The Counselor’s Companion:

What Every Beginning Counselor

Needs to Know
Authors’ Purpose

In our interactions with counselor trainees, we often hear them express uncertainty
about how to proceed after graduation. While they are in the midst of their counsel-
ing programs, students are surrounded by support systems comprised of profes-
sors, supervisors, and peers; yet, once in the field, novice clinicians often experi-
ence a sense of loss and can even become overwhelmed with questions that arise in
their clinical interactions. Although we sincerely hope beginning counselors will
create a support system with other professionals, we also recognize the harsh real-
ity that not every counselor works in an environment with other trained mental
health professionals and that there are few written resources that provide compre-
hensive and practical information for counselors who are just getting started. The
goal of this project is to provide novice counselors with a reference tool or “friend”
of sorts where they can turn when questions related to areas such as professional-
ism, ethics, research, and day-to-day clinical work arise in their practices. The jour-
ney to becoming a successful professional counselor is one that should not be
walked alone. We hope that this book will become a faithful companion for stu-
dents who have left their supervisors and teachers behind after graduation and
that being able to reference the knowledge base of counselor educators and sea-
soned practitioners will ensure a journey to professionalism that is a little less
bumpy!

Jocelyn Gregoire and Christin M. Jungers

Duquesne University
The Counselor’s Companion: What Every Beginning
Counselor Needs to Know
by Jocelyn Gregoire and Christin M. Jungers
Duquesne University

Ideal for use in practicum or graduate capstone courses, this book includes …
Cutting-Edge Topics: In addition to a focus on the traditional CACREP curriculum areas,
readers will also find chapters on important and cutting-edge trends in the counseling field.
Some of these areas include the use of neuroscience in counseling practice (chapter 28),
bioecological approaches to practice (chapter 27), crisis counseling, pastoral counseling, and
addictions counseling.
NCE Preparation Tool: Key chapters reflect specific content areas that students preparing
for the NCE will need to know. Also included is a 200-question sample exam to test knowl-
edge, application, and analysis of key concepts and information in the counseling field.
Case Examples: Throughout the book, readers will find example boxes that highlight impor-
tant points or provide case examples to clarify counseling theory and bring counseling mod-
els into day-to-day practice.
Web References: Each chapter includes Web references that readers can use to find more in-
formation, download articles, and retrieve full documents, such as the ACA Code of Ethics,
about relevant counseling-related topics.
Concise, Heart-of-the-Matter Format: The format is intentionally concise and presented in
an outline form so that counselors can easily grasp and retain main points of each topic area
without getting lost or distracted by peripheral details.

SPECIAL OFFERS!
Online Counseling Case Management Software: Athena Software, producer of Penelope, a
Web-based case management software package designed especially for counseling and hu-
man services practitioners, is offering a special package for anyone who purchases this book.
For only $7.95, you can subscribe for 120 days to the Penelope program. It is a great way for
students in their practicum and internships to become familiar with the reality of the elec-
tronic revolution in counseling practice (e.g., the program supports online record keeping,
note summary, appointment calendars, and evaluations). Visit www.athenasoftware.net/
index.html for more information.
Titles of Related Interest From Lawrence Erlbaum Associates, Inc.

䊏 Advancing Social Justice Through Clinical Practice

Etiony Aldarondo
䊏 Countertransference and the Therapist’s Inner Experience: Perils and Possibilities
Charles J. Gelso & Jeffrey A. Hayes
䊏 Handbook of Posttraumatic Growth: Research & Practice
Lawrence G. Calhoun & Richard G. Tedeschi
䊏 Empathy in Counseling and Psychotherapy: Perspectives and Practices
Arthur J. Clark
䊏 Handbook of Culture, Therapy, and Healing
Uwe P. Gielen, Jefferson M. Fish, & Juris G. Draguns
䊏 Half in Love With Death: Managing the Chronically Suicidal Patient
Joel Paris
䊏 Group Counseling and Psychotherapy With Children and Adolescents: Theory, Research,
and Practice
Zipora Shechtman
䊏 An ADHD Primer, Second Edition
Lisa L. Weyandt
䊏 Neuropsychotherapy: How the Neurosciences Inform Effective Psychotherapy
Klaus Grawe
䊏 The Professional Counselor as Administrator: Perspectives on Leadership and Management
of Counseling Services Across Settings
Edwin L. Herr, Dennis E. Heitzmann, & Jack R. Rayman
䊏 The Mind in Therapy: Cognitive Science for Practice
Katherine D. Arbuthnott & Dennis W. Arbuthnott
䊏 Emotionally Intelligent School Counseling
John Pellitteri, Robin Stern, Claudia Shelton, & Barbara Muller-Ackerman
䊏 The New Handbook of Counseling Supervision
L. DiAnne Borders & Lori L. Brown
䊏 Working With Troubled Men
Morley D. Glicken
䊏 Counseling and Therapy With Clients Who Abuse Alcohol or Other Drugs: An Integrative
Approach
Cynthia E. Glidden-Tracey
䊏 Multicultural Assessment: Principles, Applications, and Examples
Richard H. Dana
䊏 The Great Psychotherapy Debate: Models, Methods, and Findings
Bruce Wampold
The Counselor’s Companion:
What Every Beginning Counselor
Needs to Know

Jocelyn Gregoire
Christin M. Jungers
Duquesne University

L Lawrence Erlbaum Associates, Publishers

2007 Mahwah London
Copyright © 2007 by Lawrence Erlbaum Associates, Inc.
All rights reserved. No part of this book may be reproduced in any form, by
photostat, microform, retrieval system, or any other means, without prior
written permission of the publisher.

Lawrence Erlbaum Associates, Inc., Publishers

10 Industrial Avenue
Mahwah, New Jersey 07430
www.erlbaum.com

Cover design by Tomai Maridou

Interior design by Wendy MacRobbie

Library of Congress Cataloging-in-Publication Data

The counselor’s companion : what every beginning counselor needs to know /

edited by Jocelyn Gregoire, Christin Jungers.
p. cm.
Includes bibliographical references and index.
ISBN 978-0-8058-5683-5 — 0-8058-5683-8 (cloth)
ISBN 978-0-8058-5684-2 — 0-8058-5684-6 (pbk.)
ISBN 1-4106-1674-6 (e book)
1. Counseling psychology. 2. Counseling psychology—Practice. I. Gregoire,
Jocelyn. II. Jungers, Christin.
BF636.6.C68 2007
158’.3—dc22 2006030183
CIP

Books published by Lawrence Erlbaum Associates are printed on acid-free paper,

and their bindings are chosen for strength and durability

Printed in the United States of America

10 9 8 7 6 5 4 3 2 1
 Brief Contents

Preface xxxv
Acknowledgments xxxix
Meet the Contributors xli

part one
What Are the Primary Roles and Responsibilities
of the Professional Counselor? 1

chapter On Being a Professional Counselor 2

1
chapter The Demands and Obligations of Ethical Counseling 18
2
chapter The Legal Intrigues of Counseling Practice 32
3
chapter Multicultural Intricacies in Professional Counseling 52
4
chapter Supervision: An Essential for Professional Development 72
5
chapter Collaborative Supervision for the Novice Supervisor 86
6

vii
viii Brief Contents

part two
What Are the Essential Elements of Counseling With
Which All Counselors Must Be Familiar? 111

chapter Understanding Human Growth and Development 112

7
chapter Counseling Across the Lifespan 136
8
chapter Major Forces Behind Counseling Approaches 154
9
chapter Individual and Social Aspects of the Helping Relationship 194
10
chapter The Cultural Kaleidoscope: Eyeing Diverse Populations 218
11
chapter Approaches to Group Work 246
12
chapter Fundamentals of Group Work 274
13
chapter Multicultural Components of Group Work 298
14
chapter Counseling in the World of Work 314
15
chapter Multicultural Issues in Career and Lifestyle Counseling 340
16
chapter Fundamentals of Professional School Counseling 360
17
chapter Approaches to Family Counseling 376
18
chapter Understanding and Assessing Psychopathology 404
19
 Brief Contents ix

part three
What Are the Fundamental Components of Appraisal
and Research that New Counselors Should Use
in Their Practice? 433

chapter Foundations of Measurement and Psychometrics 434

20
chapter Testing and Assessment in Counseling Practice 458
21
chapter Quantitative Research Designs 486
22
chapter Fundamentals of Qualitative Research 512
23

part four
What Are the Special Topics and Important Trends
That Counselors Might Encounter? 527

chapter A Look at Consultation 528

24
chapter Crisis Intervention in Counseling 550
25
chapter Addictions Counseling 568
26
chapter Ecological-Transactional and Motivational Perspectives in
27 Counseling 586

chapter Neuroscience in Psychotherapeutic Practices 606

28
chapter Developmental Counseling and Therapy 624
29
x Brief Contents

chapter Counseling for Wellness 642

30
chapter Spirituality and Pastoral Counseling Practices 658
31
appendix Preparing for the National Counselor Exam:
A What You Need to Know 675

appendix Your Online Companion in Electronic Case Management:

B An Introduction to Penelope Software 721

appendix Hints, Helps, and FAQs About Working in a Managed Care

C Environment 731

References 741
Index 785
 Contents

Preface xxxv
Acknowledgments xxxix
Meet the Contributors xli

part one
What Are the Primary Roles and Responsibilities
of the Professional Counselor? 1

chapter On Being a Professional Counselor 2

1
A Brief History of the Counseling Profession 3
䊏 Theoretical Shifts; Specialization; Professionalization

The Counselor’s Identity 4

䊏 The Diversity of Counselor Identities; How Counseling Differs From

Psychology and Social Work; Characteristics of an Effective Counselor

Professionalism 8
䊏 Training for Professional Counselors; Licensure; Certification; Professional

Associations; Advocacy; Ethical Principles in Professional Counseling

Personal Health and Wellness 15

䊏 Countertransference; Burnout; Networking

chapter The Demands and Obligations of Ethical Counseling 18

2
The Basics of Ethics in Counseling 19
䊏 Definition of Ethics; Ethical Codes; Ethical Codes and Cultural Diversity;

Development of Ethical Codes; ACA Code of Ethics; Mandatory

and Aspirational Ethics

xi
xii Contents

Ethical Theory 22
䊏 Epicureanism; Utilitarianism; Kantianism; Situationalism

Ethical Principles and Decision Making 24

䊏 Nonmaleficence; Beneficence; Autonomy; Fidelity; Justice; An Ethical

Decision-Making Model

Common Ethical Concerns for Professional Counselors 28

䊏 Confidentiality; Dual Relationships and Potentially Beneficial Interactions;

Sexual Misconduct; Transference; Countertransference

Summary 31

chapter The Legal Intrigues of Counseling Practice 32

3
Basics of Professional, Ethical, and Legal Practice for Counselors 33
䊏 A Look at Professions, Professionalism, and Professional Identity; Legal

Issues Related to Counselors’ Professional Identity; Ethical Codes and

Standards of Practice; What Is Law?; Contracts in Counseling: Informed
Consent; Torts and Counselor Negligence

Professionalism for School Counselors 38

䊏 Building Collaborative Relationships; Facing the Political Barriers of the

School System; Community Standards in School Counselor Practice;

Protecting Students’ Best Interests

Legal and Ethical Aspects of Competence 40

䊏 Consultation; Continuing Education; Malpractice

Record Keeping 42
䊏 School Records: Family Education Rights and Privacy Act (FERPA); ASCA

Ethical Guidelines on Educational Records; Agency Records: Health

Insurance Portability and Accountability Act (HIPAA)

Dual Relationships in School and Community Settings 45

䊏 Ethical and Legal Considerations of Dual Relationships; Complexity of

Dual Relationships in Schools; Safeguarding Clients’ Emotional Health

Confidentiality, Privacy, and Privileged Communication 46

䊏 Ethical Standard of Confidentiality; Confidentiality for School Counselors;

Privacy; Legal Facets of Privileged Communication; Duty to Warn: Limit to

Privileged Communication; Duty to Protect
 Contents xiii

chapter Multicultural Intricacies in Professional Counseling 52

4
Cultural Influences in Counseling 53
䊏 Influence of Eurocentric Perspectives on Counseling; Rationale for a

Multicultural Approach in Counseling; Multicultural Competencies for

Professional Counselors

Essential Factors in Culture-Sensitive Counseling 54

䊏 Culture Defined; Cultural Convergence; Etic and Emic Cultural Viewpoints;

Cultural Encapsulation; Ethnocentrism; Acculturation and Assimilation;

Alloplastic and Autoplastic Viewpoints

Cultural Constructs: A Closer Look 60

䊏 Sex and Gender; Sexuality and Affectional Orientation; Race; Age; Ability;

Religion and Spirituality

Bias, Prejudice, Discrimination, and Oppression 64

䊏 Bias; Prejudice; Discrimination; Oppression; Privilege

Cultural Identity Development 67

䊏 Racial and Cultural Identity Development Model; White Racial Identity

Development

Multicultural Theories in Counseling 69

䊏 Multicultural Counseling and Therapy; Benefits of Multicultural Counseling

and Therapy

chapter Supervision: An Essential for Professional Development 72

5
Basics of Clinical Supervision 73
䊏 Supervision: A Key to Professionalism; Benefits of Supervision; Supervision

Defined

Models of Supervision 75
䊏 Developmental Models of Supervision; Theory-Specific Supervision

Models; Social Role Models of Supervision: Discrimination Model;

Integrated Model of Supervision; A Supervision Videotaping Method:
Interpersonal Process Recall

chapter Collaborative Supervision for the Novice Supervisor 86

6
A Look at Supervision 87
䊏 Purposes of Supervision; Importance of Supervision to the Counseling

Profession; Supervision, Professional Development, and Credentialing

xiv Contents

Becoming a Supervisor: Some Starting Points 89

䊏 Training Through Doctoral Programs; Self-Developed Supervision Skills:

Modeling as a First Step; Self-Developed Supervision Skills: Gathering

Other Resources
A Collaborative Model of Supervision: An Overview 91
䊏 Constructivist Roots of the Collaborative Model; Meeting Competencies

Through the Collaborative Model; Advantages of the Collaborative Model

Professional Development of Novice Supervisors: Knowledge Competency 92
䊏 Theoretical Foundations; Ethical and Legal Considerations; Multicultural

Impact
Professional Development of Novice Supervisors: Disposition 97
䊏 Collaborative, Learner-Focused Stance; Supportive and Critical

Dispositions: Coexisting Roles

Professional Development of Novice Supervisors: Strategies 99
䊏 The Inquiry Learning Cycle; Building the Therapeutic Alliance; Using the

FERA Inquiry Model in the Therapeutic Alliance; Promoting the

Construction of Meaning; Using the FERA Inquiry Model in the
Construction of Meaning; Evaluating the Work of the Counselor; Using the
FERA Inquiry Model for Evaluating the Work of the Supervisee
Summary 109

part two
What Are the Essential Elements of Counseling With
Which All Counselors Must Be Familiar? 111

chapter Understanding Human Growth and Development 112

7
Prenatal Development 113
䊏 Influences on Prenatal Development; Genetic Makeup; Prenatal

Developmental Periods; Risks During Prenatal Development

Infancy: The First 2 Years of Life 114
䊏 Physical Development in Infancy; Cognitive Development in Infancy;

Social-Emotional Development in Infancy

Early Childhood: The Preschool Period 119
䊏 Physical Development in Early Childhood; Cognitive Development in Early

Childhood; Social-Emotional Development in Early Childhood

 Contents xv

Middle Childhood: Elementary School Years 123

䊏 Physical Development in Middle Childhood; Cognitive Development in

Middle Childhood; Social-Emotional Development in Middle Childhood

Adolescence: Transition From Childhood to Adulthood 127

䊏 Physical Development in Adolescence; Cognitive Development in

Adolescence; Social-Emotional Development in Adolescence

Adulthood 130
䊏 Physical Development in Adulthood; Cognitive Development in Adulthood;

Social-Emotional Development in Adulthood

Death, Dying, and Bereavement 133

䊏 Death and the Young; Theory of Dying Process; Grief and Bereavement

chapter Counseling Across the Life Span 136

8
Perspectives in Human Growth and Development 137
䊏 Nature and Nurture; Continuity and Discontinuity; Developmental

Domains

Psychodynamic Theories of Human Development 139

䊏 The Psychoanalytic Approach; The Psychosocial Approach

Behavioral and Learning Theories of Human Development 143

䊏 Classical Conditioning; Stimulus–Response Model; Law of Effect; Skinnerian

Approach; Social Learning Theory

Cognitive Theories of Human Development 146

䊏 Piagetian Theory of Cognitive Development; Theory of Moral

Development; Sociocultural Theory of Development

Ethological and Maturational Theories of Human Development 150

䊏 Konrad Lorenz; Attachment Theory; Theory of Genetic Determination

Humanistic Theories of Human Development 152

䊏 Maslow’s Hierarchy of Needs

chapter Major Forces Behind Counseling Approaches 154

9
Psychodynamic Approaches: Psychoanalysis 156
䊏 View of Human Nature; Theory of Personality; Key Theoretical Concepts;

Goals of Therapy; Therapeutic Techniques; Role of Therapist; Strengths

and Limitations
xvi Contents

Psychodynamic Approaches: Analytic Psychology 159

䊏 View of Human Nature; Theory of Personality; Key Theoretical Concepts;

Goals of Therapy; Therapeutic Techniques; Role of Therapist; Strengths

and Limitations
Psychodynamic Approaches: Individual Psychology 161
䊏 View of Human Nature; Theory of Personality; Key Theoretical Concepts;

Goals of Therapy; Therapeutic Techniques; Role of Therapist; Strengths

and Limitations
Psychodynamic Approaches: Transactional Analysis 164
䊏 View of Human Nature; Theory of Personality; Key Theoretical Concepts;

Goals of Therapy; Therapeutic Techniques; Role of Therapist; Strengths

and Limitations
Cognitive-Behavioral Approaches: Behaviorism 167
䊏 View of Human Nature; Theory of Personality; Key Theoretical Concepts;

Goals of Therapy; Therapeutic Techniques; Role of Therapist; Strengths

and Limitations

Cognitive-Behavioral Approaches: Neo-Behaviorism 169

䊏 View of Human Nature; Theory of Personality; Key Theoretical Concepts;

Goals of Therapy; Therapeutic Techniques; Role of Therapist; Strengths

and Limitations

Cognitive-Behavioral Approaches: Cognitive Therapy 172

䊏 View of Human Nature; Theory of Personality; Key Theoretical Concepts;

Goals of Therapy; Therapeutic Techniques; Role of Therapist; Strengths

and Limitations
Cognitive-Behavioral Approaches: Rational-Emotive Therapy 176
䊏 View of Human Nature; Theory of Personality; Key Theoretical Concepts;

Goals of Therapy; Therapeutic Techniques; Role of Therapist; Strengths

and Limitations
Cognitive-Behavioral Approaches: Reality Therapy 179
䊏 View of Human Nature; Theory of Personality; Key Theoretical Concepts;

Goals of Therapy; Therapeutic Techniques; Role of Therapist; Strengths

and Limitations

Cognitive-Behavioral Approaches: Multimodal Therapy 182

䊏 View of Human Nature; Theory of Personality; Key Theoretical Concepts;

Goals of Therapy; Therapeutic Techniques; Role of Therapist; Strengths

and Limitations
Existential-Humanistic Approaches: Person-Centered 185
䊏 View of Human Nature; Theory of Personality; Key Theoretical Concepts;

Goals of Therapy; Therapeutic Techniques; Role of Therapist; Strengths

and Limitations
 Contents xvii

Existential-Humanistic Approaches: Gestalt 187

䊏 View of Human Nature; Theory of Personality; Key Theoretical Concepts;

Goals of Therapy; Therapeutic Techniques; Role of Therapist; Strengths

and Limitations
Existential-Humanistic Approaches: Logotherapy 190
䊏 View of Human Nature; Theory of Personality; Key Theoretical Concepts;

Goals of Therapy; Therapeutic Techniques; Role of Therapist; Strengths

and Limitations

chapter Individual and Social Aspects of the Helping Relationship 194

10 The Helping Relationship 195
䊏 Why Bother With Theories?; Theory Defined; Theories With Which

Helpers Need to Be Familiar; A Word About Eclecticism; Helping Defined;

The Helping Process; Frameworks Within Which the Helping Process
Occurs; Helping Helpees Meet Their Needs
What Constitutes Effective Helping? 199
䊏 Professional Helpers as Growth Facilitators; Personal Characteristics of

Effective Helpers; Helpers’ Skills; Helpers and Diversity Issues

Training Models for Coping Skills Development 203
䊏 People-in-System Model; Life Skills Education Model; Structured Learning

Therapy Model; Social Skills

Training Models for Interpersonal Skills Development 207
䊏 Skilled Helping: Problem Management Model; Relationship Enhancement

Therapy Model; Microskills Counseling Model; Interpersonal Process

Recall; Human Resources Development Model; The Politics of Giving
Therapy Away: Listening and Focusing
Social-Psychological Approaches to Helping 211
䊏 Symbolic Interaction; Role Theory; Social Exchange; Cognitive Consistency;

Dissonance Theory; Heider’s Balance Theory; Congruity Theory;

Newcomb’s A-B-X Model of Interpersonal Attraction; Attributions

chapter The Cultural Kaleidoscope: Eyeing Diverse Populations 218

11 Opening up to Multicultural Realities in Counseling 220
䊏 Implications of a Multicultural Worldview to Counselors’ Training;

Implications of a Multicultural Emphasis for Counselor Educators;

Implications of Multicultural Counseling for Program Development;
Cross-Cultural Differences in Counselor–Client Relationships; What Is
Cultural Context?; A Model for Understanding Differences; Avoiding
“Preferred” Clients Only; The Notion of White Privilege
xviii Contents

Challenges for Children of Specific Populations 224

䊏 Examining the Influence of Ethnicity on Children; Additional Concerns

When Working With Children of Different Ethnic Groups

Native American Population 225

䊏 Historical and Demographic Factors; Family Characteristics; Value

Orientations; Stereotypes; Communication Styles; Mental Health Issues

African American Population 228

䊏 Historical and Demographic Factors; Value Orientations; Family

Characteristics; Communication Styles; Mental Health Issues;

Considerations When Counseling

Asian American Population 231

䊏 Historical and Demographic Factors; Family Values; Common Stereotypes;

Mental Health Issues; Communication Styles; Effective Counseling

Approaches

Latin American Population 234

䊏 Historical and Demographic Factors; Family Characteristics;

Communication Styles; Value Orientations; Mental Health Issues

Arab American Population 236

䊏 Historical and Demographic Factors; Family Characteristics; Value

Orientations; Stereotypes; Counseling Issues

Elderly Population 239

䊏 Demographic Factors; Stereotypes; Mental Health Issues; Approaches to

Counseling

Ableism and Disability 241

䊏 Demographics; Stereotypes; Rehabilitation Counseling; Counseling Issues

Gay, Lesbian, Bisexual, and Transgendered Population 243

䊏 The Process of “Coming Out”; Counseling Issues

Conclusion 244

chapter Approaches to Group Work 246

12
Psychoanalytic Approach to Group Work 247
䊏 Key Theoretical Concepts; Goals and Stages; Therapeutic Techniques; Role

of Group Leader; Strengths and Limitations

Adlerian Approach to Group Work 249

䊏 Key Theoretical Concepts; Goals and Stages; Therapeutic Techniques; Role

of Group Leader; Strengths and Limitations

 Contents xix

Transactional Analytic Approach to Group Work 251

䊏 Key Theoretical Concepts; Goals and Stages; Therapeutic Techniques; Role

of Group Leader; Strengths and Limitations

Psychodramatic Approach to Group Work 254

䊏 Key Theoretical Concepts; Goals and Stages; Therapeutic Techniques; Role

of Group Leader; Strengths and Limitations

Behavioral Approach to Group Work 257

䊏 Key Theoretical Concepts; Goals and Stages; Therapeutic Techniques; Role

of Group Leader; Strengths and Limitations

Rational-Emotive Behavior Therapy Approach to Group Work 260

䊏 Key Theoretical Concepts; Goals and Stages; Therapeutic Techniques; Role

of Group Leader; Strengths and Limitations

Reality Therapy Approach to Group Work 262

䊏 Key Theoretical Concepts; Goals and Stages; Therapeutic Techniques; Role

of Group Leader; Strengths and Limitations

Person-Centered Approach to Group Work 264

䊏 Key Theoretical Concepts; Goals and Stages; Therapeutic Techniques; Role

of Group Leader; Strengths and Limitations

Gestalt Approach to Group Work 267

䊏 Key Theoretical Concepts; Goals and Stages; Therapeutic Techniques; Role

of Group Leader; Strengths and Limitations

Existential Approach to Group Work 270

䊏 Key Theoretical Concepts; Goals and Stages; Therapeutic Techniques; Role

of Group Leader; Strengths and Limitations

chapter Fundamentals of Group Work 274

13
History of Group Counseling 275
䊏 Theoretical Influences; Uses of Groups; Ethical and Legal Considerations

Fundamentals of Group Work 276

䊏 Definition of Group Work; Types of Group Work; Group Member

Activities; Leader Interventions

Group Dynamics 278

䊏 Group Processing; Group Conflict; Group Cohesiveness; Therapeutic

Factors in Groups; Group Typology

Group Leadership 281

䊏 Leadership Styles; Group Leader Attributes; A Framework for

Intervention; Concerns of Beginning Group Leaders; Coleadership

xx Contents

Cultural Considerations for Group Leaders 284

䊏 Influences on Diversity; Non-Western Values in Group Work;

Characteristics of Culturally Competent Leaders; Benefits of Multicultural

Awareness

Pregroup Planning 287

䊏 Logistics; Site Considerations; Defining the Group’s Purpose; Selection of

Members

Beginning Phase 288

䊏 Structure; Group Norms; Role of the Leader in the Beginning Phase; Goal

Setting Feedback in the Beginning Phase

Middle Phase 292

䊏 Conflict in the Middle Phase; Group Interactions; Role of the Leader in the

Middle Phase; Feedback in the Middle Phase

Final Phase 295

䊏 Final Phase Resistance; Generalization of Learning; Role of the Leader in

the Final Phase

chapter Multicultural Components of Group Work 298

14
History of Multicultural Group Work 299
䊏 Goals of Group Work; Culture and Group Work; Multicultural Group

Work Defined; Multicultural Group Work and Ethical Practice

Core Competencies of Multicultural Group Work 301

䊏 Individual Competencies of Multicultural Group Workers; Principles for

Diversity-Competent Group Workers

Theory and Multicultural Group Work 303

䊏 Diversity and Multicultural Framework; Failure to Recognize Diversity

Issues in Theory; Flexibility to Operate Within Multicultural Worldviews

Assessment and Group Ideologies 305

䊏 Assessment in Multicultural Group Work; Process of Assessment; Delivery

of Assessment Decisions; Communication Styles; Thematic

Communication in Assessment; Individual and Cultural Values in
Assessment

A Diversity-Competent Model of Multicultural Group Work 311

䊏 How to Choose a Model of Multicultural Group Work; Images of Me: An

Afrocentric Approach to Group Work

 Contents xxi

chapter Counseling in the World of Work 314

15
Career Counseling Overview 315
䊏 Historical Development of Career Counseling; Nature of Career

Counseling; Important Terminology in Career Counseling

Career Development Theory 317

䊏 Frank Parsons: Trait and Factor Theory; John Holland: Theory of

Vocational Choice and Adjustment; Eli Ginzberg: Developmental Career

Theory; Donald Super: Life-Span Theory; Anne Roe: Needs Theory; E.
Bordin: Psychoanalytic Career Theory; Tiedeman and O’Hara: Choice and
Adjustment Theory Gottfredson: Theory of Circumscription and
Compromise; John Krumboltz: Social Learning Career Theory;
Socioeconomic Career Theories; Career Theories for Women

Process of Career Counseling 325

䊏 Stage 1: Dealing With Change; Stage 2: Developing Career Focus; Stage 3:

Exploring Career Options; Stage 4: Preparing for Job Search; Stage 5:

Obtaining Employment

Use of Assessment Tools in Career Counseling 328

䊏 History of Assessment: Trait and Factor Model; Interest Inventories;

Personality Inventories; Values/Lifestyle Inventories; Qualitative Tools

Special Issues in Career Counseling 332

䊏 Job Loss; Dual-Career Considerations; Displaced Homemakers; Individuals

With Disabilities; Midlife Career Changes

Technological Competencies for Career Counselors 336

䊏 ACES Technology Competencies; Need for Technological Skills

chapter Multicultural Issues in Career and Lifestyle Counseling 340

16
Understanding Cultural Issues in Career Counseling 341
䊏 Historical Approaches to Multicultural Career Counseling; Important

Terminology: Cross-Cultural and Multicultural

Multicultural Career Development: Traditional Theoretical Approaches 342

䊏 Holland’s Person–Environment Fit Theory; Roe’s Theory of Occupational

Classifications; Super’s Life Span-Life Space Theory; Gottfredson’s Theory

of Circumscription and Compromise; Social Cognitive Career Theory;
Theories Summary

Culture-Specific Variables 349

䊏 Acculturation; Racial and Cultural Identity Development; Racial Salience;

Loss of Face
xxii Contents

Culturally Appropriate Career Counseling Models 351

䊏 Integrative Sequential Model of Career Counseling Services; Culturally

Appropriate Career Counseling Model; Developmental Approach Career

Development Assessment and Counseling; Integrative Multidimensional
Model

Future Research and Theory Development 356

䊏 Key Concepts in Career Counseling Research; Recommendations for

Future Research

chapter Fundamentals of Professional School Counseling 360

17
Foundations of Professional School Counseling 361
䊏 What Is School Counseling?; Brief Historical Background; Professionalism

for School Counselors

ASCA National Standards 364

䊏 Domain 1: Academic Development; Domain 2: Career Development;

Domain 3: Personal and Social Development

ASCA National Model 367

䊏 The Foundation; The Delivery System; The Management System; The

Accountability System; Programmatic Approach: A New Paradigm for

School Counseling; Collaboration and Systemic Support

The Transforming School Counseling Initiative 371

䊏 Implications for School Counselor Practice; The Counseling Process;

Consultation; Coordination of Services; Leadership; Advocacy;

Collaboration and Teaming; Managing Resources; Use of Data

School Counseling in the 21st Century 374

䊏 Functions and Responsibilities of the School Counselor; The Transformed

School Counselor

chapter Approaches to Family Counseling 376

18
Behavioral and Cognitive-Behavioral Family Therapy 378
䊏 Key Concepts in Behavioral and Cognitive-Behavioral Therapy; Role of

Therapist in Behavioral and Cognitive-Behavioral Therapy; Goals of

Treatment in Behavioral and Cognitive-Behavioral Therapy; Therapeutic
Techniques in Behavioral and Cognitive-Behavioral Therapy; Strengths and
Limitations of Behavioral and Cognitive-Behavioral Therapy
 Contents xxiii

Bowenian Family Therapy 380

䊏 Key Concepts in Bowenian Therapy; Role of Therapist in Bowenian

Therapy; Goals of Treatment in Bowenian Therapy; Therapeutic

Techniques in Bowenian Therapy; Strengths and Limitations of Bowenian
Therapy

Constructivist Family Therapy 383

䊏 Key Concepts in Constructivist Therapy; Role of Therapist in

Constructivist Therapy; Goals of Treatment in Constructivist Therapy;

Therapeutic Techniques in Constructivist Therapy; Strengths and
Limitations of Constructivist Therapy

Experiential Family Therapy 385

䊏 Key Concepts in Experiential Therapy; Role of Therapist in Experiential

Therapy; Goals of Treatment in Experiential Therapy; Therapeutic

Techniques in Experiential Therapy; Strengths and Limitations of
Experiential Therapy

Feminist Family Therapy 387

䊏 Key Concepts in Feminist Therapy; Role of Therapist in Feminist Therapy;

Goals of Treatment in Feminist Therapy; Therapeutic Techniques in

Feminist Therapy; Strengths and Limitations of Feminist Therapy

Psychodynamic Family Therapy 389

䊏 Key Concepts in Psychodynamic Therapy; Role of Therapist in

Psychodynamic Therapy; Goals of Treatment in Psychodynamic Therapy;

Therapeutic Techniques in Psychodynamic Therapy; Strengths and
Limitations of Psychodynamic Therapy

The Satir Growth Model of Family Therapy 391

䊏 Key Concepts in the Satir Growth Model; Role of Therapist in the Satir

Growth Model; Goals of Treatment in the Satir Growth Model;

Therapeutic Techniques in the Satir Growth Model; Strengths and
Limitations of the Satir Growth Model

Solution-Focused Brief Family Therapy 394

䊏 Key Concepts in Solution-Focused Brief Therapy; Role of Therapist in

Solution-Focused Brief Therapy; Goals of Treatment in Solution-Focused

Brief Therapy; Therapeutic Techniques in Solution-Focused Brief Therapy;
Strengths and Limitations of Solution-Focused Brief Therapy

Strategic Family Therapy 396

䊏 Key Concepts in Strategic Therapy; Role of Therapist in Strategic Therapy;

