Counseling A Comprehensive Profession, 8th Edition Samuel T Gladding Solution Manual

Instructor’s Resource Manual and Test Bank For

Counseling: A Comprehensive Profession Eighth Edition Samuel T. Gladding, Wake Forrest University

Prepared by Nathaniel Ivers, Wake Forrest University

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PREFACE This instructor’s manual was written to facilitate use of Counseling: A Comprehensive Profession, Eight Edition, by Samuel T. Gladding. This manual provides several essential features that make it a useful tool in the teaching of counseling.

First, the manual is organized on a chapter-by-chapter basis. Instructors who wish to concentrate on material covered in a particular learning unit can easily do so.

Second, in the beginning of each chapter is a brief overview of the main points covered in that unit in the textbook. Following this review is a list of key terms, concepts, and people discussed in the chapter. Thus, instructors are able to remind themselves of both general and specific aspects of a chapter in a relatively short period of time.

Third, after the chapter overviews are the chapter outlines. These outlines are summaries of each chapter’s contents. The outlines will help instructors remember important points made in each chapter along with their corresponding references.

Fourth, near the end of each chapter in the manual are a number of multiple choice and essay questions that cover the material discussed in the unit. The multiple choice format is the primary way licensure and certification tests are structured. Thus, students can demonstrate their mastery of the subject matter while simultaneously gaining practice in a particularly important way of answering professional competency questions. The essay question can be used with or in place of the multiple choice questions in testing students in a more comprehensive and integrative way about events, concepts, trends, and people discussed in the chapters.

Fifth, each chapter contains classroom exercises. Instructors can use these exercises to start group discussions or to help students realize in a more experiential way points made in the chapter.

Finally, each chapter finishes with an annotated list of additional resources that instructors can use to supplement the material in the textbook. The focus of these resources is on audio and video productions. Possible ways to access these materials are included in the lists.

Overall, you will find this manual user-friendly and a crucial supplement to your work as a teaching professional in the field of counseling.

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TABLE OF CONTENTS CHAPTER 1: PERSONAL AND PROFESSIONAL ASPECTS OF COUNSELING............1 Chapter Overview ......................................................................................................................1 Key Terms, Concepts, and People .............................................................................................1 Chapter Outline ..........................................................................................................................3 Activities ....................................................................................................................................8 Multiple Choice Questions ......................................................................................................10 Essay Questions .......................................................................................................................12 Resources .................................................................................................................................13 CHAPTER 2: ETHICAL AND LEGAL ASPECTS OF COUNSELING ..............................14 Chapter Overview ....................................................................................................................14 Key Terms, Concepts, and People ...........................................................................................14 Chapter Outline ........................................................................................................................15 Activities ..................................................................................................................................25 Multiple Choice Questions ......................................................................................................27 Essay Questions .......................................................................................................................29 Resources .................................................................................................................................30 CHAPTER 3: COUNSELING IN A MULTICULTURAL SOCIETY ..................................31 Chapter Overview ....................................................................................................................31 Key Terms, Concepts, and People ...........................................................................................31 Chapter Outline ........................................................................................................................32 Activities ..................................................................................................................................38 Multiple Choice Questions ......................................................................................................39 Essay Questions .......................................................................................................................41 Resources .................................................................................................................................42 CHAPTER 4: COUNSELING WITH DIVERSE POPULATIONS .......................................44 Chapter Overview ....................................................................................................................44 Key Terms, Concepts, and People ...........................................................................................44 Chapter Outline ........................................................................................................................45 Activities ..................................................................................................................................49 Multiple Choice Questions ......................................................................................................50 Essay Questions .......................................................................................................................52 Resources .................................................................................................................................53 CHAPTER 5: BUILDING COUNSELING RELATIONSHIPS.............................................55 Chapter Overview ....................................................................................................................55 Key Terms, Concepts, and People ...........................................................................................55 Chapter Outline ........................................................................................................................56 Activities ..................................................................................................................................60 Multiple Choice Questions ......................................................................................................62 Essay Questions .......................................................................................................................64 iv ..

Resources .................................................................................................................................65 CHAPTER 6: WORKING IN AND CLOSING A COUNSELING RELATIONSHIP ........66 Chapter Overview ....................................................................................................................66 Key Terms, Concepts, and People ...........................................................................................66 Chapter Outline ........................................................................................................................67 Activities ..................................................................................................................................80 Multiple Choice Questions ......................................................................................................81 Essay Questions .......................................................................................................................84 Resources .................................................................................................................................85 CHAPTER 7: PSYCHOANALYTIC, ADLERIAN, AND HUMANISTIC THEORIES OF COUNSELING.............................................................................................................................87 Chapter Overview ....................................................................................................................87 Key Terms, Concepts, and People ...........................................................................................87 Chapter Outline ........................................................................................................................89 Activities ................................................................................................................................100 Multiple Choice Questions ....................................................................................................101 Essay Questions .....................................................................................................................103 Resources ...............................................................................................................................104 CHAPTER 8: BEHAVIORAL, COGNITIVE, SYSTEMIC, BRIEF, AND CRISIS THEORIES IN COUNSELING ...............................................................................................108 Chapter Overview ..................................................................................................................108 Key Terms, Concepts, and People .........................................................................................108 Chapter Outline ......................................................................................................................111 Activities ................................................................................................................................125 Multiple Choice Questions ....................................................................................................126 Essay Questions .....................................................................................................................128 Resources ...............................................................................................................................129 CHAPTER 9: GROUPS IN COUNSELING...........................................................................133 Chapter Overview ..................................................................................................................133 Key Terms, Concepts, and People .........................................................................................133 Chapter Outline ......................................................................................................................134 Activities ................................................................................................................................143 Multiple Choice Questions ....................................................................................................144 Essay Questions .....................................................................................................................146 Resources ...............................................................................................................................147 CHAPTER 10: CONSULTATION AND SUPERVISION ....................................................150 Chapter Overview ..................................................................................................................150 Key Terms, Concepts, and People .........................................................................................150 Chapter Outline ......................................................................................................................151 Activities ................................................................................................................................158 Multiple Choice Questions ....................................................................................................159 v ..

Essay Questions .....................................................................................................................161 Resources ...............................................................................................................................162 CHAPTER 11: EVALUATION AND RESEARCH ...............................................................163 Chapter Overview ..................................................................................................................163 Key Terms, Concepts, and People .........................................................................................163 Chapter Outline ......................................................................................................................164 Activities ................................................................................................................................171 Multiple Choice Questions ....................................................................................................173 Essay Questions .....................................................................................................................175 Resources ...............................................................................................................................176 CHAPTER 12: TESTING, ASSESSMENT, AND DIAGNOSIS IN COUNSELING .........177 Chapter Overview ..................................................................................................................177 Key Terms, Concepts, and People .........................................................................................177 Chapter Outline ......................................................................................................................179 Activities ................................................................................................................................190 Multiple Choice Questions ....................................................................................................191 Essay Questions .....................................................................................................................193 Resources ...............................................................................................................................194 CHAPTER 13: CAREER COUNSELING OVER THE LIFESPAN ...................................196 Chapter Overview ..................................................................................................................196 Key Terms, Concepts, and People .........................................................................................196 Chapter Outline ......................................................................................................................197 Activities ................................................................................................................................206 Multiple Choice Questions ....................................................................................................207 Essay Questions .....................................................................................................................209 Resources ...............................................................................................................................210 CHAPTER 14: COUPLE AND FAMILY COUNSELING ...................................................211 Chapter Overview ..................................................................................................................211 Key Terms, Concepts, and People .........................................................................................211 Chapter Outline ......................................................................................................................212 Activities ................................................................................................................................219 Multiple Choice Questions ....................................................................................................221 Essay Questions .....................................................................................................................223 Resources ...............................................................................................................................224 CHAPTER 15: PROFESSIONAL SCHOOL COUNSELING..............................................225 Chapter Overview ..................................................................................................................225 Key Terms, Concepts, and People .........................................................................................225 Chapter Outline ......................................................................................................................226 Activities ................................................................................................................................238 Multiple Choice Questions ....................................................................................................240 Essay Questions .....................................................................................................................242 vi ..

Resources ...............................................................................................................................243 CHAPTER 16: COLLEGE COUNSELING AND STUDENT-LIFE SERVICES ..............246 Chapter Overview ..................................................................................................................246 Key Terms, Concepts, and People .........................................................................................246 Chapter Outline ......................................................................................................................247 Activities ................................................................................................................................258 Multiple Choice Questions ....................................................................................................259 Essay Questions .....................................................................................................................261 Resources ...............................................................................................................................262 CHAPTER 17: ABUSE, ADDICTION, DISABILITY, AND COUNSELING ....................263 Chapter Overview ..................................................................................................................263 Key Terms, Concepts, and People .........................................................................................263 Chapter Outline ......................................................................................................................265 Activities ................................................................................................................................279 Multiple Choice Questions ....................................................................................................281 Essay Questions .....................................................................................................................283 Resources ...............................................................................................................................284 CHAPTER 18: CLINICAL MENTAL HEALTH AND PRIVATE PRACTICE COUNSELING...........................................................................................................................288 Chapter Overview ..................................................................................................................288 Key Terms, Concepts, and People .........................................................................................288 Chapter Outline ......................................................................................................................289 Activities ................................................................................................................................296 Multiple Choice Questions ....................................................................................................297 Essay Questions .....................................................................................................................299 Resources ...............................................................................................................................300 APPENDIX A: HISTORY OF COUNSELING ......................................................................302 Chapter Overview ..................................................................................................................302 Key Terms, Concepts, and People .........................................................................................302 Chapter Outline ......................................................................................................................304 Activities ................................................................................................................................311 Multiple Choice Questions ....................................................................................................313 Essay Questions .....................................................................................................................315 Resources ...............................................................................................................................316 ANSWER KEYS TO MULTIPLE CHOICE ..........................................................................318 ANSWER KEYS TO ESSAY QUESTIONS ...........................................................................322

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CHAPTER 1 PERSONAL AND PROFESSIONAL ASPECTS OF COUNSELING CHAPTER OVERVIEW This chapter focuses on the personal and professional qualities associated with effective counselors. It emphasizes that some individuals make better counselors than others because of their temperament, experiences, knowledge, and skills. The importance of self-examination and growth is emphasized along with professional development. Academic standards for becoming a professional counselor and credentialing also are discussed. Systems in counseling are described including the development/wellness approach and the medical/pathology model. Finally, the importance of engaging in professional counseling-related activities is highlighted particularly continuing education, supervision, advocacy and communication through portfolios.

KEY TERMS, CONCEPTS, AND PEOPLE 20/20: A Vision for the Future of Counseling accredited counselor education program advocacy Association for Counselor Education and Supervision (ACES) attribution burnout certification certified mental health counselor (CCMHC) cognitive complexity compassion fatigue compensatory model Council for Accreditation of Counseling and Related Educational Programs (CACREP) continuing education units (CEUs) credentialing counseling desire for power Developmental Counseling and Therapy (DCT) developmental/wellness approach Diagnostic and Statistical Manual (DSM) dispositional eclectic counseling emotional distress empathy energy enlightenment model flexibility generalist human services workers goodwill guidance Health Insurance Portability and Accountability Act (HIPAA) inpatient settings inspection 1 ..

intellectual competence licensure loneliness and isolation long-term relationship medical model moral model National Board of Certified Counselors (NBCC) National Certified Counselor (NCC) National Council for Accreditation of Teacher Education (NCATE) National Counselor Exam (NCE) National Register of Health Service Providers nonprofessional helper need for love outpatient settings paraprofessional patients peer supervision Piagetian concepts of cognitive levels portfolio (working/presentation) professional helper psychiatrist psychologist psychotherapy registration self-awareness short-term relationship social worker solution-focused theory stress inoculation training (SIT) social justice supervision support synchronicity system therapy vicarious coping vicarious rebellion wounded healer

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CHAPTER 1 - PERSONAL AND PROFESSIONAL ASPECTS OF COUNSELING Definition of counseling: • •

Grew out of the progressive guidance movement of the early 1900s with an emphasis on prevention and purposefulness.

From 20/20: A Vision for the Future of Counseling, counseling is “a professional relationship that empowers diverse individuals, families, and groups to accomplish mental health, wellness, education, and career goals. o Emphasizes wellness, personal growth, career, education, and empowerment concerns o Is conducted with persons individually, in groups, and in families o Is diverse and multicultural o Is a dynamic process

The effectiveness of a counselor and of counseling depends on numerous variables including: • • •

The personality and background of the counselor, Formal education of the counselor, and The ability of the counselor to engage in professional counseling-related activities such as continuing education, supervision, advocacy, and the building of a portfolio.

The Personality and Background of the Counselor Negative Motivators for Becoming a Counselor •

Not everyone is cut out to be a counselor. Inappropriate reasons for entering counseling include: o Emotional distress – unresolved emotional traumas o Vicarious coping – living life through your clients or others rather than having meaningful relationships yourself o Loneliness and isolation – seeking friendships through counseling others o A desire for power – seeking to control others who feel powerless in their own lives o A need for love – individuals who are self-absorbed and believe problems are resolved through love and tenderness alone: They think they can give these to the client. o Vicarious rebellion – unresolved anger; acting out their own thoughts and feelings through their clients’ defiant behaviors

Personal Qualities of an Effective Counselor • • • •

Curiosity and inquisitiveness Ability to listen Comfort with conversation Empathy and understanding 3 ..

• • • • • •

Emotional insightfulness Introspection Capacity for self-denial Tolerance of intimacy Comfort with power Ability to laugh

Qualities of Effective Counselors over Time • • • • • •

Intellectual competence Energy Flexibility Support Goodwill Self-awareness

Maintaining Effectiveness as a Counselor • •

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Handling stressful life events while still counseling others can result in synchronicity, events that occur coincidentally result in a meaningful connection. In other words, handling one’s own life events may enhance his/her counseling.

Remain objective, accepting and confronting situations, asserting own wishes, participating in a wellness lifestyle, and grieving. o Counselors who have healthy lifestyles and learn from their mistakes and successes are more likely to be effective with their clients. o Those who wish to enter the profession need to adapt to losses as well as gains and remain relatively free from destructive triangling patterns (i.e., mom tells daughter about frustration with dad, dad tells daughter about frustrations with mom).

Avoid problematic behaviors, such as burnout. o Burnout is the state of becoming emotionally or physically drained to the point that one cannot perform functions meaningfully. Counselors must develop interests outside counseling and avoid taking their work home. o Ways to prevent burnout: • Associate with healthy individuals.

• Work with committed colleagues and organizations that have a sense of mission.

• Be reasonably committed to a theory of counseling.

• Use stress-reduction exercises.

• Modify environmental stressors.

• Engage in self-assessment.

• Periodically examine and clarify counseling roles, expectations, and beliefs.

• Obtain personal therapy.

• Set aside free and private time.

• Maintain an attitude of detached concern when working with clients.

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Retain an attitude of hope.

Professional Aspects of Counseling •

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Levels of Helping o Nonprofessional helpers ▪ Friends, colleagues, untrained volunteers, or supervisors ▪ Various degrees of wisdom and skills ▪ No specific educational requirements, level of helping varies o Generalist human services workers ▪ Have some formal training in human relations skills but work as part of a team ▪ Mental health technicians, child care workers, probation personnel, and youth counselors o Professional helpers ▪ Educated to provide assistance on both a preventive and a remedial level ▪ Counselors, psychologists, psychiatrists, social workers, psychiatric nurses, and marriage and family therapists ▪ Have specialized advanced degrees and have had supervised internships Professional Helping Specialties o Counselors frequently interact with psychiatrists, psychologists, and social workers: ▪ Psychiatrists – have an MD and complete a residency in psychiatry. They work with people who have major psychological disorders. They work within the biomedical model and prescribe medicine for disorders. Their clients are called patients. They must pass a national and state exam.

▪ Psychologists – have a doctorate of philosophy (Ph.D.), doctorate of education (Ed.D.), or a doctor of psychology (Psy.D.). Coursework and internships are centered on clinical, counseling, or school-related areas.

State licensures vary. Clinical counselors are usually listed in the national Register of Health Service Providers.

▪ Social workers – usually earn a master’s of social work degree (M.S.W.); however, some universities grant a bachelor’s of social work. Some M.S.W.s have advanced training at the doctoral level. All social workers have completed internships in social agencies.

The Education of Professional Counselors o Professional counselors hold either a master’s or doctorate (or both) in counseling and complete internships in specialty areas. They are usually certified by the National Board of Certified Counselors (NBCC) and/or are licensed by a state. o Standards for CACREP approved master’s degree programs are listed in your text.

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Credentialing of Counselors – Four types of professional credentials •

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Inspection - mental health centers are subject to personnel and program inspections (much like a child care center must be inspected). Inspections might include reviewing case notes on treatments, agency procedures, and personal interviews.

Registration – submission of information to the state about the nature of the practice.

Professional organizations, such as ACA, set standards for qualifications as a registrant.

Certification – State or national boards or departments issue certification stating that an individual has met the requirements for a specialty (just like teacher certification). A competency test is usually required along with letters of reference before certification is issued. Counselors who desire to be a NCC (national certified counselor) must have a minimum of 48 semester hours of graduate study in counseling or a related field, including a master’s degree in counseling from a regionally accredited institution of higher education. o Courses required for a program of study: ▪ Human growth and development ▪ Groups work ▪ Research and program evaluation ▪ Counseling theories/helping relationships ▪ Professional orientation ▪ Career and lifestyle development ▪ Ethics ▪ Social/cultural foundations ▪ Appraisal o Supervision ▪ Two academic terms of supervised field experience in a counseling setting o Must pass National Counselor Examination (NCE) o Non-CACREP programs require 3000 client contact hours postmaster’s experience and 100 hours of weekly face-to –face supervision. o Both national and state licensure is recommended for recognition, state politics, networking, and areas of specialty.

Licensure o All states govern the licensure process. State licensure boards oversee the codes of ethics and offer discipline to those who are licensed who violate the codes.

Attribution and Systematic Framework of the Counselor •

Attributes – what the counselor attributes the cause of a client’s problem. A system is a set of ideas, principle, and behaviors (counselor’s approaches to client’s problem or issue). Four main attribution models are used by counselors: o Medical Model – client is not held responsible for the cause or solution of their problem. Counselors of the model are usually experts and provide the necessary services for change. Client may become dependent on counselor. o Moral Model – self –help model and opposite of the medical model. Client is seen as responsible for causing and solving his/her problem. Counselors are coaches or motivators. Victims may be held responsible for their own victimization.

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o

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Compensatory Model – client is not responsible for the cause of the problem, only for the solution. Counselor and clients are partners to overcome problem.

Counselor acts as a teacher who educates, provides skills and opportunities for client to change. Clients may feel pressure to continually solve problems not created by them.

Enlightenment Model – Client is responsible for the cause but not for the solution.

Clients are seen as “guilty.” They need enlightenment about their problem and ways to resolve these problems. Counselors provide the solution. Client may become dependent on counselor.

Systems of Counseling o Developmental/Wellness Approach – based on the idea of developmental growth at different stages of life. For instance, what might be acceptable behaviors at one stage may not be appropriate at another stage of life. Ivey suggests applying Piagetian concepts of cognitive development to clinical interviews. That way, counselors can work from the sensorimotor level to bring out unrecognized feelings of the client. Wellness emphasizes the positive nature and health of clients. Individuals are seen as capable in solving their own problems. Children at-risk even show resilience and may become coping adults.

▪ Examples: Solution-focused theory, stress inoculation training (SIT) ▪ Emphasis on prevention and education: Counselors and clients function best when they are informed about the mental, physical, and social spheres of human life. They learn to focus on avoiding or minimizing internal or external stress. o Medical/Pathological Model – treatment is based on the Diagnostic and Statistical Manual of Mental Disorders (DSM). It is compatible with the International Classification of Diseases manual (ICD), published by the World Health Organization, in codifying psychiatric disorders.

Engaging in Professional Counseling-Related Activities •

Continuing Education o Treatment and practice of clients must be evaluated. Counselors can become dated in the delivery of skills (just like a medical doctor). Counselors must obtain CEUs annually to stay abreast of the latest and best methods. CEUs may be earned by attending workshops, taking correspondence courses or even reading journals.

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Advocacy and Social Justice o Advocacy is the promotion of an idea or a cause through public relations. Social justice refers to the idea of creating a society or institution that is based on the prnciples of equality, that value human rights, and that recognizres the dignity of every human being. By advocating for the concerns of clients, counselors correct injustices and improve conditions for an individual or groups. Presentation can be made to clubs and civic groups, writing articles for newspapers, engaging in community issues. Advocacy is also needed in the passage of laws when 7 ..

conditions adversely affect clients of the profession. Counselors may write letters or visit legislators.

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Portfolios o Portfolios are forms of communication that document an individual’s training, work, and pertinent life experiences. Documentation is needed for licensure, managed care organizations, employer evaluations, and even new jobs.

• Working portfolio – a continuous collection of unabridged artifacts that counselors can use as evidence of professional competence: vita/resume, documentation on counseling courses including practicum and internships, post degree supervision, work experience, professional credential, continuing education, presentations, publications, and professional service.

• Presentation portfolio – materials needed for a particular project, such as becoming an expert witness in a court of law.

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Health Insurance Portability and Accountability Act (HIPAA) o HIPAA refers to federal legislation passed in 1996. The act was intended to improve healthcare delivery and protect confidentiality and security of health information. o HIPAA called on the Department of Health and Human Services to publish new rules to ensure standardization of electronic data, provide unique health identifiers, and provide security standards to protect confidentiality and integrity of health information. o Providers of health series, including counselors, must comply with requirements and regulations regarding transmitting any health care information in an electronic form. Noncompliance includes fines and imprisonment. o Compliance requirements for large organizations include: • Building awareness of HIPAA • Assessment of the organization’s privacy practices, information security systems and procedures, and use of electronic transactions • Developing an action plan for compliance with each rule • Developing technical and management infrastructure to implement the plans • Implementing a comprehensive implementation action plan.

CLASSROOM ACTIVITIES 1. Review the personal, theoretical, and educational qualities that ideal counselors possess.

Discuss how you think these qualities might differ if you were counseling outside the United States—for example, in India, Sweden, Israel, Australia, or Argentina. Share your opinions with the class.

2. Discuss with another classmate how you might help each other grow professionally if you were unequal in ability as counselors. After you have made your list, share it with another group of two and then with the class as a whole. As a class, discuss how the strategies you have formulated might be helpful in your lifetime development as counselors.

3. With another classmate, discuss how you would approach clients differently and similarly if you were coming from a developmental/wellness perspective as opposed to a 8 ..

medical/pathological model. Report your results to the class.

4. Investigate how counseling associations or counselors have advocated for their clients’ needs and for the profession of counseling itself. A good place to begin is to consult the Public Policy section of the American Counseling Association homepage.

5. Share with the class a current event that depicts a social inequity or injustice either within an institution or society and ask students to get into small groups to discuss actions counselors could take to correct the social injustice. Also have groups discuss unique characteristics and training that counselors have that would facilitate their ability to be social change agents.

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CHAPTER 1 - MULTIPLE CHOICE QUESTIONS 1. Which one of the following is not a dysfunctional motivator for becoming a counselor? a. emotional distress b. vicarious coping or rebellion c. curiosity d. loneliness and isolation 2. Which of the following, according to Rollo May, refers to a professional helper who is able to work from a perspective of resolved emotional experience that has sensitized him or her to self and others in a helpful way. a. a wounded healer b. a wounded helper c. an effective counselor d. a mental health counselor 3. Marcus would like to become a professional counselor. He is inquisitive, listens well, and has a positive sense of humor. However, he struggles to see or feel from within. Based on this description, in which of the following personal qualities of a counselor is Marcus lacking? a. Tolerance of intimacy b. Capacity for self-denial c. Empathy and understanding d. Introspection 4. Which one of the following is not a suggested way to avoid burnout? a. associating with healthy individuals b. concentrating all your energies on counseling c. obtaining personal therapy d. retain an attitude of hope 5. Ashley, a psychiatrist, was trained to focus on the physical processes thought to underlay mental and emotional disorders. Under which model, therefore, did Ashley train? a. Biomedical model b. Moral model c. Compensatory model d. Systems model 6. Psychologists may earn all but one of the following advanced degrees in psychology in order to be eligible for licensure: a. a doctor of philosophy (Ph.D.) b. a doctor of education (Ed. D.) c. a doctor of psychology (Psy.D.) d. a medical degree (M. D.) 7. If Chelsea, a recent graduate of a CACREP-accredited counseling program, is a national certified counselor, she possesses which type of professional mental health credentials?

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a. b. c. d.

Inspection Registration Certification Licensure

8. Which of the following is a statutory process by which an agency of government grants permission to a person meeting predetermined qualifications to engage in a given occupation and/or use a particular title to perform specified functions? a. Inspection b. Registration c. Certification d. Licensure 9. The lowest of the four types of professional credentials a professional may obtain is _________. a. certification b. licensure c. inspection d. registration 10. Of the four main attribution models that counselors use on either a conscious or unconscious basis, the one where clients are held “responsible only for solving their problems but not for causing them” is the ______________ model. a. medical b. moral model c. compensatory d. enlightenment 11. Which of the following is an example of a counseling intervention based on the developmental/wellness approach to counseling? a. remediation b. stages of human growth c. stress inoculation training d. modification of chronic pain 12. Nathan bases his treatment plans in accordance with the DSM. Which one of the following views of counseling is Nathan using? a. Developmental/wellness approach b. Medical/pathological approach c. Advocacy/social justice approach d. Humanistic/scientific approach 13. Which of the following refers to the idea of creating a society or institution that is based on the principles of equality, that values human rights, and that recognizes the dignity of every human being? a. Advocacy 11 ..

b. Wellness c. Nice counselor syndrome d. Social justice 14. A counselor portfolio that contains a continuous collection of unabridged artifacts counselors can use as evidence of professional competence is called a __________ portfolio. a. presentation b. working c. professional d. continuous 15. Which of the following is accurate regarding HIPAA? a. Publishes rules to ensure the standardization of electronic patient health, administrative, and financial data b. A law passed to ensure the protection of health records, which, to date, do not include mental health records, and therefore do not apply to counseling. c. A law that counselors should be aware of and follow in the event that they work in an integrative care facility, such as a hospital or doctor’s office. Otherwise, it does not apply to mental health records. d. All of the above.

ESSAY TEST QUESTIONS 1. Experts in counseling have described a number of qualities that counselors should possess.

Pick what you consider to be the five most important qualities and explain your rationale for picking them. In addition, discuss what a counselor can do to improve himself or herself professionally throughout his or her career.

2. How would a counselor adhering to the development/wellness approach view his or her clients? What about a counselor adhering to the medical/pathology model? Compare and contrast these two main systems of counseling.

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ADDITIONAL RESOURCES American Counseling Association. (1996). The wounded healer [Film]. (Available from American Counseling Association, 5999 Stevenson Avenue, Alexandria, VA 22304) In this video, Rollo May discusses the links between pain and creativity. He highlights some well-known professionals and their journeys to becoming healers.1-800-422-2648 Rosenthal, H. (1993). Review questions: For NBCC and State Counselor Examination, 2nd ed.

[Audio Tapes]. (Available from Taylor & Francis Group, 47 Runway Road, Levittown, PA, 19057) These 5 tapes help fight pre-exam anxiety with the 275 question review and information on the National Counselor Examination. Each set comes with a 16-page booklet. 1-800-8218312.

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CHAPTER 2 ETHICAL AND LEGAL ASPECTS OF COUNSELING CHAPTER OVERVIEW This chapter focuses on the ethical standards and legal aspects of counseling. The reasons for, benefits of, and the limitations of ethical codes and legal codes are examined. Ethical decision making is explored with a special look at certain principles and procedures that counselors can follow to help them make ethically sound decisions. Furthermore, special counseling situations where ethical crises may arise are discussed, e.g., in schools and with families. Ways of dealing with unethical counselors also are included. The interface between the legal system and the counseling profession is covered as well. The issues of counselor liability are discussed, especially regarding the questions of client rights and records. Finally, the issue of counselors in the courtroom is highlighted along with a look at the different cultures in which attorneys and counselors live.

KEY TERMS, CONCEPTS, AND PEOPLE ACA Code of Ethics Administrative liability Association for Spiritual, Ethical, and Religious Values in Counseling (ASERVIC) Autonomy Beneficence Bogust v. Iverson Buckley Amendment Certification Civil liability Codes of ethics Confidentiality Criminal liability Cyber counseling or webcounseling Developmental stages of ethical reasoning Dual or multiple relationships Ethical principles Ethical reasoning Ethics Family Educational Rights and Privacy Act (Buckley Amendment) Fidelity Five-stage developmental continuum of reasoning Individual orientation Individualized education plan (IEP) Inspection Institutional orientation Iowa Law Review Note Jaffee v. Redmond Justice Law Law liability 14 ..

Liability Licensure Limited license Malpractice Morality Moral traces NBCC certification Nonmaleficence Principle (conscience) orientation Privacy Privileged communication Professional ethics Publicity Punishment orientation Registration Slippery slope effect Societal orientation Tarasoff v. Board of Regents of the University of California Tort Unethical behavior Universality Veracity Weldon v. Virginia State Board of Psychologists Examiners

CHAPTER 2 - ETHICAL AND LEGAL ASPECTS OF COUNSELING Definitions: Ethics, Morality, and Law • • •

Ethics – the standard that governs relationships between individuals, such as between a counselor and his/her clients.

Morality – the judgment or evaluation of an action. (shoulds, oughts, rights, wrongs) Law – the precise codification of governing standards that are established to ensure legal and moral justice. Created by legislation, court decisions, tradition, and English common law. Law dictates what is legal, not what is ethical. (Therefore, a behavior may be unethical but still legal.)

Ethics and Counseling •

Professional counselors are concerned with ethics and values. Many treat ethical complaints with the same degree of seriousness as lawsuits.

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Unethical behaviors in counseling include: o Violation of confidentiality o Exceeding one’s level of professional competence o Negligent practice 15 ..

o o o o o o o o •

Claiming expertise one does not possess Imposing one’s values on a client Creating dependency in a client Sexual activity with a client Certain conflicts of interest, such as dual relationships (ex., being a counselor to a client and serving as his/her tennis partner) Questionable financial arrangements, such as charging excessive fees Improper advertising Plagiarism

Association for Spiritual, Ethical, and Religious Values in Counseling (ASERVIC) under the ACA publish guideless for leaders in professional counseling organization and publish a journal, Counseling and Values, containing articles on ethical situations.

Professional Codes of Ethics and Standards •

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Reasons for Codes of Ethics o Protect the profession from government o Help control internal disagreements o Protect practitioners from the public Development of Codes of Ethics for Counselors o The first code of ethics was developed by ACA formally known as APGA based on the APA code of ethics initiated by Donald Super and approved in 1961. The codes have been revised many times since. o ACA’s latest ethics code is comprehensive in nature and a major sign that counseling has developed into a mature discipline. o ACA 2014 proposed six purposes for its code of ethics: ▪ Set for ethical obligations and provide guidance to help inform ethical practice.

▪ Identify ethical considerations relevant to counselors and counselors-intraining.

▪ Describe the principles that members of the association have in common ▪ To provide an ethical guide to assist counselors in developing a proper course of action that serves clients and establishes expectations of conduct regarding the professional counselor ▪ Support the mission of ACA ▪ Serve as the foundation for processing inquiries and ethical complaints. o ACA’s ethical standards are arranged under nine topical headings containing material similar to other ethical codes. These codes are unique to the counseling profession: ▪ Section A: counseling relationship ▪ Section B: confidentiality and privacy in counseling ▪ Section C: Professional responsibility ▪ Section D: Relationships with colleagues, employers, and employees ▪ Section E: Evaluation, assessment, and interpretation ▪ Section F: Supervision, training, and teaching 16 ..

▪ ▪ ▪

Section G: Research and publications Section H: Distance counseling, technology, and social media Section I: Resolving ethical issues

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Limitations of Ethical Codes o Codes are only guidelines based on experience and values of how counselors should behave. They do not address probable professional dilemmas. o Some of the limitations of any code of ethics include: ▪ Some issues cannot be resolved by a code of ethics ▪ Enforcing ethical codes is difficult.

▪ There may be conflicts within the standards delineated by the code.

▪ Some legal and ethical issues are not covered in codes.

▪ Ethical codes are historical documents. Therefore, what may be acceptable practice at one time may be considered unethical later.

▪ Sometimes conflicts arise between ethical and legal codes.

▪ Ethical codes do not address cross-cultural issues.

▪ Ethical codes do not address every possible situation.

▪ There is often difficulty in bringing the interest of all parties involved in an ethical dispute together systematically.

▪ Ethical codes are not proactive documents for helping counselors decide what to do in new situations.

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Conflicts Within and Among Ethical Codes o Potential dilemmas of standards ▪ Be able to differentiate ethical dilemmas from other types of dilemmas.

▪ Different ethical principles in a code may offer conflicting guidelines about what to do in a given situation. For instance, confidentiality and acting in the client’s best interest if s/he is going to harm someone else or him/herself.

▪ Codes of ethics differ from one organization to another, such as APA and ACA.

Making Ethical Decisions •

Sometimes counselors operate from personal ethical standards without consulting the ethical guidelines. When faced with a dilemma, they may make a decision that may unintentionally turn out to be unethical.

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A study conducted in New York found five types of ethical dilemmas most prevalent among university counselors surveyed: o Confidentiality (most difficult to resolve) o Role conflict o Counselor competence (most difficult to resolve) o Conflicts with employer or institution o Degree of dangerousness (least difficult to resolve)

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Ethical reasoning is the process of determining which ethical principles are involved and then prioritizing them based on the professional requirements and beliefs.

Several ethical principles relate to the activities and ethical choices of counselors: o Beneficence (doing good and preventing harm), o Nonmaleficence (not inflicting harm – current or future) o Autonomy (respecting freedom of choice and self-determination) o Justice (fairness), and o Fidelity (faithfulness or honoring commitments) Other Guidelines for Acting Ethically o Guidelines for assessing whether counselors act in ethically responsible ways.

▪ Personal and professional honesty, such as dealing with hidden agendas.

▪ Acting in the best interest of clients.

▪ Acting without malice or personal gain.

▪ Justifying an action based on the current state of the profession

Educating Counselors in Ethical Decision Making • •

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Ethical decision making can be promoted by – graduate programs and continuing education credit.

Counselors reason through their behaviors with clients in a five-stage developmental scale of reasoning: o Punishment orientation – external social standards are the basis for judging behavior. Punishment should follow a behavior. o Institutional orientation – at this stage counselors believe in and abide by the rules of the institutions for which they work. They do not question the rules. o Societal orientation – counselors at this stage base their decisions on standards set by society. The needs of society are always given priority over individual needs. o Individual orientation – the individual’s needs are prioritized over society’s needs, even though the counselor is aware of the law. o Principle (conscience) orientation – concern for the individual is most important.

Ethical decisions are based on internalized ethical standards.

Group workers may sharpen their ethics by using case studies and Carkhuff’s three goals model of helping: self-exploration, self-understanding, and action.

Kitchener uses an integrated model of goals and components for an ethics education curriculum based on research on the psychological processes underlying moral behavior and current thinking in applied ethics. Her curriculum includes: sensitization to ethical issues, improving ethical judgments, encouraging responsible ethical actions, and tolerating decision making ambiguity

Ethics in Specific Counseling Situations Ethical behavior is influenced by the attitudes in the setting in which one works, by colleagues, and by the counselor’s task at hand. If practices in an institution are unethical the counselor must either try to change the institution through educational or persuasive means or find another job.

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School Counseling and Ethics o The counselor should always show priority for the client first and the school second. This may be difficulty when a school counselor is put into an administrative position. School counselor should be familiar with the ethical standards of the American School Counseling Association.

Computers, Counseling, and Ethics o Breech of client information is a possibility with transactions on a computer.

Ethical dilemmas are issues with cyber counseling or Webcounseling.

Couple and Family Counseling and Ethics o Because individuals in a family have different goals at times Thomas has developed a framework for counselors, clients, and the counseling process: 1) responsibility, 2) integrity, 3) commitment, 4) freedom of choice, 5) empowerment, and 6) right to grieve.

Other Counseling Settings and Ethics o Counseling older adults – counselors must make ethical decisions regarding the unique needs of the cognitive impairments, terminal illness, or victims of abuse.

Principle ethics may be used that focus on socially and historically appropriate answers to: What shall I do? or, Is this action ethical? Virtue ethics might be used which focus on the character traits of the counselor and nonobligatory ideals to which professionals aspire. o Multicultural counseling o Managed care o Diagnosis of client o Counseling research – four main ethical issues must be resolved: 1) informed consent, 2) coercion and deception, 3) confidentiality and privacy, and 4) reporting the results.

Multiple Relationships •

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From the debates in the 1970s on the ethical nature of counselor-client sexual relations which concluded that this relation was unethical came the discussion about nonsexual dual relationships. The conclusion of these discussions is that nonsexual dual relationships should be avoided. No matter how harmless a dual relationship seems, a conflict of interest almost always exists, and any professional counselor’s judgment is likely to be affected. Counselor may lose their objectivity and clients may be placed in a situation in which they cannot be assertive.

As a basis of ethical behavior, counselors should remove themselves from socializing or doing business with present or former clients, accepting gifts from them, or entering into a counseling relationship with a close friend, family member, student, lover, or employee.

Although the principles underlying the ethics of multiple relationships seem clear, implementing them is sometimes difficult and ins some situations even unavoidable.

Working with Counselors Who May Act Unethically •

“Slippery slope effect” – when working with someone who acts unethically, it is easy to ignore a situation or condone the situation by rationalizing the behavior 19 ..

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Barbara Herlihy suggests steps to take in working through potential ethical dilemmas: o Identify the problem as objectively as possible and the counselor’s relationship to it. o Apply the current ACA Code of Ethics. o Consider moral principles of the helping profession, such as beneficence, justice, and autonomy; additionally, consultation with a colleague.

Taking action: (be prepared for criticism from others) o Confront the counselor in a caring context o If confrontation does not work, file an ethical complaint with the ACA and/or state licensure or national certification board. Complaint may be filed by colleague or a client who believes s/he has been unethically treated. o Counselors should use the following criteria for determining their comfort: publicity, justice, moral traces (lingering doubt), and universality (Would you recommend this course of actions to others?)

The Law and Counseling • • •

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Legal refers to law or the state of being lawful.

Law refers to a body of rules recognized by a state or community as binding on its members.

Counselors must rely on court decisions and statues that influence legal opinions because there is no general body of law covering the helping professions. o Duty to care – health providers’ legal obligation not to act negligently. The legal opinion that determined the case of the 1993 Napa County, CA case involving Gary Ramona who sued his daughter’s therapists, charging that by implanting false memories of sexual abuse in her mind they had destroyed his life. Ramona was awarded $475,000 after the jury found the therapists had negligently reinforced false memories. o In 1996 US Supreme Court decision Jaffe v. Redmond held that communications between licensed psychotherapists and their patients are privileged and do not have to be disclosed in cases held in federal court. Precedence set regarding confidentiality between a master’s-level clinician and her client. o The Amicus Curiae Brief argued before the US Supreme Court in 1997 dealt with mental health issues associated with “physician-assisted suicide.” ACA joined with other mental health groups to protect the rights of counselors and other helping specialties with aid-in-dying situations.

The law is usually supportive of: o Professional codes of ethics. o Licensure or certification of counselors to ensure minimal standards of practice. o Allowing the counseling profession to police itself and govern counselors’ relations with their clients.

The law overrides professional code of ethics when it is necessary to protect the public and safety or welfare of others. Confidentiality must be breeched in these situations in order to disclose information necessary to prevent harm. In these cases, the counselor has the duty to warn potential victims about potential harm.

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Legal Recognition of Counseling • •

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Counseling has gained professional recognition through legal situations.

In 1960 a judge ruled in the case of Bogust v. Iverson that a counselor with a doctoral degree could not be held liable for the suicide of one of his clients because counselors were “mere teacher” who received training in a department of education. Therefore, counseling was not legally recognized as a practicing profession.

In 1971 in an Iowa Law Review Note, counselors were legally recognized as professionals who provided personal, as well as, vocational educational counseling.

In 1974 in Weldon v. Virginia State Board of Psychologists Examiners counseling was rendered a profession distinct from psychology. The US House of Representative refined the definition of counseling and recognized the profession in H. R. 3270 (94th Congress, 1976) stating that counseling is “the process through which a trained counselor assists an individual or group to make satisfactory and responsible decision concerning personal, educational and career development.”

Legal Aspects of the Counseling Relationship •

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Counselors must follow specific legal guidelines in working with certain populations. o PL 94-142 (the Education of All Handicapped Children Act of 1975) provides that schools must make provisions for the free, appropriate public education of all children in the least restrictive environment possible.

▪ This law advocates that a child under this definition must be provided an IEP (individual education plan) as well as the provision for due-process procedures. Also disabled children must be identified and record kept on each child’s progress. o Child abuse laws provide legal obligation for counselors to report suspected cases of abuse to proper authorities. o Legal obligations are defined under the Family Educational Rights and Privacy Act (FERPA) of 1974, known as the Buckley Amendment. This statute gives students access to educational records kept by educational institutions. The Buckley Amendment must be followed by higher educational institution. For instance, students in college must give their permission to college advisors and/or administrators to disclose any educational or judiciary information to others including parents.

Legal concerns about information sharing have been defined into groups: confidentiality, privacy, and privileged communication. o Confidentiality – a promise to clients that information revealed during counseling will not be shared with others without their permission. o Privacy - an individual’s right to choose the time, circumstances, and extent to which s/he wishes to share or withhold personal information. If a client believes s/he has been coerced into sharing information they would not normally disclose may seek legal help against a counselor. o Privileged communication – regulates privacy protection and confidentiality of individuals in counseling (not groups or family) by protection of clients from having their confidential communications disclosed in court without their 21 ..

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permission. Most states recognize and protect privileged communication except in nine categories: ▪ In cases of dispute between counselor and client ▪ When a client raises the issue of mental condition in legal proceedings (for instance, pleading temporary insanity) ▪ When a client’s condition poses a danger to self or others ▪ In cases of child abuse or neglect ▪ When the counselor has knowledge that the client is contemplating commission of a crime ▪ During court ordered psychological evaluations ▪ For purposes of involuntary hospitalization ▪ When the counselor has knowledge that a client has been a victim of a crime ▪ In cases of harm to vulnerable adults Laws vary from state to state. Know the laws of the state in which you are practicing.

The landmark case of confidentiality is Tarasoff v. Board of Regents of the University of California (1976): o Prosenjit Poddar, a student at the Berkeley campus of the University of California, was a voluntary outpatient at the student health services. He informed the psychologist counseling him that he intended to kill his former girlfriend, Tatiana Tarasoff, when she arrived by plane to the area of the campus. o The psychologist notified the campus police, who detained and questioned the student about his threat. The student denied any intention, acted rationally, and was released. o Podder refused further treatment by the psychologist, and no additional steps were taken to stop him from his intended action. o Tarasoff was killed by Poddar two months later. Her parents sued the Regents of the University of California for failing to notify the intended victim of a threat against their daughter. o The California Supreme court ruled in favor of Tarasoff’s parents, holding the therapist responsible due to the therapist’s duty to protect the public that overrides any obligation to maintain client confidentiality.

Civil and Criminal Liability •

Liability in counseling involves issues concerned with whether counselors have caused harm to clients. o Civil liability – a person can be sued for acting inappropriately toward another person or for failing to act when there is a recognized duty to do so.

▪ Based on torts, “a wrong [against a person, property, or someone’s reputation intentional or unintentional] that legal action is designed to set right”.

▪ Civil liability with counselors is most prevalent: • Malpractice in particular situations (birth control, abortion, prescribing and administering drugs, treatment) • Illegal search 22 ..

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Defamation Invasion of privacy Breach of contract o Criminal liability – when a counselor works with a client in a way the law does not allow.

▪ Risk of criminal liability is most possible in three situations: • Accessory to a crime • Civil disobedience • Contribution to the delinquency of a minor Malpractice in counseling is defined as harm to a client resulting from professional negligence (carelessness).

Negligence is defined as the inattention to acceptable professional standards.

Counselor should protect themselves from malpractice: o Follow professional codes of ethics o Follow normal practice standards o Carry liability insurance o An excellent book of helps of malpractice is Avoiding Counselor Malpractice.

Legal Issues Involved When Counseling Minors • • •

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Minors – children under the age of 18.

Working with minors in non-school settings involves legal and ethical issues different from those in an educational environment.

Minors can enter into a contract for treatment in three ways o By parental consent o Involuntarily at a parent’s insistence – Requires parental consent. o By the order of the juvenile court – Does not require parental consent, but parents or guardians should be informed.

Failure to obtain [custodial] parental consent puts the counselor at risk of being sued for battery, failure to gain consent, and child enticement.

Suggestions in working with minors: o Be familiar with state statutes regarding privileged communication o Clarify your policies about confidentiality with the child and parent(s) at the beginning of the therapeutic relationship and ask for their cooperation. Provide a written statement of these policies that everyone signs. o Keep accurate and objective records of all contacts. o Keep above the minimum professional liability coverage. o When in doubt ask a colleague and have professional legal help available.

Client Rights and Records •

There are two main types of client rights: o Implied rights are linked to substantive due process. When a rule is made that limit a person’s constitutional rights, s/he has been denied substantive due process.

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Explicit rights focus on procedural due process (the steps necessary to initiate or complete an action when a rule is broken). When a rule is broken and the person is not informed about how to remedy the matter.

Clients have the right to know what to do when his/her rights have been violated.

Client records are legally protected except under special circumstances. o An individual has the right legally to inspect his/her record, such as with the Buckley Amendment. o Some cases permit third parties to have access to student information without the consent of the student or parent. o Counselors are legally required to protect clients of all ages by keeping records under lock and key, separate from any required business records. Disclosure of information may not be performed without a client’s written permission.

▪ Use of a release-of-information form drawn up by an attorney is a good practice.

▪ Information not obtained first-hand should not be released.

Information contained in a client’s record includes all information about the client necessary for his/her treatment. Six categories of documents are usually included: o Identifying or intake information: name, address, telephone number(s), date of birth, sex, occupation, etc. o Assessment information: psychological evaluation(s), social/family history, health history, etc. o Treatment plan: presenting problem, plan of action, steps to be taken to reach targeted behavior, etc. o Case notes: such as, the documentation of individual sessions progress toward goals. o Termination summary: outcome of treatment, final diagnosis (if any), after-care plan, etc. o Other data; client’s signed consent for treatment, copies of correspondence, notation about rationale for any unusual client interventions, administrative problems, etc.

Check state legal codes for record keeping. Third-party reimbursement sometimes requires progress in terms of a treatment plan and diagnosis.

Never give confidential information about a client over the phone.

Do not discuss counseling cases in public.

Minimizing Legal Liability •

Question to answer to reduce legal liability (Hermann (2011c): o Is there a state statute or federal law related to the dilemma? o What is the spirit of the law? o Is there a binding case law? o Is there persuasive case law? o Is there a workplace policy? o What would a reasonable person do? o What would a colleague who has similar education and experience do?

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o Act reasonably based on the information elicited from the questions in the model and in the best interest of the client.

The Counselor in Court •

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Most counselors only appear in court at the state level. Federal courts deal with cases primarily under the laws of the US or involving citizens of different states where the amount of controversy exceeds $50,000.

Two reasons counselors end up in court: o Expert witness: A counselor voluntarily serves as an expert witness who is an unbiased person with specialized knowledge, skills, or information. Expert witnesses can assist a judge or jury in reaching a legal decision. Financial compensation is provided. o Court order: A counselor is subpoenaed to court with the intention of having the counselor testify on behalf of or against a present or former client.

Available to counselors are 12 volumes in the ACA Legal Series containing information of preparing for court appearances, documenting counseling records, counseling minors, understanding confidentiality and privileged communication, receiving third-party payments, and managing a counseling agency.

Ethics and the Law: Two Ways of Thinking • •

Differences exist in the two cultures of counselors and attorneys.

Ways counselors can become acculturated to the law: 1. Counselors should become “knowledgeable with those elements that are common to both mental health and the law,” 2. Understand and be prepared to work with those elements of the law 3. Review the ACA Code of Ethics and Professional Standards and other relevant ethical codes annually 4. Participate in continuing education programs that review laws 5. Learn more about the legal systems through organizations and publications 6. Create a collaborative relationship with a lawyer, judge, or other legal practitioner 7. Develop a relationship with a counselor knowledgeable about law 8. Consult and receive feedback on possible decision when there is an ethical-legal dilemma.

CLASSROOM ACTIVITIES 1. Obtain copies of early ethical codes for the ACA. Compare these guidelines to the most recently published ACA Code of Ethics. What differences do you notice? Discuss your observations with fellow class members.

2. In groups of four, use the ACA Ethical Standards Casebook as a guide to enact specific ethical dilemmas before your classmates. Have the other groups write down at least two courses of action they would pursue in solving your enacted situation. Have them justify the personal and professional reasons for their actions. Discuss each of these situations 3. with the class as a whole and with your instructor.

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4. Invite three or four professional counselors to your class to discuss specific ethical and legal concerns they have encountered. Ask about what areas they find the most difficult to deal with. After their presentations, question them about the role of ethics and law in the future of counseling.

5. Obtain as many copies as you can of counseling laws in states where counselors are licensed. Check the NBCC Web site in carrying out this assignment. Compare these laws for similarities and differences. What areas do you think the laws need to address that are not being covered?

6. Write down ways that you, as a professional counselor, can influence the development of counseling ethics and law. Be specific. Share your thoughts with fellow classmates.

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CHAPTER 2 - MULTIPLE CHOICE TEST QUESTIONS 1. The employment of such words as “good,” “bad,” “right,” and “wrong” are associated with _________________. a. ethics b. morality c. law d. criminal liability 2. All of the following EXCEPT _______________ are examples of prevalent forms of unethical behaviors in counseling. a. violations of confidentiality b. imposing one’s values on a client c. avoiding interaction with a client on a social level d. creating dependency 3. Ethical codes do which of the following? a. protect the profession from the government b. promote stability within the profession c. protect practitioners from the public d. all of the above 4. In making ethical decisions, counselors should follow all of these principles EXCEPT a. beneficence and nonmaleficence b. justice and fidelity c. common sense and autonomy d. personal gain 5. Which of the following is not considered to be a limitation in any code of ethics? a. difficulties in enforcing ethical codes b. ethical codes address cross-cultural concerns c. ethical codes are not proactive documents that can inform counselors of what to do in new situations d. all of the above are limitations 6. When there is a potential conflict between a counselor’s employer and a counselor’s client, the counselor should __________. a. first protect the right of the client b. first serve the interest of the employer c. ask a colleague to settle the conflict d. immediately quit his or her job 7. According to Van Hoose and Paradise, which one of the following, from a developmental perspective, is the highest stage of ethical reasoning? a. societal orientation b. principle or conscience orientation 27 ..

c. institutional orientation d. individual orientation 8. Ethics that are based on a set of obligations that focus on finding socially and historically appropriate answers to the question: “What shall I do?” are called ________ ethics. a. principle b. virtue c. absolute d. relativistic 9. The law is generally ___________ toward professional codes of ethics and toward counseling in general. a. hostile b. supportive c. neutral d. “B” and “C” but not “A” 10. The Iowa Law Review Note of 1971 did which of the following ________________. a. established the need to break confidentiality in order to prevent harm (duty to warn and protect) b. first legally recognized as professionals c. clarified the role of counselors in the mental health profession d. established that communications between a licensed psychotherapist and their patients are privileged 11. Civil liability means _____________; whereas, criminal liability means ________. a. working with a client in a way that the law does not allow; being an accessory to a crime b. acting wrongly toward another; failing to stop a crime c. acting wrongly toward another or failing to act; working with a client in a way that the law does not allow d. being uncivil; engaging in unlawful practices 12. A legal wrong can be _____________. a. against a person or property b. unintentional c. direct d. all of the above 13. Which of the following types of information should not go into a client’s record? a. required business records b. consent for treatment and assessment c. case notes and copies of correspondence d. identifying information

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14. To be successful in a litigious society, counselors, as a minority culture, must become acculturated into the majority culture, the law, by ________________. a. learning more about the legal system b. creating a collaborative relationship with a lawyer or judge. c. becoming knowledgeable with those elements that are common to both mental health and the law d. all of the above 15. A counselor working with a client who she believes is at a moderate to high risk for committing suicide. While working with the client she asks herself two questions: (1) If I let the client go home tonight will she harm herself? (2) If I have her involuntarily committed, am I respecting her freedom to make her own choices? Based on these two questions, with which two ethical principles is the counselor grappling? a. Autonomy and justice b. Fidelity and beneficence c. Nonmaleficence and veracity d. Beneficence and autonomy 16. Which court case might a counselor turn to in the even that they have a counselor who expresses a desire to harm others? a. Bogust v. Iverson because this court case clearly stated that a counselor with a doctoral degree could not be held liable for the suicide of a client because the counselor is merely a teacher. This generalizes to homicidal threats as well. b. Weldon v. Virginia State Board of Psychologists Examiners because the judgment in this case was that counselors are distinct from psychologists and therefore are not bound by duty to warn and protect statutes. c. Tarasoff v. Board of Regents of the University of California because, in this case, the court ruled that therapists have a duty to protect the public that overrides any obligation to maintain client confidentiality. d. Jaffe v. Redmond because, in this case, the court ruled that communications between licensed psychotherapists and their patients are privileged and do not have to be disclosed in cases held in federal court.

ESSAY TEST QUESTIONS 1. Discuss the benefits and limitations of ethical codes for counselors. What are some resources counselors can use in making ethical decisions?

2. Explain three instances where a counselor can be sued for malpractice in either a civil or criminal liability case. What steps can counselors take to avoid such occurrences?

3. List and describe the six ethical principles, and give an example of how each may be applied to a counseling situation.

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ADDITIONAL RESOURCES Benshoff, J. M., & Borders, L. D. (2001). Legal liabilities in clinical supervision [Film].

(Available from the American Counseling Association, 5999 Stevenson Avenue, Alexandria, VA 22304) In this videotape, Dr. Ted Remley, a counselor educator and attorney, focuses on legal considerations that affect the process of clinical supervision. 1-800-422-2648 Corey, G., Corey, M. S., & Haynes, R. (Producer). (1998). Ethics in action [Film]. (Available from Brooks/Cole Publishing Company, Attn: Database Management 9BCCNC01, International Thomson Publishing, P.O. Box 6904, Florence, KY 41022) There are two different videos offered: Video 1, Student Version; and Video 2, Institutional Version. Each 60-minute video looks at various ethical dilemmas that counselors face. The student version is accompanied by a workbook and the institutional version has a facilitator’s resource manual. These can be used separately or in conjunction with each other. 1-800487-8488 Insight Media. (1983). Confidentiality [Film]. (Available from Insight Media, 2162 Broadway, New York, NY 10024-0621) This 45-minute video deals with ethical considerations for therapists when confronting confidentiality issues. Using scenarios, the video shows some appropriate responses for dealing with certain ethical dilemmas surrounding confidentiality. 1-800-233-9910 Insight Media. (1998). Ethical issues in action [Film]. (Available from Insight Media, 2162 Broadway, New York, NY 10024-0621) There are two parts to this video set. First, the “Student Version”, looks at how a counselor’s values influence their work with their clients and how to come to resolution on different ethical dilemmas. The second video, the “Institutional Version”, illustrates the same topics as above, yet more in-depth discussion is given with the possibility of using the video in conjunction with the first or on its own. Each video is 45 minutes. 1-800-233-9910

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CHAPTER 3 COUNSELING IN A MULTICULTURAL SOCIETY CHAPTER OVERVIEW This chapter examines the difficulties and possibilities of counseling in the multicultural society that is the United States. Specific populations are discussed in depth, including the following groups: culturally/ethnically distinct groups (African American, Asian American, European American, Hispanics/Latinos, Native American, and Arab Americans). Issues and theories associated with each of these topic groups are explored, along with areas that culturally sensitive counselors should consider. Specific counseling approaches and techniques that have been found to be effective are highlighted.

KEY TERMS, CONCEPTS, AND PEOPLE Acculturation Anticounselor Association for Multicultural Counseling and Development (AMCD) Blaming the victim Broaching Color-blind racial ideology Cultural bias Cultural expertise Cultural intentionality Culturally encapsulated counselor Culture Demographic variables Emic approach Ethnographic variables Etic approach Filial therapy Hispanics Historical hostility International Association for Counseling Latina/o Microassaults Microinsults Microinvalidations Minority racial identity development (MRID) Multicultural Multicultural counseling Multicultural counseling competencies Overculturalizing Racial microaggressions Racism RESPECTFUL Transcultural perspective Vision quest 31 ..

White ethnic White privilege

CHAPTER 3 - COUNSELING IN A MULTICULTURAL SOCIETY Counseling Across Culture and Ethnicity • •

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Many cultural and ethnic groups live in the United States and Canada.

In the 2014 U.S. Census projections, European Americans made up the largest group (62%), followed by Latinos/Hispanics (17%), African Americans (13%), Asian Americans (5.4%), and Native Americans (1%). Those with two or more races or ethnicities comprised 2.6% of the population.

Cultural responsiveness enhances trust and therapeutic alliance and positive counseling outcomes More than 50% of minority-culture clients who begin counseling terminate after one session, as compared with about 30% of majority-culture clients (Sue & Sue, 2016).

Defining Culture and Multicultural Counseling •

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Ways to define culture o Ethnographic variables – ethnicity, nationality, religion, and language o Demographic variables – age, gender, place of residence o Status variables – social, economic, and educational background, formal and informal memberships and affiliations Culture – any group of people who identify or associate with one another on the basis of some common purpose, need, or similarity of background.

Shared elements of culture: o Learned experiences o Beliefs o Values Additional definitions of culture include: o Similar physical features o Common history and philosophy o Combination of the above Multicultural counseling – counseling “in which the counselor and client differ”. o Differences may be cultural, life events, or ethnic environments. o Etic perspective – universal qualities exist in counseling that are culturally generalizable. o Emic perspective – counseling approaches must be designed to be culturally specific. o Fisher et al. – four conditions common to any type of counseling treatment 1. Therapeutic relationship 2. Shared world view 3. Client expectations for positive change 4. Interventions are a means of healing 32 ..

History of Multicultural Counseling •

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Gilbert Wrenn was the first prominent professional to give attention to cultural differences in counseling. o Culturally encapsulated counselor – disregards cultural differences and works under the assumptions that theories and techniques are applicable to all people equally. o However, not everyone has the same experience in counseling and should not be treated the same.

Clemmont Vontress was another activist in defining culture and influences in counseling.

Paul Pedersen chaired a panel in 1973 at the APA annual convention and later published with Lonner and Dragguns (1976) the first book on the subject, Counseling Across Cultures.

RESPECTFUL o Religious/spiritual issues o Economic class issues o Sexual identity issues o Psychological developmental issues o Ethnic/racial identity issues o Chronological issues o Trauma and threats to well-being o Family issues o Unique physical issues o Language and location of residence issues Multicultural and Social Justice Counseling Competencies (MSJCC) – a revision of the Multicultural Counseling Competencies (MCC) AMCD (Association for Multicultural Counseling and Development), a division in the o Formerly the ANWC, Association for Non-White Concerns in Personnel and Guidance; became part of the ACA in 1972. o Publishes the Journal of Multicultural Counseling and Development o Sponsors conferences to address problems related to counseling involving different cultural groups. Training includes: ▪ Cultural expertise – effectiveness in more than one culture ▪ Cultural intentionality – awareness of individual differences within each culture

Difficulties in Multicultural Counseling •

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Difference between cultural backgrounds and socio-economic status (poverty or deprived status). Not to distinguish leads to overculturalizing – mistaking socio-economic issues for cultural issues.

Many minority cultures do live in poverty. Many have 2nd languages with ESL (English as the 2nd language). Their non-verbal behaviors may not be understood or accepted by counselors from different cultures.

Racism – prejudice displayed in blatant or subtle ways.

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Acculturation – process by which a group of people give up their old ways or culture and adopt new ones.

Issues in Multicultural Counseling •

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Dominance of theories based on European North American cultural values – especially among the emic perspective counselors. o Predominant beliefs of European North Americans are the value of individuals (a.k.a., individualism). Focus on ▪ Action problem-solving ▪ Work ethic ▪ Scientific method ▪ Rigid time schedules Sensitivity to cultures in general. o Three areas in which sensitivity is needed: ▪ Knowledge of the worldviews of culturally different clients.

▪ Awareness of one’s (counselor’s) own personal worldview and how that view was developed.

▪ Skills necessary for working with culturally different clients. o In 1992 the above three areas were used as a basis for developing a set of Multicultural Counseling Competencies by the AMCD (Association for Multicultural Counseling and Development). o Before 1992 Pedersen had another model that used an anti-counselor who functioned as an alter ego. Video taping helps to generate feedback: ▪ Articulating the problem from the client’s cultural perspective.

▪ Anticipating resistance from a culturally different client.

▪ Diminishing defensiveness by studying the trainee’s own defensive response.

▪ Learning recovery skills for getting out of trouble when counseling the culturally different. o Nwachuku and Ivey’s model for understanding cultures.

▪ Counselors first study a culture and its values before trying to adapt a theory to fit a client.

▪ View popular diversity-focused films about specific cultures.

How cultural systems operate and influence behaviors. o Counselors who have gained knowledge and awareness from the cultural system are more likely to be skilled in helping members from that culture. o These counselors are able to share a worldview with clients, make skillful interventions, and maintain a sense of personal integrity.

Providing effective counseling services across cultures. Five guidelines o Recognize values and beliefs about acceptable and desirable behavior. o Awareness of cultural and generic qualities of counseling theories and traditions.

No method is culture-free. o Understand the sociopolitical environment that has influenced the lies of minority groups. o Share the worldview of clients and do not question its legitimacy.

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o o

•

Remain eclectic in counseling practice by using a variety of counseling skills.

Sue recommends a framework based on the locus of control and locus of responsibility.

▪ Locus means location. Therefore, the location of your control (internal from self or external from others). Responsibility from within self or from others.

Development and employment of counseling theories. o McFadden’s model is transcultural focusing on three primary dimension: ▪ Cultural-historical – counselors possess knowledge of client’s culture ▪ Psychosocial – counselors understand client’s ethnic, racial, and social group’s performance, speeches, or behavior to communicate meaningfully.

▪ Scientific-ideological – counselor use counseling approaches to deal with problems related to regional, national, and international environments.

Counseling Considerations with Specific Cultural Groups •

Each individual is unique.

•

There are more within-group differences than between-groups differences in counseling people from different cultures.

•

Minority counselors may also harbor “historical hostility” whether consciously or unconsciously toward members of the majority. [Not a healthy attitude.]

•

On another hand, majority counselors may carry attitudes of superiority and privilege (Not a healthy attitude).

•

European Americans – heritages of people from Sweden, Italy, France, England, Poland, Germany, Russian, Hungary, and Austria. Recent European immigrants differ widely to the same heritages than those who have been in the US for generations. Intermarriages among these heritages have created a homogeneous group valuing an individualistic worldview.

• White ethnic • White privilege – societal advantages or benefits based on the color of one’s skin rather than by virtue of merit.

• This group gravitates toward rational or logical methods in understanding themselves and others for counseling.

• Cognitive-behavioral counseling approaches may work well for this group. Other theories may also be effective, such as existential, psychoanalytic, Adlerian, and affective counseling.

•

African Americans – individual, institutional, and cultural racism are life issues, and racial discrimination and self-esteem have a negative correlation (as one variable increases, the other decreases).

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•

• • •

•

•

Hispanics/Latinos/as – ancestors come from Spanish-speaking countries. Latino/a includes Spanish and Indian descent whose ancestors lived in areas of the Southwest US formally part of Mexico. Most are bi-cultural, but vary in acculturation. Ethnic histories and cultures influence worldviews and behaviors. There are many within-group differences.

•

• • •

A counselor must understand African-American history, cultural values, conflicts, and coping mechanisms and be aware of their own attitudes and prejudices about this group. Because African-American’s are diverse, no single counseling approach works best for everyone.

Important to recognize the power of racial microaggressions, including microassaults, microinsults, and microinvalidations.

Perception of counseling is: Giving up one’s independence by “telling your business to a stranger,” then having to listen and accept the advice of that stranger.

Factors that influence counseling: 1) Many African Americans are unwilling to commit to counseling, 2) see it as a relationship between unequals, and 3) emphasis is on the collective (family, community).

Ministers often serve as the counselor. (This is also true of those in any spiritual community, especially the South).

Reluctant to seek counseling because of cultural tradition (e.g., pride) and cultural heritage (e.g., reliance on extended family). May also be accessibility of services, inadequate transportation, lack of health insurance, and absence of counseling professionals fluent in Spanish and familiar with their culture.

Expected counseling approach is active counselor who is concrete and goal directed, like a physician.

