Should You Put Your Practice on the Couch?

Psychoanalyst Now Accepting Corporate "Patients"

Cites consultant Kerry J. Sulkowicz
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Facing extinction from cost-conscious, pill-wielding managed-care insurance organizations, some psychoanalysts like Kerry J. Sulkowicz, MD, are reinventing themselves  in the form of management consultants. And Sulkowicz says his marriage of psych and consulting can help physicians master the difficulties of managing a practice.

What does psychoanalysis have to do with business management consulting, you may ask?

“Quite a bit,” says Sulkowicz, a 42-year old, psychiatrist, psychoanalyst, and the president of the Boswell Group, LLC, in New York City.

Traditionally, consultants give structural recommendations, whereas the Sulkowicz brand of consultation offers up advice on the underlying psychological causes of the management problems, whether from a dysfunctional management team, a family business bringing bedroom politics into the boardroom, a venture capitalists looking at the psychological fit of a management team in a company they are considering funding, or working with an executive search firm on good fits for important hires.

“[Companies] often fail due to leadership problems, ineffectual management teams, mistaken hiring decisions, inadequate succession planning, and culture clashes such as merging of two distinct corporate ways of life,” he says.

Consulting is not all that different from traditional psychoanalysis between a therapist and a patient. First, the consultant meets with the chief executive officer or the equivalent leaders of the client organization in search of the manifest reason for the corporate dysfunction.

“Complete access is important to success. You must immerse yourself in the life of the organization and get to know its people, practices, and culture,” Sulkowicz says. “We get to know individuals first, but the bulk of the work is with the group.”

It’s not an in-and-out operation, he says. Much like individual psychoanalysis, putting a company on a couch can take some time. The consultant often stays to see the changes integrated and develops an ongoing relationship with the client.

One goal is “enabling members of the management team and leaders to gain more empathy for one another, so they understand one another instead of blaming one another,” he says. Another goal is helping the management team develop their own set of tools to do themselves what the consultant is doing.

With respect to medical practices, the psychoanalytic consultation can help in a number of ways, Sulkowicz says. “First, it gets doctors and staff talking to one another by removing obstacles to open communication and repairing covert problems in the dynamics of the team,” Sulkowicz tells WebMD. “This in turn improves collaboration, efficiency, and overall quality of care, while decreasing the risk of mistakes.”

The analytic perspective, he says, is uniquely able to address the stresses of working with dying, demanding, psychosomatic, and difficult patients  which are made worse by the additional pressures of managed care.

Such conditions are a breeding ground for medical errors. “Analytic intervention can also help physicians, who are not necessarily natural leaders, become more effective managers,” he says.

“Medical organizations, whether group practices or hospitals, have different goals than other business, but they are still in business to make money, and as such, are subject to the same kinds of group dynamic problems as other businesses,” Sulkowicz says. “Today there is even more pressure, because changes in medical economics have forced doctors to shift focus to the competing goals of profitability versus high quality patient care.”

Consultants however can try to get these goals aligned. “They don’t have to be mutually exclusive,” Sulkowicz says.

Other doctors understand the utilization of psychoanalysis in business. “Psychoanalysis plays a unique role in management consulting,” says Kenneth Settel, MD, a consultant at SPECTRUM OED in Brookline, Mass. “This type of consulting is not just about treating the symptoms, it’s also about uncovering their root cause.”

“We try to understand what the underlying sources of the corporate dysfunction are, because you can’t be effective if you don’t understand where the problems are coming from. This may involve looking at the unconscious feelings of individuals in an organization,” he tells WebMD.

The idea for psychoanalytic management consulting took form five years ago at a cocktail party when another guest began to pick Sulkowicz brain about his company problems. Shortly thereafter, this man hired Sulkowicz on a trial basis to see what he could do. A lot, it seems.

Several more business consulting projects followed and then, two years ago, Sulkowicz formed the Boswell Group. And business is booming by all accounts. Boswell Group has about three to four ongoing clients/cases at a time.

Right now, the company is predominantly Sulkowicz, but the forecast is growth. Consulting may be one type of business that thrives in all economies.

“I think with the downturn on the economy, there may even be more need for this type of approach. We tend to see a wave of consolidation in different industries and a lot of mergers and downsizing, and those always involve a hard look at corporate culture,” he tells WebMD.

“When people start getting laid off, it has a ripple effect on those who remain and can cause dysfunction at the management level and below,” he says.

Written by Denise Mann