Goals of Treatment in Strategic Therapy; Therapeutic Techniques in

Strategic Therapy; Strengths and Limitations of Strategic Therapy
xxiv Contents

Structural Family Therapy 398

䊏 Key Concepts in Structural Therapy; Role of Therapist in Structural

Therapy; Goals of Treatment in Structural Therapy; Therapeutic

Techniques in Structural Therapy; Strengths and Limitations of Structural
Therapy
Systemic Family Therapy 400
䊏 Key Concepts in Systemic Therapy; Role of Therapist in Systemic Therapy;

Goals of Treatment in Systemic Therapy; Therapeutic Techniques in

Systemic Therapy; Strengths and Limitations of Systemic Therapy

chapter Understanding and Assessing Psychopathology 404

19
Understanding Psychological Disorders 406
䊏 What Is Abnormality?; Models of Abnormality

Assessment of Psychopathology 407

䊏 Diagnostic Classification Systems; The Assessment Process; Gathering

Information: Written, Verbal, and Observational Methods; Assessment

Results
The Diagnostic System: Some Considerations 411
䊏 Uses and Advantages of the DSM Classification System; Limitations of the

DSM System; Dimensional Diagnoses: A New Approach to Diagnosing

Disturbances Related to Anxiety 412
䊏 Approaches to Understanding Anxiety; Generalized Anxiety Disorder;

Phobias; Panic Disorder; Obsessive-Compulsive Disorder; Stress Disorders

Disturbances With Mood 415
䊏 Approaches to Understanding Depression; Unipolar Depression; Bipolar

Disorder; Suicide
Disturbances Related to Eating and Weight Loss 418
䊏 Approaches to Understanding Eating Disorders; Anorexia Nervosa;

Bulimia Nervosa (Binge–Purge Syndrome)

Disturbances in Substance Use 419
䊏 Distinctions Between Abuse and Dependence; Approaches to

Understanding Substance Abuse; Some Drugs of Choice

Disturbances With Sexuality and Gender Identity 421
䊏 Approaches to Sexual Dysfunction; Sexual Dysfunction; Paraphilias; Gender

Identity Disorder; Sex Therapy

Disturbances of Psychosis, Memory, and Other Cognitive Functions 424
䊏 Approaches to Understanding Schizophrenia; Symptoms of Schizophrenia;

Dissociative Disorders
 Contents xxv

Disturbances in Personality 426

䊏 Approaches to Understanding Problems With Personality; Odd Personality

Disorders; Dramatic Personality Disorders; Anxious Personality Disorders

Disturbances in Childhood 428

䊏 Approaches to Understanding Childhood Disturbances; Mental Health

Problems in Childhood; Elimination Disorders; Chronic Disorders

Beginning in Childhood

Disturbances Related to Aging and Cognition 431

䊏 Problems With Cognition and Neurology in Older Adults; Mood

Disorders in Older Adulthood

part three
What Are the Fundamental Components
of Appraisal and Research That New Counselors
Should Use in Their Practice? 433

chapter Foundations of Measurement and Psychometrics 434

20
Statistics: A Brief Introduction 435
䊏 Ethics in Statistical Research; Differentiation Between Descriptive and

Inferential Statistics: Some Basics

Descriptive Statistics 436

䊏 Scales of Measurement; Measures of Central Tendency: Mean, Median, and

Mode; Measures of Dispersion: Range, Variance, and Standard Deviation;

Distribution; Percentile

Inferential Statistics 441

䊏 Probability; Standard Scores; Tests of Significance

Reliability 445
䊏 Classical Test Theory; Importance of Reliability; Measurement of Reliability;

Methods of Estimating Reliability; Standard Error of Measurement; The

Confidence Interval

Validity 449
䊏 Content Validity; Face Validity; Construct Validity; Criterion-Related

Validity
xxvi Contents

Test Construction 453

䊏 Methods of Test Development; Writing the Items; Item Try-Out;

Normative Sample; Writing the Manual

chapter Testing and Assessment in Counseling Practice 458

21
Overview of Assessment 460
䊏 Uses of Assessments; Professional Organizations Supporting Assessment

Assessment Process 461

䊏 Review Referral Information; Decide Whether to Take the Case; Obtain

Background Information; Consider Systematic Influences; Observe the

Client in Several Settings; Select and Administer an Appropriate Test
Battery; Interpret Results; Develop Intervention Strategies; Document the
Assessment; Meet With Concerned Individuals; Follow Up on
Recommendations

Cognitive Assessment 463

䊏 Nature of Intelligence; Stanford–Binet Intelligence Test; Wechsler Scales;

Woodcock–Johnson Scales

Educational Assessment 468

䊏 Achievement Tests; Aptitude Tests; Psychoeducational Test Batteries

Personality Assessment 472

䊏 Rorschach Psychodiagnostic Test; Thematic Apperception Test; Minnesota

Multiphasic Personality Inventory; MMPI-A; NEO Personality

Inventory–Revised

Behavioral Assessment 475

䊏 Self-Report; Direct Observation; Behavior Rating Scales

Neuropsychological Assessment 478

䊏 The Mini Mental State Examination; The Wechsler Memory Scale–Third

Edition; The Halstead–Reitan Neuropsychological Battery

NEPSY 480

Interest in Employment 480

䊏 Strong Interest Inventory; Armed Services Vocational Aptitude Battery;

General Aptitude Test Battery; Myers–Briggs Type Indicator

Assessment of Organizational Culture 483

䊏 Discussion of Organizational Culture; Job Descriptive Index; Minnesota

Satisfaction Questionnaire; Organizational Commitment Questionnaire

 Contents xxvii

chapter Quantitative Research Designs 486

22 Foundations of Research Design 487
䊏 The Hypothesis; Types of Research Hypotheses; The Null Hypothesis;

Decision to Reject or Accept the Null; Alpha or Significance Level; Point

Estimates and Confidence Intervals; Hypothesis Testing
Experimental Research 491
䊏 Manipulation; Random Assignment; Controlling for Confounds; Treatment

Integrity; Manipulation Check; Settings for Conducting Experiments

Experimental Validity 495
䊏 Internal Validity; External Validity

Basic Experimental Design 497

䊏 One Group Posttest Only Design; Treatment–Control Posttest Only; One

Group Pretest–Posttest Design; Pretest–Posttest Control Group Design;

Posttest Only Design; Treatments and Concomitant Variables; Factorial
Designs; Solomon Four-Group Design
Quasi-Experimental Designs 502
䊏 The Nonequivalent Control Group Design; Interrupted Time-Series

Design; Counterbalanced Designs; Single Case Experimental Designs;

Multiple-Baseline Designs; Alternating Treatments Design and Changing
Criterion Design
Nonexperimental Research Designs 507
䊏 Classifications of Independent Variable; Purposes of Nonexperimental

Research Design; Types of Nonexperimental Designs; Combining

Experimental and Nonexperimental Designs; Interpretation of
Nonexperimental Research; Longitudinal Research

chapter Fundamentals of Qualitative Research 512

23 Roots of Qualitative Research 513
䊏 Cultural Anthropology; Sociology; Education

Meaning in Qualitative Research 514

䊏 The World Is Meaningful; Some Things Are Only Meaningful; Knowledge

Depends on Understanding
How to Recognize Qualitative Research 516
䊏 Natural Setting; Holistic Approach; Researcher Involvement

Basic Techniques of Qualitative Research 517

䊏 Observation; Interviews; Participation; Interpretation

Basic Products of Qualitative Research 520

䊏 Ethnography; Case Study; Grounded Theory; Material Analysis
xxviii Contents

The Role and Future of Qualitative Research in Counseling 524

䊏 Qualitative Research Tackles Complex Questions and Issues; Counselors

and Qualitative Researchers Share Similarities; Qualitative Research

Provides Possibility and Freedom

part four
What Are the Special Topics and Important Trends That
Counselors Might Encounter? 527

chapter A Look at Consultation 528

24 Historical Evolution of Consultation 529
䊏 Clinical or Expert Approach; Organizational Consultation; Client-Centered

Consultation; Total Quality Management Approach; Social Work

Perspective; Definition of Consultation; The Counselor as Consultant;
Stages in Consultation
Theories of Consultation 533
䊏 Person-Centered Theory of Consultation; Learning Theory of

Consultation; Gestalt Theory of Consultation; Psychoanalytic Theory of

Consultation; Chaos Theory of Consultation
The Consultation Relationship 535
䊏 Consultant-Centered Orientation; System-Centered Orientation

Mental Health Consultation 536

䊏 Definition of Mental Health Consultations; Basic Characteristics of Mental

Health Consultation; Psychodynamic Orientation of Mental Health

Counseling; Types of Mental Health Consultation
Behavioral Consultation 539
䊏 Definition of Behavioral Consultation; Characteristics of Behavioral

Consultation; Bergan and Kratochwill’s Model of Behavioral Consultation

Organizational Consultation 542
䊏 Definition of Organizational Consultation; Use of Systems Theory;

Diagnosing Organizational Problems; Content and Process Consultation;

Organizational Paradigm; Paradigm Shift
School-Based Consultation 545
䊏 Collaboration; Types of School Consultation; Theoretical Approach to

School Consultation
Chapter Summary 548
 Contents xxix

chapter Crisis Intervention in Counseling 550

25
Understanding Crisis and Crisis Intervention 551
䊏 Definition of Crisis; Types of Crisis; Crisis in Culture; Characteristics of an

Effective Crisis Counselor

Differences Among Psychological Emergency, Crisis, and Trauma 555

䊏 Psychological Emergency; Crisis; Trauma

Crisis Response: The Six-Step Model of Intervention 559

䊏 Step 1: Define the Problem; Step 2: Ensure Safety; Step 3: Provide Support;

Step 4: Examine Alternatives; Step 5: Make Plans; Step 6: Obtain

Commitment

Crisis Assessment: Using the Triage Assessment Form 562

䊏 Assessment of Crisis Reactions; Severity Scales

Trends in Crisis Intervention 564

䊏 Contextual Models; Strength-Based Approach; Systemic Approach

chapter Addictions Counseling 568

26
Fundamentals of the Addictive Process 569
䊏 The Use–Dependence Continuum; Classifications of Dependence;

Progression; Hallmarks of Addictive Behavior; Tolerance and Withdrawal

Models of Addiction 572

䊏 Moral; Medical and Disease; Spirituality; Impulse Control; Genetic; Social

Learning; Bio-Psycho-Social; Cultural Implications for Addiction Models

Screening and Assessment 574

䊏 Physiological and Behavioral Assessment; Clinical Interviewing;

Psychometric Instruments; Diagnosis and Co-occurring Disorders;

Intervention Level Assessment

Intervention and Treatment Considerations 579

䊏 Crisis Management; Stages of Behavioral Change; Treatment Modalities;

Beyond Addiction Management; Dual Diagnosis; Pharmacological

Interventions; Special Populations; Defining Successful Treatment; Legal,
Ethical, and Professional Issues
xxx Contents

chapter Ecological-Transactional and Motivational Perspectives

27 in Counseling 586

Background to the Ecological-Transactional Model 587

䊏 Best Practices in Counselor Education: Emphasis on Context and Culture;

Deficits of Traditional Theories in Counselor Education

An Ecological-Transactional Developmental Framework 588

䊏 Learning Theory: Vygotsky; Attachment Theory: Bowlby; Bioecological

Human Development: Bronfenbrenner

The Ecological-Transactional Model and Professional Counseling 591

䊏 Developmental Psychopathology; Resilience; Assessing Risks and Protective

Factors

Self-Determination Theory? 593

䊏 Organismic and Dialectical Underpinnings of Self-Determination Theory;

Basic Psychological Needs and the Social Context; Reasons for

Nonintrinsic Actions; Motivation

Relating Self-Determination Theory to the Helping Professions 598

䊏 Blocks to Clients’ Motivation Toward Change; How Can Counselors Help

Motivate Clients for Change?; Empirical Evidence for Self-Determination

Theory and Autonomy Support; Recommendations for Providing an
Autonomy Supportive Context

Conclusion 603

chapter Neuroscience in Psychotherapeutic Practices 606

28
Neuroscience and Psychotherapeutic Practices 607
䊏 Neuroscience and Psychotherapy: Early Connections; What Is

Neuroscience and Why Is It Important to Therapists?

The Nervous System 607

䊏 Systems Within the Nervous System; Neurons; Action Potential;

Autonomic Nervous System

The Brain 609

䊏 The Cerebral Cortex; The Forebrain; Midbrain; Hindbrain

Facilitating Neural Change 613

䊏 How Does Neural Change Occur?; Principles for Brain-Based

Psychotherapy; Understanding Schemas; Dealing With Problematic

Schemas; Changing View About Incoming Stimuli; Impact of Stress on
Neural Change; Utilizing the Hemispheres
 Contents xxxi

Ensuring Lasting Neural Change 616

䊏 Automization of Internalized Processes; Monitoring Change in Client

Thinking; Monitoring Change in Clients’ Executive State; Techniques for

Engaging Emotional States
Clients With Processing Deficits 618
䊏 Effectiveness of Cognitive Remediation Therapy; Cautions When Using

Cognitive Rehabilitation
Attention-Related Processing Deficits 619
䊏 Individualizing the Length of Therapy Sessions; Use of Cues

Memory-Related Processing Deficits 620

䊏 Rehearsal; Mnemonic Strategies; Labels, Notebooks, and Calendars; Spaced

Retrieval
Executive Functions Deficits 621
䊏 Goal Management Training; Other Approaches to Helping Clients With

Executive Functioning Deficits

Summary 622

chapter Developmental Counseling and Therapy 624

29
Historical Context of Developmental Counseling and Therapy 625
䊏 Influences of Piagetian Cognitive-Emotional Developmental Theory;

Influences of Life-Span Developmental Theory; Influences of Postmodern

Theory; Influences of Wellness Theory and Research; Impact of Traditional
Theories of Counseling and Psychotherapy; Influence of Multicultural
Counseling
Underlying Philosophy of Developmental Counseling and Therapy 626
䊏 Developmental Nature of Being; Multidimensionality in Developmental

Counseling and Therapy; Cultural Relevancy of Developmental Counseling

and Therapy
Modes of Consciousness in Developmental Counseling and Therapy 628
䊏 Sensorimotor-Elemental Style; Concrete-Situational Style;

Formal-Operational Style; Dialectic-Systemic Style

Developmental Counseling and Therapy Approach to Wellness 632
䊏 The Indivisible Self: Evidence-Based Model of Wellness; Core Factors of

the Indivisible Self

Fundamentals of Systemic Cognitive Developmental Therapy 634
䊏 Defining Disorder from the Systemic Cognitive Developmental Therapy

Perspective; Assessment in Systemic Cognitive Developmental Therapy;

Treatment in Systemic Cognitive Developmental Therapy
xxxii Contents

Developmental Counseling and Therapy Techniques: Developmental Strategies

Questioning Sequence 636
䊏 Questioning Strategies in the Opening Presentation of Issue; Questioning

Strategies in the Sensorimotor-Elemental Style; Questioning Strategies in

the Concrete-Situational Style; Questioning Strategies in the
Formal-Pattern Style; Questioning Strategies in the
Dialectic-Systemic-Integrative Style

Role of the Therapist in Developmental Counseling and Therapy 639

䊏 Precision Matching; Active Engagement of the Therapist

Evaluation of Developmental Counseling and Therapy 640

chapter Counseling for Wellness 642

30
Historical Context of the Wellness Movement 643
䊏 Philosophical Groundwork of Wellness; Counseling-Based Approach to

Wellness

Modern Definitions of Wellness 643

䊏 Differentiation Between Health and Wellness; Multiple Understandings of

Wellness; Wellness Defined From a Counseling Perspective

Wellness Models 645

䊏 Wheel of Wellness Model; Indivisible Self (IS-WEL): Evidence-Based Model

of Wellness

Assessment Tools for Examining Wellness 648

䊏 The Wellness Evaluation of Lifestyle; The Five Factor Wellness Inventory

Counseling for Wellness 650

䊏 Step 1: Introduction of the Wellness Model; Step 2: Assessment of the

Components of the Wellness Models; Step 3: Intentional Interventions to

Enhance Wellness; Step 4: Evaluation and Follow-Up; Strengths and
Limitations

chapter Spirituality and Pastoral Counseling Practices 658

31
The Importance of Spirituality in Counseling 659
䊏 Spirituality in Professional Counseling and Psychology Organizations;

Spirituality in American Society

Pastoral Counseling and Related Ideology 660

䊏 Religion and Spirituality; Spirituality and Counseling; Evolution of Pastoral

Counseling
 Contents xxxiii

Ethics, Spirituality, and Counseling 663

䊏 Ethical Decision-Making Criteria; Purpose of Ethical Codes; Counselor

Competence; Supervision
Psychodynamic Theories and Spirituality 665
䊏 Freud and Psychoanalysis; Jungian Psychology

Existential and Phenomenological Theories and Spirituality 667

䊏 Frankl and Logotherapy; May and Existentialism; Rogers and

Client-Centered Theory; Perls and Gestalt Therapy

Behavioral Theories and Spirituality 671
䊏 Watson and Behaviorism; Skinner and Behavioral Conditioning; Lazarus

and Multimodal Therapy

Cognitive and Cognitive Behavioral Theories and Spirituality 673
䊏 Glasser and Choice Theory; Ellis and REBT

Conclusion 674

appendix Preparing for the National Counselor Exam:

A What You Need to Know 675

appendix Your Online Companion in Electronic Case Management:

B An Introduction to Penelope Software 721

appendix Hints, Helps, and FAQs About Working in a Managed Care

C Environment 731

References 741
Index 785
 Preface

THE STORY BEHIND THE COUNSELOR’S COMPANION

This book was born out of the belief that having a quick, reference-style resource
can provide new counselors not only with valuable information but also with a
sense of assuredness and a way to bridge the gap between what they learned in the
classroom and the challenges they meet in their practice.
In our interactions with newly graduated counselors and with students soon
to be completing their graduate programs, we often hear them express uncer-
tainty about how to proceed after graduation. While they are in the midst of their
counseling programs, students are surrounded by support systems. Professors
encourage and coach them as they work toward the goal of graduating; supervi-
sors and colleagues at practicum and internship sites provide critical feedback
that counselors can rely on to fine-tune their techniques and skills. Yet, once these
beginning practitioners are in the field and expected to fulfill their counseling
role, they often experience a sense of loss and even can become overwhelmed
with questions that arise in their clinical interactions. Each experience with a cli-
ent may make counselors aware of lapses in their formation. Even if they are able
to form a support system similar to the one they had in graduate school, there is
still little succinct and practical information available to help counselors who are
just getting started.
What students need is a reference tool to help them answer questions and pro-
vide them with the support they need after just graduating. This idea of a compre-
hensive reference book reminded us of similar books used in other fields, such as
the Physician’s Desk Reference (PDR) used by doctors or the Monthly Index of Medical
Specialties (MIMS) that aids pharmacists. We both agreed that this type of overall
reference book tailored to counseling topics would fill this gap for counselor
trainees and so this text was begun.

ORGANIZATION OF THE COUNSELOR’S COMPANION

The contents of this book are guided by the core curriculum of the Council for Ac-
creditation of Counseling and Related Programs (CACREP), and information is in-
tentionally presented in brief form so that the main points of each section are con-

xxxv
xxxvi Preface

cise, clear, visible, and easily accessible. Moreover, the information presented here
is a collection of contributions from counselor educators and professionals in the
field, each offering a chapter or chapters on the areas of their counseling expertise.
The use of various contributors adds a diversity of viewpoints and ensures that
knowledgeable and experienced counselor educators and practitioners provide
quality content. We hope that this book will become a support system for students
who have left their supervisors and teachers behind after graduation.
A wide variety of topics are introduced in this text that familiarize readers with
more traditional theories and ideas as well as some cutting-edge areas as seen in
the chapter on using neuroscience in counseling and the chapter describing an eco-
logical approach to therapeutic interventions. Students and new counselors will
find that this book is an important resource companion for the duration of their ed-
ucational careers and beyond.
To help readers get acquainted with the layout of the book, we briefly outline the
four main parts within which the contents are packaged. Each part is framed by a
broad question that we believe new counselors may ask of themselves as they be-
gin their professional endeavors.
Part I asks “What are the primary roles and responsibilities of the professional
counselor?” To answer this question, the first part of the book looks at the following
areas:

1. On Being a Professional Counselor.

2. The Demands and Obligations of Ethical Counseling.
3. The Legal Intrigues of Counseling Practice.
4. Multicultural Intricacies in Professional Counseling.
5. Supervision, an Essential for Professional Counselor Development.
6. Collaborative Supervision for the Novice Supervisor.

Part II asks, “What are the essential elements of counseling with which all coun-
selors must be familiar?” In response to this question, the second part of the book
addresses the following areas:

7. Understanding Human Growth and Development.

8. Counseling Across the Life Span.
9. Major Forces Behind Counseling Approaches.
10. Individual and Social Aspects of the Helping Relationship.
11. The Cultural Kaleidoscope: Eyeing Diverse Populations.
12. Approaches to Group Work.
13. Fundamentals of Group Work.
14. Multicultural Components of Group Work.
15. Counseling in the World of Work.
16. Multicultural Issues in Career and Lifestyle Counseling.
17. Fundamentals of Professional School Counseling.
18. Approaches to Family Counseling.
19. Understanding and Assessing Psychopathology.
 Preface xxxvii

Part III asks, “What are the fundamental components of appraisal and research
that new counselors should use in their practice?” To answer this inquiry, the third
part discusses the following areas:

20. Foundations of Measurement and Psychometrics.

21. Testing and Assessment in Counseling Practice.
22. Quantitative Research Designs.
23. Fundamentals of Qualitative Research.

Part IV asks, “What are the special topics and important trends that counselors
might encounter?” In response to this final query, the fourth part addresses the fol-
lowing areas:

24. A Look at Consultation.

25. Crisis Intervention in Counseling.
26. Addictions Counseling.
27. Ecological-Transactional and Motivational Perspectives in Counseling.
28. Neuroscience in Psychotherapeutic Practice.
29. Developmental Counseling and Therapy.
30. Counseling for Wellness.
31. Spirituality and Pastoral Counseling Practices.

SPECIAL FEATURES OF THE COUNSELOR’S COMPANION

There are several features and enclosures in this book that make it especially ap-
pealing to newly graduating counseling students and beginning practitioners.
These aspects transform the book from a text that counselors read to a tool they can
readily use.

䊏 NCE Sample Exam

One of special features of The Counselor’s Companion is the sample National Coun-
selor Exam (NCE) that is included in Appendix A. Most states today use the NCE
as the exam of choice in their licensure process. The types of questions that are
posed and the topic areas that are covered in the sample exam are modeled after the
NCE, and, as such, the sample exam is an invaluable preparation tool for graduat-
ing students and beginning counselors who are aimed at obtaining state licensure.

䊏 Penelope: Online Case Management Software

Another unique aspect of The Counselor’s Companion is the cutting-edge software

package to which users can subscribe at the introductory price of just $7.95 (for a
xxxviii Preface

120-day trial period) with the purchase of this text. Penelope is an online case man-
agement software package suitable for human services professionals that is down-
loadable or accessible via the World Wide Web. This piece of software is an excel-
lent example of the type of case management program that is utilized in counseling
offices and agencies today. By interacting with Penelope, users, and especially
newly graduating students, will have the chance to become familiar with how on-
line case management works and increase their marketability as professionals.
Penelope offers a multitude of unique features, only a few of which include a sys-
tem for creating client case notes, assessment tools, billing features, and much
more. Appendix B more fully introduces the software and walks users through
some of the basic steps in interacting with the program.

䊏 Tips and Hints for Working in the World of Managed Care

Included in Appendix C is a set of helpful tips and answers to frequently asked

questions about practical, day-to-day issues that practitioners encounter, such as,
“How do I go about purchasing liability insurance? How do third-party reimburse-
ments take place? How do I get approved as an insurance payee?” Many other sim-
ilar questions also are addressed.

SENDING YOU FORTH WITH THE COUNSELOR’S COMPANION

We hope that readers will find that The Counselor’s Companion complements their li-
brary of counseling books. In its usefulness and indispensability, we believe The
Counselor’s Companion will become the primary reference book for graduate coun-
seling students, beginning counselors, and even practitioners in the field—a text
they can access over and over again.
We encourage users to take full advantage of the special features of this book,
such as the sample NCE, the opportunity to subscribe to Penelope at a minimal
cost, and the helpful hints for working in a managed care environment. Most of all,
we hope that The Counselor’s Companion will be for you a reliable resource and tool
that enhances your professional practice, knowledge, and skill as a counselor!

—Jocelyn Gregoire & Christin M. Jungers

Acknowledgments

First and foremost, we wish to express our sincere gratitude to all of the contribu-
tors who have so willingly offered their time, talents, and expertise in order to en-
rich the quality of this book. Moreover, their cooperation and conscientiousness
helped to ensure that the entire editing process ran smoothly and in a timely man-
ner.
A special vote of thanks goes to Steve Rutter, our editor, whose vision, experi-
ence, and excitement helped us to see “outside the box” of possibilities for this
book, and also to Nicole Buchmann, our editorial and research coordinator, who
provided her valuable input. Both Steve and Nicole have been our greatest sup-
porters throughout the various phases of the writing, editing, and publication pro-
cesses. A sincere thank also goes to Sara Scudder, the production supervisor, and
the copy editing team at LEA, whose hard work and dedication not only contrib-
uted to the quality of the book, but also enabled us to stay on schedule with produc-
tion.
Our appreciation also goes to all those whose input and feedback has been in-
valuable throughout the process of compiling this manuscript. We would like to
thank Jonathan Impellizzeri and Jennifer Dougherty, who diligently helped us to
get the manuscripts organized. Thank you, as well, to all those close to us—family
and friends—who have supported and encouraged us throughout this process. To
each and every one: Your support has been priceless!

xxxix
Meet the Contributors

Elizabeth Antkowiak is a clinical counselor for the Perinatal Addiction Center, a

division of Western Psychiatric Institute and Clinic. She instructs counselors at
PAC in applying Dialectical Behavior Therapy to women who are pregnant and
dually diagnosed. Elizabeth can be contacted at: [email protected].

Paul Bernstein, PhD, is an Associate Professor at Duquesne University as well as

the founder and President of Pennsylvania Psychological Services. He is a certified
school psychologist, a licensed psychologist, and a licensed professional counselor.
He can be contacted at: [email protected].

Dan-Bush Bhusumane, MEd, is a doctoral candidate in the Counselor Education

and Supervision Program at Duquesne University and also teaches at the Univer-
sity of Botswana. He can be contacted at [email protected].

Kimberly A. Blair, PhD, is an Assistant Professor in the Department of Psychiatry,

University of Pittsburgh School of Medicine. She also serves as the Director of the
Matilda Theiss Child Development Center at Western Psychiatric Institute and
Clinic, which is part of the University of Pittsburgh Medical Center. Dr. Blair’s aca-
demic training is in applied developmental and school psychology, with a special-
ization in early childhood emotional and behavioral disorders. She can be con-
tacted at: [email protected].

Dr. Lancelot I. Brown is an Assistant Professor in the Department of Foundations

and Leadership at Duquesne University. His research interests focus on the Carib-
bean and address the role of school leadership and other organizational and wider
systemic factors that impact the effectiveness level of the school. He is an Associate
Editor for the journal Educational Measurement: Issues and Practice. Lancelot can be
contacted at: [email protected].

William J. Casile, PhD, is an Associate Professor in the Counseling, Psychology,

and Special Education Department at Duquesne University. He also is the coordi-
nator of the doctoral program in Counselor Education and Supervision at
Duquesne. Dr. Casile can be contacted by email at: [email protected].

Pamela Cogdal, PhD, is an Assistant Professor in the Counseling, Educational Psy-

chology and Research Department at the University of Memphis. Dr. Cogdal also

xli
xlii Meet the Contributors

serves as the coordinator of psychological assessment for the Center for Rehabilita-
tion and Employment Research. Dr. Cogdal is a licensed psychologist and has been
teaching in the field of counseling and counseling psychology since 1989. She can
be contacted at the University of Memphis at (901) 678-4931.

Christian Conte, PhD, is an Assistant Professor in the Counseling and Educational

Psychology Department at the University of Nevada, Reno. Questions or com-
ments can be directed to [email protected]; or by phone (775) 784-6637 ext 2068.

Hugh C. Crethar, PhD, is an Assistant Professor in the School Counseling and

Guidance Program of the Department of Educational Psychology at the University
of Arizona. He is on the Executive Board of the National Institute for Multicultural
Competence, has served in numerous positions within the American Counseling
Association, and is currently President Elect of Counselors for Social Justice. His
work centers on promoting multicultural competence and advocacy competence in
the field of counseling. He can be contacted at: [email protected].

Carol A. Dahir, EdD, is an Associate Professor in counselor education at the New

York Institute of Technology (NYIT). Carol has co-authored of The National Stan-
dards for School Counseling Programs (1997), School Counselor Accountability: A Mea-
sure of Student Success 2e (2007), and The Transformed School Counselor (2006) and
writes and presents extensively about school counseling programs and account-
ability. Carol can be contacted at NYIT, School of Education, 21 West 60th St. New
York, NY 10023, 516 686-7777 or by e-mail at [email protected]

David L. Delmonico, PhD, is an Associate Professor at Duquesne University. He is

the Editor-in-Chief of Sexual Addiction and Compulsivity: Journal of Treatment and Pre-
vention, as well the co-founder of Internet Behavior Consulting. He can be contacted
at [email protected].

Dr. Grafton Eliason is an Assistant Professor in the Department of Counselor Edu-

cation and Services at California University of Pennsylvania. He has taught courses
in death, dying, and spirituality and has a special interest in existential philosophy
and religion. He also has earned an MDiv from Princeton Theological Seminary
and an MEd in School Counseling from Shippensburg University. He is a National
Certified Counselor (NCC), Licensed Professional Counselor (LPC) in Pennsylva-
nia, Certified School Counselor (K-12) in Pennsylvania, and he is an Ordained Pres-
byterian Minister. He can be contacted through email at: [email protected].
Co-authors for Dr. Eliason’s chapter are Colleen Triffanoff, a counselor at Thomas
Jefferson High School, and Maria Leventis, who is associated with Pace University.

Tara Greene is a doctoral student in the School Psychology Program at Duquesne

University. She earned her BS from Allegheny College in Neuroscience and Psy-
chology and her Master’s degree from Duquesne University in Child Psychology.
She can be contacted by email at: [email protected].
 Meet the Contributors xliii

L. Jocelyn Gregoire, CSSp, EdD, co-editor of this text, is a Roman Catholic priest
and an Assistant Professor in the Counseling, Psychology, and Special Education
Department at Duquesne University. Dr. Gregoire splits his time between teaching
at Duquesne University and working as a missionary in the Republic of Mauritius
in the Indian Ocean. He can be contacted at: [email protected].

Elizabeth J. Griffin, MA, LMFT, is the co-founder of Internet Behavior Consulting

and works as a therapist, consultant, and trainer in the area sexual addiction. She
can be contacted at: [email protected].

Elizabeth A. Gruber is an Associate Professor in the Counselor Education and Ser-

vices Department at California University of Pennsylvania. She serves as the field
coordinator for the clinical experience in the department. She has been at California
University since 1988. During that time, she also worked in the University Coun-
seling Center and coordinated their drug and alcohol programs. She is currently a
doctoral candidate at Duquesne University. She can be contacted at: Gruber@
cup.edu.

Arpana Gupta, MEd, is a doctoral student in the Counseling Psychology program

at the University of Tennessee, Knoxville. She obtained her Master’s from Wake
Forest University in counseling. Her research interests include cultural/racial
identity issues, the process of acculturation, stereotype threat, and discrimination
experienced by Asian Americans, mental health problems specifically related to
suicide in Asian Americans, Asian American public policy, and quantitative re-
search methods such as meta-analyses and structural equation modeling. She can
be contacted at: [email protected].

Erin E. Hardin, PhD, is an Assistant Professor in the Counseling Psychology Pro-

gram in the Psychology Department at Texas Tech University. She is interested in
multicultural psychology, with a focus on cultural differences in the self (e.g.,
self-construal, self-discrepancy) and implications for both career and personal
counseling. She can be contacted at: [email protected].

Stephanie D. Helsel, MS Ed, is pursuing a doctoral degree at Duquesne Univer-

sity, in the Counselor Education and Supervision program. Her clinical work cur-
rently is in the areas of chemical dependency as well as employee assistance coun-
seling. She can be reached at: [email protected].

Tammy L. Hughes, PhD, is an Associate Professor of School Psychology with

Duquesne University and a certified school psychologist. Her work experience in-
cludes assessment, counseling,and consultation services in forensic and juvenile
justice settings focusing on parent–school–interagency treatment planning and in-
tegrity monitoring. She can be contacted at [email protected]. Coauthors are cur-
rently associated with the Duquesne University School Psychology Program and
include Erinn Obeldobel, MS Ed, [email protected], Susie
xliv Meet the Contributors

Mclaughlin, EdD, [email protected], and Jamie King, MS Ed,

[email protected].