Issues: lower socioeconomic status, racism, and discrimination

Asian and Pacific Islanders – (Asian Americans) • • • • • • •

Chinese, Japanese, Filipinos, Indochinese, Indians, and Koreans Different cultural backgrounds – includes 40 different groups Have faced strong discriminations in the US and have been the subject of myths; stereotyped Have been denied the rights of citizenship, forbidden to own land, locked in concentration camps, maligned, mistreated, and massacred.

Have also been described as hardworking and successful and not prone to mental or emotional disturbances – the “model minority.”

Religious traditions (such as Islamic, Hindu, and Buddhist) play a role in some of their views of mental health and illness.

Many times avoid occupations that call for assertive self-expression. Well-mannered communication comes from tradition. Therefore, confrontational approaches in counseling may not be effective.

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•

Native Americans • • • •

• •

•

• •

•

Made up of 478 tribes recognized by the US Bureau of Indian Affairs. Fifty-two tribes have an unofficial status.

Diversity exists among this population, such as 149 languages.

Commonalities: harmony with nature, cooperation, holism, concern with the present, reliance on the extended family.

Issues: loss of ancestral lands, desire for self-determination, conflicts with the values of mainstream American culture, confused self-image from past stereotypes, anger about past transgressions.

Other issues: high suicide rate, unemployment, alcoholism, low life expectancy and elevated high school dropout rates.

Effective counseling depends on whether they live on a reservation; if other Native Americans help facilitate the process; and whether their acculturation is traditional, bicultural or assimilated.

Native American Acculturation Scale – measures individual’s levels of acculturation along a continuum ranging from traditional Native American to assimilated mainstream American.

One ideas to be considered when counseling Native Americans: silence, acceptance, restatement, and general lead.

Counseling approaches; • Vision quest – rite of passage and religious renewal for adult men • Creative arts • Rituals and wellness • Multiple counseling approaches: network therapy, home-based therapy, indigenous-structural therapy, and traditional native activities such as “the talking circle,” “the talking stick,” and storytelling.

• Be genuine and be willing to admit mistakes in counseling

Arab Americans • • •

• •

Arab Americans are a fast-growing and mosaic group in the United States coming from 22 countries as diverse as Egypt, Lebanon, Morocco, Yemen, Tunisia, and Palestine.

Arab Americans vary among themselves. Differences include social class, level of education, language (distinct dialects), conservatism of the country of origin, time of immigration, and level of acculturation.

Arab cultures tend to be of a high context. They differ from traditional Americans in that they emphasize social stability and the collective over the individual. The family is the most significant element in most subcultures. Men are patriarchs and women are expected to uphold the honor of the family. Education is valued in Arab American households.

Counselors need to remember the delineation of gender roles in Arab families. Honor and shame may prevent Arab Americans from seeking out outside help.

Clinical recommendations for working with members of this population include: ▪ Awareness of cultural context, 37 ..

• •

▪ Mindfulness of leadership issues and authority figures, ▪ Attention to the role family plays in decision making, ▪ Sensitivity to the part culture places as a co-participant in treatment, ▪ Consciousness that a strength-based approach to treatment works better, and ▪ The counselor is not to be seen as a rescuer or threat in his or her role.

Access to groups where Arab Americans can find support and become members of a larger community is a strategy the counselors can use.

International Counseling • Counseling is a worldwide phenomenon • Many countries have counseling associations; ACA has a European branch.

• Worldwide associations prescribe to specific theories, such as Adlerian and Reality Therapy.

• International Association for Counseling publishes the International Journal for the Advancement of Counseling.

• Super found that the counseling role in prosperous countries was a way of promoting individual interests and abilities. Less fortunate countries view counseling as a way of channeling individuals into areas necessary for cultural survival. For instance, Poland values career counseling as a way to help develop the country.

• International students often experience stress and discomfort. They are reluctant to receive counseling because of the strong emphasis of culture on the place of the extended family. Mori suggests four areas of focus: 1. Developing stress management techniques, 2. Learning assertive communication skills, 3. Becoming fully aware of the American educational system, and 4. Developing career-and life-planning skills.

Classroom Activities 1. Show the movie, The Eye of the Storm. After the movie, ask students to share their insights regarding prejudice, stereotypes, racism, and stereotype threat. Also, ask students to discuss how these insights apply directly to counseling.

2. Asks students to get into groups of two or three. Prompt the students to search the internet for counseling associations in other countries (e.g., Malaysia Counseling Association, British Association for Counselling and Psychotherapy) and to answer the following questions: What is emphasized on the websites of these countries in regard to multicultural counseling? How does that emphasis correspond to and differ from what you know about multicultural counseling in the United States?

3. Ask students to present on a local, state, regional, national, or international current event that may affect the psychological and/or economic health of ethnic and racial minority groups.

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CHAPTER 3 - MULTIPLE CHOICE TEST QUESTIONS 1. Shared elements of a culture include all of the following variables EXCEPT ________. a. learned experiences b. beliefs c. values d. personality 2. European Americans make up about _________ percent of the population of the United States. a. 48% b. 55% c. 62% d. 75% 3. Counselors should consistently remind themselves when counseling people with different cultural traditions from their own that there are probably __________. a. no within-group differences b. less within-group differences than between-group differences c. more within-group differences than between-group differences d. no between-group differences 4. Pedersen believes it is essential for counselors to be sensitive to cultures in regard to ____________. a. knowledge/awareness/skills b. function/ability/skills c. subtleness/substance/skills d. standards/awareness/skills 5. Maria, a European American counselor-in-training, who was challenged by her supervisor to consider cultural factors when working with a particular client, shared her belief that good counseling is good counseling irrespective of cultural differences. Based on this response, which perspective would you say Maria espouses? a. Etic perspective b. Emic perspective c. Culturally relativistic perspective d. Status perspective 6. Marcus struggles to differentiate between his client’s cultural patterns from the client’s response to poverty and discrimination. Which of the following terms describes Marcus’s behavior? a. Racism b. Acculturation c. Overculturalization 39 ..

d. Anticounseling 7. Which one of the following refers to the Latina/o cultural value of personalismo? a. strong connectedness with family b. filial piety c. trust d. personal relationships 8. Due to his nervousness and lack of understanding, Jerry neglects to reflect his client’s feelings and thoughts about discrimination and prejudice, even though his client has brought them up a few times. Which one of the following describes Jerry’s behavior? a. Jerry is manifested his white privilege by not reflecting the client’s experiences with discrimination and prejudice. b. Jerry is engaging in a microinvalidation by not acknowledging or reflecting the client’s thoughts and feelings associated with prejudice and discrimination. c. Jerry is engaging in a microinsult by not acknowledging the client’s perspective on discrimination and prejudice. d. All of the above are accurate.

9. Which of the following describes the philosophy of filial therapy? a. Positive symptomatic or behavioral changes occur as a result of problem-solving techniques. b. Positive symptomatic or behavioral changes happen as a result of counselors’ engaging in personalismo. c. Positive symptomatic or behavioral changes occur as a result of changes in the parentchild relationship. d. Positive symptomatic or behavioral changes occur as a result of establishing confianza in the therapeutic relationship.

10. A counselor who works with culturally diverse clients shares with her supervisor that she does not see race but, rather, focuses on the unique individual qualities of each of her clients.

She also minimizes the impact of race and racism on the current political and economic climate. Which of the following is accurate regarding this counselor? a. The counselor espouses an emic perspective of counseling. b. The counselor espouses color-blind racial ideology. c. The counselor is appropriately training herself to be culturally sensitive by seeing past race. d. The counselor is using a filial therapeutic approach to conceptualizing her work with culturally diverse clients.

11. Which of the following statements is accurate regarding the model minority stereotype of Asian Americans? a. The model minority stereotype, although not completely realistic or accurate, is a harmless myth that, at the very least, acknowledges the wonderful contributions of Asian Americans to United States society.

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b. The model minority stereotype is a realistic and accurate descriptor of all Asian American groups and individuals residing within the United States. c. The model minority myth glosses over the real social, economic, and psychological problems experienced by Asian Americans. d. None of the above is accurate.

12. Which of the following is accurate regarding research on counselors who espouse a colorblind racial ideology? a. Research suggests they are less skilled at communicating empathy b. Research suggests they are more sensitive to issues pertaining to cultural diversity c. Research suggests they are more likely to espouse an emic perspective of cross-cultural counseling d. Research indicates they are less likely to espouse an etic perspective of cross-cultural counseling 13. According to the text, racism is defined as: a. The belief that one’s race is better than another race or other races. b. Prejudices against one nationality. c. An oppressive act in which a majority culture exercises power and privilege over those in a nondominant group. d. Hate toward all types of people.

14. International students often experience __________ their American counterparts.

A. less stress than B. greater stress than C. the same stress as D. the same challenges as 15. What percentage of ethnic/racial minority clients terminate counseling after the first session?

A. 30% B. 50% C. 75% D. 100% ESSAY TEST QUESTIONS 1. Discuss possible perceptions regarding counseling in the United States that may hinder cultural minority groups from receiving adequate mental health care. Be sure to include what a counselor can do to make counseling services more accessible to, sensitive to, and effective with clients from culturally diverse backgrounds.

2. What is overculturalizing and how did it happen? Give an example.

3. Discuss what it means to be culturally knowledgeable, culturally aware, and culturally skilled. Give specific examples of how each is important in the delivery of effective counseling services to culturally diverse clients.

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ADDITIONAL RESOURCES Insight Media. (1989). Barriers to cross-cultural counseling [Film]. (Available from Insight Media, 2162 Broadway, New York, NY 10024-0621) This 75-minute video features Derald Wing Sue. Both a theory and practice-based approach for cross-cultural counseling are discussed. The video also emphasizes the need to have an understanding of cross-cultural issues and cultural differences. 1-800-233-9910 Insight Media. (1992). African-American counseling and psychotherapy [Film]. (Available from Insight Media, 2162 Broadway, New York, NY 10024-0621) With a look at Afrocentric theory and how it affects counseling practice, Thomas Parham examines some areas that may influence the counseling process with African Americans.

Clinical practice and treatment planning issues are also discussed. (2-volumes, 101minutes). 1-800-233-9910 Insight Media. (1992). Multicultural counseling [Film]. (Available from Insight Media, 2162 Broadway, New York, NY 10024-0621) These videos deal with the cross-cultural issues that can arise between counselor and client.

Volume 1 of this set focuses on ethical issues and volume 2 focuses on diversity issues.

Total running time is 73 minutes. 1-800-233-9910 Insight Media. (1994). Counseling and therapy with Native-American Indians [Film].

(Available from Insight Media, 2162 Broadway, New York, NY 10024-0621) Teresa LaFromboise examines some issues that counselors must consider when working with Native American clients. Different cultural factors that need to be addressed in designing treatment plans are discusses, as well as some of the ideas that Native Americans may have about the counseling process as a whole. (60-minutes) 1-800-233-9910 Insight Media. (1994). Latina/Latino counseling and psychotherapy [Film]. (Available from Insight Media, 2162 Broadway, New York, NY 10024-0621) This two-video set examines some of the main cultural characteristics of Latino communities, as well as, issues that counselors must consider in a helping relationship. 130minutes total running time. 1-800-233-9910 Insight Media. (1996). A world of diversity [Film]. (Available from Insight Media, 2162 Broadway, New York, NY 10024-0621) This two-part video focuses on multi-cultural communication skills and some of the common mistakes people make in communicating. The second volume looks at how to build up these communication skills. (55 minutes total running time) 1-800-233-9910

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Lerner, S. (Producer). (1995). The psychological residuals of slavery [Film]. (Available from Guilford Publications, Inc., 72 Spring St., Dept. 5Q, New York, NY 10012-9902) This 18-minute video is a special look at how understanding the legacy of slavery is crucial for any mental health providers working with African Americans today. This is great for prompting discussions in training settings. 1-800-365-7006 Magna System, Inc. (1998). I’m normal, you’re weird: Understanding other cultures [Film].

(Available from Magna System, Inc., 101 N. Virginia St., Suite 105, Crystal Lake, IL 600149800) This video takes a look at how culture is responsible for many differences in human behavior between people from different backgrounds. (23 minutes) 1-800-203-7060 Matsumoto, D. (1996). A world of diversity [Film]. (Available from Brooks/Cole Publishing Company, Attn: Database Management 9BCCNC01, International Thomson Publishing, P.O. Box 6904, Florence, KY 41022) By looking at the way culture effects our everyday interactions, this two-video set will help students acquire the basic skills need to interact as helpers in a multicultural society. 1-800487-5510

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CHAPTER 4 COUNSELING WITH DIVERSE POPULATIONS CHAPTER OVERVIEW This chapter examines populations that are diverse regardless of ethnic backgrounds.

Discussions focus around the aged population, gender-based counseling, counseling and sexual orientation, and counseling and spirituality. Issues related to these diverse populations are explored, along with counseling approaches and areas of concerns that culturally sensitive counselors should consider.

KEY TERMS, CONCEPTS, AND PEOPLE ADDRESSING model Age mystique Ageism Association for Adult Development and Aging (AADA) Association for Lesbian, Gay, Bisexual, and Transgender Issues in Counseling (ALGBTIC) Association for Spiritual, Ethical, and Religious Values in Counseling (ASERVIC) Biopsychosocial Coming out Constructivist perspective Domestic elder abuse Double standard of mental health Feminist theory Gender Gender role conflict Investment syndrome Late adulthood Life expectancy Minority stress Mythopoetic movement Noetic or spiritual dimension of human existence Non-events Old Old-old Pink collar jobs Pluralistic perspective Positive masculinity Reality-oriented groups Reminiscing groups Remotivation therapy groups Seven stages of faith Sexism Social empowerment model Spirituality Third phase of life 44 ..

Unanticipated events Young-old CHAPTER 4 - COUNSELING WITH DIVERSE POPULATIONS Counseling Aged Populations • • •

•

The Association for Adult Development and Aging (AADA) is the division within the ACA that focuses on life-span growth beyond adolescence.

Persons over 65 years old – continues to grow with better health care, etc.

Old Age 1. Young Old – between ages 55 and 75 – still physically active, mentally, and socially 2. Old – beyond age 75 3. Old Old – over 85 whose physical activity is limited 4. Deal with age-based expectations and prejudices – senile, absent-minded, and helpless.

5. Ageism – negative attitudes and stereotypes prevent close relationships with people in different age groups and sometimes lead to discrimination.

6. “The age mystique” – denial and dread of the aging process Needs of the Aged 1. Changes in physical abilities, social roles, relationships, residential relocation – may spark an identity crisis 2. According to Havighurst (1959), older adults must learn to cope with various aspects of aging: • death of friends and spouses • reduced physical vigor • retirement and the reduction of income • more leisure time and the process of making new friends • development of new social roles • dealing with grown children • changing living arrangements or making satisfactory ones 3. Positive transitions – becoming a grandparent, discount on purchases 4. Negative transitions involving a lot of stress – death of a spouse, loss of a job, or contraction of a major illness, may lack a peer support group 5. Major problems – loneliness, physical illness, retirement, idleness, bereavement, and abuse. The aged population suffers more depression and psychosis as they grow older. Thirty percent of beds in mental hospitals are filled with the aged.

Twenty-five percent of reported suicides are committed by people over 60 years old, white males representing the majority 6. Domestic elder abuse – abuse by someone who has a close relationship with an aged person makes up about 600,000 cases a year: physical abuse, psychological abuse, financial exploitation, and violation of rights including personal liberty, free speech, and privacy.

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Counseling Older Adults 1. Counselors need special training for the needs of this population; such as, teaching new skills to grandparents rearing their grandchildren. Some counselors avoid working with this group because they do not understand the needs of the aged.

2. Investment syndrome – some counselors believe their energies are best spent with younger people who can contribute more to society. (Sort of like, “you can’t teach old dogs new tricks.”)

3. Irrational fear of aging may keep counselors from working with older adults.

4. Counselors may mistake mental health issues in in older adults for the natural aging process.

5. Treat older adults as adults. Basic counseling skills can open up the aged to explore difficulties or adjustment issues.

6. Modify the attitudes of people within the system in which the aged live. Older adults may act old because that is what is expected of them. Counselor must become advocates for this population.

7. Counseling that focuses on problem solving and providing information may be most helpful. For instance, group work focusing on current needs, such as job hunting, can be very productive. Popular groups for adults 65 and older include: 1. Reality-oriented groups – helping confused members with their surroundings 2. Remotivation therapy groups – helping members become more involved in the present and future 3. Reminiscing groups – use life reviews to help members to become more integrated 4. Psychotherapy groups – directed for specific problems, such as grief 5. Topic-specific groups – focus on interests, such as the arts 6. Member-specific groups – focus on transition concerns, like hospitalization

Gender-Based Counseling •

Counseling Women – primary consumers of counseling o Concerns – development and growth, depression, eating disorders, sexual victimization, widowhood, and multiple roles 1. Adequate information about their lives – Early theories presented women as less healthy mentally than men. Lower expectations for women set up barriers.

2. Sexism – the belief that females should be treated on the basis of their sex without regard to other issues, such as interests and abilities. o

Issues and theories 1. Counselor’s response – counselor need to react to diversity and uniqueness among women as well as their similarities. Different stages of development need recognition.

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1. Special issues – eating disorders, sexual abuse and rape, suicide, and career development 2. Seven areas in which counselors should increase their knowledge of women: 1. History and sociology of sex-role stereotyping 2. Psychophysiology of women and men 3. Theories of personality and sex-role development 4. Life-span development 5. Special populations 6. Career development 7. Counseling/psychotherapy 3. Feminist theory – from the women’s movement in the 1960s -- grew into the focus on the development of females as persons with common and unique qualities. The increased integration of the theory into counseling was spurred on by Carol Gilligan’s In a Different Voice. Encourages women to be aware of socialization patterns and personal option and social change. Two main emphasis: 1. Equality in the helping relationship.

2. Valuing social, political, and economic action.

4. Androgyny – having masculine and feminine traits, nonsexist career development.

•

Counseling Men o Concerns – stem from socialization, social behavior explained by the narrow definition of traditional sex roles. Enter counseling on crises basis.

o

1. Boys are restricted from expressing feminine behaviors, such as being emotionally or behavior expressive to each other; whereas, these behaviors are encouraged among females. Therefore, boys internalize their emotional reactions and become autonomous, aggressive, and competitive.

2. An alternative view is biological – boys are aggressive and competitive because they possess more testosterone. Also, with changing generations, feminine qualities like sensitivity are encouraged among young men.

Therefore, generational differences exist.

3. Cognitive perspective in counseling work best, rather than the affective approach for females.

4. Internalizing emotions and becoming insensitive to the needs of others and self-lead to physical problems and shorter life spans. Many men fear closeness and carry a social taboo about self-disclosure, especially in front of other men.

Issues and Theories 1. Men approach counseling as a competition. Have high expectations and desire productive sessions.

2. Men approach counseling cognitively. However, Marin encourages counselors to avoid the cognitive emphasis and explore feelings.

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3. Holland’s model is recommended by others advocating for personenvironment interaction as a framework. Men operate in the realistic dimension and lack social skills but have mechanical-technical skills. A cognitive-behavioral approach is recommended to establish rapport.

4. Men’s groups focus on increasing personal awareness of sex-role conditioning, practicing new desired behaviors, and promoting lifestyles based on individual needs. Male sex offenders, gay men, and homeless men may benefit the most from these groups. Benefiting the least would be the manic, very depressed, crises situation, addicted, alcoholic, or paranoid.

5. Men ages 30 to 50 are more open to increasing their intimacies and dealing with their emotions due to their developmental stage.

6. Counseling procedure: Interview of his father using open-ended questions about family traditions.

Counseling and Sexual Orientation • • • • •

ALGBIC – Association for Lesbian, Gay, and Bisexual Issues in Counseling, division of the ACA Issues usually begin early in life. These children have identity issues. They feel isolated, stigmatized, troubled with their peer relationships, and disturbed by family disruptions. They are often harassed.

Until the mid-1970s, homosexuality was considered a disorder in the Diagnostic and Statistical Manual of the American Psychiatric Association.

Counseling issues: “coming out,” formation of community organizations, religious practices, stigma of AIDS for gay men, and loss of friends from AIDS Cognitive approach may be therapeutic.

Counseling and Spirituality •

• •

•

ASERVIC, Association for Spiritual, Ethical, and Religious Values in Counseling, a division within the ACA explores the place of spirituality in counseling. A renewed emphasis has been on the counselor as a spiritual person.

Spirituality – unique, personally meaningful experience of a transcendent dimension that is associated with wholeness and wellness.

Dimensions of spirituality o A concept of the Divine o A sense of meaning o A relationship with the Divine o Openness to mystery (unknown) o A sense of playfulness o Engagement in spiritual activities, such as prayer o Systematic us e of spiritual forces as an integrator of life Increased emphasis of those seeking counseling on spiritual focus, as well as spiritual and religious values and practices among counselors.

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Classroom Activities 1. Divide students into groups of three or four to discuss their thoughts and feelings associated with incorporating spirituality into counseling. Moreover, have groups come up with a list of questions they have about working with individuals from diverse religious or spiritual traditions.

2. Divide students into groups and assign each group one of Erikson’s eight stages of human development. Have group members research aspects of the stage they are assigned, and provide a brief presentation to the class about the stage and how knowledge of that stage can influence counselors understanding of and work with clients in that particular stage.

3. Examine feminist approaches to counseling. How do they differ from other approaches? How are they the same?

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CHAPTER 4 - MULTIPLE CHOICE TEST QUESTIONS 1. Common problems that older adults face are ___________. a. depression, psychosis, and physical illness b. retirement, idleness, and abuse c. bereavement and loneliness d. all of the above 2. Which of the following is a reason for which counselors may not be interested in working with older adults? a. They understand older adults too well and are worried about countertransference issues b. Irrational fear of aging c. They often are more psychological well. d. all of the above 3. A popular therapy group that is used with older adults in which life reviews are emphasized is a ________. a. task group b. life skills group c. reminiscing group d. educational group 4. The belief (and behavior resulting from that belief) that anyone should be treated on the basis of their sex without regard to other criteria, such as interest and ability, is known as ___________. a. sexism b. blatant bias c. discrimination d. stereotyping 5. The double standard of mental health depicts adult female behavior as _________. a. more socially desirable than male behavior b. less healthy and socially desirable as male behavior c. incompatible with providing effective mental health service d. None of the above 6. Which of the following is a main emphasis in feminist theory? a. equality in helping relationships b. emphasis placed on individualism, particularly individual pursuits c. de-emphasis on social, political, and economic contexts d. all of the above are core emphases in feminist theory 7. Which of the following accurately describes the concept of positive masculinity? a. A recognition that male issues in society stem from rigid socialization. b. An understanding that males are more aggressive and less nurturing than females c. Positive masculine roles and traits 50 ..

d. The understanding that men operate primarily from a cognitive perspective 8. Which of the following is accurate regarding the counseling utilization rate of LGBT individuals? a. LGBT individuals utilize counseling services at the same rate as heterosexual individuals. b. LGBT individuals utilize counseling services at a higher rate than heterosexual individuals. c. Due to discrimination and a small number of LGBT-affirming counselors, LGBT individuals utilize counseling services at a lower rate than heterosexual individuals. d. Lesbians access counseling services more frequently than heterosexuals, but gay men utilize counseling services at a lower rate than their heterosexual counterparts.

9. The definition of spirituality can include which of the following? a. a concept of the divine or a force greater than oneself b. a sense of playfulness c. a sense of meaning d. all of the above 10. What is the current life expectancy of a baby born in the United States? a. 56.2 years b. 78.8 years c. 85.1 years d. 92.5 years 11. According to Erik Erickson, the challenge for individuals in late adulthood is ______________ while their strength is ________________. a. Generativity vs. stagnation, production/care b. Intimacy vs. isolation, wisdom c. Industry vs. inferiority, devotion/love d. Ego strength vs. despair, wisdom 12. Robert, a clinical mental health counselor, uses myths and poetry with men in groups. Which of the following terms describes Robert’s work with men? a. reality orientation b. mythological-allegorical orientation c. mythopoetic movement d. unethical treatment 13. As a group, _________ are more reluctant to seek counseling than __________. a. gays/lesbians, heterosexuals b. women, men c. men, women d. None of the above

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14. Which of the follow adjectives refers to an individual who believes in the existence of a religious or spiritual absolute reality but who allows for multiple interpretations and paths toward it? a. religio-spiritualistic b. pluralistic c. constructivistic d. absolutist 15. What does the “R” in Hays’ ADDRESSING Model stands for? a. Race/ethnicity b. Relationships c. Religion d. Reflection ESSAY TEST QUESTIONS 1. Discuss challenges and strengths associated with older adults in terms of Erikson’s psychosocial stages. Describe how knowledge of Erikson’s stages can help counselors who work with older adults. Be specific.

2. There are some special concerns counselors must face when counseling both men and women. What are some concerns that men and women face, and what are some strategies you would employ in counseling males and females?

3. What are some unique factors to consider when working with gay, lesbian, bisexual, and transgender clients?

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ADDITIONAL RESOURCES Dartmouth-Hitchcock Medical Center (Producers). (1998). The gift of aging [Film]. (Available from Films for the Humanities & Sciences, PO Box 2053, Princeton, NJ 08543-2053) Living longer and better lives is the focus of this 28-minute video. The video highlights the inspiring lives of five people over the age of 70. 1-800-257-5126 Films for the Humanities & Sciences. (1998). Women: A true story [Film]. (Available from Films for the Humanities & Sciences, PO Box 2053, Princeton, NJ 08543-2053) This series takes an in-depth look at issues that face women around the world. Six 47-minute videos comprise this set with the following titles: The Gender Tango, The Double Shift, The Need to Know, Body Politics, The Power Game, and Postcards from the Future. This awardwinning series is hosted by actress Susan Sarandon. 1-800-257-5126 Films for the Humanities & Sciences. (1999). Gay couples: The nature of relationships [Film].

(Available from Films for the Humanities & Sciences, PO Box 2053, Princeton, NJ 085432053) Dr. Pepper Schwartz explores the lives of two couples in this 50-minute video. One of these couples is gay and the other is lesbian. Schwartz examines each couple’s views on communication, conflict-resolution, family, friends, and the influence of gender and society.

1-800-257-5126 Heller, K., & Domonkos, B. (Producers/Directors). (1993). From a secret place: America’s families cope with the coming out process of gay and lesbian youth [Film]. (Available from Guilford Publications, Inc., 72 Spring St., Dept. 5Q, New York, NY 10012-9902) This video is geared towards mental health providers and educators. Dealing with the unique issues facing gay and lesbian youth, this 40-minute video also has a leader’s guide that provides questions, a bibliography, and overall guidelines for video usage. 1-800-365-7006 Insight Media. (1988). Issues in counseling women [Film]. (Available from Insight Media, 2162 Broadway, New York, NY 10024-0621) This 74-minute video looks at sexism and how it effects counseling sessions. How to address specific women’s issues in counseling is discussed, with attention given to issues unique to counseling African-American women. 1-800-233-9910 Insight Media. (1990). Seasons of life: Adulthood [Film]. (Available from Insight Media, 2162 Broadway, New York, NY 10024-0621) With three 60-minute volumes, this video examines early, middle, and late adulthood and the issues that face individuals at each stage. 1-800-233-9910

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Insight Media. (1993). Men in therapy: Men’s issues and group treatment [Film]. (Available from Insight Media, 2162 Broadway, New York, NY 10024-0621) This 38-minute video explores issues facing men today. The video shows a real-life group therapy session for men. Fundamentals for working with men in groups are discussed. 1800-233-9910 Insight Media. (1998). Feminist Therapy [Film]. (Available from Insight Media, 2162 Broadway, New York, NY 10024-0621) Lenore Walker hosts this 100-minute video that looks at some of the main components of feminist theory and how it is applied in a counseling session. 1-800-233-9910

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CHAPTER 5 BUILDING COUNSELING RELATIONSHIPS CHAPTER OVERVIEW This chapter emphasizes that counseling is a relationship with definable stages. Some of the factors that influence this relationship are examined in detail, including structure, initiative, physical setting, client qualities, and counselor qualities. After presenting the various types of initial interviews, helpful and non-helpful interview behaviors (on the part of the counselor) are illustrated. The process of establishing rapport is highlighted throughout the chapter, with a final section devoted to exploring, identifying, and setting effective therapeutic goals.

KEY TERMS, CONCEPTS, AND PEOPLE Advice giving Attending behavior Attractiveness Battle for Initiative Battle for Structure Client-observation skills Confrontation Culturally sensitive empathy Door in the face DUDS Empathy (primary/advanced) Excessive questioning Expertness Foot in the door technique HOUNDs Initiative Lecturing Metaphors Microskills Nonverbal behavior Open question Probe Professional Disclosure Statement Rapport Reflection of content Reflection of feeling Request for clarification Resistant client Restatement Role-reversal exercise Scapegoating SOLER Storytelling Structure 55 ..

Summary of feelings Touch test Trustworthiness Uncoordinated goals Unfinished business Unrealistic goals YAVIS CHAPTER 5 - BUILDING COUNSELING RELATIONSHIPS Factors that Influence the Counseling Process •

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Seriousness of the Presenting Problem o Clients who report higher distress take more sessions to reach improvement than those reporting lower distress. o Most improvement occurs early in treatment but seriously disturbed clients benefit from longer term treatment. Talk therapy alone is least likely to bring about improvement with individuals who have conditions such as schizophrenia. o Clients who are in better shape at the beginning of treatment seem to improve the most, in the least amount of time, and with the best long term results.

Structure – an understanding between the client and counselor about what is going to occur in counseling; how, what, when, etc. A framework. o It clarifies the relationship and gives direction; protects the rights, roles and obligations of counselors and clients; and ensures the success of counseling. o Provides guidelines: time limits, action limits, role limits, and procedural limits, fee schedules o Especially important at the beginning of the counseling process. o Counselor must stay flexible to negotiate the structure with the client.

Initiative – a motivation to change. o Easy clients – come to counseling voluntarily or on a self-referred basis. o Difficult clients – are hesitant to participate in counseling. Counselors have a tendency to scapegoat the client as the problem or feel guilty for the lack of success in counseling. Role-reversal exercises (taking on the position of the client) may encourage empathy. o Reluctant client – referred by a third party, such as school children and courtreferred clients. Tend to terminate counseling early and report dissatisfaction. o Resistant client – unwilling, unready or opposed to change. Clings to present behavior even if destructive. Some refuse to make decisions and do anything the counselor says to get things over with.

▪ Four broad categories of resistance: • Amount of verbalization • Content of message • Style of communication • Attitude toward counselors and counseling sessions. o Ways to help a client win in the battle for initiative:

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Don’t be surprised by resistance. Anticipate anger, frustration, and defensiveness.

▪ Show acceptance, patience, and understanding, along with a nonjudgmental attitude. Promotes trust.

▪ Use persuasion Physical Setting o Most important factors – place where counseling occurs ▪ Should not be overwhelming, noisy, or distracting.

▪ Comfortable and attractive.

▪ Soft lighting, quiet colors, clean, harmonious, comfortable furniture, cultural diversity, child furniture. o Eight common architectural characteristics of space: ▪ Accessories ▪ Color ▪ Furniture and room design ▪ Lighting - soft ▪ Smell ▪ Sound ▪ Texture ▪ Thermal conditions o Proxemics – spatial features of the environment ▪ Comfort level is influenced by cultural background, gender, and nature of the relationship.

▪ Distance of 30 to 39 inches is average comfort zone between counselors and clients of both genders in US. o Desks are usually not used in counseling. Gives a barrier against intimacy. Two chairs are a given. o Phone calls should be held. Use “do not disturb” signs. o Professional codes of ethics mandate the right to auditory and visual privacy.

Client Qualities o First impressions stick and are vital to the establishment of a productive relationship. o Most successful clients for traditional approaches tend to be YAVIS: young, attractive, verbal, intelligent, and successful. o Less successful candidates are HOUNDs (homely, old, unintelligent, nonverbal, and disadvantaged) or DUDs (dumb, unintelligent, and disadvantaged). o Counselors enjoy working with individuals who they think have the potential to change. o Attractiveness is seen as a more motivating characteristic. These individuals were seen as more likely to change in counseling.

▪ Attractive children are viewed as more intelligent and as having less behavioral problems, also.

▪ Counselors need to identify their views of attractiveness and deal with stereotypes in order to be more effective. o Client’s nonverbal behaviors are important.

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Body gestures, eye contact, facial expression, and vocal qualities may say more than words.

▪ Cultural background is important; for instance, some cultures believe giving direct eye contact to someone in authority is rude.

Counselor Qualities o According to Strong there are three characteristics that make counselors more influential initially: ▪ Expertness – counselor is perceived as knowledgeable and informed about his/her specialty. Displaying certificates and diplomas are seen as more credible.

▪ Attractiveness – speak in clear simple sentences and offer appropriate selfdisclosure. Eye contact and non-verbal cues, such as head nodding, increase attractiveness rating. Be neat and professional looking.

▪ Trustworthiness – developed over time. Clients test counselors for trustworthiness by requesting info, telling secrets, asking a favor, inconveniencing the counselor, deprecating themselves, or questioning motives and dedication of the counselor.

Types of Initial Interviews •

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Client- versus Counselor-Initiated Interviews o Client initiated: Counselor is often unsure of the client’s intentions. Counselor may have anxiety, especially if background information is not available. Answer: listen. o Counselor-initiated: counselor should state his/her reason to see the client.

Without giving reason to the client, the client becomes very anxious. o First interviews should be multimodal – visual, auditory, written, spoken and descriptive.

Information-Oriented First Interview o Initial interview can have two functions: ▪ Intake interview to collect information ▪ Beginning of a relationship o Information gathering includes probes, accents, closed questions, open questions, and requests for clarification.

▪ Probe – a question that begins with who, what, where, or how. Requires more than a one- or two-word response. Avoid why questions – denotes judgment.

▪ Accents – highlights last words of the client.

▪ Closed question – requires a yes or no answer – is, do, or are questions.

▪ Open questions – begin with what, how, and could. Encourages the client to talk more.

▪ Request for clarification – asks the client to repeat or elaborate on information. Makes sure the counselor understands what the client has shared.

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Relationship-Oriented First Interview o Focus on feelings or relationship dynamics. Concentrate on client’s attitudes and emotions. o Counselor responses include: restatement, reflection of feeling, summary of feelings, request for clarification, and acknowledgment of nonverbal behavior.

▪ Restatement – a mirror response to what the client has said. Also known as active listening.

▪ Reflection of feeling – deals with verbal and nonverbal expression by stating what the client is feeling at a given moment or outburst.

▪ Summary of feelings – paraphrasing several feelings expressed by the client.

▪ Acknowledgment of nonverbal behavior – does not interpret the meaning of the behavior. It simply acknowledges the occurrence of the behavior.

Conducting the Initial Interview •

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Building rapport includes the counselor setting aside his/her own agendas to focus on the client. Genuine interest in the client and accepting of the client. o Two basic micro-skills for rapport building are attending behavior and clientobservation skills. o Vital for the disclosure of information, initiation of change, and success of counseling.

Empathy o The counselor’s ability to walk in the client’s shoes. Rogers’ client-centered therapy is well-known for requiring empathy for a therapeutic relationship. o Two skills involved: perception and communication ▪ Perception – seeing the client’s cultural framework. The counselor can develop culturally sensitive empathy to bridge cultural gaps.

▪ Communication – perception is not enough for effective counseling. A counselor must be able to communicate the empathy. o Primary empathy – counselor must be able to respond empathetically so that the client feels understood. Conveyed verbally and non-verbally. Ex., leaning forward and speaking softly. o Advanced empathy - helping client explore themes, issues, and emotions new to his/her awareness. Appropriate for counseling beyond the initial interview.

Verbal and Nonverbal Behavior o Attentiveness - the amount of verbal and nonverbal behavior shown to the client. o Verbal behaviors – communicate desire to comprehend or discuss what is important to the client. Includes probing, requesting clarification, restating, and summarizing. o Nonverbal behaviors – smiling, learning forward, making eye contact, gesturing, and nodding. o Five non-verbal skills in initial attending: SOLER ▪ S = squarely face the client ▪ O = open posture free from crossed arms and legs to show nondefensiveness 59 ..

▪ ▪ ▪

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L = lean toward the client but not too close E = eye contact R = relax and be comfortable o Touch should be used sparingly and ask if you would do that to a stranger.

Non-helpful Interview Behavior o Four major actions that should be avoided: advice giving, lecturing, excessive questioning, and storytelling by the counselor: ▪ Advice giving can deny the client the chance to work through personal thoughts and feelings and curtail his/her ability to make difficult decisions.

Crises counseling is an exception.

• Carkhuff model for advice giving: respect, empathy, genuineness, concreteness, self-disclosure, confrontation, and immediacy.

▪ Lecturing is a form of advice giving. Sets up a power struggle.

▪ Excessive questioning creates feelings of interrogation for the client.

Avoid asking more than two questions in a row.

▪ Storytelling can be used to direct clients to think about their own situations. Use cautiously to avoid directing the counseling session toward yourself.

Exploration and the Identification of Goals •

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Help client explore specific areas and begin to identify goals by reinforcing the client to focus on him/herself by providing structure, active listening, and identifying and clarifying goals.

Unfocused goals – too broad, not prioritized. Identify goals, state them in a workable form, and chose which ones to pursue first.

Unrealistic goals are goals that are not easily obtained, like happiness, perfection, etc.

These goals can be set as end products.

Uncoordinated goals may be incompatible with each other. Incompatibility may be client does not really want to work toward goal or client may be afraid to work toward goal.

Seven criteria for judging effectiveness of goals: o Mutually agreed on by client and counselor o Specific o Relevant to self-defeating behavior o Achievement and success oriented o Quantifiable and measurable o Behavioral and observable o Understandable and can be restated Potential problems in goal-setting stage: moving too fast or slow, fear of intensity, client rambling, and excessive time and energy devoted to the past.

CLASSROOM ACTIVITIES 1. Imagine that you are about to conduct your first counseling session in an environment of your own choosing. How would you furnish this setting, and how would you spend your first 10 minutes with an ideal client? Make notes and drawings of this experience and share it with another class member.

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2. What are some things that you can do to make yourself more attractive (likable) to your client? Share your list with fellow classmates in an open discussion. Does your combined list of behaviors differ from Okun and Kantrowitz’s list? How? Which items do you consider most crucial in becoming an effective counselor?

3. What are your feelings about being a counselor now that you have some idea about what the process is like? Discuss your feelings and the thoughts behind them with other members of the class. Do those feelings and thoughts differ substantially from what they were at the beginning of the course? How? 4. Persuasion has been mentioned as an appropriate counselor skill. In groups of three, role-play the following situations in which persuasion might be employed: (a) a small boy is afraid of all dogs, (b) a student has high test anxiety, (c) an elderly person is withdrawn, and (d) a marriage partner will not fight fairly with his or her spouse. How do you experience persuasion differently in these situations? How effective are the persuasive techniques that you used? Discuss your feelings with the class as a whole.

5. Write down ways that you think you can tell whether a counselor or client is ready to end a relationship. Then silently enact two or more of your behaviors in front of your classmates and let them describe what you are doing and how they would react to it.

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CHAPTER 5 - MULTIPLE CHOICE TEST QUESTIONS 1. In a counseling relationship, the “Battle for Structure” involves ___________. a. motivation for change b. client responsibility c. issues of administrative control d. the physical arrangement of the counseling room 2. It is important that the counselor win the _________________ and that the client win the_______________. a. battle for initiative; battle for structure b. battle for the working alliance; battle for fee schedule c. battle for structure; battle for initiative d. battle for competence; battle for autonomy 3. Which of the following is an example of a client who would be considered resistant? a. Michael, who is not ready to go through the emotional pain that counseling demands. b. Margo, who knows little about counseling and is therefore hesitant to do or say anything for fear of what might happen. c. Maggie, who has heard misrepresentations of counseling form others and, therefore, decides that superficiality in counseling is the best way to deal with the counselor d. All of the above represent resistant clients.

4. When a counselor asks a client to comply with a minor request and then later follows the initial request with one that is larger, the counselor is employing which technique? a. challenge b. the foot in the door technique c. the door in the face technique d. confrontation 5. The most successful candidates for traditional approaches to counseling are described by which acronym? a. SOLER b. YAVIS c. DUDS d. HOUNDs 6. Jackie, a counselor, asks Jill, her client, to commit to exercising twice a day, but later asks her to commit to exercising once a week. Jackie is employing which technique? a. Battle for initiative b. Foot in the door approach c. Door in the face approach d. Confrontation 7. The degree to which a counselor is perceived as knowledgeable and informed about his or her specialty is known as ___________.

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a. b. c. d.

trustworthiness attractiveness expertness dedication

8. Counselors who have developed their self-awareness skills are likely to do all of the following, EXCEPT _________. a. accurately assess both their own needs and the needs of their clients b. communicate clearly c. convey immediate trustworthiness d. be in touch with their own values, thoughts, and feelings 9. The question “why” usually is not used in counseling because __________. a. it puts clients on the defensive b. it connotes disapproval c. it leads to self-disclosure d. “A” and “B” but not “C” 10. Empathy, according to Welfel & Patterson (2005) involves the skills of ___________ and ____________. a. rapport; support b. feeling; talking c. perception; communication d. awareness; acknowledgement 11. A disguised form of advice giving is known as _________. a. storytelling b. lecturing c. excessive questioning d. exploration 12. Which of the following is a question that usually begins with who, what, where, or how? a. probe b. open ended question c. summarization d. reinforcement 13. The “E” in the acronym SOLER stands for __________. a. elevate b. eye contact c. egalitarian relationship d. equality 14. A counselor-initiated interview should ________. a. start with information gathering b. start with the counselor explaining the reason he or she wanted to see the client 63 ..

c. be shorter than a client-initiated interview d. none of the above 15. Effective goals in counseling are ________. a. agreed upon by both the client and the counselor b. broad c. relate to anything in the client’s life d. qualitative and theoretical ESSAY TEST QUESTIONS 1. Discuss how you would conduct a first client-initiated relationship counseling interview, especially in regard to verbal and nonverbal behavior. What primary behaviors do you consider most helpful? What behaviors should be avoided?

2. Describe the characteristics of and the importance of the Battle for Initiative and the Battle for Structure. What can a counselor do to make sure that these battles are won?

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ADDITIONAL RESOURCES American Counseling Association. (1996). The wounded healer [Film]. (Available from American Counseling Association, 5999 Stevenson Avenue, Alexandria, VA 22304) In this video, Rollo May discusses the links between pain and creativity. He highlights some well-known professionals and their journeys to becoming healers.1-800-422-2648 Insight Media. (1991). Basic interviewing skills [Film]. (Available from Insight Media, Broadway, New York, NY 10024-0621)

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This video breaks down basic skills for interviewing into five areas: listening, reflecting, questioning, expressing, and interpreting. Techniques for using these skills are shown separately and then a final vignette is shown incorporating all five skills. (51 minutes) 1800-233-9910 Insight Media. (1991). Communication skills for effective helping [Film]. (Available from Insight Media, 2162 Broadway, New York, NY 10024-0621) This video illustrates how to use communication skills when working with clients who are experiencing issues related to grief and loss. Dr. Dale Larson explains both non-verbal and verbal communication skills in this 30-minute video. 1-800-233-9910 Insight Media. (1992). Basic attending skills [Film]. (Available from Insight Media, 2162 Broadway, New York, NY 10024-0621) Focusing on Allen Ivey’s basic counseling skills, this video is ideal for helping counselorsin-training learn how to use reflecting, paraphrasing, summarizing, and open and closed questioning. (150 minutes) 1-800-233-9910 Insight Media. (1992). Microcounseling skills [Film]. (Available from Insight Media, 2162 Broadway, New York, NY 10024-0621) This two-volume, 227-minute video series illustrates through mock-cases how to use the basic counseling skills in actual counseling sessions. Some of the areas covered are using empathy, confronting, observing, and questioning. Effective and ineffective methods for handling certain situations are presented and contrasted. 1-800-233-9910 Insight Media. (1996). Basic influencing skills [Film]. (Available from Insight Media, 2162 Broadway, New York, NY 10024-0621) This 120-minute video examines how to use basic counseling skills to help clients open up and tell about their situation. Allen Ivey, Mary Bradford Ivey, and Norma Gluckstern integrate narrative theory and story telling techniques into their approach to counseling. 1800-233-9910

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CHAPTER 6 WORKING IN AND CLOSING A COUNSELING RELATIONSHIP CHAPTER OVERVIEW This chapter focuses on the involvement of the counselor in helping the client find a satisfactory resolution to concerns. Specific skills the counselor may use include leading, multifocused responding, using accurate empathy, self-disclosure, immediacy, humor, confrontation, contracting, and rehearsal. The process of and dangers of transference and countertransference are also examined. The final consideration in the chapter is the importance of establishing a “real relationship” between counselor and client.

This chapter also covers aspects associated with counselors and clients terminating relationships as well as premature closure. The similarities and differences between closing of individual sessions and of the counseling relationship are explored. Other issues associated with closure such as follow-up, referral, and recycling are also discussed. Emphasis is added to ending the counseling relationship on a positive note. Counselors are also given suggestions on how to deal with resistance to closure both within themselves and within the clients. The importance of proper techniques appropriate to the termination process are highlighted.

KEY TERMS, CONCEPTS, AND PEOPLE Circular counseling Confrontation Countertransference Disidentification Dyadic effect Empathy (accurate, advanced, primary) Fading Follow-up Functional fixity Generalization Hesitancy Homework (paradoxical, behavioral, risk taking, thinking, written, bibliotherapeutic, not doing anything) Hope Humor Immediacy (relationship/here-and-now/self-involving) Johari window Leading (maximum v. minimum) Metaphors (verbal, nonverbal) MUM effect Overidentification Permanent counselor-related closing Posttraumatic growth Realism Real relationship 66 ..

Referral Reframing Rehearsal (overt/covert) SAFE (specificity, awareness, fairness, efficacy) Scapegoat Self-disclosure Social construction perspective Termination Transference (positive v. negative / direct vs. indirect) Transference pull Workbooks Working alliance CHAPTER 6 – WORKING IN AND CLOSING A COUNSELING RELATIONSHIP The Johari Window

Known to Others Not Known to Others

Known to Self I. Area of Free Activity II. Avoided or Hidden Area – Self hidden from others

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Not Known to Self III. Blind Area- Blind to self, seen by others IV. Area of Unknown Activity

Phases I and II – • The object is to help clients relax so that they can tell their stories and discover information located in blind areas that they are unaware.

• As they become aware of these areas they can decide what to do next.

• With awareness in these phases comes more information from areas III and IV causing those areas to shrink, hopefully increasing area I. Counselor Skills in the Understanding and Action Phases • Changing Perceptions • Clients may come to counseling as a last resort bringing a fixed view of their situation, functional fixity.

• Counseling can help clients change distorted or unrealistic objectives by helping them explore thoughts and desires in a safe, accepting environment.

• Counselors should pay attention to verbal and nonverbal cues used by the client to become aware of where the client is and where s/he wishes to be.

• Reframing is a technique that offers the client another possibility and positive viewpoint about a situation. Reframing life experiences can give a client a different way to look at a situation.

1. A 12 step strategy process has been developed in employment counseling to help clients look back, look at the present, and look forward to widen the perspective of themselves and the labor market.

2. Reframing can help reduce resistance and help propel the client to do something differently by changing his/her perception of a problem.

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3. Gives clients greater insight and accuracy about themselves and their environments.

Leading • Persuasive skill and direction come from the counselor. Labeled leading by Francis Robinson in 1950.

• Robinson’s analogy – a quarterback anticipates where the receiver will be on the field and throws the ball to that spot. Counselors also anticipate where their clients are and where they will likely be. Then, the counselor responds accordingly.

• Counselors should be careful not to persuade or lead too far.

• Leading responses include silence, acceptance, and paraphrases which are best used at the beginning of the process. Persuasion is better used in the understanding and action phases.

• Minimal Leads, minimal encouragers, such as “yes” or “I hear you” are best used in the building phase because they are low risk.

• Maximum Leads, like confrontation, are best used after a solid relationship has been established.

Multifocused Responding • Clients receive input from their world differently and different styles of counseling influence client’s perception and behaviors. o Visual learners – influenced by what they see happening. o Auditory learners – hear the world around them. o Kinesthetic learners – feel the situation through being physically in touch with them. o Olfactory learners – describe the situation or associate through smell. o Counselors should vary their responses by senses, like “I hear what you’re saying,” or “I hear your point,” or “I feel that you are really upset.”

• Respond in the client’s own language. o Affective responses – focus on a client’s feelings. o Behavioral responses – focus on actions. o Cognitive responses focus on thought.

Accurate Empathy • Primary and advanced empathy (also in Chapter 5) o Primary accurate empathy - communicates a basic understanding of what the client is feeling and the experiences and behaviors underlying these feelings. o Advanced accurate empathy – reflects what client states and what they imply.

• Counselor sees client’s world from the client’s point of view and are able to communicate this understanding back to the client.

• Two factors that make empathy possible: o Realizing that “an infinite number of feelings” do not exist o Having a personal security so that you can let yourself go into the world of another person and still know that you can return to your own world.

• Involves three elements: perceptiveness, know-how, and assertiveness.

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Empathic Understanding in Interpersonal Process. Carkhuff has delineated five levels that either add to or subtract from the meaning and feeling tone of a client’s statement: o Level 1 Response: Counselor’s verbal and behavioral expressions do not attend to the verbal and behavioral expressions of the client. (not empathetic) o Level 2 Response: The counselor’s responses subtract affect from the communications of the client. (not empathetic) o Level 3 Response: The counselor’s responses are “interchangeable” with those of the client. o Level 4 Response: The counselor’s responses add to the client’s expressions and expresses feeling at a level deeper than the client was able to express. o Level 5 Response: The counselor’s responses add significantly to the client’s feelings and meaning in a way that accurately expresses feeling levels below what the client is able to express.

Self-Disclosure • Self-disclosure is a conscious, intentional technique in which clinicians share information about their lives outside the counseling relationship.

• Sidney Jourard o Self-disclosure means making oneself known to another person by revealing personal information. Establishes trust and facilitates the counseling relationship. o Reciprocal self-disclosure – the dyadic effect • Clients are more likely to trust counselors who disclose personal information (there is a limit) and are prone to make reciprocal disclosures.

• Serves two principal functions: Modeling and developing a new perspective. o Clients are more open when the counselor is more open. When clients hear about the counselor’s personal struggles, they may also look at similar issue in their lives. o Self-disclosures should be brief and focused, should not add to the client’s problems, and should not be used frequently. More is not always better.

• May be risky for clients. o Hesitancy may take the form of refusing to discuss issues, changing the subject, being silent, and talking excessively. o Exploration about hesitancy may take the form of modeling for the client and inviting self-disclosure, exploring negative feelings about the counseling process, encouraging the client to talk about a certain subject, and confrontation about the avoidance of an issue.

Immediacy • “A counselor’s understanding and communicating of what is going on between the counselor and client within the helping relationship, especially the client’s feelings, impressions, and expectations, and wants of the counselor”.

• Three kinds of immediacy: o Overall [counseling] relationship immediacy – “How are we doing?”

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Immediacy that focuses on a particular situation in a session – “What’s going on right now?” o Self-involving statements – “I like how you did…”

• Three fears counselors have about immediacy: o Misinterpretation of their messages by the client. o May produce an unexpected outcome. o Might influence client to terminate the counseling sessions because they can no longer control or manipulate the relationship.

• Immediacy is best used: o In a directionless relationship o Where there is tension o Where there is a question of trust o When there is considerable social distance between counselor and client, such as in diversity o Where there is client dependency o Where there is counterdependency o When there is an attraction between counselor and client Hope o The belief that something desirable, such as accomplishing a goal is possible. o Counselors can help clients develop or increase their hope. o Multiple benefits ▪ Increasing clients’ motivation ▪ Linked to academic success, athletic achievement, psychological adjustment, and physical health. o Counselor should be aware of research on hope.

Humor • Giving an incongruent or unexpected response to a question or situation.

• Requires sensitivity and timing by counselor.

• Should never be aimed as a put down.

• Can be used as a tool to get around resistance, relieve tension, and help clients distance themselves from emotional pain.

• Can lead to insight.

• Client must be comfortable with humor and trust must be built in the relationship for humor to go over well.

Confrontation • A challenge to a client to examine, modify, or control an aspect of behavior that is currently nonexistent or improperly used.

• Can help people see more clearly what is going on, what the consequences are, and how they can assume responsibility for their actions to change in ways than can lead to a more effective life.

• Sometimes not to confront is detrimental (A MUM effect). A good, responsible, caring, and appropriate confrontation produces growth and encourages and honest self-examination.

• Boundaries to confrontation: o

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1. Be sure that the relationship with the client is strong enough to sustain a confrontation.

2. Time a confrontation appropriately and remain true to the motives leading to this act.

3. More productive to confront a client’s strengths than his/her weaknesses.

4. Challenge the client to use resources s/he is failing to use.

5. Use a “you said…but look” structure for confrontation.

Contracting • Goal Setting Contracting and Final Outcome Contracting: o Counselor operates from a theoretical base that directs his or her actions. o Client learns to change ways of thinking, feeling, and behaving to obtain goals. o Useful and time saving for counselors and clients to work on goals through a contract system in order to accomplish goals within a given framework sometimes as short as five to six sessions.

• Advantages to using contracts: o Provides a written record of goals that have been agreed upon. o Time limits may act as motivators for a client who tends to procrastinate. o If broken down into definable sections, a client may get a clear feeling that problems can be solved. o Puts the responsibility for any change on the client to empower him/her to be more responsive to the environment and more responsible for his/her behaviors. o Assures the client will return to counseling regularly by outlining the number of sessions.

• Approaches to setting up contracts: o Counselor indicates that the purpose of counseling is to work not talk. o Focus change in the client rather than someone not present who exists in the client’s life (that would be consulting like with a teacher about how to help a student). o Avoid including client’s con words such as try or maybe. o Avoid shoulds or musts that are goals directed toward pleasing others.

Ask what the client really wants. o Define behaviorally what client wishes to achieve through counseling. o Contracts focus on change in client’s behaviors, thoughts, or feelings.

• SAFE o S = specificity: What are the treatment goals? o A = awareness; knowledge of procedures, goals, and side effects of counseling. o F = fairness; balance of information in the relationship between client and counselor. o E = efficacy; client believes s/he can make choices and decisions; in other words, believes in his/her ability to achieve counseling goals. o Weaknesses of Contracts ▪ [Needs to be open for renegotiating by both parties.]

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A counselor can’t hold a client to a contract.

Some problems are not oriented toward a contract system.

Focused on outward behavior but may not achieve insight or alter perceptions.

▪ Appeal of doing a contract is limited. o Ask how the client might sabotage the contract in order to identify resistance.

• Rehearsal • Practicing designated behavior helps to maximize the chance that clients will fulfill the contract.

• Overt rehearsal – client verbalizes or acts out what s/he is going to do.

• Covert rehearsal – imagining the desired goal. This can alleviate anxiety.

• Coaching during rehearsal can provide temporary aids to help the client remember what to do next. o Provides feedback in what to do next. o Feedback – helping the client recognize and correct any problem areas.

Oral and written feedback is most effective.

• Homework – o Assignments given to help client practice the skills learned in counseling.

Advantages include: ▪ Helps client to focus on relevant behavior between sessions ▪ Helps client to see progress ▪ Motivates the change of behaviors ▪ Encourages evaluation and modification of activities ▪ Gives clients responsibility for control of themselves ▪ Provides a celebration of achievements from counseling. o Cognitive-behavioral counselors use homework a lot to record what client has accomplished. o Homework is most effective if tied to a behavioral change. o Most frequently used homework: ▪ paradoxical (create the opposite effect) ▪ behavioral (practicing a new skill) ▪ risk-taking (doing something that is feared) ▪ thinking (mulling over select thoughts) ▪ written (keeping a log or journal) ▪ bibliotherapeutic (reading, listening, or viewing literature) ▪ nothing (taking a break from one’s usual habits) Transference and Countertransference • Transference o The client’s projection of past or present feelings, attitudes, or desires onto the counselor. o Useful in two ways: ▪ Help counselors understand clients better.

▪ Use it as a way to resolve client’s problems.

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Transference pull – an image generated through the use of personality and a particular theoretical approach. The client reacts to the counselor’s image from his/her past experience. The way a counselor sits, speaks, gestures or looks may trigger a client reaction. o Five patterns of transference: ▪ counselor perceived as ideal ▪ seer ▪ nurturer ▪ frustrator ▪ nonentity o Transference may be either direct (obvious) or indirect (harder to recognize). o Negative and positive transference ▪ Negative transference – client accuses the counselor of neglecting or acting negatively toward him/her.

▪ Positive transference – may not be readily acknowledged because it seems to add something to the relationship, like admiration for the counselor.

▪ The client can divert from the goals of counseling by keeping the counselor focused on transference.

▪ Resolving transference may help the client to gain insight into the past and become free to act differently in the present and future.

Countertransference o The counselor’s projected emotional reaction to or behavior toward the client can be harmful to the relationship. o Two approaches to the problem of countertransference: ▪ Classic approach – viewed as the direct or indirect unconscious reaction of the counselor to the client. (negative) ▪ Total approach – seen as a diagnostic tool for understanding aspects of the client’s unconscious motivations. (positive) ▪ Blanck and Blanck see countertransference as positive and negative. o Forms of countertransference: ▪ feeling a constant desire to please the client ▪ identifying with the problems of the client so much that one loses objectivity ▪ developing sexual or romantic feelings toward the client ▪ giving advice compulsively ▪ wanting to develop a social relationship with the client o Watkins has identified four forms of countertransference: ▪ overprotective – overidentification (counselor loses ability to remain emotionally distant) ▪ benign - overidentification ▪ rejecting – disidentification (counselor becomes emotionally removed from the client, becomes aloof, nonempathetic, hostile, cold or antagonistic) ▪ hostile – disidentification o Identify countertransference o

•

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▪ ▪ ▪

Be aware of your own feelings.

Discover the reasons behind your feelings.

Get supervision • Supervision involves working with a more experienced counselor who can oversee the relationship by observation behind a one-way mirror, monitoring audiotapes of the sessions, and critiquing videotapes of the session.

The Real Relationship • • •

Begins as a two-way experience between counselors and clients from their first encounter.

Counselors are real by being genuine, trying to facilitate genuineness in their clients and attempting to see and understand clients in a realistic manner.

Clients are real by being genuine and perceiving their own situations realistically.

Function of Closure •

• •

Signals that something is finished. o It refers to the decision, one-sided or mutual, to stop counseling. o Closure is more than an act signifying the end of therapy; it is also a motivator. o Motivating to the client and counselor. o Limiting the number of sessions makes the client and counselor more aware of time constraints and to make the most of the sessions.

A means of maintaining changes already achieved and generalizing problem-solving skills acquired in counseling.

Serves as a reminder that the client has matured. o Marks a time in the client’s life when s/he is less absorbed by and preoccupied with personal problems and more able to deal with outside people and events. o Handling external situations results in a more interdependent and satisfying life.

Timing of Closure • • • •

Closure should be planned.

Early termination may cause regression of progress.

Avoidance of closure may create dependency.

Practical issues in the timing of closure: o Have clients achieved behavioral, cognitive, or affective contract goals? o Can clients concretely show where they have made progress in what they wanted to accomplish? o Is the counseling relationship helpful? o Has the context of the initial counseling arrangement changed?

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Issues of Closure •

Closure of Individual Sessions o Define length of individual sessions. A range of 45 to 50 minutes is usually enough for individual sessions. o Sessions that are too short are as unproductive as those that are too long. o Two important factors in closing an interview: ▪ Both client and counselor should be aware that the session is ending.

▪ No new material should be introduced during the ending of the session.

• When the client introduces new material at the end, the counselor should make it the focus of the next session.

• New material may have to be dealt with on an emergency basis. o Effectively closing an interview: ▪ Make a brief statement indicating that time is up. The simpler the statement, the better.

▪ Remind the client that there are only 5 or 10 minutes left so that s/he can focus on things that are important.

▪ Use nonverbal gestures to indicate the end of the session, like looking at your watch or standing up. Best if used with verbal indicators. o Summarize the session. Tie together the main points. Be brief and to the point without interpretation. o Set up the next appointment.

•

Closure of a Counseling Relationship o Termination should be discussed early so that client and counselor can make the most of their time. Play it down. o Counselor and client must agree on when. o Termination becomes obvious. Recognition of growth or resolution is usually implied. o Behaviors that signal the end of counseling: ▪ Decrease in the intensity of work ▪ More humor ▪ Consistent reports of improved abilities to cope ▪ Verbal commitments to the future ▪ Less denial, withdrawal, anger, mourning, or dependence o Time spent in counseling devoted to termination: ▪ According to Cormier and Hackney, a relationship of more than 3 to 4 months should include in the last 3 or 4 weeks discussions of the impact of closure.

▪ Shulman suggests that 1/6 of the time spent in counseling should be devoted to focusing on closure. o Concerns surrounding closure: ▪ Has the client’s initial problem/symptoms been reduced or eliminated?

▪ Have the stress-producing feelings that led to counseling been eliminated?

▪ Has the client’s coping ability and degree of understanding of self and others increased?

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▪ ▪ ▪

o

Can the client relate better to others and is able to love and be loved?

Has the client acquired abilities to plan and work productively?

Can the client better play and enjoy life?

Two other ways to facilitate the ending of a counselor-client relationship: ▪ Fading – a gradual decrease in the unnatural structures developed to create desired changes.

• Clients gradually stop receiving reinforcers from their counselors.

• Appointments are spread out.

• Help clients become less dependent on counseling and more dependent on themselves and interdependent with others.

• Sessions are shortened.

▪ Help clients develop successful problem solving skills.

• Encourage generalization from counseling to the client’s world.

• Emphasis on education and prevention.

• Emphasis on decision-making skills for everyday life and crises.

Resistance to Closure • •

•

Especially likely when the counseling relationship has lasted for a long time or has been highly intimate.

Factors that also promote resistance include: pain of earlier losses, loneliness, unresolved grief, need gratification, fear of rejection, and fear of having to be self-reliant.

Client Resistance o Two expressions of resistance: ▪ Asking for more time at the end of a session ▪ Asking for more appointments once a goal has been reached. o Some clients develop new problems causing a sense of obligation to treat by the counselor. o Counselor can “prescribe” a limited number of future sessions or concentrate with the client on how s/he will set her/himself up for relapse. o Vickio has developed The Goodbye Brochure for college students to describe goodbyes and why they should occur. o Five Ds for successfully dealing with departure: ▪ Determine ways to make your transition a gradual process.

▪ Discover the significance that different activities have had in your life.

▪ Describe this significance to others.

▪ Delight in what you have gained and in what lies ahead of you.

▪ Define areas of continuity in your life. o Five Ds for unsuccessfully dealing with departure ▪ Deny the loss.

▪ Distort your experience by overglorifying it.

▪ Denigrate your activities and relationships.

▪ Distract yourself from thinking about departure.

▪ Detach yourself abruptly from your activities and relationships.

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o

•

Resistance results from a fear of change. Possibility that the relationship of counseling cannot be replaced. Encourage alternative sources of support, such as self-help groups.

Counselor Resistance o Counselors who have clients who have special or unusual needs or who have been very productive may be difficult to terminate. o Eight conditions in which closure may be difficult: ▪ When it signals the end of a significant relationship.

▪ When the counselor’s anxieties are aroused about the client’s ability to function independently.

▪ When the counselor feels guilty for not being more effective.

▪ When the counselor’s professional self-concept is threatened by the client who leaves abruptly and angrily.

▪ When the end of the sessions signals the end of a learning experience for the counselor.

▪ When the counselor has been living vicariously through the adventures of the client.

▪ When closure reminds the counselor of other farewells in the counselor’s life.

▪ Counselor conflicts about his/her own individuation is aroused by closure. o The counselor may need to confide in a colleague or other counselor to help resolve the issue.

Premature Closure • • • • • • • •

•

•

Closure before the client has achieved the personal goals established at the beginning.

Ending before the client is functioning well.

Clients who terminate after the first sessions because of lack of commitment or motivation.

Some clients quit after finding out how much work counseling involves.

Some clients miss or are late for their sessions.

Discussion about premature termination should occur between the client and counselor when behaviors or statements are expressed.

Sending a letter or phoning a client can give the client “space” in which to consider his/her decisions about continuing or discontinuing counseling.

An exit interview can be scheduled to discuss early closure. Four benefits include: o Helps the client resolve any negative feelings resulting from the counseling experience. o Serves as a way to invite the client to continue in counseling if s/he wishes. o Suggests alternative treatments or a different counselor. o Increases the chance that the client will seek help at a future time.

Two mistakes counselors make about premature closure: o Blame self or the client for what is happening. o Act in a cavalier manner about the situation.

Reasons clients terminate early: 77 ..

o o o o o o

• • •

To see if the counselor really cares To try to provoke positive feelings from the counselor To punish or try to hurt the counselor To eliminate anxiety To show the counselor that the client has found a cure elsewhere To express to the counselor that the client does not feel understood Counselors must realize that they do not have to be perfect. Some counseling sessions just are not going to work out.

Some clients are not ready for counseling.

