliar concepts begin to take shape and become meaningful. The varieties of corporate culture, organizational structure, leadership styles toward workers, and overall corporate strategy are described in sufficient detail to give them life, and the reader a sense of their interrelationships.

    Another concept which may be new to clinicians such as this writer, but which immediately made sense, was the discussion of stages of organizational growth and decline. Corporate developmental stages proceed from New Venture through Expansion, Professionalization, Consolidation, Early Bureaucratization, and finally Late Bureaucratization. The descriptions of each of these stages were clear, and I had little difficulty applying them to different businesses with which I am familiar. A description of the phase "Early Bureaucratization" will provide an example of how effectively Dr. Sperry communicates:

"Status Seeking, Business as Usual, and Appearances characterize the behavior of members. The organization is usually well endowed at this stage and may be cash rich for the first time its history. Later, in stage 5, the focus shifts to internal turf wars. Backbiting, coalition building, and paranoia are common. Growing pains are particularly intense as members' dissatisfaction mounts. …The best and brightest start leaving the organization. The emphasis has clearly shifted from growth and maintenance to decline."

    The relationship between a worker, job, organization, and family is illuminated by reference to Charlie Chaplin's 1936 film Modern Times. Work place stress is humorously but effectively dramatized: Chaplin's work team consists of contentious and unsupportive assembly line workers supervised by a demanding and critical line foreman. One day, a device that automatically pushed and poured food into the worker so that his hands would be free to continue working is field tested during the lunch break. The President "volunteers" Chaplin for the demonstration. In slapstick fashion, the device malfunctions and literally assaults Chaplin who later that day becomes so traumatized that "men in white coats are called to carry him off to an insane asylum." Len Sperry mines Chaplin's images and symbols productively to illustrate important workplace relationships.

    The chapter on Organizational Dynamics concludes with a description of three models for understanding organizational dynamics. The Rational Model enshrines "scientific management" and "management by objective." This is essentially a "top down" organizational model, in which the expert and the manager call the shots. The Non-Rational model, which Tom Peters espouses in In Search of Excellence, rests on the assumption that interests of workers and management are congruent and that effective motivation can be accomplished by "finding the right buttons to push." The Integrative Model combines both the Non-Rational and Rational models, and is embodied in four approaches which are set forth in technical but understandable terms.

    Chapter Four, Organizational Diagnosis, reflects more of Len Sperry's gift for conceptualization. Correlations between individual diagnosis and organizational diagnosis are outlined. As noted in the earlier taxonomy table, Sperry's correlation of familiar terms and concepts with unfamiliar concepts facilitates the reader's learning process. A detailed outline for pursuing organizational diagnosis is then presented, along with targets for organizational diagnosis and intervention. Specific examples of problems in the five target areas (power/authority, morale/cohesion, norms/standards, goals/objectives, roles/communications) allow the reader to predict potential conflicts. A more detailed organizational diagnosis appendix to Chapter 4 provides further elaboration.

    Clinical-Organizational Interventions (Chapter Six) flow from the original taxonomy table. These interventions are divided into individually-focused interventions, team-focused interventions, and organization-focused interventions. Highly specific material and immediately applicable commentary allow Dr. Sperry to provide a clear plan for coping with a wide variety of circumstances. Within the category of individually-focused interventions are included hiring discipline and termination consultation; work focus psychotherapy consultation; outplacement counseling and consultation; and stress disability and fitness for duty evaluation and consultation. To take one example of intervention, namely workplace violence and disturbed employee terminations, helpful specific recommendations are provided: "In instances when the worker is uncooperative, and termination appears to be the only alternative, the consultant can assist management by explaining the risk of termination to the worker as well as the choices open to him/her. For instance, the worker can submit to drug testing, accept a shorter long-term suspension, make significant behavioral changes, or be fired. …In a worst case scenario, the highly disturbed worker will refuse to cooperate with any suggestions. When termination appears to be the only option, corporate security guards—or if danger seems imminent, the local police—will escort the worker off the premises permanently." This example illustrates the down-to-earth quality of Dr. Sperry's writing.

    In his discussion of dual career couples' counseling and consultation, Dr. Sperry demonstrates his clinical background and depth. He notes that in some situations a relatively straightforward psychoeducational intervention will be sufficient. For other couples, problematic developmental issues can lead to conflict which interferes with work and is refractory to resolution, and a more in-depth psychodynamic intervention is needed. "Psychodynamic intervention strategies are necessary when problem solving and communication training are not working or are only partially effective because of resistances and impasses secondary to more basic developmental issues." This example illustrates Dr. Sperry's ability to provide guidelines for choosing between work-focused and individually focused interventions.

    The section "Organization-Focused Interventions" incorporates Crisis Intervention Consultation and Consulting on Resistance to Planned Change efforts, merger syndrome consultation, downsizing syndrome consultation, mental health policy consultation, violence prevention consultation trauma and treatment outcome consultation. The discussions are specific, with references provided for each form of consultation. Each of these discussions essentially serves as an introduction to the area under consideration. However, the detail provided in each of these discussions is such that the reader is given an overview for what the process would entail. Sufficient information is provided to facilitate further study and review in a focused manner.

    A chapter on Executive Dynamics serves as preparation for the following chapter on Executive Consulting, Psychotherapy, and Coaching. Clinicians who are unfamiliar with executive functioning will find this introduction informative. Dr. Sperry provides an instructive discussion of differences between male and female executive work patterns, and suggests that female executive work styles may be better suited to the current business climate. Differences between consulting, psychotherapy, and coaching are presented with the assistance of helpful tables and charts. Emphasis is placed on the provision of work-focused psychotherapy and executive coaching; traditional psychotherapy is reserved for those cases which do not respond to the more work centered approaches. Several case examples illustrate these principles. "Working around" problems which cause problems for the manager is contrasted with the traditional "working through" that occurs in traditional psychotherapy. By making distinctions between different types of intervention clear, Dr. Sperry provides a framework for approaching workplace consultation that will be helpful to the new clinician-consultant who needs to organize his approach to diagnosis and intervention.

    A chapter on Consultation to Health Care Organizations completes the book. Special challenges confronting HMOs are described with case examples.

    In summary, Len Sperry has produced a book that builds on the experience clinicians bring to consultation. Its great strength resides in the clarity with which he correlates traditional clinical interventions with corporate clinical-organizational consultation. The factors that both unite and distinguish the two activities are presented in understandable terms. Theories of organizational dynamics, diagnosis, and interventions, largely unfamiliar to traditional clinicians, are presented succinctly. The text is rich with specific guidelines regarding the consultation process. This is both a practical manual and a scholarly book with intellectual depth. It is a valuable contribution to the literature, and an essential guidebook for anyone consulting in the workplace.

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