Allen E. Ivey, EdD, ABPP is Distinguished University Professor at the University

of Massachusetts, Amherst and is Courtesy Professor at the University of South
Florida, Tampa. Allen also is the President of Microtraining Associates, Inc., and he
is known for defining the microskills of the interview and the integative theory De-
velopmental Counseling and Therapy. He is the author of over 40 books and 200
articles. Dr. Ivey’s recent focus is on spirituality in counseling and on neuro-
psychotherapy. He can be contacted at: [email protected].

Christin M. Jungers, MS Ed, co-editor of this text, is a doctoral candidate in the

Executive Counselor Education and Supervision (ExCES) Program at Duquesne
University. She is a Licensed Professional Counselor and a National Certified
Counselor. Her research interests lie in the area of aging and adult development as
well as counselor identity and development. She can be contacted by email at:
[email protected].

Steven P. Kachmar, MA, is a PhD candidate in the School Psychology Program at

Duquesne University. He received his Master of Arts degree in Counseling Psy-
chology from Kutztown University of Pennsylvania in May 2003. His interests in-
clude early childhood care and education center quality, appropriate early child-
hood assessment and intervention, and therapeutic interventions across the
lifespan. He can be contacted through email at: skachmar.msn.com.

Barbara Keaton, PhD, is the president and senior consultant of Keaton Resources.
She can be contacted through email at: [email protected].

Mariellen Kerr is completing her doctoral studies at Duquesne University and can
be contacted at [email protected]. She has had the pleasure of serving as
an elementary counselor and department head for 16 years and was awarded the
Pennsylvania Elementary School Counselor of the Year award for 2006.

Maura Krushinski, EdD, is an Assistant Professor in the Counseling, Psychology,

and Special Education Department at Duquesne University. Dr. Krushinski is the
Coordinator of the Counseling Department at Duquesne; she also is a Licensed
Psychologist, a Licensed Professional Counselor, and a National Certified Coun-
selor. She can be contacted by email at: [email protected].

Stacie A. Leffard, MS Ed, is a doctoral student in the School Psychology Program

at Duquesne University. She can be contacted at: [email protected].

Dr. Frederick T. Leong is Professor of Psychology at Michigan State University and

is affiliated with the Industrial/Organizational and Clinical Psychology programs.
He has authored or co-authored over 100 articles in various counseling and psy-
chology journals, 50 book chapters, and also edited or co-edited 8 books. He is Edi-
 Meet the Contributors xlv

tor-in-Chief of the Encyclopedia of Counseling, which is in preparation. Dr. Leong can

be reached at: [email protected].

Lisa Lopez Levers, PhD, is an Associate Professor in the Counseling, Psychology,

and Special Education Department at Duquesne University. Her research interests
include childhood trauma and, more recently, HIV/AIDS in Africa. She can be con-
tacted by email at: [email protected].

Martin F. Lynch, PhD, is an Assistant Professor at the University of South Florida/

Sarasota-Manatee. He can be contacted by email at: [email protected].

Jeffrey A. Miller, PhD, ABPP is an Associate Professor as well as the Associate

Dean for Graduate Studies and Research at Duquesne University. He also is the As-
sociate Editor for the Journal of Psychoeducational Assessment. He can be contacted by
email at: [email protected]. Nate Kegal and Julie Williams, co-authors for Dr.
Miller’s chapters, are associated with the Duquesne University School Psychology
Program.

Rick Myer, PhD, is an Associate Professor at Duquesne University and a licensed

psychologist with primary research interests in the area of crisis intervention. He is
the developer of the Triage Assessment Model, a tool widely used in crisis inter-
vention. Dr. Myer can be contacted by email at: [email protected].

Jane E. Myers, PhD, is a Professor in the Department of Counseling and Educa-

tional Development at the University of North Carolina-Greensboro. Jane can be
reached through email at: [email protected].

Sherlon P. Pack-Brown is a Professor in the Mental Health and School Counseling

Program at Bowling Green State University, Bowling Green, Ohio. She received her
doctorate in guidance and counseling from the University of Toledo, Toledo, Ohio.
She is an Ohio licensed professional clinical counselor with supervisory status, a
Fellow of the American Counseling Association (ACA), past president of the Asso-
ciation for Multicultural Counseling and Development, and past chair of the ACA
Ethics Committee. She can be contacted at: [email protected].

Sandra A. Rigazio-DiGilio, PhD, is a Professor in the Marriage and Family Ther-

apy Program at the University of Connecticut’s School of Family Studies. She can
be contacted by email at: [email protected].

Seth N. Rosenblatt is a doctoral candidate at Duquesne University in Pittsburgh,

Pennsylvania where he serves as a counselor supervisor, adjunct professor, univer-
sity counselor, and advisor. He received his master’s degree in Student Personnel
Services in Higher Education from Eastern Kentucky University. His dissertation
investigates the application of counseling theory and the cognitive exploration
process by which personal counseling philosophies are attained. He can be con-
tacted by email at: [email protected].
xlvi Meet the Contributors

Lori Russell-Chapin received her PhD from the University of Wyoming. She is a
Professor of Education at Bradley University in Peoria, Illinois where she teaches
graduate counseling practicum and internship courses and an introductory coun-
seling survey course. Lori currently is the Associate Dean of the College of Educa-
tion and Health Sciences. She has been conducting supervision workshops
throughout the world. Please contact her at 309-677-3186 and [email protected].

Dr. Gary Shank is a Professor of Educational Research at Duquesne University. He

is the author of numerous articles on qualitative research and semiotics. He is also
the author of Qualitative Research: A Personal Skills Approach (2nd Ed) and the co-au-
thor of Exploring Educational Research Literacy (forthcoming). Dr. Shank can be
reached at: [email protected].

Leslie Slagel, MS Ed, is a doctoral candidate in the Counselor Education and Su-
pervision Program at Duquesne University. She also is employed by the Women’s
Center and Shelter of Greater Pittsburgh where she counsels abused women. Leslie
can be contacted through email at: [email protected].

Rex Stockton, EdD, is a distinguished Chancellor’s Professor of Education at Indi-

ana University, Bloomington. He has spent his career investigating aspects of
group dynamics and factors of therapeutic change in groups. He can be contacted
by email at: [email protected].

Carolyn Stone, EdD, is an Associate Professor and co-program leader in the Col-
lege of Education and Human Services at the University of North Florida. Dr. Stone
specializes in the areas of counselor education and school counseling, with an em-
phasis on ethics and legal issues in school counseling. She is the president of the
American School Counselor Association (2006/2007). She can be contacted at:
[email protected].

Ellen Swaney, MS Ed, has 12 years of experience in career counseling and corpo-
rate consulting. She obtained her Master’s degree in counseling from Duquesne
University, and her Bachelor’s degree in business from Indiana University of Penn-
sylvania. She can be contacted by email at: [email protected].

Thomas J. Sweeney, PhD, is a Professor Emeritus in Counseling and Higher Edu-

cation at Ohio University. He can be contacted by email at: [email protected].

Leann J. Terry is a doctoral student in counseling psychology at Indiana Univer-

sity, Bloomington. Her research and scholarly interests include group counseling
trainings in Africa as a way to address psychosocial needs stemming from HIV/
AIDS and the unmet mental health needs of international students in the United
States. She can be contacted at [email protected] or through writing at: 201 N.
Rose Avenue, Bloomington, IN 47401.
 Meet the Contributors xlvii

Carol A. Thomas earned her master’s degree in school counseling from Duquesne
University and is currently a doctoral candidate in Duquesne University’s Coun-
selor Education and Supervision Program. She has worked as Director of School
Counseling in the Western Beaver County School District for the last seven years.
Carol can be reached by email at: [email protected].

Laurie Vargas, MS, is a mental health counselor with the San Francisco Unified
School District and spends much of her time working with the multi-cultural and
social justice issues her families face. She can be contacted by email at: l.vargas@
earthlink.net.
 part one

What Are the Primary Roles

and Responsibilities
of the Professional Counselor?
chapter On Being a Professional Counselor

1 Lisa Lopez Levers

Duquesne University

In This Chapter

䉴 A Brief History of the Counseling Profession

䊏 Theoretical Shifts

䊏 Specialization

䊏 Professionalization

䉴 The Counselor’s Identity

䊏 The Diversity of Counselor Identities

䊏 How Counseling Differs From Psychology and Social Work

䊏 Characteristics of an Effective Counselor

䉴 Professionalism
䊏 Training for Professional Counselors

䊏 Licensure

䊏 Certification

䊏 Professional Associations

䊏 Advocacy

䊏 Ethical Principles in Professional Counseling

䉴 Personal Health and Wellness

䊏 Countertransference

䊏 Burnout

䊏 Networking

2
CHAPTER ONE On Being a Professional Counselor 3

A BRIEF HISTORY OF THE COUNSELING PROFESSION

The counseling profession has evolved extensively from its early roots in the last
century. These roots are shared with the other schools of helping practices that
emerged from the works of 19th-century theoreticians like Freud, Jung, and Adler.

䊏 Theoretical Shifts

The field has seen four main theoretical phases:

1. Psychodynamic perspectives.
2. Person-centered therapy.
3. Behavioral and cognitive interventions.
4. Systemic and ecologically oriented approaches.

䊏 Specialization

During the latter half of the last century, counselor education programs moved
from a generalized training model for professional counselors to one that empha-
sizes specialization while still preserving a core counseling curriculum.

䊏 Professionalization

The momentum toward passing counselor licensure laws across the country was
one sign of professionalization. Another was the evolution of an association serv-
ing the field. The name changes that the association experienced represent the
field’s development:

1. The American Personnel and Guidance Association was inaugurated in 1952.

2. The name of the American Personnel and Guidance Association was changed
in 1983 to the American Association of Counseling and Development.
3. In 1992, the American Association of Counseling and Development became the
American Counseling Association (ACA).

It was not until relatively late in the 20th century that the terms professional coun-
seling and professional counselor were used, largely to designate a credentialed pro-
fession and a licensed professional. The ACA (1997) adopted this definition:

Professional counseling: “The application of mental health, psychological or

human development principles, through cognitive, affective, behavioral or
systemic interventions, strategies that address wellness, personal growth, or
career development, as well as pathology.”
4 What Are the Primary Roles and Responsibilities of the Professional Counselor? PART ONE

THE COUNSELOR’S IDENTITY

Professional counseling is an expanding field, with credentialed counselors pro-

viding a variety of mental health and human development services in a multitude
of settings. Given such a broad spectrum of helping roles, it is difficult to succinctly
characterize what a counselor is. However, some generalizations can be made.

Assumptions About Professional Identity

䊏 Because we live and practice in diverse contexts, counselors strive to develop a
mature multicultural perspective, one that includes sensitivity to race, ethnicity,
class, gender, ability, religion, sexual orientation, and other issues of diversity.
䊏 Because individual clients are whole persons with multiple and complex social
and cultural connections, and because their problems cannot be compartmental-
ized easily, counselors tend to operate from more or less holistic or ecological
frameworks and engage clients in a collaborative counseling process.
䊏 Counselors largely operate from a strengths-based model, even though we
routinely assist clients in working through problem areas, often involving diag-
nosis.
䊏 Counselors are mandated to engage in ethical practices and are bound ethically
to maintain confidentiality about clients, although privileged communication
varies from state to state, depending on state legal codes.
䊏 Effective counseling relies on the keen ability of the professional counselor to en-
gage in self-reflection.
䊏 Because such a significant portion of preservice training focuses on interpersonal
skill building, counselors typically value empathy, trust, respect, therapeutic re-
lationship building, empowerment, and process.

䊏 The Diversity of Counselor Identities

A number of specialty areas attract professional counselors, who provide services

to clients in situations that are highly diverse. The following lists include some of
the possibilities.

Specialty Areas
䊏 Clinical mental health.
䊏 Rehabilitation.
䊏 Family and marriage.
䊏 Pastoral counseling.
䊏 Wellness counseling.
䊏 Career counseling.
䊏 School and college counseling.
CHAPTER ONE On Being a Professional Counselor 5

䊏 Student affairs leadership.

䊏 Sports counseling.
䊏 Consulting on gender issues.
䊏 Gerontology.
䊏 Addictions counseling.
䊏 Forensics.

Specialty Populations
䊏 Children.
䊏 Adults.
䊏 Elders.
䊏 Couples.
䊏 Families.
䊏 Groups.
䊏 Persons with disabilities (physical, developmental, cognitive, and psychiatric).
䊏 Persons who have been traumatized.
䊏 Persons with addictions.
䊏 Persons who are or have been incarcerated.
䊏 Other counseling professionals (clinical and administrative supervision).
䊏 Business and policy organizations (consultation).

Settings
䊏 Community-based agencies.
䊏 Schools and institutions of higher education.
䊏 Nonprofit agencies.
䊏 Governmental organizations.
䊏 Nongovernmental organizations.
䊏 Hospitals.
䊏 Outpatient clinics.
䊏 Rehabilitation centers.
䊏 Nursing homes.
䊏 Respite care facilities.
䊏 Penal institutions.
䊏 Private practices.

䊏 How Counseling Differs From Psychology and Social Work

Many of the theories and techniques used by professional counselors (discussed

elsewhere in this book) are the same as those used by other helping professionals.
However, due to epistemological variations among different types of helpers, the
6 What Are the Primary Roles and Responsibilities of the Professional Counselor? PART ONE

ways in which counselors approach the helping process are often paradigmatically
different from others. Van Hesteren and Ivey (1990) postulated that counseling falls
somewhere between psychology and social work. The differences among the three
professions might be explicated as follows:

Psychological paradigm: Approach to the helping relationship that empha-

sizes the etiology of psychopathology as intrinsic to the individual.

Sociological paradigm: Approach to the helping relationship that focuses on

systems.

Professional counseling paradigm: Approach to the helping relationship

that pays particular attention to the interface between clients and their cul-
tural and systemic connections, with strong emphasis on interpersonal rela-
tionships.

It has been the province of professional counselors to focus on intra- and interper-
sonal factors, attending to both client risks and resiliencies.
An argument can be made that counseling is a highly interdisciplinary profession,
influenced not only by psychology and sociology, but also benefiting historically
from the influences of disciplines like education, anthropology, philosophy, theol-
ogy, other humanities, and the biological sciences. This argument is enhanced by the
fact that students matriculate into counseling master’s degree programs from a wide
variety of undergraduate disciplines (Zimpher, 1996; Zimpher & DeTrude, 1990).

An argument can be made that counseling is a

highly interdisciplinary profession, influenced not
only by psychology and sociology, but also
benefiting historically from the influences of
disciplines like education, anthropology,
philosophy, theology, other humanities, and the
biological sciences.

Although counseling is a separate mental health and human development pro-

fession, there is a great deal of overlap among all helping professionals in terms of
what we actually do with clients and in terms of the theories that drive our prac-
tices. These similarities and differences have been points of contention within the
counseling profession for some time. Interested readers can peruse lengthier dis-
cussions on their own (e.g., Gale & Austin, 2003; Hanna & Bemak, 1997; Ivey &
Ivey, 1998; Myers, Sweeney, & White, 2002; Skovholt, Rønnestad, & Jennings, 1997;
Van Hesteren & Ivey, 1990). It is sufficient to say here that the identity of profes-
sional counseling is marked by its emphasis on pluralism and multidisciplinary in-
fluences, both in terms of service delivery and professional affiliation, as well as by
its focus on clients’ interpersonal relationships.
CHAPTER ONE On Being a Professional Counselor 7

䊏 Characteristics of an Effective Counselor

The delivery of truly effective professional counseling requires the synthesis and
synergy of many professional and personal characteristics. However, one primary
and essential characteristic of the effective counselor is the mastery of at least base-
line technical competencies. These technical competencies, when used properly,
are enhanced by the infusion of certain values commonly adhered to within the
profession.

Technical Competencies (Ivey & Ivey, 2003)

䊏 Attending.
䊏 Focusing.
䊏 Listening actively.
䊏 Questioning.
䊏 Observing.
䊏 Reflecting feelings.
䊏 Confronting.
䊏 Interviewing.
䊏 Operating from an ethical framework.
䊏 Influencing.
䊏 Integrating technical skills.

Values
䊏 Respect.
䊏 Understanding.
䊏 Warmth.
䊏 Genuineness and authenticity.
䊏 Client empowerment.

The effective counselor also has a strong knowledge of theory, with a demon-
strated ability for application. Multicultural competencies and ethical competen-
cies are infused throughout the counselor’s skill level, values, and knowledge base.
The effective counselor is able to move beyond the mere technology of helping
to a more tacit dimension. This includes less tangible skills, such as focusing on cli-
ent meaning making and facilitating whatever form of self-actualization or self-ef-
ficacy the client desires or tolerates (Levers, 1997). The counselor must have a com-
plex array of not only technical skills, but also sensitivity, recursion, timing, and
maturity to manage this dimension. The counselor demonstrates an attitude of car-
ing by empathy, trust, respect, empowerment, and diversity.
There are no cookbook recipes for addressing the integration of the tacit dimen-
sion of counseling with the technology of helping. Perhaps one of the most important
nontechnical characteristics of an effective counselor, to embrace this array suffi-
ciently, is therefore the capacity for honest self-reflection and self-discovery. Al-
8 What Are the Primary Roles and Responsibilities of the Professional Counselor? PART ONE

though some theorists attempt to dichotomize the counseling process as either art or
science, the efficacious practice of counseling is probably best represented as a bal-
ance between mature self-knowledge and a keen mastery of theory and technique.

PROFESSIONALISM

The professional counseling literature offers divergent discussions of professional-

ism (e.g., Gale & Austin, 2003; Hanna & Bemak, 1997; Ivey & Ivey, 1998; Myers et
al., 2002; Ritchie, 1990; Van Hesteren & Ivey, 1990). Most can agree on the following
tenets of professionalism for individual counselors:

䊏 Graduation from an accredited program.

䊏 Acquisition of appropriate credentials.
䊏 Membership in professional associations.
䊏 Adherence to the profession’s code of ethics.

See Chapter 5 for more on professionalism.

䊏 Training for Professional Counselors

The master’s degree is the entry level for professional counselors. Most licensure
laws and professional certifications require at least a master’s degree from an ac-
credited university program, as well as postdegree supervision, to qualify for ap-
plication. Some licensure laws require additional graduate courses that address
specified clinical areas (e.g., the Professional Clinical Counselor credential under
Ohio’s licensure law).
Some professional counselors return to the university to acquire a doctoral de-
gree—a PhD or EdD—to enhance their clinical skills and theoretical knowledge.
The doctoral degree is often a basic requirement for teaching in a university coun-
selor education program (CEP) or in another related program. Nearly all instruc-
tors of counselor education have their doctorates; exceptions include when doc-
toral students teach or supervise master’s students in their CEPs, under the
supervision of their professors, or when counselors with master’s degrees—and
usually a lot of clinical experience—teach at universities at the instructor level.
A number of credentialing bodies govern the educational practices associated
with the preservice preparation of professional counselors, and numerous creden-
tials qualify counselors to practice.

Accreditation for Counselor Education Programs

䊏 Universities are accredited by regional accrediting bodies—for example, the
Middle States, New England, North Central, Northwest, Southern, and Western
CHAPTER ONE On Being a Professional Counselor 9

Associations of Colleges and Schools—and CEPs are a part of the larger univer-
sity environment.
䊏 As a part of a school or college environment, usually a school or college of educa-
tion, CEPs can be accredited, along with their schools or colleges, through the
National Council for the Accreditation of Teacher Education or the Teacher Edu-
cation Accreditation Council.
䊏 If a CEP offers a school counseling program, state department of education ac-
creditation is necessary.
䊏 The accreditations of most specific concern to counselors and counselor educators
are those of the Council for Accreditation of Counseling and Related Educational
Programs (CACREP) and the Council on Rehabilitation Education (CORE).

CACREP and CORE govern both master’s-level and doctoral programs.

The CACREP and CORE Web sites offer guidelines for rigorous
professional curricula and provide standards for academic training.
䉴 www.cacrep.org
䉴 www.core.org

䊏 Licensure

According to the ACA (2002), more than 80,000 professional counselors have been
licensed throughout the country.

Licensure Requirements
䊏 The applicant must have graduated from a master’s or doctoral program in
counseling or a closely related field.
䊏 The applicant must have a graduate degree that includes supervised practicum
and internship experiences.
䊏 The applicant must have passed an examination.
䊏 The applicant must have had 2 to 3 postdegree years of supervised clinical expe-
rience.

Licensure is a mandatory process for counselors who practice in states where the
profession has been legally codified; however, criteria vary, depending on whether
the law is a title-only law or a practice law. The licensee is responsible for under-
standing the mandates and restrictions of the particular law.
The primary reason for enacting laws that govern professional practices is to
protect consumers. In addition, mental health-related laws, in general, facilitate the
consumer’s freedom of choice of services.
10 What Are the Primary Roles and Responsibilities of the Professional Counselor? PART ONE

States Offering Licensure

䊏 The first law aimed at licensing professional counselors in the United States was
passed in Virginia in 1976.
䊏 As of the summer of 2004, licensure laws had been passed in 48 states and the
District of Columbia.
䊏 Only California and Nevada have not yet passed state laws to license profes-
sional counselors (California has a Board of Behavioral Sciences, but it does not
have a Professional Counseling Board, nor does it provide for the licensure of
professional counselors).

Because so much variability exists across licensure laws, many counselors have
experienced great difficulty when moving from one state to another. The American
Association of State Counseling Boards (AASCB) has facilitated coordination
among the state licensure boards. AASCB and other professional organizations
have worked hard on the portability issues surrounding professional counseling
credentials. Portability of a license means that once the counselor is licensed, he or
she can practice with that license in another state without necessarily repeating the
full application process. Because it is not unusual for a licensed counselor to move
to a new state or practice regionally in multiple states, portability is important for
professional development. Counselors need to be able to practice without unrea-
sonable restrictions on mobility. States need to have reciprocal portability agree-
ments, and the National Credentials Registry was recently inaugurated to address
the portability needs of the profession.

Keep tabs on the progress being made in coordinating the require-

ments of state licensure boards at the Web site of the National Board
for Certified Counselors.
䉴 www.nbcc.org
The American Counseling Association Web site provides information
about the licensure laws in individual states.
䉴 www.counseling.org

䊏 Certification

Certification is a voluntary process. Certifications tend to be based on best practice

standards, as determined by experts in the particular area of certification. Whereas
licensure has legal implications, certification usually is not encoded in the law, ex-
cept regarding school counselors. All states require school counselors to hold state
certifications (Bureau of Labor Statistics, 2004), but this is not the same as the na-
tional certification for school counselors.
CHAPTER ONE On Being a Professional Counselor 11

National Certifications
䊏 The National Certified Counselor, the National Certified School Counselor, and
the Master Addictions Counselor, all endorsed by the National Board of Cer-
tified Counselors (NBCC).
䊏 The Certified Rehabilitation Counselor, endorsed by the Council for the Certifi-
cation of Rehabilitation Counselors.
䊏 The Certified Clinical Mental Health Counselor, endorsed by the Academy of
Clinical Mental Health Counselors and NBCC.

Obtaining a professional certification involves an application process; the require-

ments for each type of application are set by the governing body of the specific cer-
tification and vary greatly across certifications.
In addition to national certifications, individual states may have state-specific
requirements for state-based certification of school counselors, addictions coun-
selors, and those employed at various levels of the mental health service delivery
system.

䊏 Professional Associations

The paramount professional association for counselors is the ACA, although nu-
merous other professional affiliations are also available. Professional associations
are important to the individual professional counselor’s professional growth and
development. Associations keep abreast of current issues in the field, mediate ad-
herence to the professional code of ethics, assist in maintaining necessary levels of
training, enhance professional identity, and advocate for needed changes in the
field.

Professional Counseling Organizations

䊏 ACA.
䊏 American School Counselor Association (ASCA).
䊏 National Rehabilitation Counseling Association.
䊏 National Rehabilitation Association.

The ACA has 18 divisions under its organizational umbrella, representing a

plethora of professional counseling interests.

Divisions of the ACA

䊏 Association for Assessment in Counseling and Education.
䊏 Association for Adult Development and Aging.
䊏 Association for Creativity in Counseling.
䊏 American College Counseling Association.
12 What Are the Primary Roles and Responsibilities of the Professional Counselor? PART ONE

䊏 Association for Counselors and Educators in Government.

䊏 Association for Counselor Education and Supervision.
䊏 Association for Gay, Lesbian, and Bisexual Issues in Counseling.
䊏 American Mental Health Counselors Association.
䊏 American Rehabilitation Counseling Association.
䊏 American School Counselor Association.
䊏 Association for Spiritual, Ethical, and Religious Values in Counseling.
䊏 Association for Specialists in Group Work.
䊏 Counseling Association for Humanistic Education and Development.
䊏 Counselors for Social Justice.
䊏 International Association of Addiction and Offender Counselors.
䊏 International Association of Marriage and Family Counselors.
䊏 National Career Development Association.
䊏 National Employment Counseling Association.

In addition to the national organization and its divisions, the ACA has regional-
and state-level associations and divisions. Most of the individual state associations
have their own Web sites, offering more information about state-specific issues and
activities.

Other Professional Associations

䊏 Chi Sigma Iota is the international honor society for professional counselors.
Membership in the society is contingent on academic achievement in a CEP. The
society operates through university-based local chapters and has members
throughout the world.
䊏 The American Educational Research Association has Division E for Counseling
and Human Development.
䊏 American Psychological Association Division 17 is for counseling psychologists.

Check out the following Web sites for basic information about each
association’s membership requirements and activities:
䉴 www.counseling.org (ACA)
䉴 www.schoolcounselor.org (ASCA)
䉴 www.nrca-net.org (National Rehabilitation Counseling Association)
䉴 www.nationalrehab.org (National Rehabilitation Association)
䉴 www.csi-net.org (Chi Sigma Iota)
CHAPTER ONE On Being a Professional Counselor 13

䊏 Advocacy

Client advocacy and professional advocacy are both significant elements of the
counseling profession. These two types of advocacy are profoundly intercon-
nected. It is difficult to advocate sufficiently for our clients if we have not advo-
cated adequately for the profession and are therefore operating from a weak pro-
fessional position.
Many people who seek counseling are marginalized or disenfranchised and
might not be in a position to advocate for themselves; therefore, professional coun-
selors often find themselves assuming an advocacy role with clients. Although not
all professional counselors are positioned well to assume the role of client advo-
cate, many counselors are attracted to the field precisely out of a strong sense of so-
cial justice. For these counselors, a social justice agenda might be nearly insepara-
ble from their counseling objectives.
Altruism is always admirable, and advocating for clients is important. However,
we must take a closer look when advocacy transgresses personal boundaries or
goes unrecognized as countertransference. Proper clinical supervision can help the
counselor avoid potential trouble in this area.

Aspects of Client Advocacy

䊏 Client advocacy might be prompted by the inadvertent neglect of some clients or
groups of clients on the part of an organization, agency, or school. It can be reme-
died easily by drawing attention to the resulting inequity or raising the con-
sciousness of those involved.
䊏 Client advocacy might be prompted by a benign acceptance of a more complex
situation.
䊏 Client advocacy might be prompted by cultural and social disparities arising
from issues related to race, ethnicity, class, gender, ability, religion, and sexual
orientation.

Wherever on the continuum the injustice might be found, counselors can have a
profound impact on people’s lives. Thus counselors have a duty to maintain dig-
nity, integrity, and ethics while advocating for clients.
Counseling has been around for a long time, and counselors have provided
services to people in need for a long time. However, the profession of counseling
needs to catch up to other licensed professions in its self-advocacy. One dimen-
sion of professionalism is keeping abreast of current affairs that could have an
impact on the profession, as well as on the profession’s ability to provide quality
services to clients.
The ACA, along with other counseling organizations, has initiated advocacy
strategies designed to affect policy and legislation surrounding issues that are cru-
cial to the profession.
14 What Are the Primary Roles and Responsibilities of the Professional Counselor? PART ONE

Professional Advocacy Initiatives

䊏 Of special historical significance is the ACA’s 1990 appointment of the Pro-
fessionalization Directorate, with a vision of guiding the progress of counselors’
developing professionalism.
䊏 The Directorate later became the Professionalization Committee, and since then
the work of the former Committee has been divided among several of the ACA’s
national professionalism-related committees.

Counselors must continue to pursue a stronger and better coordinated profes-

sional advocacy agenda (Myers & Sweeney, 2004). Individual professional counsel-
ors have ample opportunities to become involved with the work of ACA’s advo-
cacy committees at state, regional, and national levels.

EXAMPLE

Importance of Advocacy for Counselors

The importance of professional advocacy cannot be overstated, especially in light of the fact
that counselors arrived relatively late to the licensure table. Other licensed professionals have
ensured that their services were encoded in state laws. Counselors need to attend to this lack
of parity; while counselors continue high levels of advocacy for clients, counselors also need to
engage in vigorous, systematic, and unrelenting advocacy for the profession.

䊏 Ethical Principles in Professional Counseling

Adherence to professional ethics is arguably the most important aspect of profes-

sionalism with which a counselor must deal on a day-to-day basis. Licensed coun-
selors are required by state licensure laws to adhere to professional ethics.

Ethical Codes for Professional Counselors

䊏 The ethical standards for professional counselors are codified by the ACA Code of
Ethics. The Code was reauthorized recently (ACA, 2005).
䊏 School counselors adhere to the ACA Code of Ethics, as well as the ASCA’s (2004b)
Ethical Standards for School Counselors. State-certified school counselors also must
follow state-mandated ethical practices, often derived from ACA and ASCA eth-
ical standards.
䊏 The NBCC (2005b) requires board-certified counselors to adhere to the ACA Code
of Ethics.
CHAPTER ONE On Being a Professional Counselor 15

䊏 Certified Rehabilitation Counselors follow the Code of Professional Ethics for Reha-
bilitation Counselors, as established by the Commission on Rehabilitation Coun-
selor Certification (2002).

These various codes govern areas such as the counseling relationship, confidential-
ity, professional responsibility, relationships with other professionals, evaluation,
assessment, interpretation, supervision, training, teaching, research, publication,
and methods for resolving ethical issues.
Forester-Miller and Davis (1996) provided an excellent brief discussion of the
moral principles on which the codes of ethics are constructed; they also offered a
useful seven-step model for ethical decision making. Understanding the underly-
ing moral principles of ethical practice and having a ready model when facing ethi-
cal dilemmas can reinforce counselors in maintaining higher standards of profes-
sionalism.

See Chapter 3 for more on ethical codes for counselors.

PERSONAL HEALTH AND WELLNESS

Although the work of counselors can be highly fulfilling and rewarding, it also can
be challenging and stressful. Counselors see clients who are experiencing varying
degrees of problems, dilemmas, and crises. Without a personal sense of wellness,
accompanied by healthy outlets for stress, it is easier for counselors to become
overburdened or to take on their clients’ problems. Many senior members of the
profession emphasize the importance of counselors taking care of themselves. The
CACREP standards, and by extension, many CEPs, encourage counselors’ contin-
ued self-development. In the face of stressful work environments, counselors must
maintain optimum levels of personal health and wellness.

Refer to Chapter 30 for more information about wellness movements in counseling.

䊏 Countertransference

Countertransference arises from taking on client problems. It can potentially lead

to therapeutic misadventures. It is usually when countertransference goes unde-
tected or is denied that it becomes a potential clinical hazard.
Incidentally, countertransference is not necessarily a negative dynamic; it hap-
pens quite frequently in counseling, and the skilled and self-aware practitioner
knows how to identify it and then process it with a clinical supervisor. With proper
handling, a countertransference event can lead to dynamic and productive inter-
ventions with clients.
16 What Are the Primary Roles and Responsibilities of the Professional Counselor? PART ONE

EXAMPLE

Encountering and Managing Countertransference in Practice

I can provide an example from my own clinical work. I once was counseling a client diagnosed
with Borderline Personality Disorder. During one particular session, the client unleashed ex-
treme anger that unnerved me. I began to experience my own anger in response, then caught
myself engaging in countertransference. As soon as I was able to identify the counter-
transference, and quickly process it, my anger was replaced with compassion. I then was able
to reframe my perspective on this client and to understand better what it must be like in the cli-
ent’s world—especially how other people receive the client’s anger. Immediate acknowledg-
ment and self-reflection about my countertransference response assisted me in understanding
my client’s dilemma from a more visceral perspective. Failure to understand the counter-
transference dynamic in this situation could have led to a less productive, or even counterpro-
ductive, response.

䊏 Burnout

When counselors do not take care of themselves—emotionally, spiritually, existen-

tially, or physically—they run the risk of eventual professional burnout. Coun-
selors burn out in response to constant levels of high or intense stress.

Effects of Burnout on Personal and Professional Levels

䊏 Burned-out counselors can end up feeling helpless, hopeless, cynical, resentful,
and depressed.
䊏 Unchecked professional burnout eventually can affect job performance.
䊏 One’s health, career, and relationships with others could be threatened by high
levels of stress.
䊏 Unchecked professional burnout also easily progresses to professional impair-
ment.