Ways to prevent premature closure o Appointments – keep regular appointments and less time between appointments o Orientation to counseling – educate clients at the beginning of counseling about what they should expect o Consistency of counselor – the intake counselor should try to stay with the client o Reminders – cards, telephone calls, emails with client’s permission

Counselor-Initiated Closure •

•

•

• • •

Good reasons counselors close counseling: o Illness o Working through countertransference o Relocation to another area o The end of an internship or practicum experience o An extended trip o Realization that client needs could be better served by someone else Poor reasons counselors terminate counseling: o Anger o Boredom o Anxiety Client benefits from counselor closure o By realizing that the counselor is human and replaceable o Realizing they have choices about how to deal with interpersonal relationships o They may explore previous feelings and major life decisions and learn new behaviors. o Refocusing on issues on which to work Make sure clients have the names and numbers of a few other counselors to contact in case of an emergency.

Put client losses in perspective and plan accordingly.

Counselors should be open with clients about where they are going and what they will be doing.

Ending on a Positive Note • •

Closure should be mutually agreed upon.

Four guidelines to end an intense counseling relationship in a positive way:

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o o o o

“Be clearly aware of the client’s needs and wants and allow the client time to express them.”

“Review the major events of the counseling experience and bring the review into the present.”

“Supportively acknowledge the changes the client has made.”

“Request follow-up contact.”

Issues Related to Closure: Follow-Up and Referral •

Follow-Up o Checking to see how the client is doing, with respect to whatever the problem was, sometime after termination has occurred. o Follow-ups may be encouraging to client growth. o Reinforces the gains clients have made in counseling and helps both counselor and client reevaluate the experience. o Emphasizes counselor’s genuine care and concern for the client. o Short-term follow-up – 3 to 6 months after closure. o Long-term follow-up – at least 6 months after closure. o Four main ways in which follow-ups may take form: ▪ Invite the client in for a session to discuss any progress s/he has continued to make in achieving desired goals. (most effective) ▪ Telephone the client.

▪ Send a letter asking about the client’s current status.

▪ Mail the client a questionnaire dealing with his/her current levels of functioning (impersonal). o Graphing or charting progress can help a client keep up with his/her progress.

•

Referral and Recycling o When the counseling situation seems unproductive, the counselor should either terminate the relationship or make a referral. o Reasons to refer: ▪ Counselor does not know how to handle the client’s problem.

▪ Counselor does not have the necessary skills for the client’s problem.

▪ A nearby expert may be more helpful to the client.

▪ The counselor and client personalities are incompatible.

▪ The counseling relationship cannot get beyond the initial phase. o How, when, and who of referrals: ▪ How – How to help the client make the transition to another counselor with minimal resistance. One way to do this is to meet with the client and the new counselor for the initial visit.

▪ When – (timing) The longer a client works with a counselor, the more reluctant the client may be to see someone else.

▪ Who – Know the interpersonal skills of the new counselor. Would you send a family member to see this person? o Recycling – reexamining all phases of the therapeutic process. Counselor and client can decide how or whether to revise and reinvest. (To start over) 79 ..

CLASSROOM ACTIVITIES 1. In groups of three, discuss ways of using the counseling skills that you learned about in this chapter. For example, how will you know when to be silent and when to confront?

2. In groups of four, two people should role play a counselor and client and two should observe. Enact situations in which the counselor demonstrates that he or she knows how to display the different levels of empathy. After the counselor has demonstrated these skills, he or she should receive feedback from the client and observers about their impressions of each enactment.

3. In the same groups that were formed for activity 3, practice confrontation and immediacy skills. Discuss among yourselves and then with the class as a whole, the differences and similarities between these two counseling skills.

4. Transference and countertransference are still hotly debated in counseling. Divide the class into two teams. One team should take the position that these phenomena occur in counseling, while the other should argue that only real relationships are manifested between counselors and clients. Select a three-member panel from the class to judge the debate and give the class feedback on the points made by each side.

5. In pairs, discuss the most significant closure experience of your life, such as the death of a loved one, graduation, or moving from one life stage to another. Evaluate with your partner the positive things you learned from these experiences as well as the pain you felt.

6. In small groups, take turns role-playing different forms of counselor–client resistance to termination at the end of a session. Have one person play the part of the counselor, one person the part of the client, and one person the part of an observer/evaluator. After everyone has had a chance to play the counselor role, discuss the feelings you had related to resistance as a counselor and a client and what strategies you could use in overcoming resistance.3.

7. What are your thoughts and feelings about recycling? How might you refer a difficult client to another professional? What would you say to him or her?

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CHAPTER 6 - MULTIPLE CHOICE TEST QUESTIONS 1. According to the Johari Window model of growth, successful counseling will result in the expansion of quadrant number ________ and the shrinking of the other quadrants. a. 1 (area of free activity) b. 2 (avoided or hidden area) c. 3 (blind area) d. 4 (area of unknown activity) 2. Functional fixity is _________. a. seeing things from only one perspective b. operating in a stereotyped interpersonal style c. a habit d. a breakdown in overall functioning 3. _____________ reflects not only what the client says overtly but also what they imply or state incompletely? a. Primary empathy b. Maximum leads c. Advanced empathy d. Acceptance 4. Empathy involves which of the following? a. awareness b. assertiveness c. know-how d. all of the above 5. Through the process of ________ the counselor offers the client another way to look at a situation. a. leading b. reframing c. empathy d. functional fixity 6. Making oneself known to another person by revealing personal information is known as __________. a. ego disclosure b. self-disclosure c. reverse empathy d. countertransference 7. Immediacy in counseling is best used in each of the following situations EXCEPT _________. a. where there is a question of trust b. where there is tension 81 ..

c. where there is a relaxed relationship d. where there is counterdependency 8. Humor in the counseling process is ____________. a. only appropriate if client-initiated b. used to build bridges between counselors and clients c. often leads to an awareness of “ah-ha” and a clearer perception of the situation d. “b” and “c” but not “a” 9. Avoiding confrontation of clients’ behaviors is known as the ________________. a. countertransference effect b. MUM effect c. insecure attachment effect d. transference effect 10. Effective contracts in counseling include all EXCEPT the following ______________. a. client con words (“try” and “maybe”) b. a focus on change c. concreteness d. personal responsibility 11. Using homework with clients can do all of the following EXCEPT__________. a. help clients see clearly what progress they are making b. help make clients more responsible for control of themselves c. keep clients focused on relevant behavior between sessions d. change other peoples’ behaviors 12. A counselor’s __________ may contribute to a transference pull. a. personality b. posture c. gestures d. all of the above 13. A counselor being hostile, cold, or antagonistic toward a client is an example of __________. a. overidentification b. transference c. disidentification d. a blind spot 14. When a client says, “I think talk in counseling is a cheap and an ineffective way to bring about change,” the client is displaying ___________. a. frustration b. direct transference c. indirect transference d. transference pull

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15. What are the twin components of a real relationship, according to Gelso? a. genuineness and realism b. unconditional positive regard and nonjudgment c. autonomy and confidence d. transference and countertransference 16. Which one of the following terms describes positive life changes that result from struggles and or challenges that come from human-created or natural traumatic events? a. Posttraumatic growth b. Ah-ha moment c. Reframe d. Motivator 17. A counselor intentionally begins to increase the time between counseling sessions for a particular client and also makes a concerted effort to reduce the amount of reinforcement she provides to the client for certain behaviors in which the client is engaging. What is the counselor’s actions an example of? a. Resistance b. Indirect transference c. Affective empathy d. Fading 18. According to the text, closure is often a taboo subject because it is associated with _____________. a. loss b. death c. microskills d. ambiguity 19. Closure serves which of the following positive functions? a. it is a reminder that the client has matured through the counseling process b. it may act as a motivator c. it serves as a way for the client to practice independence d. all of the above 20. If a client brings up new material at the end of a session, a counselor should __________. a. always deal with the material on an emergency basis b. work to make the new material the anticipated focus of the next session c. subtly ignore the new material d. call the client’s attention to the inappropriate timing 21. A good way to end an individual counseling session is to _________. a. spend the last half of the session focusing on the session closure b. make a brief statement about the time left in the session c. use only nonverbal clues d. let the end come naturally in the session 83 ..

22. A poor reason for a counselor to initiate termination of a counseling relationship is ___________. a. anxiety or anger b. illness c. countertransference d. relocation 23. Given the mobile society we live in, _________________ is a situation that counselors need to know how to handle given it is more painful for clients and more challenging for counselors than the natural end of the counseling process. a. temporary counselor initiated termination b. premature termination c. permanent counselor initiated termination d. permanent referral 24. Reexamining all phases of the therapeutic process to determine if there may be improperly defined goals or an inappropriate strategy in place is known as ________. a. restating b. recycling c. referring d. regrouping ESSAY TEST QUESTIONS

1. Discuss the use of self-disclosure and why it is deemed important in certain counseling situations. While illustrating the ways to use it effectively, also discuss some of its advantages and disadvantages.

2. Describe ways in which counselors can effectively close counseling relationships with clients on a good note.

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ADDITIONAL RESOURCES American Counseling Association. (1996). The wounded healer [Film]. (Available from American Counseling Association, 5999 Stevenson Avenue, Alexandria, VA 22304) In this video, Rollo May discusses the links between pain and creativity. He highlights some well-known professionals and their journeys to becoming healers.1-800-422-2648 Association for Humanistic Education and Development. (1992). Uses of metaphors and poetry in counseling [Film]. (Available from American Counseling Association, 5999 Stevenson Avenue, Alexandria, VA 22304) Sam Gladding presents ways in which metaphors and poetry can be used in counseling to help facilitate the therapeutic process. This 51-minute video shows the viewer role-plays and steps for using these techniques.1-800-422-2648 Insight Media. (1991). Basic interviewing skills [Film]. (Available from Insight Media, Broadway, New York, NY 10024-0621)

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This video breaks down basic skills for interviewing into five areas: listening, reflecting, questioning, expressing, and interpreting. Techniques for using these skills are shown separately and then a final vignette is shown incorporating all five skills. (51 minutes) 1800-233-9910 Insight Media. (1991). Communication skills for effective helping [Film]. (Available from Insight Media, 2162 Broadway, New York, NY 10024-0621) This video illustrates how to use communication skills when working with clients who are experiencing issues related to grief and loss. Dr. Dale Larson explains both non-verbal and verbal communication skills in this 30-minute video. 1-800-233-9910 Insight Media. (1992). Basic attending skills [Film]. (Available from Insight Media, 2162 Broadway, New York, NY 10024-0621) Focusing on Allen Ivey’s basic counseling skills, this video is ideal for helping counselorsin-training learn how to use reflecting, paraphrasing, summarizing, and open and closed questioning. (150m minutes) 1-800-233-9910 Insight Media. (1992). Microcounseling skills [Film]. (Available from Insight Media, 2162 Broadway, New York, NY 10024-0621) This two-volume, 227-minute video series illustrates through mock-cases how to use the basic counseling skills in actual counseling sessions. Some of the areas covered are using empathy, confronting, observing, and questioning. Effective and ineffective methods for handling certain situations are presented and contrasted. 1-800-233-9910

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Insight Media. (1993). Three approaches to counseling [Film]. (Available from Insight 2162 Broadway, New York, NY 10024-0621)

Media,

This 80-minute video features Allen Ivey working with one client, using three different approaches: psychodynamic dream analysis, humanistic positive reframing, and behavioral assertiveness training. Ivey illustrates how these models can be integrated into a counseling approach. 1-800-233-9910 Insight Media. (1996). Basic influencing skills [Film]. (Available from Insight Media, 2162 Broadway, New York, NY 10024-0621) This 120-minute video examines how to use basic counseling skills to help clients open up and tell about their situation. Allen Ivey, Mary Bradford Ivey, and Norma Gluckstern integrate narrative theory and story telling techniques into their approach to counseling. 1800-233-9910 Rosenthal, H. (1993). Review questions: For NBCC and State Counselor Examination (2nd ed.). [Audio Tapes]. (Available from Taylor & Francis Group, 47 Runway Road, Levittown, PA, 19057) These 5 tapes help fight pre-exam anxiety with the 275 question review and information on the National Counselor Examination. Each set comes with a 16-page booklet. 1-800-8218312.

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CHAPTER 7 PSYCHOANALYTIC, ADLERIAN, AND HUMANISTIC THEORIES OF COUNSELING CHAPTER OVERVIEW This chapter begins with a discussion about the nature and importance of relatively early theories of counseling. It also provides information about the importance of theory in counseling. The three theoretical schools examined in detail in this chapter include Sigmund Freud’s theory of psychoanalysis, Alfred Adler’s theory of Individual Psychology and humanistic theories, including Person-Centered, Existential, and Gestalt. An exploration of the view of the theories in regard to human nature, the role of the counselor, goals, techniques, and strengths/contributions, and limitations are provided.

KEY TERMS, CONCEPTS, AND PEOPLE Acting “as if” Adler, Alfred Anal stage Birth order Catching oneself Conditional regard Confrontation Congruence Conscious mind Defense mechanisms Diagnostic instruments Dichotomies of life Dream analysis Eclectic Ego Empathy Empty chair technique Equalitarian atmosphere Exaggeration Existentialism Faulty style of life Fixated Frankl, Victor Free association Freud, Anna Freud, Sigmund Genital stage Gestalt Heuristic Humanistic Id Ideal self 87 ..

Individual psychology Inferiority complex Integrationism I take responsibility Latency Latent content Logotherapy Making the rounds Manifest content May, Rollo May I feed you a sentence?

Neurotic fiction Oral stage Perls, Fritz Perls, Laura Person-centered counseling Phallic stage Phenomenological perspective Positive regard Preconscious mind Psychoanalysis Psychoanalytic techniques Psychosexual developmental stages Push button Real self Rogers, Carl Self-actualization Sexuality Social interest Spitting in the client’s soup Striving for perfection Style-shift counseling Syncretism Superego Superiority complex Task setting Topdog/underdog Traditional eclecticism Transference Transtheoretical model Unconditional positive regard Unconscious mind Unfinished business

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CHAPTER 7 - PSYCHOANALYTIC, ADLERIAN, AND HUMANISTIC THEORIES OF COUNSELING Introduction • •

Counseling is a process that involves interpersonal relationships.

Four variables determine the amount of growth and change in any type of counseling o Counselor, o Client, o Setting, and o Theoretical orientation

Theory • • •

• •

•

A model that counselors use as a guide to hypothesize about the formation of possible solutions to a problem.

Effective counselor chose a theory or theories to use based on their educational background, philosophy, and the needs of clients Five requirements of a good theory: o Clear, easily understood, and communicable o Comprehensive o Explicit and heuristic o Specific in relating means to desired outcomes o Useful to its intended practitioners.

A good theory is also one that matches the personal philosophies of helping for counselors.

Counselors who wish to be versatile and effective should learn a wide variety of counseling theories and know how to apply each without violating its internal consistency.

Importance of Theory o The foundation of good counseling. o Without a theoretical background, counselors operate haphazardly in a trial-anderror manner and risk being both ineffective and harmful. o Helps explain what is happening in the counseling relationship and assists in predicting, evaluating, and improving results. o Provides a framework for making scientific observations. o The why behind the how of counselors’ roles. The framework within which to operate. o Six functions of a theory that helps counselors: ▪ Provides unity and relatedness within the diversity of existence.

▪ Compels examination of relationships.

▪ Operational guidelines to work by and help counselors to evaluate their professional development.

▪ Provides focus on relevant data and provides a guide to what to look for.

▪ Assist in modification of behavior.

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▪ •

Provides evaluation of new and old approaches.

Theory into Practice o Effective counselors scrutinize theories for proven effectiveness and match them to personal beliefs and realities about the nature of people and change. There are more than 1,000 theories of psychotherapy and counseling. o One theory cannot provide all the answers for clients. o Eclectic counselors – use various theories and techniques to match clients’ needs. o Style-shift counseling – changing from one theory to another as the needs of counseling change. o Disadvantages of eclecticism: A counselor may not be familiar with all aspects of a different theory chosen. o Hierarchy of eclectic practices ▪ Syncretism (lowest level) – a sloppy, unsystematic process of putting unrelated clinical concepts together.

▪ Traditional (second level) – a combination of compatible features from diverse sources into a whole.

▪ Theoretical integrationism (third level) – the counselor masters at least two theories before trying to make any combinations. Assumes the theories are equal.

▪ Technical eclecticism (fourth level) – using different techniques from different theories but not subscribing to the theories that the techniques were chosen from.

▪ Transtheoretical model (TTM) – direction focused and proposes five stages of change from precontemplation to maintenance. Includes five levels of change • Symptom/situation problems • Maladaptive cognitions • Current interpersonal conflicts • Family system conflicts • Intrapersonal conflicts ▪ TTM allows for: • Macroscopic approach – broad and comprehensive theoretical framework • Personal adaptation – increase in critical, logical, accurate thinking…rather than personal adjustment • Drawbacks: depth and difficulty and newness o Cavanagh proposes a healthy eclectic approach requiring counselors to have: ▪ A sound knowledge and understanding of the counseling theories used ▪ A basic integrative philosophy of human behavior that brings unequal parts of conflicting theories into a meaningful collage ▪ A flexible means of fitting the approach to the client

Psychoanalytic Theories – Psychoanalysis •

Founder(s)/Developers 90 ..

Sigmund Freud (1856-1939) – founder of Psychoanalysis Theory Anna Freud, daughter of S. Freud, elaborated on his ideas as they related to children and development of defense mechanism. o Heinz Kohut has further elaborated on Freud’s theory to developmental issues in Object Relations Theory, focusing on attachment.

View of Human Nature o Freud believed that humans are motivated by the unconscious, where the Id is found along with the aggression and sex instincts. o Believed that the nature of man was basically evil. o He viewed the development of personality as made of three parts (Id, Ego, Superego) in an “iceberg.”

▪ Conscious mind – awareness of the outside world (is like the tip of the iceberg that is seen).

▪ Preconscious mind – contains hidden memories or forgotten experiences (is like the iceberg right under the water). This information can be remembered if so desired.

▪ Unconscious mind – contains the instinctual forces. o Three parts of the personality: ▪ Id – basic instincts operating on the Pleasure Principle. (If it feels good, do it.).

▪ Ego – conscious, decision-making “executive of the mind”. Operates on the Reality Principle. The balance between the id and superego.

▪ Superego – the conscience of the mind that contains the inner parent.

Operates on the Moral Principle. o Fixation in Psychosexual Stage – When a basic need is not met, a child becomes “stuck” at that stage. o Freud’s Psychosexual Stages of Development: [Foundation for other development theories.]

▪ Oral – birth to 1 year; mouth is the chief pleasure zone. Basic gratification is from sucking and biting. Fixations as an adult – biting nails, overeating, sucking thumb, chewing mouth, smoking, etc.

▪ Anal – 1 to 3 years; delight is in either withholding or eliminating feces.

Fixations are either anal retentive personality (uptight) because parents were over-emphasizing potty training: Or, anal expulsive (messy) because parents were negligent about potty training.

▪ Phallic – 3 to 6 years; zone of pleasure is the sex organs (masturbation).

Fixations are either Oedipus complex (males) or Electra complex (females; penis envy). Both are in love with opposite sex parent but are intimidated by sexual organs of same sex parent. Fear that they cannot compete will identify and form friendship with same-sex parent.

▪ Latency – 6 years to puberty; No fixations. Energy is focused on peer activities and personal mastery of cognitive learning and physical skills.

▪ Genital – 12 years and up; focus is on relationship with opposite sex. o Ego defense mechanisms – help the ego find balance between the id and superego and to cope with reality: o o

•

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Repression – pushing things out of the conscious (awareness) into preconscious; ex., not thinking about having an exam next week.

▪ Denial – refusing to see or accept a problem or conflict. Example, not looking or looking away when an animal is about to be hit by a car.

▪ Regression – someone behaving less mature than his/her age. Example, a colleague stomping her foot while crossing her arms, or walking away when frustrated.

▪ Projection – projects own feelings onto someone else. Example, “I know that ‘Jackie’ feels the same way about ‘Roberta’ because ‘Jackie’ is in the same class with me.”

▪ Rationalization – reasoning through a certain action. Example, “Officer everyone else was speeding. Why did you stop me?”

▪ Reaction Formation – acting in the opposite way you feel. Example, “Honey, I love that color on you.” [To another friend] “That colors look terrible on her.”

▪ Displacement – redirecting your emotions onto a “safer” object. Example, college student fusses at her mom over the phone because she’s frustrated with a roommate.

Role of the Counselor o Freud used case studies (detailed note-taking) with his clients. He used a direct approach believing that the therapist was in control of the therapy. Wrote Interpretation of Dreams. o Free Association: Client was encouraged to speak about whatever came to mind. o Used the fainting couch to help the client to free associate. o The therapist’s role is to analyze the information given by the client from free association, dreams (therapist interprets the dreams), transference, and Freudian Slips.

Goals o Personal adjustment. o Help client become more aware of the unconscious. o Work through an unresolved developmental stage. o Cope with the demands of the society. Stresses environmental adjustment. o Strengthening of the ego.

Techniques o Free Association – client says whatever comes to mind. Unconscious material enters the conscious, and the counselor interprets it. o Dream Analysis – avenue to study the unconscious. Dreams were thought to be childhood wishes and unacknowledged sexual desires. Manifest content (obvious meaning) and the latent content (hidden but true meaning). o Analysis Transference – the client’s responds to a counselor as if the counselor were some significant figure in the client’s past. Counselor interprets the positive or negative feelings of the client. Release of feeling is an emotional catharsis.

Client becomes aware of the emotions and is free to move onto another developmental stage. o Analysis of Resistance – progress slows; missing appointments, being late for appointments, not paying fees, persisting in transference, blocking thoughts ▪

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during free association, or refusing to recall dreams or early memories. Therapist must help interpret resistance to client to help him/her move on. o Interpretation – counselor helps the client understand the meaning of past and present personal events: explanations and analysis of a client’s thoughts, feelings, and actions Strengths and Contributions o Emphasis of sexuality and the unconscious. o Produced a lot of research. o Provides a theoretical base of support for many diagnostic instruments. o Continues to evolve. o Can be used for a variety of disorders – hysteria, narcissism, obsessivecompulsive disorders, personality disorders, anxiety, phobias, and sexual difficulties. o Stresses developmental growth stages.

Limitations o Time-consuming and expensive o Not as useful for older clients o Used mostly in psychiatry o Terminology is overly complicated o Deterministic o Associated with people who have major adjustment difficulties

Adlerian Theory •

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Founder o Alfred Adler (1870-1937) – founder o Individual Psychology – emphasized the holistic and indivisible nature of people ▪ Adler had a difficult childhood plagued with illness.

▪ He believed people moved from a sense of inferiority to superiority in order to overcome their short-comings. o Stressed the importance of subjective feelings and social interests. o Followers: Driekurs, Sonstegrard, Christensen, Corsini, Dinkmeyer, Sweeney, et al.

View of Human Nature o People are primarily motivated by social interests – feelings of being connected to society as a part of the social whole, an active interest in and empathy with others, as well as a need and willingness to contribute to the social good. o Conscious aspects of behavior, rather than unconscious as with Freud, are central to the development of personality. o People strive to become successful (striving for perfection) – inferiority to superiority; thus, the inferiority or superiority complexes. o The future influences behavior as much as the past. Freud believed the past influenced behavior. o Emphasized birth order: five ordinal positions – firstborns, secondborns, middle children, youngest children, and the only child.

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Family environment is important to a person’s development – the first 5 years. A style of life is created by age 5.

▪ Negative family atmosphere: authoritarian, rejecting, suppressive, materialistic, overprotective, or pitying.

▪ Positive family atmosphere: democratic, accepting, open, and social.

▪ Perception of the family atmosphere rather than actual events is crucial to the development of a style of life. o Three main life tasks: society, work, and sexuality o Two other challenges of life: spirituality and coping with self. o Courage is crucial when facing any life task.

Role of the Counselor o Diagnosticians, teachers, and models in an equal relationship with the client. o Gathers information on the family constellation and client’s earliest memories. o Client is encouraged to examine and change a faulty lifestyle by developing social interests. o Share hunches or guesses with clients. o Directive when assigning homework, such as act “as if” the client were the person s/he wants to be.

Goals o Helping people develop healthy holistic lifestyles. o Educating or reeducating clients about what healthy lifestyles are and helping them overcome feelings of inferiority. o Help clients overcome a faulty style of life – a life that is self-centered and based on mistaken goals and incorrect assumptions associated with feelings of inferiority o Client is ultimately in charge of deciding whether to pursue social or selfinterests.

Techniques o Counseling relationship must be established by developing a warm, supportive, empathic, friendly, and equalitarian relationship with clients.

▪ Active listening and responding (much like person-centered therapy).

Example, client says, “I hate mean people.” Counselor says, “You hate mean people.” o Analysis of the client’s lifestyle: family constellation, early memories, dreams (like Freud), and priorities.

▪ Childhood events remembered are consistent with client’s present view of self, others, and the world. Counselors look for themes and details within these memories.

▪ Dreams are a possible rehearsal for future courses of action. o Development of client insight by asking open-ended questions and making interpretations.

▪ Open-ended questions – allows clients to explore patterns in their lives that have gone unnoticed.

▪ Interpretation – intuitive guesses using empathy. May also be based on counselor’s knowledge of ordinal position in family and family constellation. o

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Behavioral change – counselor uses the following techniques: • Confrontation • Asking “the question” – “What would be different if you were well?”

• Encouragement • Acting “as if” – as if they were the person they wanted to be • Spitting in the client’s soup – ruining the payoff for the client’s behavior • Catching oneself - catching self-destructive behaviors • Task setting – short or long-term goals • Push button – making a choice to remember negative or positive experiences Strengths and Contributions o Equalitarian atmosphere: rapport and commitment, encouragement and support, educational orientation and optimistic outlook on life. o Versatile over the life span. o Useful with a variety of disorders o Contributed to other helping theories and public awareness and understanding of human interactions. o Useful with different cultures.

Limitations o Lacks research. o Some terms and concepts are vague. o Maybe too optimistic about human nature. o Family constellation may not work with other cultures. o May not be applicable to clients who are not intellectually bright ▪

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Humanistic Theories 1. Person-Centered Counseling •

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Founder o Carl Rogers (1902-1987) ▪ First formulated nondirective (therapist not in control as with Freud) in 1942 in his book Counseling and Psychotherapy.

View of Human Nature o People are essentially good; in opposition to Freud’s view of man being evil. o Self-actualization – a striving to actualize, maintain, and enhance existence.

▪ People are capable of finding personal meaning and purpose in life. o Phenomenological perspective – client’s perception of reality is more important than the actual event. Similar to Adler’s theory.

▪ Referred to as self theory. The self is the results of experiences. o Right conditions are necessary for a person to become him/herself.

▪ Positive regard – love, warmth, care, respect, and acceptance.

▪ Conditional regard – based on love given on condition, not freely given from parents and others in childhood and later. Conforming to conditions 95 ..

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develops feelings of worth, building incongruities between self-perception and experience.

• Ideal self – what the person is striving to become • Real self- what the person is Role of the Counselor o Counselor provides the right atmosphere focusing on the counselor-client relationship, “I-Thou” relationship. o Counselor is aware of the client’s verbal and nonverbal language. o Counselor reflects back what s/he (counselor) is hearing or observing. o Counselor trusts client to develop an agenda to work on. o Counselor works as a facilitator.

Goals o To develop a counselor-client relationship where the client feels in control. o Assists client in learning how to cope with situations. o Helps client become a fully functioning person who has no need to apply defense mechanisms to everyday experiences.

▪ Client becomes more and more willing to change and grow.

▪ Becomes more open to experience, more trusting of self-perception, and engaged in self-exploration and evaluations ▪ Greater acceptance of self and others.

▪ Better decision maker in here and now.

Techniques o Three conditions necessary for counseling: ▪ Empathy – counselor’s ability to feel with client and convey understanding. Think with the client.

▪ Positive regard (acceptance) – a deep and genuine caring for the client as a person.

▪ Congruence (genuineness) – being transparent in the therapeutic relationship by giving up roles and facades. o Active and passive listening o Accurate reflection of thoughts and feelings o Clarification o Summarization o Confrontation o Open-ended leads Strengths and Contributions o Links counseling with psychotherapy, provides transcript of counseling session. o Applicable to a wide range of human problems. o Generated a lot of research. o Effective approach. Improves psychological adjustment, learning, frustration tolerance and decreases defensiveness. o Helpful with mild to moderate anxiety, adjustment disorders, uncomplicated bereavement or interpersonal relations. o Focuses on an open and accepting relationship and is short-term. o Approach is easy to learn. Foundation for training paraprofessional helpers. o Positive view of human nature.

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Limitations o Initially provided few instructions for counselors on how to establish relationships with clients and bring about change. o Depends on bright, insightful, hard-working clients. Not applicable with severely disabled or young children. o Ignores diagnosis and the unconscious and sexual aggressive drives. Overly optimistic. o Deals only with surface issues.

2. Existential Counseling •

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Founders o Rollo May (1909 – 1994) – dealt extensively with anxiety o Viktor Frankl (1905 – 1997) – focused on the meaning of life View of Human Nature o People form their lives by the choices they make and the action that goes with choices. o People are the authors of their lives. o People are responsible for any choice they make. Some choices are healthier and more meaningful than others. o Frankl – the “meaning of life always changes but it never ceases to be” ▪ Meaning goes beyond self-actualization and exists at three levels: • Ultimate meaning (e.g., order to the universe) • Meaning of the moment • Common, day-day meaning ▪ Three ways to discover life’s meaning: • Doing a deed • By experiencing a value • By suffering o Psychopathology is a failure to make meaningful choices and maximize potential.

Choices are avoided and potentials are not realized.

▪ Anxiety is associated paralysis.

▪ May – normal anxiety may be healthy and motivating.

Role of the Counselor o No uniform counselor roles. Every client is unique. o Counselor is aware of verbal and nonverbal behavior of client. o Counselor concentrates on being authentic and entering into deep and personal relationships with them. o Counselor may share personal experiences with the client to deepen the relationship. o Frankl – focused on engaging clients in dialogue in search of truth. o Help clients focus on feeling, self-understand, and movement toward a new way of being in the world. o Focus on the present, not the past. o Focus on human concerns – death, freedom, isolation, and meaninglessness.

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Helping clients realize the importance of meaning, responsibility, awareness, freedom, and potential. o Encourage responsibility. o Free client from being an observer of events to become author of meaningful life.

Techniques o Borrow from other theories of counseling. o Developing a meaningful relationship with the client is seen as their strongest technique. o Relationship emphasizes: authenticity, honesty, and spontaneity. o Confrontation – about responsibility. o Borrow techniques: imagery exercises, awareness exercises, and goal-setting activities.

Strengths and Contributions o Emphasis is on uniqueness of individuals. o Anxiety can be positive. o Philosophy and literature about human nature. o Stresses human growth and development. Utilizes directed reading and therapeutic encounters with the counselor. o Effective in multicultural counseling. o Connects individuals to universal problems. o Can be combined with other methods, such as behavioral, to deal with difficult problems like alcoholism.

Limitations o Not a fully developed model of counseling. o Lacks educational and training programs. o Difficult to implement beyond an individual level. o Closer to philosophy than a theory of counseling.

3. Gestalt Therapy (“the whole”) •

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Founders/Developers o Fritz Perls (1893-1970) - founder o Laura Perls (Fritz’s wife) and Paul Goodman – developed and refined ideas. o Joen Fagan and Irma Lee Shepherd– developed theory further combined it with Gestalt theory View of Human Nature o Human beings work for wholeness and completeness in life. o Individuals have a self-actualizing tendency centered in the present. o Trusts the inner wisdom of people (like person-centered). o People seek to live integrative and productive lives, striving to coordinate their parts into a healthy, unified whole. o Antideterministic – people are able to change and become responsible (unlike Freud’s view). o People are actors in the events around them. o Now is what really matters (existential, experiential, and phenomenological).

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Common problems of individuals: 1. Overdependency on intellectual experience.

2. Inability to identify and resolve unfinished business – earlier thoughts, feelings, and reactions that still affect personal functioning and interfere with living life in the present. Most significant unfinished business – not forgiving one’s parents for their mistakes.

3. Being unaware of experiencing the now. Healthy individuals are most aware of experiences.

4. Individuals experience difficulty in several ways: 1. Lose contact with the environment and resources in it.

2. Person becomes over-involved with the environment and out of touch with the self.

3. Fails to put aside unfinished business.

4. Become fragmented or scattered in many directions.

5. Experiences conflict between the top dog (what should do) and the underdog (what wants to do).

6. Difficulty handling dichotomies of life (love/hate, masculinity/femininity, pleasure/pain).

Role of the Counselor o To create an atmosphere that promotes a client’s exploration of what is needed to grow. o Being intensely and personally involved with clients and being honest. o Being exciting, energetic, and fully human. o Stays in the now by blocking energy in positive and adaptive ways and helping the client recognize patterns.

Goals o Emphasis on the here and now. o Focus on nonverbal and verbal expressions. o Choices o Resolving the past to become integrated by “growing up.” o Acceptance of polarities within the person. o Emphasize action, pushing clients to experience feelings and behaviors. o “Now = experience = awareness = reality” Techniques o Experiments – activities that grow out of the interaction between counselor and client. o Exercises – ready-made techniques, such as enactment of fantasies, role-playing, and psychodrama. Evoke certain responses, such as anger or exploration. (4-7 used in groups) 1. Dream work – experience dreams as messages of a place at a certain time.

2. Empty chair – client talks to parts of their personality. Very useful in talking with someone from client’s past.

3. Confrontation – counselor points out incongruent behaviors and feelings, such as smiling when you say you are angry. What and how questions.

Why is avoided.

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4. Making the rounds – Theme or feeling is faced by group members. This technique can be very hurtful if not used appropriately.

5. I take responsibility – creates ownership of behaviors and feelings.

6. Exaggeration – overplaying gestures and discovering their meanings.

7. May I feed you a sentence? – Counselor makes a guess about what the client will say next.

Strengths and Contributions o Incorporates and accepts all aspects of life. o Resolving unfinished business. o Emphasis on doing rather than talking. o Flexible in techniques. o Versatile Limitations o Lacks strong theoretical bases. o Deals only with now and how. Does not allow for insight and change. o Avoids diagnosis and testing. o Focuses only on the client’s self-issues.

CLASSROOM ACTIVITIES 1. Talk with another classmate about what counseling would be like without theories.

Then talk with your class as a whole about counseling as an atheoretical profession and the advantages and disadvantages of such an approach.

2. Compare and contrast the strengths and limitations of psychoanalysis. How would you explain its benefits and drawbacks to a person unfamiliar with it?

3. Adler emphasized courage (a willingness to take risks without knowing what the consequences may be) as one part of his theory. Talk to another classmate about when you have had courage and what a difference it has made in your life.

4. Which of the humanistic theories described in this chapter appeals to you the most?

Divide into subgroups within your class with individuals who also find that theory appealing and talk about the way it resonates in your mind as well as its strengths and weaknesses.

5. Which of the theories covered in this chapter appeals most to you? Try to understand why that is so, in other words, is the appeal more emotional, cognitive, pragmatic, etc.

Talk with your classmates about the theory you favor most and the reasons for it.

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CHAPTER 7 - MULTIPLE CHOICE TEST QUESTIONS 1. According to Boy and Pine, theory is the ________ behind the _______ of counselors’ roles. a. how; why b. what; why c. why; how d. what; how 2. Marcia has mastered cognitive and person-centered therapy and often uses them harmoniously in combination. Which of the following accurately describes Marcia’s level of eclecticism? a. syncretism b. traditional c. unsystematic d. theoretical integrationism 3. Basing their work in theory helps counselors to ______________. a. find unity and relatedness within the diversity of experience b. focus on relevant data and helps them know what to look for c. make effective modifications of their behavior d. all of the above 4. Which of the following techniques originated with the work of Sigmund Freud? a. free association b. catharsis c. hypnosis d. insight 5. The most powerful and dominant influencer of human behavior according to psychoanalytic theory is the _________; according to Adlerian thought, this influencer is the __________. a. conscious mind; unconscious mind b. unconscious mind; conscious mind c. preconscious mind; conscious mind d. conscience; societal pressure 6. The most basic of the defense mechanisms is ___________. a. repression b. displacement c. rationalization d. reaction formation 7. In this technique, a counselor abandons the normal way of censuring thoughts by consciously repressing them and instead says whatever comes to mind, even if the thoughts seem silly, irrational, suggestive, or painful. a. Determinism b. Free association 101 ..

c. Analysis of resistance d. Interpretation 8. According to Adler, the three main life tasks are ________. a. social order, work, and sexuality b. society, work and sexuality c. contributing to society, family interconnectedness, and spirituality d. coping with life, courage, working in society 9. Which of the following describes a life that is self-centered and based on mistaken goals and incorrect assumptions associated with feelings of inferiority? a. family contra-constellation b. superiority complex c. faulty style of life d. inferiority complex 10. Jackson, a college counselor, aims to focus his attention on the client as a person rather than the client’s problems. Jackson attempts to accomplish this goal by helping clients learn how to cope with situations and develop a greater acceptance of self and others. Which one of the following theories would reflects Jackson’s goals? a. Psychoanalysis b. Individual Psychology c. Person-Centered Counseling d. Cognitive Therapy 11. Which one of the following is one of Rogers’ “necessary and sufficient conditions” for bringing about change in counseling? a. empathy b. congruent client and incongruent counselor c. conditional regard d. self-disclosure 12. According to Viktor Frankl, clients discover life’s meaning by ___________. a. doing a deed b. suffering c. experiencing a value d. all of the above 13. A major goal of existential counseling is to _________________. a. help the client as a person to become a fully functioning person who has no need to apply defense mechanisms to everyday experiences. b. help clients realize the importance of meaning, responsibility, awareness, freedom, and potential. c. help clients realize that life includes making choices, including the importance of mentally growing up. d. help clients develop healthy and holistic lifestyles.

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14. Nathan, a school counselor, often asks his students to talk to the various parts of their personality, such as the part that is dominant and the part that is passive. In doing so, an empty chair is used to vicariously represent one part of the self. Which theoretical orientation would you say Nathan espouses based on this technique? a. Existential b. Adlerian c. Gestalt d. Psychodynamic 15. In Gestalt Therapy, top dog is to ____________ as underdog is to _______________. a. what one thinks one should do; what one wants to do b. what one wants to do; what one thinks one should do c. reality; awareness d. awareness; reality ESSAY TEST QUESTIONS 1. Compare and contrast Adlerian and Psychoanalytic theory. How do these theories resemble and differ from each other in respect to viewing human nature, the role of the counselor, and goals?

2. Discuss the main premises and goals of person-centered and existential counseling. How are these theories similar to and different from Gestalt therapy?

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ADDITIONAL RESOURCES American Counseling Association. (1996). Rudolph Dreikurs: Demonstration with a parent, a teacher and a child, Parts I and II [Film]. (Available from American Counseling Association, 5999 Stevenson Avenue, Alexandria, VA 22304) Dr. Dreikurs shares his Adlerian perspective on a counseling session with a boy in this 70minute video. After conducting a session with this child, Dreikurs shares his thoughts with the boy’s parent and teacher. 1-800-422-2648 American Counseling Association. (1996). Rudolph Dreikurs: Individual Psychology in education, Parts I and II [Film]. (Available from American Counseling Association, 5999 Stevenson Avenue, Alexandria, VA 22304) In this 70-minute video, the concept of the “individual” is fully examined. Dr. Dreikurs explores the history of Adlerian Individual Psychology and its basic tenets. 1-800-422-2648 Insight Media. (1970). Freud: The hidden nature of man [Film]. (Available from Insight Media, 2162 Broadway, New York, NY 10024-0621) Using dream analysis, this video features dramatized interviews with Freud that focus on the development of his main tenets of psychoanalysis. (29 minutes in length) 1-800-233-9910 Insight Media. (1976). Everybody rides the carousel [Film]. (Available from Insight 2162 Broadway, New York, NY 10024-0621)

Media,

This recommended animated 72-minute video explains the different stages of personality development according to Erik Erikson. Creativity abounds in the depiction of the positives and negatives of moving through these eight life stages. 1-800-233-9910 Insight Media. (1980). Psychological defenses [Film]. (Available from Insight Media, 2162 Broadway, New York, NY 10024-0621) There are two parts to this video which uses still images to illustrate different points about psychological defenses. Each video is 45 minutes and length. The first part focuses on three defenses in respect to levels of consciousness: repression, avoidance and denial, and regression. The second video deals with projection, identification, reaction formation, sublimation, and displacement. 1-800-233-9910 Insight Media. (1993). What the therapist does: Distinguished lectures in Adlerian Psychology [Film]. (Available from Insight Media, 2162 Broadway, New York, NY 10024-0621) Dr. Bernard Shulman discusses Adlerian therapy in this 45-minute video. Confrontation and maladaptive schemata correction are highlighted along with the concept of taking an active stance in therapy. 1-800-233-9910

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Insight Media. (1995). Sigmund Freud [Film]. (Available from Insight Media, 2162 Broadway, New York, NY 10024-0621) This 50-minute video follows Freud’s personal and professional history with a look at his theories and how he developed some of his key concepts (transference, free association, etc.). 1-800-233-9910 Insight Media. (1998). Adlerian Therapy [Film]. (Available from Insight Media, 2162 Broadway, New York, NY 10024-0621) Dr. Jon Carlson explores Adlerian therapy and the how to use the approach to help clients uncover patterns in their lives so that better decision can be made for the future. (100minutes in length) 1-800-233-9910 American Counseling Association. (1996). Carl Rogers on group [Film]. (Available from American Counseling Association, 5999 Stevenson Avenue, Alexandria, VA 22304) Carl Rogers presents his insights into group work in this two-part video set. The first part, Carl Rogers Conducts an Encounter Group, illustrates the different stages of group process with Rogers providing his views on how the stages develop. The second part, Carl Rogers on Facilitating a Group, features Rogers highlighting the important criteria for success group facilitation. Areas of discussion include the group leader’s role, honest expression by both the members and the facilitators, and how physical contact is used in a group. (100 minutes in length) 1-800-422-2648 American Counseling Association. (1996). Rollo May on Existential/Humanistic Counseling Film]. (Available from American Counseling Association, 5999 Stevenson Avenue, Alexandria, VA 22304) Throughout this 100-minute video, Rollo May discusses his viewpoint on different aspects of counseling. There are four-parts to the video: 1) Rollo May on Counseling, 2) On Existential Psychology, 3) On Humanistic Psychology, and 4) On Creativity and the Tragic.

May shares his ideas about the development of existential and humanistic psychology, as well as some of his personal struggles that have influenced his beliefs. 1-800-422-2648 Insight Media. (1978). Anxiety, love, will, and dying [Film]. (Available from Insight 2162 Broadway, New York, NY 10024-0621)

Media,

This 28-minute video focuses on existential anxiety. Rollo May discusses this concept and illustrates the relationship between anxiety and depression. 1-800-233-9910 Insight Media. (1978). Reactions to psychoanalytic concepts [Film]. (Available from Media, 2162 Broadway, New York, NY 10024-0621)

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Insight

Rollo May discusses his perspective on psychoanalytic theory and comments on the ideas presented by Freud and other psychoanalytically oriented theorists. (29 minutes in length).

1-800-233-9910 Insight Media. (1980). Maturity and creativity [Film]. (Available from Insight Media, 2162 Broadway, New York, NY 10024-0621) Rollo May discusses his major contributions to the field of psychology and provides reaction to some of his critics. May also examines the components of mental health and how maturity and creativity fit into the human experience. (29 minutes in length) 1-800-233-9910 Insight Media. (1986). Conversations with Viktor Frankl [Film]. (Available from Insight Media, 2162 Broadway, New York, NY 10024-0621) Viktor Frankl discusses his theories in comparison to the theories of other psychology greats: Skinner, Adler, Jung, Freud, and Lorenz. Logotherapy is discussed as well as Frankl’s advice for new counselors and therapists. (43 minutes in length) 1-800-233-9910 Insight Media. (1987). Viktor Frankl: The search for meaning in life today [Film]. (Available from Insight Media, 2162 Broadway, New York, NY 10024-0621) This 90-minute video features Viktor Frankl discussing Logotherapy and the difficulties that face people in today’s narcissistic society. 1-800-233-9910 Insight Media. (1988). The human dilemma: Rollo May [Film]. (Available from Insight 2162 Broadway, New York, NY 10024-0621)

Media,

Rollo May examines existential psychology and the need for people to appreciate their difficulties instead of remaining positive at a surface level of existence. 1-800-233-9910 Insight Media. (1994). Peeling the onion: Gestalt Therapy [Film]. (Available from Insight Media, 2162 Broadway, New York, NY 10024-0621) Using both individual and group demonstrations, this video examines the basic theory and techniques of Gestalt therapy. The benefits of the theoretical approach are also discussed.

(119 minutes in length) 1-800-233-9910 Insight Media. (1998). Carl Rogers: The essence of Client-Centered Therapy [Film].

(Available from Insight Media, 2162 Broadway, New York, NY 10024-0621) Dr. Roman Corrales explains Rogers’ approach to therapy and the major tenets and techniques involved in client-centered therapy. This 45-minute video takes a modern look at Rogers and how his theory can be linked to family systems theory.

1-800-233-9910 106 ..

Insight Media. (1998). Existential-Humanistic Therapy [Film]. (Available from Insight 2162 Broadway, New York, NY 10024-0621)

Media,

Dr. James Bugental leads this discussion of the existential/humanistic approach to therapy.

Through the use of a counseling session and a question answering period, this 100-minute video explains the approach and the importance of allowing clients to form their own values and identities. 1-800-233-9910

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CHAPTER 8 BEHAVIORAL, COGNITIVE, SYSTEMIC, BRIEF, AND CRISIS THEORIES OF COUNSELING CHAPTER OVERVIEW In this chapter covers a plethora of counseling theories that are currently in vogue: behavioral counseling, cognitive counseling, systemic counseling, brief counseling, and crisis counseling.

The backgrounds of founders of these approaches are highlighted, along with their views about human nature, the role of the counselor in the counseling process, goals of their approaches, and most often used techniques. An evaluation of strengths and limitations of these approaches is also made.

KEY TERMS, CONCEPTS, AND PEOPLE A-B-C-D-E Model of REBT Adding cognitive constructions Assertiveness training Behavior therapy Behavioral disputation Behavioral processes Behavioral rehearsal Behavioral theory Boundary making Bowen systems theory Caplan, Gerald Catastrophizing Celebrations Certificates Coalitions Cognitions Cognitive counseling Cognitive disputation Complainants Compliments Contingency contracts Covert sensitization Crisis (developmental, situational, existential, environmental) Crisis counseling Critical incident stress debriefing (CISD) Cross-generational alliances Customers Cutoff deShaser, Steve Defining the problem Defusing Detriangulation Differentiation 108 ..

Ellis, Albert Enactment Ensuring client safety Environmental planning Epston, Michael Erickson, Milton Examining alternatives Exceptions Externalization of the problem Extinction Family homeostasis Family interaction Family rules Flooding Fusion Genogram Glasser, William Grieving Homework Imaginal disputation Implosion Implosive therapy “ing” verbs In-crisis action Intensity Irrational beliefs (iBs) Irrational thinking Lindemann, Erich Making plans Minuchin, Salvador Miracle question Narrative reasoning Narrative therapy Obtaining commitment O’Hanlon, Bill One-to-one counseling Overcorrection Paradox Paradoxing Postcrisis recovery Postmodern Pragmatic fictions Precrisis preparation Prescribing the symptom Predicting setbacks Providing support 109 ..

Psychological first aid Punctuation Punishment Rational Emotive Behavior Therapy (REBT) Rational emotive education (REE) Rational emotive imagery (REI) Reality therapy Reauthoring Reframing Reinforcers Relabeling Restructuring Scaling Schedules of reinforcement (ratio/interval) Self-monitoring Self-observation Self-recording Self talk Shaping Skeleton keys Skinner, B. F. Social constructionist approach Socratic dialogue Solution-focused therapy Spillover effect Strategic (brief) counseling Structure Structural family counseling Systems theory Systematic desensitization Time-out Trauma Trauma counseling Triangulate Unbalancing Visitors WDEP system White, Michael Yes set

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CHAPTER 8 – BEHAVIORAL, COGNITIVE, SYSTEMIC, BRIEF, AND CRISIS THEORIES OF COUNSELING Behavioral Counseling • • • •

Focus is on broad range of behaviors.

Often there is a deficit or excess of behavior.

Focus is to learn new, appropriate ways of acting or modifying or eliminating excessive actions.

Popular in institutional settings and with specific problems.

Behavioral Therapy •

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Founders/Developers o B.F. Skinner (1904-1990) – ▪ known for operant conditioning – • use of reinforcers to increase behaviors • use of punishers to decrease behaviors ▪ reinforcers – rewards; i.e., giving a puppy a treat for sitting o Ivan Pavlov ▪ Known for classical conditioning.

▪ Was studying digestion by collecting saliva from dogs.

▪ Noticed an association between the presentation of food with the increase in saliva. o John B. Watson – Classical Conditioning o Mary Cover Jones o Albert Bandura – Social Learning Theory o John Krumboltz o Neil Jacobson View of Human Nature o Concentrates on behaviors, except for cognitive-behaviorists. o Here and now focus. o All behavior is learned. o Learning can be used to change behavior. o Well-defined therapy goals. o Reject idea that human personality is composed of traits.

Role of the Counselor o Active in counseling sessions. o Functions as a consultant, teacher, adviser, reinforcer, and facilitator. o May instruct or supervise people in client’s environment assisting in the change.

Goals o Counselor wants to help clients make good adjustments to life circumstances and achieve personal and professional objectives. o Focus is on modifying or eliminating behaviors. o Focus is on replacing unproductive behaviors with more constructive behaviors. o Counselors and clients must agree on goals.

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Techniques – general behavioral techniques o Reinforcers ▪ When applied after a behavior, they increase a behavior.

▪ Example, giving a child a sticker for staying in his seat. o Schedules of reinforcement ▪ Reinforcing (rewarding) a behavior after every time the behavior occurs (continuous reinforcement); gets the behavior to occur.

▪ Reinforcing (rewarding) a behavior after every other time it occurs maintains a behavior (intermittent schedules of reinforcement): • Fixed (a set number or time) • Variable (the number or time changes each time) • Ratio (number of responses) • Interval (duration of time) • Therefore, there are four possible intermittent schedules: fixed ratio, fixed interval, variable ratio, variable interval o Shaping ▪ Rewarding successive approximations to a goal. In other words, rewarding a small step toward a goal with the individual having to get closer to the goal each time to receive the reward. o Generalization ▪ Applying the learned behavior to another situation or setting outside of the counseling session. o Maintenance ▪ Client being able to perform the behavior without support from the counselor: self-control and self-management.

▪ Self-monitoring or keeping up with one’s own behavior and keeping record of the behavior: self-observation and self-recording o Extinction ▪ Withdrawing the reinforcement (reward) for a behavior will stop (eliminate) the behavior.

▪ Example, no one laughs when the client says a sarcastic response. o Punishment ▪ Either giving an unpleasant consequence for a behavior, or ▪ Taking away something pleasant that the person wants Techniques – specific behavioral techniques o Behavioral rehearsal ▪ Practicing a desired behavior. o Environmental planning ▪ Setting up part of the environment in order to encourage or discourage a behavior. o Systematic desensitization ▪ Used well with anxieties.

▪ Relaxation response – breathing deep and relaxing is used while the client is exposed to larger and larger amounts of the feared object or situation. o Assertiveness training

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The client is taught that everyone has the right of self-expression without anxiety.

▪ Counter-conditioning (pairing something pleasant with something unpleasant like eating ice cream while looking at a snake in a glass cage, the feared object) and reinforcement are used with assertiveness training. o Contingency contracts ▪ Contracts between the client and counselor that spell out what behavior is to change under what conditions and what are the consequences. o Implosion and flooding ▪ Implosion – imagining the anxiety-producing situation without relaxation.

▪ Flooding – putting the client in the middle of the situation. o Time-out ▪ Client is taken out of a situation that s/he would like to be in, short periods (5 min.) are best. This is a negative punishment – taking something desired away in order to decrease a behavior. o Overcorrection ▪ Client makes the situation better than normal or better than before. o Covert sensitization ▪ Associating an undesired behavior with something unpleasant.

Strengths and Contributions o Symptoms are dealt with immediately. o Here and now. Brief. Saves money. o A lot of techniques. o It’s a learning theory that has much research to back itself up. o Supported by the Association for the Advancement of Behavior Therapy (AABT) o Deals with defining and working on behaviors. Demystifies the counseling process.

Limitations o Only deals with the behavior, not the whole person. o Can be mechanical. o Difficult to replicate outside of the counseling situation. Needs a controlled situation. o Ignores past history and the unconscious. o Ignores developmental stages. o Leans toward the minimum performance of behavior and ignores self-fulfillment, self-actualization, and feelings of worth.

Cognitive and Cognitive-Behavioral Counseling • • •

Cognitions – thoughts, beliefs, and internal images.

The focus is on mental processes and their influences on behavior and mental health.

Most successful with the following client characteristics o Average to above-average intelligence o Moderate to high levels of functional distress o Able to identify thoughts and feelings o Are not psychotic or disabled by present problems 113 ..

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Willing to complete systematic homework assignments Have many behavioral skills and responses Are able to process information on a visual and auditory level.

Have inhibited mental functioning like depression

1. Rational Emotive Behavior Therapy (REBT) •

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Founders/Developers o Albert Ellis - founder o Maxie Maultsby (RBT) – more behavioral View of Human Nature o People have both self-interest and social interest o People are inherently rational and irrational, sensible and crazy. o Irrational thinking (irrational beliefs) include making up upsetting and disturbing thoughts. o Children are more vulnerable to outside influences and irrational thinking than adults. o Human beings are gullible, highly suggestible, are easily disturbed. o People have within them the means to control their thoughts, feelings, and actions, but they must first realize what they are telling themselves (self-talk) to gain control of their lives.

Role of the Counselor o Counselors are active and direct. o Instructors who teach and correct the client’s cognitions. o Listen carefully for illogical or faulty statements and then challenge beliefs. o Desirable characteristics for REBT counselors: bright, knowledgeable, empathetic, respectful, genuine, concrete, persistent, scientific, interested in helping others, and users of REBT. Goals o Help people realize that they can live more rational and productive lives. o Help clients stop making demands and “catastrophizing.” o Help clients avoid having more of an emotional response to an event than is necessary. o Help client change self-defeating habits of thought or behavior through the A-BC-D-E model of REBT ▪ A = Activating experience ▪ B = persons Beliefs about an experience ▪ C = emotional Consequence to the Beliefs ▪ D = Disputing irrational thoughts and replacing them with E ▪ E = Exceptional thinking of new philosophies of thought o Emotional anatomy – how feeling are attached to thoughts o Thoughts about experiences: positive, negative, neutral, or mixed o Teach clients to be more tolerant of selves and others and to achieve personal goals Techniques

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Teaching – clients learn the basic ideas of REBT and understand how thoughts are linked with emotions and behaviors – rational emotive education (REE) o Disputing thoughts and beliefs – has three forms ▪ Cognitive disputation – use of direct questions, logical reasoning, and persuasion ▪ Imaginal disputation – client imagines and employs a technique known as rational emotive imagery (REI).

▪ Behavioral disputation – behaving in a way that is opposite of one’s usual way, including role-playing and homework, doing the behavior in a different environment. Homework may also include bibliotherapy (reading self-help books). o Confrontation o Encouragement Strengths and Contributions o Clear, easily learned, and effective o Can be combined with other behavioral techniques o Short-term o Has generated a lot of literature and research o Continues to evolve as techniques are refined Limitations o Not useful with clients having mental problems or limitations o Difficult to separate from founder, Ellis o Direct and can be over-powering o Changing thinking may not be the simplest was to change emotions. o

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2. Reality Therapy •

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Founders/Developers o William Glasser (1925 – present) developed theory in mid 1960s. o Robert Wubbolding has advanced theory.

View of Human Nature o Human beings operate on a conscious level. They are not driven by unconscious forces or instincts. o Everyone has a health/growth force. Two levels: physical and psychological.

▪ Physical: the need for the basics – food, water and shelter. Need are automatically controlled by the body, such as breathing, are called oldbrain needs.

▪ Psychological needs (new brain needs): • Belonging • Power • Freedom • Fun • Identity o Human learning is a life-long process based on choice Role of the Counselor

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Teacher and model, accepting client in a warm, involved way and warm environment.

Develops trust through friendliness, firmness, and fairness.

Use “ing” verbs, such as angering, to describe client thoughts and actions.

Emphasis on client’s choice to do or feel.

Emphasizes positive, constructive actions.

Pay attention to client’s use of metaphors and themes.

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Help clients become psychologically strong and rational and help them realize they have choices in the ways they treat themselves and others. o Help clients clarify what they want in life (life goals) by examining personal assets and environmental supports and hindrances. o Help client come up with a realistic plan to achieve needs and wishes o Counselor becomes involved with the client in a meaningful relationship; based on understanding, acceptance, empathy, and expressing faith in client’s ability to change. o Focus on behavior and the present. o Eliminate punishment and excuses.

Techniques o Action-oriented techniques that help clients realize they have choices in how to respond to events and people. Others do not control them nor them others.

▪ Seven deadly habits: • Criticizing • Blaming • Complaining • Nagging • Threatening • Punishing • Bribing ▪ Effective and active techniques: teaching, employing humor, confronting, role-playing, offering feedback, formulating specific plans, and composing contracts o WDEP system ▪ W = wants ▪ D = directions of their lives ▪ E = evaluation; humor, role-playing, and feedback help at E ▪ P = plan; client makes a commitment to the plan Strengths and Contributions o Versatile approach o Concrete – both client and counselor can see progress. o Short-term o Has national training centers and is taught internationally. o Promotes responsibility and freedom within individuals. o Challenges the medical model. o Addresses conflict resolution. o Focused on the present.

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Limitations o Focuses on here and now and ignores the past and unconscious. o Assumes mental illness is a means to deal with external events. o Has few theoretical constructs. o Ignores developmental stages. o May be overly moralistic. o Depends on a good counselor-client relationship. o Depends on verbal interaction and two-way communication. Not for the nonverbal client. o Keeps changing its focus.

3. Cognitive Therapy •

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Founder/Developer o Aaron Beck (1921 – present), a psychiatrist, founded cognitive therapy (CT).

Around the same time of Ellis’s work Beck, also trained to be psychoanalytic, developed his therapy after conducting research into the effectiveness of using psychoanalytic theories in the treatment of depression.

View of Human Nature o Perception and experience are active processes that involve both inspective and introspective data. o An individual’s assessment of a situation is evident in his or her cognitions.

Dysfunctional behavior is caused by dysfunctional thinking.

Role of the Counselor o The counselor is active and works with the client to make covert thoughts more covert. o Automatic thoughts are examined.

Goals o Help clients examine and modify unexamined and negative thoughts. o Counselors focus on excessive cognitive distortions, such ▪ All-or-nothing thinking ▪ Negative prediction ▪ Overgeneralization ▪ Labeling of oneself ▪ Self-criticism ▪ Personalizations o Counselors work with clients on overcoming their lack of motivation linked with client’s view of problems.

Techniques o Challenging the way individuals process information o Counter mistaken belief systems (i.e., faculty reasoning) o Self-monitoring exercises to stop negative “automatic thoughts” o Improving communication skills o Increasing positive self-statements and exercises o Doing homework, including disputing irrational thoughts Strengths and Contributions 117 ..

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Adapted to a wide range of disorders, including depression and anxiety.

Has spawned, in conjunction with cognitive-behavioral therapy, dialectical behavior therapy, treatment for individuals who are at risk for self-harm such as those with borderline personality disorder (BPD). o Is applicable in a number of cultural settings and has been introduced in China. o Well-researched, evidence-based therapy proven for clients from multiple backgrounds. o Has spawned clinical instruments including ▪ Beck Anxiety Inventory ▪ Beck Hopelessness Scale ▪ Beck Depression Scale o CT has several training centers in the US and Europe.

Limitations o Is structured and requires clients to be active and may include homework. o Is not appropriate for those seeking unstructured, insight-oriented therapy that does not require strong participation. o Not usually the best approach for those who are intellectually limited or who are unmotivated to change. o CT is demanding. It requires an active and innovative clinician and client.

Systems Theories • •

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Systems theory –a group of people interacting as a family or group.

Three basic assumptions distinguish systems theory from other counseling approaches: o Interpersonal causes o Repeated patterns of interpersonal interaction o Behavior are understood form an interactional viewpoint Circular causality – feedback loops relate events. For example, person A say X, person B takes offense to X and tells person C, C talks to person A Scapegoating – a family or group member is blamed for problems of family or group Linear causality – elimination of X causing Y; move toward triangling or scapegoating

1. Bowen Systems Theory •

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Founders/Developers o Murray Bowen (1913-1990) - founder • Unresolved patterns are passed down to the following generations.

• Succeeded by Michael Kerr and Edwin Friedman.

View of Human Nature o Chronic anxiety in all life – both emotional and physical. o Previous generations determine how families cope with anxieties. o High anxiety produces illness. o Focus is on differentiation, or distinguishing one’s thoughts from one’s emotions and oneself from others. o Terms used in Bowen therapy • Fusion – undifferentiated emotional togetherness 118 ..

Cutoff – physical or psychological avoidance Triangulate – pull in a third party Role of the Counselor o Coach and teaches the client to think through involvement with others Goals o Client modifies coping strategies with stress passed down from previous generations. o Client to display a non-anxious presence in their daily lives. o Client should be able to separate their thoughts from their feelings. o Client should be able to separate themselves from others.

Techniques o Assessment of self and family through a multigenerational genogram, a visual of the client’s family tree over three generations. o Cognitive processes • Asking content-based questions of one’s family • Go home again – visit family in order to get to know them better • Person-to-person relationships • Asking of questions – to family members about events impacting the family, such as deaths, births, and marriages o Detriangulation • Resolve anxiety over family situations and not project feeling onto others.

• Avoid becoming a target or scapegoat for people who may be overcome with anxiety. o Differentiation of self – ability to distinguish between subjective feeling and objective thinking.

Strengths and Contributions o Focuses on multigenerational family history and focuses on dealing with past patterns so behaviors may be avoided in the future. o Use of genograms to plot historical links. o Cognitive emphasis, differentiation of self and detriangulation.

Limitations o Extensive and complex. o Works best with severely dysfunction or low differentiation of self. o May require investment on multiple levels.

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2. Structural Family Counseling •

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Founders/Developers o Salvador Minuchin (1921 – present) – founder o Braulio Montalvo and Jay Haley also are contributors.

View of Human Nature o Structure – the informal way in which a family organizes itself and interacts. o Hierarchical structure works well, parents are higher in authority than children. o No structure/little structure increases family stress, rigidity, chaos, and dysfuntionality: ▪ Coalitions – alliances between family members against a third member 119 ..

Cross-generational alliances – alliances between family members of two different generations.

Role of the Counselor o Observers and experts in making interventions to modify and change the structure. o Advocate for structural changes in family, with attention given to patterns in subsystems of the family such as in the marital dyad. o Establish clear boundaries among family members. o Take on position of leadership to determine dysfunctional pattern and how to change it.

Goals o Action emphasized over insight in order to reorganize family to be more functional. o Replacement of old rules with ones related to current realities. o Stress distinctions and differentiation between subsystems, such as parents over children.

Techniques o Family interaction – counselor rearranges the physical environment to have family act in a different way; for example, have people face each other to talk o Reframing – helping the family see its problem from a different perspective. o Punctuation – declaring a person competent at a moment in time. o Unbalancing – counselor takes up for an individual against the rest of the family. o Enactment – resolving outside problems in the counseling session. o Boundary making – separating subsystems from each other in order to develop the group; for example, encouraging a married child to bond with his/her spouse away from the rest of the family. o Intensity – strongly encouraging a member to do something different. o Restructuring – altering existing hierarchies or interaction patterns. o Adding cognitive constructions – advice and information for change; paradox – frustrating messages to get people to change.

Strengths and contributions o Versatile. o Effective with different groups. o Culturally sensitive. o Clear definition of terms and procedures and easily applied. o Emphasizes symptom removal and reorganization of family.

Limitations o Not complex enough, sexist at times, and focuses too much on present. o Influenced by strategic family therapy. o Families may not become empowered enough since counselor is in charge.

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3. Strategic (Brief) Counseling •

Founders/Developers o John Weakland o Paul Watzlawick 120 ..

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Jay Haley Cloe Madanes Two Braches: ▪ Mental Research Institute (California) ▪ Family Therapy Institute (Washington, DC) View of Human Nature o When dysfunctional symptoms occur, they are attempts to help people adapt. o Problems occur within a developmental framework of the family life cycle. o Dimensions of family life: ▪ Family rules – overt (obvious) and covert (covered or not seen) rules families use to govern themselves.

▪ Family homeostasis – family patterns that stay in balance or check unless challenged.

▪ Quid pro quo – treat others in family the way they are treated by them.

▪ Circular causality – events are interconnected.

Role of the Counselor o Focus on process rather than content of problem. o Get people to try new behaviors. o Hope for a spillover effect – generalization of one behavior or situation to another. o Strive to resolve presenting problems, little attention to insight. o Active, direct, and goal oriented. o Problem focused, matter-of-fact, and brief. o Visits are usually limited to 10.

Goals o Resolve, remove or improve a problem behavior. o Increase motivation by limiting sessions. o Persons learn new skills for resolving future conflicts.

Techniques o Each intervention is tailored to the specifics of person and problems. o Accept the presenting problems and view symptoms as serving a positive purpose. o Relabeling – give a new perspective to a behavior. o Paradoxing – insist on the opposite of what one wants. o Prescribing the symptoms – have family display voluntarily what they had previously expressed involuntarily, such as fighting. o Pretend – client makes changes or carries out homework assignments that would not be completed otherwise. o Ordeals – an issue introduced during treatment process to work on in counseling. o Homework – given in the form of prescriptions or directives completed between sessions.

Strengths and Contributions o Therapists sometimes work in teams. o Pragmatic (matter-of-fact) and flexible. o Counselor is innovative and creative. o Change individual’s perceptions to foster new behaviors. o Work on one problem at a time and limit sessions to do so.

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Limitations o Foundations and techniques overlap with other system and brief therapy theories. o Controversial beliefs. o Clients may not gain independence since counselor is in a power position.

Brief Counseling Approaches 1. Solution-Focused Counseling •

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Founders/Developers o Steve deShazer and Bill O’Hanlon (1980s) – both influenced by Milton Erickson, creator of brief therapy (1940s). o Michele Weiner-Davis and Insoo Kim Berg View of Human Nature o Does not have a comprehensive view of human nature. o Erickson believed that people have within themselves the resources and abilities to solve their own problems even if they do not understand them (much like Carl Rogers). Small changes lead to further changes. o People are constructivist in nature – reality is a reflection of observation and experience. o People really want to change and change is inevitable.

Role of the Counselor o Collaborates with the client. o Determines how active and committed a client is to change. o Clients have three categories: ▪ Visitors ▪ Complainants ▪ Customers o Act as facilitators of change. o Encourage, challenge, and set up expectations for change. o Don’t blame or ask “why?” o Allow client to be the expert on his/her life (like Rogers).

Goals o Help clients tap inner resources and notice exceptions to the times when they are distressed. o Direct client toward solutions to situations that already exist. o Focus is on positive and possibilities either now or in the future.

Techniques o Encourage client to examine exceptions to times when there are problems. o Miracle question – hypothetical situation where a problem has disappeared. o Scaling – using a scale from 1 to 10 (highest) to evaluate severity of problem. o Compliments – written messages to praise client. o Clues – idea that some behaviors will likely continue and should not be worried about. o Skeleton keys – things that have worked before and can be used to unlock other problems.

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Strengths and Contributions o Short and empowering. o Flexible and has research support. o Works with a variety of clients. o Focuses on change and gives credit to small changes.

Limitations o Little attention given to client history. o Lacks focus on insight. o Uses teams by some to make the cost of treatment high.

2. Narrative Counseling •

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Founders/Developers o Michael White and David Epston – founders o Michael Durrant and Gerald Monk View of Human Nature o Knowledge is constructed through social interaction. o No absolute reality except as a social product. o People internalize and judge themselves through creating stories of their lives. o Stories highlight negative qualities about individuals or situations in their lives – troublesome or depressing. o Treatment allows clients to reauthor their lives and change their outlooks in positive ways.

Role of the Counselor o Collaborators and masters of asking questions. o Engage clients and use basic relationship skills such as attending, paraphrasing, clarifying, summarizing, and checking to make sure they hear the client’s story or problem correctly. o Address and eliminate problems. o Uses narrative reasoning.

Goals o Shift to a narrative way of understanding and interpreting the world. o Clients learn to value their life experiences and stories when successful. o Clients learn how to construct new stories and meaning in their lives, create new realities.

Techniques o Externalization – problem brought to counseling; Separates a person from problems and makes it objective in order help client find resources to cope. o Awareness and objectivity – how the problem affects the person and how the person affects the problem. o Raising dilemmas – client examines possible aspects of a problem before the need arises. o Predicting setbacks o Reauthoring – refining one’s life and relationships through a new narrative, change is possible. o Counselor sends letters to families about progress.

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Counselor holds celebrations at termination and gives out certificates of accomplishment.

Strengths and Contributions o Blame is alleviated and dialogue is generated by solving a common problem. o New stories and possibilities for action. o Exceptions to problems highlighted. o Client prepared ahead of time for setback or dilemmas.

Limitations o Works better with intellectual clients. o No norms are set. o No family history is taken or history of a behavior.

Crises Counseling Approaches •

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Founders/Developers o Erich Lindemann (1944, 1956) and Gerald Caplan (1964) – pioneers o Lindemann – normal grief and stages o Caplan – expounded Lindemann’s view to traumatic events View of Human Nature o Loss is going to happen in life. o Healthy people grow and move on. o Some things are left behind – intentionally, by accident, or out-grow things o Grieving – a natural reaction to loss o Extent of grief is associated with the value of what was lost and how. o Four most common crises: • Developmental – birth or retirement • Situation – car wreck, loss of job • Existential – inner conflicts and anxieties, like turning 50 • Environmental – hurricane, terrorism Role of the Counselor o Need to be mature with a variety of life experiences with which they have successfully dealt. o Good command of basic helping skills, high energy, and quick mental reflexes. o Poised, calm, creative, and flexible. o Direct and active in crisis situations.

Goals o Time is limited and sessions last between 6 and 8 weeks. o Get those who are suffering immediate help in a variety of forms (psychological, financial, legal). o Counselor recognizes and corrects distorted emotions, behaviors, and thoughts brought on by trauma.

Techniques o Three essential listening activities: • Defining the problem • Ensuring client safety

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Providing supports – communicating to the client genuine and unconditional caring o Acting strategies: • Examining alternatives • Making plans • Obtaining commitment o Follows-up on clients about strategies o Critical Incident Stress Debriefing (CISD), also known as psychological first aid, and one-on-one counseling makes use of the above strategies.

• CISD – 7 stages used to help clients deal with thoughts and feelings in a controlled environment with two counselors: • Introduction • Facts • Thoughts • Reaction • Symptoms • Teaching • Reentry • 1 to three hours given 1 to 10 days after a crises and 3 to 4 weeks after a disaster.

Strengths and Contributions o Brief and direct o Modest goals and objectives o Relies on intensity o More transitional Limitations o Limited to immediate situation o Does not go into depth o Time limited and trauma oriented •

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CLASSROOM ACTIVITIES 1. Talk with another classmate about what counseling would be like without theories. Then talk with your class as a whole about counseling as an atheoretical profession and the advantages and disadvantages of such an approach.

2. Compare and contrast the strengths and limitations of cognitive and behavioral theories of counseling. How would you explain its benefits and drawbacks to a person unfamiliar with it?

3. Which of the theories covered in this chapter appeals most to you? Try to understand why that is so, in other words, is the appeal more emotional, cognitive, pragmatic, etc. Talk with your classmates about the theory you favor most and the reasons for it.

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CHAPTER 8 - MULTIPLE CHOICE TEST QUESTIONS 1. Which of the following refers to events that, when they follow a behavior, increase the probability of the behavior repeating? a. Reinforcers b. Punishments c. Rehearsals d. all of the above 2. Learning behavior through a series of gradual steps is a process known as _________. a. generalization b. maintenance c. shaping d. flooding 3. Restoring an environment to its original state and then making it better is a behavioral process known as ____________. a. covert sensitization b. overcorrection c. environmental planning d. flooding 4. Rational emotive behavior therapy states that human beings are ________. a. inherently good b. inherently rational and irrational c. inherently bad d. neutral 5. Maria, a clinical mental health counselor who has an REBT orientation, asks her client to comport herself in a way that is the opposite of the client’s usual way. This is an example of which of the following? a. A dream interpretation b. A cognitive disputation c. A behavioral disputation d. An imaginal disputation 6. Reality therapy emphasizes the elimination of ____________. a. punishment and excuses b. behavioral consequences c. client responsibility d. the past 7. What is the primary goal of reality therapy? a. To help clients become psychologically strong and rational and realize they have choices in the ways they treat themselves and others. b. To help people realize that they can live more rational and productive lives.

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c. To help clients make good adjustments to life circumstances and achieve personal and professional objectives. d. To help clients modify the coping strategies and patterns of coping with stress that have been passed on from generation to generation.

8. Which of the following describes the idea that events are related through a series of interacting feedback loops? a. linear causality b. scapegoating c. circular causality d. psychosocial systems 9. According to Bowen family therapy, less mature couples who experience friction in their relationship tend to display a high degree of _________. a. differentiation b. fusion c. triangulation d. empathy 10. In structural family counseling, which technique involves helping the family see its problem from a different and more positive perspective? a. punctuation b. boundary making c. restructuring d. reframing 11. Strategic family therapy is based on the premise that dysfunctional symptoms are attempts to help people _____________. a. adapt b. rebel c. change the system d. ask for help 12. All of the following EXCEPT _________ are techniques used in solution-focused counseling. a. scaling b. skeleton keys c. compliments d. paradox 13. Two concepts emphasized by the narrative family counseling approach are ____________. a. miracle questions and exceptions b. reauthoring and externalizing c. utilization principle and homework d. structure and reframing

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14. A crisis that emerges as a result of inner conflicts and anxieties that accompany important human issues of purpose, responsibility, independence, freedom, and commitment is known as a(n) ______________________ crisis. a. developmental b. situational c. existential d. environmental 15. All EXCEPT _________ are essential listening activities that need to be implemented initially in a crisis situation. a. defining the problem b. ensuring client safety c. providing support d. examining alternatives ESSAY TEST QUESTIONS 1. Why do you think cognitive and behavioral approaches to counseling are so popular? What do you think are some strengths and limitations of cognitive counseling approaches as you now understand them?

2. Compare and contrast the systems theories (Bowen, Structural, Strategic) in regard to strengths and limitations. Which ones do you prefer? Why?

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ADDITIONAL RESOURCES American Counseling Association. (1996). Demonstrations of counseling: Rational Emotive Therapy [Film]. (Available from American Counseling Association, 5999 Stevenson Avenue, Alexandria, VA 22304) This 90-minute video, focused on Albert Ellis’ theory of counseling, is divided into three parts: 1) Demonstration with an Elementary School Age Child, 2) Demonstration with a Woman Fearful of Expressing Emotion, and 3) Demonstration with a Young Divorced Woman. Within each section, Ellis interacts with a client from an RET perspective and then offers discussion on the interaction and the techniques used. 1-800-422-2648 American Counseling Association. (1996). A teenage mind is a beautiful mind [Film].

(Available from American Counseling Association, 5999 Stevenson Avenue, Alexandria, VA 22304) This 102-minute video is based on Dr. William Glasser’s book, Unhappy Teenagers, and uses a combination of lecture and role play to address the topic of parent-teenager relationships. 1-800-422-2648 Association for Specialists in Group Work. (1995). Reality Therapy groups [Film]. (Available from American Counseling Association, 5999 Stevenson Avenue, Alexandria, VA 22304) Dr. Robert Wubbolding presents an introduction to group work and Reality Therapy in this 118-minute video. Appropriate for counselors who are new to group work, this video is divided into two sections. The first part is a presentation of Reality Therapy and how it can be used in the different stages of group work. The second section includes a mock group session from a Reality Therapy approach. 1-800-422-2648 Films for the Humanities & Sciences. (1999). Mixed anxiety and depression: A Cognitive Behavioral Approach with Dr. Donald Michenbaum [Film]. (Available from Films for the Humanities & Sciences, PO Box 2053, Princeton, NJ 08543-2053) This 67-minute video focuses on a brief approach to the treatment of anxiety and depression.

Dr. Michenbaum illustrates this approach through the dramatization of the highlights from 12 sessions with a depressed and anxious client. 1-800-257-5126 Insight Media. (1977). B. F. Skinner on Behaviorism [Film]. (Available from Insight Media, 2162 Broadway, New York, NY 10024-0621) A discussion on the basics of behaviorism is the primary focus of this video featuring B. F. Skinner. During this 28-minute video, Skinner illustrates how behaviorism can be applied in a variety of areas, as well as how to use behavioral techniques to shape behavior. 1-800-2339910

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Insight Media. (1988). B. F. Skinner [Film]. (Available from Insight Media, 2162 Broadway, New York, NY 10024-0621) Two separate videos comprise this series. In the first video, Skinner discusses Freud’s theories and his viewpoint on some behavioral concepts. In the second video, Skinner takes a look at some societal concerns in a discussion of his book, Walden Two. (Each video is 50 minutes in length) 1-800-233-9910 Insight Media. (1975). A demonstration of behavioral processes by B. F. Skinner [Film].

(Available from Insight Media, 2162 Broadway, New York, NY 10024-0621) Skinner illustrates some of the main concepts in Behaviorism in this 28-minute video.

Using pigeons, he explains the concept of operant conditioning. 1-800-233-9910 Insight Media. (1995). A sidelong glance at Bowen Theory [Film]. (Available from Insight Media, 2162 Broadway, New York, NY 10024-0621) In this 56-minute video the main components of Murray Bowen’s theory are discussed. The dangers of narrowing one’s theoretical stance are explored, along with the need for clinicians to have a systematic way of understanding the plethora of theories that have emerged in the recent past. 1-800-233-9910 Insight Media. (1998). Family Systems Theory [Film]. (Available from Insight Media, 2162 Broadway, New York, NY 10024-0621) In this 100-minute video Kenneth Hardy takes a look at how the Family System Theory works and uses a mock family session to illustrate this approach. 1-800-233-9910 Insight Media. (1988). A different kind of caring: Family therapy with Carl Whitaker [Film].

(Available from Insight Media, 2162 Broadway, New York, NY 10024-0621) Using a real-life therapy session, this video shows Carl Whitaker in action with discussion of the rationale for different interventions given in separate segments. 1-800-233-9910 Insight Media. (1997). Narrative therapy [Film]. (Available from Insight Media, 2162 Broadway, New York, NY 10024-0621) This 55-minute video features Dr. Ramon Corrales conducting couples therapy. The major elements of narrative therapy are discussed and illustrated. 1-800-233-9910 Insight Media. (1983). Constructing the multigenerational family genogram [Film].

(Available from Insight Media, 2162 Broadway, New York, NY 10024-0621) This 31-minute video helps clinicians to learn how to create and utilize a mulitgenerational family genograms. Using a case example, the basics of this approach are explored as well as how a clinician can start using this approach in the first family session. 1-800-233-9910 130 ..

Insight Media. (1998). Fundamental principles of therapy with Virginia Satir [Film].

(Available from Insight Media, 2162 Broadway, New York, NY 10024-0621) Conjoint family therapy is the topic that Virginia Satir explores in this 60-minute video.

Satir looks at the similarities and differences between this approach and other treatment options. 1-800-233-9910 Insight Media. (1977). Demonstration of the cognitive therapy of depression [Film].

(Available from Insight Media, PO Box 621, New York, NY 10024-0621) In this 40-minute video, Dr. Aaron Beck conducts an interview with a depressed client who is also suicidal. Beck illustrates how to use a cognitive approach in the treatment of depression. 1-800-233-9910 Insight Media. (2003). Cognitive counseling [Film]. (Available from Insight Media, 2162 Broadway, New York, NY 10024-0621) This video features Dr. Jan Holden presenting specific examples of cognitive strategies for counseling clients across the life span. 1-800-233-9910 Insight Media. (1988). A guide to rational living: Albert Ellis [Film]. (Available from Insight Media, 2162 Broadway, New York, NY 10024-0621) Ellis discusses the connections among thoughts, feelings, and actions in this 90-minute video. During this interview with Ellis he discusses irrational beliefs and how to spot them, cognitive homework, humor and modeling. 1-800-233-9910 Insight Media. (1988). Albert Bandura [Film]. (Available from Insight Media, 2162 Broadway, New York, NY 10024-0621) In part one of this two-part video series, Bandura compares his approach to other theories and explains how he developed his theory of social learning. The second part of this series focuses on the Bobo doll experiment and the concepts of morality and violence. (Part 1 is 29 minutes in length, Part 2 is 28 minutes in length) 1-800-233-9910 Insight Media. (1998). Cognitive-Behavior Therapy [Film]. (Available from Insight Media, 2162 Broadway, New York, NY 10024-0621) John Krumboltz illustrates how to use Cognitive-Behavior Therapy in this 100-minute video. Through a real counseling session and discussion of techniques, this video explains how to use this approach to modify one’s thoughts and behaviors. 1-800-233-9910 Insight Media. (1998). Reality Therapy [Film]. (Available from Insight Media, 2162 Broadway, New York, NY 10024-0621)

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This 100-minute video features Dr. Robert Wubbolding and explores reality theory as developed by William Glasser. Using a mock counseling session, Wubbolding discusses how clients must make choices and understand the goals of their treatment. 1-800-233-9910 Insight Media. (1998). Solution-focused therapy [Film]. (Available from Insight Media, 2162 Broadway, New York, NY 10024-0621) This 100-minute video features Insoo Kim Berg discussing the basis for and the benefits of solution-focused therapy. Special attention is given to the role solution-focused therapy can play in counseling clients who are financially disadvantaged, culturally diverse, or hard to work with. 1-800-233-9910 Research Press (1998). Rational Emotive Therapy [Film]. (Available from Research Press, Dept 99, P.O. Box 9177, Champaign, IL 61826) Albert Ellis demonstrate the concepts of RET through working with clients in this 30-minute video. The process of RET is described, as well as Ellis’ thoughts on how RET developed.

User’s manual is included. 1-800-519-2707 Research Press (1998). B. F. Skinner and behavior change: Research, practice, and promise [Film]. (Available from Research Press, Dept 99, P.O. Box 9177, Champaign, IL 61826) This 45-minute video looks at Skinner’s work and some of the issues that surround behaviorally-based psychology. Discussion by Skinner and several other professionals is featured. User’s guide included. 1-800-519-2707 Research Press (1998). Recognizing four behavioral principles in action [Film]. (Available from Research Press, Dept 99, P.O. Box 9177, Champaign, IL 61826) Through 33 brief scenarios, this video demonstrates how behavioral principles can effect interpersonal dynamics within the workplace. The 20-minute video is accompanied by a leader’s guide. 1-800-519-2707

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CHAPTER 9 GROUPS IN COUNSELING CHAPTER OVERVIEW This chapter examines the place for groups in counseling. Primary types of groups are described, including psychoeducational, counseling, psychotherapy, and task/work groups.

Distinctions between each are made. T-groups, encounter groups, group marathons, and selfhelp/support groups are explained. Stages in group work and issues in working with various types of groups are examined. The impact of group size, setting, leadership, and confidentiality are explored in depth. After a discussion of self-disclosure, feedback, and follow-up, the future of group work is addressed.

KEY TERMS, CONCEPTS, AND PEOPLE Action stage Altruism Association for Specialists in Group Work (ASGW) Catharsis Closed group Co-leaders Confidentiality Corrective recapitulation of the primary family group Counseling group Deming, W. Edwards Development of socializing techniques Educational groups Encounter group Existential factors Feedback Focus group Follow-up Forming, storming, norming, performing, adjourning Gibb, Jack Group Group cohesiveness Group counseling Group dynamics Group process Group psychotherapy Groupthink Group work Guidance groups Heterogeneous groups Homogeneous groups Imitative behavior Imparting of information Instillation of hope 133 ..

Interpersonal learning Interpersonal problem-solving groups Lewin, Kurt Moreno, Jacob L. Open group Perls, Fritz Personality reconstruction groups Pratt, Joseph Hershey Pregroup interview Pregroup training Psychodrama Psychoeducational group Psychotherapy group Quality circle Quality work groups Rogers, Carl Schutz, William Self-disclosure Self-help group Stoller, Frederick Support group T-group Task/work group Universality Yalom, Irvin

CHAPTER 9 - GROUPS IN COUNSELING A Brief History of Groups • • • • • • •

Joseph Hersey Pratt, Boston physician, credited with first psychotherapy/counseling group in 1905.

Jacob L. Moreno – introduced group psychotherapy in counseling literature in the 1920s.

Kurt Lewin – 1930s and 40s, field theory influenced Tavistock small study group in Great Britain and T-groups in US. Fritz Pearls, Gestalt Therapy approach to groups attracted interest.

W. Edwards Deming – introduced idea of quality work groups to improve the processes and products of morale in business workers.

William Schutz and Jack Gibb – added a humanistic aspect to T-groups; focused on personal growth as a goal.

Carl Rogers – developed the basic encounter group in 1960s, a model for growth-oriented group approaches.

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Psychodrama • • • • •

Jacob L Moreno, Viennese psychiatrist – originator of psychodramas with ordinary citizens.

Used for years with mental patients at St. Elizabeth’s Hospital in DC. Members enact unrehearsed role-plays.

Group leader is director, other groups members are actors in the protagonist’s play and give feedback.

Used by behaviorist, Gestaltists, and affective-oriented group leaders.

T-Groups • • • • • •

T = training First used at National Training Laboratories (NTL) in Bethel, Maine in 1946.

Existed before group counseling or group psychotherapy.

Kurt Lewin – formed the basis for the original group. Based on his group dynamics.

Focus is on task accomplishment or on interpersonal relationships.

Members learn from their experience how members’ behaviors influence others in the group.

Encounter Groups • • •

Emerged from T-groups to focus on growth of individual group members rather than the group.

For normal functioning individuals who want to grow and change and develop.

Groups focus is on individual expression and recognition of affect.

Groups Marathons • • • •

A 24 hour minimum group session that breaks down defensive barriers.

Pioneered by Frederick Stoller and George Bach in 1960s.

Useful with substance abusers in rehab, as well as normal functioning people in other group settings.

Used by labor and peace negotiations.

Self-Help/Support Groups •

•

Self-Help Groups o Grown since 1970s. o Develops spontaneously, centers on single topic, led by layperson with experience with common event of members. o Short or long term. o Help members gain greater control of their lives. o Over 10 million people are involved in around 500,000 US groups.

Support groups

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o

• •

Focus on particular concern or problem but established by professional helping organization or person (for instance, AA). o May charge fees. o Involvement of laypeople as group leaders varies. o Center around topics that are physical, emotional, or social.

Might meet in churches, recreation centers, schools, or other community centers.

Healthy and complementary to other health services.

Misperceptions and Realities about Groups • •

Misperceptions began in the 1960s when groups were unregulated but popular with some inappropriate behaviors.

Myths about groups o Artificial and unreal. o Second-rate structures for dealing with problems. o Force people to lose their identity by tearing down psychological defenses. o Require people to become emotional and spill their guts. o Touchy-feely, confrontational, and hostile. o They brainwash members.

The Place of Groups in Counseling • • •

• •

• •

Group – two or more people interacting together to achieve a goal.

Economical and effective means of helping people who share similar problems.

Decide when, where, and with whom to use group. o Schedule a regular time for people to meet. o Quite, uninterrupted setting. o Equal status.

Differ in purpose, composition, and length.

All involve work, the dynamic interaction between collections of individuals for prevention or remediation of difficulties or for the enhancement of personal growth/enrichment.

Group work – work that goes on within the group.

Advantages of working with a group (therapeutic factors ): o Instillation of hope – You will get through this. o Universality – You’re not alone. o Imparting of information – how to cope. o Altruism – helping each other. o Corrective recapitulation of the primary family group – reviewing previous conflicts and resolving them. o Development of socializing techniques – learning social skills. o Imitative behavior – imitating positive behavior of other members. o Interpersonal learning – insight; working through past issues. o Groups cohesiveness – bonding with others. o Catharsis – being able to express emotions. o Existential factors – taking responsibility; determining choices.

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•

Propels person forward and help him/her recognize needs or wants.

Benefits and Drawbacks of Groups •

•

Benefits: o Help 9th and 10th graders learn social problem solving to help with career decisions. o Promote career development and useful in vocational planning. o Can help women improve functioning and subjective well-being . o Help heart attack victims deal with stressors better. o Increase maturation processes of adolescent offenders.

Drawbacks o Some clients’ problems and personalities are not suited for groups. o Some problems need more individual attention. o Group pressure may force client to take action like self-disclose before s/he is ready. o Groupthink – defensive thinking as a group without problem-solving. o Individuals may not be able to generalize skills outside of the group. Group may not represent a normal interaction. o May not resolve conflicts or development. May become regressive and unproductive or even destructive, such as scapegoating, narcissistic, and project.

Types of Groups •

The following groups have training standards developed by the ASGW.

1. Psychoeducational Groups • • • • •

Guidance groups or educational groups.

Preventive and instructional.

Purpose: to teach group members how to deal with potential threat, developmental event, or crisis.

May find these groups outside of schools: hospitals, mental health centers, social service agencies, and universities.

One of most important parts: discussion of how members will personalize the information presented in the group. o Schools use instruction materials, such as: unfinished stories, puppet plays, films, audio interviews, and guest speakers. o Adult setting: written materials or guest lecturers. o College setting: control of anger, dating, study skills.

2. Counseling Groups • •

Interpersonal problem-solving groups.

Help resolve problems of living through interpersonal support and problem solving.

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• •

Help members develop existing interpersonal problem-solving competencies in order to better handle future problems.

More direct than Psychoeducation groups – o Attempt made to modify attitudes and behaviors, more emphasis on emotional involvement of members. o Smaller and in a more intimate setting. o Members get “airtime” to speak. o More interaction and personalizing of information.

3. Psychotherapy Groups • • • •

•

Personality reconstruction groups.

Help members remediate in-depth psychological problems.

Usually in inpatient facilities, psychiatric hospitals residential units.

Types of problems: depression, incessant talking, paranoia, schizoid and sociopathic personalities, suicidal, and extreme narcissists. Easier to recognize those who should be excluded.

American form of treatment.

4. Task/Work Groups • • •

• •

Help members apply principles and processes of group dynamics to improve practices and accomplish a goal.

Useful for task forces, committees, planning groups, community organizations, discussion groups, study circles, learning groups.

Best if following factors are in place: o Clear purpose o Dynamics and information are balanced o Time needed for culture building and learning about each other o Conflict resolution o Feedback between members o Here-and-now addressed o Reflection on group Examples: team in athletics, art, and employment settings.

Quality circle – employee-run group of workers who meet weekly to examine the processes they are using in their jobs; devise ways to improve them.

Theoretical Approaches in Conducting Groups • •

Theoretical approaches vary just as in individual counseling.

Ward evaluated seven major theoretical approaches to groups: o Psychoanalytic, Gestalt, and behavioral approaches focus on the individual but weak on interpersonal and group level component. o Person-centered approach is strong on the individual level and medium on group level. o Consider factors when choosing a theory: group task and membership maturity.

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• •

• • •

• •

Multiple theoretical models provide more choices and diversity for conducting groups.

Useful factors for deciding on theoretical approach: o Do I need a theoretical base for conducting the groups? o What uses will the theory best serve? o What criteria will be employed in the selection process?

Theory provides direction and guidance in determining view of human nature, goals, counselor role, and explaining group interactions. Helps in evaluating group outcomes.

Theory gives meaning and framework for experience and facts. Leads to research.

Four main factors when selecting a theory: o Personal experience o Consensus of experts o Prestige o Verified body of knowledge A good theoretical approach also fits with a counselor’s personality style.

Stages in Groups •

•

Tuckman’s four stage process for counseling: 1.

Forming stage ▪ Foundation for what is going to happen.

▪ Members express anxiety and dependency and talk about shallow issues.

▪ Relaxes members by going over rules of sessions, etc.

2.

Storming stage ▪ Turmoil and conflict ▪ Forces group members to make basic decisions about the degree of independence and interdependence in their relationship with one another.

▪ Hierarchy of group established.

▪ Deal with issues concerning anxiety, power, and future expectations.

▪ Group leader may be attacked at this time.

3.

Norming stage ▪ Storm survival generates enthusiasm and cohesion.

▪ Goals and tools to problem-solve are determined.

4.

Performing ▪ Group members become involved with each other and their individual and collective goals.

▪ Group is productive.

Tuckman & Jensen fifth stage of adjourning and Waldo’s fifth stage of mourning: o Adjourning or mourning/morning stage ▪ Group comes to an end, members say good-bye.

▪ Members either feel fulfilled or bitter.

▪ A closure ceremony almost always takes place.

Issues in Groups Selection and Preparation of Group Members • Group success is determined by maturity, readiness, and composition of membership.

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• • • • •

• • • •

•

Every person wanting to be in a group is not an appropriate candidate. If allowed in the group may monopolize or manipulate or trouble the group leader and cause regression.

Use of pregroup interviews and training help to screen and prepare candidates.

Pregroup Interview: Selection of candidates should include individuals whose needs and goals are compatible with the group’s goals.

Pregroups training – members learn about the group and what is expected, provides information and gives them a chance to lower their anxiety.

Screening – follow ethical guidelines to screen out candidates or candidates screen themselves out. o Candidate may not be a good fit for the group, or at that time, or for the leader. o Group members may be able identify potential issues.

Group process – how group member interactions influence the development of the group.

Less likely to have conflict if the group is homogeneous (more alike than unalike) than homogeneous (unalike).

Process should be balanced with content.

Issues to be clarified before enrollment in a group: o A clear statement of the group’s purpose. o Description of the group format, ground rules, and basic procedures. o Statement about the educational and training qualifications of the group leader(s). o Pregroup interview determines the potential group leader and member compatibility. o Disclosure about the risks involved in a group and discussion about member rights and responsibilities. o Discussion about limitations and confidentiality and group leader(s)’ role.

Group leader needs skills to handle challenges and resistance.

Groups Size and Duration • • • • •

Size is determined by group’s purpose and preference.

Large groups – less likely to focus on the needs of individuals.

A good number for a group is six to eight members.

Groups running 6 months may be productive with up to 10 people.

Groups with children may be as small as three or four.

Open versus Closed Groups • •

Open-ended groups – admit new members after they have started.

Closed-ended groups – do not allow new members after they start, but may have more cohesiveness and attain goals.

Confidentiality • •

What is said in the group should stay in the group.

Confidentiality should be discussed in the prescreening stage, first meeting, and ongoing.

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•

Group leader should protect members by enforcing confidentiality and immediately discussing betrayal.

Physical Structure • • •

Setting can be an asset or liability.

Room should ensure the safety and growth of group members.

Physical structure should be attractive and preferably in a circle.

Co-Leaders • • • •

•

Co-leaders are not required.

Co-leaders can break the group up into two smaller groups.

A more experienced co-leader can be paired with a less experienced co-leader.

Successful, experienced co-leaders : o Possess a similar philosophy and operational style. o Have similar experience and competence. o Establish a model relationship for effective human interaction. o Be aware of splitting and member loyalty ties to a certain co-leader. o Agree on counseling goals and the processes to achieve them to prevent power struggles.

Sit opposite of each other in a group to maximize responsibility and observation.

Self-Disclosure • • • •

Here and now feelings, attitudes, and beliefs.

Depends on the trust group members have for each other.

Self-disclosure builds on itself. Group leaders should model self-disclosure in the beginning.

Group members who make few self-disclosure are more likely to drop out.

Feedback • • •

•

Process of group members’ responding to verbal messages and nonverbal behaviors of one another.

Honest, careful feedback can be used to gauge their behavior and try new behaviors.

Feedback at termination – group members should be clear, concise, and concrete with one another giving feedback about how they have changed during the experience.

Feedback should be recorded to show progress toward their goals.

Criteria for feedback evaluation: o Should be beneficial to the receiver and not serve the needs of the giver. o More effective when is based on describable behavior in early stages, positive feedback is more beneficial and more readily accepted than negative feedback. o Most effective when it immediately follows a stimulus behavior and is validated by others. o Beneficial when the receiver is open and trusts the giver.

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Follow-Up • •

• • • •

Used after termination to keep in touch with members to see how well they are progressing on personal or group goals.

ASGW’s Best practice Guidelines state that group leaders provide for follow up after group termination as appropriate to assess outcomes or when requested by group members.

Allows for assessment of gains of group experience and allows leader to make necessary referrals.

Maximize effects of a group experience and encourages original goals.

Follow-up session for a short-term group should be conducted 3 months after termination.

Individual follow-up is important.

Qualities of Effective Group Leaders •

•

• • • •

•

Group leaders who are authoritarian, aggressive, confrontational, or emotionally removed are ineffective and produce group casualties (members who drop out or are worse after the group experience).

Four positive leadership qualities: o Caring o Meaning attribution – clarify, explain, provide cognitive framework for change o Emotional stimulation – involve activity, challenge, risk taking, self-disclosure o Executive function – set norms, structure, and suggest procedures Find a balance between emotional stimulation and executive function.

Understand forces in the operation – if therapeutic, encourage; if negative, redirect.

Effective group leaders are committed to self-improvement.

Personal qualities related to effective group leadership: o Presence o Personal o Power o Courage o Willingness to confront oneself o Sincerity o Authenticity o Enthusiasm o Sense of identity o Inventiveness/creativity Well-educated in group theory, practice, and techniques - translate symptoms into interpersonal issues.

The Future of Group Work • •

Development of new ways of working in groups that are theory driven.

Solution-focused counseling and brief therapy groups have grown in popularity and effectiveness.

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•

• •

Becoming focused on prevention: o Life-skill training o Interpersonal communication and human relations o Problem solving and decision making o Physical fitness and health maintenance o Development of identity and purpose of life Prevention focus is encouraged by managed health care to reduce premiums.

More attention is being given to multicultural issues.

CLASSROOM ACTIVITIES 1. Reflect on the types of groups mentioned in this chapter. Discuss those groups you are most knowledgeable of and comfortable with now. Anticipate the types of groups you might lead in the future.

2. Divide into pairs and discuss the problems and potentials you see in leading a group. Pretend you have been asked to lead a group of your own choosing. What feelings do you have about this upcoming event? How do you see yourself behaving and thinking during each stage of the process?

3. Examine copies of professional counseling journals from the past 5 years. Report to the class on articles about groups in which you are particularly interested. Compare your findings with those of other class members.

4. Imagine you are a counselor without any group skills. How do you see yourself functioning in the following settings: a school, an employee assistance program, a private practice?

Discuss with the class your thoughts about counselor engagement in various types of groups.

5. Select a topic that is interesting to a wide variety of individuals (e.g., proper diet or dealing with anger), and present a psychoeducational group lesson to your classmates based on information you have researched. Process this experience directly with the class as soon as you complete it.

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CHAPTER 9 - MULTIPLE CHOICE TEST QUESTIONS 1. ________________ is credited with introducing the term “group psychotherapy” into the counseling literature. a. Fritz Perls b. Kurt Lewin c. Jacob L. Moreno d. Joseph Pratt 2. Each of the following is an example of the advantages of groups EXCEPT __________. a. members realize that they are not alone b. members learn about themselves in social situations c. members can try out new behaviors in the safe group environment d. members develop a groupthink mentality 3. Group counseling focuses on ____________ involvement; whereas, group guidance focuses more on __________ understanding. a. affective; cognitive b. educational; therapeutic c. cognitive; affective d. passive; active 4.

_______________ groups help individual group members remediate in-depth psychological problems. a. Task/work b. Psychotherapy c. Guidance d. Marathon

5. Alcoholics Anonymous, Weight Watchers, and Lamplighters are all examples of which type of group? a. encounter b. counseling c. T-group d. self-help/support 6. ___________ is useful in determining goals for the group, clarifying one’s role and functions as a leader, and explaining the group interactions. a. Group training b. A theory c. A professional statement d. Supervision 7. The following statement is true about stages of groups: _______________. a. groups always go through the stages in sequential order b. the different stages of a group are easily differentiated 144 ..

c. a group does not necessarily move step by step through stages, but may move back and forth to different stages as it develops d. most groups do not go through stages of development 8. All EXCEPT ________ are qualities a group leader needs in order to have a positive effect on the outcome of a group. a. caring b. confrontation c. meaning attribution d. emotional stimulation 9. A generally agreed upon number of group members in most types of adult groups is ___________. a. 4-5 b. 6-8 c. 11-12 d. 13-15 10. A main advantage of an open-ended group is __________. a. member confidentiality b. size flexibility c. group cohesiveness d. productivity 11. Successful, experienced co-leaders ______________. a. possess a similar philosophical and operational style b. have similar experience and competence c. establish a model relationship for effective human interaction d. all of the above 12. Before joining a group, prospective participants should obtain all of the following EXCEPT ______________. a. a description of the group format b. a clear statement of the group’s purpose c. a statement about the psychological history of all the group members d. a disclosure about the risks involved in being in a group 13. According to Tuckman and Jenson, the working stage of the group is known as the ____________ stage, while the _________ stage is where the most enthusiasm and cohesion is generated. a. forming; norming b. storming; forming c. performing; norming d. performing; forming

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14. Group follow-up should ideally occur approximately ___________ months after a short-term group ends. a. three b. five c. two d. six 15. Feedback is most effective when ______________. a. it is based on describable behavior b. it is beneficial to the giver c. it immediately follows a stimulus behavior d. “A” and “C” but not “B” 16. Jamie’s counselor has recommended that she consider joining a group being offered in the community for individuals who are caring for loved ones with dementia. Jamie’s counselor shares that he believes the group will be helpful for Jamie because (a) it will help her realize that she is not alone in her caregiving struggles and (b) she might be able to learn some coping strategies and skills from other group members. Jamie’s counselor is describing which two therapeutic factors of groups? a. Catharsis and imitative behavior b. Existential factors and group cohesiveness c. Universality and imparting of information d. None of the above.

ESSAY TEST QUESTIONS 1. You have been asked to set up a counseling group for a population of your choice. Describe how you would set up such a group. Be specific.

2. Explain some of the advantages and limitations of groups. What qualities can a leader display that would help a group function better?

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ADDITIONAL RESOURCES American Counseling Association. (1996). Carl Rogers on group [Film]. (Available from American Counseling Association, 5999 Stevenson Avenue, Alexandria, VA 22304) Carl Rogers presents his insights into group work in this two-part video set. The first part, Carl Rogers Conducts an Encounter Group, illustrates the different stages of group process with Rogers providing his views on how the stages develop. The second part, Carl Rogers on Facilitating a Group, features Rogers highlighting the important criteria for success group facilitation. Areas of discussion include the group leader’s role, honest expression by both the members and the facilitators, and how physical contact is used in a group. (100-minutes in length) 1-800-422-2648 Association for Specialists in Group Work. (1985). Group work: Leading in the here and now [Film]. (Available from American Counseling Association, 5999 Stevenson Avenue, Alexandria, VA 22304) Led by Peg Carroll, this three-part video illustrates group work techniques. The three parts can be purchased separately or together: 1) The Initial Stage, 2) Reassessing Goals…Transition and Flight, and 3) The Group in Conflict and Summation. This video aims at helping the viewer understand more about the group process and why it is so effective. (Each part is 60 minutes in length). 1-800-422-2648 Association for Specialists in Group Work. (1992). Developmental aspects of group counseling: Process, leadership, and supervision [Film]. (Available from American Counseling Association, 5999 Stevenson Avenue, Alexandria, VA 22304) Rex Stockton hosts this three-part video series focusing on teaching the viewer about several crucial aspects of group work: developmental stages, group leader professional development, and supervision of the group leader. Each of the three videos is 45-minutes in length and has a unique focus: 1) Early Development, 2) Moving Through Transition to the Working Stage, and 3) The Working Stage and Termination. 1-800-422-2648 Association for Specialists in Group Work. (1995). Group work for eating disorders and food issues [Film]. (Available from American Counseling Association, 5999 Stevenson Avenue, Alexandria, VA 22304) In this 109-minute video, Dr. Cynthia Kalodner presents a detailed plan to assist counselors in working with females at risk for developing eating disorders. The main focus is on high school and college age youth. The rationale for developing a group for these clients is discussed, as well as a description of each session in this group program. Specific exercises are illustrated and other resources are provided. 1-800-422-2648 Association for Specialists in Group Work. (1995). Reality Therapy groups [Film]. (Available from American Counseling Association, 5999 Stevenson Avenue, Alexandria, VA 22304)

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Dr. Robert Wubbolding presents an introduction to group work and Reality Therapy in this 118-minute video. Appropriate for counselors who are new to group work, this video is divided into two sections. The first part is a presentation of Reality Therapy and how it can be used in the different stages of group work. The second section includes a mock group session from a Reality Therapy approach. 1-800-422-2648 Corey, G., Corey, M. S., & Haynes, R. (Producer). (1999). The evolution of a group [Film].

(Available from Brooks/Cole Publishing Company, Attn: Database Management 9BCCNC01, International Thomson Publishing, P.O. Box 6904, Florence, KY 41022) This video illustrates the stages of group development through watching an actual group progress. The 2-hour video and the student workbook that comes with it can be used to help students integrate the video with their learning of group process.1-800-487-8488 Insight Media. (1991). Groups and group dynamics [Film]. (Available from Insight Media, 2162 Broadway, New York, NY 10024-0621) This 30-minute video illustrates the different categories of groups and what characteristics separate one from another. Conformity, individualism, intra-group relationships, and intergroup interactions are explored. 1-800-233-9910 Insight Media. (1991). Groups and group dynamics [Film]. (Available from Insight Media, 2162 Broadway, New York, NY 10024-0621) Dr. Rosemarie Smead is featured in this two-part video demonstrating ways to work with groups in late elementary/middle schools. Dr. Smead illustrates the different group skills that help create a successful group atmosphere. She also demonstrates group skills within a real group which is focused on anger-management. Each video is 30-minutes and a copy of Dr. Smead’s book, Skills and Techniques for Group Work with Children and Adolescents, is included. 1-800-233-9910 Insight Media. (1992). Gazda on groups [Film]. (Available from Insight Media, 2162 Broadway, New York, NY 10024-0621) George Gazda leads the discussion in this 80-minute video on the different stages of group development and on developmental group counseling theory in general. Additionally, Gazda looks at the use of social skills training, setting group ground rules, and using groups with children, teens, and adults. 1-800-233-9910 Smead, R. (1998). Skills and techniques for group counseling with youth [Film]. (Available from Research Press, Dept 99, P.O. Box 9177, Champaign, IL 61826) This two-video set comes with Dr. Smead’s book, Skills and Techniques for Group Work with Children and Adolescents. Through working with students in a group setting, Dr. Smead illustrates many different group skills.1-800-519-2707

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Yalom, I. D. (1994). Understanding group psychotherapy: Process and practice [Film].

(Available from Jaylen Productions, 1806 Austin Street, Snohomish, WA 98290 and Insight Media, 2162 Broadway, New York, NY 10024) This 3-volume set consists of 5 video tapes featuring Dr. Yalom’s work with outpatients, inpatients, and in an interview. An instructor’s manual accompanies the set. 1-800-5774762 or 1-800-233-9910.

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CHAPTER 10 CONSULTATION AND SUPERVISION CHAPTER OVERVIEW This chapter emphasizes that consultation is an indirect service activity similar to, but distinct from, counseling. Definitions, models, levels, stages, and areas of consultation activity are highlighted, along with a description of the types of training needed to be a consultant. The chapter also discusses supervision and briefly describes different types of coaching.

KEY TERMS, CONCEPTS, AND PEOPLE Adlerian-based approach Agency consultation Approved Clinical Supervisor Behavioral approach Board Certified Coach Coaching C group Circular progressive model Client-centered case consultation Collaborative consultant Community-centered ad hoc consultation Community Mental Health Centers Act of 1963 Conceptualization issues Conjoint behavioral consultation (CBC) Constructive negative-thinking process Consultation Consultee-centered ad hoc consultation Consultee-centered administrative consultation Consultee-centered case consultation Counselor-consultants DIRECT Discrimination model of supervision.

Doctor-patient or prescription model Executive coaching Expert or provision model Kurpius, DeWayne Life coaching Mediation model Mental health approach Mindfulness Peer consultant Peer supervision Personalization issues Process issues Process consultation or collaboration model Program-centered administrative consultation 150 ..

Reflective team model Role-reversal process School consultation Self-maintenance Self-measurement Self-mediation Self-monitoring STIPS Structured Peer Consultation Model for School Counselors (SPCM-SC) Supervision Triadic supervision Values-based consultation

CHAPTER 10- CONSULTATION Consultation: Defining a Multifaceted Activity •

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Consultation is a process between two professional persons, the consultant, who is a specialist, and the consultee, who invokes the consultant’s help in regard to current work problems.

Five publications in counseling (e.g., Personnel and Guidance Journal, The Counseling Psychologist, and Journal for Counseling and Development) brought attention to consultation and provided common ground for consultation: problem-solving focus, tripartite nature, and emphasis on improvement.

Lag in consultation research is due to: o an atheoretical attitude towards it that inhibits its development. Many specialists do not understand it or practice consultation as a specialized profession. o it is not the primary activity of professions: lacks the organization support, leadership, and resources for research. o social, political, or technical issues.

Additional inhibiting factors: o Defining variables and getting permission to do specialized research in organizational settings. o Initial goals may change.

Redefined in pre-1995 editions of the ACA code of ethics that originated by Kurpius: Consultation is “a voluntary relationship between a professional helper and help-needing individual, group, or social unit in which the consultant is providing help to the client(s) in defining and solving a work-related problem or potential problem with a client or client system.”

Common consultation characteristics: o Content based (recognized body of knowledge). o Goal oriented. o Governed by variable roles and relationship rules. o Process oriented - involves gathering data, recommending solutions, and offering support.

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Triadic (involves a consultant, a consultee, and a client….example, guidance counselor, teacher, and student who is expressing the problem). o Based on ideologies, value systems, and ethics.

Involves system changes – forces within systems either help or hurt the openness to consultation. o

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Consultation versus Counseling • • • • • • • • •

Most counselors do not distinguish between consulting and counseling.

Many principles and processes are similar.

Difference – what is addressed in consulting is about a situation outside the consulting relationship; about a situation between the consultee and his/her client.

Consulting may take place in the consultee’s environment. Counseling takes place in the counselor’s office.

Consulting is sought after when a system is in decline or crisis.

During a session a consultant focuses more on content (information) rather than feelings because the focus is on problem solving.

Consultants play more of a catalyst role in sessions because they do not deal directly with the designated client (the consultee deals directly with the client).

Goals in consultation are indirect because they are directing the consultee rather than the client.

Consultants are teaching consultees a skill that can be applied to a third party.

Four Conceptual Models •

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Expert or provision model o Consultant provides a direct service to a consultee who does not have the time, inclination or skills to deal with a problem. o First model to develop and used a lot in the 1940s and early 1950s. o Advantage – experts can handle difficult problems and leave consultees free to do other things without work conflicts. o Disadvantage – consultants are blamed if problem does not get better.

Doctor-patient or prescription model o Consultants advise consultees about what is wrong with the third party. o Consultants tell what should be done about problem. o Works well in situations where consultees lack confidence in their own intervention strategies. o Consultants do not have to make a change or cure.

Mediation model o Consultants act as coordinators. o Main function is to unify the services of a variety of people who are trying to solve a problem. o Goals are accomplished by ▪ Coordinating the services already being provided.

▪ Creating alternative plans of services that represent mutually accepted solutions.

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For instance, coordinating the different services received by a handicapped child in a school.

Process consultation or collaboration model o Facilitators of the problem-solving process. o Main task is to get consultees actively involved in finding solutions to the problem existing with the client. o For instance, this is the solution based focus of IEPs (Individual Educational Plans) used in schools to bring together all teacher and administrator concerns for a child to focus on a solution in each situation.

Levels of Consultation Individual Consultation • •

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Role-reversal process – consultant role-plays the consultee while the consultee role-plays the client. Consultant asks “client” about the payoffs and risks of the ideas for change.

Teaching self-management skills. Kahn’s four-part interdependent component model: o Self-monitor – persons observe their own behavior. o Self-measurement – person validates the degree to which the problem exists. o Self-mediation – person develops and implements strategies of change. o Self-maintenance – person continues to monitor and measure the desired effects.

Kahn’s examples of excessive and deficit behavior that may be managed with the selfmanagement process: o Cigarette smoking o Obesity o Assertiveness o Depression mutual trust and respect are essential.

Teaching negative-thinking can alleviate anxiety; for instance, “the worse thing that could happen is…”

Consultant may model a skill or prescribe a solution.

Group Consultation •

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Used when several consultees share a similar problem; such as in a work setting. o When problem solving in groups, the consultant acts as a catalyst and facilitator. o When used in person-focused groups, the consultant helps group members build teams to understand and resolve person problems.

The C group, one of the first effective collaborative consultation models: o Main purpose is to present new knowledge about behaviors to the group. o C – collaboration, consultation, clarification, confrontation, concern, confidentiality, and commitment: ▪ Collaboration - Encourages members to work together as equals.

▪ Consultation - Give and receive input from each other.

▪ Clarification - Understand the relationship among beliefs, feelings, and actions.

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▪ ▪ ▪ ▪

Confrontation - Share openly with each other.

Concern - Empathize with one another.

Confidentiality - Keep information within the group.

Commitment - Make plans for specific changes.

Organization/Community Consultation • • • •

Consultants are external to the project.

Environmental mapping – individuals in the organization/community can be targeted by the consultant to improve the situation of the population.

Consultants encourage the consultee to change stress-producing environments.

Works better to change the structure of the system rather than the person within it.

Stages and Attitudes in Consultation •

Splete’s nine-stage process based on the premise that clients (consultees) collaborate with consultants to work on predetermined concerns: o Precontract – consultant clarifies personal skills and expertise that can be used in the process. o Contract and exploration of relationship – consultee’s readiness and consultant’s ability to respond are determined. o Contracting – a mutual agreement is determined defining services. o Problem identification – problem and outcome are defined. o Problem analysis – reviewing the problem and coming up with solutions. o Feedback and planning – evaluating solutions and planning implementation. o Implementation of the plan o Evaluation of the plan o Conclusion and termination of relationship

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Five-stage process of consultation with counselor techniques and behaviors: o Phasing in – consultant uses active listening, self-disclosure, and empathy to build trust. o Problem identification – determine if third-party problem exists; consultant uses focusing skills, paraphrasing, restatement, genuineness, and goal setting. o Implementation – defines strategies and sets up a time frame; skills - feedback, flexibility, dealing with resistance and negative feeling, and patients. o Follow-up and evaluation – skills include – risk taking, openness, and persistence. o Termination - consultant brings closure; uses relationship skills – empathy and genuineness, giving and asking for feedback, determine what four attitude areas needed for consulting: o Professionalism – take responsibility for helping client deal with problems. o Maturity – stand up for own views, take risks, deal with hostility or rejection. o Open-mindedness o Importance of people - place people above technology.

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Specific Areas of Consultation School Consultation •

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Consultation is effective in prevention and intervention in schools. o Enhances overall school achievement, improves student self-concept. o Reduces stress in certain populations. o Leads to better classroom management skills. o Facilitates the moral growth of students.

Schools counselors are in the perfect position to consult and be change agents. o Positioned as a staff authority – expected to have specialized knowledge, such as familiarity with local, state, and federal laws. o Act in advisory and supportive ways. o Can bring about environmental and systemic changes. o Advise those in power about what conditions need modifying and support change efforts.

Umansky and Holloway – four approaches to consultation in the schools: o Adlerian-based approach ▪ Psychoeducational model assuming individuals, groups, and communities lack information.

▪ Consultant teaches ways to promote positive behavior in children. o Behavioral approach ▪ Concentrates on instructing consultees how to use behavioral principles.

▪ Consultant teaches how to collect data to validate strategies. o Mental health approach ▪ Based on community mental health approach.

▪ Psychodynamic theory underlies this approach.

▪ Goal is to help teachers and administrators gain new insight into themselves and students. o Organizational development approach ▪ Emphasizes the context in which problems arise.

▪ Consultant works on changing the school’s atmosphere and structure.

▪ May need administrator support that may be difficult to gain.

▪ School counselor may set up environment to encourage teachers to do the consulting.

Group consultation sessions with teachers are effective; for example, with parents. o Parent-counselor consulting model – ▪ Solve student problems and educate parents on how to help their child with situation.

▪ Parental resistance: excuses, negative mindsets, denial.

Use of peers is time efficient. Provides: o Case consultation o Solution-focused problem solving o Peer support o Constructive feedback without concern for evaluation or need for change. o Access to needed materials and resources’.

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Collaborative consultant from outside the school work with the school community in an action research approach. o Global o Based on reason that school counselor cannot provide overall consultation services or their schools. o Five major phases: ▪ Planning ▪ Analyzing ▪ Designing ▪ Implementing ▪ Evaluating o Consultant meets with school officials. Parents and students have a voice to contribute to the change or focus.

Agency Consultation •

Resulted from Community Mental Health Centers Act of 1963. o Mental health should be viewed from a local community perspective with an emphasis on prevention. o Three level definition of prevention: ▪ Primary prevention –reduction in the incidence of mental disorders.

• Accomplished by teaching life skills.

• Consultation is one of the primary activities.

▪ Secondary prevention – reduction in the duration of mental disorders.

• Work is done with individuals to get rid of problem areas and detect and reverse acute psychological crises.

▪ Tertiary prevention –reduction in the impairment from psychological disorders through treatment. o Six levels of community mental health consultation: ▪ Client-centered case consultation ▪ Consultee-centered case consultation ▪ Program-centered administrative consultation ▪ Consultee-centered administrative consultation ▪ Community-centered ad hoc consultation ▪ Consultee-centered ad hoc consultation o Five trends that continue to influence agency consultation: ▪ Downsizing of organizations ▪ Creation of semiautonomous work units brought about by mergers ▪ Rebirth of commitment leadership by managers ▪ Process-based technologies in manufacturing ▪ Egalitarian social and organizational values

Training in Consultation •

Stum’s Directed Individual Response Educational Consulting Technique (DIRECT)

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o

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Synthesizes previous knowledge and helps students learn what they are supposed to do in a consulting interview and how to do it. o Consulting is a systematic process with sequential steps: ▪ Establish the consulting relationship ▪ Identify and clarify the problem ▪ Determine the desired outcome ▪ Develop ideas and strategies ▪ Develop a plan ▪ Specify the plan ▪ Confirm the consulting relationship o Cues words are provide at each step and level. A Technique and Relationship Evaluation Chart (TREC) is available to assess competency that the consultant trainee achieves.

Brown’s developmental stages for training human services consultants. o Didactic, laboratory, and field placement competencies. o Focuses on problems (resistance) and strategies to overcome problems. o Instructors help trainees master consultation skills by analyzing case histories, modeling cognitive strategies by talking through cases, employing a Socratic method of inquiry. o Five stages of consultation where conceptual and relationship skills should be mastered: ▪ Relationship or entry ▪ Assessment or problem identification ▪ Goal setting ▪ Choosing and implementing change strategies ▪ Evaluation and termination Gallessich future models should be based on three models: o Scientific/technological consultation o Human-development consultation o Social/political consultation Zins emphasizes the need to educate consultees in skills such as problem solving, communication, and intervention techniques for consultation process.

Supervision

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Supervision is an interactive and evaluative process in which someone with more proficiency oversees the work of someone with less knowledge and skill to enhance the professional functioning of the junior member (Bernard & Goodyear, 2014).

The supervision process in counseling is central to beginning counselors’ development.

Discrimination Model of Supervision o Process issues o Conceptualization issues o Personalization issues Supervision is a required area of instruction in all CACREP-accredited programs.

To be effective, supervision must be given on a counselor’s developmental level and help the novice counselor conceptualize better what counseling is like.

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STIPS – a format for organizing and structuring thinking about a case (Scheel, 2002, p.

11) o S = signs and symptoms o T = topics discussed in counseling o I = counseling interventions used o P = clients’ progress and counselors’ continuing plan for treatment o S = any special issues of importance regarding clients (e.g. suicide) With advanced-level supervisees, supervisors help supervisees work through what is known as the client-centered stage, process-centered stage, and the context-centered stage Mindfulness has been found to be helpful in supervision.

Reflective team model o Graduate students cooperate and collaborate, brainstorm, and take their clients’ perspectives as they advance hypotheses about client behaviors and view situaions from the clients’ framework. o From this perspective, their knowledge of individuals, couples, and families grow Triadic supervision o Two supervisees working with one supervisor o A method of supervision in which novice counselors can gain insight from both their supervisor and peer (Lawson et al.).

Peer supervision o Supervision among equals o Opportunity to give and gain information about self and clinical skills.

CLASSROOM ACTIVITIES 1. How do you distinguish consultation from counseling? Discuss your ideas with a fellow classmate and then with the class as a whole.

2. Which of the four comprehensive models of consultation do you think is most appropriate for clients you plan to work with in the future? Why? Which of these models do you consider least appropriate for your future work? Discuss your opinions with another classmate and then with the class as a whole.

3. Which stage in the consultation process do you think is most important? Which one do you think is most difficult? Are they the same? With three other classmates, discuss what skills you possess that will enable you to be an effective consultant.

Identify skills you must refine or develop within yourself to work in this capacity.

4. What theoretical approach do you find most attractive as a basis for consultation services? Divide the class into groups based on similar orientations. After each group has had an opportunity to discuss its ideas, share them with fellow classmates.

5. Do you think there are other proactive activities counselors can engage in that cannot be classified as a part of counseling or consultation? What specific behaviors would you place in this category? Discuss your ideas in groups of four and then with the class as a whole.

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CHAPTER 10 - MULTIPLE CHOICE TEST QUESTIONS 1. The reason(s) theory and research have lagged far behind the practice of consultation is/are _________________. a. consultation is atheoretical b. consultation is not the primary activity of most professionals c. consultation is an ever changing activity d. all of the above 2. Consultation is _______________. a. not well conceptualized by many counselors b. the same as counseling c. an indirect service for helping others d. “a” and “c” but not “b” 3. Miriam is a consultant who provides direct services to consultees who do not have the time, inclination, or perceived skills to deal with a particular problem area. Under which model of consultation is Miriam working? a. Doctor – patient or prescription model b. Mediation model c. Expert or provisional model d. Process consultation or collaboration model 4. Which of the following is accurate regarding differences between consultants and counselors? a. Consultants are more likely to meet with clients in professional office setting, whereas counselors are more likely to meet with clients in natural settings. b. Consultants are more likely to focus on feelings, and counselors are more likely to focus on content c. Consultants are more likely to focus on content, and counselors are more likely to focus on feelings d. Consultants engage in direct activity, and counselors engage in indirect and direct activity.

5. A counselor who is giving consultation services is more likely to operate as a(n) ______________ than he or she would if providing counseling services. a. catalyst b. direct enforcer c. antagonist d. devil’s advocate 6. In the ____________ model, consultants act as “coordinator.” a. expert b. mediation c. prescription d. collaboration 159 ..

7. Teaching self-management skills as a form of consultation is usually done at the ________________ level. a. individual b. group c. organization d. community 8. In this type of consultation, outside experts in human services or the helping professions work with individuals to assist them in becoming more insightful and aware of what they are doing and what they could do better. a. Self-monitoring consultation b. C-group consultation c. Self-maintenance consultation d. Coaching 9. The C Group is used ______________. a. with children b. for sharing information and mutual support c. with adults and children d. for counseling purposes 10. In ___________________ persons validate the degree to which a problem exists. a. self-monitoring b. self-mediation c. self-measurement d. self-maintenance 11. In the developmental consultation model proposed by Splete, _____________ is used to determine and define the precise problem to be worked on and the desired outcome. a. problem analysis b. contracting c. problem identification d. planning 12. In Scott and colleagues’ model, in which stage is evidence gathered and a determination made about whether what was implemented was effective? a. Preliminary b. Outcome c. Intervention and implementation d. Termination 13. Sally, a school consultant, teaches within the organizational structure of a school and emphasizes ways to promote positive behavior in children. Which approach accurately describes this? a. Behavioral approach 160 ..

b. Mental health approach c. Organizational development approach d. Adlerian-based approach 14. In which level of community mental health consultation is the goal to collaboratively identify consultee difficulties in working with certain types of clients and help the consultee develop the skills to deal effectively with this and similar situations in the future? a. Client-centered case consultation b. Consultee-centered case consultation c. Program-centered administrative consultation d. Consultee-centered administrative consultation 15. Which of the following is defined as an interactive and evaluative process in which someone with more proficiency oversees the work of someone with less knowledge and skill to enhance the professional functioning of the junior member? a. The discrimination model b. Process coaching c. Supervision d. Social/political consultation 16. A supervisor and supervisee are focusing on how well the supervisee formulates cases from theory and how well they convey what it is they know. This is an example of which type of skill building based on the discrimination model of supervision? a. Process issues b. Conceptualization issues c. Personalization issues d. All of the above.

ESSAY TEST QUESTIONS 1. Describe the different levels of consultation in regard to their purposes and their effectiveness.

2. Explain how counseling and consultation are both alike and different in regard to the populations they serve and their emphases.

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ADDITIONAL RESOURCES Films for the Humanities & Sciences. (2002). Job coaching strategies [Film]. (Available from Films for the Humanities & Sciences, PO Box 2053, Princeton, NJ 08543-2053) This DVD and 100-page handbook provide a concise, goal-oriented program for career and guidance counselors. The program and manual follow the chronology of a successful job placement—from getting to know the client to maintaining employer relations. The manual features real-life examples to illustrate techniques and strategies, while the DVD focuses on the successful supportive employment of Nick, a young man with multiple disabilities.

Interviews with Nick’s parents, job coach, and employer highlight the concepts discussed in the handbook. The program also features a step-by-step functional assessment interview, with an expert explanation of each topic. A handbook is included. Not available for preview.

(60 minutes) 1-800-257-5126 Learning Communications. (2006). Coaching and counseling: Maximizing opportunities [Film]. (Available from Learning Communications LLC, 38 Discovery, Suite 250, Irvine, CA, 92618) This course prepares and motivates participants to pass on their knowledge and skills to create a more productive workplace. It demonstrates how coaching is one of the most effective ways to improve the performance of the people around you. It shows participants how to recognize and transform seemingly ordinary situations into coaching opportunities.

(24 minutes in length) 1-800-622-3610

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CHAPTER 11 EVALUATION AND RESEARCH CHAPTER OVERVIEW This chapter examines the differences between evaluation and research in counseling and the importance each holds in the field. The chapter also discusses the major ways these processes are conducted, for example, through case studies and experimental designs. Methods and models of evaluation and research and the place of statistics in counseling are explored, too.

KEY TERMS, CONCEPTS, AND PEOPLE AB design (simple time series) ABAB design (reversal design) Action research Applied research A priori questions Average Basic research Bubbles (flaws) Case study Comparative research studies (correlational studies) Contaminating variables Context evaluation Context-Input-Process-Product (CIPP) Control group Correlational statistics Correlational studies Counseling portfolio Counseling research Criterion-referenced Cross-cultural research Cross-section Dependent variable Dbescriptive research Descriptive statistics Evaluation Experimental research Ex post facto questions Field research Halo effect Independent variable Inferential statistics Input evaluation Laboratory research Longitudinal Mean Measures of the central tendency 163 ..

Median Meta-analysis Method Mode Multiple baseline design N of 1 (single-subject research) Needs assessment Nonparametric tests Normal curve (bell-shaped curve) Normative-referenced Outcome research Parametric tests P + P = R evaluation Personnel evaluation Planning, Programming, Budgeting System (PPBS Model) Process evaluation Process research Product evaluation Program evaluation Psychohistory Qualitative research Quantitative research Regression towards the mean Reliability Research Research question Research relevancy Results evaluation Sampling procedure Single-subject research Standard deviation Statistics Survey SurveyMonkey Validity Washout period Zoomerang CHAPTER 11 - EVALUATION AND RESEARCH The Nature of Evaluation and Research •

Evaluation o Mission oriented. o Less subject to control. o Provides information for decision makers.

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o o

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Less rigorous or sophisticated.

Explain events and relationships to established goals and objectives.

Research o Theory oriented and discipline focused. o Control over the activity. o Results may be more than can be immediately applied. o Sophisticated in terms of complexity and design. o Judgment used on the researcher’s part. o Explains and predicts phenomena.

Pure versus applied research o Pure – purely for the sake of knowledge. o Applied – use information gained from research and apply it to their own work settings.

Evaluation •

Gathering information on different areas of the counseling program in order to help make decisions about where to put resources and assures program effectiveness.

Incorrect Evaluation Methods • •

Incorrect evaluation procedures produce invalid and unreliable results.

Incorrect evaluation procedures have some of the following defects: o Restrict opinion sampling. o Compare groups that are not equal. o Promote services rather than evaluate. o Make assessments without clear goals.

Steps in Evaluation • •

Program evaluation should be organized and follow an orderly step-by-step process.

Burck and Peterson laid out a plan to be implemented in a program evaluation: o Needs assessment – identify problems or concerns within the program.

▪ Need – a lack of something.

▪ Assumption that needs exists based on factors.

• Institutional or personal philosophy • Government mandate • Available resources • History or tradition • Expert opinion ▪ Needs assessment techniques • Identifying the target of the survey • Specifying a method of contact • Resolving measurement related issues o State the goals and performance objectives ▪ Terminal program outcomes – outcomes that are immediately recognized 165 ..

Ultimate program outcomes – outcomes that are most enduring, continue to be issues Designing a program – developed to meet stated objectives Revising and improving a program – activities and communication patterns are evaluated Making note of and reporting program outcomes ▪ Making results known to the public ▪

o o o

Selecting an Evaluation Model • •

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Set aside to conduct evaluation and educate yourself and others about the different models of evaluation.