Counselor impairment is an ethical issue that must be taken seriously and ad-
dressed responsibly—by the counselor, by professional peers, and by those in-
volved in supervisory relationships with the impaired counselor.
Counselors who work with survivors of trauma and clients with posttraumatic
stress disorder (PTSD) run the risk of experiencing secondary victimization, or vi-
carious trauma. Vicarious trauma can occur when bearing witness to the results of
extreme or unexpected harm or violence to another person. Counselors who offer
trauma counseling need to be vigilant about protecting the integrity of their own
emotional and existential constitutions.
CHAPTER ONE On Being a Professional Counselor 17

In the case of professional burnout or vicarious trauma, the age-old dictum,

“Doctor, heal thyself,” easily can read “Counselor, heal thyself.” The best line of de-
fense is prevention.

Strategies for Preventing Burnout

䊏 Seeking adequate clinical supervision.
䊏 Varying the daily routine.
䊏 Maintaining a healthy sense of humor.
䊏 Having a stress management plan.
䊏 Having a professional development plan.
䊏 Having a personal development plan.
䊏 Seeking personal counseling when needed

Knowing up front that counseling is a high-stress field can help the new counselor
to maintain personal health and wellness.

䊏 Networking

Networking with other professionals is an important aspect of the counselor’s

sphere of work and contributes to both client advocacy and professional growth.
Counselors can find opportunities to network with other professionals at work-
shops, conferences, and conventions, as well as through their professional associa-
tions.

Chapter 1: Key Terms

䉴 Professional counseling 䉴 Sociological paradigm 䉴 Burnout
䉴 Psychological paradigm 䉴 Professional counseling 䉴 Secondary victimization
paradigm
chapter The Demands and Obligations
of Ethical Counseling
2
Christian Conte
University of Nevada, Reno

In This Chapter

䉴 The Basics of Ethics in Counseling

䊏 Definition of Ethics

䊏 Ethical Codes

䊏 Ethical Codes and Cultural Diversity

䊏 Development of Ethical Codes

䊏 ACA Code of Ethics

䊏 Mandatory and Aspirational Ethics

䉴 Ethical Theory
䊏 Epicureanism

䊏 Utilitarianism

䊏 Kantianism

䊏 Situationalism

䉴 Ethical Principles and Decision Making

䊏 Nonmaleficence

䊏 Beneficence

䊏 Autonomy

䊏 Fidelity

䊏 Justice

䊏 An Ethical Decision-Making Model

䉴 Common Ethical Concerns for Professional Counselors

䊏 Confidentiality

䊏 Dual Relationships and Potentially Beneficial Interactions

䊏 Sexual Misconduct

䊏 Transference

䊏 Countertransference

䉴 Summary

18
CHAPTER TWO Demands and Obligations of Ethical Counseling 19

THE BASICS OF ETHICS IN COUNSELING

Ethics defines counseling as much as theory and practice define it. Conscious or
not, professional counselors all act under belief systems or ethical positions that
help or hinder their clients. Over the course of two millennia, ethical thought in
Western civilization has evolved into wide-ranging guidelines that provide a back-
ground against which the relationship between counselor and client can be as-
sessed. This chapter provides an overview of ethical thought as it relates to coun-
seling.

䊏 Definition of Ethics

Counseling is nothing if it is not about character, appropriate as the Greek word

ethos means character. Ethics can be understood in two contexts:

1. Ethics sometimes refers to the study of morality and specific moral choices.
2. Ethics can be understood as a philosophical discipline concerned with the stan-
dards that govern conduct perceived to be acceptable by a culture or society.

Ethical thought related to the counseling profession falls primarily within the sec-
ond context and has a direct impact on counselors’ relationships with their col-
leagues and their former and current clients. For counselors, ethics can be defined
as follows:

Ethics: The standards governing the conduct of members of the counseling

profession.

䊏 Ethical Codes

If ethics are the standards that govern conduct, ethical codes can be understood in
this way (Gladding, 2005):

Ethical codes: The written form of ethical conduct that is intended to improve
professionals’ ability to successfully and competently respond to clients’
needs.

Although not all encompassing, ethical codes provide detailed guidelines to which
counselors can refer when making decisions about their own behavior or actions
taken on behalf of the client. Thoughtful consideration and implementation of the
codes results in the protection of client welfare and the welfare of counseling pro-
fessionals. The general public gains trust in the integrity of a profession that re-
quires clinicians to live up to an ethical code, and professionals who act within the
recommendations of the codes are safeguarded from unfounded lawsuits.
20 What Are the Primary Roles and Responsibilities of the Professional Counselor? PART ONE

Consequences for breeches of the ethical code also ensure that the counseling
process will be safe for the general public. The American Counseling Association
(ACA) provides a governing body that establishes and enforces consequences for
ethical code violations. Although the ACA has subdivisions, some of which have
developed best practices statements, the national branch’s ethical codes serve as
the quintessential guidelines for all counselors.

䊏 Ethical Codes and Cultural Diversity

The general public the code of ethics strives to serve is recognizably diverse. Ac-
counting for variances in moral standards, values, and a range of interpretation
about human conduct is an important concern in developing ethical standards and
codes. Thus, the ethical codes must be rooted in standards that, while mirroring
some moral tenets, respect cultural diversity.

EXAMPLE

Cultural Issues and Ethical Codes

Respecting all cultures is a pragmatic contradiction. Some Satanic cultural ideals exonerate
torture and pain, whereas the majority of other cultures do not condone such ideals. Incorpo-
rating ethical codes that equally consider all cultural codes of conduct is not possible.

䊏 Development of Ethical Codes

Ethical codes are not static. New research and expanding awareness both contrib-
ute to the need for constant revision of the ethical codes.

Revisions of the ACA Code of Ethics and Standards of Practice

䊏 The American Personnel and Guidance Association adopted its first code of eth-
ics in 1961.
䊏 Since the first revision in 1974, the code has been revised every 7 years.
䊏 The latest revision of the ACA Code of Ethics was released in 2005.

䊏 ACA Code of Ethics

The most recent revision of the ACA Code of Ethics (2005a) contains eight sections
that address the following areas:

1. The counseling relationship.

2. Confidentiality, privileged communication, and privacy.
CHAPTER TWO Demands and Obligations of Ethical Counseling 21

3. Professional responsibility.
4. Relationships with other professionals.
5. Evaluation, assessment, and interpretation.
6. Supervision, training, and teaching.
7. Research and publication.
8. Resolving ethical issues.

Each section includes an introduction that clarifies the conduct toward which coun-
selors aspire and lets readers know what will be presented in the section. Briefly,
goals of the standards outlined in the ACA code can be summarized as follows.

Aims of the ACA Code of Ethics (ACA, 2005a)

䊏 Clarify the nature of ethical responsibility of ACA members.
䊏 Support the mission of the ACA organization.
䊏 Establish principles, ethical guidelines, and best practices for counselors.
䊏 Assist counselors to make the best decisions on behalf of clients and to support
the values of the profession.
䊏 Provide a reference against which complaints about counselors can be evaluated.

Use the following link to view a full text of the code.

www.counseling.org/Resources/CodeOfEthics

䊏 Mandatory and Aspirational Ethics

When acting in response to the code of ethics, a difference exists between what a
counselor has to do and what a counselor strives to do. That difference is summed
up in the concepts of mandatory ethics and aspirational ethics (Remley & Herlihy,
2001).

Mandatory ethics: The level of functioning counselors must exhibit to fulfill

the minimum ethical obligations.

Aspirational ethics: The highest standards of conduct to which counselors

aim to meet ethical standards.

The concept of mandatory ethics suggests that there are minimal requirements if
counselors are to act ethically. At the same time, the goal of ethical codes generally
is not to outline specific behaviors. The following example provides more detail
about the distinction between mandatory and aspirational ethics.
22 What Are the Primary Roles and Responsibilities of the Professional Counselor? PART ONE

EXAMPLE

Intimate Relationships With Clients

Section A.5.a. Current Clients of the ACA Code of Ethics (2005a) states that counselors cannot
have sexual intimacies with their clients. This code is a mandatory ethic. In other words, it
does not need to be interpreted, only read literally.
A.5.b. Former Clients of the same section, however, describes guidelines by which a healthy
length of time (5 years) is needed to pass before it is considered ethical to engage in sexual inti-
macies with former clients. Although 5 years is clearly stated, this code leaves room for coun-
selors to aspire to make sound ethical choices about the nature of their relationships to former
clients. It would be unethical, for example, to prematurely terminate counseling with a client
only to begin waiting 5 years with the hope that at the end of that time a sexually intimate rela-
tionship can begin. It is hoped that counselors will use aspirational ethics when considering
the most beneficial course of action when dealing with such issues.

It is imperative for counselors to contemplate and discuss current ethical issues,

although the answers will not always be addressed by a code of ethics. Because
codes of ethics are incomplete, counselors can benefit from understanding ethical
theories and the ethical principles on which the ethical codes are based.

ETHICAL THEORY

Like counseling theories, ethical theories are the groundwork on which profes-
sional counselors build uncompromising clinical practices. The ethical theories
presented here span more than 2,000 years and constitute only four of many possi-
ble views. Studying ethical theories in greater detail is essential to integrating per-
sonal beliefs with sound ethical reasoning.
In general, ethical systems or theories fall into four classes based on their foci,
identified as follows:

1. The best interest of the self.

2. The best interest of others.
3. A rational approach that leads to universal principles.
4. The best interest of an individual within a specific circumstance.

䊏 Epicureanism

Epicurus (341–270 B.C.) advocated an ethical theory that focused on the individual.
Tenets of Epicureanism include the following:

䊏 Mental pleasures are emphasized over physical pleasures.

䊏 Balance is the key to happiness.
CHAPTER TWO Demands and Obligations of Ethical Counseling 23

䊏 Happiness is the supreme good.

䊏 The goal of human activity is pleasure.

Epicureanism as an ethical system is relevant for counselors because it supports

phenomenology (i.e., it provides a philosophical rationale for accepting and sup-
porting clients’ desires). A drawback for counselors who accept Epicureanism as
their ethical system is that they could easily focus on their own, rather than their cli-
ents’ needs. Also, because Epicureanism technically supports pure relativism, it
might be used to justify a client’s decision to harm others.

䊏 Utilitarianism

John Stuart Mill (1806–1873) is an excellent envoy of utilitarian ethical theory. In the
context of utilitarianism, performing the greatest good for the greatest number is
the core of ethics. Accordingly, an action is considered good if it produces the great-
est amount of happiness for the greatest number of people.
Using utilitarian ethical theory can be advantageous for counselors because this
viewpoint encourages them to carefully consider whether or not their actions will
benefit the maximum number of people. However, strict adherence to utilitarian
ethical theory might not be practical if counselors must wait until all possible out-
comes have been considered before they act.

䊏 Kantianism

For Westerners, Immanuel Kant (1724–1804) is the hallmark philosopher of ethics.

Kant described a clear method for moral reasoning that can be summed up in this
statement: Whatever decision individuals make, they must be comfortable having
the decision become a universal law. In other words, people should make ethical
decisions based on the principle that, given the same circumstances, everyone in
the world would choose the same course of action.
Counselors may benefit from Kantian ethics because this viewpoint will push
them to thoroughly evaluate the decisions they make. A criticism of Kantian ethics
is that this perspective does not consider cultural differences that call into question
the possibility of universal law.

䊏 Situationalism

In the middle of the 20th century, from the wellspring of contextualism sprang an
ethical theory called situationalism. Joseph Fletcher (1905–1991) articulated this
perspective in his classic work, Situation Ethics: The New Morality (1966). These prin-
ciples characterize situationalism:
24 What Are the Primary Roles and Responsibilities of the Professional Counselor? PART ONE

䊏 Ethical decisions take into account individual circumstances.

䊏 Ethical decisions reflect a balance between legalism (law as an absolute) and
antinomianism (no laws whatsoever).
䊏 Ethical decisions use maxims and principles as guides rather than answers.

Situationalism as an ethical system provides counselors with two advantages: It

allows them to carry their own morals and values into the counseling process with-
out imposing their beliefs on others, and it enables counselors to evaluate unique
situations without violating laws or breaking professional codes. A criticism of
situationalism is that it has the potential to enable people to rationalize any action,
regardless of the consequences for self or others.

ETHICAL PRINCIPLES AND DECISION MAKING

Kitchener (1984) outlined the following five principles that serve as the basis of eth-
ics in the counseling profession act as the foundation on which the ACA Code of Eth-
ics is established:

1. Nonmaleficence.
2. Beneficence.
3. Autonomy.
4. Fidelity.
5. Justice.

䊏 Nonmaleficence

The first ethical principle, nonmaleficence, is the keystone of counselors’ ethical

obligations and can be defined in this way:

Nonmaleficence: The ethical principle stating that counselors should do no

harm.

Counselors must not knowingly engage in behavior they know will be harmful to
their clients. Harm can come in many forms. Implementing the principle of non-
maleficence means everything from counselors not practicing outside the scope of
their competence to counselors not attempting to use techniques that are inappro-
priate for addressing clients’ needs.

䊏 Beneficence

In addition to the mandate not to cause harm, counselors have an ethical obligation
to strive to do something beneficial for their clients.
CHAPTER TWO Demands and Obligations of Ethical Counseling 25

Beneficence: The ethical principle stating that counselors actively do some-

thing good for clients.

Beneficence can be as simple as providing referral numbers to clients who counsel-

ors decide they cannot ethically treat. Reading a book a client references time and
again in the hope of gaining further insight into the client can also be an act of be-
neficence. At its zenith, counselors who most effectively uphold the ethical princi-
ple of beneficence are authentic and intellectually and psychologically prepared to
engage in every counseling session.

䊏 Autonomy

Autonomy entails creating an atmosphere that allows clients to make well-in-

formed choices about every aspect of their involvement with the therapeutic pro-
cess. Counselors can adopt the following definition of autonomy:

Autonomy: The ethical precept stating that counselors respect clients’ right to
be self-governed.

Counselors respect the ethical precept of autonomy when they dialogue with cli-
ents about treatment options and accept the choices their clients make.

䊏 Fidelity

The concept of fidelity encourages counselors to be honest with clients and faithful
to the relationships they have established with them.

Fidelity: The ethical principle stipulating that counselors act faithfully and
honestly with their clients.

Counselors can adhere to this principle by being open with their clients. Kell and
Mueller (1966) noted that glossing over issues (e.g., “Don’t worry, everything will
be okay.”) trivializes clients’ problems and provides a false sense of security that
can be detrimental to clients’ psychological health.

䊏 Justice

Counselors who follow the principle of justice treat their clients with equal respect
for their religion, culture, ethnicity, gender, age, or any variable that visibly or in-
visibly differentiates clients from themselves. Justice can be defined as follows:

Justice: The ethical precept specifying that counselors act fairly toward all po-
tential, current, and past clients.
26 What Are the Primary Roles and Responsibilities of the Professional Counselor? PART ONE

An example of implementing justice is granting pro bono service to a client who

has no means of providing compensation. The ethical precept of justice ensures
counselors strive to interweave equal treatment into every facet of their practice.

EXAMPLE

Giving Advice: Ethical or Unethical?

Have you ever heard of counselors being equated to advice givers? Have you ever heard
people say they are going to counseling because they want someone to tell them how to get out
of a tough situation?
Giving advice is not a regular part of the counseling process because it breaks the ethical prin-
ciple of autonomy. If a client takes a counselor’s advice and it works, the client is likely to re-
turn to the counselor to get further successful advice. This creates a dependence on the coun-
selor, which disregards the client’s autonomy. If the counselor’s advice works out poorly, on
the other hand, the client will likely blame the counselor for the resulting misfortune, thus es-
chewing responsibility for his or her actions. Either result of advice giving is generally not
helpful. It should be noted, however, that never giving advice is an extreme position and also
unethical. Many crisis situations warrant providing direct advice to clients to protect the
safety of all involved.

The five underlying ethical principles are vital to the counseling profession. Al-
though all five have distinct properties, every ethical dilemma can be viewed in
light of these ethical principles. Professional counselors and counselor trainees
should know the five underlying ethical principles well.

䊏 An Ethical Decision-Making Model

The awareness of ethical principles coupled with an ethical decision-making model

provides counselors with a systematic way to approach ethical dilemmas. Because
ethical decisions are often made in minutes, and sometimes seconds, stopping to
reread a step-by-step ethical decision-making model is not practical. Thus, counsel-
ors should infuse into their everyday work an ethical decision-making process by
which they choose to approach ethical dilemmas.
The following seven-step model, based on the work of Kitchener (1984) and
Welfel (2002), is only one of many ethical decision-making models, but it provides a
useful, systematic approach to making ethical decisions. The seven steps are as fol-
lows:

1. Recognize ethical situations.

2. Play out alternative solutions.
3. Refer to the ACA ethical codes.
CHAPTER TWO Demands and Obligations of Ethical Counseling 27

4. Consider legal consequences.

5. Seek supervision.
6. Make a choice.
7. Reflect on your decision.

To understand the relevance of an ethical decision-making model, consider the

following example; then, visualize applying this model in your own counseling
situations.

EXAMPLE

Applying a Model of Ethical Decision Making

A 10th-grade student named Colton arrives in his guidance counselor’s office and tells her
two other students are picking on him by calling him names. His counselor, Miss Solana,
knows the two students well and realizes that she has a good enough rapport with them to
convince them to stop picking on Colton.
From her readings, course work, and training, Miss Solana adeptly follows Step 1 because she
recognizes this situation as an ethical dilemma. In Step 2, she begins to formulate options. For
instance, she realizes that if she approaches the other students, she might in fact help Colton to
experience relatively quick relief from his current situation. Also, by addressing the other stu-
dents, she might send a message, at least to the two antagonists, that bullying will not be toler-
ated in the school. In providing Colton with quick relief, however, she might also send an un-
derlying message to Colton that he needs to rely on others to solve his problems. Furthermore,
by addressing the bullies, it strikes Miss Solana that she will not be providing Colton any in-
sight into what behavior he contributed (if any) to the situation. Lastly, Miss Solana considers
that by addressing the bullies, she will not provide Colton with the skills necessary to handle
future situations in which he is “picked on.”
It is here that following Step 3 can be helpful. The ACA Code of Ethics encourages counselors
to avoid fostering dependent counseling relationships. Miss Solana must ask then, “Will my
decision respect Colton’s autonomy?” Next, Step 4 leads her to consider any legal conse-
quences. Applied to this case, gathering information on what specifically was said is the
first step. If it turns out that no threats were made, this is not likely to be a situation that
warrants legal consultation. Thus considered, Miss Solana can move on to Step 5 and seek
supervision. If Colton stopped by her office only briefly, with the intention of sitting down
with her at a later time, then she might in reality have an opportunity to seek supervision
ahead of time. If not, discussing her decision with her supervisor ex post facto is strongly
recommended.
After considering alternative solutions, consulting the ethical codes, taking into account un-
ethical and illegal ramifications, it is time for Step 6: Make a decision and act on it. The final
step of the ethical decision-making model, Step 7, entails reflecting on the decision made so
that psychological growth might result from the counseling interaction.
28 What Are the Primary Roles and Responsibilities of the Professional Counselor? PART ONE

Although following a decision-making model might appear to be a linear pro-

cess, the actual decision-making process is often recursive. Counselors might need
to revisit steps of the ethical decision-making model to reach a decision that is in the
best interests of the client.

COMMON ETHICAL CONCERNS FOR PROFESSIONAL

COUNSELORS

The scope of ethical dilemmas is vast and varied; however, some concerns are more
frequently encountered than others. Some common ethical concerns are addressed
next.

䊏 Confidentiality

Most people who have a secret betrayed by a close friend or confidant experience
feelings of fear, anger, or sadness; this introduces an element of mistrust into the re-
lationship. Preventing this type of psychological harm is just one reason confidenti-
ality is recognized as an essential component of the counseling process. An equally
important reason for maintaining confidentiality is to shield clients from the social
stigma that historically has been associated with mental illness. Counselors, there-
fore, keep disclosed information confidential to assure clients that they are engag-
ing in a safe process.
Confidentiality is not absolute, however, and clients have the right to under-
stand its limits.

Limits to Confidentiality
䊏 Client waiver of privilege for release of information to third parties (e.g., coun-
selors’ supervisors).
䊏 Prevention of clear and imminent danger that clients pose to themselves or others.
䊏 Court mandates that confidential information be revealed.

Clients must be made fully aware of the right to and limitations of confidentiality.
At the onset of counseling, counselors provide such awareness to clients through a
process called informed consent.

Informed Consent
䊏 Informed consent is the written and verbal disclosure to clients of what takes
place in the counseling process.
䊏 Informed consent should include the purpose, goals, techniques, procedures,
limitations, and potential risks and benefits of entering professional counseling.
䊏 Informed consent should not stop after clients give their initial consent; rather,
informed consent should be viewed as an ongoing process that holds the welfare
of clients and their best interests in the foreground of treatment.
CHAPTER TWO Demands and Obligations of Ethical Counseling 29

䊏 Dual Relationships and Potentially Beneficial Interactions

The ACA Code of Ethics states that counselors should avoid dual relationships when
possible. Dual relationships are deleterious to therapeutic relationships because
they can compromise counselors’ objectivity.

Dual relationship: Any significantly different relationship a counselor has

with a client outside of his or her counselor–client relationship.

Recent research, however, appears to indicate that dual relationships might not al-
ways be detrimental and at times can even be beneficial (Moleski & Kiselica, 2005). In
some rural areas, dual relationships are often unavoidable. In such cases, the goal is
not to go to extremes to avoid dual relationships, but rather to be keenly aware of the
impact the nontherapeutic relationship has on the therapeutic one. Section A.5.d. Po-
tentially Beneficial Interactions recognizes that in some circumstances, clients may
profit from an ethically appropriate dual relationship. Engaging in close supervision
can help counselors discern the impact of potentially beneficial interactions. Future
ethical codes may consider the effect community size and contact inevitability have
on dual relationships, but current ethical codes do not.

Engaging in close supervision can help

counselors discern the impact of potentially
beneficial interactions. Future ethical codes may
consider the effect community size and contact
inevitability have on dual relationships, but
current ethical codes do not.

Regardless of the stance one takes on dual relationships, boundaries in the coun-
seling process must be clearly defined. Boundaries can be understood in this way:

Boundaries: The physical and psychological limits that frame a professional

counseling relationship.

Boundaries such as professional language and mannerisms constitute a framework

from which a professional relationship can begin and help professionals to estab-
lish and maintain objectivity. Clients can feel confused without clear boundaries,
whereas counselors often feel overexposed when clear boundaries are not set.

䊏 Sexual Misconduct

Section A.5.a. Current Clients clearly states that sexual or romantic counselor–client
interactions or relationships with current clients, their romantic partners, or their
family members are prohibited.
30 What Are the Primary Roles and Responsibilities of the Professional Counselor? PART ONE

Although clients enter counseling with their whole selves, counselors are en-
couraged to remain veiled throughout the therapeutic process (Kell & Mueller,
1966). In other words, by offering only relevant self-disclosures, counselors remain
blank slates on whom clients project aspects of their unconscious. This is a great re-
sponsibility, as clients often project that counselors are capable helpers who only
hold the best of intentions. Such projections set up vulnerabilities that do not exist
in nontherapeutic relationships. Abusing the vulnerability of clients through sex-
ual misconduct can be detrimental to clients in a number of ways.

Detriments of Sexual Misconduct

䊏 When feelings of trust are used to elicit sexual activity, clients can feel overex-
posed, guilt ridden, and a general sense of mistrust of others.
䊏 Clients’ self-efficacy may become contingent on pleasing their counselors.
䊏 As a whole, sexual activity with clients exploits clients, counselors, and the repu-
tation of the counseling profession (Welfel, 2002).

䊏 Transference

The concept of transference was articulated by Sigmund Freud to specifically refer

to the phenomenon whereby people project the dynamics of their response pat-
terns to their parents onto their therapists. Perls (1973) expanded what is meant by
transference to encompass all the dynamics of response patterns clients project
onto their therapists, not just how clients reacted to their parents.

Transference: Projections clients cast on their counselors.

For example, consider the contemporary client that begins to describe her life using
an antiquated form of formal English. If this is not a part of her daily commun-
ication to others, she might be transferring onto the counselor the way she re-
sponds to perceived authority figures. By recognizing transference, counselors can
observe a historical chunk of a person’s psyche and raise clients’ awareness of their
dynamics.

䊏 Countertransference

Countertransference is the antithesis of transference. The concept can be defined

as follows:

Countertransference: Projections counselors cast on their clients.

In general, countertransference occurs when counselors project their own undis-

covered psyches onto their clients. For instance, a counselor who experienced
CHAPTER TWO Demands and Obligations of Ethical Counseling 31

abuse in the past might be guarded and unable to empathize with a client who is in
counseling to treat his abusive behaviors.
Countertransference is essential to a discussion of ethics because what counsel-
ors do not know about themselves can hurt their clients. In other words, when
counselors are not aware of what clients stir up in them, their unconscious reac-
tions hold no therapeutic intention, though, as Jung (1957) pointed out, the poten-
tial for therapeutic value is present in all human interaction. Countertransference is
detrimental to the counseling process because counselor–client interactions are di-
rected by unconscious agendas rather than systematic therapy. Understanding
countertransference sheds a new light on the relevance of self-awareness as a vital
part of the counseling process.

SUMMARY

The subject of ethics refers to the study of morals and the specific moral choices
people make. These choices relate to the standards that govern human conduct that
is perceived to be acceptable or not by a culture or society. Ethical codes are the
written form of the codes. A written code of ethics provides the public some assur-
ance that professional counselors are held accountable for their professionalism.
The ACA Code of Ethics is rooted in five underlying ethical principles: nonmale-
ficence, beneficence, autonomy, justice, and fidelity.
Ethical decisions can best be made through the use of a sound ethical deci-
sion-making model. Although following the letter of the law enables counselors to
perform mandatory ethics, it is hoped that counselors will follow the spirit of the
law and aspire to go above and beyond for their clients. Counselors should avoid
multiple relationships with their clients, unless doing so provides a benefit to their
clients.

Chapter 2: Key Terms

䉴 Aspirational ethics 䉴 Dual relationships 䉴 Justice
䉴 Autonomy 䉴 Ethics 䉴 Mandatory ethics
䉴 Beneficence 䉴 Ethical codes 䉴 Nonmaleficence
䉴 Boundaries 䉴 Fidelity 䉴 Transference
䉴 Countertransference 䉴 Informed consent
 chapter The Legal Intrigues of Counseling Practice

3 Carolyn Stone
University of North Florida

Christian Conte
University of Nevada, Reno

Elizabeth Antkowiak
Western Psychiatric Institute and Clinic

In This Chapter

䉴 Basics of Professional, Ethical, and Legal 䉴 Record Keeping

Practice for Counselors 䊏 School Records: Family Education Rights
䊏 A Look at Professions, Professionalism, and Privacy Act (FERPA)
and Professional Identity 䊏 ASCA Ethical Guidelines on Educational

䊏 Legal Issues Related to Counselors’ Profes- Records

sional Identity 䊏 Agency Records: Health Insurance Porta-

䊏 Ethical Codes and Standards of Practice bility and Accountability Act (HIPAA)
䊏 What Is Law?

䊏 Contracts in Counseling: Informed Con- 䉴 Dual Relationships in School

sent and Community Settings
䊏 Torts and Counselor Negligence 䊏 Ethical and Legal Considerations of Dual

Relationships
䉴 Professionalism for School Counselors 䊏 Complexity of Dual Relationships in

䊏 Building Collaborative Relationships Schools

䊏 Facing the Political Barriers of the School 䊏 Safeguarding Clients’ Emotional Health

System
䊏 Community Standards in School Coun- 䉴 Confidentiality, Privacy, and Privileged
selor Practice Communication
䊏 Protecting Students’ Best Interests 䊏 Ethical Standard of Confidentiality

䊏 Confidentiality for School Counselors

䉴 Legal and Ethical Aspects of Competence 䊏 Privacy

䊏 Consultation 䊏 Legal Facets of Privileged Communication
䊏 Continuing Education 䊏 Duty to Warn: Limit to Privileged Com-
䊏 Malpractice munication
䊏 Duty to Protect

32
CHAPTER THREE Legal Intrigues of Counseling Practice 33

BASICS OF PROFESSIONAL, ETHICAL, AND LEGAL PRACTICE

FOR COUNSELORS

Professional counseling in the 21st century is a developing discipline. Because

counseling involves working with complex human beings, the rapid growth and
many changes the field has experienced since its inception are likely to continue.
The professional, ethical, and legal principles that guide school and mental health
counselors are especially prone to advancements and evolution. With an emphasis
on this area, the aims of this chapter are to highlight professional, ethical, and legal
concerns relevant to school and mental health counselors as well as to review legal
and ethical obligations with respect to specific areas such as counselor competence,
record keeping, dual relationships, and confidentiality.

䊏 A Look at Professions, Professionalism, and Professional Identity

When talking about the ethical and legal obligations of professional counselors, it is
helpful to understand what is meant by both a profession and a professional. Pro-
fessions often are distinguished from occupations or jobs in that the former tends to
center on the betterment of others, whereas the latter tends to focus on the better-
ment of the self. Additionally, a profession usually is characterized by a body of
specialized knowledge that a group of people commit to acquire, sustain, and pro-
mote (Sperry, 2007). Professionals, or individuals who commit themselves to a cho-
sen profession, likewise have several notable characteristics. Krushinski (2005) de-
scribed the characteristics of professionals this way:

Four Traits of Professionals

1. Professionals have a graduate degree.
2. Professionals practice in a field that focuses work on others.
3. Professionals belong to an organization representative of their field.
4. Professionals contribute academically to their fields.

The idea that professions are rooted in a helping mode of behavior sets the founda-
tion for counseling as a profession and counselors as professionals. Professional-
ism in the counseling field suggests specific responsibilities of school and commu-
nity counselors.

Obligations of Professional Counselors

䊏 Attend to the welfare of others.
䊏 Serve students’ ongoing and ever-changing needs.
䊏 Remain current with the latest research, theory, and techniques.
䊏 Become members of counseling organizations.
䊏 Contribute academically to the profession.
䊏 Attend or present at local, state, and national conferences and workshops.
34 What Are the Primary Roles and Responsibilities of the Professional Counselor? PART ONE

䊏 Share experiences and clinical progress with both colleagues and the community.
䊏 Adhere to the standards of competency set by the field.

䊏 Legal Issues Related to Counselors’ Professional Identity

Counselors’ professional identity is influenced by a number of legal and, in some

cases political, arenas that affect how they represent themselves to the general pub-
lic and the ways they practice; a few of these areas include job titling, testing and di-
agnosis, and reimbursement.
Professional counselors have an obligation to accurately represent themselves.
Titling, such as “licensed professional counselor,” is a legal matter reserved for in-
dividuals who have fulfilled licensure requirements established by state licensing
boards. Moreover, counselors can only claim expertise in areas in which they re-
ceived formal professional training. For example, a master’s-level counselor who
earns a PhD in English literature cannot use the title “Dr.” to represent himself or
herself as a counselor.
Historically, counselors have had to fight to establish the legal right to engage in
testing and diagnosis practices. Yet most counselor education programs require
course work in these areas, and counselors long have been involved in the process
of testing and diagnosis. There is variation from state to state on counselors’ legal
right to use tests and diagnose mental and emotional disorders.
In the U.S. health care system, insurance reimbursements are often provided for
mental health intervention, and counselors who offer these services have fought to
be approved providers by insurance companies. Especially for private practitio-
ners, the ability to receive third-party payment (i.e., from insurance companies) is
crucial to their practices and clients.

䊏 Ethical Codes and Standards of Practice

Counseling professionals in all settings must comply with the ethical guidelines and
legal statutes that bring scrutiny to their conduct. When the welfare of any member
or group of the public is at stake, the law ultimately can override ethical guidelines;
nonetheless, legal issues are closely tied to and complement ethical guidelines.
Two national organizations that have done a great deal to set the ethical stan-
dards counselors follow are the American Counselor Association (ACA) and the
American School Counseling Association (ASCA). Adhering to the guidance of-
fered by these organizations through their ethical codes and standards of practice is
a means for counselors to avoid potential liability, defined as:

Liability: The legal responsibility one person has to another as a result of

committing a negligent act.

The codes of these national counseling organizations are mentioned next.

CHAPTER THREE Legal Intrigues of Counseling Practice 35

Codes of Ethics in School and Community Practice

䊏 The Ethical Standards for School Counselors were developed by ASCA (2004b) to
clarify the ethical responsibilities of its members to students, parents, colleagues,
the profession, the community, and school counselors.
䊏 The ACA Code of Ethics (ACA, 2005a) developed by ACA for community counsel-
ors is set forth for the welfare of the public, profession, and individual prac-
titioners.

Counselors have the responsibility to become knowledgeable and understand the

ethical standards to which they are bound. Although the codes cannot be all-en-
compassing or directly address every ethical dilemma, they do serve a number of
important purposes.