List of evaluation models o Systems analysis – for managers/economists to determine program efficiency o Behavioral objective - for managers/psychologists to determine productivity and accountability o Decision making – for administrators to determine effectiveness and quality control o Goal free – for consumers to determine choices and social utility o Art criticism – for connoisseurs/consumers to determine improved standards o Accreditation – for jury/public to provide a resolution o Transaction – for client/practitioners to provide an understanding Internal and external restrictions define the limits which each model may be applied.

Questions raised before an evaluation is conducted are more likely to be answered.

Concept mapping o Questioning of the underlying structures of a phenomenon is experienced. o When a particular answer is blocked a person can find an alternative.

PPBS – planning, programming, budgeting systems o Emphasizes planning programs with specifically stated goals, objectives, and evaluation criteria. o Criterion referenced – related to the number of the criteria (goals) have been accomplished. o Norm-referenced – related to how well someone performs compared to a norm group (comparison to how well others have performed).

CIPP – context-input-process-product model o Context evaluation – comparison between what the program set out to accomplish and what it actually did. o Input evaluation – information is gathered about what resources are needed and which are available to meet program objectives; demonstrates cost-effectiveness and points out the need for additional resources. o Process evaluation – focuses on strengths and weaknesses of the program’s design. o Product evaluation ▪ Focus on the final results of the program; how effective was the program.

▪ Plans can be made to continue, reuse, expand, or eliminate the program.

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Counselors and Research • • •

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Some counselors are drawn to research. Others are afraid to research seeing it as cold and impersonal.

Some counselors have little time to do research .

Negative feelings about research can be accounted for due to: o Lack of knowledge o Absence of clear goals and objectives o Lack of awareness to the importance of it o Fear of finding negative results o Discouragement from peers or supervisors o Lack of financial support o Low aptitudes and limited abilities (Heppner & Anderson, 1985; Sexton, 1993).

Stages in Counseling compared to Stages in Outcome Research Stages in Counseling Identification of problems or difficulties Formulation of goals Determine interventions Implementation of counseling Appraisal and evaluation of progress Termination

Stages in Outcome Research Identification of research questions Formulation of research design Determine methods for ensuring treatment integrity and measures of outcome Data collection Data analysis Interpretation and conclusions

Research •

The systematic collection, organization, and interpretation of observations in order to answer questions.

Steps in the Research Process • • • • • • • •

Statement of the problem Identification of information needed to solve the problem Selection or development of measures for gathering data Identification of the target population and sampling procedures Design of the procedure for data collection Collection of data Analysis of data Preparation of a report

The Relevance of Research • • •

Research methods appropriate for counseling need to be developed.

A need exists for funding of studies directed at counseling.

Ways to define relevance in research 167 ..

o o

Emphasize studies that focus on the reasons individuals seek counseling – goals, intentions, purposes.

Experience-near research - “how closely the research approximates what is done in the counseling office” ▪ Action research • A form of experience-near research.

• Focuses on resolving practical problems encountered by counselors. o How to manage a child with learning disabilities o How to evaluate the effects of a self-esteem program on a group of children.

• Includes studies focused on diagnostic action, participant action, empirical action, and experimental action.

• Less controlled and not easily generalizable.

Choosing a Research Method • •

Method – a procedure that may be applied to many disciples. More appropriate when referring to ways of carrying out counseling research.

Technique – a discipline-specific procedure

Emphases of Research – four most prominent emphases •

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Laboratory versus field research o Laboratory – concentrates on conducting the investigation within a confined environment, such as a counseling lab in order to rule-out outside (extraneous) variables. o Field – view laboratory research as artificial and believe theories and techniques are best observed and recorded in actual counseling setting.

Basic versus applied research o Basic – oriented to theory, such as the number of times a person-centered therapist uses reflective versus confrontive methods. o Applied research – examine practical problems and apply findings to existing problems.

Process versus outcome research o Process – focuses on what happens in counseling and therapy sessions. o Outcome research – the determination of how clients have been impacted by counseling. Focuses on the before and after.

Quantitative (group) versus qualitative (individual) research o Quantitative ▪ Experiment and survey ▪ Deductive and objective, linearity, cause and effect, repeatability, predictability. o Qualitative ▪ Field research and in-depth interviewing

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▪

Inductive, phenomenological, focusing on what people are doing rather than cause and effect.

Major Research Methods • • •

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Research question – determines where to begin in considering a method.

Research strategy – underlying force that directs a research project.

Historical Methods o Involves experiencing and reporting events and procedures from earlier times that have influenced the development of the profession. o Involves embellishing current theories and generating new research hypotheses.

Descriptive Methods o Surveys ▪ Can be collected four ways: personal interviews, mailed questionnaires, telephone interviews, and through existing records or archives.

▪ Data gathered structured or non-structured way with • Cross-section of people – many people representing different generations, for instance.

• Longitudinally – surveying the same people twice or more ▪ Advantage – can provide a lot of information about a counseling program or client needs from a lot of people.

▪ Four major problems • Survey instruments may be poorly constructed.

• Surveys may not generate a high rate of return.

• Sample surveyed may not be representative of the population focused on.

• Expensive ▪ Social impact of research • Alfred Kinsey’s study o Case Studies ▪ Taking detailed notes and observation of a person or group of people or program over a long period of time.

▪ Sometimes relies on self-reports that are not reliable.

▪ May not be generalizable to other groups or individuals or programs. o Comparative Studies – aka, Correlational Studies ▪ Determine only the relationship between two variables.

▪ Does NOT determine cause and effect.

▪ For instance, a positive correlation means that both variables increase: As counselor responses increase, the client responses increase.

▪ A negative correlation means that the variables go in opposite directions: As counselor responses increase, client responses decrease. o Experimental Methods ▪ Determine cause and effect.

▪ Independent variable – the variable that is manipulated.

▪ Dependent variable – changes depends on changes through manipulation of the independent variable.

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For example, as temperature (Independent variable) is increased or made warmer in the classroom, students become sleepy (dependent variable).

▪ Contaminating variables – variables that invalidate a study, such as one group of clients are all one gender.

▪ Experimental Group – the group receiving the treatment (Independent Variable).

▪ Control Group – receives a placebo (fake treatment) or nothing.

▪ Advantages to single-case (N=1) research designs: • Theory free.

• Flexible and appropriate for use in practice settings.

• Improve counseling effectiveness.

• Do not require statistical methods.

• Produce scientifically effective evidence.

• Consistent with CACREP standards.

▪ Six major advantages that single subject research has over traditional group studies: • Better description of what happens between a counselor and client.

• Positive and negative outcomes understood in terms of process data.

• Outcome measures tailored to client’s specific problems.

• Allows for study of rare issues or problems.

• Allow for novel procedures in diagnosis and treatment.

• Useful in evaluating effectiveness of intervention strategy.

▪ Problems with single-subject studies • When used following a treatment that has not worked.

• Improvement may not have anything to do with treatment.

Washout period may be necessary (a time of no treatment to reduce effects of previous treatment).

Three intense experimental designs that focus on individuals: ▪ Simple Time Series – AB design; A = baseline before treatment, B = treatment added; targeted behavior is recorded and plotted in A and B. ▪ Reversal Design – ABAB design; same as AB but treatment is reduced to see if that is what is changing behavior. If behavior returns to A phase then treatment is added back – hence, the second B in ABAB. ▪ Multiple Baseline Design – • Across individual, across situation, across behaviors • Common trait – Intervention is employed with a select individual, situation, or behavior while baseline is continued with other persons, situation, or behaviors.

Guidelines for Using Research • • •

Recognize flaws and strengths of research methods.

Define terms carefully.

Do not over-generalize beyond the particular findings.

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Statistics •

Statistics are means to use in analyzing and interpreting findings and communicating the results.

Statistical Concepts •

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Measures of central tendency o Mean - average o Median – the midpoint score o Mode – score that occurs the most Standard deviation – how far away from the mean or average scores fall; the larger the deviation, the greater the differences are between scores.

Sampling – a small, representative portion of the population studied.

Statistical Methods •

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Descriptive statistics o Describe characteristics of a sample. o Include mean and standard deviation.

Correlational statistics – strength and connection of variables Inferential statistics o Group comparisons or make predictions about an entire population from a sample. o Determine if results are due to chance or the treatment of variables in a study.

Parametric and Nonparametric test are used to measure the probability of change occurring by chance. o Parametric – more powerful, population has evenly distributed characteristics; examples, Pearson Product Moment correlation and t-tests. o Nonparametric tests – used when no normal curve distribution can be assumed but sharp differences can. Require larger sample sizes; examples, Spearman r (rankorder) correlation and chi-square.

Meta-analysis – large amounts of data from different studies are compared and contrasted.

CLASSROOM ACTIVITIES 1. In small groups, visit a mental health agency or school and find out what procedures are used to evaluate services and personnel. Read the institution’s annual reports, and assess how uniformly an evaluative method is employed in describing the institution’s activities.

Report your field study findings to the class. Discuss what recommendations you would make to the agency or school.

2. As a class, gather examples of needs assessments from schools and agencies. Evaluate the instruments according to the step-by-step procedure outlined in this chapter. What are the strengths and weaknesses of these assessments? What improvements would you make if you were put in charge of the procedure? Have select members of the class role-play the steps they would take when conducting a needs assessment at a particular site.

3. As a class, choose two three-person teams to debate the pros and cons of this statement: 171 ..

Counseling research must be relevant. What definition of relevant does each side advocate? How does an interpretation of the term influence the type of research recommended? After the debate, discuss the merits of doing basic and applied research.

4. Which of the three major types of research (historical, descriptive, or experimental) would you be most comfortable conducting? Divide the class according to research interests and, in individual groups, discuss the reasons behind your choice. After your group agrees on a combined rationale for choosing a particular research approach, report your ideas to the class as a whole.

5. What are your feelings about statistics? In triads, discuss how feelings can either promote or interfere with learning statistical procedures. Practice taking a thinking approach to learning statistics. Does thinking rather than feeling affect your attitude and approach to learning these procedures? Discuss your impressions with the class. Does your class believe there are any counseling approaches that would be useful in helping a person overcome anxiety related to learning statistics? Which ones?

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CHAPTER 11 - MULTIPLE CHOICE TEST QUESTIONS 1. Counselors must engage in evaluation and research to _____________. a. be ethical b. obtain funding c. be accountable d. all of the above 2. Amanda, a doctoral student in counselor education, proposes to her dissertation committee her desire to see how many counselors compared to social workers have blonde hair. On which grounds should the dissertation committee not support her proposal? a. research relevancy b. the fact that this is an experimental design and experimental designs are not as strong as correlational designs. c. the fact that it is unprofessional to examine differences across helping professions without the express written consent of each profession’s governing body. d. data instrumentation and analysis bubbles 3. As compared to research, evaluation is ______________. a. less rigorous or sophisticated b. not concerned with providing information to decision makers c. more rigorous and sophisticated d. “B” and “C” but not “A” 4. Incorrect evaluation methods include ______________. a. restricting opinion sampling b. making comparisons between nonequivalent groups c. promoting services rather than evaluating them d. all of the above 5. The first step in doing an evaluation is _______________. a. assessing needs b. stating goals c. designing the program d. reporting outcome 6. Which of the following refers to the process of evaluating the status of a particular program against established program standards to ascertain the degree to which the program is being implemented? a. Personnel evaluation b. Status evaluation c. Benchmark evaluation d. Program evaluation 7. _______________ refers to questions that are raised before an evaluation, while _______________ refers to questions that are raised after an evaluation is complete.

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a. b. c. d.

ex post facto; a priori a priori; ex post facto P + P= R evaluation; PPBS model PPBS model; P+P=R evaluation

8. Which type of research is Stephanie interested in if she enjoys investigating a puzzle related to theory? a. Qualitative research b. Basic research c. Field research d. Laboratory research 9. When research approximates what is done in the counseling office, it is known as ________________. a. process-near b. replication c. experience-near d. perfect 10. Martha is conducting research to examine practical problems. Her goal is to apply the findings generated by her research to existing problems. What type of research is Martha conducting? a. applied b. basic c. outcome d. process 11. N of 1 research can be applied to which of the following? a. historical studies b. case studies c. intensive design d. all of the above 12. James is doing semi-structured interviews with counselor educators to better understand how they developed their counselor identity. After he collects their stories, he plans to look for themes across interviews. James is conducting which type of research? a. survey b. quantitative research c. qualitative research d. mixed-methods research 13. The term average is identical to the term ______________. a. mode b. median c. mean d. all of the above 174 ..

14. Which type of statistics does Johnny plan to run if he wants to examine the relationship between two psychological constructs? a. Descriptive b. Inferential c. Correlational d. Standard 15. Allison conducts a study to see if cognitive behavioral therapy is more effective at reducing symptoms of depression than person-centered counseling. What is the independent variable and the dependent variable in Allison’s study, respectively? a. The counseling techniques (cognitive behavioral therapy and person-centered counseling); depression b. Cognitive behavioral therapy; person-centered counseling c. Depression; cognitive behavioral therapy d. None of the above, because experimental designs do not have independent and dependent variables.

ESSAY TEST QUESTIONS 1. Why have counselors resisted doing research or even reading research according to Goldman and other critics of counselor research? How must research change if counselors are to benefit more from it?

2. Discuss the major methods of research and the place of statistics in analyzing research data.

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ADDITIONAL RESOURCES Films for the Humanities & Sciences. (1998). Why use statistics? [Film]. (Available from Films for the Humanities & Sciences, PO Box 2053, Princeton, NJ 08543-2053) This four-part series takes a look at the importance of statistics and covers the basics of statistical methods. Each video examines different areas of statistics: Handling Variability, Describing Data, Using Samples, and Bivariate Data: When y Depends on x. Using animation and real-life examples of how statistics are used, this series can add any students learning of statistical methods.1-800-257-5126 Insight Media. (1989). Experimental Design [Film]. (Available from Insight Media, 2162 Broadway, New York, NY 10024-0621) This two-part 60-minute video illustrates different types of research design, with sections discussing causation, randomization, comparison, and replication. 1-800-233-9910 Insight Media. (1990). Research methods [Film]. (Available from Insight Media, 2162 Broadway, New York, NY 10024-0621) This 30-minute video illustrates some of the historically erroneous research designs in psychology. It includes cognitively based interviewing techniques and explains why the scientific research method is so important. 1-800-233-9910 Insight Media. (1993). Observation [Film]. (Available from Insight Media, 2162 Broadway, New York, NY 10024-0621) This 38-minute video explains techniques for observation and the different types of observation. It focuses on observing children and the difficulties associated with this type of observation. 1-800-233-9910 Insight Media. (1995). Research methods for the social sciences [Film]. (Available from Insight Media, 2162 Broadway, New York, NY 10024-0621) This 33-minute video explains the scientific method, different types of research design, and some ethical considerations for researchers. 1-800-233-9910 Insight Media. (1996). Crash course: Easy statistics [CD-Rom]. (Available from Insight Media, 2162 Broadway, New York, NY 10024-0621) This CD-ROM (Macintosh/Windows) can be used to learn about many of the standard elements of statistics. 1-800-233-9910

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CHAPTER 12 TESTING, ASSESSMENT, AND DIAGNOSIS IN COUNSELING CHAPTER OVERVIEW This chapter examines the use of testing, assessment, and diagnosis in counseling. Qualities of good test are defined and major types of tests, such as intelligence/aptitude, interest/career, personality, and achievement are discussed. This chapter also highlights some issues surrounding test administration and interpretation. In addition, the role of assessment and diagnosis are covered. Guidelines for dealing with these factors by counselors are given.

KEY TERMS, CONCEPTS, AND PEOPLE Achievement test Alpha and Beta intelligence tests Aptitude Aptitude test Assessment Association for Assessment and Research in Counseling (AARC) Binet, Alfred Buros Institute of Mental Measurements Buros, O. K. Cattell, James M. Career Beliefs Inventory Comorbid Component ability tests Consequential validity Construct validity Content validity Criterion validity Diagnosis Dictionary of Occupational Titles (DOT) Dual diagnosis Edumetrics Edwards Personal Preference Schedule (EPPS) Employment Stabilization Research Institute Face validity Galton, Francis Goldman, Leo Holland, John Intelligence Intelligence/aptitude tests Interest/career tests Internal consistency analysis Kuder, Gerald Kuder Occupational Interest Survey (KOIS) Linguistic and problem-solving capabilities Mental Measurement Yearbook (MMY) 177 ..

Mental status examination Minnesota Multiphasic Personality Inventory-2 (MMPI-2) Multiaptitude batteries Myers-Briggs Type Indicator (MBTI) National Defense Education Act (NDEA), Title V National Education Association Resolution 72-44 Norms Objective tests Otis, Arthur Parallel forms of validity Parsons, Frank Percentile rank Personal Data Sheet Personality Personality tests Projective tests Psychological tests Psychometrics Psychometrist Reliability RIASEC Rorschach Inkblot Test Score Scoring procedures Self-Directed Search Self-fulfilling prophecy Spearman, Charles Standards for Multicultural Assessment Standards for Psychological and Educational Testing Standardization Standardized test Stanford-Binet Intelligence Scale Strong, Edward K. Strong Vocational Interest Blank (SVIB) Strong Interest Inventory (SII) Structured clinical interview Teacher-made test Terman, L. M. Test Test battery Test developers Test scores Test-retest reliability Test takers Test users Validity 178 ..

Wechsler, David Wechsler Adult Intelligence Scale – Fourth Edition (WAIS-IV) Wechsler Intelligence Scale for Children – Fourth Edition (WISC-IV) Wechsler Preschool and Primary Scale of Intelligence – III (WPPSI-III) Yerkes, Robert CHAPTER 12 - TESTING, ASSESSMENT, AND DIAGNOSIS IN COUNSELING A Brief History of the Use of Tests in Counseling •

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Present-day tests developed and grew out of the late 19th century study of individual differences. o Counselors have been part of the testing movement since Frank Parsons (1909) based vocational guidance on formal assessment.

WWI – army hired psychologists to construct paper-and-pencil intelligence test to screen recruits. o These test pioneers included Arthur Otis and Robert Yerkes. o Testing was based on ▪ Alfred Binet – originator of early intelligence test based on determining the educability of French children.

▪ Charles Spearman – an important early contributor to test theory; known for the Spearman g (general intelligence).

▪ Sir Francis Galton - an inventor of early techniques for measuring abilities.

▪ James M. Cattell – early researcher into the relationship of scores to achievement; known for Cattell’s 16PF testing instrument.

1930s o Vocational testing was emphasized due to the Great Depression. o Vocational testing movement was led by The University of Minnesota’s Employment Stabilization Research Institute.

▪ Batteries of test were given to help the unemployed find work.

▪ Around 30% of unemployed workers were mismatched with their stated job preferences and training.

1957 – Soviet Union launched Sputnik o Testing interest mounted with Americans thinking we had fallen behind in science. o National Defense Education Act (NDEA) containing Title V ▪ Provided funding for testing in the secondary schools in order to identify students with outstanding talents.

▪ Encouraged students to continue education, especially in science.

1959 – review of tests o Journal of Counseling and Development, known as the Personnel and Guidance Journal, began publishing test reviews to supplement the Mental Measurements Yearbook (MMY) from 1959 to 1966. Revived in 1984.

1970s and 1980s – criticism of testing o Goldman declared marriage between counseling and testing to have failed.

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National Education Association (NEA) passed Resolution 72-44 calling for a moratorium on the use of standardized intelligence, aptitude, and achievement tests.

Bills have been introduced in state legislatures to prohibit the administration of certain tests.

1970s trends making it challenging to select tests and interpret scores.

Testing in schools, however, have become more popular. Such as, intelligence and achievement tests, substance abuse screening instruments, and career inventories.

Tests and Test Scores • • • •

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Psychological tests – objective and standardized measures of behavior.

Test scores – statistics that have meaning only in relation to a person. o Provide information for counseling.

Score – a reflection of a particular behavior at a given moment.

Counselors should know the following about testing: o Characteristics of the standardized sample o Reliability and validity types o Reliability and validity of comparable tests o Scoring procedures o How to administer the test o Limitations and strengths.

Test manuals contain most of the above information. However, testing takes experience.

Psychometrists – specialist in testing and appraisal of tests.

Psychometrics – the discipline of comparing the test scores of a person to a normreferenced group.

Edumetrics – client achievement is compared to the client’s previous and best results.

Most people administering tests are counselors and others in the helping profession.

Testing can be mechanical, creating distance between the counselor and client. To overcome this, counselors need to be well trained in test practice.

Periodicals that review standardized test: o Measurement and Evaluation in Counseling and Development o Journal of Counseling Psychology o Journal of Counseling and Development o Review of Educational Research O.K. Buros o Tests in Print updated periodically by his institute, Buros Institute of Mental measurements.

▪ In its 5th edition, two volume set containing around 3000 tests ▪ Reference books on personality test, vocational tests, etc. o Mental Measurements Yearbook ▪ Edited eight editions ▪ In its 14 edition 180 ..

Problems and Potential of Using Tests • • • •

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Test battery – test used as part of a group.

Test batteries only have value when interpreted by well-educated counselors.

Most testing problems are result of the way the instruments are administered and interpreted.

Those who oppose testing usually do for the following reasons: o Client becomes dependent on the counselor and on testing as a source of information for problem solving. o Counselor’s views of an individual may be prejudice due to test data. o Tests values are limited due the lack of validity and reliability of the test data.

To some people tests are culturally biased and discriminatory, measure irrelevant skills, obscure talent, are mechanical, invade privacy, can be faked, and foster undesirable competition.

Tests are regressive and used for predictability rather than for screening or for selfexploration.

Minorities – some tests have not taken into account the different influences and experiences of diverse cultures and ethnic backgrounds. o AACE has developed multicultural assessment standards. o Ethical Standards of the American Counseling Association also has guidelines for test use.

Success or failure with tests is related to the sensitivity, ability, and knowledge of the counselors who choose, administer, and interpret them.

In order to consider multiple criteria in the selection process, some counselors include clients in the process of test selection.

The general public’s attitude toward testing is positive. They believe the primary function of tests is to help clients make better choices about their futures.

Tests may be advantageous: o Help clients gain self-understanding. o Help counselors decide if clients’ needs are in their range of expertise. o Help counselors understand their clients better. o Help determine which counseling methods are more appropriate. o Help predict the future performance of clients in areas of interests. o Stimulate new interests in clients o Help with the evaluation of the outcome of counseling effort.

Qualities of Good Tests •

Validity o Most important test quality o Validity defined - Test measures what it says it measures. o Determined by comparing its results with measures of a separate and independent criterion. o If scores on a test correlates highly and positively with the independent measures of success, the test is said to have a high degree of validity. o Four types of validity: content, construct, criterion, and consequential: 181 ..

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Content Validity • Known also as face validity.

• The degree to which a test appears to measure what is says it measures.

• Concerned with whether the test includes a fair sample of the universe of factors it is supposed to assess.

• Associated with achievement, aptitude, and ability tests ▪ Construct Validity • Most general • The degree the test measures the construct or trait it says it measures, such as empathy or intelligence.

• Most applied to personality and interest inventories.

▪ Criterion Validity • The comparison of test scores with a person’s actual performance of a certain skill across time and situations.

• When the criterion is not available until after the test is administered, then the predictive validity of the test is being measured.

• Two well-known criterion-based tests used in counseling: o Minnesota Multiphasic Personality Inventory (MMPI-2) has concurrent validity o The revised Strong Interest Inventory (SII) – has predictive validity.

▪ Consequential validity • Newest type of validity • The social implications or consequences of test use and interpretation.

• Test score interpretations have both long-term and short-term effects on clients.

• Counselors should not be too dogmatic or authoritarian. o Meta-analysis of more than 125 psychological test validities found that psychological tests are comparable with the validity of most medical tests and have strong validity for use in the counseling practice, especially with a multimethod assessment procedure.

Reliability o A measure of the degree to which a test produces consistent test scores when people are retested with the same or an equivalent test. o A test score can be reliable without being valid. o Three ways of determining reliability: ▪ Test-retest: The same test is given again after a period of time.

▪ Parallel-form or alternate-form: Two equivalent forms of the same test are administered at the same time.

▪ Internal consistency analysis: Scores of two arbitrarily selected halves of a test are compared. Like cutting a test in half and comparing the first half with the last half. o Test results are either reliable or unreliable, not the test itself.

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Standardization and Norms o The uniform conditions under which a test is administered and scored. o Standardization allows for the comparison of client’s scores over time as well as the comparison of scores of different individuals. o Norms – average performance scores for specified groups.

Classification of Tests •

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Seven classifications of tests: o Standardized versus nonstandardized: Test administered and scored based on specific directions versus those that are not. o Individual versus group o Speed versus power: Timed test versus those giving plenty of time to express knowledge. o Performance versus paper and pencil: Manipulation of objects versus marking answers or giving a written response. o Objective versus subjective: Clearly right or wrong versus the interpretation of the responses by a counselor. o Maximum versus typical performance: Best performance versus likes such as an interest inventory. o Norm versus criterion based: Comparing individual’s scores with a group versus comparing an individual’s score with a desired level or standard.

Classification can be made by their intended purpose. Six categories of tests: o Mental ability o Aptitude o Achievement o Interests o Career development o Personality Elmore and Roberge classification of tests: o Educational o Vocational o Personal aspects of counseling Sylvania groups tests by their frequency of use. o Intelligence/scholastic aptitude o Vocational (and other aptitude) o Achievement/diagnostic

Intelligence/Aptitude • •

Intelligence – overloaded with certain functions, such as verbal ability…validated against measures of academic achievement…designated as tests of scholastic aptitude.

Alfred Binet developed the first intelligence test in the early 1900s: o Revised became the Binet-Simon scales. o Revised again became the Stanford-Binet Intelligence Scale by L.M. Terman in 1916 of Stanford University.

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David Wechsler developed a series of individually administered intelligence tests. o Provide a verbal IQ, performance IQ, and over-all IQ. o Much research has been performed on the Wechsler scales; usually are the instruments of choice with intelligence. o Includes: • Wechsler Preschool and Primary Scale of Intelligence – (WPPSI) for ages 4 to 6 years and 6 months • Wechsler Intelligence Scale for Children – (WISC ) – for ages 6 years to 16 years • Wechsler Adult Intelligence Scale - (WAIS) – for ages 16 years to 89 years Other individually administered intelligence tests: o Bayley Scales of Infant Development – low correlation with other intelligence scales o Vineland Social Maturity Scale o Kaufman Assessment Battery for Children (K-ABC) o McCarthy Scales of Children’s Abilities o Peabody Picture Vocabulary Test (PPVT) o Kaufman Adolescent and Adult Intelligence Test (KAIT) Group tests: o Developed in WWI when US Army created the Alpha and Beta intelligence tests to screen recruits and classify them for training according to ability level. o Otis-Lennon School Ability Test o Cognitive Abilities Test o Test of Cognitive Skills Aptitude o Designed to determine a narrower range of ability. o Aptitude: A capability for a task or skill. o Aptitude test – measures a person’s ability to profit from further training or experience in an occupation or skill. o Two categories: • Multi-aptitude batteries – test a number of skills by administering a variety of tests.

• Component ability tests – assess a single ability or skill, such as music. o Best known: • Scholastic Aptitude Test (SAT) • American College Testing (ACT) • Miller Analogies Test (MAT) • Differential Aptitude Test (DAT) • Armed Services Vocational Aptitude Battery (ASVAB)

Interest/Career •

Interest inventory – test or checklist that assesses a person’s preferences for activities and topics.

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Responses are compared with scores of others at a similar developmental level or with those working in a particular area.

Career interests inventories began in 1927 with the publication of the Strong Vocational Interest Blank (SVIB). o Revised in 1994, the Strong Interest Inventory (SII) o Included 207 occupations o Founded by E. K. Strong, Jr. on 10 Occupational Scales o Explained in three forms: ▪ General Occupational Themes ▪ Basic Interest Scales ▪ Occupational Scales o Linked to John Holland’s theory of career development. Proposes six major types of people and environments: ▪ R = realistic ▪ I = investigative ▪ A = artistic ▪ S = social ▪ E = enterprising ▪ C = conventional ▪ The closer the correlation between people and environment types, the more satisfying the relationship. o Self-Directed Search (SDS) revised in 1994 is also based on Holland’s six types.

▪ Self-administered, self-scored, and may be self-interpreted.

▪ 228 items divided into three sets: activities, competencies, and occupations ▪ A three-letter Occupational Code finder is compared with career codes found in the Dictionary of Occupational Titles (DOT). o Kuder Occupational Interest Survey (KOIS) ▪ First published in 1939 and latest revision was in 1991.

▪ Six forms of this activity preference, item-type, untimed instrument, forced-choice, and triad-response format.

▪ Some forms are computer scored, others are self-scored.

▪ Scores correlate highly with interests of select career groups and college majors.

▪ 10 broad career areas include: • Social services • Persuasive • Clerical • Computational • Musical • Artistic • Literary • Mechanical • Outdoor • Scientific o Career Beliefs Inventory (CBI) 185 ..

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Helps identify what beliefs might be blocking a client.

Best used at the beginning of career-counseling.

Helps with the exploration of deep-seated attitudes and assumptions.

Other interest/career tests: ▪ California Occupational Preference System ▪ Jackson Vocational Interest Survey ▪ Ohio Vocational Interest Survey ▪ Unisex Edition of the ACT Interest Inventory ▪ Vocational Preference Inventory Non-college bound student inventories: ▪ Minnesota Vocational Interest Inventory ▪ Career Assessment Inventory ▪ Career Guidance Inventory in Trades, Services, and Technologies

Personality • • • • •

Normal is determined by a culture.

Examine the biological, social, and environmental aspects of human beings.

Henry A. Murray, most popular 20th century theorist of personality assessment.

Personality test – any of several methods of analyzing personality, such as checklists, personality inventories, and projective techniques.

Two main categories: objective and projective o Objective: Scores are independent of opinions of the scorer.

▪ Minnesota Multiphasic Personality Inventory – (MMPI) • Most widely used test in the world.

• 10 clinical scales • Three major validity scales: Lie (L), Infrequency (F), and Correction (K) • Distinguishes people who are experiencing psychiatric problems.

• Discern characteristics such as anger, alienation, Type A behavior, and marital distress.

• Extensive training and experience is needed for accuracy and appropriateness.

▪ Myers-Briggs Type Indicator (MBTI) • Reflects Carl Jung’s theory of personality type.

• 166 two-choice items concerning preferences or inclinations in feelings and behaviors.

• Gives four indexes: o Extroversion or Introversions (E or I) o Sensing or Intuitive (S or N) o Thinking or Feeling (T or F) o Judgment or Perception (J or P) • 16 possible personality types based on the combinations of the four indexes • Different types appear to be attracted to certain occupations and lifestyles.

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Alternative test similar to the MBTI is the Keirsey Temperament Sorter and the Personal Preferences Self-Description questionnaire (PPSDQ).

▪ Edwards Personal Preference Schedule (EPPS) • Based on the need-press theory of personality developed by Henry Murray.

• 225 forced-choice questions examining the strength of 15 individual needs in relation to a person’s other needs.

• Scores are plotted on a percentile chart based on group norms.

• Other self-report personality tests include: California Psychological Inventory (CPI), Guilford-Zimmerman Temperament Survey, Mooney Problem Check List, Sixteen Personality Factor Questionnaire (16 PF), State-Trait Anxiety Inventory (STAI).

Projective: Measures depend on the judgments and interpretations of scorer/administrator.

▪ Less structured and more difficult to score.

▪ Harder for the client to fake.

▪ Rorschach Inkblot – first significant projective test published in 1921.

▪ Thematic Apperception Test (TAT) ▪ House-Tree-Person (HTP) Test ▪ Other tests: • Holtzman Inkblot Technique • Bender Gestalt • Draw-a-Person Test • Children’s Apperception Test • Rotter Incomplete Sentences Blank

Achievement • • • •

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Achievement test – measure of an individual’s degree of accomplishment or learning in a subject or task.

More direct and give client a good idea of what they have learned in a certain area.

Teacher made or standardized Advantages of teacher-made tests: o Measure specific units of study emphasized in an educational setting o Easy to keep up-to-date o Reflect current emphases and information Standardized tests o Measure more general educational objectives o More carefully constructed o Give the test taker a good idea how s/he compares with a wider sample of individuals in a particular subject.

Achievement tests are used for distinct purposes: o Schools – combination of teacher-made and standardized tests is linked to age and grade levels.

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General achievement batteries used in schools: ▪ TerraNova Tests ▪ Iowa Tests of Basic Skills ▪ SRA Achievement Series ▪ Metropolitan Achievement Tests ▪ Wide Range Achievement Test ▪ Stanford Achievement Test Measurement of adult achievement ▪ Adult Basic Learning Examination ▪ Tests of General Education Development (GED) ▪ Professional orientation tests of achievement • National Teacher Examination • Law School Admissions Test (LSAT) • National Counselor Examination (NCE)

Administration and Interpretation of Tests • •

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For test results to be valid, administrators of the test must follow the procedure and specialized instructions laid out in the test manual.

Having the test taker involved in the selection of the test may be beneficial. Some cases as with administration of achievement test in elementary schools is inappropriate for test taker involvement.

Advantages of involving test takers in test selection: o Willingness of the tested population to accept test results o Promotion of independence o Value of decision-making experience o Opportunity for diagnosis based on the test taker’s reactions to various tests o Selection of tests that best fit the needs of the tested population Four basic help interpretations o Descriptive interpretation – providing info on the current status of the test taker o Genetic interpretation – how tested person got to be the way s/he is o Predictive interpretation – forecasting the future o Evaluative interpretation – includes recommendations by the test interpreter Misuse of tests can result from administering and interpreting a good test in the wrong way or giving it to the wrong person for the wrong reason.

Ways to correct deficiencies in interpretive skills: o Counselor needs education in test theory and construction. o Scores should only be seen as clues. o Before meeting with a client, the counselor must be prepared to make a clear and accurate interpretation of test result.

▪ Begin with concrete information, such as interests or achievement scores, and then move to abstract information, such as personality or ability results.

▪ Emotional needs of the client must be considered.

▪ Only interpret test results on an as-needed basis.

Rapport between counselor and client must be achieved before test interpretation occurs.

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Miller’s five-point plan for interpreting test results to clients: o Have client remember feelings on the test day and give impressions of the test. o Review the purpose of testing and how test scores are presented. o Counselor and client examine the test results together and discuss what they mean by asking the client open-ended questions so client can integrate scores with other aspects of self-knowledge. o Incorporate all knowledge into a client-originated plan for continuing self-study. o Present results in a simple graph.

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Assessment – the procedures and processes of collecting information and measures of human behavior outside of test data.

Assessment has six purposes: o Obtain information on client’s presenting problem and related problems o Identify controlling or contributing variables o Determine client’s goals and expectations for counseling outcomes o Gather baseline data to motivate client o Use information to plan effective treatment interventions and strategies Variety of techniques: Standardized tests, diagnostic interviews, projective personality measures, questionnaires, mental status examinations, checklists, behavioral observation, and reports by other professions.

Goal – comprehensive evaluation of individuals, usually in the present Jongsma & Peterson manual that includes definitions of problematic behaviors with long and short-term goals.

One ways of conducting assessment is through biographical and behavioral measures; i.e., structured clinical interviews.

Mental status examination (MSE) is used in work settings requiring assessment, diagnosis, and treatment of mental disorders. Categories are: o Appearance o Mood o Speech and language o Thought process o Cognition o Insight and judgment

Diagnosis • • • • •

The meaning received from assessment information and translated in the form of a classification system A description of a client’s condition Some diagnostic categories are shared with clients; others are withheld.

Diagnoses can set up self-fulfilling prophesies for clients.

Diagnosis provide: o Person’s current functioning o Common language for clinicians to use in discussing the client 189 ..

o o o

•

Lead to consistent and continual care Direct and focus treatment planning Help determine treatment.

Importance of diagnosis: o Provides reimbursement to counselor by some insurance companies. o Helpful in developing a proper treatment plan for a client. o To communicate with other professionals, counselors must be able to speak about, understand, and report a client’s diagnosis.

CLASSROOM ACTIVITIES 1. Look on-line for educational and psychological test from major test publishers. Examine the variety of tests available and the information the publisher gives you about each. Try to group these tests under the four categories outlined in this chapter. What tests are easy to classify? Which ones are most difficult? Report your results to the class.

2. In pairs, do an in-depth report on one of the tests mentioned in this chapter or one recommended by your instructor. Be sure to notice the validity, reliability, standardization, and norms of the instrument. When you report your results to the class, explain when you think the instrument could be appropriately used in counseling.

3. Some counselors do not think that tests should be used in counseling. Divide the class into two debate teams. One side should take the position that counseling and testing are not compatible. The other side should advocate the use of tests in counseling. Discuss your conclusions.

4. In triads, discuss times when you have had a test interpreted for you. What did you think when the test interpreter explained your results? What do you remember most from the experience, e.g., the data, your feelings, your behavior? How does this experience still affect your reaction to tests, test interpretations, and the assessment process?

5. In groups of four, discuss the ethical and legal considerations of diagnosis. What issues does your group think are most sensitive? Consult the ethical codes and guidelines of professional associations on diagnosis. Share your group’s findings and opinions with the class as a whole.

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CHAPTER 12 - MULTIPLE CHOICE TEST QUESTIONS 1. “An objective and standardized measure of behavior” is an accurate definition of which of the following? a. psychological test b. interest test c. Diagnosis d. intelligence test 2. In order to understand a test, a counselor must know ______________. a. characteristics of its standardized sample b. reliability and validity results c. methods of administration d. all of the above 3. The XYZ assessment instrument is consistent but it does not measure the construct that it purports to measure. Which of the following statements is accurate regarding the psychometrics of the XYZ assessment instrument? a. It is reliable but not valid b. It is valid but not reliable c. It has content validity but not test-retest reliability d. It has construct validity but not internal consistency 4. The ABC instrument has been tested with an equivalent form of the instrument and has been found to be reliable. It has not been found to be reliable after it has been re-administered after a period of one month. Based on this information, which of the following statements is true regarding the ABC instrument? a. The instrument is valid but not reliable. b. The instrument has internal consistency but not test-retest reliability. c. The instrument has criterion validity but not test-retest validity d. The instrument has alternate-form reliability but not test-retest reliability.

5. The degree to which a test produces consistency of test scores is _____________. a. reliability b. validity c. correlation d. standardization 6. Which one of the following forms of validity refers to the comparison of test scores with a person’s actual performance of a certain skill across time and situations? a. content validity b. construct validity c. consequential validity d. criterion validity

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7. A test that must be completed within a specific period of time, such as an achievement test, is known as a ______________ test. a. speed b. power c. criterion-referenced d. performance 8. Which of the following is not considered a standardized intelligence test? a. Stanford-Binet b. Wechsler Series of Tests c. Kaufman Battery of Tests d. Myers Briggs Type Indicator 9. The Rorschach Inkblot Test is a(n) ____________ test. a. interest b. intelligence c. personality d. achievement 10. Which type of test interpretation involves forecasting the future? a. Evaluative b. Genetic c. Predictive d. Descriptive 11. Those who are employed as specialists in the area of testing and appraisal are known as ________________. a. psychologists b. psychometrists c. assessment counselors d. psychiatrists 12. Which of the following types of tests measures an individual’s degree of accomplishment or learning in a given subject or task? a. Achievement b. Aptitude c. Intelligence d. Interest/career 13. During a test interpretation, a counselor provides information on the current status of the test taker. This counselor is giving a ___________________. a. descriptive interpretation b. genetic interpretation c. predictive interpretation d. evaluative interpretation

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14. Nancy, who recently received a serious diagnosis, has since begun to behave in ways that are consistent with the diagnosis. Nancy’s behavior post-diagnosis may be an example of which one of the following? a. A dual diagnosis b. A diagnostic comorbidity c. A self-fulfilling prophesy d. An alternative behavioral conceptualization 15. Which one of the following terms is defined as the meaning or interpretation that is derived from assessment information and is usually translated in the form of some type of classification system? a. testing b. appraisal c. diagnosis d. counseling ESSAY TEST QUESTIONS 1. Discuss the historical linkage between counseling and tests. What are necessary qualities for good tests?

2. Describe the various classifications of tests and give examples of tests in each category.

3. Describe the potential benefits and limitations of diagnosis, as well as best practices counselors can employ to diagnose properly.

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ADDITIONAL RESOURCES Annenberg/CPB. (1992). Personality disorders [Film]. (Available from Insight Media, 2162 Broadway, New York, NY 10024-0621) This 60-minute video highlights the major features of several personality disorders, including the following: narcissistic, antisocial, obsessive-compulsive, and borderline personality disorders. Diagnosis and treatment concerns are explored. 1-800-233-9910 Films for the Humanities & Sciences. (1998). Diagnosis According to the DSM-IV [Film].

(Available from Films for the Humanities & Sciences, PO Box 2053, Princeton, NJ 08543-2053) This three-part series focuses on how to obtain the information needed in a clinical interview to make appropriate diagnoses. Real patients are seen in the series with a clinical discussion after each interview showing how the clinician obtained the necessary information to diagnose different disorders. Ten interviews are presented over the three videos (approximately 190-minutes total running time). 1-800-257-5126 Films for the Humanities & Sciences. (1998). Understanding schizophrenia, depression, and addiction [Film]. (Available from Films for the Humanities & Sciences, PO Box 2053, Princeton, NJ 08543-2053) This three-part video series illustrates the multifaceted components of schizophrenia, depression, and addiction. Real life patients are shown in this series to help enhance understanding about these disorders. The disorders are explained using the same process that is used to explain other medical conditions (64-minutes total running time). 1-800-257-5126 Films for the Humanities & Sciences. (1999). Depression: A cognitive approach with Dr. Arthur Freeman [Film]. (Available from Films for the Humanities & Sciences, PO Box 2053, Princeton, NJ 08543-2053) Dr. Freeman illustrates his techniques for working with depressed client from cognitive therapy approach. Dramatized segments from 21 real-life session are presented insight provided into what is occurring in treatment. (71 minutes in length) 1-800-257-5126 Insight Media. (1990). Testing and intelligence [Film]. (Available from Insight Media, 2162 Broadway, New York, NY 10024-0621) Philip Zimbardo hosts this 30-minute video in which he discusses the assessment instruments used to examine intelligence, personality, behaviors, and abilities. 1-800-2339910 Insight Media. (1995). The insider’s complete guide to the DSM-IV [Film]. (Available from Insight Media, 2162 Broadway, New York, NY 10024-0621)

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In this 274-minute video the history of the DSM system is examined along with the changes that were made to create the DSM-IV. Michael First discusses the rationale behind the changes and the problems that the workgroups faced in making these changes. 1-800-2339910 Sperry, L., Carlson, J., & Kjos, D. (Producers). (1998). Psychopathology and psychotherapy: Diagnosis and treatment [Film]. (Available from Taylor & Francis Group, 47 Runway Road, Levittown, PA, 19057) This 120-minute video uses actors to demonstrate the correct approach for DSM-IV diagnosis on all 5 axes. The video teaches the viewer crucial skills in making diagnoses.

Study guide included. 1-800-821-8312

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CHAPTER 13 CAREER COUNSELING OVER THE LIFE SPAN CHAPTER OVERVIEW The major theoretical approaches to working with individuals in choosing careers are examined in this chapter. A life span emphasis is highlighted. Topics dealt with include career information, career guidance, career development, and career counseling. The needs of specific populations at different ages and stages are explored, too.

KEY TERMS, CONCEPTS, AND PEOPLE Adult career counseling Bordin, Edward C=W+L Career Career counseling Career data Career Development Quarterly Career development theories Career fairs Career genogram Career guidance Career information Career information delivery systems (CIDS) Career pattern counseling Career plus life counseling Career shadowing Children’s Dictionary of Occupations Computer-assisted career guidance systems (CAGS) Computer-based career planning systems (CBCPSs) Crites, John Developmental approach to career counseling Developmental life-span career theory Developmental theories Differential approach to career counseling DISCOVER Emerging adults Ginzberg, Eli Glass ceiling Guidance Happenstance/serendipity Holland, John Integrative Contextual Model of Career Development (ICM) Job Journal of Employment Counseling Kuder Career Planning System Late adulthood 196 ..

Lavender ceiling Life-career developmental counseling National Career Development Association (NCDA) National Employment Counselor Association (NECA) NOICC (National Occupational Information Coordinating Committee) National Vocational Guidance Association (NVGA) Nontraditional careers Occupation Occupational counseling Occupational sex-role stereotyping O*Net Online Career Portfolio Parsons, Frank Patterson, C. H. Rainbow theory Research based assessments RIASEC (Holland’s six categories) Role overload Self-efficacy SIGI (System of Interactive Guidance and Information) Social-cognitive career theory Super, Donald Tiedeman, John Trait-and-factor theory Unrealistic aspirations Vocational counseling Vocational guidance Work Work-family conflicts (WFC) CHAPTER 13 – CAREER COUNSELING OVER THE LIFE SPAN The Importance of Career Counseling • • • •

Does not carry the same prestige as counseling or psychotherapy.

Most preferred by high school and college undergrads.

May be a good solution to emotional problems.

Important aspects of career counseling: o “The need for career counseling is greater than the need for psychotherapy.” o “Career counseling can be therapeutic.” o “Career counseling is more difficult than psychotherapy.”

Career Counseling Associations and Credentials •

Two divisions within the American Counseling Association (ACA) devoted to career development and counseling.

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o

o

National Career Development Association (NCDA) ▪ Formerly the National Vocational Guidance Association (NVGA) ▪ Since 1913 is the oldest division within ACA. ▪ Made up of professionals in business and industry, rehab agencies, government, private practice, and educational settings who associate with NCDA’s special-interest groups.

▪ Publishes the Career Development Quarterly National Employment Counselors Association ▪ Formerly a division of the NCDA ▪ Publishes the Journal of Employment Counseling

The Scope of Career Counseling and Careers • •

• • • •

•

•

Career counseling is a hybrid discipline.

Defined by the NCDA as a process of assisting individuals in the development of a lifecareer with a focus on the definition of the worker role and how that role interacts with other life roles.

Known by different names: vocational guidance, occupational counseling, and vocational counseling.

The word career is broader than the word occupation to define this field of counseling.

A job is an activity to gain economic returns.

Factors that career counselors must consider when helping with career decisions: o Avocational interests o Age or stage in life o Maturity o Gender o Familial obligations, and o Civic roles McDaniels emphasizes the idea of leisure in career. o C=W+L ▪ C = career ▪ W = work ▪ L = leisure Well-informed people may need less counseling services than others and respond well to this type of helping.

Career Information • • • •

Defined by NCDA as information related to the world of work that can be useful in the process of career development.

Guidance is usually reserved for activities that are mostly educational.

Career guidance includes all activities that disseminate information about vocations.

Guidance activities: o Career fairs o Library assignments o Outside interviews 198 ..

o o o o

• • • • • •

•

Computer-assisted information experiences Career shadowing Didactic lectures Experiential exercises such as role-playing Career guidance is conducted in schools as well as at governmental agencies, industries, libraries, etc.

According to C. H. Patterson, career guidance is for those who have no emotional issues that would interfere with career decisions.

Unrealistic aspirations, goals beyond a person’s capabilities, may create difficult vocational decisions that are less effective.

Qualitative and Quantitative information is necessary to make an informed decision.

Lack of enough information or up-to-date information is a reason behind lack of decision making or unwise choices.

References on careers and trends: o Dictionary of Occupational Titles o Occupational Outlook Handbook o Additional helps like What Color is Your Parachute?

Computer-assisted career guidance systems (CAGSs) – help individuals sort through values and interests or job information o SIGI (System of Interactive Guidance and Information ) contains five components: self-assessment (Values) o Identification of occupational alternatives (Locate) o Reviewing occupational information (Compare) o Reviewing information on preparation programs (Planning) o Making tentative occupational choices (Strategy) o DISCOVER contains nine modules: 1.

2.

3.

4.

5.

6.

7.

8.

9. o

Beginning the career journey Learning about the world of work Learning about yourself Find occupations Learning about occupations Making educational choices Planning next steps Planning your career Making transitions

NOICC (National Occupational Information Coordinating Committee)

Career Development Theories and Counseling • •

Explain why individuals choose careers.

Deal with the career adjustments people make over time. The average person changes jobs five times in a working life.

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• Trait-and-Factor Theory •

•

•

•

•

Origin can be traced back to Frank Parsons. o Stressed that the traits of clients should be first be assessed then matched with factors inherent in various occupations. o Widespread influence was during the Great Depression when E. G. Williamson championed its use. o Resurfaced in the 1950s and 1960s and is reflected in John Holland’s work. o Stressed the uniqueness of persons. o Originally assumed that a person’s abilities and traits could be measured objectively and quantified. o Personal motivation was considered relatively stable o Satisfaction in an occupation depended on a good fit between one’s abilities and the job requirements.

Modern form o Stresses the interpersonal nature of careers and associated lifestyles as well as the performance requirements of a work position. o Holland’s six categories in which personality types and job environments can be classified: ▪ Realistic ▪ Investigative, ▪ Artistic ▪ Social ▪ Enterprising ▪ Conventional o According to prestige levels ▪ Investigative occupations rank highest followed by ▪ Enterprising, ▪ Artistic, and ▪ Social.

▪ Lowest levels of prestige are Realistic and Conventional occupations.

Personal satisfaction in a work setting depends most on the degree of congruence between personality type, work environment, and social class o Women value language-related tasks more, and men value mathematics-related tasks more. o Economic or cultural influences account for reasons many workers accept and keep their jobs.

Holland’s theory o Three-letter codes represent a client’s overall personality which can be matched with a type of work environment. Remain stable over time o The interaction of letter codes influences the makeup of the person and his/her fit in an occupational environment.

Trait-and-factor career counseling: o First interview sees – gather information on client’s background and assigning tests. o Client takes batter of tests and returns for second interview for test interpretation.

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o

•

•

Third interview – client reviews career choices related to results and is sent out to find further information on specific careers.

Developmental Theories • More inclusive, more concerned with longitudinal expression of career behavior, and more inclined to highlight the importance of self-concept.

• Super believes that vocational development unfolds in five stages in which each stage contains a developmental task to be completed. o Growth (birth to age 14) – Children form a mental picture of themselves in relation to others. Become oriented to the world of work.

▪ Fantasy (ages 4–10) ▪ Interest (ages 11-12) ▪ Capacity (ages 13-14) o Exploration (Ages 14-24) – Focus is on the general exploration of the world of work and the specification of a career preference.

▪ Tentative (ages 14-17) ▪ Transition (ages 18-21) ▪ Trial (ages 22-24) o Establishment (ages 24-44) – Becoming established in a preferred and appropriate field of work.

▪ Trial (ages 24-30) ▪ Advancement (ages 31-44) o Maintenance (ages 44-64) – Preserving what one has already achieved. o Decline (age 65 to death) – A time for disengagement from work and alignment with other sources of satisfaction.

▪ Deceleration (ages 65-70) ▪ Retirement (age 71 to death) • Major Contributions – emphases on the importance of the life span in career decision making and on career decisions that are influenced by other processes and events in a person’s life.

• Conceptualized as career-pattern counseling.

Social Cognitive Career Theory • Social cognitive career theory (SCCT) was first published in 1994.

• It stems from the initial work of Albert Bandura and his emphasis on the triadic reciprocal model of causality. Self-efficacy is the most important part of his triad.

• SCCT can be used in a number of settings, such as with first-generation college students and with diverse groups.

• Krumboltz’s approach includes four factors that influence a person’s career choice: o Genetic endowment o Conditions and events in the environment o Learning experiences o Task-approach skills (e.g., values, work habits) • Career decisions are controlled by internal and external processes (Krumboltz).

• Results of continues learning include: self-observation generalizations, task-approach skills, and actions (Krumboltz).

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Career Counseling with Diverse Populations •

•

•

Career counseling and education are conducted with a wide variety of individuals in diverse settings.

• Reimbursement is a drawback to offering career counseling outside its traditional populations and settings. Career concerns are not covered in the DSM and most health care companies exclude this service from reimbursement.

• People have difficulties making career decisions related to three factors: lack of readiness, lack of information, and inconsistent information.

Career Counseling with Children • Begins in the preschool years and becomes more direct in elementary schools.

• During the first 6 years of school many children develop stable self-perceptions and make tentative commitments to vocations.

• In areas with limited employment opportunities it is beneficial to have a systematic program of career counseling and guidance in the schools focusing on awareness rather than firm decision making.

• Levels of career awareness may be raised through such activities as field trips to area businesses.

• Inviting parents into the elementary classroom and encouraging parents to invite students into their work environments expands awareness of careers. o Invite in speakers with nontraditional occupations. o Reading stories about or seeing videos about people and their typical activities on jobs. o Using the Children’s Dictionary of Occupations.

• Splete’s comprehensive program for working with children includes parent education and classroom discussion jointly planned by the teacher and counselor. o Three key career development areas at the elementary school level: selfawareness, career awareness and exploration, and decision making.

Career Counseling with Adolescents • The American School Counselor Association (ASCA) has developed role statements on the expectations and responsibilities of school counselors engaged in career guidance. o Emphasize that school counselors should involve others, both inside and outside the school, in the delivery of career education to students.

• Cole stresses career guidance activities in middle high school should include the exploration of work opportunities and students’ evaluation of their own strengths and weaknesses in regard to possible future careers. o Assets to be evaluated include talents and skills, general intelligence, motivation level, friends, family, life experience, appearance, and health.

• Senior high school – career guidance and counseling activities are related to students’ maturity. o Three emphasis: ▪ Stimulating career development ▪ Providing treatment ▪ Aiding placement 202 ..

o

•

•

Counselors provide students with reassurance, information, emotional support, reality testing, planning strategies, attitude clarification, and work experiences • Techniques in helping adolescents crystallize ideas about careers o Cognitive techniques ▪ Guided fantasies, such as imagining a typical day in the future, an awards ceremony, a mid-career change, or retirement.

▪ Providing fundamental information about career entry and development, for example a Career Day. ▪ Completing an occupational family tree to find out how present interests compare with the careers of family members. o Experiential and comprehensive techniques include such approaches as offering youth apprenticeships to provide work-based learning.

• Providing career counseling to at-risk high school students. o Mann’s four Cs (cash, care, computers, and coalitions) involve students in career explorations and development o Six guidelines for successful educational counseling programs for at-risk students: • Make a connection between a student’s present and future status • Individualize programs and communicate caring • Form successful coalitions with community institutions and businesses.

• Integrate sequencing of career development activities • Offer age- and stage-appropriate career development activities.

• Use a wide variety of media and career development resources, including computers.

Career Counseling with College Students • Half of all college students experience career-related problems. Most are uninformed.

• Services provided in higher education institutions: o Helping with the selection of a major field of study o Offering self-assessment and self-analysis through psychological testing o Helping students understand the world of work o Facilitating access to employment opportunities through career fairs, internships, and campus interviews o Teaching decision-making skills o Meeting the needs of special populations.

• Need life-career developmental counseling.

• In order to avoid problems and create realistic job previews (RJPs) of a specific job students should contact and interview people with knowledge about the careers they are considering.

Career Counseling with Adults • Career interest patterns tend to be more stable after college, although many adults need career counseling. o Experience cyclical periods of stability and transition throughout their lives. o Some have midlife career change as they enter their 40s and Erikson’s stage of generativity versus stagnation.

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▪

•

Some change careers due to becoming more introspective seeking more meaning in their lives.

▪ May seek career changes after a trauma such a death, layoff, or divorce.

• Some adults find themselves unhappy with their career and career decisions.

• Two ways of working with adults in career counseling: o Differential approach – avoids age-related stereotypes, gender and minority group issues, and the scientific and practical difficulties of dealing with life span problems.

▪ Career counselor can predict the characteristic ways a given person may cope with career problems using such approaches as Holland’s.

▪ Explains career shifts at any age. People who shifts careers seek to find more consistency between personality and environment. o Developmental approach – examines a greater number of individual and environmental variables.

▪ Proposes that adults are always in the process of evaluating themselves in regard to how they are affected by outside influences (e.g., spouse, family, and friends) and how they impact these variables.

▪ Focuses on a combination of six elements: • Developmental • Comprehensive • Self-in-group • Longitudinal • Mutual commitment • Multi-methodological ▪ Considers the person’s total identity over time.

• Chusmir stresses the interaction of multiple factors in the process that men undergo when choosing nontraditional careers.

Career Counseling with Women and Ethnic Minorities • Women and ethnic minorities have historically received less adequate career counseling than white males and have faced more barriers.

• Women o Career patterns have changed ▪ Children are being exposed to a variety of career choices.

▪ Women have moved into careers previously reserved for men. o Research findings ▪ Women in the workforce have risen from 20% in 1900 to 50% in the 1970s to 75% at present.

▪ Most career development theories were formulated for men or are incomplete. o Myths ▪ Occupational sex-role stereotyping • Viewing women a primarily mothers (nurturing), children (dependent) iron maidens (hard driving), and sex objects.

• Assuming that females prefer social, artistic, and conventional occupations.

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▪

•

“Glass ceiling” phenomenon – women are seen as able to rise only so far in a corporation because they are not viewed as being able to perform toplevel executive duties.

▪ Women and girls are not challenged to explore their abilities or gifts to their fullest.

• They may never work, develop low or moderate commitments to work, focus on “safe,” traditional, female-dominated occupations. o Other Barriers ▪ Company expectation of working far more hours than described in a job description.

▪ Attending certain events ▪ Being “one of the guys” o Combining Career and Family o Career plus life counseling – focuses on career issues along with personal and relationship issues. o Demographics and trends – shift in market needs may cause women to take service-producing jobs that pay less.

• Cultural Minorities o Have difficulty with discrimination practices, lack of marketable skills, and limited access to informal networks that lead to good jobs. o Interest patterns do not fall within Holland’s theory as European Americans. o High need for assistance in finding information about work: ▪ African Americans – 44% ▪ Asian/Pacific Islanders – 36% ▪ Hispanics/Latinos – 35% o Have special needs in regard to establishing themselves in careers.

▪ Need sensitivity to issues ▪ May be real or artificial barriers ▪ African-American youths • Need structured programs with positive role models that affirm cultural or ethnic heritage.

• Counselors help distinguish between barriers they have control and transcending those in which they have no control.

▪ Chinese- and Korean-Americans • Parents make career decision for their children.

• A neighborhood workshop to inform parents introduces them to American career opportunities.

• Need bilingual role models and career materials in native language.

Career Counseling with Gays/Lesbians/Bisexuals/Transgenders o Issue of disclosing their sexual orientation at work. o Career-counseling is needed to asses the fit between lifestyle preferences and specific work environments. o Stereotypes and biases must be considered. o Counselors 205 ..

▪

Must use gender-free language and become familiar with support networks for these members in the communities.

▪ Become informed about overt and covert discrimination in the workplace, such as blackmail, ostracism, harassment, exclusion, and termination. o “Lavender ceiling” – career plateaus early due to discreet prejudice by upper management against persons because of beliefs about them related to their sexuality.

CLASSROOM ACTIVITIES 1. Think back to your childhood and the careers you were aware of at that time. How do your early career dreams (before age 12) relate to your present professional aspirations? With the class discuss your memories and how they have or continue to influence you.

2. With another classmate discuss your opinions about the importance of including the concept of leisure in the definition of career. Do you agree with McDaniels’ emphasis, or do you think leisure is really a separate entity? Share your ideas with the class as a whole.

3. Read about and evaluate a technique that could be used in career information guidance with an age group that you are interested in. Share your information with the class in an oral report.

4. Evaluate Krumboltz’s theory of career choice in relation to an individual you know who is established in a career. Interview the person, if possible. Discuss with your classmates how Krumboltz’s theory was or was not verified by the information you obtained.

5. Which particular group covered in this chapter appeals to you most in regard to career counseling? Divide the class into groups according to preferences. Focus on areas you consider crucial for your group to master in regard to career decision making. Report your results back to the class as a whole.

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CHAPTER 13 - MULTIPLE CHOICE TEST QUESTIONS 1. Which one of the following terms refers to information related the world of work that can be useful in the process of career development, including educational, occupational, and psychosocial information related to working? a. Career data b. Career information c. Career aspirations d. Career portfolio 2. The word “career” is more ________ than the term “vocation” and ___________than the word “occupation.” a. ancient; broader b. inclusive; narrower c. narrow; broader d. inclusive; broader 3. Which of the following theories can be traced back to Frank Parsons and stresses that the traits of clients should first be assessed and then systematically matched with factors inherent in various occupations. a. Trait-and-factor theory b. Developmental theory c. Social-Cognitive Career Theory d. Constructivist Career Theory 4. According to McDaniels, the formula to illustrate the definition of a career is as follows (where C=career, W=work, L=leisure, J=job, F=free time), ___________. a. “C = W – L” b. “C = J + F” c. “C = W + L” d. “C = J/F” 5. Career fairs, career shadowing, and didactic lectures are all examples of ________. a. career counseling b. career guidance c. job coaching d. occupational enhancement 6. Mechanics who enjoy their work have a high ________ theme according to John Holland’s theory. a. conventional b. realistic c. social d. investigative 207 ..

7. Which one of the following is not a factor, according to Krumboltz’s theory, that influences a person’s career decision? a. Conditions and events in the environment b. Learning experiences c. Task-approach skills, such as values d. All of the above, according to Krumboltz, are factors that influence a person’s career decision.

8. During Donald Super’s _____________ stage, a person becomes stabilized in a career. a. growth b. establishment c. exploration d. maintenance 9. Which of the following, according to Social-Cognitive Career Theory, is a person’s beliefs regarding her or his ability to successfully perform a particular task? a. Self-efficacy b. Self-concept c. Self-dynamism d. Self-esteem 10. An appropriate career awareness activity for elementary school children is ___________. a. a lecture on banking b. a personal interview with a banker outside of class c. a field trip to the bank d. making a model of a bank 11. Which of the following is an appropriate career guidance activity for middle school youth? a. evaluations of student’s own strengths and weaknesses b. exploration of work opportunities c. apprenticeships d. involvement of people both inside and outside the school to help deliver career education.

12. Educational counseling programs that focus on high school students who are at risk of leaving school before graduation should include the following: a. a connection between the student’s present and their future status b. using a wide variety of media and career development resources c. coalitions with community institutions and businesses d. all of the above 13. The ______________________ approach to working with adults in career counseling contends that people who shift careers, at any point in life, seek to find more consistency between their personality and their environment. a. differential b. psychodynamic 208 ..

c. developmental d. social-cognitive 14. Which of the following describes a phenomenon in which women are seen as able to rise only so far in a corporation because they are not viewed as being able to perform top-level executive duties? a. Glass ceiling phenomenon b. Lavender ceiling phenomenon c. Work-family-conflict phenomenon d. Career discrimination phenomenon 15. Many cultural minorities have difficulty obtaining meaningful employment because of _____________. a. employers’ discrimination patterns b. lack of marketable skills c. limited access to informal networks that lead to good jobs d. all of the above ESSAY TEST QUESTIONS 1. How does career counseling with children and adolescents differ from career counseling with adults? How are the two similar? Be specific.

2. Explain the main concepts behind the Holland’s trait-and-factor theory and Super’s developmental theory.

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ADDITIONAL RESOURCES Magna Systems, Inc. (1999). Early adulthood – The world of work [Film]. (Available from Magna Systems, Inc., 95 West County Line Road, Barrington, IL 60010) This 29-minute video examines how young adults view the role of work in their lives. Major career development theories and the work stages of an “average” adult are highlighted.

Changes in the employment environment and dual-career families are also discussed. 1-800203-7060.

The New Careers Center, Inc. (1996). One stop career center video series [Film]. (Available from The New Careers Center, Inc, P. O. Box 339-RD, Boulder, CO, 80306) This five-video series offers a complete range of videos related to the different career search elements that are recommended for a effective search. The first video, Self-Assessment: The Work Activities Inventory, features how self assessment tools are used and the benefits of personality awareness (23 minutes). The second video, Informational Interviewing: A Foot in the Door, illustrates the steps one should take to getting the most out of an informational interview (20 minutes). The next video, Putting It All Together: Your Best Career Plan, focuses on assessing many different facets of one’s life to create a realistic and appropriate career plan (21 minutes). The fourth video, Career Exploration: Using the Internet, looks at how the internet can assist in a career search and what tools are available (22 minutes). The final video, Using Career Center Resources, discusses the variety of resources that career centers offer and how to use these materials in the most efficient manner (22 minutes). All five videos can be purchased separately or together as a set. 1-800-634-9204 The New Careers Center, Inc. (1995, 1998). Video guide for Occupational Exploration (Available from The New Careers Center, Inc, P. O. Box 339-RD, Boulder, CO,

[Film].

80306)

This video set includes 16 different videos that look at 12 major vocational categories. Each category is illustrated through interviews with people who work in each given profession.

This highly recommended series gives a real-life perspective on the advantages and disadvantages of different jobs. 1-800-634-9024

See the following catalog for a wide range of general and specific resources related to career counseling: The Whole Work Catalog by The New Career Center, Inc., P.O. Box 339-RD, Boulder, CO 80306. 1-800-634-9024.