Functions of Ethical Codes

䊏 Offer guidelines and standards with which counselors must be familiar before
beginning their practices.
䊏 Reflect changes in the practice of ethical conduct with which counselors must re-
main current and to which counselors can turn in times of uncertainty.
䊏 Provide the community with a sense of security essential to a profession.
䊏 Enable the field of counseling to have a composite understanding of such con-
cepts as confidentiality, acceptance, and fairness.

Professionalism means knowing your professional association’s codes as well as

adhering to them. The ethical standards from ASCA that are most germane to being
a professional school counselor are characterized by the following behaviors:

䊏 Avoiding dual relationships when possible.

䊏 Establishing healthy relationships with peers.
䊏 Treating colleagues with respect, courtesy, and fairness.
䊏 Having knowledge of resources for students.
䊏 Establishing clear relationships with students’ other counselors.
䊏 Being a gatekeeper in regard to hiring new employees.
䊏 Maintaining well-being.
䊏 Not recruiting students for private practice clients.
䊏 Contributing to the profession.
䊏 Providing mentoring.
䊏 Making sound ethical decisions.

See Chapter 1 for more on professionalism and professional identity and Chapter 2 for
more on ethics in counseling.
36 What Are the Primary Roles and Responsibilities of the Professional Counselor? PART ONE

Check out these sites for a downloadable version of the ASCA and
ACA ethical codes:
http://www.schoolcounselor.org/files/ethical%20standards.pdf
http://www.counseling.org

䊏 What Is Law?

Professional counselors are bound to practice within ethical standards; likewise,

counselors also must abide by federal and state laws that govern their professional
behavior. Although law in the United States is complex and cumbersome, counsel-
ors can benefit from a cursory understanding of the law as it pertains to potential
legal ramifications to their practice. Generally, law is defined as the rule of conduct
established by society and enforced by that society’s government. Two distinct
types of law exist: criminal law and civil law. Anderson (1996) described the dis-
tinction between these two types of law this way:

Criminal law: Involves crimes punishable by fine, imprisonment, or death

and is prosecuted by the government.

Civil law: Includes everything that does not fall under the category of crimi-
nal law and is exemplified by lawsuits resulting in sanctions (generally mone-
tary awards).

According to Anderson (1996), counselors find that most of their legal involve-
ments fall under the category of civil law. Contracts and the law of torts also are
handled under civil law.

䊏 Contracts in Counseling: Informed Consent

Contracts are the soul of any commercial transaction (Bullis, 1993), and counseling
can in some sense been seen as a commercial transaction, with informed consent
serving as the contract between counselors and clients. More important, informed
consent defines the basic treatment relationship (Anderson, 1996). It is imperative
that clients participate in the process (Bullis) because informed consent is meant to
protect clients’ legal right to consent to or refuse treatment. Therefore, although in-
formed consent should be written, counselors also have an ethical responsibility to
explain the contract verbally. A special consideration with regard to informed con-
sent involves minors, who cannot legally consent to treatment. Counselors are
therefore required to obtain parental consent prior to treatment of minors.
CHAPTER THREE Legal Intrigues of Counseling Practice 37

EXAMPLE

What Are the Necessary Elements of an Informed Consent Document?

Duffy (2007b) defined at least 10 elements that should be included in an informed consent con-
tract, as follows:

1. Type of treatment that will be offered.

2. Professional qualifications of the therapist.
3. Nature of the confidential client–therapist relationship and exceptions to confidentiality.
4. Risks and benefits of therapy.
5. Treatment alternatives.
6. Right to refuse treatment without recourse.
7. Client’s statements of competence and lack of coercion.
8. Office hours, emergency and business contact information.
9. Fee schedule and payment options.
10. Privacy statement.

䊏 Torts and Counselor Negligence

Torts are civil wrongs recognized by law as grounds for a lawsuit. In regard to the
counseling profession, negligent torts occur when counselors harm clients and the
clients then seek compensation for the harm done. Negligence can be understood
as follows:

Negligence: Any conduct that does not meet the minimum requirements for
acceptable professional behavior.

Torts essentially fall into the two categories (Anderson, 1996) described here:

1. Unintentional violation may involve counselors not using all of their skill in
dealing with clients.
2. Negligence refers to a demonstrated failure to follow all the requirements of a
protective statute.

According to Anderson, four factors come into play for plaintiffs pursuing negli-
gent torts.

Factors That Define Counselor Negligence

1. A counselor–client relationship existed.
2. The clinical treatment fell below the minimally acceptable standard of care.
3. An actual loss or injury (harm) occurred.
4. The substandard treatment caused the harm.
38 What Are the Primary Roles and Responsibilities of the Professional Counselor? PART ONE

PROFESSIONALISM FOR SCHOOL COUNSELORS

All counselors are equally subject to ethical and legal standards within their profes-
sional organizations and with respect to the laws of the states in which they practice.
Additionally, school counselors have distinct professional responsibilities as a result
of the setting in which they practice. In this section we look at some of the unique as-
pects that come into play in the practice of professional school counseling.

䊏 Building Collaborative Relationships

Collaboration is a critical skill in the counseling profession but especially critical in

the school setting where optimum school counseling programs require that school
counselors be part of the leadership team (Idol, Nevin, & Paolucci-Whitcomb,
2000). Relationship development with the principal, teachers, parents, and other
stakeholders garners support for counselors and ultimately benefits the students.
After all, school counselors need the input of as many stakeholders as possible to
deliver programs that have the potential to reach as many students as possible. In
difficult political relationships, the key to success is the genuine offering of respect
and support to teachers within the sensitive positions in which they must operate.

Collaboration is a critical skill in the counseling

profession but especially critical in the school
setting where optimum school counseling
programs require that school counselors be part
of the leadership team

Collaborative efforts build trust within relationships. Consequently, having

firmly established confidences is important. When counselors have to share neces-
sary information, students’ privacy rights should be respected. Specifically, this
means counselors should only provide germane information to teachers, facilitat-
ing their ability to support students’ academic and social environments. If counsel-
ors are uncertain whether or not principals or teachers will deal deftly with a deli-
cate situation, they should prepare alternative plans. Identifying allies, such as the
assistant principal or someone who will use compassion and a nonjudgmental ap-
proach to problem solving, will help in the throes of a dilemma (Stone, 2005).

䊏 Facing the Political Barriers of the School System

Systemic barriers are a daily fact of life for school counselors. Effective school coun-
selors are vigilant in understanding policies, practices, attitudes, and beliefs that
stratify students’ opportunities and act as systemic change agents to remove these
barriers. Failure to understand the political climate will hinder a counselor’s efforts
to advocate for important policy changes. The ethical school counselor uses finesse
CHAPTER THREE Legal Intrigues of Counseling Practice 39

and diplomacy to navigate the political landscape and advocate for the needs of
students.

䊏 Community Standards in School Counselor Practice

Community and institutional standards can differ significantly from school to

school and community to community. It is difficult to accept the fact that profes-
sional behavior varies depending on the prevailing standards of the community;
however, it is counselors’ ethical obligation to be aware of and respectful toward
the standards of the community that the school serves (Stone, 2005).

EXAMPLE

Responding to Teen Pregnancy: Community Considerations

Community standards can have a significant impact on how counselors advocate for their stu-
dents in moments of crisis. For example, it is acceptable behavior for school counselors in cer-
tain schools and communities to refer pregnant students to agencies that assist pregnant mi-
nors. Yet, in many other communities this would be considered a serious breach of ethics,
infringing on parents’ rights to be the guiding voice in their children’s lives.

䊏 Protecting Students’ Best Interests

Acknowledging the prevailing standards of a community does not mean uncondi-

tionally accepting the standards. School counselors are respectful of the values of
their students and their families, diligently separating out their own values and be-
liefs and offering an objective voice in every situation. If school counselors believe a
practice, policy, or law of a particular school or community is in any way detrimen-
tal to a student, their ethical imperative is to work in a responsible manner and be
change agents to protect students (Stone, 2005). “The professional school counselor
supports and protects the educational program against any infringement not in
students’ best interest” (ASCA, 2004, D.1).

EXAMPLE

Advocating Against Corporal Punishment Standards

If the school’s discipline plan and the standards in the community accept the use of corporal
punishment, school counselors might have a difficult time beginning the change process
needed to promote the well-being of all students, and might also have a difficult time creating
an inviting place for students to work. It is the duty of school counselors to explore what
would be a good approach to influence the culture and climate of the school. School counsel-
40 What Are the Primary Roles and Responsibilities of the Professional Counselor? PART ONE

ors, for instance, could discuss with the administration the idea of forming a committee to de-
velop a revised discipline approach for the school that helps students feel “invited to work.”
School counselors could also involve community resources by interviewing supervisors in
Child Protective Services to determine what constitutes abuse, the incidence of abuse in the
community, the number of students who have been removed from homes for abuse, and per
capita the number of children who have died at the hands of parents locally as compared to
other parts of the United States. These data can inform and compare two communities in dif-
ferent locations with adverse views on the issue of corporal punishment. By actively directing
community members’ attention to the controversy of corporal punishment and using advo-
cacy skills, school counselors can ignite important conversations about topics that need to be
more thoroughly examined (Stone, 2005).

LEGAL AND ETHICAL ASPECTS OF COMPETENCE

Counselor competence is implied in the professional identity of helping practitio-

ners. At the very least, counselors are charged with complying with minimum ethi-
cal standards such as, “Do no harm.” However, because counselors are engaged in
interpersonal and organizational work aimed at serving others, they should aspire
to the maximum levels of competence. A couple recommendations for attaining
and maintaining competence are provided first in this section; ethical and legal
ramifications of incompetence also are mentioned.

䊏 Consultation

Mental health counselors who remain isolated in their clinical practice tend to limit
their awareness and understanding of the healing process in counseling. Although
experience is necessary for professional development, by itself, it is not sufficient
for providing effective services to the community. Palmer (1998) noted that teach-
ers who are isolated from each other in individual classrooms run the risk of be-
coming insipid; in the same way, counselors who are secluded (even for reasons of
confidentiality) run a similar risk of limiting their ability to provide effective ser-
vices. Thus, consultation is an important component of attaining a high level of
competence. Counselors need to communicate with other professionals to continu-
ally broaden their understanding of counseling, treatment, client issues, and their
own involvement in the therapeutic process.

See Chapter 24 for a more in-depth look at consultation.

䊏 Continuing Education

Continuing education is a means by which counselors can expand their knowl-

edge while engaging in clinical practice and, additionally, ensure their compe-
CHAPTER THREE Legal Intrigues of Counseling Practice 41

tence as practitioners. Both ethical and legal codes inform the area of continuing
education. The ACA Code of Ethics (ACA, 2005a), for example, specifies that coun-
selors recognize the need for ongoing education, take the steps necessary to
maintain competence in the skills they use, and keep current with the diverse
populations with whom they work (Section C.2.f). This ethical standard reinforces
public confidence in the profession because it ensures that professional counsel-
ors will continually strive to be informed on how to provide the best possible
level of care.
Credentialing bodies, such as state licensing boards, dictate the legal require-
ments associated with how much continuing education licensed practitioners are
required to have and which programs, workshops, or other activities (e.g., publi-
cations) are approved. There is no federal standard that addresses continuing ed-
ucation; therefore, individual states regulate how much continuing education is
essential to maintain licensure. Despite state-to-state variability, counselors typi-
cally should expect to acquire around 30 continuing education units every 2
years.

䊏 Malpractice

On the continuum of counselor competence, the extreme of unethical behavior is

incompetence, and counselors can be held legally accountable for malpractice.
Malpractice includes any harm done to clients due to counselor negligence. Ander-
son (1996) provided examples of types of malpractice lawsuits that can be brought
against counselors. Some of these cases are listed here.

Malpractice Suits Sometimes Brought Against Counselors

䊏 Abuse (physical, sexual, mental) of a client.
䊏 Sexual misconduct.
䊏 Incompetent practice (e.g., practicing outside the scope of professional training,
misdiagnosing clients).
䊏 Violations of confidentiality (e.g., communicating information to a third party
who has neither need or privilege to have the information).
䊏 Failure to treat or refer clients.
䊏 Breaches of the counselor–client contract.
䊏 Defamation of character.
䊏 Illegal search and seizure (e.g., attempting to unreasonably search a student or
community member for drugs).
䊏 Any act involving moral turpitude.

One way to avoid malpractice is to provide both written and verbal informed con-
sent to clients, because it is a statute of case law, not simply an ethical standard
(Crawford, 1994).
42 What Are the Primary Roles and Responsibilities of the Professional Counselor? PART ONE

RECORD KEEPING

Counselors keep records known as case notes to validate the clinical treatment of
clients. Record keeping is such an integral part of ethical behavior for counselors
that the adage, “If it wasn’t charted, it didn’t happen” emerged. More important
than the adage, however, is that counselors are charged with protecting the con-
tents of client records. Protecting client information is important in both school and
community settings. However, because the legislation defining record keeping in
these sites is unique, in this section we look at record keeping in both settings.

䊏 School Records: Family Education Rights and Privacy Act (FERPA)

Ideally, school counselors should not be in charge of managing education records,

but they still need a working knowledge of the legal guidelines to support their role
in advocating for the legal and ethical protection of any written information kept
on a student (ASCA, 2004). The 1974 Family Education Rights and Privacy Act
(FERPA) is federal legislation that governs education records and dictates how all
written information on a student will be handled and disseminated for the protec-
tion of the student and his or her family (Alexander & Alexander, 2005; Fischer &
Sorenson, 1996; Imber & Van Geel, 2004). FERPA, also known as the Buckley
Amendment, is administered by the Family Policy Compliance Office and has en-
acted safeguards so that parents can access their children’s education records and
have a voice in how that information is shared with others (Alexander & Alexan-
der, 2005; Fischer & Sorenson, 1996; Imber & Van Geel, 2004).

Purposes of and Protections Outlined by FERPA

(Alexander & Alexander, 2005)
䊏 FERPA was expressly written to identify parents’ right to view their children’s
education records and to decide, within certain parameters, who has access to
their child’s records.
䊏 Students who are at least 18 years of age or who are in postsecondary school are
eligible to access their records.
䊏 Noncustodial and certain stepparents are granted rights under FERPA (20 U.S.C.
§ 1232g; 34 CFR Part 99).
䊏 The FERPA legislation allows parents and eligible students to request that correc-
tions and amendments be made to records that could be erroneous or potentially
misleading.
䊏 FERPA requires that parents be given due process to protest the contents of
records when they disagree with the school district about the accuracy of the
record.
CHAPTER THREE Legal Intrigues of Counseling Practice 43

According to FERPA guidelines, schools must have written permission from par-
ents or the eligible student before any information is released from a student’s edu-
cation record. There are, however, a number of exceptions to the regulations on dis-
closing information.

Exceptions to FERPA Standards Pertaining to Release of Information

䊏 School officials with legitimate education interest (school counselors are consid-
ered school officials along with teachers).
䊏 Other schools to which a student is transferring.
䊏 Officials for purpose of audit or evaluation.
䊏 Persons involved with the financial aid of the student.
䊏 Those involved with conducting specific research studies for the school.
䊏 Organizations involved in accreditation.
䊏 Holders of a judicial order or lawfully issued subpoena.
䊏 Persons involved with emergencies or in cases of health and safety.
䊏 Local and state authorities in the juvenile justice system, in compliance with spe-
cific state law.

In addition to the exceptional cases in which release of information is permitted by

FERPA, the federal act further allows for the dissemination of directory information,
or public information on students such as their name, address, or telephone num-
ber without parent or eligible student consent. Within certain parameters, FERPA
allows states to define what they will classify as directory information. School dis-
tricts can establish policies and procedures regarding the release of directory infor-
mation and decide not to participate. It should be noted, however, that the military
cannot be excluded from directory information unless a student’s parents have
signed to opt out of releasing directory information (Alexander & Alexander, 2005).

Check out the U.S.Department of Education Web site for more infor-
mation about FERPA at:
http://www.ed.gov/policy/gen/guid/fpco/ferpa/index.html

䊏 ASCA Ethical Guidelines on Educational Records

The ethical standards from ASCA that are most germane to ethical and legal con-
siderations for educational records pertain to some of the following areas.
44 What Are the Primary Roles and Responsibilities of the Professional Counselor? PART ONE

ASCA Ethical Guidelines on Student Records

䊏 Maintaining and securing student records, including electronic transmissions.
䊏 Informing parents or guardians of the counselors’ role.
䊏 Making reasonable efforts to honor the wishes of parents or guardians.
䊏 Understanding limits and rights of sharing information.
䊏 Conducting appropriate research and protecting students’ identity when using
data.

䊏 Agency Records: Health Insurance Portability and Accountability Act (HIPAA)

In April 2003, with the implementation of the federal government’s 1996 Health In-
surance Portability and Accountability Act (HIPAA), protecting clients’ records
became a federal standard. HIPAA emerged to address the substandard level of
care in place to address sharing and releasing of client information. HIPAA forced
the Department of Health and Human Services to publish new standards ensuring
the protection of clients’ physical and mental health information. Essentially,
HIPAA guidelines were developed to improve health care organizations by two
primary means.

Ways HIPAA Protects Health Care Recipients’ Private Information

1. Standardization of how electronic data is transferred and kept (including ad-
ministrative and financial data).
2. Protection of the confidentiality, integrity, and security of individual health
care information through setting and enforcing standards and penalties.

The seriousness with which the HIPAA regulations are enforced for providers of
physical and mental health care becomes clear on examination of the fines and pen-
alties associated with breaches of privacy.

Examples of Penalties for HIPAA Violations

䊏 Fines up to $25,000 for multiple violations of the same standard in a calendar year.
䊏 Fines up to $250,000, imprisonment up to 10 years, or both for knowing misuse of
individually identifiable health information.

Check out the U.S. Department of Health and Human Services Web
site for HIPAA statutes and regulations at:
http://www.hhs.gov/ocr/hipaa
CHAPTER THREE Legal Intrigues of Counseling Practice 45

DUAL RELATIONSHIPS IN SCHOOL AND COMMUNITY

SETTINGS

Dual or multiple relationships are potentially harmful to clients in either commu-

nity or school settings because of the inherent power differential between counsel-
ors, who hold the position of power, and clients, who are more vulnerable.

䊏 Ethical and Legal Considerations of Dual Relationships

Some dual relationships, such as sexual relationships, are recognized as always un-
ethical because they exploit clients’ vulnerabilities (Duffy, 2007a). Sexual involve-
ment between therapists and clients, moreover, potentially can represent negli-
gence on the part of the counselor and be grounds for malpractice lawsuits. At the
same time, literature on dual relationships also suggests that, at times, multiple re-
lationships between counselors and clients might be unavoidable or potentially
beneficial (ACA, 2005a; Duffy, 2007a).

See Chapter 2 for more information about dual relationships in professional counseling.

䊏 Complexity of Dual Relationships in Schools

The reality of multiple relationships is particularly present in schools. Therefore,

counselors must be especially vigilant to maintain a professional distance with stu-
dents and parents. Professional distance is the appropriate familiarity and closeness
that a school counselor engages in with students and their family members (Stone,
2005). However, when professional distance is disregarded, dual relationships
transpire (ASCA, 2004b, A.4.). For example, accepting an invitation to attend a spe-
cial event might simply be a show of support for a student who needs to know
someone cares. However, when a counselor accompanies this with behaviors such
as trying to groom friendships with students and singling out a few on whom to
lavish attention, that counselor violates professional distance.
Not only do dual relationships involve an inappropriate boundary crossing, but
they also involve personal gains (Stone, 2005). Whereas professional school coun-
selors work vigilantly to ensure that they do not gain any unfair advantages
through their work, unethical counselors cross boundaries for personal gain.

Examples of Personal Gains From Boundary Crossing

䊏 Using the dual relationship to boost one’s ego or sense of self-worth.
䊏 Using the dual relationship to receive benefits from select parents.
46 What Are the Primary Roles and Responsibilities of the Professional Counselor? PART ONE

EXAMPLE

Dual Relationships in Schools: Whose Needs Is the Counselor Serving?

It is unethical for school counselors to nourish the belief they are “heroes” in advocating for
students, currying favor with students or their parents, or establishing themselves as heroes
for students (Stone, 2005). Professional school counselors must continually examine their ac-
tions and ask this question: Whose needs are being met by my behaviors? If the answer is
“only a select few students with whom I work” or “I am feeding my own personal needs by
my behavior,” then these counselors are in the midst of a significant ethical violation.

䊏 Safeguarding Clients’ Emotional Health

Both school and community counselors have a duty to guarantee the emotional
safety of their minor students or their clients. Dual relationships are to be
avoided because they have the potential to harm clients and the counseling pro-
fession, as well as put employers in jeopardy (Stone, 2005). Unfortunately, when
counselors work in small communities and in closed settings like schools where
everyone knows each other, dual relationships might be unavoidable. In such
cases, the counselor is responsible for eliminating or reducing the potential for
harm.

Safeguards Against Dual Relationships (ASCA, 2004b)

䊏 Informed consent.
䊏 Consultation.
䊏 Supervision.
䊏 Documentation.

CONFIDENTIALITY, PRIVACY, AND PRIVILEGED

COMMUNICATION

Whether working in schools or community settings, counselors need to under-

stand the meaning, implications, and limits of confidentiality as defined by their re-
spective ethical standards (e.g., ACA or ASCA). To understand confidentiality,
counselors also have to have a working knowledge of its legal aspects, encom-
passed in privileged communication and privacy. Corey, Corey, and Callanan
(2003) defined these three concepts this way:

Confidentiality: An ethical standard that safeguards clients from unautho-

rized disclosures of information given in a counseling relationship.
CHAPTER THREE Legal Intrigues of Counseling Practice 47

Privileged communication: A legal concept that guards against compulsory

disclosure in legal proceedings that breaks a promise of privacy.

Privacy: Refers to the constitutional right of people to decide the time, place,
manner, and extent of personal disclosure.

䊏 Ethical Standard of Confidentiality

Confidentiality is first an ethical guideline that charges counselors to protect client

disclosures in the therapeutic relationship. The ACA and ASCA codes regarding
confidentiality are grounded in ethical principles of beneficence and nonmale-
ficence.

For more on confidentiality and ethical principles, see Chapter 2.

䊏 Confidentiality for School Counselors

The legal and ethical complexities of working with minors in schools require that
school counselors remain vigilant to the rights and responsibilities of students and
their parents, as well as to the implications of these rights on their work (ACA,
2005a; ASCA, 2004b; Imber & Van Geel, 2004). The numerous responsibilities
school counselors have in a setting designed to deliver academic instruction fur-
ther complicate the legal and ethical world of school counseling (Baker & Gerler,
2004; Gibson & Mitchell, 2003; Sink, 2005; Stone, 2001). These complications are
acutely present in individual counseling (Thompson, Rudolph, & Henderson,
2004; Vernon, 2004) and even more so in group counseling, where confidentiality
cannot be guaranteed and sensitive information about the private world of stu-
dents and their families is often discussed (Corey, 2004b; Greenberg, 2003).

How School Counselors Can Protect Confidentiality

䊏 School counselors gather informed consent at the beginning of the counseling re-
lationship to inform the counselee of the purposes, goals, techniques, and rules
of procedure under which she or he may receive counseling.
䊏 The meaning of confidentiality is explained in developmentally appropriate terms.
䊏 The limits of confidentiality are outlined and include exceptions of danger to self
or others and court-ordered disclosures of information.

Confidentiality is difficult in school settings because of the competing interests

and obligations that extend beyond the students to parents, administrators, and
teachers. Working with clients who are minors poses special considerations with
parents but never more so than in a setting designed for academic instruction and
not counseling. In some instances, parents might demand and obtain information
that their child is discussing.
48 What Are the Primary Roles and Responsibilities of the Professional Counselor? PART ONE

Generally speaking, school counselors should feel free to discuss relevant but
controversial issues with students such as drug and alcohol abuse, sexual experi-
mentation, pregnancy, abortion, and birth control. When engaged in individual
and group counseling, professionals must carefully consider the developmental
and chronological levels, in loco parentis (to assume the responsibilities of the par-
ents), and parents’ rights to be the guiding voice in their children’s lives.

EXAMPLE

Implications of Court Rulings on Confidentiality in Schools

In Parents v. Williams-Port Area School District (1991) a psychologist could not use his profes-
sional confidentiality as a basis for refusing to reveal to parents what was said in an individual
counseling session recorded in individual case notes. This decision informs counselors that
parents probably have a right to their child’s information, especially information that is value
laden and revealed to a school counselor in a setting designed for academic instruction. Other
court cases have supported the school counselor’s confidentiality to the extent possible; how-
ever, the courts tell counselors to be ready to defend their competence in addressing issues of
interest with a student in isolation of his or her parents.

䊏 Privacy

Ensuring client privacy is the aim of confidentiality. A basic client right, privacy
suggests that clients have the autonomy to choose how and when they will disclose
personal information, and, additionally, that they are in control of their private
health and mental health records. Thus, counselors must only give germane infor-
mation when reporting to third-party payees to safeguard clients’ privacy.

䊏 Legal Facets of Privileged Communication

All states have some form of privileged communication, although the details of
that communication differ from state to state. Laws that address privileged com-
munication ensure that in legal proceedings, client disclosures of personal informa-
tion will be protected from exposure by therapists. In other words, based on privi-
leged communication, therapists can refuse to produce a client’s records in court.
Despite the protections afforded to clients by the law, there are a number of excep-
tions to privileged communication.

Exceptions to Privileged Information

䊏 A client consents to disclosure.
䊏 Child or elder abuse is occurring.
䊏 A duty to warn exists.
䊏 Legal rules require disclosure.
CHAPTER THREE Legal Intrigues of Counseling Practice 49

䊏 A client brings a lawsuit.

䊏 In the case of an emergency.

Typically, groups and family therapy do not fall under privileged communication.
Confidentiality, like privileged communication, also has limitations.

See Chapter 2 for more on the limits to confidentiality.

䊏 Duty to Warn: Limit to Privileged Communication

One of the most well-known and recognized limits to privileged communication is

the duty to warn, and probably the most well-known legal battle upholding the
duty to warn is the 1976 case of Tarasoff v. Regents of the University of California. Fol-
lowing the court decisions handed down in Tarasoff and similar landmark cases,
mandates have been put into place that require mental health professionals to oper-
ate under the obligation to warn of clear and imminent danger to the client or any
other identifiable persons that is disclosed in the process of counseling.

Duty to warn: The responsibility of a counselor or therapist to breach confi-

dentiality if a client or other identifiable person is in clear or imminent
danger.

In situations where there is clear evidence of danger to the client or other persons,
the counselor must determine the degree of seriousness of the threat and notify the
person in danger and others who are in a position to protect that person from harm
(Herlihy & Sheeley, 1988; Pate, 1992). For example, if a student tells the school
counselor that another student is planning to commit suicide, the counselor is
obliged to investigate and should not leave the indicated student alone until the
parents or guardians have arrived (Davis & Ritchie, 1993).

EXAMPLE

Landmark Case: Implications of the Tarasoff Decision to the Duty to Warn

The Tarasoff case was monumental in the formulation of counselors’ duty to warn others of im-
pending danger. On October 27, 1969, Prosenjit Poddar murdered Tatiana Tarasoff. Following
her death, Tarasoff’s parents claimed that 2 months earlier Poddar had confided his intentions
to kill their daughter to Dr. Lawrence Moore, a psychologist who was at that time a member of
the staff at the Cowell Memorial Hospital at the University of California at Berkeley. They fur-
ther claimed that on Moore’s request the university police briefly detained Poddar but re-
leased him when he appeared, to them, to be rational. Finally, Tarasoff’s parents claimed that
Moore’s supervisor, Dr. Harvey Powelson, directed that no further action needed to be taken
to detain Poddar and that no one ever warned them, or Tarasoff, of her impending peril.
50 What Are the Primary Roles and Responsibilities of the Professional Counselor? PART ONE

䊏 Duty to Protect

McWhinney, Haskins-Herkenham, and Hare (1992) noted the effects of the Tarasoff
case, stating that the case imposed an affirmative duty on therapists to warn a po-
tential victim of intended harm by the client. In short, the right to confidentiality
ends when public peril begins. This legal decision sets an affirmative duty prece-
dent in cases of harm to others that is generally accepted within the helping profes-
sions. According to Davis and Ritchie (1993), this case indicates that contacting the
police in the event of a threat does not meet the burden of counselor responsibility
under the duty to protect, and this action alone will not safeguard the counselor
from lawsuit if the threat is realized. In keeping with ripple effect of these circum-
stances counselors must diligently and tirelessly labor under the obligation of be-
ing sentinels that safeguard others through what was originally labeled a duty to
warn about possible harm and is now understood to be a duty to protect from the
same threat.

Chapter 3: Key Terms

䉴 Liability 䉴 Family Education Rights 䉴 Privileged communication
䉴 Law and Privacy Act (FERPA) 䉴 Privacy
䉴 Criminal law 䉴 Health Insurance Portabil- 䉴 Duty to warn
䉴 Civil law ity and Accountability Act
䉴 Torts (HIPAA)
䉴 䉴 Confidentiality
Negligence
 chapter Multicultural Intricacies
in Professional Counseling
4
Hugh C. Crethar
University of Arizona

Laurie Vargas
San Francisco Unified School District

In This Chapter

䉴 Cultural Influences in Counseling 䊏 Race

䊏 Influence of Eurocentric Perspectives on 䊏 Age
Counseling 䊏 Ability
䊏 Rationale for a Multicultural Approach in 䊏 Religion and Spirituality
Counseling
䊏 Multicultural Competencies for Profes- 䉴 Bias, Prejudice, Discrimination,
sional Counselors and Oppression
䊏 Bias

䉴 Essential Factors in Culture-Sensitive 䊏 Prejudice

Counseling 䊏 Discrimination

䊏 Culture Defined 䊏 Oppression

䊏 Cultural Convergence 䊏 Privilege

䊏 Etic and Emic Cultural Viewpoints

䊏 Cultural Encapsulation 䉴 Cultural Identity Development

䊏 Ethnocentrism 䊏 Racial and Cultural Identity Development
䊏 Acculturation and Assimilation Model
䊏 Alloplastic and Autoplastic Viewpoints 䊏 White Racial Identity Development

䉴 Cultural Constructs: A Closer Look 䉴 Multicultural Theories in Counseling

䊏 Sex and Gender 䊏 Multicultural Counseling and Therapy
䊏 Sexuality and Affectional Orientation 䊏 Benefits of Multicultural Counseling

and Therapy

52
CHAPTER FOUR Multicultural Intricacies in Professional Counseling 53

CULTURAL INFLUENCES IN COUNSELING

Our intent in this chapter is to introduce areas of cultural concern that are relevant
to counseling professionals by focusing on the contributions of diversity-sensitive
literature in the counseling profession. In particular, we will look at the impact of
culture on the counseling relationship, provide an overview of key concepts of
multicultural counseling, and address multiculturally sensitive approaches to
counseling.

䊏 Influence of Eurocentric Perspectives on Counseling

The United States is a diverse, multicultural, and constantly evolving nation. How-
ever, despite numerous peoples and cultures having long coexisted in the United
States, European and Western cultures traditionally have held a dominant position
in defining cultural norms, rules, laws, and mores, or convictions about the moral
rightness or wrongness of behavior. Early approaches to counseling, too, have been
defined from a Eurocentric perspective and have reflected the customs, values, lan-
guage, and philosophies of European cultures (Ponterotto & Casas, 1991).

䊏 Rationale for a Multicultural Approach in Counseling

Although the overwhelming majority of counseling and psychotherapy theories

arose from the dominant cultures found in Europe and the United States (Pon-
terotto & Casas, 1991), increasing attention is being paid to the influence of minor-
ity groups and, thus, to the elements of cultural differences in counseling relation-
ships. Ultimately every competent counselor is required to account for social and
cultural factors in her or his clinical work. New awareness in the field of counselor
education related to the need for a multicultural approach is grounded in a number
of rationales for the shift to a multicultural perspective.

Why a Multicultural Worldview Is Necessary

1. Every client comes to the counseling relationship with a worldview that is dis-
tinct from that of the counselor due to personal experience within an array of
cultural contexts (Ibrahim, 1991; Ivey & Ivey 2007).
2. Without cultural sensitivity, many counselors and psychologists fail to recog-
nize that they are approaching the counseling relationship from a perspective
that is quite different from their clientele.

To ground the rationales for adopting multicultural perspectives, one need only
consider the example of counselors who might not have gained awareness that the
great majority of cultures and societies in the world emphasize a collectivistic
rather than an individualistic perception of identity. In cultures that operate out of
collectivist values, individualism is seen more as a hindrance to healthy develop-
ment than as evidence of healthy development (White & Parham, 1990). When
54 What Are the Primary Roles and Responsibilities of the Professional Counselor? PART ONE

working with clients from collectivist-minded backgrounds, counselors who adopt

individualist perspectives must recognize the implications of differing values for
the counseling process.

䊏 Multicultural Competencies for Professional Counselors

In an article that was published in both The Journal of Counseling and Development
and The Journal for Multicultural Counseling and Development, Sue, Arredondo, and
McDavis (1992) outlined multicultural competencies that are now an integral and
foundational part of counselor training programs and practice. The authors out-
lined a number of rationales for adopting multicultural standards in the counseling
field, among them the ever-increasing diversity of the United States and the histori-
cal Eurocentric approach to psychological theory. The multicultural standards can
be summarized as follows.

Components of the Multicultural Standards for Counselors

(Sue et al., 1992)
1. Awareness of personal assumptions, values, and biases.
2. Knowledge about the worldview of the culturally different client.
3. Ability to develop appropriate strategies and techniques for culturally differ-
ent clients.

To download a copy of the multicultural competencies for profes-

sional counselors, see
www.counseling.org/Resources

ESSENTIAL FACTORS IN CULTURE-SENSITIVE COUNSELING

In this section, we focus on a review of concepts that provide a framework for talking
about and understanding social and cultural approaches to the helping process.

䊏 Culture Defined

Pedersen (1991) described multicultural counseling as the fourth force in counsel-

ing. Today, it can be argued that all counseling is multicultural in nature and that all
good counseling is multicultural in perspective (Pedersen). Understanding the
CHAPTER FOUR Multicultural Intricacies in Professional Counseling 55

complex arena of multiculturalism begins with creating a definition of culture that

is suitable to the counseling field. For the purposes of this text, counselors can
adopt this definition of culture:

Culture: A combination of learned behaviors, thoughts, and beliefs as well as

the results of learned behaviors, thoughts, and beliefs whose components and
elements are shared and transmitted by the members of a particular society.

Every society that shares and transmits these factors to its members has a culture.
The learned behaviors, thoughts, and beliefs supported by a culture also include
some of the more specific dimensions mentioned later (see, e.g., Falicov, 1998;
Lewis, Lewis, Daniels, & D’Andrea, 2003; Robinson & Howard-Hamilton, 2000).

Key Dimensions of Culture

䊏 Race or ethnicity.
䊏 Religion and spirituality.
䊏 Language.
䊏 Gender or sex.
䊏 Affectional orientation.
䊏 Age or cohort.
䊏 Physical ability.
䊏 Socioeconomic status.
䊏 Education (formal and informal).
䊏 Experience with trauma.
䊏 Migration history (including region of upbringing).

䊏 Cultural Convergence

Each of the key dimensions of culture just mentioned is important in its own right
and has a unique impact on individuals’ experiences; yet, all of the dimensions of
culture also overlap, interact, or converge. Robinson and Howard-Hamilton (2000)
referred to convergence this way:

Convergence: The phenomenon of overlapping cultural dimensions affect-

ing experience and identity.

The dimensions of culture converge in different ways based on people’s experi-

ences, contexts, and interpersonal interactions. To understand culture and the ef-
fect it has on clients, counselors must strive to develop clear understandings of
each cultural construct as well as awareness of the multiple ways in which the con-
structs converge.
56 What Are the Primary Roles and Responsibilities of the Professional Counselor? PART ONE

EXAMPLE

Convergence in a Counseling Relationship

Mayra, a 21-year-old Latina working in child care, comes to a public agency seeking couple’s
counseling. A culturally competent counselor working with her would need to attend to a
number of merging cultural constructs. Mayra is bicultural, as her mother was originally from
El Salvador and father was originally from Mexico. A daughter of Spanish-speaking farm
workers, Mayra was born and raised in the Central Valley of California. Reared as a Jehovah’s
Witness, Mayra attended religious services with her family on a weekly basis. She has a high
school diploma and is now attending night classes at the local community college to obtain
licensure to open her own child-care center. Because seeking help from a counselor is not in
concert with the precepts of her religion, once she steps into the counseling office she must face
how her actions reflect beliefs differing from those of her parents. Converging issues to con-
sider in this case include (a) language differences (not raised in an English-speaking home), (b)
religious differences (not raised in a mainstream Christian religion), (c) social class differences
(not middle class), and (d) sex or gender differences (as a woman, she does not have male priv-
ilege). As each of these issues has an impact on the reality of Mayra’s experiences, a culturally
competent counselor needs to take into account each issue as well as the convergence of all is-
sues when selecting a helping approach.

䊏 Etic and Emic Cultural Viewpoints

Literature that addresses multiculturalism recognizes two primary approaches to

the helping process: cultural universality, often referred to as the etic perspective,
and cultural relativism, known as the emic perspective. It is useful for counselors to
understand the distinction between these approaches.

What Is Cultural Universality?

䊏 Cultural universality, or the etic perspective, suggests that many aspects of hu-
man behavior are universal, and counselors, therefore, can apply therapeutic
techniques similarly across cultures and contexts.
䊏 The etic perspective attempts to find universal definitions of health and sickness,
normality and abnormality, and effectiveness and ineffectiveness of treatment
assessment across cultures.
䊏 Counselors who approach clients from an etic perspective use their own cultural
standards as the basis for interpretation.

What Is Cultural Relativism?

䊏 Cultural relativism, or the emic perspective, suggests that cultural values,
worldviews, and contexts all affect definitions of normal and deviant behavior.
CHAPTER FOUR Multicultural Intricacies in Professional Counseling 57

䊏 Counselors who function from this perspective are both receptive to and respect-
ful of various cultures’ meanings and evaluations of experiences.
䊏 Emic perspectives allow counselors to account for clients’ cultural contexts
rather than rely solely on universal or even stereotypical assumptions.

Few counseling professionals embrace the extremes of either cultural universality

or cultural relativism, as both have validity (Sue & Sue, 2003). Counselors who
approach their work from a multicultural perspective maintain the awareness,
knowledge, and skills necessary to adjust to multiple cultural and contextual vari-
ables, while responding to relatively universal psychological phenomena. Bal-
ancing these two approaches, counselors are able to accommodate diverse cultural
groups, while acknowledging that their own cultural values come into play in the
counseling relationship.

䊏 Cultural Encapsulation

As are all people, counselors are prone to being culturally encapsulated by their
own perceptions and, therefore, hindered in recognizing their biases that may be
harmful to clients. Skovholt and Rivers (2004) proposed this definition of cultural
encapsulation that counselors can adopt:

Cultural encapsulation: Counselors’ reliance on a narrow model of helping

that fails to account for cultural values, beliefs, and variables and interprets
health and wellness the same across cultures.

Wrenn (1962, 1985) suggested that counselors are vulnerable to the experience of
cultural encapsulation when five basic stances are present. The characteristics and
behaviors of culturally encapsulated counselors are presented next.

Identifying Behaviors of Culturally Encapsulated Counselors

1. Define truth and reality on a rigidly maintained set of cultural assumptions
that is presumed to be constant and unchanging.
2. Become trapped by their particular way of thinking that resists adaptation, re-
jects alternatives, and is insensitive to perspectives from other cultures.
3. Maintain perspectives based on unreasoned assumptions without proof and
regard to empirical reality and, when confronted with evidence contrary to
their encapsulated assumptions, ignore or otherwise invalidate the informa-
tion presented.
4. Fail to carefully evaluate the viewpoints of others when those viewpoints are
not similar their own and are not apt to accommodate the needs of others who
are different from them.
5. Make judgments of others based on the viewpoint of their own criterion with-
out regard for the cultural context of others.
58 What Are the Primary Roles and Responsibilities of the Professional Counselor? PART ONE

To challenge culturally encapsulated perspectives and attitudes, counselors can en-

gage in some of the following behaviors.

Ways to Challenge Culturally Encapsulated Perspectives

(Wrenn, 1962, 1985)
䊏 Become aware of personal culture and worldviews.
䊏 Seek out contact with groups of people that are culturally different than oneself.
䊏 Search for ways to recognize unique qualities within various cultures.
䊏 Avoid using one’s own group as the standard by which appropriate behavior is
assessed.

EXAMPLE

Vulnerability to Being Culturally Encapsulated

One of the challenges to confronting cultural encapsulation is the fact that many of the things
people do on a daily basis inherently reinforce its existence. The criteria counselors use in
self-referencing fosters ongoing cultural encapsulation because many of the labels that people
use to define themselves are based on culturally laden concepts. For example, a man who con-
sistently refers to himself as “self-made” and “independent” is choosing to define himself in
terms that highlight specific culturally encapsulated values. In this case, the preferred value is
individualism. The value-based use of such labels highlights one cultural perspective while
deemphasizing or even denigrating other cultural perspectives (e.g., collectivism). Even if
people do not say anything directly negative about another person or culture, their self-de-
scriptions automatically place priorities on certain values, actions, thoughts, and attitudes.

䊏 Ethnocentrism

Counselors who are culturally encapsulated generally approach clients from an

ethnocentric perspective. Ethnocentrism can be defined this way:

Ethnocentrism: The tendency to use one’s own cultural standards as the stan-
dards by which to evaluate other groups and to rank these standards higher
than all others (Berry, Poortinga, Segall, & Dasen, 1992).

䊏 Acculturation and Assimilation

Although acculturation and assimilation frequently have been used inter-

changeably, the two terms represent two distinct forms of adaptation. The distinc-
CHAPTER FOUR Multicultural Intricacies in Professional Counseling 59

tion between acculturation and assimilation can be understood this way

(Roysircar-Sodowsy & Maestas, 2000):

Acculturation: Suggests that minority groups adapt to the culture, values,

and norms of the dominant group rather than the dominant group adjusting
to the presence of the minority group.

Assimilation: Refers to adaptations that are made by the minority group to

the norms, values, and culture of the dominant group as well as structural ad-
aptations made by the dominant group to include portions of the culture, val-
ues, and norms of the minority group.

Although people who are highly acculturated have adopted the values, norms, lan-
guage, and behaviors of the core dominant society, the latter does not make any ad-
justments to meet those of the incoming people. In a fully assimilated society, con-
versely, members of various groups interact with each other as friends and equals
to the extent that even marriage partners are selected without biased regard to eth-
nic or racial identities. The dominant culture in assimilated societies adjusts to in-
clude key elements of the incoming culture.

EXAMPLE

Differences in Assimilating Cultural Groups in the United States

A good example of the variance in how minority groups are assimilated to the dominant cul-
ture can be seen by examining the way that U.S. culture has adapted more to Irish customs,
culture, and values than to Chinese customs, culture, and values. Despite the fact that large
numbers of both populations have resided in the United States for approximately the same
amount of time, assimilation has occurred to a greater extent with people of Irish descent than
with people of Chinese descent.

䊏 Alloplastic and Autoplastic Viewpoints

Related to the concepts of acculturation and assimilation are the concepts referred
to as alloplastic and autoplastic viewpoints. The terms define two different levels of
adaptation in society.

Autoplastic perspective: Suggests that people focus on adapting to the regu-

lations of the dominant social structure and setting.

Alloplastic perspective: Suggests that people focus primarily on working to

adjust society to better fit their needs and preferences.
60 What Are the Primary Roles and Responsibilities of the Professional Counselor? PART ONE

Counselors may work with their minority clientele to adopt the dominant culture,
make adaptations to it, or some combination thereof (Pedersen, 1976). Although
intentionality in this viewpoint is important, any choice does not take away from
the fact that assimilation will not occur without the dominant society adjusting to
meet the norms, values, and behaviors of the incoming culture.

EXAMPLE

Autoplastic and Alloplastic Perspectives

A counselor who encourages her minority clientele to strive for acculturation is working from
an autoplastic perspective. She is presuming that it is in the best interest of her clientele to
change to fit into society. She is also presuming that mainstream society cannot or should not
have to adjust to the diversity that her clientele bring. On the other hand, a counselor who en-
courages her minority clientele to strive for assimilation will help them develop heightened
understanding and sharpened abilities to advocate for structural changes in society around
their own culture, values, and norms.

CULTURAL CONSTRUCTS: A CLOSER LOOK

Counselors who strive to be multiculturally competent develop as clear an under-

standing of cultural constructs as possible. We present here a brief overview of
some of the significant concepts that counselors must understand to practice
competently.

䊏 Sex and Gender

Two important areas of cultural consideration are sex and gender. Because of the
influence these facets of personhood have on clients’ identity development and be-
cause of the role that sex and gender can play in the helping relationship, counsel-
ors need to be knowledgeable of these constructs. Additionally, counselors can in-
crease their effectiveness in the therapeutic relationship when they are aware of
and comfortable with their own sexual and gender identity. Although the terms sex
and gender have at times been used interchangeably, they are distinct concepts and
can be differentiated this way:

Sex: The system of sexual classification based on biological and physical dif-
ferences, such as primary and secondary sexual characteristics, which create
the categories of male and female.
CHAPTER FOUR Multicultural Intricacies in Professional Counseling 61

Gender: A system of sexual classification based on the social construction of

the categories of men and boys and women and girls and usually refers to a
person’s masculinity or femininity.

Although sex and gender refer broadly to the physical characteristics of men and
women or to the social construction of maleness and femaleness, there are also sex
and gender groups with more ambiguous characteristics. These groups are known
respectively as intersex and androgynous.

Intersex: A person who was born with genitalia, secondary sexual character-
istics, or both of indeterminate sex, or with features combined from both
sexes. A more archaic and less preferred term for people who are intersex is
hermaphrodite.

Androgynous: A person who has both feminine and masculine qualities and
who may assume female and male roles.

The area of gender, in particular, is receiving increasing attention in the helping

field, as professionals are recognizing the impact of gender and gender identity on
clients’ experiences. The interplay between gender and culture can have a signifi-
cant effect on the counseling relationship because the meaning of gender and gen-
der roles are socially constructed and may be understood differently by the coun-
selor and the client. Counselors can benefit from being aware of several more
concepts related to the area of gender, including gender roles, gender stereotypes,
transgender, cisgender, and androcentism.

Gender roles: Behaviors, attitudes, values, emotions, beliefs, and attire that a
particular cultural group considers appropriate for males and females on the
basis of their biological sex.

Gender role stereotypes: Socially determined models that contain the cul-
tural beliefs about what the gender roles should be.

Transgender: A person whose gender identity does not match her or his as-
signed gender (gender assignment is usually based on biological physical
sex).

Cisgender: People who possess a gender identity or perform a gender role so-
ciety considers appropriate for one’s sex.

Androcentrism: The practice, conscious or otherwise, of placing male human

beings or the masculine point of view at the center of one’s view of the world
and its culture and history.
62 What Are the Primary Roles and Responsibilities of the Professional Counselor? PART ONE

䊏 Sexuality and Affectional Orientation

The term affectional orientation is preferred today over the more traditional term sex-
ual orientation, as it presumes that the orientation of a person’s affections goes be-
yond sexuality.

Affectional orientation: Orientation toward the type of person with whom a

given individual is predisposed to bond emotionally and share personal
affection.

Although sexual attraction plays a role in affectional orientation, it is not the sum
of any relationship; therefore, a broader description of orientation allows for an
inclusion of interpersonal affection as significant to the relational bonds people
form.

䊏 Race

Race as a biological construct has become increasingly invalidated and controver-

sial (Jackson & Sellers, 1997); however, it continues to be used as a nominal cate-
gory within the human service fields (Helms & Cook, 1999). Viewed as an inher-
ently biological construct, Zuckerman (1990) defined race this way:

Race: “An inbreeding, geographically isolated population that differs in dis-

tinguishable physical traits from other members of the species” (p. 1297).

Scientists who interpret race biologically have created from as few as 3 categories of
race (Caucasoid, Mongoloid, and Negroid) to as many as 200 distinct racial catego-
ries, suggesting that there is little agreement on the empirical groundings of race as
a biological concept. With the completion of the human genome mapping, scien-
tists have been able to assess genetic differences in racial distinctions and, on re-
view of the empirical studies on race, have concluded that race as a biological con-
struct is fictional, whereas race as a social construct is real (Cornell & Hartmann,
1997; Smedley & Smedley, 2005; Zuckerman, 1990).
Although race is more accurately considered a social construction, understand-
ing the way it interfaces in society is key in developing empathic relationships with
clientele. According to West (1993), racial distinctions have long been used as a
method to differentiate, distinguish, separate, segregate, and oppress. The con-
structed variable of race is employed in decisions made by bankers, attorneys, law
enforcement, parents, teachers, and policy writers. People make assumptions
about others based on perceptions of race and ethnicity on a daily basis. Recently, it
has become apparent that racially biased attitudes have evolved from an uncon-
cealed and openly hostile approach to one that is more subtle and ambivalent
(Brief, Dietz, Cohen, Pugh, & Vaslow, 2000).
CHAPTER FOUR Multicultural Intricacies in Professional Counseling 63

䊏 Age

In U.S. society, the increasing need for competence in working with the aged is
clear. The demographic of the U.S. population is shifting toward growing numbers
of older adults, which suggests that counselors need to be aware of the issues and
potential biases related to ageism. At the same time, stereotypes and myths about
young adults also abound. Thus, the demographic factor of age also is of concern to
counselors who work with youth who might experience a type of prejudice known
as adultism.

䊏 Ability

Ability is another cultural dimension that is of immense concern to counselors be-

cause the profession is centered on helping individuals who experience impair-
ment on cognitive, emotional, and, at times, physical levels. Ableism is the term
that describes prejudice toward persons who are limited in ability. This type of prej-
udice creates a hostile, unfriendly, or unyielding environment for people whose
mental, physical, and sensory abilities are not within the scope of what is defined as
socially acceptable.

䊏 Religion and Spirituality

Although many forms of religious and spiritual bias and oppression exist, one of
the most significant in history is that of anti-Semitism. Historically, there are two
forms of anti-Semitism, religious anti-Semitism and racial anti-Semitism. Religious
anti-Semitism, or anti-Judaism, predominated throughout history up until the
mid-19th century. During this period of time, most anti-Semitism was primarily re-
ligious in nature, as Judaism was the largest minority religion in Christian Europe,
as well as in the Muslim world. This form of prejudice was directed at the religion
itself instead of at all people of Jewish ancestry.
By the late 19th century, racial anti-Semitism became the predominant form of
prejudice against Jewish people, emerging largely out of conceptualizations of
race that were prevalent during the Enlightenment. Racial anti-Semitism was
based on the belief that Jewish people were a racially discrete group regardless of
religious practice. This form of anti-Semitism effectively replaced the hatred of
Judaism as a religion. As a result of this shift, Jewish people as a race became tar-
gets of discrimination, segregation, and persecution regardless of religious per-
suasion.

See Chapter 31 for more information about pastoral counseling and spirituality
and counseling.
64 What Are the Primary Roles and Responsibilities of the Professional Counselor? PART ONE

BIAS, PREJUDICE, DISCRIMINATION, AND OPPRESSION

To effectively treat a diverse population of clients, counselors need to be aware of the

influences of bias, prejudice, discrimination, and oppression in their clients’ lives.
Moreover, counselors themselves consciously have to avoid biased viewpoints so
that they can treat clients with the dignity and respect afforded them as humans.

䊏 Bias

Prejudice, discrimination, and oppression stem from worldviews that are biased.
Skovholt and Rivers (2004) suggested that bias is a “preference, tendency, or inclina-
tion toward particular ideas, values, people, or groups” (p. 31). Bias tends to constrict
a person’s perspective and can lead to prejudiced beliefs or acts of discrimination.

䊏 Prejudice

Prejudice refers to generalizations or stereotypical beliefs about a group of individ-

uals that are not grounded in empirical evidence (Skovholt & Rivers, 2004). There
are countless examples of the effects of prejudice on minority groups in the United
States, some of the most well known of which include prejudice against African
Americans, women, and gay and lesbian persons. Like biased views, prejudicial
perspectives can lead to misuses and abuses of power as well as overt or covert acts
of aggression against groups who are seen as inferior.

䊏 Discrimination

Characterized by unfair and unequal treatment that systematically prevents cer-

tain groups from being afforded opportunities that are provided to other groups,
discrimination can have deleterious effects (Skovholt & Rivers, 2004). One of the
most widely recognized types of discrimination in the United States is racism,
which can be defined this way:

Racism: The belief that racial or ethnic groups other than one’s own are psy-
chologically, intellectually, or physically inferior (Ridley, 1989).

Racism is based on the view that there are qualitative differences across racial lines.
This form of discrimination results in a pattern of behavior that denies access to oppor-
tunities or privileges to members of one racial or cultural group while favoring access
to another racial or cultural group. There are at least three categories of racism, includ-
ing individual, institutional, and cultural racism; these are described briefly next.

Types of Racism
1. Individual racism is comprised of personal attitudes, beliefs, and behaviors de-
signed to convince oneself of the superiority of her or his race over other races.
CHAPTER FOUR Multicultural Intricacies in Professional Counseling 65

Acts of individual racism include various forms of oppression, discrimination,

and bias toward others based on conceptions of their race.
2. Institutional racism is manifested in the regulations, laws, public policy, and
practices in decision making that serve to maintain the social and economic ad-
vantage of the racial group currently in power. This is accomplished through
oppression, subjugation, and compulsory dependence on the larger society. In-
stitutional racism is commonly legal, or at least customary, and, therefore, is
embedded within laws, policy, traditions, and expectations throughout all lev-
els of institutional organizations.
3. Cultural racism includes societal beliefs and customs that promote the assump-
tion that the products of the dominant race (e.g., language, traditions, appear-
ance) are superior to those of other races. Cultural racism results in rigid defini-
tions of attractiveness, intellect, and capability and can curtail the range of a
person’s perceived choices, dreams, privileges, creative expression, and self-ac-
tualization.

Although racism is probably the best known type of discrimination, it is by no

means the only kind of discrimination that is perpetuated by biased viewpoints
and prejudiced beliefs. Some other forms of discrimination relate to a person’s sex-
uality, gender, age, ability, and religion.

Forms of Discrimination
䊏 Sexism is the belief that women and men are inherently and qualitatively differ-
ent, with men being presumed superior to women.
䊏 Cultural heterosexism is the stigmatization, repudiation, subjugation, or defa-
mation of sexual minorities within societal institutions.
䊏 Psychological heterosexism is the individual internalization of worldviews un-
derlying cultural heterosexism resulting in prejudice against people who are not
heterosexual.
䊏 Homophobia is the expression of irrational fears about people who exhibit signs
of accepting or using behaviors related to same-sex forms of sexual desire and
orientation.
䊏 Affectional prejudice subsumes homophobia as it incorporates negative atti-
tudes and biases based on affectional orientation, including homosexuality, bi-
sexuality, or heterosexuality.
䊏 Ageism is systematic and stereotypic prejudice against people simply because
they are old.
䊏 Adultism is prejudice and accompanying systematic discrimination against
young people.
䊏 Ableism is a pervasive system of discrimination and exclusion that oppresses
people who have mental, emotional, and physical disabilities.
䊏 Anti-Semitism is the systematic discrimination against, hatred, denigration, or
oppression of Judaism, Jews, and the cultural, religious, and intellectual heritage
of Jewish people.
66 What Are the Primary Roles and Responsibilities of the Professional Counselor? PART ONE

EXAMPLE

Combating Ableism
Eric is a 37-year-old man seeking counseling for help with career decisions and how his deci-
sions will affect his family. Although Eric has attempted counseling in the past and thought it
was not successful, a friend has referred Eric to a licensed marriage and family therapist. Dur-
ing the initial phone call, the therapist asked Eric if he required any modifications, which was a
question that no other therapist had ever asked him. Susan, the therapist to whom Eric was re-
ferred, was not aware that Eric was born with vision impairment and was considered legally
blind even with the aid of glasses. Asking about modifications was standard practice for Su-
san, who strives to be a culturally competent counselor.
Eric felt it was important to understand how his family history has played a role in his deci-
sion-making process. Susan understood that the use of a genogram would be helpful for Eric
and designed one using art materials. Following the concepts of a basic genogram, Susan used
pipe cleaners to represent males (squares) and females (circles). Sand was used to represent
substance abuse and mental health diagnosis. String was used to represent the relationships
between family members. Once presented to Eric, he was able to visually see some of the con-
cepts and, most important, feel his family history. Susan understood the importance of being
aware of ableism and discussed with Eric how this affected his decisions in the past.

䊏 Oppression

Counselors who approach their work from a multicultural perspective must take
into account the experience of oppression in the lives of the people they serve. Op-
pression affects the daily realities of most minority groups in a given society and
cannot be ignored as a significant part of clients’ life experience.

Oppression: The unjust or cruel exercise of authority or power that functions

to crush or burden by abuse of power, privilege, or authority; oppression may
also be an act of physical or psychological violence that hinders a person from
being entirely human or alive (Freire, 1988).

䊏 Privilege

Intentional oppression occurs when people are oppressive of others through

actions they choose, or through choosing to overlook inequities in society. How-
ever, oppression also can be unintentional, as is elucidated in the concept of
privilege.
CHAPTER FOUR Multicultural Intricacies in Professional Counseling 67

Privilege: The state of being preferred or favored in society combined with a

set of conditions that systematically empower select groups based on specific
variables such as race and gender, while systematically not empowering
others.

Counselors from privileged backgrounds commonly have difficulty acknowledg-

ing the privilege that they experience because they have been socialized not to rec-
ognize the results of privilege. Most White people do not make the effort to under-
stand and respond to the privileges they experience due to their racial status. By
ignoring the reality of privilege, White people take part in oppressing people of
color and potentially can engage in a form of unintentional racism. This difference
in rights and privileges is normative in society and commonly overlooked in dis-
cussions of racism. Privilege also exists in other arenas of oppression, such as gen-
der differences, class differences, ability differences, and so forth. For a deeper un-
derstanding of White privilege, readers are referred to McIntosh (1992), who wrote
of an invisible container of 46 unearned assets that a White person can count on
cashing in each day, but about which she or he is generally unmindful.

EXAMPLE

White Privilege and the Counseling Relationship

When White privilege is present in the counseling relationship, a counselor may inadvertently
harm the relationship and client. A counselor who is not aware of her or his own White privi-
lege might not understand the full impact of the stories that are relayed. For instance, a coun-
selor might not understand how difficult it is to be one of a handful of minorities in a large
business and feel as if he or she does not have a voice. Similarly, the counselor might not un-
derstand the impact of a family living in an ethnocentric neighborhood having to drive two
hours to obtain cultural foods. Culturally competent counselors acknowledge the privilege
they hold and their responsibilities to those who are not equivalently privileged. Whether it is
race, language, gender, or sexual orientation, the counselor remains aware of how the privi-
lege may or may not impinge on the counseling process.

CULTURAL IDENTITY DEVELOPMENT

To begin to understand others accurately, counselors first need to understand

themselves. A key area of awareness for counselors relates to their cultural identity
development. Numerous scholars have developed models to clarify the existence
of cultural identity development. Historically, these models were limited to de-
scribing the transformation that African Americans underwent in developing
awareness of themselves as racial beings (Cross, 1972; Jackson, 1975). Cross (1995),
68 What Are the Primary Roles and Responsibilities of the Professional Counselor? PART ONE

for example, developed a model of African American development that begins

with viewing the world through the dominant European-American lens, moves to
viewing the world based on one’s own personal experiences, progresses to full ac-
ceptance of the African American culture and nonacceptance of others (particu-
larly European Americans), and culminates with the desire to end racism for all in-
dividuals, both people of color and European Americans. More recently, models
have been developed that address the identity development of Latinos (Bernal &
Knight, 1993), Whites (Helms, 1995), and biracial people (Kerwin, Ponterotto, Jack-
son, & Harris, 1993). Models such as these function well to aid counselors in under-
standing the behaviors and attitudes of their clients from culturally different back-
grounds.

䊏 Racial and Cultural Identity Development Model

A few models have been developed that sum up the developmental process of ra-
cial and cultural identity (e.g., Atkinson, Morton, & Sue, 1998; Helms, 1995; Sue,
Ivey, & Pedersen, 1996; Sue & Sue, 2003). Sue and Sue (2003) developed the racial
and cultural identity development model (R/CID). The R/CID integrates the expe-
riences of oppressed people of various racial and cultural backgrounds as they
strive to understand themselves in relation to their own culture, the dominant cul-
ture, and the interface between these cultures. The model separates cultural iden-
tity development into five stages: (a) conformity, (b) dissonance, (c) resistance and
immersion, (d) introspection, and (e) integrative awareness. These stages view de-
velopment as moving from an ethnocentric perspective of self in relation to a multi-
cultural perspective of self in system. A brief outline of each stage is mentioned.

R/CID Stages (Sue & Sue, 2003)

䊏 In the conformity stage, people of minority backgrounds hold appreciative atti-
tudes toward the dominant group, while holding deprecating or neutral atti-
tudes toward themselves and others of the same minority group.
䊏 In the dissonance stage, people of minority backgrounds are in a state of internal
conflict about the dominant group as well as about themselves and others of the
same minority group.
䊏 In the resistance and immersion stage, people of minority backgrounds become
more appreciative of themselves and others of their minority group and are less
affirming toward the dominant culture.
䊏 In the introspection stage, people of minority backgrounds question the validity of
both blanket negativity toward the dominant group and unequivocal apprecia-
tion of the minority group.
䊏 The integrative awareness stage of development is a period characterized by secu-
rity in oneself and one’s cultural background and selective trust in and apprecia-
tion for the dominant group.
CHAPTER FOUR Multicultural Intricacies in Professional Counseling 69

The five stages within the R/CID suggest a progression from complete immersion
in the dominant culture to complete immersion in the minority culture to, finally,
an appreciation of both the minority and dominant cultures.

䊏 White Racial Identity Development

Racial identity is not limited to people of color. Helms’s (1984, 1995) model of White
racial identity development allows White Americans to assess their own beliefs
and identity development. Helms’s model is based on the idea that White Ameri-
cans have had to acknowledge their own identity. When White Americans move
through Helms’s stages, they are able to recognize their beliefs about minorities
and understand ways in which society views White Americans and people of color
as being different. White Americans, then, can have a positive sense of their own
culture, be able to question some of society’s norms, and ultimately engage in on-
going internal dialogue on racial identity.

MULTICULTURAL THEORIES IN COUNSELING

Despite the increasing diversity that characterizes the United States—a nation
where racial and ethnic minorities soon will become the numerical majority
(Atkinson, Morton, & Sue, 1998)—traditional counseling theories do not address
adequately the complexity of cultural diversity, social context, and ecological per-
spectives (Sue, 1995). Theories that do address social factors are overlooked in
counselor education. The difficulty with approaching counseling relationships
only from traditional theoretical approaches is that the worldviews inherent in
these perspectives favor individualism and often are at odds with the worldviews
of clients who do not embrace or originate from Euro-American cultures (Ibrahim,
1985; Sue et al., 1996). Therefore, the focus of this section is Multicultural Counsel-
ing and Therapy (MCT), an approach to understanding human behavior that spe-
cifically accounts for factors of culture and diversity.

The difficulty with approaching counseling

relationships only from traditional theoretical
approaches is that the worldviews inherent in
these perspectives favor individualism and often
are at odds with the worldviews of clients who
do not embrace or originate from
Euro-American cultures.
70 What Are the Primary Roles and Responsibilities of the Professional Counselor? PART ONE

䊏 Multicultural Counseling and Therapy

MCT (Sue et al., 1996) was designed as a metatheory (a theory about theories) to
help counselors develop an organizational framework for applying the multicul-
tural competencies to the counseling relationship. MCT is based on the accumula-
tion of years of research and theoretical development on counseling clients in a di-
verse society. A forward-looking theory, MCT is responsive to past data and
learning while calling for research to challenge and modify it in the future. The fol-
lowing are some key precepts followed by counselors who use MCT.

Key Behaviors of Counselors Employing MCT

䊏 MCT-oriented counselors work with the clients instead of on the clients, thus
helping them to serve as active and equal participants as they coconstruct defini-
tions of both the problems and the goals in the counseling relationship.
䊏 MCT-oriented counselors avoid overemphasizing either cultural differences or
cultural similarities but, instead, approach clients from a combined perspective.
䊏 MCT-oriented counselors are aware of and responsive to the fact that salient cul-
tural features (individual, group, or universal) change for clients during counsel-
ing, and, thus, track and respond to the various cultural affiliations of their cli-
ents instead of presuming stagnant, oversimplified definitions of culture.
䊏 MCT-oriented counselors are aware that cultural identity evolves in response to
a person’s experiences and context.
䊏 MCT-oriented counselors avoid treating the individual, family, or group in isola-
tion; therefore, the focus of work moves from a more traditional focus on
self-concept to a focus on self-in-relation.
䊏 MCT-oriented counselors avoid using theories of identity that disregard cultural
context and instead understand that identity is learned within cultural context.
䊏 MCT-oriented counselors realize that the client’s perspective must be under-
stood comprehensively and within historical context.
䊏 MCT-oriented counselors realize that a linear approach to thinking is appropri-
ate for some clients, whereas others are best served with a nonlinear approach.
䊏 MCT-oriented counselors differentiate between individual differences and cul-
tural differences.
䊏 MCT-oriented counselors continually strive to expand their repertoire of helping
responses as they realize that no single approach is equally effective across all
populations and situations.
䊏 MCT-oriented counselors realize that any theory or technique must be ap-
proached from a culturally appropriate frame of reference.
䊏 MCT-oriented counselors follow the Golden Rule of counseling: Do unto others
as they would have you do unto them. Avoid doing unto others as you would
have them do unto you, as they may prefer something very different.
䊏 MCT-oriented counselors approach helping from multiple roles, ranging from
one-to-one remedial work to systemic intervention and prevention.
CHAPTER FOUR Multicultural Intricacies in Professional Counseling 71

䊏 MCT-oriented counselors value and incorporate Western methods of helping as

well as traditional and non-Western methods.
䊏 MCT-oriented counselors focus on developing critical consciousness, or the rela-
tion of clients to their entire context, thus teaching their clients about the under-
lying cultural, sociological, and historical dimensions of presenting concerns
and creating potential liberation of consciousness.