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CHAPTER 14 COUPLE AND FAMILY COUNSELING CHAPTER OVERVIEW This chapter highlights the growth and uniqueness of couple and family counseling and the major associations that represent professionals in this specialty. The importance of developmental ages and stages, as found in the family life cycle, are emphasized. An overview of couple and family counseling is given along with the processes associated with different stages of the counseling.

KEY TERMS, CONCEPTS, AND PEOPLE Ackerman, Nathan Acquired cultures Aging family Alateen Al-Anon Alcoholics Anonymous American Association for Marriage and Family Therapy (AAMFT) American Family Therapy Association (AFTA) Baby boom Battle for initiative Battle for structure Bateson, Gregory Blended family Bowen, Murray Childless family Circular questioning Circumplex model of marital and family systems Codependent Communication Couple deShazer, Steve Division 43 of APA (Family Psychology) Double bind Dual-career family Enmeshment Epston, David Equifinality Family Family adaptability Family cohesion Family dance Family life cycle Family rules First order change Follow-up 211 ..

Frame Gay/lesbian family General systems theory Genogram Haley, Jay Homeostasis Homework Identified patient (IP) Inherited cultures International Association of Marriage and Family Counselors (IAMFC) Long-term goals Maintenance Marriage McGoldrick, Monica Mimesis Minuchin, Salvador Morphogenesis Multicultural family Multigenerational family Nonsummativity Nuclear family Overresponsible-underresponsible phenomenon Predicting setbacks Pseudo-individuation Psychoeducational assignments Reframe Ripple effect Satir, Virginia Scapegoating Second order change Single-parent family Stage-critical tasks Substance abuse families Tracking Triangulation Whitaker, Carl White, Michael Wynne, Lyman CHAPTER 14 – COUPLE AND FAMILY COUNSELING The Changing Forms of Family Life • Marriage is generally defined as a socially or religiously sanctioned union between two adults for economic and/or procreational reasons.

• Before WWII, two types of families dominate American cultural life: o The nuclear family 212 ..

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The multigenerational family After WWII, the divorce rate increased which added two more prevalent family types: o The single-parent family o The remarried family (i.e., blended, step) Current changes have added several other family forms: o The dual-career family o The childless family o The aging family o The gay/lesbian family o The multicultural family Couple and family counseling is a popular specialty: o Persons are directly affected by how their families function. o Financial considerations give way to the economics of counseling as a couple or family. o The nature of marriage and family counseling is intrinsically appealing.

The Beginnings of Couple and Family Counseling • Relatively new profession.

• Began around the 1940s and early 1950s, • Growth spurt around the late 1970s and the 1980s (Nichols, 1993).

• Popularity has followed changes in the American family (Markowitz, 1994).

Trends • Divorce rates o Sharp rise in the divorce rate at the end of WWII that leveled out in the 1990s. o Baby boom began in 1946. o Current divorce rate today is around 50% to 65%.

• Changing role of women o More women sought employment after WWII and became the main breadwinner. o Women’s rights movement of the 1960s changed traditions and expectations for women.

• Expansion of the life span Couple and Family Therapy Pioneers and Contemporary Leaders • Nathan Ackerman o New York City psychoanalyst o Applied psychoanalytic practices to the treatment of families.

• Virginia Satir and Carl Whitaker o Satir wrote and presented about family therapy. o Whitaker was a maverick with an unorthodox style and creativity.

• Jay Haley o The dominant figure of the early family therapists. o Gathered ideas from Milton Erickson and blended them with his own. o Developed strategic family therapy and influenced structural family therapy.

• Teams that worked with family dynamics and the etiology of schizophrenia o Gregory Bateson group in Palo Alto, California ▪ Double bind

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Murray Bowen and Lyman Wynne groups at the National Institute of Mental Health (NIMH).

▪ The genogram The group movement o John Bell – began the practice of couple/family group counseling. o Foreign-born therapists ▪ Salvador Minuchin – the originator of Structural Family Therapy ▪ Michael White and David Epston – founders of Narrative Therapy Recent Leaders o Steve deShazer and Bill O’Hanlon – developed brief therapeutic therapies. o Monica McGoldrick – emphasized multicultural factors and cultural background in treating families.

▪ Inherited cultures ▪ Acquired cultures o Betty Carter and others have focused on gender-sensitive issues in working with families. o John Gottman and Neil Jacobson – educated practitioners on the dynamics within marriages and families, such as domestic violence and higher functioning marriage relationships.

Associations, Education, and Research Associations • American Association for Marriage and Family Therapy (AAMFT) o Oldest, established in 1942 • International Association of Marriage and Family Counselors (IAMFC) o Division within the American Counseling Association (ACA) o Chartered in 1986 • Division 43 (Family Psychology) o A division within the American Psychological Association (APA) o Formed in 1984 o Consisted of psychologists who work with families • American Family Therapy Association (AFTA) o Formed in 1977 o An academy of advanced professional interested in the exchange of ideas.

Education • Guidelines for training professions in working with couples and families o AAMFT standards are drawn up and administered by the Commission on Accreditation for Marriage and Family Therapy Education (CAMFTE) o IAMFC are controlled through the Council for Accreditation of Counseling and Related Educational Programs (CACREP) Research • Approximately 50% of all problems brought to counseling are related to marriage and family issues: o Unemployment o Poor school performance o Spouse abuse 214 ..

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Depression Rebellion and self-concept issues.

Findings o Family counseling is at least as effect as individual counseling. o Some forms of family counseling are more effective than others. o The presence of both parents, especially non-compliant fathers, improves the chances for success. o Problems may worsen if the couple or family does not meet together. o High client satisfaction exists with marital and family counseling services.

Family Life and the Family Life Cycle • The family life cycles – stages a family goes through as it evolves over the years.

• Some families and family members achieve stage-critical tasks before others.

• Family cohesion and adaptability o Family cohesion – emotional bonding o Family adaptability – ability to be flexible and change • Most successful families o Functional o Happy o Strong o Balanced and committed o Appreciate each other o Spend time together o Have good communication patterns o Have a high degree of religious/spiritual orientation o Able to deal with crisis in a positive manner • Counselors need to be aware of the different family stages as well as to the developmental tasks of individual members. o Become aware of depression, career indecisiveness, and substance abuse • Assessment o Assessment should be based on the type of family and developmental stage of the family.

• Terms that describe family dysfunction o Enmeshment – over dependency on each other or undifferentiating o Triangulation – family fusion; other members pull additional members in two different directions • Counselors need guidelines; do not fail to act; do not overreact.

Couples/Family Counseling versus Individual/Group Counseling • Similarities o Some share theories. o Both recognize the family role in the individual’s life. o Both focus on problem behaviors and conflicts between the individual and environment. o Both are developmental.

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Counseling sessions are similar in organization, basic dynamics, and stage development. o Both have an interpersonal emphasis.

Differences o Some theories are unique to marriage and family counseling. o Individual counseling treats the person outside the family. o Couple and family counseling includes the involvement of other family members in the counseling. o Couple and family counseling resolves issues within the family in order to help individual members. o Family members are not equal in status and power. o Families may perpetuate myths, whereas groups are usually more objective. o Family members carry more emotional baggage. o Couple and family counseling has emphasis on dynamics. Individual and some group counseling focus on linear causality.

Questions that help the counselor become more attuned to the family (and couple) functioning and dynamics: o What is the outward appearance of the family? o What repetitive, nonproductive sequences are noticeable? o What is the basic feeling state in the family and who carries it? o What individual roles reinforce family resistance, and what are the most prevalent family defenses? o How are family members differentiated from one another, and what are the subgroup boundaries? o What part of the life cycle is the family experiencing, and what are its problemsolving methods?

Overview of Couple and Family Counseling Couples Counseling • Early pioneers focused only on the relationship.

• New emphasis considers three entities: two individuals and one couple.

• Reasons couples seek counseling: o Finances o Children o Fidelity o Communication o Compatibility • It is crucial that the counselor sees both members of the couple from the beginning. o Not doing so may cause harm. o Even one or two sessions with one spouse may increases resistance and anxiety in the other spouse. o Change in one spouse can cause conflict when the other spouse does not support the change or is not knowledgeable about the change.

• Five of the main approaches used when both partners attend counseling: o Psychoanalytic, o Cognitive-behavioral, 216 ..

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Bowen system, Structural-strategic, and Rational emotive behavior therapy • The theoretical basis for couple counseling is not as strong as it is for family counseling.

Most of the theories have been borrowed from individual and family theories.

Family Counseling • Different reasons families enter counseling: o Identified patient (IP) – an individual who is seen as the cause of trouble within the family structure. o Most counselors do not see one person as the problem but rather the whole family system. o Ripple effect – working with one family member in hope that changes in this individual will positively impact a family.

• Most family counselors operate from a general systems framework. View the family as an open system that evolves through the family life cycle in a sociocultural context.

• Functional families follow rules and are flexible.

• Family systems counselors stress circular causality.

• Concepts o Nonsummativity – The family is greater than the sum of its parts. o Equifinality – Origin may lead to different outcomes, and outcomes may result from different origins. o Communication – content (factual information) and relationship (how message is understood). The what of a message is conveyed by how it is delivered. o Family rules – explicit and implicit rules ▪ Redundancy principle - a small set of predictable rules. o Morphogenesis – family modification of its functioning to meet changing demands.

▪ Requires a second-order change – make a new response rather than a firstorder change. o Homeostasis – a steady, stable state of equilibrium.

• Genograms are used to help detect intergenerational patterns of family functioning that impact the present. o Draw three generations of the family. o Include names, dates of birth, marriage, separation, and divorce, along with current age and occupation.

The Process of Couple and Family Counseling • Based on several premises: o Persons conducting the counseling are psychologically healthy and understand their own families of origin.

▪ Prevents counselors from contaminating sessions with their own family life. o Counselors will balance the therapeutic process. For instance, not worrying about making everyone happy but keeping members involved. o Counselor wins the battle for structure while letting the family win the battle for initiative.

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Battle for structure – establish the parameters of counseling, such as how often they will meet.

▪ Battle for initiative – motivation to make needed changes. o Family counselors need to be able to see the couple or family difficulties in the context in which they are occurring.

▪ Be developmentally sophisticated on family and individual life.

▪ Have life experiences.

Presession Planning • Matters addressed before counseling begin: o The reason the caller for the initial session is seeking therapy. May not match the reasons of everyone else to seek or not seek counseling. o Counselor obtains essential clinical information: problem description and contact information. o Counselor listens for what is and is not being conveyed. Begins hypothesis about issues. o Schedules an appointment.

Initial Session(s) • The first few sessions are the most critical in predicting success.

• They provide a means in which a counselor evaluates how the family is functioning and what may need to be done to help.

• Get off to a good start. o Build rapport with each family member and the family as a whole. o Build a therapeutic alliance through: ▪ Maintenance – counselor supports a family member’s position, ▪ Tracking – counselor tracks a sequence of events, and ▪ Mimesis – counselor adopts family’s style or tempo. o Therapeutic alliances involve a frame: ▪ A perspective on how individuals view the presenting problem, person, or situation.

▪ Reframe – to change the frame; another way of looking at the situation.

• The counselor acts as an observer. o Looks for the family dance – the way the family typically interacts on verbal or nonverbal levels. o Scapegoating – blaming an individual for the family’s problems. o May probe and challenge the family members’ perceptions.

• Counselor clarifies what is happening in the family. o Asks circular questions – questions that focus attention on family connections and highlight differences among members. o Looks for triangulation – drawing in of a third person into a dyadic conflict.

• Counselor develops capacity to draw initial conclusions about the way the family behaves.

• Tentative goals are set and a return appointment is made.

The Middle Phase of Couple and Family Counseling • Sessions between the initial sessions and termination.

• Where needed changes are made by the family.

• Time in which new behaviors are explored and chances are taken.

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First-order change – superficial changes made by resistant families.

Second-order change – structured rules are altered.

• Counselor stays active mentally, verbally, and behaviorally.

• Counselor encourages family to go beyond just a cognitive understanding of the dynamics.

• Counselor links the family to outside agencies, such as AA. • Focus is continuously on the process of what is happening within the family. o Easiest changes usually come first. o Counselor pushes the family into changing cognitions, affective responses and behaviors.

• Counselor looks for evidence of stability of change.

• Counselor should stay in pace with the couple or family members and not get ahead of them. o Homework outside of the sessions keeps the family engaged and making progress. o Psychoeducational assignments, like reading a book, helps the family learn more and interact together.

Termination/Closure • The final phase of treatment.

• May be initiated by the family, the counselor, or both.

• Should not be sudden or seen as the highlight of counseling.

• Provides closure and is a means of assessing whether goals have been reached.

• Reasons why termination is being entered should be clarified.

• Counselor makes sure progress is summarized and celebrated so family feels stronger.

• Long-terms goals are set that gives family members something to think about and plan out.

• Predicting setbacks provides awareness so families do not become too upset.

• Follow-up conveys care and lets families know that they can return to counseling to finish anything they began or to work on other issues. Families realize that their progress is being monitored. o o

CLASSROOM ACTIVITIES 1. What family forms, e.g., nuclear, dual-career, blended, multicultural, etc., are you most familiar with? How do you think this knowledge could help or hinder you in working with couples and families?

2. Determine where you are in your own family life cycles. Talk with a classmate about what changes you anticipate making in the next few years because of life-cycle demands.

3. What are the advantages and disadvantages of working with individuals with family concerns on a one-to-one basis rather than a family counseling basis? Do you think it is possible to work effectively with only one member of a couple or family? Divide the class into two teams and debate the issue.

4. Which processes in couple and family counseling do you prefer or believe you might be best in accomplishing? What are the reasons behind your decision? Form groups with classmates who share your view and present your rationale to other class members.

5. Research the contributions of a pioneer in family counseling. What legacy did the person leave? Are there still processes or techniques this individual advocated that are used with 219 ..

couples and families today?

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CHAPTER 14 - MULTIPLE CHOICE TEST QUESTIONS 1. Before World War II, the two types of families that dominated American cultural life were the _____________ and ___________ families. a. nuclear, multigenerational b. single-parent, remarried c. dual-career, aging d. childless, gay/lesbian 2. A ____________ occurs when a person receives two contradictory messages at the same time and, unable to follow both, develops physical and psychological symptoms as a way to lesson tension and escape. a. double bind b. frame c. triangulation d. morphogenesis 3. The largest and oldest of the associations devoted to marriage and family therapy/counseling is ________________. a. American Association of Marriage and Family Therapy b. International Association of Marriage and Family Counselors c. Family Psychology (Division 43 of APA) d. American Family Therapy Association 4. A person in the family who is seen as the individual causing the most trouble within the family structure is called the ___________. a. weakling b. trouble maker (TM) c. target client (TC) d. identified patient (IP) 5. The redundancy principle refers to the fact that _______________. a. families seldom say anything new b. families operate on a small set of predictable rules c. families continue to do the same things over and over again d. families have limited relationships that repeat themselves 6. Family environments where members are undifferentiated or overly dependent on each other are referred to as _____________. a. triangulated b. nonsummative c. enmeshed d. configured 7. The concept that the same origin may lead to different outcomes and the same outcome may result from different origins is known as _____________________.

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coincidence happenstance equifinality morphogenesis

8. The tendency for a family to remain in a steady, stable state of equilibrium unless forced to change is known as _________. a. morphogenesis b. homeostasis c. equifinality d. nonsummativity 9. The statement that “the family is greater than the sum of its parts” exemplifies the concept of ___________. a. nonsummativity b. equifinality c. homeostasis d. morphogenesis 10. A counselor must initially win which battle in working with a family? a. Battle for Structure b. Battle for Initiative c. Battle for Change d. Battle for Maintenance 11. ____________ is the process whereby a counselor adopts a family’s style or tempo of communication, such as being jovial with a light-hearted family. a. maintenance b. mimesis c. tracking d. joining 12. The purpose of circular questions in family counseling is to _____________________. a. confuse the family and make them more amenable to therapy b. highlight family connections and difference among members c. draw a third person into a family conflict d. unbalance the power structure in the family 13. A superficial change within the way a family behaves is known as ________________. a. first-order change b. second-order change c. third-order change d. linear repetition 14. An example of a psychoeducational homework assignment that a couple counselor might give a couple is ______________.

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a. b. c. d.

attend an athletic event attend an artistic event watch television together read a book together

15. Termination can be initiated in family therapy most appropriately by ___________. a. the family b. the counselor c. both the family & counselor d. an outside agency ESSAY TEST QUESTIONS 1. In what ways might it be important for family counselors to know the different types of family forms and the family life cycle?

2. Compare and contrast actions you would take as a family counselor in each of the steps of the process, e.g., preplanning, initial session, middle phase, and termination/closure.

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ADDITIONAL RESOURCES Films for the Humanities & Sciences. (1999). Gay couples: The nature of relationships (Available from Films for the Humanities & Sciences, PO Box 2053, Princeton, 08543-2053)

[Film].

NJ

Dr. Pepper Schwartz explores the lives of two couples in this 50-minute video. One of these couples is gay and the other is lesbian. Schwartz examines each couples views on communication, conflict-resolution, family, friends, and the influence of gender and society.

1-800-257-5126 Films for the Humanities & Sciences. (1999). The legacy of unresolved loss: A Family Systems Approach with Dr. Monica McGoldrick [Film]. (Available from Films for the Humanities & Sciences, PO Box 2053, Princeton, NJ 08543-2053) This comprehensive video features Dr. Monica McGoldrick and her work with a family over an 18-week period. Dr. McGoldrick highlights different aspects of therapy and how to use different interventions to help families work through unresolved multigenerational loss. 1800-257-5126 Lerner, S. (Producer). (1993). Betty Carter’s clinical dilemmas in marriage: The search for equal partnership [Film]. (Available from Guilford Publications, Inc., 72 Spring St., Dept.

5Q, New York, NY 10012-9902) This 44-minute video illustrates ways to create positive solutions for couples experiencing difficulties in their home, work, and parenting lives. 1-800-365-7006 Lerner, S. (Producer). (1994). Evan Imber-Black’s family secrets: Implications for theory and therapy, [Film]. (Available from Guilford Publications, Inc., 72 Spring St., Dept.

5Q, New York, NY 10012-9902) This 43-minute video illustrates the connections between family secrets and symptoms.

Through a case example, techniques to help families work through their secrets are shown.

1-800-365-7006 Lerner, S. (Producer). (1995). Betty Carter’s addressing economic inequality in marriage: A new therapeutic approach, [Film]. (Available from Guilford Publications, Inc., 72 Spring St., Dept. 5Q, New York, NY 10012-9902) This 29-minute video uses a case-example of a couple experiencing difficulties after their children reach adulthood. The main approached utilized is to focus how working with the couples economic inequity could effect. 1-800-365-7006

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CHAPTER 15 PROFESSIONAL SCHOOL COUNSELING CHAPTER OVERVIEW This chapter examines elementary, middle, and secondary school counseling. It emphasizes the uniqueness in each type of counseling and the roles and activities of counselors at these various levels. Special attention is given to both preventative and remedial interventions made by counselors with children, parents, and school personnel. Strategies for developing effective and well-utilized counseling programs are explored, too.

KEY TERMS, CONCEPTS, AND PEOPLE African worldview American School Counselor Association (ASCA) Antibullying efforts ASCA National model Assessment service cluster At risk children Bibliotherapy Bubblegummers Bullying Career resource cluster Center for School Counseling Outcome Research & Evaluation Communication service cluster Community contact cluster Coping skills Counseling service cluster Crisis center cluster Crisis person Curriculum service Cyberbullying Deficit-based counseling Depression Developmental Counseling and Therapy Dinkmeyer, Don Divorce Ecological framework for school counseling Education trust Elkind, David Five C’s of Competency Gifted and talented studnts HELPING Human Development Center (HDC) model Individualized educational programs (IEPs) Information administration Information retriever Interactive bibliotherapy 225 ..

Interpersonal violence Keat, Donald Life skills training Mattering Middle school counseling Multiple concurrent actions Myrick, Robert National Defense Education Act (NDEA), Title V-A Needs assessments Parental divorce Peer mediators Peer mentoring Play materials Play reconstruction Play therapy Positive behavior support approach Prevention Prevention-based curriculum offerings Professional growth cluster Professional School Counseling Psychoeducational drama Remediation Resilience School-based health centers (SBHCs) School bonding School counseling School counseling program School-wide positive behavioral support (SWPBS) program Self-concept Self-counseling Self-esteem Service coordination Service coordinator Steering committee Strengths-based school counseling (SBSC) Student assistance programs (SAPs) Substance abuse Suicide Teacher-advisor programs (TAP) Teenage parenting Thematic groups Transescents Type A stress situation Type B stress situation Type C stress situation Wrap-around programs 226 ..

CHAPTER 15 – PROFESSIONAL SCHOOL COUNSELING Introduction • School counseling involves a wide range of ages, developmental stages, background experiences, and types of problems School children face overwhelming numbers of events and processes that temporarily and permanent impact them. Some o these events include alcohol and drug, changing family patterns, and teenage pregnancy.

• School counselors and comprehensive guidance and counseling programs help children and adolescents become better adjusted academically and developmentally.

• Outcome research o Children are helped to become better adjusted academically and developmentally while feeling safe. o They are helped to have better relationships with teachers. o Children have fewer problems in school. o Children earn higher grades.

The ASCA National Model • The ASCA National model supports the mission of schools by promoting o Academic achievement, o Career planning, and o Personal and social development.

• The four components of ASCA o Foundation (beliefs and philosophy, mission), o Delivery system (guidance curriculum, individual student planning, responsive services, systems support), o Management systems (agreements, advisory council, use of data, action plans, use of time and calendar), o Accountability (results reports, school counselor performance standards, program audit).

• ASCA National Model recommends that: o School counselors collaborate with parents, students, teachers, and support staff to focus on the development of all students. o Eighty-percent of school counselors’ time should be spent in direct contact with students. o Inappropriate duties assigned to school counselors should be replaced with appropriate responsibilities.

School Counselors at Various Levels • Professional literature focuses on three distinct school-age populations: elementary school children (Grades K-5), middle school children (Grades 6-8), and secondary school children (Grades 9-12).

Elementary School Counseling and Guidance • Newer area of development. Subject was first recognized in the 1950s.

• Reasons for slow development: o Many believed that elementary school teachers should serve as counselors. o Counseling was primarily concerned with vocational development. o The need for counseling was not recognized.

• First elementary school counselors were employed in the late 1950s.

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The National Defense Education Act (NDEA) title V-A was passed by congress in 1964 which included counseling services for elementary school children.

• The Joint Committee on the Elementary School Counselor issued a report defining the roles and functions of the elementary school counselor. o Cooperative effort between the Association for Counselor Education and Supervision [ACES] and ASCA. o Emphasized counseling, consultation, and coordination (ACES-ASCA, 1966).

• Government grants for training counselors were authorized in 1968.

• By 1972, more than 10,000 elementary school counselors were employed.

• Stabilization in the number of counselors in the 1970s was due to a decline in enrollment and economic problems.

• Accrediting agencies and state departments began mandating counseling services in the 1980s producing a counselor surge.

• A Nation at Risk released by the National Commission of Excellence in Education renewed interest in the specialty.

Emphases and Roles • Elementary school counselors work with children from a preventive and developmental perspective.

• Tasks regularly performed: o Implement effective classroom guidance, o Provide individual and small-group counseling, o Assist students in identifying their skills and abilities, o Work with special populations, o Develop students’ career awareness, o Coordinate school, community, and business resources, o Consult with teachers and other professions, o Communicate and exchange information with parents/guardians, and o Participate in school improvement and interdisciplinary teams.

• Research findings: o Majority of counselors surveyed in a California study reported spending most of their time in counseling, consultation, and parental-help activities. o A North Carolina study found similar results of counselor time spent counseling with individuals and groups and consulting with teachers o Pacific Northwest elementary school counselors expressed preferences involving consultation, counseling, and group work.

• Lowest-ranked and most inappropriate tasks given to counselors by school personnel: substitute teaching, monitoring lunchrooms or playgrounds, and acting as a school disciplinarian or student records clerk. Serving in these rolls costs counselor effectiveness.

• Counselor effectiveness: o Different theoretical approaches taken by elementary school counseling programs can have positive effects on the affective, behavior, and inter-personal domains of children’s lives and can have a positive effect on children’s achievement. o Keat’s multimodal approach called HELPING: • H – health • E – emotions 228 ..

L – learning P – personal relationships I – imagery N – need to know G – guidance of actions, behaviors, and consequences • Rationale for keeping and increasing elementary school counselors: o The fact that counselors can and do make a difference in the lives of children. o Handling difficulties during the younger years before they become more difficult problems. o Vision and follow through of a counselor can transform the culture of a school.

Activities • One responsibility of elementary school counselors is the law mandated reporting of child abuse.

• Most activities are prevention and remediation related.

• Prevention o Counselors emphasize the four Cs in order to create a positive school environment: ▪ Counseling services ▪ Coordination of activities ▪ Consultation with others ▪ Curriculum development o Counselors should make themselves known and establish links with others by publicizing who they are, what they do, and how and when they can help.

Publicizing is done through ▪ Orientation programs ▪ Classroom visits ▪ Offering prosocial classroom guidance lessons to the very young (3 to 5 years olds). o Working with parents and the community ▪ Having lunch with parents where they work.

▪ Family counseling interventions to focus on three primary subsystems: the family, the school, and the subsystem together.

▪ Multiple concurrent actions – accessing more than one set of services within the community at a time. o Classroom guidance ▪ Have a proactive, developmental, comprehensive approach to guidance programs: • Two to three large classroom meetings each week and twice as many small-group sessions • Focus on structured learning, such as self-understanding, decision making, etc.

▪ Address conflict resolution and peer mediation for students to learn peaceful and constructive ways of settling differences and preventing violence. o Peer counselor programs and consultation/education activities: • • • • •

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Peer helpers – selected and trained students who serve the school and the counselor in positive and unique ways.

• Help students get to know one another • Create and atmosphere of sharing and acceptance • Provide opportunities for other students to resolve personal difficulties • Enhance the problem-solving skills of the students.

▪ Consultation/education sessions for teachers, administrators, and parents address common concerns and teach new ways of handling old problems.

• Recognizing student diversity.

• Promoting communication skills between teaches and students.

• Providing classes on parenting skills that promote communication procedures and behavior management. o The counseling role serves as a prevention.

▪ At-risk children – Children most likely to develop problems due to backgrounds or current behaviors.

• Counselors can assess children’s functioning and devise intervention plans.

▪ Bullying – physical assault/threat, name-calling, teasing, stealing, etc.

• Counselors can provide positive adult role models and address negative influences such as parental discipline, negative peer models, lack of adult supervision, and neighborhood safety. o Prevention for groups and behaviors: ▪ Gifted and talented students • Counselors help with the management of stress, planning ahead, and not being overcritical of themselves or their abilities.

▪ Children and divorce • Counselors can offer classroom guidance on the topic with information to alleviate negative stereotyping and myths.

• Small group counseling may concentrate of specific needs to prevent further problems.

Remediation – the act of trying to make a situation right. o Children’s self-esteem ▪ Related to self-concept or how they perceive themselves.

▪ Results from comparing oneself to others in a peer group, or how well one likes what is seen.

▪ Enhancement of self-esteem of low-self-esteem children at risk for failure by • Focusing on the “Five Cs of Competency” 1. Critical school academic competencies, 2. Self-concept, 3. Communication skills, 4. Coping ability, and 5. Control • Focusing on skill building, such as social skills, problem-solving skills and coping skills.

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Making environmental changes and modifications. o Determine what needs to be remediated by using needs assessments.

▪ Needs assessments – structured surveys that focus on the types, depths, and scope of problems ▪ May be purchased, borrowed and modified, or self-made by a school staff.

▪ Four areas uncovered through needs assessments: school, family relations, relationships with others, and the self. o Counseling strategies for remediation sessions ▪ Best when built around techniques that require active participation.

▪ Three strategic interventions that help counselors establish rapport: • Play Therapy 1. Children express emotions by manipulating play media such as toys.

2. Counselors participate in the play process and establish rapport and a helping relationship.

3. Approaches – many approaches can be used, but Jungian and person centered are the most popular.

4. Play materials fall into three broad categories: real-life toys, acting-out or aggressive toys, and toys for creative expression.

• Bibliotherapy 1. The use of books or media to help children gain insight into their problems to find solutions.

2. Counselors may summarize stories, openly discuss characters’ feelings, explore consequences of a character’s action, and draw conclusions.

3. Non-threatening approach for abused children. Examples include 1. I Can’t Talk About It 2. My Body is Private • The use of games 1. A safe and non-threatening connection to children’s problems.

2. Familiar to children and valued by them.

3. Fun and enhance the counseling relationship.

4. Used with problems such as assertiveness, anger, selfcontrol, anxiety, and depression.

Middle School Counseling • Came into prominence in the 1970s.

• Transescents or bubblegummers – middle school children between the ages of 10 and 14 and grades 6 through 9.

• Middle school children are adjusting to body changes and experiencing pressure from peers and demands by the school, conflicting attitudes of parents, as well as other selfidentity problems.

• Major physical, intellectual, and social developmental tasks include: o Becoming aware of increased physical changes 231 ..

o o o o o o

Organizing knowledge and concepts into problem-solving strategies Making the transition from concrete to abstract symbols Learning new social and sex roles Identifying with stereotypical role models developing friendships Gaining a sense of independence Developing a sense of responsibility.

• Three basic stress situations: o Type A – foreseeable and avoidable o Type B – neither foreseeable nor avoidable o Type C – foreseeable, but not avoidable • Middle school students experience more anxiety than other school age groups. o At risk for not achieving or successfully resolving developmental tasks. o Counselors can offer different and creative ways to experience the world.

Emphases and Roles • Counselors emphasize a holistic approach to stress growth and development and the process of transition involved in leaving childhood and entering adolescence.

• Counselor roles include: o Working with students individually and groups, o Working with teachers and administrators, o Working in the community with education agencies, social services, and businesses, and o Partnering with parents to address unique needs of specific children.

• The ideal counselor role includes: o Individual counseling, o Group experiences, o Peer support systems, o Teacher consultation, o Student assessment, o Parent consultation, and o Evaluation of guidance services.

• Publicity and delivery of services is crucial.

Activities • Prevention • Succeeding in School approach • These are 50-minute classroom guidance units geared toward helping children become comfortable with themselves, their teachers, and their schools.

• Multimodal. Children participate actively in the learning process with lesson plans focusing on prosocial aspects of personal and institutional living.

• Morganett’s group counseling activities for young adolescents.

• Activities that develop skills for living.

• Small groups focus on dealing with anger, grief, stress, divorce, assertiveness, and friendship.

• Individual counseling, peer counseling, and consultation activities

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Use of the Developmental Counseling and Therapy (DCT) approach that incorporates developmental concepts from individual theories and family theories and multicultural theories.

• DCT provides a systematic approach to relate to middle schoolers in their preferred developmental orientation.

• Peer mentoring • An older student is paired with a younger student. The older student accepts and teaches the younger student through a cooperative learning arrangement.

• Mentoring may increase parental relations and self-esteem, better conflict resolution skills, and enhance organization skills.

• Teacher-advisor programs (TAP) • Based on the grounds that guidance responsibility belongs to everyone including teachers who are needed to supplement the guidance counselor due to too many needs and not enough trained counselors.

• Teachers become more involved with counselors and the nonacademic lives of their students.

• Remediation • The best way to remediate is to combine remediation with prevention.

• Develop a rapport with students, teachers, parents and the community and coordinate middle school counseling and guidance services with others to provide the most productive program possible.

• A counselor’s job includes coordinating service activities as well as delivering direct services when able.

• Eight service areas vital to middle school counseling and guidance program: 1. Communicate service cluster is concerned with public relations.

2. Curriculum service cluster concentrates on facilitating course placements and academic adjustment.

3. Assessment service cluster provides testing and evaluation services.

4. Career resource cluster focuses on the student’s future goals and vocation.

5. Counseling service cluster are provided on an individual, peer, and group level and are offered during off-school and in-school hours.

6. Crises center cluster may include a crisis person who is available during the day to deal with emergencies and help the counselor find ways to assist a child in distress.

7. Community contact cluster focuses on working with parents and others to open communication lines between the school and other agencies.

8. Professional growth cluster provides programs for school staff and paraprofessionals.

Secondary School Counseling and Guidance • Began in the early 1900s when its primary emphasis was on guidance activities that would help build better citizens. o Frank Parsons influenced the early growth of the profession. o John Brewer 233 ..

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Pushed for the establishment of the secondary school guidance in the 1930s.

▪ His ideas of assisting young people in living through guidance and education flourished later under the name life skills training.

• Its growth more than tripled during the 1960s from about 12,000 secondary counselors in 1958-1959 to more than 40,000 in 1969-1970.

Emphases and Roles • Tasks of high school counselors: o Providing individual and group direct counseling, o Providing educational and support services to parents, o Offering consultation and in-service programs to teachers and staff, o Facilitating referrals to outside agencies, o Networking to postsecondary schools and businesses, and o Advising academically.

• Secondary counselors are faced with two conflicting needs: o Engaging in student counseling and o Doing academic administrative tasks, such as scheduling.

• Counselors must combat inappropriate roles by developing and publicizing what they do and how they do it to students, teachers, principals, and administrators. Steps to publicizing include o “Writing monthly newsletters o Posting the counselor’s schedule o Distributing the American School Counselor Association (ASCA) role statement, o Developing a guidance service handbook, o Making presentations at faculty meetings,” and o Pointing out the cost efficiency of a correctly performed job.

• The Peer survey o Opinions of secondary school counselors: 1. Principals, superintendents, students, college and university personnel, other secondary school counselors, and counselor educators held secondary school programs in highest regard.

2. Teachers, parents, community leaders, and business leaders were less positive. o Secondary school counselors are not seen as being actively involved in group counseling or group guidance, not serving as consultants, and not making an impact on most students. However, the counselors were viewed as nondisciplinarians, well qualified, and helpful to individuals.

• Improvement on the perception and behavior of secondary school counselors include emphasizing roles that meet real needs. o Counselor must function as facilitators in student-adult interactions and adultadult transactions.

• The counseling program must be constantly remodeled. o Evaluation, not just implementation, of services must be conducted periodically to keep services and roles appropriate and current.

Activities • Prevention 234 ..

o o

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Preventive services “need to be comprehensive, multifaceted, and integrated because problems inside and outside of the school are interrelated.

Education in the classroom provides prevention. Students become more selfreliant and feel less peer pressure. This approach enhances relationship between the teacher and counselor and student and counselor.

Ways for counselors to build primary prevention programs: 1. Become familiar with current popular songs to understand subcultures and help adolescents cope with their problems.

2. Run groups, particularly groups based, on themes of similar problems that students are experiencing.

3. Teach prevention-based curriculum offerings in classes.

1. Topics include: anxieties about school and tests, study skills, interpersonal relationships, self-control, and career planning.

2. Two major advantages: 1. Less time needs to be devoted to remediation and intervention activities.

2. Counselors maintain a positive high profile with teachers and students.

3. Bibliotherapy can be integrated as part of the curriculum offerings.

Four examples of problem areas in which prevention can make a difference: 1. Substance abuse 1. These prevention programs work best when they are started early in students’ lives, based on social influence models, tailored to the age and stage of different student groups, and involve student, parents, teachers, and community members in the planning process.

2. Multidimensional approaches with at-risk students increase selfesteem, reduce negative peer influence, and provide drug information.

3. Student assistance programs (SAPs) set up by counselors in schools are composed of school personnel from a variety of backgrounds and function similar to a multidisciplinary special education team in schools.

2. Adolescent suicide/homicide 1. Suicide and homicide prevention programs focus on broad-based approaches that stress the seriousness of such violence and alternatives.

1. Facts 1. Suicide is the fastest-growing cause of death among adolescents in American society.

2. Homicide rates, especially multiple deaths in schools, have increased dramatically in recent years.

3. Suicide attempts occur almost every minute, making approximately 775,000 attempts annually.

4. Girls attempt suicide more than boys; however, boys are more successful.

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5. Boys tend to be exclusive perpetrators of adolescent homicides.

2. Suicide and homicides are multi-determined phenomena and need a variety of interventions to prevent them.

1. Help students, parents, and school personnel to become aware of danger sings and alert counselors and other mental health professionals. Involve school peers, families, and significant others in the community Wrap-around programs have multiple services provided by a team of many mental health professionals, including counselors, who work together to provide direct assistance to the youth at risk of violence and their families and community/school personnel.

2. Common factor – among those contemplating suicide and homicide are feelings of depression and anger.

1. Prevention programs should deal with improving self-esteem and coping with loss and rejection.

2. Programs should also be aimed at preventing copycat and cluster suicides and making the community aware.

3. Prevention should also focus on identifying individuals at risk for either suicide or homicide.

3. Prevention of HIV infection/AIDS 1. Counselors may or may not persuade students to change their sexual activity.

2. Counselors can help adolescents avoid the contraction of AIDS and other sexually transmitted diseases (STDs) by providing an informational and skills-based intervention system.

1. Counselors can provide information about how HIV is spread.

2. Counselors can simulate situations that are potentially hazardous.

3. They can support teenagers who want to make positive behavioral changes.

4. Support groups, workshops for parents and administrators, and peer education programs can also be provided.

5. Peer education is one of the strongest deterrents of engaging in destructive behaviors.

4. Interpersonal violence/Abusive relationships 1. Counselors work with students in groups to emphasize that slapping, pushing, and emotionally threatening language are not normal or necessary parts of interpersonal relationships.

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2. Counselors teach students violence-prevention strategies such as anger management, assertiveness, and responsible verbal and nonverbal communication.

3. An example of a prevention model is Dating Safely.

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Remediation o Remediation and intervention programs help students with specific problems that are not prevention techniques. o Common mental disorders of childhood and adolescence express themselves in such ways as problems centering around adjustment, behavior, anxiety, substance abuse, and eating. o Counselors at times must identify, assess, refer, and sometimes treat disorders found in the DSM. Most of the time counselor consult with other mental health providers and focus only on the behaviors that occur in their setting. o Three most prevalent problems are depression, parental divorce, and teenage parenting.

1. Depression 1. Depression is related to negative life stress.

2. As many as 15% of all school children bay be depressed due to external stressors.

3. Among the variety of approaches to depression the most prominent are 1. Lazarus’s multimodal model, 2. teaching the student how to develop self-esteem, 3. helping the student become aware of depression and the stress factors that influence it, and 4. teaching relaxation procedures, new coping skills and ways of modifying negative self-messages.

2. Parental divorce 1. About one million children experience divorces each year, and about 45% of all American children can expect their families to break up before they reach the age of 18.

2. Counselors can provide direct and indirect services to help children, parents, and teachers adjust.

3. Direct interventions include individual and group counseling services within the school for the children 4. Indirect services include consulting with teachers and parents about the children’s feelings.

3. Teenage parenting 1. Counselors must develop outreach strategies for working with pregnant teens.

2. Personal and career concerns must be addressed along with making necessary referrals.

3. Prevention of a second pregnancy becomes an essential task for the counselor.

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4. Another task for counselors is to keep unwed mothers and fathers in school and increasing their success in academic, personal, and interpersonal arenas.

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Cooperation and Facilitation o The counselor must become involved with others outside of direct counseling services. o Counselors can become more involved with teachers, administrators, and sponsors of extracurricular activities in order to integrate their views into the total life of the school. o Devoe and McClam stress the importance of three counselor roles: 1. Information retriever – the counselor works alone or with other professionals to collect information about particular complex situations, such as abuse.

2. Service coordination – the counselor determines his/her competencies to meet particular students’ needs. If the counselor is not competent a referral is made.

3. Information administrator – the counselor coordinates a plan in which individuals or agencies in nonschool counseling settings deliver student services. o Individualized Education Programs (IEPs) 1. IEPs provide a tailored educational program to meet the specialized needs of certain children.

2. Counselors engage in either direct interventions or support services with students.

21st-Century School Counseling • School counselors are frontline mental health professionals for students and families who present the gamut from normal developmental issues to serious dysfunctional problems.

• School counselors are encouraged to be involved in a variety of educational and mental health initiatives.

• In the 21st century, school counselors’ roles within schools and society are both evolving and being debated.

• The Educational Trust has charted “A New Vision for School Counselors”.

• In the 21st century, school counselors will need to define who they are more definitively as well as deal with external forces that wish to define or confine them.

CLASSROOM ACTIVITIES 1. In groups of three, talk about your perceptions of and experiences with counselors in your elementary, middle, and high schools. How did they exemplify the roles outlined in this chapter? What were the best things they did for you or your school? What could they have done differently to improve their services?

2. Read several articles focusing on the influence of the ASCA National Model® and the Educational Trust initiative on school counseling. What outcomes or trends do you notice?

What does this information tell you about the direction in which school counseling is headed?

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3. Reflect on your life as a middle school student. What were your greatest concerns then, and how did you handle them? With another classmate, share your reflections (to the point you feel comfortable doing so). What counselor-related activities do you think might have been helpful to you then?

4. What do you think are the greatest concerns of high school students today? Write down your top five ideas. Share them with other classmates in groups of three, and then compare your rank-ordered group list with the class as a whole. How much agreement exists among the class? As a class, discuss ways of addressing one of these problems.

5. Pretend that you are an elementary school counselor. Design a guidance lesson on the topic of your choice. Then either tell or show the class how you would carry out your plan. What is your rationale for choosing your topic? How might children in your class eventually benefit from the experience?

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CHAPTER 15 - MULTIPLE CHOICE TEST QUESTIONS 1. Elementary school counseling is unique in its emphasis on ____________. a. remediation b. discipline c. prevention d. parents 2. Which of the following is/are considered appropriate tasks for elementary school counselors? a. classroom guidance b. consultation c. group counseling d. all of the above 3. Each of the following activities is helpful for elementary school counselors to use in remediation practices EXCEPT _____________. a. play therapy b. bibliotherapy c. needs assessments d. orientation programs 4. Middle schoolers are sometimes referred to as ___________. a. bubblegummers b. intranscients c. junior adults d. mid-life adolescents 5. Which kind of stress is foreseeable and avoidable? a. Type A b. Type B c. Type C d. Type D 6. A “Type B” stress situation is ___________. a. foreseeable and avoidable b. neither foreseeable nor avoidable c. foreseeable but not avoidable d. none of the above 7. In the Human Development Center (HDC) model, a middle school counselor _____________. a. solicits the help of others in performing tasks b. performs all the tasks in the service cluster c. works primarily at the task of public relations d. focuses only on development

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8. Which one of the following terms refers to an adaptive process whereby an individual willingly makes use of internal and external resources to overcome adversity or threats to development? a. Wraparound self-efficacy b. Resilience c. Remediation d. Service coordination 9. Primary prevention at the secondary school level can _______________. a. help students avoid parental advice b. help students become more reliant upon their peer relationships c. help students be more self-reliant d. help students get along better with teachers 10. In adolescence, depression is positively related to which one of the following? a. negative life stress b. resilience c. rapport with school counselors d. coping skills 11. Peer counselors in the schools ______________. a. help students get to know one another b. create a positive atmosphere c. help students resolve personal difficulties d. all of the above 12. The “Succeeding in School” approach to working with middle schools is multimodal in focus and _____________. a. involves passive learning b. involves peer counselors c. involves active learning and prosocial behavior d. involves reading guidance lessons 13. Which of the following refers to connecting students to their schools and the people and organizations within the school? a. school bonding b. Success in School program c. Wraparound programs d. Life skills training 14. What percentage of American children can expect their families to break up before they reach the age of 18? a. 22% b. 34% c. 45% d. 68% 241 ..

15. A counselor who is operating as an information administrator would perform which of the following tasks? a. Collect information or work with other professionals to collect information about particularly complex situations. b. Coordinates a plan in which individuals or agencies in non-school counseling settings deliver student services. c. Determines whether he or she has the expertise to meet particular students’ needs. d. All of the above are tasks of an information administrator.

ESSAY TEST QUESTIONS 1. Compare and contrast the emphases and roles of elementary, middle, and secondary school counselors with each other.

2. Compare and contrast the present focus of school counseling with the new vision of it proposed by the Education Trust.

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ADDITIONAL RESOURCES American School Counselor Association. (1986). Elementary school counseling: From dream to reality [Film]. (Available from American Counseling Association, 5999 Stevenson Avenue, Alexandria, VA 22304) This 11-minute video is designed for use as a public relations tool to help explain the unique role an elementary school counselor plays in the school environment. This video is appropriate for use with anyone interested in what a school counselor does at their elementary school (teachers, parents, board members) or in learning more about becoming an elementary school counselor (students). 1-800-422-2648 Barkley, R. A. (1997). Managing the defiant child: A guide to parent training [Film].

(Available from Guilford Publications, Inc., Dept. 5Z, 72 Spring Street, New York, NY 10012) This 34-minute video demonstrates a behavior management approach to use with children that can enhance the parent-child relationship. A 32-page manual accompanies the video. 1800-365-7006 Barkley, R. A. (1997). Understanding the defiant child [Film]. (Available from Guilford Publications, Inc., Dept. 5Z, 72 Spring Street, New York, NY 10012) This 34-minute video features Dr. Barkley and a close look at ODD. This is an excellent informative resource for parents, teachers, and helping professionals who work with children. A 28-page manual accompanies the video. 1-800-365-7006 Films for the Humanities & Sciences. (1999). Attention Deficit Disorder: The diagnosis and treatment of Attention Deficit Disorder in children [Film]. (Available from Films for the Humanities & Sciences, PO Box 2053, Princeton, NJ 08543-2053) The main focus of this video is on how to diagnose ADD and what are the best treatment methods. Dr. John Ratey and Dr. Ned Hallowell discuss these issues and profile an alternative education program for children with this disorder. 1-800-257-5126 Films for the Humanities & Sciences. (1999). Learning disabled [Film]. (Available from Films for the Humanities & Sciences, PO Box 2053, Princeton, NJ 08543-2053) The dilemmas that face parents of children with learning disabilities are the focus of this 25minute video. Different educational options are explored with input from parents, teachers, and students. 1-800-257-5126 Films for the Humanities & Sciences. (1999). Society’s problems in children’s lives [Film].

(Available from Films for the Humanities & Sciences, PO Box 2053, Princeton, NJ 085432053)

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Several experts, Dr. Carl Bell, Joy Dryfoos, and Dr. Katherine Kauffer Christoffel, discuss the societal problems today that adversely affect children and adolescents. 1-800-257-5126 Films for the Humanities & Sciences. (1999). Teen depression [Film]. (Available from for the Humanities & Sciences, PO Box 2053, Princeton, NJ 08543-2053)

Films

Several teenagers share their stories of personal experience with clinical depression in this 16-minute video. Dr. William Del Monte from the Mayo Clinic provides information about the causes, symptoms, and treatment options for depression. 1-800-257-5126 Films for the Humanities & Sciences. (1999). Writing about coming of age [Film]. (Available from Films for the Humanities & Sciences, PO Box 2053, Princeton, NJ 08543-2053) This program looks at the journey to adulthood through the eyes of some of the best contemporary authors. These authors discuss the difficulties that children face when coming of age and the rites of passage associated with this development. (24 minutes in length) 1800-257-5126 Goldstein, A. P., & McGinnis, E. (no date-1998?). The skillstreaming video: How to teach students prosocial skills [Film]. (Available from Research Press, Dept 99, P.O. Box 9177, Champaign, IL 61826) This 26-minute video with accompanying books, Skillstreaming the Elementary School Child and Skillstreaming the Adolescent, examines how staff can help kids with their social and behavioral problems. A training session is shown in which the authors work with a small group of youth on their prosocial skills. 1-800-519-2707 Insight Media. (1982). School professionals and parents [Film]. (Available from Insight Media, 2162 Broadway, New York, NY 10024-0621) Using 13 vignettes, this 22-minute video looks at communication problems between families and schools. 1-800-233-9910 Insight Media. (1995). Conflict resolution: Elementary grades [Film]. (Available from Media, 2162 Broadway, New York, NY 10024-0621)

Insight

This 25-minute video explains how to teach the skills needed to resolve conflicts at the elementary school level. Two elementary school conflict-resolution programs are presented.

1-800-233-9910 Moustakas, C. (1998). Relationship play therapy [Film]. (Available from Western Psychological Serves, 12031 Wilshire Boulevard, Los Angeles, CA 90025-1251) This video illustrates how play therapy from a child-centered perspective can help children experiencing both temporary and more long-term troubles. A real session is shown with

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Moustakas illustrating how to implement therapeutic limits with a hostile client. A book on the subject can be included with the video. 1-800-648-8857 Rosenthal, H. (1989). Suicide prevention audio tapes: Crash course for counselors & therapists [Audio Tapes]. (Available from Taylor & Francis Group, 47 Runway Road, Levittown, PA, 19057) This 2-tape set is designed to be used by professionals to enhance their skills in suicide prevention. 1-800-821-8312.

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CHAPTER 16 COLLEGE COUNSELING AND STUDENT-LIFE SERVICES CHAPTER OVERVIEW This chapter traces the history and theories associated with college counseling and student-life services. Professional preparation is addressed, too. In the chapter there is an emphasis on the roles and activities of both college counselors and the student-life professionals. Common problems among college students are discussed along with prevention and remedial approaches in working with this diverse population, including the needs of nontraditional college students (e.g., older students, first-generation students, minority culture students, and student athletes).

KEY TERMS, CONCEPTS, AND PEOPLE Administrative model Adaptive coping strategies Adult children of alcoholics (ACOAs) Alcohol abuse American College Counseling Association (ACCA) American College Personnel Association (ACPA) Behavior (B) is a function (f) of person (P) and environment (E) Berdie, Ralph Binge drinking BRIMS Campus-wide programs and individual assistance Chickering, Arthur Cognitive-structural theories Cognitive discomfort or cognitive dissonance College Adjustment Scales College counselors Comprehensive programs Council for the Advancement of Standards in Higher Education Counseling as: psychotherapy, vocational guidance, as traditionally defined, consultative, global Counseling model Cube concept Depression Developmental model Directed and counselor-centered approach Eating disorders Emerging adulthood English residential liberal arts tradition Erikson, Erik First-generation college students First-year experience Friendsickness German university tradition Helicopter parents 246 ..

Holland, John In loco parentis Journal of College Counseling Journal of College Student Development Lewin, Kurt Major life crisis Mandated referrals Morrill Land Grant Act (1862) Motivational interviewing Nontraditional students Peer counselors Person-environment interaction theories Precontemplative stage of readiness Primary prevention Psychosocial theories Resident assistants Sanford, Nevitt Secondary prevention Senior students Service learning Sexual assault and violence Social Readjustment Rating Scale Student athletes Student development Student life professionals Student paraprofessionals Student personnel point of view (Minnesota point of view) Student services model Suicide Tertiary prevention Type A behavior Typological theories US paradigm Williamson, E. G. CHAPTER 16 – COLLEGE COUNSELING AND STUDENT-LIFE SERVICES Introduction • •

Currently, higher education enrolls around 20 million people annually. o Approximately 30% of US population had a bachelor’s degree or higher.

Student-life services in higher education include co-curricular activities, support programs, and counseling. o Student-life services and counseling emerged at the beginning of the 20th century.

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o Student Personnel Point of View began at the University of Minnesota. This counseling model set the precedence for other programs that followed after World War II when the federal government began funding for diverse services and other completing points of views evolved. o These services have been known as the field of student affairs since the 1970s. o Sometimes student-life services and college counseling are connected; sometimes they are not.

• Offices involved in student-life services vary. o Professionals involved in student-life include those employed in financial aid, admissions, career planning and placement, health education, campus unions, registration, residence life, advising, and international activities. o Services offered include services connected with ▪ Student behaviors (e.g., achievement, attrition, campus activities) ▪ Describing student characteristics (e.g., aptitudes, aspirations) ▪ Student growth (e.g., cognitive, moral, social/emotional) ▪ Academic performance (e.g., study skills). o These professional hold memberships in professional organizations including: ▪ The American College Personnel Association (ACPA). ⬧ The ACPS was affiliated with ACA until 1992. ⬧ ACPS was organized in 1924 and has changed names.

▪ The American College Counseling Association (ACCA), a division of the ACA since 1992. ⬧ ACCA members are professional who work mostly in colleges and universities and identify themselves as counselors.

▪ The National Association of Student Personnel Administrators (NASPA), Division 17 (Counseling Psychology) of the APA, and the postsecondary division of the American School Counselor Association (ASCA).

▪ A united organization of professionals who work in various college student-life services has been attempted several times through the years but has not been successful.

• Leading periodicals in student-life services include: o The Journal of College Student Development o The National Association of Student Personnel Administrators Journal o The Journal of College Counseling o New Directions for Students Services (published by Jossey-Bass) is a themeoriented quarterly series that is influential and popular.

The Beginning of Student-Life Services and College Counseling •

Began by default over nearly 300 years of history in American higher education due to: o The passage of the Morrill Land Grant Act in 1862 which established and created dominance of state universities in American higher education. o The growth of pluralistic opinions and populations among US college students

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o Change in faculty role: professors no longer took roles in encouraging student character and no longer played parental roles o Faculty interest in research and intellectual development increased o Faculty interest in institutional governance decreased o Helping professions such as counseling developed o Documentation by Sanford that student development during the college years can be promoted by challenge and support and that curriculum and cocurriculum activities can initiate, accelerate, or inhibit developmental change.

Grew rapidly in higher education between the end of World War 1 and the depression of the 1930s. o A strong theoretical rationale for implementing student-life programs was not formulated. o Many student-life professionals were terminated during the Great Depression because of lack of funding and definition of job duties.

College counseling as a profession began in the late 1940s. o Faculty and college presidents served as the counselors before that time. o Students who entered college were perceived as well adjusted causing a delay of college counseling. Psychiatrists were considered the only help for mentally distressed college students. o After World War II counseling psychologists and counselors were allowed to work with students in newly formed campus counseling centers. These centers were set up to provide help for the large number of veterans who returned to colleges. o After World War II, counseling psychologist won the privilege to work with clients as psychiatrists did.

The Theoretical Bases and Professional Preparation for Working with College Students •

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College counseling and student-life services involve understanding how college students of all ages learn, grow, and develop. o Very few professionals understand student development theory or practice. o College counselors need to distinguish between normal problems tied to developmental struggles, such as autonomy, identity, and intimacy and more serious or chronic problems of psychological disturbance.

Theoretical Bases o Three traditions dominate among theoretical models as guides in working with students experiencing predictable developmental situations. o In loco parentis ▪ This model gives faculty and staff the parental role of teaching moral values. o Student Services ▪ This model emphasizes the student as consumer and mandates services that facilitate development. This is a cafeteria-style manner of programs offered. Students select what they think they need. o Student Development

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This model creates research-based environments that help college students learn and develop.

Four kinds of developmental theories guide professional’s activities.

Psychosocial theories o Chickering contends that there are seven specific developmental tasks of college students: competence, autonomy, managing emotions, identity, purpose, integrity, and relationships. o Chickering elaborates and specifies Erik Erikson’s ideas about the developmental processes of youth. o College counselors and student-life professional can plan and evaluate their practices and programs around three key issues: career development, intimacy, and formulations of an adult philosophy of life.

Cognitive-structural theories o These theories focus on how individuals develop a sense of meaning in the world. o They deal with perception and evaluation and are best described in the moral and intellectual models of Perry and Kohlberg. o These models are process oriented, hierarchical, and sequential. Each new stage contains the previous one and is a building block for the next one. o Cognitive discomfort is the impetus for change.

Person-environment interaction model o Refers to various conceptualizations of the college student and the college environment and the degree of congruence that occurs when they interact. o Congruence leads to satisfaction, stability, and perhaps, development. o Stress that development is a holistic process that involves all parts of the person with the environment in an interacting way. This model is similar to psychosocial theory in assuming that development in one area of life can facilitate growth in another area, such as volunteering facilitates the understand of environmental needs. o Unlike psychosocial theories, they are not developmental per se. They are rooted in Kurt Lewin’s formula.

Typological theories o Focus on individual differences, such as temperament, personality type, and patterns of socialization. They persist over time and include combinations of types. o Personality patterns influence individuals to vary in their developmental growth patterns and are related their motivation, effort, and achievement.

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o John Holland’s theory expresses the connection between personality and work environments.

Professional Preparation o Student-life professionals diversify among their functions. Therefore, no single professional preparation program can meet the needs of all graduate students. o The Council for Accreditation of Counseling and Related Educational Program (CACREP) provides different specialty standards for the field. o Specific course work and experiences needed for graduation have been outlined bye the Council for the Advancement of Standards for Student Services/Development Programs.

College Counseling •

Emphases and Roles o Emphases and role of college counselors vary and are influenced by the models under which they operate. o Four main models of counseling services that college/university counseling centers have followed: ▪ Counseling as psychotherapy – long-term counseling emphasized with small percentage of students. o Emphases: personality change.

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o Referrals: Vocational and educational concerns referred to academic advisers.

Counseling as vocational guidance – deals with academic or vocationally undecided. o Emphases: helping students relate academic and career matters. o Referrals: Refers those with personal or emotional problems to other agencies.

Counseling as traditionally defined – Counselor’s role is diverse. o Emphases: broad range of counseling services (short- or longterm, personal, academic, and career) Counseling as consultation – Counselor offers indirect services to students through interventions.

o Emphases: work with the various organizations and personnel who have a direct impact on student mental health. o Counseling as global is a fifth model that has recently been advocated. o Counselor’s role: Counselor works interactively with others in the college/university community.

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Emphases: Target (individual or group), purposes (remedial, preventive, or developmental), methods (direct, consultation and training, or media); based on the “Cube” concept.

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Activities o Similarities exist between activities of college counselors and student-life professionals. o Nine counseling functions: ▪ Academic and educational counseling ▪ Vocational counseling ▪ Personal counseling ▪ Testing ▪ Supervision and training ▪ Research ▪ Teaching ▪ Professional development ▪ Administration o Personal, vocational, and educational counseling account for more than 50% of college counselors’ time. o Application of counseling theories in college counseling: ▪ RET can be effective in reducing Type A behavior.

▪ Person-centered was found to be effective in helping students with present and future plans.

▪ Systems theory has been effective in helping students understand family - dynamics, interaction, and patterns.

▪ Brief therapy has been used with nonfamilial members in a campus community. o Educational and preventive programs must be modified to deal with current issues.

▪ Student culture is constantly changing.

▪ Depression and depressive symptoms are a commonality among college students. o The College Adjustment Scales is useful in screening students for developmental and psychological problems and is useful for determining what services and programs need to be emphasized. o Peer counselors ▪ Students turn first to friends for help, then to close relatives, then finally to faculty and counseling services.

▪ Resident assistants (RAs) take on this role. o Counseling services and programs can be offered in conjunction with other student-life professionals. The most needed services include: ▪ Alcohol o Alcohol-related problems are prevalent on college campuses.

Close to 90% of students drink alcohol sometime during an academic year.

About 20% of students who drink are heavy drinkers, averaging one ounce of alcohol per day per month.

Binge drinking is increasing with one in three college students drinking primarily to get drunk

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Irresponsible drinking may lead to violence: date rape, unsafe sex, academic difficulties, and suicide.

Alcohol abuse may bring students in contact with counselors and other student-life professionals. o Before effective treatment can take place, students need to realize their need for help. o Intervention can be individual or in groups.

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o Treatments vary, including insight and behavioral change. o Other treatments include identifying roles in family-life dramas. Peer counseling may also be helpful.

Sexual Abuse and Violence o Matters related to sexual abuse and violence include incest and rape. o Women are primarily affected. o Most college related cases involve alcohol 90% of the time where the assailant, the victim, or both have consumed alcohol

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o Two-stage recovery process: Acute – characterized by disorganization.

Long-term reorganization – includes dealing with the pain of trauma and rebuilding one’s life through support.

Eating Disorders o This problem area includes bulimia and anorexia nervosa. o Women with these disorders usually have maladaptive cognitions or faulty information concerning weight control. o An estimated 65% of women in their first year of college display some characteristics of an eating disorder. o Programs are productive that highlight the characteristics of the eating disorders and ways to combat the eating disorders before they get full-blown.

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o These programs can also provide a safety net for those already in a bulimic cycle.

Depression o College students approximately are twice as likely to have clinical depression and dysthymia as are people of similar ages and backgrounds in the workforce. o Depression and symptoms often interfere with learning and lead to a lack of success. o Approaches that are effective include: Cognitive approaches, such as Beck’s thought modification process; Behavioral approaches, such as helping clients engage in activities where they have success; and 253 ..

Cognitive-behavioral approaches, such as rational emotive behavior therapy. o Depression seems to be modified through positive life experiences. o Preventive action ▪ Tertiary prevention – is similar to remediation and includes direct services such as counseling.

▪ Secondary prevention – is geared toward existing problems on campus and is aimed at raising awareness among potential victims and perpetrators.

▪ Primary prevention – focuses on stopping problems from developing by modifying the environment, addressing causes, and providing training.

Student-Life Professionals •

Emphases and Roles o Student-life services originally focused on helping new students adjust to campus life. o The emphasis has expanded to include older returning students. o An increased concern for all aspects of the college/university community includes working with minority culture students and students with learning disabilities. o Student-life professionals work increases during specific times of the year, such as during orientation and finals. o Certain problems are universal regardless of age or stage of development, such as health, anxiety, and depression. o Other concerns are specific to student populations.

▪ First-year college students

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o May need help during their initial months Face challenges of managing time, making choices about courses, taking academic tests, and coping with fellow students, handling finances, and coping with family and personal problems.

Based on the Social Readjustment Rating Scale, 12 of the 43 items almost exclusively apply to first-year college students in their adjustment to a new environment.

New students who face other changes outside the college/university environment are likely to move in the “major life crisis” category.

Many institutions employ special student-life staff to work with each incoming class to enhance the first-year experience and initially promote positive individual development as well as a sense of community.

Greek life and rush The fraternity and sorority systems may produce feelings of depression among students who are not offered bids. Student-life 254 ..

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professionals may offer assistance in finding fulfilling peer groups for these individuals o Impaired academic performance ▪ Regardless of prevention attempts, approximately 10% of all students encounter emotional difficult during college that impairs academic performance.

▪ Stress to pass exams or get into a professional school increases the incidents of major depression.

▪ About 40% to 60% of students who begin 4-year institutions do not graduate. Lack of intervention may aid these numbers.

▪ Stress of college may also lead to suicide, Approximately 6 out of every 100,000 college students in the US commit suicide. o Predictors of staying in school and maintaining good mental health are related to student-life services.

▪ Student-life professionals offer campus-wide programs and individual assistance.

▪ The goal of comprehensive programs is to make a positive impact on students and help them identify problems or concerns at strategic points where intervention strategies may be most beneficial.

Activities o Student life activities are related to the specialty area in which the student-life professionals work: ▪ Administrative model – admissions, records, food, health, and financial aid ⬧ This model is based on the emphasis of administrative, serviceoriented unit…that provides many facilitating and development activities.

▪ Developmental model – stresses education, such as decision-making skills like leadership seminars. ⬧ Counseling model – emphasizes social and emotional growth in interpersonal and vocational decisions.

▪ Seminars may include topics of interests, such as dating, careers, or stress. o Paraprofessionals ▪ A national survey found that 72% of college/university student affairs division use student paraprofessionals to supplement and implement their offerings.

▪ Paraprofessionals are undergraduate students who have been selected and trained to offer services or programs to their peers.

▪ Paraprofessionals are employed in residence halls and orientation programs, crisis lines, student judiciaries, academic advising, financial aid, international student programs, and student activities.

Counseling and Student-Life Services with Nontraditional Students •

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o Common characteristics of nontraditional students is financial independence (51%), part-time attendance (48%), and delayed enrollment (46%). o Nontraditional students are the majority at most colleges and universities now, with many of them enrolled in public two-year college.

Older Students o Many nontraditional students are older than the traditional college age. Over half of all undergraduate students are more than 50% of all graduate students are over age 30. o Older students are highly motivated, prefer interactive learning, have family and financial concerns, view education as an investment, and have multiple commitments and responsibilities that are not related to school. o Two subgroups exist: ages 25 to 50 and ages 50 to 80.

▪ Ages 25 to 50 Subgroup ⬧ Return to college because of changing job or career requirements or opportunities that include family life transitions (e.g., marriage, divorce). ⬧ The focus of the student life services is to build self-esteem and provide academic and social support.

▪ Senior Students Subgroup ⬧ Come to campus for many reasons, such as to obtain degrees and find personal enrichment. ⬧ Counselors and student life services much focus on considerations, such as modifications to the environment, the students’ developmental stage, the pace of counseling, difficult areas of counseling and different techniques. o Increase in nontraditional students ▪ Nontraditional students will increase because of business downsizing, the rapid advance of technology, and increased opportunities for professional development.

▪ More females than males will enroll.

▪ The number of part-time students will increase.

▪ More cultural and racial monitories will seek a college education.

Part-Time Students o Part-time students make up about 40% of students in higher education. o As a group they are at a distinct disadvantage: ▪ They come from minority and low-income family backgrounds.