䊏 Benefits of Multicultural Counseling and Therapy

Use of a metatheoretical approach such as MCT provides a number of benefits to

culturally sensitive counselors. A few of these advantages are highlighted here:

䊏 Allows for the understanding of multiple oppressions clients might experience.

䊏 Promotes recognition of the collectivist identity crucial to many cultures.
䊏 Allows clients to define wellness within their own context.
䊏 Encourages counselors to recognize the multiplicity of strengths clients bring to
bear from their diverse backgrounds.
䊏 Recognizes the numerous roles counselors may have to fill in response to client
diversity.

Chapter 4: Key Terms

䉴 Mores 䉴 Intersex 䉴 Sexism
䉴 Culture 䉴 Androgynous 䉴 Cultural heterosexism
䉴 Convergence 䉴 Gender roles 䉴 Psychological heterosexism
䉴 Etic perspective 䉴 Gender role stereotypes 䉴 Homophobia
䉴 Emic perspective 䉴 Transgender 䉴 Affectional prejudice
䉴 Cultural encapsulation 䉴 Cisgender 䉴 Ageism
䉴 Ethnocentrism 䉴 Androcentrism 䉴 Adultism
䉴 Acculturation 䉴 Affectional orientation 䉴 Ableism
䉴 Assimilation 䉴 Race 䉴 Anti-Semitism
䉴 Autoplastic perspective 䉴 Bias 䉴 Oppression
䉴 Alloplastic perspective 䉴 Prejudice 䉴 Privilege
䉴 Sex 䉴 Discrimination 䉴 Unintentional racism
䉴 Gender 䉴 Racism
chapter Supervision: An Essential for
Professional Counselor Development
5
Lori Russell-Chapin
Bradley University

In This Chapter

䉴 Basics of Clinical Supervision

䊏 Supervision: A Key to Professionalism

䊏 Benefits of Supervision

䊏 Supervision Defined

䉴 Models of Supervision
䊏 Developmental Models of Supervision

䊏 Theory-Specific Supervision Models

䊏 Social Role Models of Supervision: Discrimination Model

䊏 Integrated Model of Supervision

䊏 A Supervision Videotaping Method: Interpersonal Process Recall

72
CHAPTER FIVE Supervision 73

BASICS OF CLINICAL SUPERVISION

The counseling profession, like any discipline offering a public service, has a re-
sponsibility to assess continually its quality of service. Likewise, individual coun-
selors have the responsibility to analyze the degree to which counseling helps cli-
ents and to evaluate the overall effectiveness and outcome of the counseling
process (Nugent, 1990).
One of the most exciting and fruitful methods of achieving this professional atti-
tude and behavior is to engage in clinical supervision throughout the life span of a
counseling career.

䊏 Supervision: A Key to Professionalism

For many counselors, clinical supervision begins in graduate school, and once the
program of study is completed, so too are the days of supervision. However, as
Neukrug (2003) so eloquently stated:

Embracing a professional lifestyle does not end once one finishes graduate school, ob-
tains a job, becomes licensed, has ten years of experience or becomes a “master” thera-
pist. It is a lifelong commitment to a way of being, a way that says you are constantly
striving to make yourself a better person and a more effective counselor, committed to
professional activities. (p. 72)

Engaging in regular clinical supervision is one method of maintaining and regu-

lating counseling performance for the counselor and consumer. Additionally,
many counselors enhance their professionalism by becoming credentialed supervi-
sors who guide new counselors and trainees. Organizations such as the National
Board of Certified Counselors (NBCC) and the American Counseling Association
(ACA) support supervisory efforts, training, and practice.

Visit the Center for Credentialing and Education site for information
about the Approved Clinical Supervisor Credential:
䉴 www.cce-global.org/credentials-offered/acs

䊏 Benefits of Supervision

Helping professionals who understand the importance of clinical supervision

throughout the life span of counseling careers benefit in a number of ways:
74 What Are the Primary Roles and Responsibilities of the Professional Counselor? PART ONE

䊏 Committing to continual supervision adds to the professionalism of the counsel-

ing field as it keeps the supervisee and the supervisor on the cutting edge of best
practice methods.
䊏 Continued supervision allows for connectedness to others in the profession.
䊏 Supervision provides resources for coping with the stressors that the counseling
profession brings.

It does take a certain amount of courage to remain in supervision, expose and dem-
onstrate individual skills, and share overall knowledge. If counselors allow super-
vision to enhance their counseling outcome and overall effectiveness, the profes-
sion will continue to thrive.

䊏 Supervision Defined

Russell-Chapin and Ivey (2004b) provided a concise definition of supervision:

Supervision: A distinctive, structured approach in which an often more expe-

rienced professional counselor responds to a counselor trainee or super-
visee’s needs with attention to the supervisee’s differing developmental and
competency levels.

The supervisor usually will clarify and combine three aspects throughout supervi-
sion: roles, expectations, and functions. A brief description of the supervisor’s
roles, the joint expectations of the supervisor and supervisee, and functions of the
supervision process are given here.

Supervision Roles
䊏 Among the roles that supervisors assume, a number of common stances include
that of teacher, consultant, evaluator, and encourager (Bernard & Goodyear,
1998).
䊏 Based on an informal or formal assessment of the supervisee’s needs, the super-
visor decides which role or “hat” is most appropriate to the supervisee’s needs.

Supervision Expectations
䊏 Prior to every supervision session, the expectations of supervisor and supervisee
must be clarified because it is essential to know what is expected from each of the
team members.
䊏 The expectations of the supervisor and supervisee are shared throughout the
lifetime of supervisory experience.

Supervision Functions
䊏 The functions of supervision will vary based on the supervisee’s needs.
䊏 Major responsibilities of supervision include administration, education, and
support.
CHAPTER FIVE Supervision 75

Holloway and Carrol (1999) suggested that it is the supervision tasks and roles plus
the functions of those tasks that equal the supervision process. In other words,
when the roles and responsibilities of the supervisor are combined with the need of
the counselor in training, then a supervision process has begun.

EXAMPLE

Clarifying Expectations in Supervision

An example of a clarifying question that can be used to open the supervisory process is this:
“What do you need and want out of supervision today?”(Russell-Chapin & Ivey, 2004a,
2004b). This simple question is an effective way to illuminate the expectations of supervisees
in the supervision session.

MODELS OF SUPERVISION

Most supervision models emphasize the value of a healthy supervisee–supervisor

relationship, stress the importance of feedback and communication, and describe a
variety of supervisor tasks and functions. Four supervision models and one super-
vision method are presented here, including the following:

1. Developmental models.
2. Theory-specific models.
3. Social role models.
4. Integrated models.
5. Interpersonal Process Recall method.

䊏 Developmental Models of Supervision

A developmental model of supervision usually is selected if a major goal of super-

vision is to assess and better understand the developmental level and process of the
supervisee. One of the underlying assumptions of developmental models is that
supervisees grow at individual paces with differing needs and unique learning
styles. Some other generalizations about this approach also can be made.

Assumptions About the Developmental Approach to Supervision

䊏 There seem to be predictable stages or levels through which many supervisees
progress as they learn the skills of the counseling process.
76 What Are the Primary Roles and Responsibilities of the Professional Counselor? PART ONE

䊏 The work of supervision is to discover and articulate the individualized needs of

the supervisee (Stoltenberg, McNeill, & Delworth, 1998).
䊏 Strategies should maximize the supervisee’s strengths and minimize the liabili-
ties (Russell-Chapin & Ivey, 2004b).

In the developmental model, change and growth are not only assessed for the indi-
vidual supervisee, but are also reflected in the supervisory relationship. Supervisees
strive for cognitive advances and skills acquisition. As that growth takes place, the
interaction between supervisee and supervisor must evolve to meet the demands of
the supervisee. Another way of conceptualizing the developmental aspect of the su-
pervision relationship is to look at parallels between the supervision and counseling
relationships. In individual counseling, assessing the developmental level of the cli-
ent is essential to choosing an appropriate, corresponding intervention (Ivey & Ivey,
2003). A parallel process occurs within developmental supervision.
Two key figures who gave a detailed description of the characteristics of super-
visees’ developmental phases and parallels in the supervisory relationship are
Stoltenberg and Delworth (1987; see also Stoltenberg, 1981). They formulated a su-
pervision model describing four distinct assessment levels of supervisee growth.
Table 5.1 provides a brief synopsis of the four levels outlined by Stoltenberg and
Delworth along with the corresponding supervisee and supervisor behavior for
each level.
During each level or stage, the job of the supervisor is to structure supervision so
that it moves from imitative and demonstrative functions at the beginning level to
more competent and self-reliant functions at the advanced levels (Stoltenberg et al.,
1998). In this model, a strong emphasis is placed on understanding the supervisee’s
world, motivational levels, and degree of autonomy, as each of these is described in
the beginning, intermediate, advanced, and master counselor levels. Additionally,
nine growth areas are identified in each of the four levels.

TABLE 5.1
Developmental Levels of Supervisees

Levels Supervisee Behavior Supervisor Behavior

Beginning—Level 1 Little experience; Models needed skills and

dependent on the behaviors; teacher role
supervisor
Intermediate—Level 2 Less imitative; strives for Provides some structure
independence but encourages
exploration
Advanced—Level 3 More insightful and Listens and offers
motivated; more suggestions when asked
autonomous sharing
Master Counselor—Level 4 Skilled interpersonally, Provides collegial and
cognitively and consultative functions
professionally
CHAPTER FIVE Supervision 77

Supervisee Growth Areas in the Developmental Model

1. Intervention.
2. Skill competence.
3. Assessment techniques.
4. Interpersonal assessment.
5. Client conceptualization.
6. Individual differences.
7. Theoretical orientation.
8. Treatment goals and plans.
9. Professional ethics.

To evaluate the supervisee’s level of performance correctly and support the super-
visee throughout the supervision process, the supervisor who works from a devel-
opmental approach engages in a number of tasks.

Supervisor Tasks in the Developmental Model

(Stoltenberg, 1981; Stoltenberg & Delworth, 1987)
䊏 Use the supervisee’s questions and general skills to assess the supervisee’s devel-
opmental level of functioning from Levels 1 through 4 (e.g., if supervisees seem to
be aware of their impact on the client, functioning is likely at Level 2 and 3).
䊏 Attend to the supervisee’s levels of awareness of self and others, motivation to-
ward the developmental process, and the ability to think independently.
䊏 Highlight client conceptualization and treatment goals and plans.
䊏 Encourage the supervisee to gain confidence in skill development (Levels 2 and 3).
䊏 Listen more than lead and be collegial in nature (Level 4).

䊏 Theory-Specific Supervision Models

Helping professionals who adhere to a specific therapeutic orientation (e.g., cogni-

tive-behavioral, psychodynamic, person-centered) may believe it is wise to super-
vise from the same theoretical orientation. If supervisors choose to operate from a
discipline-specific perspective, the supervisor is typically guided by the tenets of
the chosen theory throughout the supervisory process. Theory-specific supervision
is selected when there is a need for expansion of knowledge of theory and its corre-
sponding techniques. There are a number of benefits to using theory-specific ap-
proaches to supervision.

Major Advantages of Theory-Specific Supervision Models

䊏 Supervisors and supervisees who share the same theoretical orientation can
maximize modeling that occurs in supervision (Bernard & Goodyear, 1998).
䊏 Supervisors can demonstrate discipline-specific skills as well as integrate neces-
sary theoretical constructs.
78 What Are the Primary Roles and Responsibilities of the Professional Counselor? PART ONE

The link between the counselor role and the tasks and function of the supervisor in
theory-specific supervision are highlighted next through a brief description of Ra-
tional Emotive Behavioral Therapy (REBT), psychodynamic, and person-centered
models of supervision.

Key Components of REBT Supervision

䊏 The supervisor identifies the problem and irrational thinking of both the super-
visee and the client.
䊏 The supervisor and supervisee select ways to dispute and challenge the irratio-
nal thoughts as a method for changing and learning new, productive thoughts
and behaviors (Ellis, 1989; Woods & Ellis, 1996).
䊏 Behavioral and cognitive-behavioral supervisors emphasize and expect demon-
stration of more technical mastery than most supervisors (Bernard & Goodyear,
1998).

Using REBT as a supervisory approach will require the supervisor to incorpo-

rate the general tenets of Ellis’s theory as outlined for counseling. Similarly, the
psychodynamic approach to supervision also reflects some of the main ideas that
underlie the psychodynamic theory of counseling.

Tenets of Psychodynamic Supervision Model

䊏 Parallel process (Doehrmann, 1976), or the dynamic that occurs in the cli-
ent–therapist relationship that is played out in the supervisee–supervisor rela-
tionship, is emphasized.
䊏 The supervisor focuses on client resistance during the session and investigates
the resistance the supervisee may have toward the client.

As is true of REBT and the psychodynamic approaches, a person-centered

supervision model also is highly reflective of the person-centered approach to
counseling.

Principles of Person-Centered Supervision Model

䊏 The supervisor ensures that the basic facilitative conditions are in process
throughout the supervision session.
䊏 The supervisor emphasizes establishing unconditional positive regard, building
trust, and creating a genuine environment for the supervisee to express
self-doubts and fears about confidence in the counseling process (Hackney &
Goodyear, 1984).

Whatever discipline-specific supervisory orientation is chosen, the continuity

from counseling to supervision will assist the supervisee in expanding skills, con-
structs, and self-confidence.
CHAPTER FIVE Supervision 79

䊏 Social Role Models of Supervision: Discrimination Model

The main premise of social role models is that the supervisor emphasizes the vary-
ing roles and foci required during the supervisory process. An example of one so-
cial role model of supervision is the discrimination model. The model has been
widely researched, and its supporters believe it is an inclusive approach to supervi-
sion. Its roots are in technical eclecticism (Bernard & Goodyear, 1998).
A main goal of the discrimination model is to focus on the needs of the super-
visee by having the supervisor respond flexibly with appropriate strategies,
techniques, and guidance. To respond to supervisees’ needs, the supervisor em-
phasizes two primary functions during each supervision session, namely the
supervisor’s role and the focus of the session. There are three possible supervisor
roles and three possible supervision functions identified in the discrimination
model.

Supervisor’s Roles in the Discrimination Model

(Bernard & Goodyear, 1998)
1. The teacher role is used to directly instruct or demonstrate constructs and
skills.
2. The counselor role is used to help supervisees locate “blind spots” or become
aware of countertransference issues.
3. The consultant role is used when the supervisor needs to act as a colleague or
during times when bouncing around intervention ideas about the client is re-
quired.

During the supervision process, the roles and focus of the work can change. The su-
pervisor might decide that the teacher’s role, a counselor’s role, or a consultant’s
role is best suited to a supervisee’s particular needs. Each of the supervisor roles ac-
cordingly emphasizes different foci of the session.

Supervision Foci in the Discrimination Model

1. The process focus is used to examine the communication between client and
counselor.
2. The conceptualization focus is used to explore intentions behind the chosen
skill intervention.
3. The personalization focus is used to identify mannerisms employed in interac-
tions with clients, such as body language and voice intonation.

The elegance of discrimination supervision is that as the supervisor continues to

supervise, the foci and roles change across and within sessions (Bernard & Good-
year, 1998). Supervisors may choose to focus on basic intervention skills by being in
the role of teacher and counselor during a first session, and they may actually teach
80 What Are the Primary Roles and Responsibilities of the Professional Counselor? PART ONE

new skills and work on the supervisee’s influence on the client. In later sessions,
the supervisor’s role may reflect that of a consultant more than a teacher. Through-
out the process, supervisors decide which foci to select and which role to use to ac-
complish identified supervision goals.

䊏 Integrated Model of Supervision

Much like eclectic orientations to counseling, integrated models of supervision

tend to be atheoretical but still operate from an organized framework. Supervisory
integrationists blend the best from each model and its corresponding interven-
tions. An example of an integrated model of supervision is the microcounseling su-
pervision model (MSM). Highlighted here are some of the key points in the history
of MSM’s development.

Evolution of MSM
䊏 The use of microcounseling skills was first reported by Ivey, Normington, Miller,
Morrill, and Haase (1968).
䊏 Baker and Daniels (1989) analyzed 81 studies on microcounseling skills training
and concluded that the microcounseling training surpassed both the no-training
and attention placebo control comparison.
䊏 Daniels (2003) continued his work by following microcounseling training over a
period of decades and identified more than 450 data-based studies on micro-
counseling skills training.
䊏 The research into microcounseling skills eventually led to an investigation into
the benefits of microcounseling skills and supervision (Russell-Chapin & Ivey,
2004b).

The initial goal of MSM is to help supervisees learn to identify and classify es-
sential interviewing counseling skills. Once that goal has been achieved, the super-
visor or supervisory team and supervisee can begin to process the flow of the ses-
sions and focus on case conceptualization, diagnosis, strengths, and liabilities.
Supervisors will select the MSM when essential micro- and macrocounseling skills
are not utilized effectively.
There are several terms that are unique to MSM, including intention, basic mas-
tery, and active mastery. Understanding these concepts is necessary for supervisors
who choose to use the MSM approach. The terms can be defined as follows:

Intention: Choosing the best potential response from among the many possi-
ble options (Russell-Chapin & Ivey, 2004b).

Basic mastery: The ability to demonstrate chosen counseling skills during the
counseling interview.
CHAPTER FIVE Supervision 81

Active mastery: The ability to produce specific and intentional results from
the chosen counseling skill.

Supervisors who use the MSM model should be familiar not only with key termi-
nology, but also with the three major stages of MSM:

1. Reviewing microcounseling skills with intention.

2. Classifying skills with mastery.
3. Summarizing and processing supervisory needs.

The first stage of MSM begins by practicing, defining, and reviewing all the
microcounseling skills and understanding how they are used with intention. Other
steps include those listed here.

Steps in Stage 1 of MSM: Reviewing Microcounseling Skills With Intention

䊏 Supervisees review each of the basic interviewing skills and understand their in-
tention until they are comfortable with how the skills are defined and used.
䊏 Supervisees learn not to look for the “right” solution and skill, but to select re-
sponses that adapt individual counseling style to the needs and culture of clients
(Ivey & Ivey, 2003).

Once the supervisee has illustrated an understanding of the microcounseling skills

and intention, the supervisor can assist the supervisee in rapidly entering into the
second phase of the supervision model.

Steps in Stage 2 of MSM: Classifying Skills With Mastery

䊏 Supervisors begin to teach mastery by having supervisees watch someone dem-
onstrate the microcounseling skills and their uses.
䊏 Supervisees are introduced to the Counseling Interview Rating Form (CIRF;
see Russell-Chapin & Sherman, 2000), an instrument designed to identify all
the micro- and macrocounseling skills plus the five stages of the counseling in-
terview.
䊏 Once supervisees are familiar with the CIRF, they can observe another counselor
conducting a counseling session and use the CIRF to identify and classify skills
being used with mastery and intention.
䊏 The supervisor and supervisee begin to observe tapes from the supervisee using
the CIRF as an evaluative tool.

The final stage of the MSM begins by summarizing and later processing the dem-
onstrated skills on the CIRF as well as other important dimensions of the session.
82 What Are the Primary Roles and Responsibilities of the Professional Counselor? PART ONE

Steps in Stage 3 of MSM: Summarizing and Processing Supervisory Needs

䊏 The supervisee presents the interview video and case presentation ahead of time
and is asked to formulate supervisory questions and concerns, which are ad-
dressed as a team in a round-robin fashion going over supervisory concerns,
strengths, and areas of improvement.
䊏 Using the CIRF and the interview video, supervisees summarize skill usage with
frequency tallies for each of the counseling responses.
䊏 At the end of the session or during each response, the counselor’s responses are
categorized as basic mastery or active mastery.
䊏 The CIRF is tallied by the members of the supervisory team so that the process-
ing aspect of microcounseling supervision can begin.
䊏 The counselor’s rating is compared with the supervisor’s rating and results are
discussed.
䊏 Scores can be assigned to the entire counseling session or tape or used just to
identify which skills are being used correctly and which skills are not being prac-
ticed at all.
䊏 The very last question asked during the process is, “What did you learn in super-
vision today that will assist you in more effectively working with this client?”

MSM successfully combines many skills from a variety of counseling theories

and supervision models and can be used in supervision with all orientations (Rus-
sell-Chapin & Ivey, 2004b). The cardinal rule of any integrative supervision is to
customize supervision to meet the needs of the individual supervisee. In other
words, “the ‘how’ of supervision should parallel the ‘what’ of supervision”
(Norcross & Halgin, 1997, p. 210).

䊏 A Supervision Videotaping Method: Interpersonal Process Recall

Four main supervisory models have been presented. Many of these models require
videotaping of counseling interviews or conducting counseling sessions in an ac-
tual live observation setting either digitally or with telephones. One of the most
widely used videotaping supervision methods is Kagan’s interpersonal process re-
call (IPR; Haynes, Corey, & Moulton, 2003). Borders and Leddick (1998) conducted
a national survey of counselor educators and found IPR to be one of two distinct
methods used during supervision courses.
Supervisors select IPR when immediacy is called for in a supervision session.
Kagan believes that most people act diplomatically and often do not say what they
actually mean or feel. This assumption is reflected in the goals of IPR.

Goals of IPR
䊏 Create a supervision environment where supervisees can safely analyze their
communication styles and strategies.
CHAPTER FIVE Supervision 83

䊏 Encourage the supervisee to reflect on and interpret his or her experience in the
counseling session (Kagan, 1980).
䊏 Generate discussion of essential personal or counseling issues through the use of
a videotaped counseling session that can be stopped at opportune moments.

Besides its distinctive use of videotaping, another hallmark of IPR is its focus on
raising awareness about supervisees’ communication styles as well as their own
processes and affect during the counseling session. IPR employs a variety of ques-
tions to tease out the supervisee’s feelings and thoughts during the counseling ses-
sion.

Questions Germane to IPR (Bernard & Goodyear 1998, p. 102)

䊏 What were your thoughts, feelings, and reactions? Did you want to express them
at any time?
䊏 What would you like to have said at this point?
䊏 What was it like for you in your role as counselor?
䊏 What thoughts were you having about the other person at that time?
䊏 Had you any ideas about what you wanted to do with that?
䊏 Were there any pictures, images, or memories flashing through your mind then?
䊏 How do you imagine the client was reacting to you?
䊏 How do you think the client was seeing you at this point?
䊏 Did you sense that the client had any expectations of you at that point?
䊏 What did you want to hear from the client?
䊏 What message did you want to give the client? What prevented you from doing
so?

These questions can be used with or without a videotaped counseling session in al-
most any of the supervision models presented in this chapter. Indeed, the flexibility
of the IPR method allows it to continue to be adapted and extended to many super-
vision needs. Examples of how IPR is used by or inspired the development of other
supervision approaches are given next.

Extensions of IPR to Other Supervision Needs

䊏 The work of Kagan (1980) and Ivey and Ivey (2003) inspired the development of
the MSM.
䊏 The creation of the CIRF for use while videotaping is an extension of Kagan’s
work of analysis and processing of the counseling interview.
䊏 IPR inspired the newly advanced supervision technology using Landro Play Ana-
lyzer, which is a customized program that allows for digital, tapeless counseling
sessions that have been created to assist supervisors in coding frame-by-frame
performance analysis of supervisees’ skills (Dandeneau & Guth, 2005).
84 What Are the Primary Roles and Responsibilities of the Professional Counselor? PART ONE

Our main purpose in this chapter was to present the main tenets of four supervi-
sion models and one supervision approach. Using this information, supervisees
and supervisors can ascertain how certain models might be more appropriate with
specific supervisee needs. Determining which approach might fit the supervisee’s
learning and counseling style is a journey that constantly changes as the supervisee
progresses and grows.

Chapter 5: Key Terms

䉴 Supervision 䉴 Intention 䉴 Active mastery
䉴 Parallel process 䉴 Basic mastery
 chapter Collaborative Supervision
for the Novice Supervisor
6 William J. Casile
Duquesne University

Elizabeth A. Gruber
California University of Pennsylvania

Seth N. Rosenblatt
Duquesne University

In This Chapter

䉴 A Look at Supervision 䉴 Professional Development of Novice

䊏 Purposes of Supervision Supervisors: Knowledge Competency
䊏 Importance of Supervision to the Coun- 䊏 Theoretical Foundations

seling Profession 䊏 Ethical and Legal Considerations

䊏 Supervision, Professional Development, 䊏 Multicultural Impact

and Credentialing
䉴 Professional Development of Novice
䉴 Becoming a Supervisor: Some Starting Supervisors: Disposition
Points 䊏 Collaborative, Learner-Focused Stance
䊏 Training Through Doctoral Programs 䊏 Supportive and Critical Dispositions:
䊏 Self-Developed Supervision Skills: Coexisting Roles
Modeling as a First Step
䊏 Self-Developed Supervision Skills: 䉴 Professional Development of Novice
Gathering Other Resources Supervisors: Strategies
䊏 The Inquiry Learning Cycle

䉴 A Collaborative Model of Supervision: 䊏 Building the Therapeutic Alliance

An Overview 䊏 Using the FERA Inquiry Model in the

䊏 Constructivist Roots of the Collaborative Therapeutic Alliance
Model 䊏 Promoting the Construction of Meaning
䊏 Meeting Competencies Through the Col- 䊏 Using the FERA Inquiry Model in the Con-

laborative Model struction of Meaning

䊏 Advantages of the Collaborative Model 䊏 Evaluating the Work of the Counselor

䊏 Using the FERA Inquiry Model for Evalu-

ating the Work of the Supervisee

䉴 Summary

86
CHAPTER SIX Collaborative Supervision for the Novice Supervisor 87

A LOOK AT SUPERVISION

This chapter is intended as a resource for counselors who find themselves in a su-
pervisory role for the first time. Although all master’s programs in counseling have
a supervision component during which counselor trainees are monitored, pro-
grams normally do not include formal training in counselor supervision. Thus,
graduates of a counselor training program typically have experienced supervision
only as a supervisee and have no specific training on how to be an effective clinical
supervisor. Although endorsing the profession’s efforts to establish training and
practice standards for counselor supervisors, we also recognize the immediate and
very practical needs of counselors faced with the day-to-day challenge of provid-
ing clinical supervision (Borders, Bernard, Dye, Fong, & Nance, 1991; Campbell,
2000). In response to those needs, this chapter, although not intended to be a com-
prehensive training program for counselor supervisors, introduces the collabora-
tive model of supervision as a starting point for novice or untrained supervisors
who need resources in their search for competency.

䊏 Purposes of Supervision

In their definition of supervision, Bernard and Goodyear (2004) incorporated three

equally important and essential purposes for this distinct intervention:

1. Enhance the professional competence of the supervisee.

2. Monitor the quality of counseling offered to the client.
3. Serve as a gatekeeper to the profession of counseling.

It is assumed that in the supervisory relationship, the supervisor, a more experi-

enced, better trained, more complete professional, will serve as a teacher, consul-
tant, counselor, and evaluator for a less experienced counselor, the supervisee (Ber-
nard, 1997). The ability to discriminate when and how to apply these multiple roles
to accomplish supervisory goals distinguishes the competent from the novice su-
pervisor (Bernard & Goodyear, 2004).

䊏 Importance of Supervision to the Counseling Profession

The place of clinical supervision in the process of providing professional counsel-

ing or any professional service is indisputable. The concern for the ethical, legal,
and effective professional practice of counseling and other related human services
requires that professionals participate in supervision of their work (Bernard &
Goodyear, 2004). Prudent counselors need supervision to ensure that their clients
receive appropriate and effective treatment and that they continue to engage in
personal and professional development, a hallmark of being a professional coun-
selor. The Ethical Guidelines for Counseling Supervisors (Hart, Borders, Nance, & Par-
88 What Are the Primary Roles and Responsibilities of the Professional Counselor? PART ONE

adise, 1995) substantiate the need for supervision by outlining some necessary re-
sponsibilities of supervision.

Responsibilities of Supervision (Hart et al., 1995)

䊏 Monitoring client welfare.
䊏 Ensuring compliance with applicable legal, ethical, and professional standards
of practice.
䊏 Evaluating clinical performance and professional development of supervisees.
䊏 Gatekeeping, or assuming responsibility to certify supervisee performance and
potential for academic selection, employment, and credentialing.

䊏 Supervision, Professional Development, and Credentialing

The counseling profession has consistently recognized the supervision of counsel-

ors as an essential component to the development of competent counselors and the
delivery of therapeutic services (Bernard & Goodyear, 2004; Bradley & Ladany,
2001).

State and Board Requirements for and Endorsements of Supervision

䊏 In each state that offers a professional license for counselors, the established pro-
cedures require all applicants to practice counseling for a significant number of
hours under the direct supervision of a licensed counselor capable of supervis-
ing their work (ACA, 2006).
䊏 The National Board of Certified Counselors (NBCC) recognized the unique prac-
tice of supervision by publishing the Standards for Ethical Practice of Clinical Super-
vision (NBCC, 1999).
䊏 The NBCC developed the Approved Clinical Supervisor (ACS) credential in
1997, a credential that identifies mental health professionals who have met the
national supervision standards, promoted professional identity, and encouraged
the professional growth of clinical supervisors. This certificate is now available
from the Center for Credentialing and Education, Inc. (CCE, 2001).

Clearly, the essential role of supervision in the development of a capable profes-

sional counselor is irrefutable.

Visit the CCE site for more information on the ACS credential and to
download an application form at:
䉴 www.cce-global.org
CHAPTER SIX Collaborative Supervision for the Novice Supervisor 89

BECOMING A SUPERVISOR: SOME STARTING POINTS

In the counseling profession, many practitioners are promoted to the supervisory

position as a result of their seniority, exceptional work as a counselor, or desire to be
a supervisor. Moreover, successful counselors often are promoted to supervisory
positions without systematic, formal training on how to supervise, despite the fact
that there is increasing agreement in the professional literature that counselor su-
pervision is a unique process requiring specific preparation and training and that
practicing supervision without appropriate training is an ethical violation (Haynes
et al., 2003). There are numerous obstacles counselors face to receiving the formal
supervisory training recommended by the profession.

Barriers to Professional Supervisory Training

䊏 Master’s-level counselor education programs typically do not prepare graduates
to be supervisors.
䊏 Most counselors work in organizations that do not provide their employees with
adequate clinical supervision.
䊏 Agencies or organizations that employ counselors normally do not commit the
resources to train counselors to become supervisors. Although essential to the
quality of treatment, supervisory training usually is not seen as a billable part of
the treatment model.

Counselors who want to develop supervision skills are practically limited to two
choices. They can join a doctoral program in counselor education and supervision,
or they can self-define and construct a personal route to competency.

䊏 Training Through Doctoral Programs

Most doctoral programs in counselor education emphasize a strand devoted to de-

veloping the knowledge base and skills needed to be successful as a counselor su-
pervisor. However, doctoral work is a long and expensive route of continuing edu-
cation that is available to only a few professional counselors. More frequently, the
novice supervisor is left alone to identify a course of self-development activities
that he or she deems appropriate.

䊏 Self-Developed Supervision Skills: Modeling as a First Step

Because all professionally trained counselors have at least experienced supervision

as a supervisee, they can begin the journey of becoming competent supervisors by
modeling the practice of past supervisors they have experienced. However, reli-
ance on modeling has several obvious limitations.
90 What Are the Primary Roles and Responsibilities of the Professional Counselor? PART ONE

Limitations of Modeling as the Predominant Supervisory

Training Experience
䊏 Many counselors in private practice, schools, or some agencies may not have a
current supervisor to model.
䊏 When available, there is no assurance that the existing supervision experiences
are worthy of emulation.
䊏 The power of a learning model that relies solely on modeling without the clarifi-
cation of reflection, feedback, and guided practice is undoubtedly a highly unre-
liable approach to preparing professionals for the complex demands of supervi-
sion (Schön, 1987).

䊏 Self-Developed Supervision Skills: Gathering Other Resources

Because of the limitations of modeling as a primarily approach to learning how to

supervise, counselors may attempt to assemble some combination of seminars,
workshops, conferences, and contracted supervision of supervision to enhance
their skills as a supervisor. This informal and self-structured approach of learning
to become a supervisor typically begins with many questions that emphasize learn-
ing needs.

Self-Inquiries That Guide Learning Needs of Untrained Supervisors

䊏 What is my role as a supervisor?
䊏 What are my ethical responsibilities and legal liabilities?
䊏 What theory and model of supervision do I use?
䊏 Do I focus on the client or the supervisee?
䊏 What do I have to document in supervision?
䊏 How do I supervise multiple supervisees?
䊏 Am I creating dual relationships with my supervisees?
䊏 How do I obtain supervision?