▪ They are not as well-prepared for college as their full-time peers.

▪ They are highly concentrated in 2-year colleges and nondegree/certificate programs.

▪ Many of them work full time while enrolled in classes and are not enrolled continuously. o College counselors and student personnel professionals must make special efforts to stay in contact with students as they transition in and out of classes.

First-Generation Students o These are students who are the first in their family to enter college.

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o Backgrounds vary – including second-generation immigrants and upwardly mobile poor o Needs ▪ They must master knowledge of the college environment, such as vocabulary (e.g., GPA).

▪ They must commit to the student roll, decipher the value systems of second-generation college students, and gain understanding of studentlife services and study skills.

▪ Language barriers and social customs must also be addressed.

Minority Culture Students o Minority cultures in the US are predominantly African American, Native American, Asian American, or Hispanic/Latino. o Additional challenges ▪ First-generation, older, and/or student athletes ▪ Also experience a lack of support and an unwelcoming academic climate. o College counselors and student-life personnel can offer ▪ Encouragement and social support and tangible means to foster ethnic pride, such as Black History Month.

▪ Small-or large-groups events that promote and enhance ethnic identity and self-concept, and ▪ Mentoring. o Campus environment ▪ If racism and stereotyping are apart of the climate, then counseling and life-skill strategies that effectively respond to these degrading influences need to be fostered and self-efficacy promoted.

Student Athletes o Problems ▪ May have problems relating to the university system and the larger society. o Viewed by others ▪ Often seen as problem students who have trouble relating either socially or academically. o Minorities ▪ Many are from minorities and are first generational students. o Coach dependence ▪ Many of these students are dependent on a coach or team. Therefore, they become isolated from the mainstream college life. o College counselors and student-life personnel can offer ▪ Time management and social skills.

▪ Integrative transition back to college for those who lose eligibility or become injured.

▪ Provide emotional and cognitive basis by helping athletes identify and express their feelings. Personnel may also have to confront and correct irrational thoughts.

▪ Career counseling and life-planning skills beyond the college years.

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CLASSROOM ACTIVITIES 1. Check your college library to see which of the journals mentioned in this chapter it subscribes to. Examine recent issues of the journals and find an article that you think is interesting. Summarize the contents of this article for your classmates in an oral report.

2. Invite a resident assistant at your college/university to discuss his or her job with the class. How does the actual job compare with your idea of what it could be? What parts of the position do you find appealing or not appealing?

3. Ask a professional in the student-life services division at your college/university to describe the universal and unique aspects of his or her job with your class. Discuss how student-life services activities relate to academic activities. How might the two be linked even more closely?

4. College/university students are bright and articulate. What theories do you imagine might be effective with this population that would not be as useful with a less educated group?

5. What concerns or problems on your college campus do you think college counselors and student-life professionals should address? Pretend that you have been asked to set up programs to take care of these situations. What are some steps you might take to be effective?

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CHAPTER 16 - MULTIPLE CHOICE TEST QUESTIONS 1. Which of the following is an example of a student behavior that might be the target of a student life service? a. Student aspirations b. Student grades c. Student attrition d. None of the above 2. When the institutional focus of a university is on educating the whole person, the university is using a ____________ tradition. a. German university tradition b. U.S. paradigm c. English residential liberal arts tradition d. French experience 3. Which of the following influenced the establishment and eventual dominance of state universities in American higher education? a. Passage of the Morrill Land Grant Act b. World War II c. Sputnik d. all of the above 4. The model in college counseling and student life services that emphasizes the student as consumer and mandates services that facilitate development is known as _______________. a. in loco parentis model b. student services model c. student development model d. cognitive consumption model 5. _______________________ theories focus on how individuals develop a sense of meaning in the world. a. Cognitive-structural b. Person-environment interaction c. Psychosocial d. Typological 6. Arthur Chickering’s psychosocial theories concentrate on three key issues that include _________________. a. intimacy b. academic achievement c. career development d. “A” and “C” but not “B”

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7. The model of counseling services that emphasizes working with various organizations and personnel who have a direct impact on student mental health is counseling as _________________. a. psychotherapy b. consultation c. vocational guidance d. traditionally defined 8. Students who receive counseling services in college ______________. a. usually drop out b. are more likely to stay in school and have improved mental health c. have lower grades d. “B” and “C” only 9. When seeking help, college students commonly turn to _________________ first. a. friends b. faculty c. close relatives d. counselors 10. Which of the following statements is accurate regarding binge drinking? a. It is defined as having five or more drinks at a time for men and four or more drinks for women. b. It is defined as having five or more drinks at one time for men or women. c. It is defined as having seven or more drinks for men and six or more drinks for women at one time. d. None of the above is accurate regarding binge drinking.

11. Stages within the recovery process of sexual assault and rape include _________________. a. the acute (disorganization) and long-term reorganization b. the chronic (total disorganization) and healing c. the manifestation of anger and cathartic behavior d. total numbness and then total anger 12. It is estimated that up to _________ of women in their first year of college display some behavioral and psychological characteristics of disturbed eating. a. 35% b. 50% c. 65% d. 80% 13. Student life professionals and counselors who address problems that already exist on campus (e.g., date rape) are acting on a __________ prevention level. a. primary b. secondary c. tertiary 260 ..

d. remedial 14. Over the traditional four years of college, ___________ percent of all students encounter an emotional difficulty that is serious enough to impair academic performance. a. 5 b. 10 c. 30 d. 45 15. College students who are over the age of 50 are referred to as ____________. a. young-old students b. generativity students c. senior students d. none of the above ESSAY TEST QUESTIONS 1. Compare the emphases and roles of student-life services professionals with those of college counselors. Which occupation appeals to you the most? Why? 2. Describe three of the six main categories of nontraditional students. Discuss at least two factors that college students should consider when working with each of these groups.

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ADDITIONAL RESOURCES American Counseling Association. (1996). The assertive college student [Film]. (Available from American Counseling Association, 5999 Stevenson Avenue, Alexandria, VA 22304) This 20-minute video and leader’s guide provide an introduction to assertiveness training and how college students can use a four-step model to change their behavior. A variety of scenarios are presented in which students must assert themselves or suffer academic consequences. 1-800-422-2648 Association for Specialists in Group Work. (1995). Group work for eating disorders and food issues [Film]. (Available from American Counseling Association, 5999 Stevenson Avenue, Alexandria, VA 22304) In this 109-minute video, Dr. Cynthia Kalodner presents a detailed plan to assist counselors in working with females at risk for developing eating disorders. The main focus is on high school and college age youth. The rationale for developing a group for these clients is discussed, as well as a description of each session in this group program. Specific exercises are illustrated and other resources are provided. 1-800-422-2648 Films for the Humanities & Sciences. (1999). Eating disorders [Film]. (Available from Films for the Humanities & Sciences, PO Box 2053, Princeton, NJ 08543-2053) In this 15-minute video, two women tell their stories about struggling with anorexia nervosa and bulimia nervosa. Information about these disorders and the specialized treatment options for treating these disorders is also presented. 1-800-257-5126

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CHAPTER 17 ABUSE, ADDICTION, DISABILITY, AND COUNSELING CHAPTER OVERVIEW This chapter examines the theories and techniques associated with abuse, addiction, and disability in counseling. It highlights the contributions each specialty has made to the field of counseling. The development of services within these counseling traditions are emphasized and the roles and functions of practitioners who specialize in these areas is noted. Furthermore, the training and credentialing process for each area is addressed.

KEY TERMS, CONCEPTS, AND PEOPLE 12-step program Ability Abuse Addiction Al-Anon Alateen Alcoholics Anonymous (AA) American Rehabilitation Counselor Association (ARCA) Americans with Disabilities Act of 1990 Attention deficit disorder (ADD) Attention deficit/hyperactivity disorder (ADHD) Bibliotherapeutic approach Biomedical model Child abuse Child neglect Child sexual abuse Council of Rehabilitation Education (CORE) Comorbid Compulsive gambling Disability Domestic violence Dual diagnosis Emotional abuse Gamblers Anonymous Gaming Habilitation Handicap Handicapism Individuals with Disabilities Education Act International Association of Addictions and Offender Counseling (IAAOC) Interpersonal abuse Intrapersonal abuse Just Say No program Journal of Addictions & Offender Counseling M.A.D.D. (Mothers Against Drunk Driving) 263 ..

Marital/partner violence Medical model Motivation Motivational interviewing (MI) Narcotics Anonymous (NA) National Association of Alcoholism and Drug Abuse Counselors (NAADAC) Nicotine abuse Nicotine addiction Nonrecovering counselors Older adult abuse or elder abuse Peer-counselor model Person-first language Physical abuse Physical disability Physiological addiction Polysubstance abuse Polysubstance addiction Posttraumatic stress disorder Prevention programs Process addictions Protective factor Psychological abuse Rehabilitation Rehabilitation counseling Rapid smoking Recovering counselors Relapse S.A.D.D. (Students Against Drunk Driving) Self-help materials Sexual abuse Sibling abuse Skills training SLANT Sociopolitical model Solution-focused approach Spouse and partner abuse Substance abuse Telephone counseling Three Cs of addiction Ticket to work Triggers Vocational Rehabilitation Act (1920) Work addiction Workaholism Work Incentives Improvement Act (WIAA) Wright, George 264 ..

CHAPTER 17 – ABUSE, ADDICTION, DISABILITY, AND COUNSELING Introduction •

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The treatment focus includes: o Promoting healthy lifestyles, o The identification and elimination of stressors, o The modification of toxic environments, and o The preservation or restoration of physical and mental health.

Counselors are influenced by government, professional, and peer standards that set or mandate the delivery of services.

Abuse • The misuse or maltreatment of people, places, or things.

• The two primary areas of abuse are interpersonal and intrapersonal.

Interpersonal Abuse • Interpersonal abuse involves violent or neglectful actions against others, especially those within one’s family. Forms of interpersonal abuse include emotional abuse and physical abuse.

• Emotional Abuse o This abuse is probably the most common. o It is often subtle. o Emotional abuse is not restricted to age, stage, or gender. It is prevalent across the life span and is more prevalent in partners. o 12 signs of emotional abuse: ▪ Jealousy ▪ Controlling behavior ▪ Unrealistic expectations ▪ Isolation ▪ Blaming for problems and for feelings ▪ Hypersensitivity ▪ Verbal abuse ▪ Rigid sex roles ▪ Sudden changes in personality and mood ▪ Threats of violence ▪ Breaking or striking objects ▪ Use of force during arguments • Child Abuse o Child abuse involves acts of commission. Child neglect involves acts of omission.

▪ Each year 2.5 million children are victims of child abuse and neglect.

▪ It involves physical abuse, sexual abuse, psychological abuse, and neglect and abandonment.

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▪ Abuse is seldom of one type.

▪ Families who engage in abuse are usually chaotic in nature and have relationship deficits. o Effects of child abuse ▪ Aggression ▪ Delinquency ▪ Suicide ▪ Cognitive, academic, and psychological impairment in children ▪ Influence on adult behavior ▪ Less satisfaction with life as adults and prone to suffer for disorders that are behavioral, cognitive, and affective (i.e. depression and low selfesteem) in content.

▪ A causal relationship between abuse and adult symptoms has not been established. o Child physical abuse includes physical contact that is mild to severe.

▪ Manifestation include: • Skin injuries • Physical traumas - broken bones, soft-tissue swelling, and bleeding • Death ▪ Psychological consequences: • Fearfulness • Distrust of others • Delinquency • Depression • Posttraumatic stress responses • Difficulty forming close, lasting relationships with peers ▪ Cognitive problems • Cognitive impairment • Poor school performance • Later substance abuse o Childhood sexual abuse (CSA) ▪ Acts include • Unwanted touching (i.e., fondling) • Sexual remarks • Voyeurism • Intercourse • Oral sex • Pornography ▪ Long-term effects are the same regardless of the perpetrator’s gender or sexual preference and include • Distress, • Acute trauma, and • Post-traumatic stress disorder (PTSD).

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▪ Statistics • Sexual abuse is believed to be significantly underreported, especially in abuse of boys.

• Perpetrators of boys are not usually in the family. Girls are usually offended by a family member.

• One out of three girls is sexually abused by age 18. Twelve to 18% of boys are sexually abused during childhood or adolescence.

• Sibling Abuse o An estimated 40% of children in the United States engage in physical aggression against siblings, and as many as 85% engage in verbal aggression against siblings on a regular basis. o Reasons for abuse include rivalry for dominance and power struggles for resources. o Sibling abuse increases the chance of becoming a victim or perpetrator in abusive relationships. o Three dominant forms: ▪ Sexual • Often acts of brothers perpetrated on sisters.

• May be a one-time act or continue over years.

▪ Physical - the infliction of harm by physical actions: • Hitting • Kicking • Biting • Scratching • Use of objects ▪ Psychological includes: • Constant, intense, or exaggerated teasing, • Contempt or downgrading, and • May be part of sexual or physical abuse. o Victims of sibling abuse may become more violent with those less powerful than they are as time goes by.

• Spouse and Partner Abuse is frequently referred to as “domestic violence” or “marital/partner violence.” o The attempt to “control the thoughts, beliefs, or behaviors of an intimate partner or punish the partner for resisting one’s control. o More women than men are victims.

▪ Twenty-one percent to 39% of all women will experience this abuse.

▪ Twenty percent of emergency room visits for trauma and 25% of homicides of women involve intimate partner violence. o Forms of spouse and partner abuse include physical, sexual, psychological, and economic abuse. o Spouse and partner abuse crosses economic, family structure, sexual orientation, and ethnic lines.

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o Battering is the worst form and “includes sever physical assault or risk of serious injury. o There is an association between alcohol consumption and violence.

Preventing and Treating Interpersonal Abuse • Prevention is mainly educational in nature focusing on listening skills and appropriate behavioral interactions. They usually stress cooperation, collaboration, and self-esteem.

Programs include marriage enrichment.

• Treatments for spouse/partner abuse: o Marital therapy o Anger management training o Individual therapy o Domestic conflict containment programs • Counseling approaches for sibling abuse include direct participation of parents/guardian, children, and others involved. Supervision of children, appropriate sexual education, and violence proofing the home are stressed.

• Prevention and treatment of child abuse and neglect involve legal, developmental, and psychological issues. o Mental health workers and other professional helpers are required by all states to report child abuse and neglect. Failure to do so may lead to disciplinary action. o In most cases legal issues must be resolved before treatment can begin. o Developmental and psychological matters must be dealt with. Child sexual abuse often is not treated until adulthood. o Counselor issues in working with child abuse include: ▪ Anger and feelings of betrayal by the abuser ▪ Correcting the problem and preventing it from happening again ▪ The abuser in the family may be separated from the family o Organizations ▪ Prevent Child Abuse America ▪ Parents Anonymous o Treatments for children who have been abused physically or sexually vary. There is not one treatment modality that works.

Intrapersonal Abuse and Addiction • • •

Intrapersonal abuse involves the misuse of objects or substances that were produced for one purpose, such as healing (prescriptive medication) or entertainment (video games), but are exploited excessively to the detriment of the person involved.

The result is that often an addiction (a state of physiological or psychological dependence) occurs with excessive amounts of time and effort being devoted to the object or substance.

Three C’s of addiction conceptualize its core characteristics: loss of control over addictive behaviors; compulsive use; and continued use regardless of negative consequences

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Substance abuse and addiction o The habitual misuse of intoxicating and addicting substances, such as alcohol, drugs, and tobacco. o Drugs – any substance other than food that can affect the way a person’s mind and body works, including stimulants, depressants, and hallucinogens. o Abuse and addiction cause mental, physical, emotional, social, and spiritual damage. o A major public health issue found across all demographic areas.

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The General Nature of Substance Abuse and Addiction o Occurs frequently as a mental health problem in the US. ▪ One of 10 adults in the US has a significant problem related to alcohol use.

▪ Alcohol abuse/addiction is believed to be greater among Native Americans.

▪ A significant percent of patients who are hospitalized abuse alcohol.

▪ Health care costs are doubled among alcoholic families. o Drug abuse/addiction among adolescents affects development and well-being more than crime, social pressure, grades, or sex.

▪ Approximately 3 million teenagers are addicted to or abuse alcohol, ▪ Half a million are marijuana users, and ▪ One out of 10 teenagers has tried cocaine. o Substance abuse/addiction affects more than just the individual.

▪ Other than the abuser, up to four others are being adversely affected including family members, friends, or associates. o Polysubstance abuse/addiction ▪ Abuse of two or more substances at the same time is a growing problem.

▪ Social conditions may evoke other substance abuse/addiction, such as smoking.

▪ Conditions related to smoking • Unsatisfactory life rooted in poverty and hopelessness • Peer pressure • Poor school performance • Parental smoking • Minority ethnic status • External locus of control

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Addiction o A behavior pattern with biological, psychological, sociological, and behavioral components. o A persistent and intense involvement with and stress upon a single behavior pattern, with a minimization or even exclusion of other behaviors, both personal and interpersonal. o Addiction is characterized as a preoccupation with one object that controls behaviors and limits other actions over time.

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Preventing Substance Abuse/Addiction o Prevention Programs 269 ..

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“Just Say No” • Sponsored by local governments and found in schools and public agencies.

• The program’s message is incorporated into public service announcements on television to influence preteens and teens by their peers to say “no” when offered a cigarette or other addictive or dangerous substance.

▪ D.A.R.E. • Drug Abuse Resistance Education • Found in late elementary and early middle school grades • Uses police as instructors and provides case scenarios that challenge fifth and sixth graders to think about and answer them.

▪ S.A.D.D. and M.A.D.D. • Students against Drunk Driving • Mothers against Drunk Driving • These associations help educate and orient young people about the hazards of drug abuse and the dangers of addiction ▪ Tobacco and Cocaine Programs • These programs focus on the external and internal factors important to teens. External factors o External factors include: breath, teeth, clothes, and costs. o Internal factors include: lifestyle choices, time management, and nutrition. o Group pressure and dynamics are common elements in prevention.

▪ Adolescents who get involved in the use of drugs do so because of friends who use drugs.

▪ When a group perceives drugs as hazardous, its members are less likely to engage in the behavior.

▪ Educational and support groups are a valuable tool to help ward off abuse and addictive behaviors .

Treating Substance Abuse/Addiction o Characteristics ▪ About 25% of counseling cases relate to substance abuse and addiction.

▪ Substance abusers have dysfunctional dynamics making them difficult to work with.

▪ Three most common ways counselors work with addicted persons include outpatient, residential, and inpatient.

▪ Addicts must be “dry” or “dried out” for 30 days or more to give them a “clean” body and mind to use in doing something different and positive.

▪ Alcoholic family systems have an overresponsible/underresponsible phenomenon.

• Over-responsible people are codependent and seek to control others and feel inadequate when faced with disappointments but are easier with whom to work in counseling situations.

• Underfunctioning people are less motivated to change. o Factors Affecting Treatment include: 270 ..

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Motivation – Most substance abusers/addicts do not desire to change and are self-centered and are comfortable where they are.

▪ Denial - is minimizing the effects of substance abuse/addiction on either oneself or others.

▪ Dual Diagnosis – An abuser/addict has more than one aspect of personality that needs treatment (i.e., addiction and depression).

▪ Matching – Finding the right treatment for a disorder.

▪ Control – the regulation of a behavior ▪ Relapse – the reoccurrence or recidivism of dysfunctional behaviors one they have been treated. o Treatment Strategies for Individuals ▪ Motivational Interviewing (MI) is used to lower resistance in substance abuse/addiction cases.

• This approach draws from person-centered counseling and includes such skills as active listening, reflection, and reframing.

▪ Bibliotherapy • Bibliotherapeutic approach may work with some individuals.

• Abusers and addicts read books or view/listen to media and discuss ideas related to what they have experienced.

▪ Cautions to remember for counselors working with adolescents regarding alcohol and substance use: • Working with adolescents is a treatment specialty.

• Family and significant people in their lives should be included for counseling to be effective.

• Adolescents need to be educated about what counseling is.

• Therapeutic techniques need to be specifically tailored to adolescents.

• Counselors cannot function as the adolescent’s friend.

• Counseling focus should be centered around problem solving, skill building, and just being heard.

• “Therapeutic moments” are more uneven with adolescents.

Specific Treatments •

Treatment for Alcohol Abuse/Misuse and Addiction – Alcoholics Anonymous (AA) o Background of AA ▪ AA is the oldest successful treatment program in the world and was founded in the 1930s.

▪ AA is a fellowship and a rehabilitation program.

▪ Alcoholics have “character defects” that “are feelings, beliefs, and behaviors that dispose them to seek a sense of well-being by abusing alcohol.

▪ Meetings are conducted with small groups and literature. o Key component in AA ▪ A 12-step program that has its basis on a spiritual foundation 271 ..

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Group discussions center on the need and availability of support of others and a dependence on a higher power.

Members are never “cured;” rather they are “in recovery.”

Emphasis is also given to responsibility, forgiveness, restitution (when possible), affirmation, ritual, and fellowship.

Treating Nicotine Addictions o Over 25% of Americans smoke cigarettes, three million of whom are adolescents. o About 80% of those who abuse or are addicted to alcohol smoke. o Most nicotine dependent people are not successful as a group in their goal of smoking cessation. o Successful techniques for counselors ▪ Telephone counseling • Counseling consists of a 15- to 30- minute phone call where counselors give positive, nonjudgmental feedback to those who are trying to quite smoking.

• The goal is to promote self-efficacy.

▪ Rapid smoking • After counseling, smokers go through a series of six 1-hour sessions where they inhale a cigarette every 6 seconds until they feel too sick to continue.

• The goal is to produce a conditioned negative response to the taste of cigarettes.

▪ Skills training • Coping skills are taught after clients have learned to recognize the triggers that produce the urge to smoke.

• Most successful skills taught: o Self-statements about the financial and health benefits of discontinuing smoking o Oral substitutes o Increased physical activity o Buddy system ▪ Self-help materials • “Clearing the air” – National Institute of Health Publication #95-1467, call 1-800-4-CANCER • “Smart Move” – American Cancer Society

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Treating Drug Abuse and Addiction o Around half a million Americans are heroin addicts, and four million are regular users of marijuana. o Treatment is often based on the AA model. o Because of incarceration of illegal drug abusers, jail is the usual context for treatment.

▪ “Stay’n Out” is a prototype of a jail treatment program that works well and has a recidivism rate of only 25%.

Process Addictions 272 ..

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Addictions to such things as sexuality, shopping, Internet use, work, tanning, and gambling (often called gaming by casinos and state lottery personnel) Behavior moves from normal to addictive when it both produces pleasure and reduces negative moods and includes two key features: o Individuals are unable to control, cut back, or stop the behavior o Individuals continue to use the behavior despite substantial negative consequences Compulsive Gambling o Found in about 2.5% of the population o Compulsive gambling and internet compulsion parallel alcohol, nicotine, and drug addiction in numerous ways o Pattern of behavior in compulsive gambling revolves around the “action” that occurs when placing a bet. o Treating compulsive gambling: ▪ Gamblers Anonymous Work Addiction (Workaholism) o “compulsive and progressive, potentially fatal disorder characterized by selfimposed demands, compulsive overworking, inability to regulate work habits, and overindulgence in work to the exclusion and detriment of intimate relationships and major life activities” (Ng, 2006, p. 213). o Negatively affects families of those involved and can lead to mental health problems in marriage. o Treating work addiction (Chamberlin & Naijian, 2009; Robinson, 1995, p. 33) ▪ Help them slow down their pace.

▪ Teach them to learn to relax.

▪ Assist them in evaluating their family climate.

▪ Stress the importance of celebrations ▪ Help them get back into the social swing ▪ Address living in the now ▪ Encourage clients to nurture themselves ▪ Stress the importance of proper diet, rest, and exercise ▪ Help clients grieve the loss of their childhoods and address self-esteem ▪ Inform clients that 12-step programs are available as a complement to the individual work you do with them ▪ Help clients identify their individual reinforcement history ▪ Explore consequences and rewards of workaholic behavior Internet Addiction o Not officially listed as an addiction in the DSM o Considered an addiction by many counselors and other helping professionals o Treating internet addiction ▪ Treatable, but many individuals with it do not seek treatment.

Treating Women and Minority Cultural Groups in Substance Abuse o Approximately five to seven million women abuse alcohol in the US alone. o Women face societal rebuke and chastisement for alcohol abuse.

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o Barriers to treatment include need for childcare, cost, family opposition, and inadequate diagnosis. o Little evidence exists on the benefits of AA and NA on the one-third of the AA membership that women represent due to gender differences and cultural differences.

▪ “Women for Sobriety” is an alternative help group program that is based on a cognitive-behavior modification approach. Thinking is changed to overcome feelings of helplessness, powerlessness, guilt, and dependence.

▪ Cultural differences may play a part in the recovery process. Spiritual elements may be different for women and different ethnic backgrounds.

Affiliation, Certification, and Education of Substance Abuse Counselors • IAAOC o International Association of Addictions and Offender Counseling o Focuses on the prevention, treatment, and description of abusive and addictive behaviors. o Publishes the Journal of Addictions & Offender Counseling • NAADAC o National Association of Alcoholism and Drug Abuse Counselors o A national organization that certifies addiction counselors • NBCC o In 1994 the National Board of Certified Counselors added a certification process for becoming a substance abuse counselor.

• Two types of counselors o Recovering counselors ▪ Those who have been abusers, now are dry, and have taken specialized courses to qualify for a NAADAC certification.

▪ More likely to engage in activities that are consistent with the philosophy described in the 12 steps of Alcoholics Anonymous.

▪ They are “prone to be involved in community education programs, socialize with clients away from the work environment, and visit clients in the hospital.”

▪ Prone to see alcohol and drug problems on a continuum rather than as a yes or no diagnosis. o Nonrecovering counselors ▪ Those who have earned at least a master’s degree in counseling, usually with a concentration in substance abuse.

Counseling People with Disabilities •

“About 1 in 6 Americans have physical, sensory, psychiatric, or cognitive disabilities that interfere with daily living” o Over 9 million Americans with disabilities are unable to work or attend school; o It cost the U.S. government about $60 billion dollars a year to support people with disabilities;

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•

• • • • •

o Disabilities are higher among older people, minorities, and lower socioeconomic groups; and o 8 out of 10 most causes of death in the U.S. are associated with chronic illness.

Ethnic minorities suffer from disabilities more than the general population due to o Low income and poverty, o Employment in physically dangerous jobs, o Lack of health insurance coverage, o Low educational attainment, and o Faulty and inaccurate testing and assessment.

Rehabilitation counseling – focuses on serving individuals with disabilities o The job of a rehabilitation counselor is a multidimensional task of being a “case manager and skilled therapeutic counselor.

Rehabilitation – the reeducation of disabled individuals who have previously lived independent lives.

Habilitation – focuses on educating clients who have been disabled from early life and have never been self-sufficient.

Goals of rehabilitation services are: successful employment, independent living, and community participation.

Federal legislation has been a driving force in the establishment of services for the disabled. o Vocational Rehabilitation Act (1920) – focused on working with physically disabled Americans. o Americans with Disabilities Act (1990) – heightened awareness of the needs of the over 40 million disabled in the US. This Act also increased national efforts in providing multiple services for people with mental, behavioral, and physical disabilities. o Disabilities Act of 1997 – requires educational institutions to provide a free and appropriate public education (FAPE) for all students with disabilities. o Ticket to Work and Work Incentives Improvement Act (WIIA) of 1999 enhanced the ability of consumers with disabilities to make a choice of service providers between private nonprofit, state rehabilitation agency and private proprietary providers.

The Nature of Disabilities •

Disability – either a physical or a mental condition that limits a person’s activities or functioning. o Manifestations are physical, emotional, mental, and behavioral, including diagnoses such as alcoholism, arthritis, blindness, cardio-vascular disease, deafness, cerebral palsy, epilepsy, mental retardation, drug abuse, neurological disorders, orthopedic disabilities, psychiatric disabilities, renal failure, speech impairments, and spinal cord conditions. o Misconceptions and biases about limitations of disabilities ▪ Biases may lead to harassment and may affect the disabled person’s “everyday social interactions”.

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The disabled tend to withdraw from mainstream interacts and are unemployed or unable to achieve an independent-living status.

▪ Disabled may suffer from low self-esteem, lack of confidence in decision making, social stigma, a restricted range of available occupations, and few successful role models. Early life experiences may be limited.

A handicap is “an observable or discernible limitation that is made so by the presence of various barriers”. o Example: a quadriplegic assigned to a third-floor apartment in a building without an elevator. o Counselors help these clients overcome handicaps and cope with their disabilities.

Working with People with Disabilities • Medical model – is historically linked to counseling the disabled. o Medical professionals treated those who were physically challenged. o Today, rehabilitation counselors are required to know medical terminology.

• Minority model – assumes that persons with disabilities are a minority group rather than people with pathologies.

• Peer counselor model – assumes that people with direct experience with disabilities are best able to help those who have recently acquired disabilities.

• Counselor’s role o To assess the client’s current level of functioning and environmental situation that either hinders or enhances functionality. o After assessing the client’s current level of functioning, counselors use a wide variety of counseling theories and techniques, including affective, behavioral, cognitive, and systemic theories.

• Muthard and Salomone’s 1960 systematic investigation of rehabilitation counselors’ work activities: o Eight major activities characterize the counselor’s role. o A high degree of importance was attached to affective counseling, vocational counseling, and placement duties. o Rehabilitation counselors reported spending 33% of their time in counseling activities, 25% in clerical duties, and 7% in client placement.

• The US Labor Department list 12 major functions of rehabilitation counselors: ▪ Personal counseling ▪ Case finding ▪ Eligibility determination.

▪ Training, ▪ Provision of restoration ▪ Support services ▪ Job placement ▪ Planning ▪ Evaluation ▪ Agency consultation ▪ Public relations ▪ Follow-along

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Clients with Specific Disabilities • Hershenson’s practical way to conceptualize a disability and provide appropriate services o According to Hershenson disabilities result from one of four forces: supernatural or fate, medical, natural, or societal. o Treatment can be based on explanations and techniques emphasizing faith (for the supernatural), logic (for the medical and natural), and power (for the societal).

▪ Undergraduates who attributed a client’s disability to fate chose to get the person to accept the disability as one’s lot in life.

▪ When disabilities were attributed to natural or medical causes, medical or retraining services were the preferred choices of treatment.

▪ When socially imposed barriers were seen as the cause of the disability, the removal of these barriers was advocated.

• Physical Disabilities o Clients who have physical disabilities may have distinguished adjustment phases.

▪ 12 phases of adjustment • Shock • Anxiety • Bargaining • Denial • Mourning • Depression • Withdrawal • Internalized anger • Externalized aggression • Acknowledgment • Acceptance ▪ Adjustment/adaptation ▪ There are behavioral correlates that accompany each phase and intervention strategies for each. o Counselors should offer timed supportive counseling, crisis intervention, and confrontation with those involved in helping the physically disabled person.

▪ Counselors must simultaneously help the client with the injury develop an internal locus of control for accepting responsibility for his or her life.

▪ The counselor must also be an advocate, a consultant, and an educator.

•

Intellectual Disabilities o Clients with intellectual disabilities include those who have mild to severely limited cognitive abilities. o When working with children, the counselor’s tasks and techniques may be similar to those employed with a physically disabled adult or adolescent; for instance, using supportive counseling and life-planning activities. o Young children require more and different activities. Parents must be helped with their feelings about and interactions with their child.

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o Social issues and therapeutic activities must be addressed with adolescents with mental difficulties resulting from head injuries. o Increased time and effort in attending to psychosocial issues is required.

•

ADD or ADHD o Attention deficit disorder (ADD) and attention deficit/hyperactivity disorder (ADHD) interfere with learning and day-to-day functioning. o ADHD ▪ Affects between 3% and 5% of school-age children.

▪ Three subtypes • Inattentive • Hyperactivity-impulsivity • Combination of both ▪ Symptoms that occur with ADHD include distractibility, impulsivity, disorganization, and interpersonal problems that persist and sometimes worsen with age.

▪ Individuals may become frustrated, anxious, distressed, depressed, and have lower self-concepts. o Strategies for working with people with ADD and ADHD have been developed by clinicians in educational and community settings.

▪ “SLANT” is a mnemonic to help ADHD students on how to behave in certain situations: • S = “Sit up straight” • L = “Lean forward” • A = “Activate thinking and Ask questions” • N = “Name key information and Nod your head to validate the teacher/speaker” • T = “Track the teacher or speaker” • Treatment may be multidimensional due to the multiple effects of these disorders on personality.

• Interventions for children or adolescents with ADHD include: ▪ Parent counseling and training ▪ Client education ▪ Individual and group counseling ▪ Social skills training o Medical treatment and proper medication “often results in increased attentiveness and decreased impulsivity and overactivity ▪ Stimulant medications include • Methylphenidate (Ritalin) • Dextroamphetamine (Dexedrine) • Pemoline (Cylert) ▪ Not all children who have ADHD need medication.

▪ When medication is prescribed small dosages should be tried first.

•

PTSD o Re-experiencing an extremely traumatic event.

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o o o o

Often prevalent in soldiers returning from war zones However, it is found among all segments of the population Approximately 7 million people in the United States with PTSD Treated with medications and sometimes with other treatments such as EMDR

Affiliation, Certification, and Education of Disability Counselors • •

• • •

•

Rehabilitation counseling is the most common specialty working with the disabled and the area in which most connected to disabilities affiliate.

American Rehabilitation Counselor Association (ARCA) o Organized after WWII as an interest group of the National Vocational Guidance Association (NVGA). o Became part of ACA (then APGA) as the Division of Rehabilitation Counseling (DRC) in 1958. o Became known as ARCA in 1961.

The Council of Rehabilitation Education (CORE) accredits institutions that offer rehabilitation counseling. o Over 100 CORE accredited programs operate in the US. The Commission of Rehabilitation Counselor Certification (CRCC) certifies rehabilitation counselors who complete CORE-accredited programs.

Since the late 1960s, there has been a movement of employment of rehabilitation counselors from government agencies to for-profit agencies and private practice. o This employment change has been the result of economic changes, new emphases by businesses and insurance companies, national professional certification requirements, and state licensure laws.

12 major functions of rehabilitation counselors: o Personal counseling o Case finding o Eligibility determination o Training o Provision of restoration o Support services o Job placement o Planning o Evaluation o Agency consultation o Public relations o Follow-along

CLASSROOM ACTIVITIES 1. Attend an open meeting of Alcoholics Anonymous. Inform the class about your experience and compare it with theirs.

2. As a class, generate ideas about what you consider to be the most pressing societal needs in the next decade. Describe how substance abuse and addiction counselors can help in alleviating stress that often goes with meeting needs. In other words, what can substance 279 ..

abuse and addictions counselors do on a preventive level to keep at-risk people from becoming abusive or addicted?

3. In small groups, examine how legislation has influenced the development of disability services in the United States as a whole and in your state in particular. Report your findings to the class.

4. Investigate the educational training needed to become a rehabilitation counselor as opposed to being an addiction counselor. Where are the areas of overlap? What are the unique areas in each specialty?

5. There are some remarkable stories of individuals who have overcome addictions and disabilities and lived remarkable lives. Investigate and find at least a couple of examples.

Share your findings with the class.

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CHAPTER 17 - MULTIPLE CHOICE TEST QUESTIONS 1. ___________________ is an act of commission; whereas, ___________________ is an act of omission. a. physical abuse; emotional abuse b. emotional abuse; physical abuse c. child abuse; child neglect d. child neglect; child abuse 2. Which of the following forms of abuse refers to constant, intense, or exaggerated teasing; contempt; or downgrading. a. physical b. sibling c. psychological d. neglect 3. Which of the following would constitute older adult or elder abuse? a. Margaret, an older adult, shares with her counselor that she is often locked in her room for hours at a time. b. When, John, an older adult, meets with his physical therapist, he smells of sweat and bodily fluids and doesn’t appear to have showered for a while. When asked about it, he says that he doesn’t often receive assistance with showering from staff members at his nursing home and can’t do it himself. c. Sylvia arrives at her medical appointment dehydrated because her caregiver has not given her something to drink in over eight hours. d. All of the above are considered older adult or elder abuse.

4. Which of the following refers to minimizing the effects of substance abuse on either oneself or others? a. denial b. reaction formation c. relapse d. control 5. Which of the following motivational interviewing terms refers to the eliciting of clients’ inner resources? a. autonomy b. evocation c. collaboration d. matching 6. Which strategy for treating substance abuse and addiction consists in having clients read books or view/listen to media and discuss ideas related to what they experienced? a. narrative therapy approach b. solution-focused approach c. bibliotherapeutic approach 281 ..

d. developmental counseling and therapy approach 7. A person who has been a substance abuser but is now dry and has taken special courses to qualify for a NAADAC (National Association of Alcoholism and Drug Abuse Counselors) certification is called a(n) ______________ counselor. a. nonrecovering b. recovering c. addictions d. alcoholism 8. Thomas abuses alcohol, is addicted to tobacco, and occasionally uses cocaine. Which of the following statements is accurate regarding Thomas. a. Thomas’s substance use warrant a dual diagnosis. b. Thomas’s substance use indicates polysubstance abuse. c. Thomas’s substance use meet the criteria for substance dependence but not abuse. d. Thomas’s substance use require a solution-focused approach to treatment.

9. When a person with an addiction has more than one aspect of his or her personality that is open to treatment, the person is said to have a _________________. a. dual diagnosis b. codependency c. dual digression d. multiple symptoms 10. An approach to working with nicotine addiction that teaches coping skills, such as reframing and thought stopping, is known as _________________. a. telephone counseling b. rapid smoking c. skills training d. physical training 11. Individuals who are addicted to work may be helped through _________. a. slowing down their pace b. getting back into social settings c. nurturing themselves d. all of the above 12. Elizabeth, a rehabilitation counselor, confides in you that she views disabilities as deficiencies that reside within people. Elizabeth’s view of disabilities is consistent with which of the following models? a. biomedical b. sociopolitical c. peer counselor d. all of the above

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13. Which of the following refers to an inability or a limitation that prevents a person from performing some or all of the tasks of daily life? a. disability b. handicap c. barrier d. trait 14. In reference to the theories and techniques used by rehabilitation counselors, the following statement is true: ______________. a. virtually all of the affective, behavioral, cognitive, and systemic theories of counseling are employed b. the skills of the counselor and the needs of the client determine the actual theory or technique used c. affective and insight strategies are appropriate in the early phases of the adjustment process d. all of the above 15. Which model assumes that persons with disabilities are a minority group rather than people with pathologies? a. prevention b. sociopolitical c. peer counselor d. environmental and functional 16. _______________ occurs when rehabilitation counselors attempt to make their services known to agencies and potential clients through promotional and educational materials. a. Case finding b. Provision of restoration c. Support services d. Agency consultation 17. In the mnemonic “SLANT,” which is used to help those who have learning problems focus on classroom lectures, the letter “L” stands for ______________. a. learn b. listen c. lean forward d. look at the teacher ESSAY TEST QUESTIONS 1. Describe different manifestations of child abuse including physical, psychological, relational, and cognitive impairments associated with child abuse.

2. What are some things counselors should be aware of when working with adolescents who are using alcohol?

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3. Describe two models of working with people with disabilities.

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ADDITIONAL RESOURCES Aquarius Health Care Videos. (1993). Withstanding ovation: Confronting disability [Film].

(Available from Aquarius Health Care Videos, 5 Powderhouse Lane, PO Box 1159, Sherbon, MA 01770) This video gives a new and refreshing picture of occupational and rehabilitation therapy.

(24-minutes) (508) 651-2963 Aquarius Health Care Videos. (1997). My country [Film]. (Available from Aquarius Health Care Videos, 5 Powderhouse Lane, PO Box 1159, Sherbon, MA 01770) Through the stories of three individuals, this video discusses issues of disability rights and is great for increasing disability awareness. (60-minutes) (508) 651-2963 Dartmouth-Hitchcock Medical Center. (1999). Addictions and mental illness [Film]. (Available from Films for the Humanities & Sciences, PO Box 2053, Princeton, NJ 08543-2053) Clients who suffer from both an addiction and a mental illness have some unique diagnosis and treatment concerns. This video illustrates these concerns through a look at two clients who have a dual-diagnosis. Dr. Fred Goodwin, formerly of NIMH, highlights research efforts that focus on identifying adolescents who are prone to developing similar problems.

1-800-257-5126 Films for the Humanities & Sciences. (1999). Gambling: The chance of a lifetime [Film].

(Available from Films for the Humanities & Sciences, PO Box 2053, Princeton, NJ 085432053) This 28-minute video examines how gambling can sometimes be a harmless social event or can become an addiction. The development of a gambling addiction and treatment options are discussed by both a treatment specialist and a gambling addict. 1-800-257-5126 Hear and Now. Documentary film directed by Irene Taylor Brodsky; produced by Irene Taylor Brodsky (New York, NY: Filmakers Library, 2008), 1 hour 24 mins.

This film documents the phenomenological experience of a deaf couple who, at the age of 65, decides to get cochlear implants. Along with describing the physical, emotional, and psychological effects of such a decision, the film also provides a window into the daily life of two deaf individuals.

Films for the Humanities & Sciences. (1999). Moyers on Addiction: Close to Home [Film].

(Available from Films for the Humanities & Sciences, PO Box 2053, Princeton, NJ 085432053) Each video in this five-part series focuses on a different aspect of addiction and incorporates real-life stories of addicts, parents, children, and helping professionals involved in the 285 ..

prevention and treatment of addiction. The first video, Portrait of Addiction, looks at the stories of nine recovering addicts and illustrates how addiction does not have a “typical” face; it can reach anyone (57 minutes). The second video, The Hijacked Brain, focuses on the science of addiction and the research being done on the development of addictions (57 minutes). Video three, Changing Lives, looks at the road to recovery and how treatment needs to be individualized. Some unique treatment programs are highlighted (81 minutes).

The next video, The Next Generation, examines prevention issues and illustrates these issues through several programs currently working in this area (57 minutes). The final video, The Politics of Addiction, takes a societal perspective on the issue of addiction and examines political and legislative issues concerning this area (57 minutes). 1-800-257-5126 Films for the Humanities & Sciences. (1999). Altered states: A history of drug use in America [Film]. (Available from Films for the Humanities & Sciences, PO Box 2053, Princeton, NJ 08543-2053) This 57-minute film takes a historical look at substance abuse patterns in America. The video discusses how different societal movements influenced and were influenced by substance use. 1-800-257-5126 Home Box Office. (1999). Without pity: A film about abilities [Film]. (Available from Films for the Humanities & Sciences, PO Box 2053, Princeton, NJ 08543-2053) Christopher Reeve narrates this 56-minute film which focuses on the abilities that disabled individuals have and how they are able to lead satisfying and productive lives. Highlighting resilience and self-sufficiency, this program takes the viewer into the lives of several individuals with amazing stories. 1-800-257-5126 Insight Media. (1991). Inside the addictive personality [Film]. (Available from Insight PO Box 621, New York, NY 10024-0621)

Media,

This 35-minute video illustrates the stages of addiction and how addicts in recovery can work toward reconstructing their lives. 1-800-233-9910 Insight Media. (1991). The twelve steps: Recovering from addiction [Film]. (Available from Insight Media, 2162 Broadway, New York, NY 10024-0621) Thirteen volumes comprise this video collection (30-minutes each). Each of the twelve steps from Alcoholics Anonymous are discussed with accompanying true stories. An additional video covers issues associated with relapse. 1-800-233-9910 Insight Media. (1992). Substance abuse disorders [Film]. (Available from Insight Media, 2162 Broadway, New York, NY 10024-0621) Focusing on nicotine, alcohol, and cocaine, this 60-minute video explains both addiction and its treatment. 1-800-233-9910

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Insight Media. (1994). Dealing with addictions [Film]. (Available from Insight Media, 2162 Broadway, New York, NY 10024-0621) In this video, Albert Ellis works with a client on the client’s various abuses of substances. A discussion after the session is provided by Dr. Ellis and Dr. DiGiuseppe. 1-800-233-9910 Neef, N. A., et al. (Producers). (1998). Caring for persons with developmental disabilities [Film].

(Available from Research Press, Dept 99, P.O. Box 9177, Champaign, IL 61826) This video focuses on training individuals to care for people with physical and mental disabilities. Six videotapes illustrate the different aspects of respite care. A program guide accompanies the video. 1-800-519-2707

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CHAPTER 18 CLINICAL MENTAL HEALTH AND PRIVATE PRACTICE COUNSELING CHAPTER OVERVIEW This chapter provides an overview of clinical mental health and private practice counseling. The multiple nature of counseling in these settings is highlighted. Treatment and prevention are emphasized along with the practical aspects of working as a counselor in a public or private agency, such as a mental health clinic or employee assistance program. The benefits and drawbacks of being a counselor in private practice are also highlighted.

KEY TERMS, CONCEPTS, AND PEOPLE Adapted-SAD Persons scale (A-SPS) American Mental Health Counselor Association (AMHCA) Anxiety Biopsychosocial functioning Certified Clinical Mental Health Counselor (CCMHC) Clinical mental health counselor Cognitive wellness Community Mental Health Centers Act of 1963 Configural model of prevention Continuing therapy model Crisis intervention model Crisis oriented organizations Deinstitutionalization Depression Ecosystemic thinking EcoWellness Employee assistance program (EAP) Existential-constructivist framework Fee-for-service Generalized anxiety Incidence formula Indivisible self Journal of Mental Health Counseling Mental health counseling Multimodal therapy (BASIC ID) Panic disorder Primary prevention “Pull marketing” relationships SAD PERSONS scale Secondary prevention Social anxiety Social-ecological perspective Suicide Tertiary prevention 288 ..

Wellness or positive wellness Wheel of Wellness CHAPTER 18 – CLINICAL MENTAL HEALTH AND PRIVATE PRACTICE COUNSELING Introduction • Working in a clinical mental health counseling setting provides opportunities to work with the public and governmental organization in the prevention and treatment of mental illnesses.

• Many clinical mental health counselors belong to the American Mental Health Counselor Association (AMHCA). Others join associations that reflect their specialties or philosophical orientation to treatment.

The Development of Clinical Mental Health Counseling •

Clinical Mental Health Counseling o The Community Mental Health Centers Act of 1963 ▪ Provided funding for the establishment of more than 2,000 community mental health centers nationwide.

▪ Helped local communities employ mental health professions from a variety of backgrounds.

▪ Focused on mental health education in the form of outreach programs.

▪ In the late 1970s and early 1980s mental health centers shifted from prevention to treatment as federal mental hospitals were deinstitutionalized and centers picked up these individuals as clients. o Mental Health Counseling Defined ▪ Mental health counseling is a specialized form of counseling performed in noneducational, community-based, or mental health settings.

▪ Different views of mental health counseling have evolved ● Developmental ● Relationship focused ● Treatment, advocacy, or personal and environmental coping ▪ CACREP (2009) – The Council for Accreditation of Counseling and Related Educational Programs has developed a detailed description of clinical mental health counseling, while simultaneously, deleting the ambiguous term “community counseling.” Clinical mental health counseling is a specialty with requirements for course work, basic knowledge, and skills. o A distinct profession, such as mental health counseling, is due factors such as ▪ Specialized Curriculum – psychodiagnosis, psychopathology, psychopharmacology, and treatment planning ▪ Collaborative affiliation with ACA ▪ Intent of its founders, leaders, and followers ▪ Publications ▪ Accreditation requirements (i.e., a 60-hour program) 289 ..

Clinical Mental Health Counseling as a Specialty • Clinical mental health counseling is interdisciplinary in its history practice settings, skills/knowledge, and roles performed. o “Mental health counselor” is a term used to describe many practitioners in the clinical mental health counseling field. Some states also use this title for licensed counselors. o Variety of settings where mental health counselors work: ▪ Mental health centers ▪ Community agencies ▪ Psychiatric hospitals ▪ Health maintenance organizations (HMOs) ▪ Employee assistance programs (EAPs) ▪ Health and wellness promotion programs (HWPs) ▪ Geriatric centers ▪ Crisis control agencies ▪ Child guidance clinics ▪ Private practitioners o Diverse group of clients ▪ Rape victims ▪ Depressive’s families ▪ Potential suicide victims ▪ Those with diagnosable disorders o Clinical mental health counselors consult, educate, and sometime perform administrative duties. Often times they work as part of a team with other professionals and need to know psychopathology in order to work with other health professionals. o Major duties of clinical mental health counselors include ▪ Assessing and analyzing background and current information on clients ▪ Diagnosing mental and emotional conditions ▪ Exploring possible solutions ▪ Developing treatment plans ▪ Preventive mental health activities ▪ Recognizing the relationship between physical and mental health o Professional development in areas of applied counseling ▪ Marriage and family counseling ▪ Substance abuse/chemical dependency ▪ Third-party reimbursement ▪ Small group counseling o The American Mental Health Counselor Association (AMHCA) ▪ Initiated task forces to broaden counselors and to develop skills • Business and industry • Aging and adult development • Treatment of various disorders • Prevention

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▪

•

Emphasizes total health and health counseling to provide health information and support and prevent more serious problems like alcoholism.

▪ Set up certification standards for counselors to become Certified Clinical Mental Health Counselors (CCMHC).

• In 1978 the National Academy of Certified Clinical Mental Health Counselors (NACCMHC) was established as an independently incorporated certification group.

• In 1993 NACCMHC merged with the National Board for Certified Counselors (NBCC). A counselor must become a national certified counselor (NCC) before seeking certification from CCMHC. Interests, Theories, and Functions o Mental health counselors use a variety of theories and techniques depending on their clients’ needs and the settings in which they work. o Primary Prevention and the Promotion of Mental Health ▪ Many mental health counselors are actively involved in primary prevention types of programs through the schools, colleges, churches, community health centers, and public and private agencies where they are employed.

▪ Primary prevention is “before the fact” and is oriented toward “groups”.

▪ Successful primary prevention results in healthier and better adjusted individuals and communities.

▪ Two primary prevention models for adolescents • Bloom’s configural model of prevention focuses on three dimensions: o Counselors need to work to increase individual strengths and decrease weaknesses o Social support through parents and peers, for example, need to increase and social stress needs to decrease o Environmental variables, such as poverty, must be addressed.

• Albee’s incidence formula emphasizes that counselors must decrease negative effects of biology and stress and increase the coping skills, self-esteem, and supportive systems of adolescents.

▪ Primary prevention of suicide • Suicide ranks as the ninth cause of death for adults and third cause for adolescence 17years and younger. It is the fifth-leading cause of death among Canadians.

• Assessments used to determine suicidal tendencies: o SAD PERSONS scale (for adults) o Adapted-SAD PERSONS scale (A-SPS) for children o A combination of the following facts in an interactive process likely yield information needed in prevention: ▪ Sex (male) ▪ Age (older clients) ▪ Depression 291 ..

▪ ▪ ▪ ▪ ▪ ▪ ▪

▪

▪

▪

▪

Previous attempt Ethanol (alcohol) abuse Rational thinking loss Social support system lacking (lonely, isolated) Organized plan No spouse Sickness (particularly chronic or terminal illness) Primary prevention emphasizing healthy development – positive coping and growth so that individuals are able to deal effectively with crises they may face.

• The integration of Erik Erikson’s and Abraham Maslow’s systems yields six personal development trends from which mental health counselors can work: o Survival – focus on the self o Growth – focus on the self o Communication – focus on interpersonal functions o Recognition – focus on interpersonal functions o Mastery – focus on the accomplishment of tasks o Understanding – focus on the accomplishment of tasks Adolescent’s psychological maturity predicts adult mental health and vocational adaptation.

• The degree of maturity is related to marital sexual adjustment and vocational adaptation.

• General principles that counselors can apply in promoting client developments: o Encourage the anticipatory rehearsal of new adaptations. o “Require constant externalization of what is learned and its correction by action.” o Allow a person to experience the consequences of his or her decisions and acts. o Appreciate and affirm strengths.

Primary prevention through the social-ecological perspective which focuses on a person’s environment.

• Environments have personalities just as people do. Some are rigid, whereas others are more flexible and supportive.

• Mental health counselors should follow these guidelines to make effective use of the social-ecological perspective: o Identify the problem within the setting. o Make an agreement that the environment is the client. o Assess the dynamic variables within the environment and determine how the environment functions in favor of or counter to the clients’ needs. o Evaluate the outcome and have the client state his/her criteria for the ideal environment.

Primary prevention through ecosystem thinking

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•

▪

Ecosystem thinking is thinking that recognizes the indivisible interconnectedness of individual, family, and sociocultural context.

• The cultural contexts in which people relate and communicate impacts mental health.

• Marriage emphasizes the importance of personal and environmental factors in individuals’ well-being. o According to one study, the most significant predictor of martial satisfaction is the compatibility of personality typologies. People seek interaction in environments that meet their psychological needs. o Interracial marriages can be aided by encouraging couples to identify and address predictable stressors, such as prejudice or identity issues regarding their children, and helping them find support or marriage enrichment groups.

Primary prevention based on positive wellness • Positive wellness includes health-related activities that are both preventive and remedial and have a therapeutic value to individuals who practice them consistently.

• O’Donnell emphasizes the following health-related activities: o Eating natural foods o Taking vitamins o Going to health spas o Meditating o Participating in regular exercise o Exploring a variety of humanistic and transpersonal approaches to helping • Signs of the holistic movement toward health and well-being are becoming more apparent through the positive and negative habits of different age groups. o Regular exercise can have a beneficial effect on people’s physical and psychological health.

• Other counselor strategies that emphasize a wellness perspective include: o Dwelling on positive, life-enhancing things the individual can do o Alter traditional screening to include more emphasis on overall health o Conduct more research o Highlight the physical feature dimension which Lazarus calls multimodal therapy (BASIC).

▪ Basic I.D. 1. Behavior 2. Affect 3. Sensation 4. Imagery 5. Cognition 293 ..

o

6. Interpersonal relationships 7. Drugs/biology Secondary and Tertiary Prevention ▪ Secondary prevention – controlling mental health problems that have already surfaced but are not severe ▪ Tertiary prevention – controlling serious mental health problems to keep them from becoming chronic or life threatening ▪ Mental health counselors assess client functioning and, if appropriate, use theories and techniques to treat symptoms and conditions.

▪ Challenges faced by mental health counselors: • Responding adequately to the number of people who need and seek mental health services o The nation’s health providers cannot adequately deal with everyone who needs treatment services for minor or major disorders.

• A trend exists in inpatient psychiatric hospitals to shorten the length of stays for severely disturbed clients. o More disturbed individuals are being seen by mental health counselors in outpatient facilities.

• According to the Journal of Mental Health Counseling, mental health counselors are dealing with treatment like other helping professions.

▪ Areas mental health counselors focus on in treatment • Life-span disorders, such as mild depression • Smoking cessation • Obsessive-compulsive behavior • Eating disorders ▪ Mental health counselors assess and treat disorders using the DSM. • Films may be viewed to familiarize counselors with disorders, such as Sybil, Three Faces of Eve, and A Beautiful Mind.

• Depression and anxiety are the most common clinical symptoms treated.

• Counselors also work with individuals experiencing episodes of depression that lead to hopeless, one of which is suicidal ideology.

▪ Working with suicide • Crises intervention model and continuing-therapy model o Stress the significance of a positive therapeutic relationship and the understanding and validation of client’s feelings. o These models emphasize the importance of helping suicidal clients develop self-awareness and construct a new identity. o The continuing-therapy model provides a lengthier time frame for client/counselor interactions.

• The existential-constructivist framework provides an increased understanding of suicidal individuals from a phenomenological meaning perspective.

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o

This approach requires the counselor and client to commit to long-term therapeutic work. o Deals with the community and others and with intrapersonal thoughts and feelings.

Two General Clinical Disorders: Depression and Anxiety Depression seems to be especially rampant, having increased to epidemic proportions with “roughly 10% to 25% of the population” experiencing “some form of depression” and with depression being “10 times as prevalent now as it was in 1960.

Anxiety affects 40 million adults or 18 percent of the adult population. The disorder has both a genetic and a behavioral component. Anxiey disorders take on a number of forms: generalized anxiety (characterized by at least 6 months of persistent and excessive anxiety, worry), social anxiety (characterized by emotional discomfort or apprehension over social situations that require interaction with others), panic disorder (intense fear, usually accompanied by physical symptoms, such as heart palpitations, sweating, or dizziness, that something bad will happen that is unexpected) Employment of Clinical Mental Health Counselors Employee assistance programs (EAPs) are hiring clinical mental health counselors ▪ EAPs work with employees in preventive and remedial ways to help them avoid or work through problems that could affect their on-the-job behavior.

▪ EAP counselors set up programs that employees have interest in, such as positive wellness or retirement.

▪ EAP counselors invite outside experts to make presentations and arrange for follow-up material or input.

▪ EAP counselors offer short-term, time-limited (three sessions) counseling services too employees experiencing difficulties. Referrals are made to mental health professionals with more expertise.

▪ Large companies house EAP services, while small companies rely on EAP counselors serving a number of companies. o Crises-oriented organizations, such as the Red Cross or local emergency telephone and walk-in counseling centers, employ mental health counselors.

▪ Counselors take care of many needs ranging from physical to mental health.

▪ Counselors service victims of disasters and are hired by local communities and even by international groups . o Clinical mental health counselors are found in settings where other helping specialists work.

▪ Substance abuse, hospice, child guidance clinics, wellness centers, colleges, hospitals, and private practice ▪ Clinical mental health counselors have a solid training in CACREPrequired counseling areas and have versatility in regard to helping people with a wide variety of difficulties or concerns.

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Private Practice as a Specialty • Before insurance, third-party payments, and managed care, the professional lives of private practice counselors was fairly simple. They worked on a fee-for-service basis.

• In the 1980s managed care began to replace fee-for-service arrangements.

• Doctoral graduates of counseling programs indicate the private practice is their preferred method of service delivery.

• Difficulties Setting Up a Private Practice ○ Counselors must be able to balance business skills and counseling skills. ○ Counselors must build support networks with those who can supply information on treatment or referrals. ○ Counselors must invest time and hard work in “pull marketing” relationships. ○ Counselors must be willing to donate services and participate in endeavors for the public good in order to build up a reputations and a practice.

• Advantages in Setting Up a Private Practice ○ Consumers are becoming more dissatisfied with mental health managed care. ○ Private practice affords counselors the opportunity to become known in their communities as professional who provide quality service. ○ Office hours can be set for times that are most convenient. ○ Counselors can become specialists in treatment.

CLASSROOM ACTIVITIES 1. In a team, with four other classmates, devise a primary prevention plan for some underserved group in your community (e.g., people in poverty, older adults, individuals who have been abused). Note the number of resources you must coordinate to make your plan successful. Present your plan to your class as a whole.

2. Do a literature review of wellness and healthy development for the past five years. What are the latest trends? How can these trends be related to the work of mental health or community counselors?

3. Visit an EAP program. What services offered in the program surprise you? Ask the EAP counselor you speak to in your visit to assess the effectiveness of the program in which he or she works.

4. What do you see as the advantages and limitations of being a counselor in private practice? Make a list. Discuss your opinions with fellow classmates.

5. Invite a counselor in private practice to speak to your class about what his or her work is like. Ask the counselor about the business side of private practice as well as the clinical side of this specialty.

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CHAPTER 18 - MULTIPLE CHOICE TEST QUESTIONS 1. Which of the following is responsible for the establishment of more than 2,000 community mental health centers nationwide? a. Community Counseling Act of 1982 b. Tarasoff v. The University of California at Berkeley c. Health Maintenance Organizations Act of 1998 d. Community Mental health Centers Act of 1963 2. Generally, the literature about clinical mental health counseling focuses on two major issues that have theoretical implications. They include treatment of disorders and dysfunctions and __________________________. a. modification of the environment b. prevention and promotion of mental health c. crisis management d. community feedback and dialogue 3. _________ prevention is characterized by its before the fact quality; its intentional and group/mass orientation. a. primary b. secondary c. tertiary d. community 4. The initials for the AMHCA national certification are _____________. a. CORE b. CHAMPUS c. CCMHC d. NCC 5. The letter “D” in the SAD Persons scale stands for _________. a. dropout b. depression c. dim-witted d. drugs 6. In addition to working with individuals, mental health counselors utilize a social-ecological perspective that focuses on ________________ as the client a. the environment b. social relations c. the family d. work groups 7. Health-related activities that are both preventive and remedial and that have a therapeutic value to individuals who practice them consistently are known as those related to _________ wellness.

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a. b. c. d.

primary positive perfect preventive

8. The two most common clinical symptoms associated with presentation for counseling services are _________________. a. mania and depression b. depression and schizophrenia c. anxiety and depression d. abuse and anxiety 9. ______________ are programs whose purpose is to work with employees in preventive and remedial ways in order to help them avoid or work through problems that might detrimentally affect their on-the-job behavior. a. Employer Assistance Programs b. Employee Assistance Programs c. Arbitrator Assistance Programs d. Equal Opportunity Programs 10. Approximately what percentage of individuals in the United States will suffer a traumatic event in their lifetime? a. 33% b. 67% c. 80% d. 94% 11. To be successful in private practice a counselor must ____________. a. balance business skills with those of counseling b. build up support networks c. be willing to donate services for the public good d. all of the above 12. An advantage of being in private practice as a counselor is the opportunity to __________. a. set up one’s own hours of practice b. fill out and learn about government forms c. work long hours d. learn more about marketing 13. Which approach to helping clients through trauma delves into an increased understanding of clients from a phenomenological meaning perspective? a. biopsychosocial functioning approach b. cognitive-behavioral framework c. existential-constructivist framework d. continuing-therapy model

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14. Which one of the following is the name of Arnold Lazarus’ therapeutic approach that includes the BASIC ID approach? a. multitalented b. multifaceted c. multimodal d. multidisciplinary 15. Which one of the following statements is accurate regarding suicide? a. Suicide is far less prevalent in Canada than it is in the United States b. Three times as many males attempt suicide than females, but three times more females complete suicide than males c. Three times as many women attempt suicide, but three times as many males complete suicide d. Latino adolescents have a lower rate of suicide than European American youth.

ESSAY TEST QUESTIONS 1. Describe in detail what the SAD PERSONS scale is, and how clinical mental health counselors can use it to assess clients for suicide risk.

2. Imagine that you are going to set up a private practice as a counselor. Outline the steps you would take to reach your goal. How would you insure your success?

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ADDITIONAL RESOURCES Annenberg/CPB. (1992). Personality disorders [Film]. (Available from Insight Media, 2162 Broadway, New York, NY 10024-0621) This 60-minute video highlights the major features of several personality disorders, including the following: narcissistic, antisocial, obsessive-compulsive, and borderline personality disorders. Diagnosis and treatment concerns are explored. 1-800-233-9910 Dartmouth-Hitchcock Medical Center. (1999). Post-Traumatic Stress Disorder [Film].

(Available from Films for the Humanities & Sciences, PO Box 2053, Princeton, NJ 085432053) This video illustrates how techniques used with Vietnam veterans suffering from PTSD can be used with other people who also suffer from this disorder. Jamie Guth hosts this 28minute program, in which two people, a veteran and an incest survivor, explain their experiences with PTSD. 1-800-257-5126 Films for the Humanities & Sciences. (1999). Alzheimer’s: The tangled mind [Film]. (Available from Films for the Humanities & Sciences, PO Box 2053, Princeton, NJ 08543-2053) New research and medication options are explored in this 23-minute video focusing on Alzheimer’s disease. Using case studies and interviews with doctors, the video illustrates new technology being used to treat this debilitating disease. 1-800-257-5126 Films for the Humanities & Sciences. (1999). Coping with phobias [Film]. (Available from Films for the Humanities & Sciences, PO Box 2053, Princeton, NJ 08543-2053) This program illustrates how phobias develop and can be treated. Focusing primarily on the fear of flying, this 28-minute video demonstrates how clients can overcome fears. 1-800257-5126 Films for the Humanities & Sciences. (1999). Eating disorders [Film]. (Available from Films for the Humanities & Sciences, PO Box 2053, Princeton, NJ 08543-2053) In this 15-minute video, two women tell their stories about struggling with anorexia nervosa and bulimia nervosa. Information about these disorders and the specialized treatment options for treating these disorders is also presented. 1-800-257-5126 Films for the Humanities & Sciences. (1999). Mental illness [Film]. (Available from Films for the Humanities & Sciences, PO Box 2053, Princeton, NJ 08543-2053) This video provides an overview of mental illness, with discussion of illnesses ranging from minor discomfort to serious life-disruption. 1-800-257-5126

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Films for the Humanities & Sciences. (1999). Mixed anxiety and depression: A cognitive behavioral approach with Dr. Donald Michenbaum [Film]. (Available from Films for the Humanities & Sciences, PO Box 2053, Princeton, NJ 08543-2053) This 67-minute video focuses on a brief approach to the treatment of anxiety and depression. Dr. Michenbaum illustrates this approach through the dramatization of the highlights from 12 sessions with a depressed and anxious client. 1-800-257-5126 Films for the Humanities & Sciences. (1999). Obsessive-Compulsive Disorder [Film]. (Available from Films for the Humanities & Sciences, PO Box 2053, Princeton, NJ 08543-2053) Two people with OCD tell their stories in this 15-minute video. The symptoms of OCD are discussed as well as some insights from a psychiatrist. 1-800-257-5126 Films for the Humanities & Sciences. (1999). The midlife passage [Film]. (Available from Films for the Humanities & Sciences, PO Box 2053, Princeton, NJ 08543-2053) This 24-minute video examines the issues that many adults face when they approach “midlife.” Concerns with time, success, and asserting needs are all discussed. This video also explores how adults can take control of their lives at the midlife point in order to gain a higher level of satisfaction. 1-800-257-5126

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APPENDIX A

HISTORY OF COUNSELING APPENDIX OVERVIEW This appendix defines counseling and its uniqueness as a profession. It gives a decade by decade review of counseling from the early 1900s to the present. Throughout the chapter, major events and influential people are featured. Current trends in the counseling field, such as dealing with trauma, the challenge of managed care, and the promotion of wellness are explored, too.

KEY TERMS, CONCEPTS, AND PEOPLE A Mind that Found Itself acute stress disorder (ASD) advocacy American Association for Counseling and Development (AACD) American Counseling Association (ACA) American Personnel and Guidance Association (APGA) American Psychological Association (APA) Association for Counselor Education and Supervision (ACES) Beers, Clifford Brewer, John Chi Sigma Iota Choosing a Vocation community counselor Community Mental Health Centers Act Council for Accreditation of Counseling and Related Educational Programs (CACREP) counseling counseling psychology counseling specialty crises Davis, Jesse B. Diagnostic and Statistical Manual, Fourth Edition, Text Revised (DSM-IV-TR) Dictionary of Occupational Titles Division 17 of APA (Counseling Psychology) ERIC Clearinghouse on Counseling and Personnel Services (CAPS) feminist theory George-Dean Act of 1938 George-Barden Act of 1946 Gilligan, Carol guidance helping-skills human growth and development inpatient setting Ivey, Allen Journal of Counseling and Development Krumboltz, John 302 ..

licensure long-term relationships managed care Minnesota point of view National Board for Certified Counselors (NBCC) National Defense Education Act (NDEA) National Vocational Guidance Association (NVGA) outpatient settings Parsons, Frank personnel and guidance posttraumatic stress disorder (PTSD) professional counseling psychometrics psychotherapy Revolution in Counseling Rogers, Carl school guidance short-term relationships Smith-Hughes Act strategic planning Strong Vocational Interest Inventory technology The Counselor in a Changing World The Counseling Psychologist therapy trait-factor counseling 20/20: The Future of Counseling Veterans Administration (VA) Vocational Bureau wellness Williamson, E. G. Wrenn, C. Gilbert

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APPENDIX A – HISTORY OF COUNSELING Definition of Counseling o o

•

•

•

Focus on growth and wellness and the remediation of mental disorders.

Grew out of the guidance movement, in opposition to traditional psychotherapy.

Guidance o The process of helping people makes important choices that affect their lives. o Has more of a historical significance than present-day usage. o Guidance focuses on helping individuals choose what they value most, while counseling helps them make changes. o Early work in guidance occurred in schools and career centers where students were helped to make decisions, such as career choices. An unequal relationship was between an adult and student. o Helps to gain an understanding of self and own world through guidance, such as from parents, ministers, scout leaders, and coaches.

Psychotherapy o Therapy initially focused on serious internal conflicts. o Emphasized past more than present, insight more than change, detachment of the therapist, and the therapist as an expert. o Long-term relationships (20 to 40 sessions over 6 months to 2 years) focused on reconstructive change. [Short-term relationship = 8 to 12 sessions over less than 6 months.] o Seen as more of an inpatient treatment rather than outpatient. o In more modern times, psychotherapy and counseling have become blurred with professions who determine whether the client receives counseling or psychotherapy.

Counseling o In 2010, 29 counseling associations accepted a definition of counseling as follows Counseling is a professional relationship that empowers diverse individuals, families, and groups to accomplish mental health, wellness, education, and career goals (http:// www.counseling.org/20-20/index.aspx). o

Important points for counselors and consumers to realize: ▪ Counseling deals with wellness, personal growth, career, and mental health concerns.

▪ In other words, the internal concerns and concerns of relationship with others are related in counseling to finding balance and adjustment for the client in certain settings including schools, family, and career.

▪ Counseling is conducted with persons who are considered to be functioning well and those who are having more serious problems.

▪ In other words, clients may be seen for many reasons, including developmental issues (i.e., aging) or situational concerns (i.e., like a break304 ..

up) that require assistance in gaining adjustment or remediation. Problems are usually short-term, but may require longer treatment, especially when the client has a disorder included in the DSM (Diagnostic and Statistical Manual of Mental Disorders).

▪ Counseling is theory based. Counselors may glean from different counseling theories. These theories include theoretical approaches from cognitive, affective, behavioral, and systemic perspectives. Applications can be made to individuals, groups, and families.

▪ Counseling is a process that may be developmental or interventional.

Reaching goals, making change, (or both) may be the focus of counseling. o Counseling specialty: specialized areas within counseling, such as school or college counseling, marriage and family counseling, mental health counseling, gerontological counseling for the aging population, rehabilitation counseling, addiction and offender counseling, and career counseling. Requirements for general counseling must be met before becoming a specialist.

History of Counseling • Before 1900 o Counseling developed in the late 1890s and early 1900s. Sigmund Freud’s ideas were known at this time. His approach to therapy is where many lay people get their ideas of psychological counseling. o Before 1900, most counseling was in the form of advice or information. o In the US, counseling developed out of humanitarian concern to improve lives during the Industrial Revolution of the late 1800s. o Also, counseling was influenced by the social welfare reform movement (child labor), public education, and various changes in population makeup (immigration). o Most counselors were teachers and social reformers: most were involved in child welfare, educational or vocational guidance, and legal reform.

• 1900-1909 (The Gilded Age) o Three leaders in counseling emerged: Frank Parsons, Jesse B. Davis, and Clifford Beers. o Frank Parsons: “Father of Guidance” ▪ Focused on growth and prevention, multiple disciplines – lawyer, engineer, college teacher, and social worker before he became a social reformer and worked with youth.

▪ Best known for founding Boston’s Vocational Bureau in 1908, beginning of the institutionalization of vocational guidance.

• Theorized that choosing a vocation was a matter of relating three factors: knowledge of work, knowledge of self, and a matching of the two.

• Procedures included a lengthy questionnaire that asked about: experiences, preferences, and morals.

• Book Choosing a Vocation (1909) published a year after his death was influential in the designation of vocational counselors in Boston and spread to 35 cities by 1910. o Jesse B. Davis – first to set up a system for guidance programs in the public schools.

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▪

Superintendent of the Grand Rapids, Michigan school system; suggested in 1907 that English teacher teach lessons in guidance once a week to build character and prevent problems. He believed that proper guidance would help cure ill of American society.

▪ Hence, school guidance was developed: a preventive educational means of teaching students how to deal effectively with life events. o Clifford Beers – A Mind That found Itself (1908) ▪ Beers wrote a book about his hospitalizations for depression. He found the conditions in the mental institution unacceptable and exposed them in his book.

▪ Beers used his book to make a platform to reform the treatment of the mentally ill. He also solicited funds from well-known people such as the Fords and Rockefellers to encourage the reform.

• 1910s – Three events impacted development of counseling o 1913, founding of the National Vocational Guidance Association (NVGA).

NVGA began publishing a bulletin in 1915 which evolved into the Journal of Counseling and Development. o 1917, passage of the Smith-Hughes Act of 1917 provided funding for public schools to support vocational education. o During WWI the military began to use testing and placement practices to categorize military personnel, hence came the stanine system for intelligence, as well as the Army Alpha and Army Beta intelligence tests. Psychometrics (psychological testing) became popular through this era.

• 1920s – A quiet era for counseling o Education courses focused on vocational counseling, especially with war veterans. o First certification of counselors in Boston and New York. o First stands for the preparation and evaluation of occupational materials. o Publication of new psychological instruments such as Strong Vocational Interest Inventory in 1927. o Abraham and Hannah Stone’s 1929 establishment of the first marriage and family counseling center in NYC marked the beginning of marriage and family counseling.

• 1930s o Great Depression influenced the need for helping strategies and counseling methods that related to employment. o First theory of counseling, E.G. Williamson, John Darley, Donald Paterson, et al., at the University of Minnesota. Williamson modified Parson’s theory and used it with students and the unemployed. Was a counselor-centered approach (counselor in control of sessions giving direction to where counseling is going and what goals will be attained), known as the Minnesota point of view and trait-factor counseling.

▪ Traits (aptitudes, interests, personalities, achievements) could be integrated in a variety of ways to form factors (constellations of individual characteristics).

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▪ Counseling was a problem-solving, scientific method tailored to each client helping him/her to stop obstructive thinking/behavior and become a better decision maker. o Edward Thorndike, known for Law of Effect, challenged the vocational emphasis of the guidance movement. John Brewer completed the challenge and published his book titled Education as Guidance in 1932 proposing that every teacher be a counselor and that guidance be incorporated in the school curriculum as a subject.

He believed that focus should be on preparing students to live outside the school environment. o 1938, Congress passed the George-Dean Act that created the Vocational Education Division of the US Office of Education and an Occupational Information and Guidance Service. Further, evolved the creation of state supervisors of guidance positions in state departments of education. Also, the US Employment Service was established and published the first Dictionary of Occupational Titles (DOT) in 1939 (a source of career information coded occupations).

• 1940s o Carl Rogers (1942) publication of Counseling and Psychotherapy emphasized the importance of “client-centered” counseling (client gives direction and sets goals for therapy). He believed if right conditions (unconditional acceptance, active listening, and genuineness and congruency) were available to the client; the client would become more congruent and know him/herself better. The therapist served as a mirror to the client. Thus, a shift began from guidance to counseling. o WWII brought about the need for counselors and psychologists to train specialists for the military and for industry. Women began to work because of necessity and traditional occupational roles began to be questioned. o George-Barden Act of 1946 provided vocational education funds through the US Office of Education for counselor training institutes. The VA funded the training of counselors and psychologists by granting stipends and paid internships for students engaged in graduate study. It also coined the term “counseling psychologist.”

• 1950s o American Personnel and Guidance Association (APGA) founded ▪ The APGA grew out of the Council of Guidance and Personnel Associations (CGPA) operating from 1934 to 1951; lacked power to commit its members.

APGA formed in 1952 organized groups interested in guidance, counseling, and personnel matters.

O American School Counselor Association (ASCA) ▪ ASCA was chartered in 1953 and joined APGA as the fifth member. o Division 17 (Counseling Psychology) within the American Psychological Association (APA) changed its name and dropped any reference to guidance.

▪ The above three groups desired to work with the “normal” population rather than clinical population and focused on both vocational counseling and humanistic psychotherapy. o National Defense Education Act (NDEA), 1958

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▪ The NDEA was enacted following the Soviet Union’s first space satellite launch, Sputnik I. The purpose was to identify scientifically and academically talented students and promote their development.

• Act provided funds through Title V-A for upgrading school counseling programs.

• Title V-B offered funds to establish counseling and guidance institutes. o New guidance and counseling theories ▪ The shift to applied behavioral theories, e.g. Joseph Wolpe’s systematic desensitization, became influential.

▪ Cognitive theories, e.g. Albert Ellis’s rational emotive therapy (RET or REBT; B = behavioral) ▪ Eric Berne’s transactional analysis, as well as learning theory, and self-concept theory.

• 1960s o At the beginning of the 60s the focus was on counseling as a developmental profession. Gilbert Wren (1962) set the tone with his book The Counselor in a Changing World. The impact of Wren’s book lessened with other influences of the 60s: o The Vietnam War, civil rights movement, and the women’s movement all influenced the focus of counseling and issues in counseling. o Humanistic (focuses on the client’s ability to become his/her best and selfactualize) counseling became prominent due to individuals like Abraham Maslow, Dugald Arbuckle, and Sidney Jourard. Counseling shifted from one-on-one counseling to group therapy. Also behavioral counseling (self-control and regulation, for example) became influential. o 1963 Community Mental Health Centers Act opened up job opportunities for counselors to focus on abuse, addiction and marriage and family counseling by putting mental health centers into communities. o APGA published first code of ethics for counselors in 1961 and APA’s division 17 began publishing a professional journal in 1969, The Counseling Psychologist. o ERIC clearinghouse on Counseling and Personnel Services (CAPS) established in 1966.

• 1970s o Diversity in Counseling Setting ▪ Mental health centers and community agencies began to employ counselors following the decline and need of counselors in the educational setting.

▪ Specialized training began to be offered in counselor education programs.

▪ The term “community counselor” was coined to describe this type of counselor.

▪ Formation of the Mental Health Counseling Association (AMHCA) as a division within APGA. o Helping Skills Programs ▪ Helping skills programs of Robert Carkhuff, Allen Ivey, et al. focused on teaching basic counseling skills to professionals and non-professionals by o State Licensure 308 ..

▪ Virginia was the first state to adopt a professional counselor licensure law in 1976. Arkansas and Alabama followed in the 70s. o A Strong APGA ▪ The APGA built its headquarters in Alexandria, Virginia.

▪ A division of APGA, Association of Counselor Educators and Supervisors (ACES), outlined the standards for a master’s degree in counseling.

▪ ACES approved guidelines for the doctorate in counseling in 1977.

▪ Membership increased within APGA and four new divisions were added.

• 1980s o Standardization of Training and Certification ▪ Council for Accreditation of Counseling and Related Educational Programs (CACREP) was formed in 1981 as an affiliate organization of APGA. In 1987, CACREP achieved membership in the Council on Postsecondary Accreditation (COPA), bringing it into a position of power equal to the APA. CACREP standardized graduate programs in counseling.

▪ In 1983 the National Board for Certified Counselors (NBCC) began to certify counselors on the national level. Eight subject areas were included in a standardized exam: 1) human growth and development, 2) social and cultural foundations, 3) helping relationships, 4) groups, 5) lifestyle and career development, 6) appraisal, 7) research and evaluation, and 8) professional orientation. To become a national certified counselor (NCC), the National Counselor Exam must be passed and experiential and character references must be ascertained. o Counseling as a Distinct Profession ▪ In 1983, APGA changed its name to the American Association for Counseling and Development (AACD) to replace its outdated name referring to personnel and guidance.

▪ Chi Sigma Iota was formed in 1985 by Thomas J. Sweeney to promote excellence in the counseling profession by setting up an international academic and professional honor society.

▪ AACD made membership services such as liability insurance policies available. o More Diversification of Counseling ▪ As counselors in educational settings continued, community /agency counselors increased dramatically. Thus, the Association for Adult Development and Aging (AADA) and the International Association for Marriage and Family Counselors (IAMFC) were formed. Many other interest groups developed. o Increased Emphasis on Human Growth and Development ▪ New emphasis on Erik Erikson’s stages of development began.

▪ Increased emphasis on the elderly resulted in the Association for Adult Aging and Development (AAAD).

▪ Attention began being given to gender issues. Carol Gilligan emphasized the moral values in females and introduced the feminist theory into counseling forcing the examination of gender differences.

▪ Emphasis on moral values developed; e.g., Lawrence Kohlberg’s theory of moral development. Cognitive ability and empathy were found to be correlated in counselor education research.

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▪ Multicultural issues became an additional focus and resulted in the refinement of the AACD division Association of Multicultural Counseling and Development (AMCD).

• 1990s o The AACD changed its name in 1992 to the American Counseling Association (ACA) to fully encompass its mission. o Counseling was recognized by the Center for Mental Health Services and by the National Institute of Mental Health as a primary mental health profession. o Writing of the multicultural counseling standards by Sue, Arredondo, and McDavis (1992) set the stage for multicultural counseling. o Increase in managed health care began causing the decline in independent counselor practitioners and the number of sessions offered to clients under managed health care plans. o Emphasis on social factors became more important to the development of mental health and prevention. o The National Academy of Clinical Mental Health Counselors merged with NBCC. o Growth in CACREP accredited programs.

Current Trends in the New Millennium – Over 60 years of service under ACA • Dealing with Violence, Trauma, and Crises o New emphasis began in training counselors to respond to trauma and tragedies due to school shootings, the Oklahoma City bombing, and 9/11’s terrorist attack. Focus on the treatment of ASD (acute stress disorder) and PTSD (posttraumatic stress disorder). ASD lasts for about a month and PTSD includes flashbacks and may last for years.

• The Challenge of Managed Care o Managed care companies determine how health care providers deliver services and what rights and sources of help consumers have to receive regarding treatment. A primary physician must make arrangements for the client.

Reimbursement through insurance is limited, as well as the number of sessions. o Ethical concerns under managed care arise.

• Promoting Wellness o Emphasis of wellness in counseling has increased including: physical, intellectual, social, psychological, emotional, and environmental wellness.

• Concern for Social Justice o Counselors of today are drawn to social justice due to the interest in welfare of people in society. Major elements of a social justice approach include the identification and challenge of environmental limits and freeing clients from oppressive actions. o Counselors are taking an active role in social justice by advocating for the profession and for client, along with community outreach, and public policy making. o Counselors must possess skills and have commitment to social issues to be effective as advocates.

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•

•

o Leading advocacy groups within the ACA include Counselors for Social Justice (CSJ) and ACES. Outside the ACA leading groups include Chi Sigma Iota (Counseling Academic and Professional Honor Society International) and NBCC. • Greater Emphasis on the Use of Technology o Technology promotes dialogue between counselors. Websites are utilized with counseling organizations, counselor education programs, and individual counselors. Additionally, on-line counseling journals are available along with research information, the first being the Journal of Technology in Counseling; o Internet counseling is controversial. Ethical and legal risks include problems with confidentiality, the handling of emergencies, the lack of nonverbal information, crossing state judicial lines, the lack of outcome research, technology failures, and difficulties with rapport. o Counseling services are offered across the Internet (e.g., suicide prevention) and through the telephone (e.g., crisis counseling). Telephone counselors can use Web technology to enhance their services if NBCC guidelines for Internet counseling are followed. o Clients who may be well served through the use of online counseling are those who are geographically isolated, the physically disabled, those who would not ordinarily seek counseling, and those who are more prone to writing than speaking. o Counselor competencies for technology use include proficiency in word processing programs, audiovisual equipment, e-mail, the Internet, Listservs, and CD-ROM databases. However, the Internet, telephone, and other technologies will never fully replace face-to-face counseling.

Leadership o A need exists for counselors to develop their leadership, planning, and advocacy skills. Counselors are challenged in agencies and schools to move beyond clinical supervision and into managerial leadership roles. The ACA and Chi Sigma Iota are focused on building leadership skills through workshops and seminars.

• One area of leadership, strategic planning, involves envisioning the future and making preparations to meet proposed needs. This skill is usually accomplished in a group and involves hard data and anticipations.

Identity • The ACA has not been as successful as the medical field to diversify its counseling tracks into separate areas of practice. However, divisions within ACA have continued to hold strong membership. Nineteen divisions and affiliates operate under ACA’s structure.

CLASSROOM ACTIVITIES 1. How do you distinguish between counseling, guidance, and psychotherapy? How do you think the public perceives the similarities and differences in these three ways of helping?

Discuss your ideas with your classmates.

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2. What decade do you consider the most important for the development of counseling? Is there a decade you consider least important? Be sure to give reasons for your position.

3. What do you know about counseling now that you have read this chapter? Describe how it is like and unlike what you expected. What did you discover about the profession? Explain your answer fully.

4. Investigate in more detail the life and influence of a historical or contemporary figure in counseling. You may choose one of the innovators mentioned in this chapter or a person suggested by your instructor. Share your information with the class.

5. What do you consider pressing future issues for the profession of counseling? How do you think counselors should address these concerns? See whether there is a consensus of topics and ways to address them within your class.

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APPENDIX - MULTIPLE CHOICE TEST QUESTIONS 1. The organization that was the forerunner of the American Counseling Association (ACA) was the ___________________. a. National Vocational Guidance Association b. Counseling and Guidance Division of APA c. National Defense Education Association d. Association for Humanistic Education and Development 2. The term “guidance” has traditionally dealt with the process of ______, while the term “counseling” is more associated with ________. a. change; choice b. reconstruction; adjustment c. choice; change d. adjustment; reconstruction 3. Counseling usually differs from traditional psychotherapy in that it ______. a. is shorter in duration b. focuses on less severe problems c. is more present- than past-oriented d. all of the above 4. According to the consensus definition of professional counseling adopted by 29 counseling association, counseling deals with the following concern(s): __________. a. wellness b. career c. education d. all of the above 5. Which is not a specialty area in the counseling field? a. group work b. assessment c. clinical psychology d. careers 6. ___________ was the founder of the Boston Vocational Bureau and is sometimes referred to as the “Father of Guidance”. a. Clifford Beers b. Frank Parsons c. John Dewey d. Jesse B. Davis 7. ____________, a former Yale student, advocated for better mental health facilities after his own struggles with mental illness and witnessing, first-hand, deplorable conditions in mental institutions. He helped to start a mental health movement that reformed the treatment of the mentally ill.

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a. b. c. d.

Clifford Beers Frank Parsons John Dewey Jesse B. Davis

8. E. G. Williamson’s ___________ point of view of counseling, as well as the major tenets of Freudian psychoanalysis, was challenged by Carl Rogers in the publication Counseling and Psychotherapy which illustrates his ____________ approach. a. person-centered; client-centered b. client-centered; counselor-centered c. counselor-centered; client-centered d. counselor-centered; directive 9. The passage of the National Defense Education Act (NDEA) provided funds for the training/education of _________ counselors. a. school b. mental health c. rehabilitation d. military 10. Behavioral counseling gained importance through ____________ publication ____________, in which he focused on learning (instead of insight) as the root of change. a. Carl Rogers’; Counseling and Psychotherapy b. John Krumboltz’s; Revolution in Counseling c. C. Gilbert Wrenn’s; Counselor in a Changing World d. Frank Parsons’; Choosing a Vocation 11. The first state to pass licensure for counselors in the 1970’s was __________. a. Alabama b. North Carolina c. Virginia d. Florida 12. The move in counseling toward standardized training and certification in counseling resulted in the founding in 1981 of the ______________ as the national accreditation organization for counseling programs in the United States. a. Council for Accreditation of Counseling and Related Educational Programs (CACREP) b. National Board for Certified Counselors (NBCC) c. American Association for Counseling and Development (AACD) d. Division 17 (i.e., counseling psychology) of the American Psychological Association 13. A lively debate about the nature of multicultural counseling occurred in the 1990s as a result of the publication of _____________________. a. the multicultural counseling competencies and standards b. the licensure of counseling in states with large ethnic minority populations c. the founding of the Association for Multicultural Counseling and Development 314 ..

d. the managed care movement 14. Counselors can develop their leadership skills through involvement in the following areas, EXCEPT ____________. a. participating in Chi Sigma Iota training workshops and seminars b. strategic planning c. participating in ACA regions d. working independently of others on all projects 15. Which act provided vocational funding through the US Office of Education for counselor training institutes? a. George Dean Act b. George Barden Act of 1946 c. 1963 Community Mental Health Centers Act d. Counselor Training Act of 1949 ESSAY TEST QUESTIONS 1. Since the early 1900’s, how has the counseling profession developed and changed? Be sure to discuss how major figures in the field have helped to shape counseling into its present form. Also include any major events in history that had an impact on the development of the profession.

2. Discuss two of the major trends counselors must face in the twenty-first century. Be sure to include both positive and negative characteristics of these trends and how counselors can rise to the challenges.

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ADDITIONAL RESOURCES American Counseling Association. (1984). Conversations with Rollo May [Film]. (Available from American Counseling Association, 5999 Stevenson Avenue, Alexandria, VA 22304) This 30-minute video features Rollo May and his perspective on the field of counseling. 1800-422-2648 American Counseling Association. (1996). C. Gilbert Wrenn: Contemporary counselor [Film].

(Available from American Counseling Association, 5999 Stevenson Avenue, Alexandria, VA 22304) Wrenn focuses on school counselors in this 35-minute video, with discussion on roles of school counselors and institutional issues. 1-800-422-2648 American Counseling Association. (1996). C. Gilbert Wrenn: The development of modern guidance [Film]. (Available from American Counseling Association, 5999 Stevenson Avenue, Alexandria, VA 22304) This 30-minute video features Wrenn giving a historical look at counseling. Wrenn highlights major developments within the counseling field. 1-800-422-2648 American Counseling Association. (1996). Carl Rogers: A personal perspective at 75 [Film].

(Available from American Counseling Association, 5999 Stevenson Avenue, Alexandria, VA 22304) Carl Rogers shares his views on many different aspects of counseling and his ideas concerning the nature of man. He talks about the importance of reflecting feelings and other areas of counseling work. (25 minutes) 1-800-422-2648 American Counseling Association. (1996). Rollo May on Existential/Humanistic Counseling [Film]. (Available from American Counseling Association, 5999 Stevenson Avenue, Alexandria, VA 22304) Throughout this 100-minute video, Rollo May discusses his viewpoint on different aspects of counseling. There are four-parts to the video: 1) Rollo May on Counseling, 2) On Existential Psychology, 3) On Humanistic Psychology, and 4) On Creativity and the Tragic. May shares his ideas about the development of existential and humanistic psychology, as well as some of his personal struggles that have influenced his beliefs. 1-800-422-2648 American Counseling Association. (1996). Leona Tyler on counseling [Film]. (Available from American Counseling Association, 5999 Stevenson Avenue, Alexandria, VA 22304) This 50-minute video includes Leona Tyler discussing some critical aspects of the counseling profession. The two parts of this video focus on the role of the counselor and the increasing need for counselors and counseling in general. 1-800-422-2648

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American Counseling Association. (1986). The inner world of counseling with Carl Rogers [Film]. (Available from American Counseling Association, 5999 Stevenson Avenue, Alexandria, VA 22304) Three sessions comprise this 80-minute video which features Carl Rogers conducting clientcentered counseling in a one-on-one session. Rogers’ shares his thoughts on this client and the case. 1-800-422-2648 Insight Media. (1977). B. F. Skinner on Behaviorism [Film]. (Available from Insight Media, PO 2162 Broadway, New York, NY 10024-0621) A discussion on the basics of behaviorism is the primary focus of this video featuring B. F. Skinner. During this 28-minute video, Skinner illustrates how behaviorism can be applied in a variety of areas, as well as how to use behavioral techniques to shape behavior. 1-800-2339910 Insight Media. (1986). Conversations with Viktor Frankl [Film]. (Available from Insight Media, 2162 Broadway, New York, NY 10024-0621) Viktor Frankl discusses his theories in comparison to the theories of other psychology greats: Skinner, Adler, Jung, Freud, and Lorenz. Logotherapy is discussed as well as Frankl’s advice for new counselors and therapists.1-800-233-9910 Insight Media. (1989). Reflections on empathy: Heinz Kohut [Film]. (Available from Insight Media, 2162 Broadway, New York, NY 10024-0621) Dr. Kohut hosts this 45-minute video which focuses on his concept of empathy and how is has evolved over the last few decades. 1-800-233-9910 Insight Media. (1995). Sigmund Freud [Film]. (Available from Insight Media, 2162 Broadway, New York, NY 10024-0621) This 50-minute video follows Freud’s personal and professional history with a look at his theories and how he developed some of his key concepts (transference, free association, etc.).

1-800-233-9910 Insight Media. (1991). Communication skills for effective helping [Film]. (Available from Insight Media, 2162 Broadway, New York, NY 10024-0621) This video illustrates how to use communication skills when working with clients who are experiencing issues related to grief and loss. Dr. Dale Larson explains both non-verbal and verbal communication skills in this 30-minute video. 1-800-233-9910

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ANSWER KEYS TO MULTIPLE CHOICE QUESTIONS CHAPTER 1 Multiple Choice 1) c

2) a

3) d

4) b

5) a

6) d

7) c

8) d

9) c

10) c

9) d

10) b

9) c

10) b

9) d

10) b

9) d

10) c

9) b

10) a

11) c 12) b 13) d 14) b 15) a CHAPTER 2 Multiple Choice 1) b

2) c

3) d

4) d

5) b

6) a

7) b

8) a

11) c 12) d 13) a 14) d 15) d 16) c CHAPTER 3 Multiple Choice 1) d

2) c

3) c

4) a

5) a

6) c

7) d

8) b

11) c 12) a 13) c 14) b 15) b

CHAPTER 4 Multiple Choice 1) d

2) b

3) c

4) a 5) b

6) a

7) c

8) b

11) d 12) c 13) c 14) b 15) c CHAPTER 5 Multiple Choice 1) c

2) c

3) d

4) b

5) b

6) c

7) c

8) c

11) b 12) a 13) b 14) b 15) a CHAPTER 6 Multiple Choice 1) a

2) a

3) c

4) d

5) b

6) b

7) c

8) d

11) d 12) a 13) c 14) c 15) a 16) a 17) d 18) a 19) d 20) b 21) b 22) a 23) b 24) b

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CHAPTER 7 Multiple Choice 1) c

2) b

3) d

4) a

5) b

6) a

7) b

8) b

9) c

10) c

9) b

10) d

9) b

10) c

9) b

10) c

9) c

10) a

9) c

10) c

11) a 12) d 13) b 14) c 15) a CHAPTER 8 Multiple Choice 1) a

2) c

3) b

4) b

5) c

6) a

7) a

8) c

11) a 12) d 13) b 14) c 15) d

CHAPTER 9 Multiple Choice 1) c

2) d

3) c

4) b

5) d

6) b

7) c

8) a

11) d 12) c 13) c 14) a 15) d 16) c

CHAPTER 10 Multiple Choice 1) d

2) d

3) c

4) c

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6) b

7) a

8) d

11) c 12) b 13) d 14) b 15) c 16) b

CHAPTER 11 Multiple Choice 1) d

2) a

3) a

4) d

5) a

6) d

7) b

8) b

11) d 12) c 13) d 14) c 15) a

CHAPTER 12 Multiple Choice 1) a

2) d

3) a

4) d

5) a

6) d

7) a

11) b 12) a 13) a 14) c 15) c

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8) d

CHAPTER 13 Multiple Choice 1) b

2) d

3) a

4) c

5) b

6) b

7) d

8) b

9) a

10) c

9) a

10) a

9) c

10) a

9) a

10) a

9) a

10) c

9) b

10) b

11) b 12) d 13) a 14) a 15) d CHAPTER 14 Multiple Choice 1) a

2) a

3) a

4) d

5) b

6) c

7) c

8) b

11) b 12) b 13) a 14) d 15) c CHAPTER 15 Multiple Choice 1) c

2) d

3) d

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5) a

6) b

7) a

8) b

11) d 12) c 13) a 14) c 15) b

CHAPTER 16 Multiple Choice 1) c

2) c

3) a

4) b

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6) d

7) b

8) b

11) a 12) c 13) b 14) b 15) c

CHAPTER 17 Multiple Choice 1) c

2) c

3) d

4) a

5) b

6) c

7) b

8) b

11) d 12) a 13) a 14) d 15) b 16) a 17) c

CHAPTER 18 Multiple Choice 1) d

2) b

3) a

4) c

5) b

6) a

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11) d 12) a 13) c 14) c 15) c

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8) c

APPENDIX Multiple Choice 1) a

2) c

3) d

4) d

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7) a

11) c 12) a 13) b 14) b

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8) c

9) a

10) b

ANSWER KEYS TO ESSAY QUESTIONS CHAPTER 1 Essay 1. Five qualities of an effective counselor and ways counselors can improve professionally throughout their career.

• Students should choose from five of the following qualities of counselors and describe their rationale for each: ▪ Curiosity and inquisitiveness ▪ Ability to listen ▪ Comfort with conversation ▪ Empathy and understanding ▪ Emotional insightfulness ▪ Introspection ▪ Capacity for self-denial ▪ Tolerance of intimacy ▪ Comfort with power ▪ Ability to laugh ▪ Intellectual competence ▪ Energy ▪ Flexibility ▪ Support ▪ Goodwill ▪ Self-awareness • Options for what counselors can do to improve professionally throughout their career: ▪ Monitor biases ▪ Listen attentively ▪ Ask for clarification ▪ Explore racial and cultural differences in open and positive ways ▪ Practice “alonetime” ▪ Modify environmental as well as individual and interpersonal factors to avoid compassion fatigue and burnout ▪ Associate with healthy individuals ▪ Work with committed colleagues and organizations that have a sense of mission ▪ Be reasonably committed to a theory of counseling ▪ Use stress-reduction exercises ▪ Modify environmental stressors ▪ Engage in self-assessment ▪ Periodically examine and clarify counseling roles, expectations, and beliefs ▪ Obtain personal therapy ▪ Set aside free and private time ▪ Maintain an attitude of detached concern when working with clients 322 ..

▪

Retain an attitude of hope

2. Developmental/wellness approach versus the medical/pathological model • Developmental/wellness perspective ▪ Problems viewed as potentially related to a developmental task ▪ Emphasizes the positive nature and health of clients ▪ Clients are seen as having the resources to solve their own problems in practical and immediate ways ▪ Problems are not seen as underlying pathology ▪ Emphasis placed on prevention and education • Medical/pathological model ▪ Treatment plans based on DSM diagnoses ▪ Emphasis placed on the identification of mental disorders and treating them.

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CHAPTER 2 Essay 1. Benefits and limitations of ethical codes in counseling, and resources counselors can use in making ethical decisions • Benefits of ethical codes ▪ Offer formal statements for ensuring protection of clients’ rights while identifying expectations of practitioners ▪ Make it possible for individuals with similar interests to be part of a professional organization ▪ Provide guidelines for the professional behavior of members on a personal level ▪ Protect the profession from government ▪ Help control internal disagreements ▪ Protect practitioners from the public ▪ Increase public trust in the integrity of a profession ▪ Provide clients with protection from charlatans and incompetent counselors • Limitations of ethical codes ▪ Some issues cannot be resolved by a code of ethics ▪ Enforcing ethical codes is difficult ▪ There may be conflicts within the standards delineated by the code ▪ Some legal and ethical issues are not covered in codes ▪ Ethical codes are historical documents. Thus, what may be acceptable practice at one time may be considered unethical later ▪ Sometimes conflicts arise between ethical and legal codes ▪ Ethical codes do not address cross-cultural issues ▪ Ethical codes do not address every possible situation ▪ There is often difficulty in bringing the interests of all parties involved in an ethical dispute together systematically ▪ Ethical codes are not proactive documents for helping counselors decide what to do in a new situation • Resources in making ethical decisions ▪ Ethical reasoning ▪ Ethical Principles of beneficience, nonmaleficence, autonomy, justice, fidelity, and veracity ▪ Swanson’s (1983) guidelines for assessing ethical responsiveness • Personal and professional honesty • Acting in the best interest of clients • Acting without malice or personal gain • Justifying an action based on the current state of the profession ▪ ACA Ethical Standards Casebook 2. Three instances where a counselor can be sued for malpractice in either civil or criminal liability cases; steps counselors can take to avoid such occurrences.

• Examples malpractice in civil or criminal liability cases: 324 ..

•

▪ Failing to report child abuse ▪ Engaging in sexual relations with a client ▪ Defamation Steps to avoid liability: ▪ Follow professional codes of ethics ▪ Follow normal practice standards ▪ Act in professional, attentive, and courteous manner at the beginning of a counseling relationship so communication is enhanced and clients perceive that the counselor really cares about them

3. Six ethical principles, and give an example of how each may be applied in a counseling situation • Beneficence ▪ Doing good and preventing harm ▪ Following standards of practice when working with clients. Moreover, reporting clients’ intent to kill themselves if a suicide assessment indicates that it is appropriate • Nonmaleficence ▪ Not inflicting harm ▪ Avoiding practices that go beyond the standard of care and that are outside of one’s scope of practice • Autonomy ▪ Respecting freedom of choice and self-determination ▪ Giving clients informed consent about your philosophy of counseling and the interventions you aim to use.

• Justice ▪ Fairness ▪ Treating clients fairly in regards to time, payment, and effort • Fidelity ▪ Faithfulness or honoring commitments and promises ▪ Following through with your responsibilities to the client, such as not abandoning him or her • Veracity (truthfulness) ▪ Being honest in advertising and in session with clients about your credentials and training, and how helpful you believe counseling will be for the client.

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CHAPTER 3 Essay 1. Perceptions of counseling in U.S. that may hinder cultural minority groups from receiving adequate care, and how counselors can be more sensitive to and effective in working with cultural minority clients • Perceptions of counseling: ▪ Belief that the counseling relationship takes place among unequals ▪ Perception that psychological problems are physical problems ▪ Perception of relinquishing independence by telling one’s business to a stranger ▪ Collectivistic values conflicting with individualistic values of counseling • What counselors can do: ▪ Develop self-awareness ▪ Develop awareness of others ▪ Increase cultural knowledge ▪ Engage in cultural responsiveness ▪ Develop cultural skills – able to use multiple skills and techniques.

2. What is overculturalizing and how did it come about?

• Mistaking people’s reactions to poverty and discrimination for their cultural patterns • It occurs because of an overrepresentation of racial and ethnic minority groups living in poverty in the United States • Examples may be assuming that things like mode of dress, time orientation, and vernacular are directly tied to a culture and neglecting to consider the role of poverty 3. Cultural knowledge, awareness, and skills. Give specific examples: • Cultural knowledge: knowledge of one’s own culture as well as that of other cultures. Includes recognition of historical and contemporary oppression.

• Cultural awareness: awareness of one’s beliefs and attitudes toward culturally diverse groups. It includes awareness of one’s worldview and how it is a product of cultural conditioning • Cultural skills: abilities necessary to work with culturally diverse clients. It may include cultural responsiveness as well as an ability to use a variety of interventions to meet the needs of culturally diverse clients

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CHAPTER 4 Essay 1. Challenges and strengths associated with older adults based on Erikson’s stages. Discuss how knowledge of Erikson’s stages can help counselors working with older adults • Middle adulthood: generativity vs. stagnation; Older adulthood: Ego integrity vs.

Despair ▪ Strengths: • Wisdom ▪ Challenges: • Changes in physical abilities, social roles, relationships, ad residential location. Can spark an identity crisis • Loneliness, physical illness, retirement, idleness, bereavement, and abuse ▪ How knowledge of Erikson’s stages can help • Recognition of strengths (e.g., wisdom) • Identification of common struggles in older adulthood 2. How are the concerns of men and women similar? How do they differ? Strategies for counseling men and women.

• Concerns of men and women ▪ Interest and involvement in fundamental issues such as intimacy, career options, and life development (women) ▪ Concerns related to counseling men often stem from their socialization ▪ Men find psychological safety in independence, whereas women are often more relational ▪ Men are more reluctant to seek counseling • Strategies ▪ Understanding the relational nature of women ▪ Conveying empathy, warmth, and understanding helps when working with women ▪ Feminist theory ▪ Working from a positive masculinity perspective with men ▪ Developmental relational counseling for men ▪ Group work recommended for men 3. Working with gay, lesbian, bisexual, and transgender clients: • Difficulties with coming out • Forming community organizations • Following religious practices • Coping with AIDS and relationships • Dealing with prejudice and discrimination (e.g., homophobia)

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CHAPTER 5 Essay 1. How to conduct a client-initiated relationship counseling interview. Helpful behaviors?

Behaviors to avoid?

• Client-initiated interview ▪ Counselor should work to overcome feelings of uncertainty and anxiety.

▪ Be sure to listen attentively ▪ No formula to the session ▪ Must work out a style based on experience, stimulation, and reflection ▪ Good to start with “what brought you here to see me?”

▪ Helpful not to inquire initially about any problem the client may have because the client may not have a problem in the traditional sense of the word and may be seeking information 2. Battle for Initiative and Battle for Structure. How may each be won?

▪ Battle for structure - Issues of administrative control (e.g., scheduling, feels, participation in sessions) ▪ How to win it: • Time limits • Role limits • Procedural limits • Professional disclosure statements • Battle for initiative - Motivation for change and client responsibility ▪ How to help clients with initiative: • Counselors can anticipate anger, frustration, and defensiveness that some clients display • Counselors can show acceptance, patience, and understanding as well as a general nonjudgmental attitude • Counselors can use persuasion (e.g., foot in the door, door in the face) • Confrontation • Metaphors • Mattering Pragmatic techniques, such as silence, reflection, questioning, etc.

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CHAPTER 6 Essay 1. Self disclosure: What it is, how it can be used effectively, and its advantages and disadvantages.

• What it is: ▪ Complex, multifaceted phenomenon ▪ Conscious, intentional technique in which clinicians share information about their lives outside the counseling relationship • Used effectively (advantages) ▪ Can improve trust ▪ Provides modeling and helps clients develop a new perspective ▪ Should be brief and focused ▪ Should not add to the clients’ problems ▪ Should not be used frequently • Disadvantages ▪ More does not mean better ▪ Can distract clients and make the focus more on the counselor 2. How to effectively close a counseling relationship: • Use fadingg • Help clients develop successful problem-solving skill • For intense relationships ▪ Be aware of the client’s needs and desires and allow the client time to express them ▪ Review the major events of the counseling experience and bring the review into the present ▪ Supportively acknowledge the changes the client has made ▪ Request follow-up contact

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CHAPTER 7 Essay 1. Psychoanalytic theory versus Adlerian theory: •

•

•

Psychoanalytic theory ▪ Founders and developers: Sigmund Freud, Anna Freud, and Heinz Kohut ▪ View of human nature: • Conscious mind, preconscious mind, unconscious mind • Id, ego, superego • Psychosexual developmental stages • Fixation and defense mechanisms ▪ Role of the counselor: experts who help clients gain insights by working through unresolved past experiences; transference and interpretation encouraged ▪ Techniques: free association, dream analysis, analysis of transference, analysis of resistance, interpretation Adlerian theory ▪ Founders and developers: Alfred Adler (pupil of Freud) ▪ View of Human nature: • People motivated not by psychosexual desires but by social interest • Striving for perfection • Inferiority and superiority complexes • Style of life ▪ Role of the counselor: diagnosticians, teachers, and models in an egalitarian relationship; assess why clients are oriented to a certain way of thinking and behaving; emphasis placed on family constellation and earliest memories; active in sharing hunches or guesses; often directive ▪ Techniques: confrontation, asking “the question,” encouragement, acting “as if,” spitting in the client’s soup, catching oneself, task setting, push button Similarities ▪ Belief in unconscious motivation – one regarding psychosexual impulses, the other, social interest ▪ Belief in the strong influence of past experiences.

▪ Directiveness in session, teaching, and interpretation

2. Person-centered, existential, and gestalt therapies: • Person-centered ▪ Phenomenological perspective ▪ Self- theory ▪ Empathy, congruence, and positive regard ▪ Self-actualization ▪ Internal locus of control • Existential Counseling ▪ People form their lives by the choices they make 330 ..

▪

•

Meaning goes beyond self-actualization and exists of three levels: ultimate meanings, meaning of the moment, and common day-to-day meaning Gestalt Therapy ▪ Self-actualization ▪ Antideterministic view ▪ Unfinished business

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CHAPTER 8 Essay 1. Popularity of CBT, and the strengths and limitations of cognitive theories: •

•

•

Popularity of CBT: ▪ These answers may vary significantly considering the prompt is asking for students’ opinions.

▪ However, some things to look for include the tangible nature of behavioral and cognitive techniques, which lend themselves very nicely to a formula and manual. Some students may also indicate that the manualized nature of the techniques lend themselves nicely to research, which increases the popularity of these approaches Strengths and limitations (REBT) ▪ Clear, easily learned, and effective ▪ Can easily be combined with other behavioral techniques to help clients more fully experience what they are learning ▪ Relatively short term, and clients may continue to use the approach on a self-help basis ▪ Has generated a great deal of literature and research for clients and counselors ▪ Has continued to evolve over the years as techniques have been refined ▪ Has been found effective in treating major mental health disorders such as depression and anxiety ▪ Cannot be used effectively with individuals who have mental problems or limitations, such as schizophrenia ▪ May be too closely associated with its founder ▪ Direct approach may lead to counselors being overly zealous rather than therapeutic ▪ Emphasis on changing thinking may not be the simplest way of helping clients change their emotions Strengths and limitations (Reality therapy) ▪ Versatile and can be applied to many populations ▪ Concrete ▪ Emphasizes short-term treatment ▪ Has national training centers and is taught internationally ▪ Promotes responsibility and freedom within individuals without blame or criticism or as an attempt to restructure the entire personality ▪ Challenged the medical model of client treatment ▪ Addresses conflict resolution ▪ Stresses the present because current behavior is most amenable to client control ▪ Emphasizes the here and now of behavior so much that it sometimes ignores other concepts ▪ Holds that all forms of mental illness are attempts to deal with external events (Glasser, 1984) ▪ Has few theoretical constructs, although it is now tied to choice theory 332 ..

•

▪ Does not deal with the full complexity of human life ▪ Susceptible to becoming overly moralistic ▪ Dependent on establishing a good counselor-client relationship ▪ Depends on verbal interaction and two-way communication Strengths and limitations (Cognitive therapy) ▪ Has been adapted to a wide range of disorders ▪ Has spawned, in conjunction with CBT, dialectical behavior therapy ▪ Applicable in a number of cultural settings ▪ Well-researched, evidence-based therapy ▪ Spawned a number of useful and important clinical instruments ▪ Has a number of training centers across the US and Europe ▪ Structured and requires clients to be active ▪ Not appropriate for individuals seeking an insight-oriented approach ▪ Not the best approach for individuals who are intellectually limited ▪ Demanding

2. Compare and contrast systems theories based on strengths and limitations: • Bowen Systems Theory ▪ Focuses on multigenerational family history and the importance of noticing and dealing with past patterns in order to avoid repeating these behaviors in interpersonal relationships ▪ Uses genograms to plot historical links ▪ The cognitive emphasis of the approach and its focus on differentiation of self and detriangulation are unique ▪ Extensive and complex ▪ Those who benefit the most from this theory are severely dysfunctional ad have a low differentiation of self ▪ May require considerable investment on multiple levels • Structural Family Counseling ▪ Versatile, in that it is a process that is appropriate for low-socioeconomic level families and other families ▪ Effective, having been used in treating juvenile delinquents, alcoholics, and individuals with anorexia ▪ Culturally sensitive and appropriate for use in multicultural settings ▪ Clear in its definition of terms and procedures and is easily applicable ▪ Emphasizes symptom removal and a reorganization of the family in a pragmatic way ▪ Not complex enough, may be sexist at times, and focuses too much on the present ▪ Influenced by and difficult to differentiate it from strategic family therapy ▪ May not empower families enough • Strategic ▪ Many times the therapists work in teams ▪ Nature o the approach is pragmatic and flexible ▪ Focus of practitioners is on innovation and creativity

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▪

•

Emphasis is to change the perception within people as a way of fostering new behaviors ▪ Intentional attempts are made to work on one problem at a time and limit the number of therapeutic sessions so that the focus and motivation for doing things differently is enhanced ▪ May be modified and carried over into settings, such as schools, where it may be systemically applied to serve a total population ▪ Some of its underlying foundation and techniques overlap with other systems and brief therapy theories ▪ Some stands taken by leading strategic practitioners are controversial ▪ Clients may not attain as much independence or ability Preferences ▪ Will vary, but supporting information should be logical and accurate.

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CHAPTER 9 Essay 1. Setting up a counseling group for population of choice: •

Answer will vary depending on the population of choice. However, it is important that students consider and justify their decisions related to the following: ▪ Theoretical orientation ▪ Selection and preparation of group members ▪ Group size and duration ▪ Open vs. closed ▪ Physical structure of the group ▪ Number of group leaders

2. Advantages and limitations of groups. Qualities of effective group leaders: • Advantages: ▪ Groups can help individuals with a variety of problems ▪ Groups can be beneficial for: elementary through high school students; promoting career development; adult women; adult men; dealing with stressors; adolescent offenders; and many more • Limitations ▪ Groupthink mentality: stereotypical, defensive, stale thought processes become the norm ▪ Individuals may not be dealt with in-depth enough ▪ Individuals may try to use groups as an escape • Qualities of group leaders ▪ Caring – the more the better ▪ Meaning attribution – clarifying, explaining, providing cognitive framework for change ▪ Emotional stimulation – activity, challenging, risk taking, self-disclosure ▪ Executive function – developing norms, structuring, suggesting procedures

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CHAPTER 10 Essay 1. Different levels of consultation based on purpose and effectiveness: • Individual ▪ Self-monitoring ▪ Self-measurement ▪ Self-mediation ▪ Self-maintenance • Group ▪ Several individuals share a similar problem • Organization/community consultation ▪ Consultants possess sophisticated knowledge of systems ▪ Organization or community consultants are external to the project ▪ Most of the activities involve individuals and/or groups • Effectiveness and purpose: ▪ Effectiveness of each level depends on the problem at hand. Each can be effective if they are aligned appropriately with a problem. For example, a group level problem that is addressed on an individual level may be less effective.

2. Similarities and differences regarding consultation and counseling: • Ultimate goal of both are very similar • Counseling occurs in formal settings • Consultation can take place informally • Consultation activities work indirectly • Counseling works directly with individuals, groups, couples, and families

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CHAPTER 11 Essay 1. Counselors’ resistance to research and how it should change to be beneficial to counselors: • Resistance to research by practitioners ▪ Relevance of the results to practitioners ▪ Many research efforts lack vision ▪ Failed to develop research methods appropriate for counseling • Ways it should change ▪ Conduct experience-near research ▪ Engage in action research ▪ Emphasize studies that focus on the reasons individuals seek counseling, such as their goals, intentions, and purposes 2. Major methods of research and place for statistics: • Major research methods ▪ Qualitative ▪ Quantitative ▪ Outcome ▪ Experimental ▪ Basic ▪ Applied ▪ Historical ▪ Descriptive ▪ Case studies ▪ Comparative studies • Place for statistics ▪ Used in quantitative research ▪ The lifeblood and bane of helping professionals ever since.

▪ Means for researchers to use in analyzing and interpreting findings and communicating those findings to others

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CHAPTER 12 Essay 1. Historical linkage of counseling and testing, and necessary qualities of good tests: • Historical linkage: ▪ WWI – Employed intelligence tests to screen inductees ▪ Vocational testing emphasized in 19380s because of the Great Depression ▪ National Defense Education Act ▪ National Education Act Resolution 72-44 • Qualities of good tests: ▪ Validity ▪ Reliability ▪ Standardization and Norms 2. Various classification of tests and examples of each: • Intelligence / Aptitude (e.g., Stanford-Binet) • Interest / Career (e.g., Strong Interest Inventory) • Personality (e.g., MMPI) • Achievement (e.g., Iowa Test of Basic Skills) 3. Benefits, limitations, and best practices of diagnosis: • Benefits ▪ Describes a person’s current functioning ▪ Provides a common language for clinicians ▪ Leads to a consistent and continual type of care ▪ Helps direct and focus treatment planning ▪ Helps counselors fit clients within a scope of treatment (Rueth et al., 1998) • Limitations ▪ Can over-pathologize clients ▪ Can be used by clients as a crutch ▪ Not always culturally sensitive, and sometimes fails to take into account alternative conceptualized based on factors such as development • Best Practices ▪ Receive extensive training ▪ Observe a client for signs and symptoms, listen for complaints, and look for functional disturbances ▪ Take into account cultural, developmental, gender, sexual orientation, socioeconomic, and spiritual aspects of a client’s life as well as coping mechanisms, stressors, and learned behavior ▪ Must learn clinical decision-making skills and cultural sensitivity ▪ Delay making diagnostic decisions initially when unsure ▪ Consider alternative conceptualizations of behavior

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CHAPTER 13 Essay 1. Career counseling with children and adolescents compared to adults • Children ▪ Begins in preschool years and becomes more direct in elementary school ▪ Programs include the following emphases: awareness, experiential activities, choice, career information, and career opportunities and education • Adolescents ▪ Career guidance activities should include the exploration of work opportunities and students’ evaluation of their own strengths and weaknesses in regard to possible future careers ▪ Often includes formal career assessments.

• Adults ▪ Differential approach ▪ Developmental approach • Similarities ▪ Focus on the career information ▪ Take into account the person’s developmental level ▪ With children, career work is more informational in nature ▪ With adolescents, more information about matching interests to possible careers is provided ▪ With adults, career interests, skills, and values are all taken into account, along with understanding the influence of environmental factors.

▪ Helping adults differentiate between career choices also is emphasized more than it is with adolescents 2. The main concepts of Holland and Super’s Theories: • Holland: ▪ Six types of personality and occupational environment: • Realistic • Investigative • Artistic • Social • Enterprising • Conventional ▪ Traits of clients should be assessed and matched with factors inherent in various occupations • Super: ▪ Career choice is linked with implementing one’s vocational self-concept ▪ He suggested five stages of vocational development: Growth, exploration, establishment, maintenance, and decline/disengagement

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CHAPTER 14 Essay 1. Importance of the Family Life Cycle?

• • • • •

Stages a family goes through as it evolves over the years Includes stage-critical tasks Understanding potential stages that families go through, including the stagecritical tasks of each stage, can help counselors better conceptualize a family and their presenting concerns.

It is important to note, however, that not all families follow the family life cycle in the same linear time frame in which it is presented.

In terms of family counseling

2. Actions you would take as a family counselor in each of the steps of the process: • Preplanning ▪ Understand expectations the client has for treatment ▪ Gather essential clinical information ▪ Hypothesize about possible issues for the family ▪ Schedule an appointment • Initial session(s) ▪ The counselor must establish rapport ▪ Therapeutic alliance can be created through the following: • Maintenance – confirm or support a family member’s position • Tracking – following a series of events • Mimesis – adopting a family’s style of communication ▪ Counselor observes the family dance, or the way a couple or family typically interacts verbally or nonverbally ▪ Counselor may ask circular questions, which are questions that focus attention on couple or family connections and highlight differences among members • Middle phase ▪ Couples or families and the counselor explore new behaviors and take chances ▪ Types of change: • First-order change – superficial change • Second-order change – structured rules are altered; the change hoped for in counseling ▪ The middle phase can be enhanced with homework – tasks to complete outside sessions – or psychoeducational assignments to learn more and interact together • Termination/closure ▪ The final phase of treatment ▪ The couple or family, the counselor, or both may initiate termination.

▪ In beginning termination, the counselor and couple or family should ask themselves why they are entering this phase 340 ..

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Counselor should make sure that the work the couple or family has done is summarized and celebrated so the family feels more aware and stronger Termination also includes creating long-term goals, predicting setbacks, and follow-up

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CHAPTER 15 Essay 1. Emphasis and roles of elementary, middle, and secondary school counselors with what they do •

•

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Elementary School Counselors ▪ Implement effective classroom guidance ▪ Provide individual and small-group counseling ▪ Assist students in identifying skills and abilities ▪ Work with special populations ▪ Develop career awareness ▪ Coordinate school, community, and business resources ▪ Consult with teachers and other professionals ▪ Communicate with parents/guardians ▪ Participate in school improvement and interdisciplinary teams (ASCA, 2012) Middle School Counselors ▪ Counselors stress growth, development, and transition ▪ The ideal role of middle school counselors includes providing individual counseling, group experiences, peer support systems, teacher consultation, student assessment, parent consultation, and evaluation of guidance services ▪ Counselors must also help students make decisions so that students can help themselves in the future.

Secondary School Counselor ▪ Providing direct counseling services individually, in groups, and to the school as a whole ▪ Providing educational and support services to parents ▪ Offering consultation and in-service programs to teachers and staff ▪ Delivering classroom guidance ▪ Facilitating referrals to outside agencies ▪ Networking to postsecondary schools and businesses ▪ Advising academically (Campbell & Dahir, 1997)

2. Current state of school counseling compared to the vision of the Education Trust •

Education trust ▪ Academic/student achievement focus ▪ Whole school and system concerns/issues ▪ Academic focus, building on student strengths ▪ Leader, planner, program developer ▪ Focus on academic counseling, learning and achievement, supporting student success ▪ Integral members of educational team ▪ Focused mission and role identification ▪ Use of data to effect change 342 ..

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Advocates for inclusion in rigorous preparation for all – especially poor students and students of color ▪ Teaming and collaboration with all educators in school in resolving issues involving the whole school and community ▪ Agents for changes, especially for educational equity for all students ▪ Involvement with students, parents, education professionals, community, community agencies ▪ Brokers of services for parents and students from community resources/agencies as well as school system’s resources ▪ Champions for creating pathways for all students to achieve high aspirations Present focus ▪ Mental health providers ▪ Individual students’ concerns/issues ▪ Clinical model focused on student deficits ▪ Service provider, 1-1, and small groups ▪ Primary focus on personal/social ▪ Ancillary support personnel ▪ Loosely defined role and responsibility ▪ Gatekeepers ▪ Sorters, selectors in course placement process ▪ Work in isolation or with other counselors ▪ Guardians of the status quo ▪ Involvement primarily with students ▪ Dependence on the use of system’s resources for helping students and families ▪ Postsecondary planners with interested students

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CHAPTER 16 Essay 1. Emphases and roles of student-life services professionals with those of college counselors; which you would prefer • College Counseling: ▪ Four main models that college/university counseling centers have followed: ▪ Counseling as psychotherapy – long-term counseling with a small percentage of students ▪ Counseling as vocational guidance - emphasizes helping students productively relate academic and career matters ▪ Counseling as traditionally defined - emphasizes a broad range of counseling services, including short- or long-term relationships and those that deal with personal, academic, and career concerns ▪ Counseling as consultation - emphasizes working with the various organizations and personnel who have a direct impact on student mental health ▪ Counseling as global – a fifth model, is an interactive approach in which the counseling center staff work interactively with other members of a college/university community to create a mentally healthy environment and use personnel and other resources within a campus • Student-life services professionals ▪ To help students have a successful and productive college experience, student-life professionals offer campus- wide programs and individual assistance ▪ Many colleges and universities now employ special student-life staff to work with each incoming class to enhance the first-year experience • Preference ▪ Will vary based on students’ beliefs ▪ Should be supported by tangible information 2. Describe three of the six main categories of nontraditional students, and include at least two factors to consider when counseling each: • First-year students ▪ First-year college students may especially need help during their initial months in college.

▪ Commonly reported crises in the first year involve difficulties in social adjustment manifested as feelings of homesickness and loneliness ▪ Friendsickness – psychological pain because of the disruption in established friendship networks ▪ Other areas of assistance for first-year students include: learning how to study, getting along with roommates, and establishing a routine.

• Graduate students ▪ Graduate students, regardless of their background, must manage multiple roles as students, researchers, colleagues, and sometimes spouses.

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▪ ▪

•

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Often deal with issues of intimacy and even generativity Groups, particularly support groups, are one major way college counseling centers can assist graduate students ▪ Brief workshops and seminars may bring graduate students together, promote a sense of camaraderie, as well as provide helpful information on thriving in a stress-filled environment ▪ Technology may also be an effective way of connecting with graduate students Older students ▪ Older nontraditional students tend to be highly motivated, prefer interactive learning, have family and financial concerns, view education as an investment, and have multiple commitments and responsibilities that are not related to school ▪ Senior students – come to campus for many purposes, which include obtaining degrees and finding personal enrichment ▪ The overall number of nontraditional students will increase because of business downsizing, the rapid advance of technology, and increased opportunities for professional development Part-time students ▪ Part-time students comprise almost 40% of students in higher education ▪ They are at a distinct disadvantage relative to those who are enrolled full time because: • They come from minority and low-income family backgrounds • They are not as well-prepared for college as their full-time peers • They are highly concentrated in 2-year colleges and nondegree/certificate programs • Many of them work full time while enrolled and are not enrolled continuously ▪ College counselors and student personnel professionals must make special efforts to stay in contact part-time students First generation students ▪ First-generation college students are students who are the first in their family to enter college ▪ They represent 27% of all graduating high school students and have special needs, one of which is family support ▪ Needs of first-generation students: ▪ Mastering knowledge of the college environment ▪ Becoming committed to role of student ▪ Deciphering values-systems of second-generation students ▪ Understanding student-life services and study skills Minority culture students ▪ Minority culture students in the U.S. are mainly African American, Native American, Asian American, Hispanic/Latino, or multiethnic individuals ▪ For African American students on predominantly White campuses, three themes may help them succeed:

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Adopting expanded definitions of student centeredness that are consistent with African American expectations, ▪ Remaining mindful of the complexities of maintaining strong ties to family and friends at home ▪ Encouraging participation in student organizations that provide support for the shared concerns of African American students (Guiffrida & Douthit, 2010) Student athletes ▪ Student athletes are less likely than others to seek help through counseling (Watson, 2005) ▪ Areas that may be difficult for student athletes (Watson, 2005): • Being seen by others as “problem students” • Being a first-generation students • Becoming dependent on a coach or a team based on one’s sportsoriented environment • Experiencing stress from dual roles of student and athlete ▪ Counselors can help by teaching time management and social skills, helping to transition to college life, helping identify and express feelings, and confronting and correcting irrational thoughts

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CHAPTER 17 Essay 1. Continuum of child abuse, including different manifestations of it: • From skin injuries to death • Physical traumas such as broken bones • Psychological consequences such as fearfulness of others and PTSD • Difficulties forming and sustaining close relationships with peers and adults • Cognitive problems such as poor school performance and substance abuse later on 2. Adolescents and alcohol • Working with adolescents is a treatment specialty • For counseling to be effective with adolescents, family and other significant people in the adolescent’s life should be included • Adolescents need to be educated as to what counseling is • Because adolescents do not respond well to many adult treatments, therapeutic techniques need to be specifically tailored to them • Although relationship skills are important, the counselor cannot function well trying to be the adolescent’s friend • Counseling works best with adolescents if it is centered around problem solving, skill building, and being heard • Therapeutic moments are much more uneven with adolescents than with adults (Pollock, 2006, p. 331) 3. Model of disability • Biomedical model ▪ Steeped in the language of medicine, but silent in the language of social justice ▪ Disabilities are objective conditions that exist in and of themselves ▪ Disabilities are considered deficiencies residing within the individual who is totally responsible for the problem • Environmental and functional model ▪ People carry a label with them ▪ The label may lead to some degree of social prejudice and discrimination ▪ Places blame for disabilities outside the individual • Sociopolitical model ▪ Minority model ▪ Assumes that persons with disabilities are a minority group rather than people with pathologies ▪ Includes self-definition, the elimination (or reduction) of the prejudice and discrimination, rejection of medical diagnoses and categories, and the drive to achieve full equality and civil rights.

• Peer counselor model ▪ People with direct experience with disabilities are best able to help those who have recently acquired a disability 347 ..

CHAPTER 18 Essay 1. SAD PERSONS Scale and how it may be used to assess suicide •

•

What it is: ▪ Sex (male) ▪ Age (older clients ▪ Depression ▪ Previous attempt ▪ Ethanol (alcohol) abuse ▪ Rational thinking loss ▪ Social support system lacking (lonely, isolated) ▪ Organized plan ▪ No spouse ▪ Sickness (particularly chronic or terminal illness) How it can be used to assess suicide: ▪ An instrument that can be used to help determine the suicide risk level a client is at.

▪ The combination of these factors in an interactive process likely yields information that is pertinent for counselors to use in prevention of suicide

2. Steps for setting up a private practice, and how to insure success: • • • • • • • •

Develop business skills Remain realistic, patient and persistent as I build up clientele Network and build up an outside clinical and ethical support system Become technologically savvy in developing a website, using e-mail, iPhones, and other technology to keep up with clients, get referrals, and market oneself Overcome or avoid restrictive covenants or noncompetitive agreements that some agencies put in their contracts with counselors Invest time and hard work in pull marketing relationships Find a way to make sure emergency situations and the unexpected crisis are covered when out of town or out of the office Donate services and participate in endeavors for the public good to build up a reputation and practice

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APPENDIX Essay 1. How has the counseling program developed and changed • Began with an emphasis on vocational guidance (Frank Parsons) and working in the schools (Jesse B. Davis). Now there are addiction, career, school, clinical mental health, rehabilitation, and college counselors, working a wide variety of settings.

• Moved from very little organization, starting with the NVGA, to ultimately having a very strong professional counseling association: ACA, with many divisions, state chapters, and local chapters.

• It has changed in terms of theoretical orientation, moving from an emphasis on psychoanalysis, to behaviorism, to humanism, to multiculturalism, and ultimately to social justice.

• Counseling has moved from little regulation to now having licensure in all 50 United States 2. Two major trends counselors must face in the 21st century, including positive and negative characteristics of both trends • Dealing with violence, trauma, and crisis ▪ Negative: trauma from natural events and human atrocities continue to be a part of the 21st century ▪ Positive; Renewed emphasis on the treatment of PTSD and acute stress disorder ▪ Positive: Counselors being trained to work with people who have experienced trauma through crisis counseling training • Use of technology ▪ Negative: technology, particularly the overreliance on it, can negatively affect relationships and connections to others, particularly in reference to internet addiction ▪ Positive: Technology can be used in the training of counselors, the dissemination of knowledge and research, and in making counseling practice more efficient and effective. It also can be used to facilitate program evaluation.

▪ Negative: navigating some ethical issues associated with distance counseling, such as confidentiality, handling emergency situations, etc.

▪ Positive: Competencies are being developed to help counselors navigate ethical decisions associated with distance counseling

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