Unfortunately, these questions usually are generated out of desperation as

novice supervisors attempt to learn their new role and do not support a systematic
approach to becoming a supervisor (Allstetter-Neufeldt, 1999; Falendar &
Shafranske, 2004). Rather, reflections and questions generated in moments of stress
or desperation tend to promote a hodge-podge of activities cobbled together by the
aspiring supervisor. What counselors need, therefore, is a simple framework or
model of supervision that guides professional development and that can be used
by novice supervisors who might not have had the opportunity to receive formal
supervisory training. A collaborative approach to supervision offers the most effec-
tive map that beginning supervisors might use on their journey toward proficiency.
CHAPTER SIX Collaborative Supervision for the Novice Supervisor 91

A COLLABORATIVE MODEL OF SUPERVISION: AN OVERVIEW

The collaborative model of supervision described in this and subsequent sections is

a tool to assist experienced counselors in becoming effective supervisors. The
model borrows generously from the developmental and constructivist elements of
existing theories of supervision to provide novice supervisors with a structural
frame to begin constructing a personal approach to the practice of supervision.
Novice supervisors can gain confidence quickly as they discover that their prior
learning to become effective counselors also will support their learning to become
competent supervisors. Additionally, the use of a constructivist approach to learn-
ing helps novice supervisors understand their new roles and responsibilities by
emphasizing the isomorphic relation between counseling and supervision. Finally,
this model of supervision can assist novice supervisors in laying the philosophical
groundwork for their supervisory tasks and conceptualizing how and why they re-
spond the way they do in supervision sessions.

䊏 Constructivist Roots of the Collaborative Model

Constructivism is concerned with the nature of how knowledge is created and is

based on the assumption that people actively create meaning by connecting pre-
vious knowledge to new information gained through experience (Fosnot, 1996).
The result is the creation of new understanding and meaning (McAuliffe,
Eriksen, & Associates, 2000). The collaborative model of supervision takes ad-
vantage of the constructivist theory of learning and acts like a conceptual scaffold
that helps the counselor acquire the knowledge, disposition, and skills needed to
become a supervisor. The model allows competent counselors to begin conceptu-
alizing their practice of supervision by building on their current understanding
of the developmental processes in counseling. That is, the model encourages
counselors to become active creators of new meaning by helping them relate
what they already know about counseling to similar processes found in supervi-
sion.

䊏 Meeting Competencies Through the Collaborative Model

The collaborative model of supervision focuses on the fact that in both counseling
and supervision, one of the most important outcomes is that both supervisees and
clients develop, learn, and change in ways that allow them either to practice more
effectively or live healthier lives without the risk of harm in the process of growth.
Counselor education prepares counselors to facilitate and monitor this process
with clients. The collaborative model helps to bridge existing counseling compe-
tencies to the competencies required of successful supervisors.
92 What Are the Primary Roles and Responsibilities of the Professional Counselor? PART ONE

Knowledge, Disposition, and Strategies Competencies

1. Building a knowledge base: In the collaborative model, novice supervisors build a
knowledge base for supervision by beginning with what they have learned to
become effective professional counselors. Specifically, supervisors must ex-
plore, understand, and apply theoretical foundations, ethical and legal princi-
ples, and cultural awareness to the process of supervision.
2. Promoting a collaborative disposition: The collaborative model encourages super-
visors to approach supervision with a disposition that promotes a collabora-
tive partnership, the nature of which is characterized by a critical friendship.
3. Identifying strategies: The collaborative model identifies three essential tasks or
strategic areas that must be addressed to discharge the major responsibilities or
obligations of the supervisor. These tasks are building a therapeutic or working
alliance, promoting the construction of meaning, and evaluating and monitor-
ing the work of the counselor.

䊏 Advantages of the Collaborative Model

The use of this model has several advantages derived from its premise that the
competent counselor already has learned much that can be applied to supervision.
First, it provides a solid theoretical platform on which the novice supervisor can
stand confidently. Second, it encourages supervisors to emphasize the collabora-
tive perspective of supervision over the evaluative component in their relation-
ships with supervisees. Third, the model emphasizes the supervisor’s responsibil-
ity, parallel to that of the counselor, to create a safe environment where supervisees
become active partners, empowered to reflect and examine their own resources,
performance, and needs for development.

PROFESSIONAL DEVELOPMENT OF NOVICE SUPERVISORS:

KNOWLEDGE COMPETENCY

The knowledge base of the successful counselor can form a sturdy foundation on
which to build the new learning needed for working as a supervisor. Trained coun-
selors have assimilated much information about (a) theoretical foundations, (b)
ethical and legal principles, and (c) the impact of cultural variables on the process
of counseling; thus, these three areas are essential starting points for novice super-
visors to construct the knowledge needed to become effective clinical supervisors.

䊏 Theoretical Foundations

Counseling theories are the basis of successful clinical work; theoretical founda-
tions of supervision are equally essential to competent supervision. Supervisors
CHAPTER SIX Collaborative Supervision for the Novice Supervisor 93

must be grounded in a supervisory theory that speaks to their beliefs about how
supervisees and clients think, learn, grow, and change. The process of theory explo-
ration lays the foundation for how the novice supervisor begins to conceptualize
supervision. The emergence of an individualized theory of supervision ultimately
structures the practice of supervision, guiding what the supervisor attends and re-
sponds to during the supervisory session.

Supervisors must be grounded in a supervisory

theory that speaks to their beliefs about
how supervisees and clients think,
learn, grow, and change.

To develop a personalized supervision theory, practitioners first must read and

reflect on currently proposed theories. Most prevalent supervision theories in the
counselor supervision field have their roots in counseling theory. Only relatively
recently have dedicated theories of supervision been described. Bernard and
Goodyear (2004) presented a concise overview of three classifications of counselor
supervision models that are a useful starting point for creating a theoretical foun-
dation to supervision; the three categories are psychotherapy-based models, devel-
opmental models, and social role models.

Three Classifications of Counselor Supervision Models

(Bernard & Goodyear, 2004)
1. Psychotherapy theory-based supervision models are grounded in assump-
tions about human change, what change means, and how it occurs in the coun-
selor–client therapeutic alliance. These beliefs about the therapeutic alliance
are applied to the supervisor–supervisee relationship.
2. Developmental supervision models focus on how supervisees grow and
change during their personal and professional lives. The major tenet of the de-
velopmental philosophy holds that individual stages of growth occur among
the diverse pool of supervisees. The supervisor must recognize the individual
needs and growth potential of supervisees and then create an environment tai-
lored to fit the individual, developmental needs of each supervisee.
3. Social role supervision models recognize that supervisors and supervisees
bring a variety of professional role experiences, learned knowledge, and con-
ceptualizations about the process of counseling and supervision to the supervi-
sory experience. Social role theories presuppose that supervision acts as a
metarole used to monitor supervisee needs and guide the supervisor in the se-
lection of the most efficacious role (e.g., teaching, consulting, and counseling
roles) to meet supervisee needs.
94 What Are the Primary Roles and Responsibilities of the Professional Counselor? PART ONE

Although there is not space to describe the various theories that comprise the three
categories of supervision theory, a list of theories is given here for interested
readers.

Psychotherapy-Based Supervision Models

䊏 Psychodynamic model (Frawley-O’Dea & Sarnat, 2001; Gill, 2001).
䊏 Person-centered model (Lambers, 2000; Patterson, 1997).
䊏 Cognitive-behavioral model (Liese & Beck, 1997; Rosenbaum & Ronen, 1998).
䊏 Systemic/family therapy model (Liddle, Becker, & Diamond, 1997; Montgom-
ery, Hendricks, & Bradley, 2001).
䊏 Narrative model (Clifton, Doan, & Mitchell, 1990).
䊏 Solution-focused model (Marek, Sandifer, Beach, Coward, & Protinsky, 1994;
Rita, 1998)
䊏 Feminist model (Carta-Falsa & Anderson, 2001; Prouty, Thomas, Johnson, &
Long, 2001).

Developmental Theories of Supervision

䊏 The Littrell, Lee-Borden, and Lorenz model (Littrell, Lee-Borden, & Lorenz, 1979).
䊏 The Stoltenberg model (Stoltenberg, 1981).
䊏 The Loganbill, Hardy, and Delworth model (Loganbill, Hardy, & Delworth, 1982).
䊏 The Stoltenberg and Delworth model (Stoltenberg & Delworth, 1988).
䊏 The Skovholt and Rønnestad model (Rønnestad & Skovholt, 1993; Skovholt &
Rønnestad, 1992).

Social Role Theories of Supervision

䊏 The discrimination model (Bernard, 1979, 1997).
䊏 The Hawkins and Shohet model (Hawkins & Shohet, 1989, 2000).
䊏 The Holloway systems model (Holloway, 1995, 1997).

䊏 Ethical and Legal Considerations

No counselor can practice without a thorough understanding of the legal and ethi-
cal principles that guide appropriate professional behavior. Similarly, no supervi-
sor can operate responsibly without adhering to the principles that define legal and
ethical supervisory practice. The ACA Code of Ethics (2005a) outlines ethical issues
of importance for supervisors and supervisees. Additionally, the Association for
Counselor Education and Supervision (ACES), the professional organization for
counselor educators and supervisors, has developed Ethical Guidelines for Clini-
cal Supervisors (ACES, 1993).
CHAPTER SIX Collaborative Supervision for the Novice Supervisor 95

ACES Guidelines for Ethical Supervisory Behavior (ACES, 1993)

䊏 Observe ethical and legal protection of clients’ and supervisees’ rights.
䊏 Meet the training and professional development needs of supervisees in ways
consistent with clients’ welfare and programmatic requirements.
䊏 Establish policies, procedures, and standards for implementing programs.

These same Ethical Guidelines for Clinical Supervisors (ACES, 1993) also describe
the functions of the supervisory role.

Functions of the Ethical Supervisor (ACES, 1993)

䊏 Monitor client welfare.
䊏 Encourage compliance with relevant legal, ethical, and professional standards
for clinical practice.
䊏 Monitor supervisee clinical performance and professional development.
䊏 Evaluate and certify current performance and potential of supervisee.

Bernard and Goodyear (2004) categorized the major ethical issues facing coun-
selor supervisors. A summary of these issues is given here.

Key Ethical Issues Facing Counseling Supervisors

䊏 Due process refers to the procedures that guarantee notice and fair hearing prior
to the removal or abridgment of a person’s rights.
䊏 Informed consent is the client’s right to be fully informed of the parameters of
treatment, including potential harm.
䊏 Dual relationship refers to a relationship a supervisor forms with a client or
supervisee in addition to the therapeutic or supervisory relationship.
䊏 Competence is the ability to practice (therapy and supervision) effectively and
within the limits of the professional’s training and ability.
䊏 Confidentiality is the ethical responsibility of the counselor or supervisor not to
disclose information obtained in professional relationships with clients, except
when required to ensure safety or meet a judicial order.

Borders and Brown (2005) added to this list the issue of evaluation. Supervisors have
an ethical responsibility to provide their supervisees with continuous feedback
based on regular face-to-face review of actual performance samples.
It is clear that supervisors are both ethically and legally responsible for the qual-
ity of their supervisee’s work (Bernard & Goodyear, 2004; Borders & Brown, 2005;
Disney & Stephens, 1994; Falvey, 2002). Supervisors may be directly or vicariously
liable for the actions of the supervisee. Therefore, it is critical that supervisors learn
how to maintain careful documentation of their work so that they can promote the
professional development of their supervisees, ensure the appropriateness of treat-
ment for clients, and manage their own exposure to professional liability (Falvey).
96 What Are the Primary Roles and Responsibilities of the Professional Counselor? PART ONE

Allstetter-Neufeldt (1999), Campbell (2000), and Falvey et al. (2002) all provide
valuable information on documentation in supervision.

For more information on ethical and legal issues in counseling, see Chapters 2 and 3.

䊏 Multicultural Impact

Multicultural awareness and competence is perhaps the most important force

shaping the practice of counseling and supervision today. The recent revision of
the ACA Code of Ethics (ACA, 2005a) focused on the inclusion of multicultural
and diversity issues to all aspects of the counseling professional’s work. Indeed,
the code states, “Counseling supervisors are aware of and address the role of
multiculturalism/diversity in the supervisory relationship” (ACA, 2005a, F.2.b).
By maintaining contact with the ACA, the ACES, and the Association for Multi-
cultural Counseling and Development, supervisors integrate and reinforce the
multicultural aspects of relevant ethical standards into their work with super-
visees.
According to Sue and Sue (2003), the first step to becoming a multiculturally
competent counselor is increasing awareness of one’s own assumptions, values,
and biases that may affect the therapeutic alliance. Likewise, cultural competence
is central to the supervisory relationship to ensure that supervisors will not allow
cultural assumptions, values, and biases to interfere with the supervisee’s devel-
opment, affect the welfare of the supervisee’s clients, or interfere with the work-
ing alliance.

Ways to Ensure Cultural Sensitivity in the Supervisory Relationship

䊏 Identify and discuss explicitly multicultural issues present in both counseling
and supervisory relationships (Neufeldt, 1999).
䊏 Use the working alliance between supervisor and supervisee to collaboratively
and authentically examine the impact of culture on the supervisory work.
䊏 Develop trusting, open, and congruent avenues of communication about cul-
ture in the supervisory relationship to help counselors and supervisees con-
struct parallel discussions around culture in their therapeutic relationships
with clients.
䊏 Respond respectfully to differences and use culturally appropriate interven-
tions.

Counselors and supervisors must understand and integrate into practice the criti-
cal skills needed to be multiculturally competent professionals. Ignoring multicul-
tural issues potentially can lead to ineffective supervision or result in harm to the
supervisee or client. Thus, it is essential that cultural awareness and competence
underlie both counseling and supervision practice. Ladany, Brittan-Powell, and
Pannau (1997); Ladany, Inman, Constantine, and Nutt (1997); and Pope-Davis and
CHAPTER SIX Collaborative Supervision for the Novice Supervisor 97

Coleman (1997) all provided useful and more detailed reflections on multicultural
awareness in supervision.

See Chapter 4 for more information about multicultural competence in counseling.

PROFESSIONAL DEVELOPMENT OF NOVICE SUPERVISORS:

DISPOSITION

Constructing a wide knowledge base is one aim of the collaborative model of su-
pervision; additionally, the model suggests that novice supervisors will be most
successful if they consciously cultivate a professional disposition characterized by
an amalgam of support and critique. Through supportive, yet critical partnerships,
supervisees will be able to receive the feedback needed for their development, the
assurance that their practice will do no harm to their clients, and the validation that
their performance meets the standards demanded by the profession. Whether
working in the role of teacher, consultant, counselor, or evaluator, supervisors’ ef-
fectiveness will be enhanced if they are able to frame their work from a supportive
or critical or collaborative perspective.

䊏 Collaborative, Learner-Focused Stance

The collaborative model of supervision is consistent with a postmodern view of

learning and development in that it emphasizes an epistemological shift from
objectivism to constructivism. Implications of the shift to a constructivist philoso-
phy in the supervision relationship are mentioned here.

Characteristics of a Collaborative Supervisory Relationship

䊏 The “learners” or the clients and supervisees, as well as their social contexts, are
accentuated over the “content” that emerges during the supervision sessions
(Neufeldt, 1997; Sexton, 1997).
䊏 The expert authority, didactic, and abstract instructional paradigm that presup-
poses “expert” supervisors know what the novice supervisees need is deempha-
sized.
䊏 A collaborative disposition that creates a culture of trust, openness, and the mu-
tual or shared responsibility for the well-being and development of the client,
counselor, and supervisor is emphasized (Casile & Davison, 1998).
䊏 Supervisors working from a collaborative disposition do not abandon their
evaluative responsibility; rather, they invite the supervisee to treat it as another
problem to be solved and another mutual opportunity for learning.
98 What Are the Primary Roles and Responsibilities of the Professional Counselor? PART ONE

One way to understand the collaborative disposition is to examine the fundamen-

tal nature of the relationship between supervisor and supervisee that serves the de-
velopmental and evaluative aims of supervision.

䊏 Supportive and Critical Dispositions: Coexisting Roles

To simultaneously assume a supportive, friendly role and a critical stance in the

same supervisory relationship seems to be a contradiction. Indeed, combining the
roles and norms of both a critic and a friend may appear to pose a dilemma
(Achinstein & Meyer, 1997; Bambino, 2002; Hill, 2002). However, current conceptu-
alizations of the supervisory process are unable to avoid the merging of develop-
mental and evaluative roles that are both critical and supportive. It is, in fact, the
role of supervisors to be the critical friend of counselors who promote development
by holding counselors’ work up to the ethical and professional practice standards
that define competency. Costa and Kallick (1993) described the critical friend as
follows:

Critical friend: “[A] trusted person who asks provocative questions, pro-
vides data to be examined through another lens, and offers critiques of a per-
son’s work as a friend. A critical friend takes the time to fully understand the
context of the work presented and the outcomes that the person or group is
working toward. The friend is an advocate for the success of that work”
(p. 50).

Hill (2002) introduced a competency model for framing the work of a successful
critical friend in terms of knowledge, skills, and attitudes.

Characteristics of the Competent Critical Friend (Hill, 2002)

䊏 The critical friend is knowledgeable about a critical framework and how as-
sumptions underpin people’s justification for their practices.
䊏 The critical friend is skillful at reflective responding, scholarly and investigative
reframing, facilitated silence, encouraging documentation and data collection,
scholarly reading, articulating an inquiry paradigm, big-picture facilitation, and
encouraging publication.
䊏 The critical friend’s attitude is intricately linked to beliefs about one’s provi-
sion of critical friendship, the value of reflection as a professional skill, and
oneself.

Interactions between a supervisor and counselor should be a true dialogue be-

tween eager listeners, not a struggle between contending and defensive interests.
The critical friend or the supervisor who assumes a collaborative disposition en-
CHAPTER SIX Collaborative Supervision for the Novice Supervisor 99

courages the creation of effective therapeutic working alliances, the construction of

meaning, and the shared, formative evaluation of the practicing supervisor.

PROFESSIONAL DEVELOPMENT OF NOVICE SUPERVISORS:

STRATEGIES

As mentioned in the overview of the collaborative model, there are three strategies
employed by all supervisors:

1. The collaborative supervisor is the consultant or counselor who creates a sup-

portive and developmental relationship with the supervisee.
2. The collaborative supervisor is the teacher who cultivates the supervisee’s per-
sonal and professional growth by fostering new meaning and understanding
in the work.
3. The collaborative supervisor is the evaluator who assesses the supervisee’s
competence and effectiveness, ensuring that the work does no harm.

Although not meant to be an exhaustive description of supervisor tasks, these three

strategies are necessary and essential components of effective supervision. In addi-
tion, they provide a structural parallel between what counselors do and what su-
pervisors must learn to do. Thus, the novice supervisor can begin to construct or
learn the tasks of supervision by building on what he or she already knows about
the tasks associated with the counseling process.
Effective counselors have the ability to engage clients in working relationships,
similar to Bordin’s (1994) concept of a working alliance in supervision. The con-
struction of meaning through the exploration and understanding stages of the
counseling process described by Egan (1998, 2002) and others parallels the mean-
ing-making aspect of supervision facilitated in the collaborative model of supervi-
sion through the inquiry learning cycle (Hill & O’Brien, 1999). Finally, counselors
must develop strategies to evaluate and monitor the work and progress of their cli-
ents. Supervisors, too, must learn how to evaluate their supervisees’ work, its im-
pact on their clients, and the supervisors’ fitness for the profession.
These three strategies—developing the working alliance, generating new mean-
ing, and evaluating the work—are central to the work of collaborative supervision.
However, each of these functional tasks is dependent on the context of the unique
interpersonal role relationship that evolves between the supervisor and super-
visee. This supervisory relationship, like any other relationship, is susceptible to in-
terpersonal interferences such as transference and countertransference (Ladany
et al., 2000), attachment styles (Watkins, 1995), and power and influence (Holloway,
1995). To mitigate the effects of these and other factors that influence the working
alliance, the collaborative model of supervision uses the inquiry learning cycle as a
tool to guide the novice supervisor through the stages associated with learning and
100 What Are the Primary Roles and Responsibilities of the Professional Counselor? PART ONE

development. For more information on factors that influence the supervisory rela-
tionship, see Bernard and Goodyear (2004), Frawley-O’Dea and Sarnat (2001), and
Gill (2001).

䊏 The Inquiry Learning Cycle

In the collaborative model of supervision, the skills of inquiry learning are used to
structure and support the primary tasks of supervision in developing a working
relationship, constructing deeper meaning, and evaluating the performance of
supervisees and their impact on clients.
Collaborative supervisors can effectively address the developmental or learning
tasks and the evaluative tasks of supervision by applying the stages of the FERA
learning cycle—focusing, exploring, reflecting, and applying—to monitor their
work with counselors in supervision.
In the collaborative model, the process of supervision can be conceptualized as a
continuously recursive learning cycle that includes the use of the following stages
and associated methods to address the primary tasks of building the relationship,
fostering insight, and evaluating the work.

Stages of the FERA Learning Model in Supervision

1. Focus by engaging the counselor and determining what is known and what is
not known about both content and process. The supervisor must listen for and
determine what is explicit and what is implied in the counseling or supervision
relationship.
2. Explore by encouraging the counselor to frame questions, develop hypotheses,
and predict consequences of action that might be taken. This stage promotes
the investigation of issues and processes that are emerging in the counseling or
supervisory relationships.
3. Reflect through facilitating dialogue that promotes shared or mutual under-
standing and insight into the counseling and supervising experiences. New
learning and the removal of blind spots help both the counselor and the super-
visor gain different perspectives on the work and the relationships.
4. Apply by monitoring the implementation of new learning as it is used in the
practice of counseling and supervision. Each decisive action plan or action can
become the target of an investigation to determine if it is working and if the
practice is effective.

These stages of the FERA learning cycle can be applied to each task of supervision
identified in the collaborative model of supervision. One way to demonstrate the
use of the FERA model in the development of collaborative supervision is to exam-
ine some case examples. Each of the following three case studies provides exam-
ples of supervisor probes to move the work of supervision toward the accomplish-
ment of one of the primary tasks of supervision: building the therapeutic alliance,
promoting the constructing of meaning, and evaluating and monitoring the work
CHAPTER SIX Collaborative Supervision for the Novice Supervisor 101

of the counselor. It is important to note that some of the probes target the supervi-
sory relationship, and some questions are directed at the counseling relationship.
Although these are not addressed simultaneously, it is important for the supervisor
to ensure that both of these systems are examined in the course of supervision.

䊏 Building the Therapeutic Alliance

To best serve the purposes of supervision, the relationship between the supervisor
and supervisee must function as a therapeutic working alliance (Bordin, 1983). In
the context of supervision, the therapeutic working alliance can be described as fol-
lows:

Therapeutic working alliance: A supervisee-centered, collaborative relation-

ship driven by the clinical and developmental needs of the supervisee, in
which the process of identifying and addressing the supervisee’s needs as
they arise must be the mutual responsibility of both professionals.

The creation of a working alliance between the supervisor and supervisee that
emphasizes mutual responsibility for the work of supervision is the foundation of
collaborative supervision. This relationship is a precursor and necessary condition
to the construction of meaning and evaluation of outcomes in supervision. It is the
formation of this alliance that supports authentic learning for the supervisee, as
well as the supervisor, and it ensures that the supervisee’s and clients’ learning and
welfare are held to the highest level of professional standards of accountability.
The relationship or working alliance in collaborative supervision is fostered by
explicitly creating a safe and secure environment through the application of the
core Rogerian conditions for effective helping: genuineness, respect, and empathy
(Rogers, 1951). This parallels the relationship that the counselor is attempting to
develop with the client. However, the parallels also extend to the threats to these re-
lationships. Both are susceptible to defense mechanisms, projections, and other in-
terpersonal processes that can interfere with awareness and expression.
The inquiry learning cycle applied to the process of relationship development
will establish a supervision culture that emphasizes the development of healthy
supervisor–counselor attachments and decreases the probability that the attach-
ments will be anxious or compulsive as a result of an excessive emphasis on the hi-
erarchical power structure in the counseling or supervisory relationship. Spe-
cifically, as the counselor and supervisor move through the FERA cycle, their
awareness, or the ability to perceive what is going on with the client, counselor, and
supervisor systems, will be increased. The supervisor must learn to model and fa-
cilitate expression, or the willingness to verbalize questions, interpretations, and
confrontations that invite the pair into deeper, more accurate, and complete under-
standing of their experiences. The combination of increased awareness and risked
expression fuels the developmental process in supervision in the same way it does
in counseling.
102 What Are the Primary Roles and Responsibilities of the Professional Counselor? PART ONE

EXAMPLE

The Case of Gwen: Building the Relationship

Gwen was promoted to clinical supervisor 3 months ago. She has been with her agency for 4
years as a clinician. Gwen has a master’s degree in community counseling and is well re-
spected by her peers as a clinician. One of her supervisees presented the following case:
Margarita (supervisee) is counseling an 11-year-old female who was referred to counseling by
her grandmother. The client lost her mother about 6 months ago and is currently living with
her grandmother. She is suffering from sleep deprivation, grief and loss, panic attacks, and
separation anxiety. The separation anxiety intensifies when she is at school due to her fear that
if she is not with her grandmother, she may pass away like her mother. Margarita hopes in pre-
senting this case she can deal with her confusion of where to focus with this client, as well as
receive feedback on how effective she has been in forming a relationship with this client.
Gwen and Margarita have a positive working alliance. They have been colleagues for 2 years
and discussed their new supervisor and supervisee roles. There is trust in their relationship
and agreed-on goals in the supervision contract. Margarita, the counselor, is not sure if she
knows how to develop the relationship with a client this young. She wants to develop a safe
and trusting environment with the client. However, when she presents the case in supervision,
she focuses on the content of the child’s narrative. Gwen, the supervisor, wants the counselor
to focus more concretely on the counselor’s relationship with the client and with her as the su-
pervisor.

䊏 Using the FERA Inquiry Model in the Therapeutic Alliance

The first step in the FERA model is to focus, by engaging the counselor and deter-
mining what is known and what is not known, about both content and process. The
supervisor chooses interventions that first promote focusing on the mutual goals of
the supervisory dyad.

Probes That Focus on the Goals of the Supervisory Alliance

䊏 How do you perceive your relationship with me in supervision?
䊏 I feel that our supervisory relationship has benefited by our shared experience as
peer counselors.
䊏 Tell me about your relationship with this client.
䊏 What is not safe or trusting in your relationship with the client?
䊏 What are your thoughts when an 11-year-old tells you of her recent loss?

The second step in the inquiry model is to explore by encouraging the counselor to
frame questions, develop hypotheses, and predict consequences of action that
might be taken. Once the supervisor feels the counselor is focused on an aspect of
one of the relationships, the supervisor might shift to encouraging the counselor to
experiment with the situation.
CHAPTER SIX Collaborative Supervision for the Novice Supervisor 103

Probes That Help Supervisees Explore Their Relationships

䊏 How do you feel aspects of your culture affect your working relationship with
me in supervision?
䊏 What do you want to ask me about our work together in supervision?
䊏 Tell me what you need from me in supervision.
䊏 How do you explain the part of our work together that is least effective?
䊏 How might supervision be different if I did live supervision of your next session?
䊏 What questions have you formed or asked your client about her culture?
䊏 Does your ethnicity affect your working relationship with this client?
䊏 What are you curious about in your relationship with this client?
䊏 What might get in the way of building a trusting relationship with your client?
䊏 What might happen if you stopped taking responsibility for suggesting things
she could talk about?
䊏 What questions do you think you need to ask your client?

The third step in the FERA model is to reflect, which can be done by facilitating dia-
logue that promotes a shared understanding of the counseling and supervising ex-
periences. After exploring the supervisee’s experience and their shared experience,
the supervisor poses interventions that invite the counselor to derive new meaning
from these experiences. The supervisee constructs new meaning by building on
what is already known. Where appropriate, the supervisor adds meaning from al-
ternative perspectives.

Probes That Can Add Meaning to the Supervisory Experience

and the Working Alliance
䊏 Tell me what you have learned about our working relationship.
䊏 What has been difficult for you in our supervision?
䊏 How have you become more aware of yourself in supervision?
䊏 How have you become more aware of yourself in counseling?
䊏 How has this work been the same or different than your work with other clients?
䊏 What have you learned about your relationship with your client?
䊏 What do you think about most frequently when you see this client?
䊏 I am wondering what you hold back and do not say to your client.

In the last step, apply, the supervisor monitors the implementation of new learning
into the counseling and supervision process.

Probes That Facilitate the Use of New Learning About

the Therapeutic Alliance
䊏 What will you do to acknowledge cultural differences in supervision?
䊏 How will we know if we are addressing your issues and concerns in supervi-
sion?
104 What Are the Primary Roles and Responsibilities of the Professional Counselor? PART ONE

䊏 What are the most helpful ways for me to give you feedback on your responses to
this client?
䊏 How do you evaluate your effectiveness as a supervisee?
䊏 What have you learned about strengthening the therapeutic relationship with
this client?
䊏 What will you do to acknowledge cultural differences in counseling?
䊏 What techniques are you considering using in your next counseling session?
䊏 How will you know if you are developing a safer, more trusting relationship
with this child?

䊏 Promoting the Construction of Meaning

Inquiry-based learning utilizes questioning or probing techniques that promote an

applied research or active inquiry approach to learning. Examples of similar tech-
niques in current supervision practice include Kagan’s interpersonal process recall
(IPR) (1976, 1980) and Anderson’s (1987) use of reflecting teams. Inquiry is de-
signed to uncover or help construct meaning and promote insight in the use of in-
terventions, conceptualization of case issues, and the process of therapy and super-
vision.
In this phase of supervision, the supervisory alliance turns its attention to de-
veloping effectiveness. Focusing on the skills of counseling and supervision
(Rønnestad & Skovholt, 1993) and brainstorming possible and alternative re-
sponses to the expressed and implied content, as well as the process emerging in
the relationships between client and counselor and counselor and supervisor, new
insight and the possibility of a more effective future emerges.

EXAMPLE

The Case of Penina: Promoting Insight

Penina (supervisee) is working with a 19-year-old female college student who is abusing alco-
hol and other substances at least four times a week. Her grades have dropped over the past se-
mester and she is contemplating changing her major. She missed 30% of her classes before
11:00 a.m. She is in a verbally abusive relationship. She also reports mood swings and signs of
depression. Penina refers her for an assessment at an alcohol and drug treatment facility but
the client refuses to go, and she denies she has a problem with substances. The client believes
alcohol and drug use and abuse is just part of the college culture. The client’s goal for counsel-
ing is to control the mood swings to help her relationship improve. She has expressed an inter-
est in continuing to work with Penina. Penina is frustrated because the client will not follow
through with the recommendations she makes. She is seeking supervision to help her deal
with her frustration in this case.
CHAPTER SIX Collaborative Supervision for the Novice Supervisor 105

䊏 Using the FERA Inquiry Model in the Construction of Meaning

The questions in this section and the following three sections attempt to guide
supervisees in the construction of new meaning in the supervisory process. Focus,
the first step in the FERA model, calls supervisors to engage the counselor and de-
termine what is known and what is not known, about both content and process.

Probes That Help Focus the Counselor on Alternative Meanings

䊏 What are the major reasons for presenting this case in supervision?
䊏 What do you need from me?
䊏 How do I frustrate you?
䊏 How does the client frustrate you?
䊏 What do you know about substance abuse?
䊏 What do you know about the developmental levels of college students and the
norms of the college culture?
䊏 What is the client not telling you?

Next, the supervisor explores with the supervisee ways to frame questions, de-
velop hypotheses, and predict consequences of action that might be taken.

Probes That Explore New Meanings

䊏 What more do you need to know about me as your supervisor?
䊏 How has our progress been affected by working with a supervisor of a different
race or gender?
䊏 What ethical issues need to be addressed?
䊏 What are the challenges for you in this case?
䊏 How do you feel about addicts … this addict?
䊏 Tell me about your frustrations.
䊏 What more do you need to know about your client?
䊏 What are your concerns about the relationship your client is in?
䊏 What theories help you understand what this client is doing in therapy?

After exploring the supervisee’s experience and their shared experience, the su-
pervisor poses interventions that invite the counselor to reflect and to derive new
meaning for these experiences. The supervisee constructs new meaning by build-
ing on what he or she already knows. The supervisor facilitates this process and,
where appropriate, adds meaning from alternative perspectives.

Probes That Add Meaning for the Counseling and Supervisory Experience
䊏 What have you learned about working with me?
䊏 What do you struggle with in supervision?
䊏 How can we be more effective in supervision?
106 What Are the Primary Roles and Responsibilities of the Professional Counselor? PART ONE

䊏 What have you learned about working with this client?

䊏 How is your theory of counseling giving you a foundation to work with this cli-
ent?
䊏 How has new awareness changed your goals?

In the last step, apply, the supervisor monitors the implementation of new learning
into the counseling and supervision.

Probes That Facilitate the Use of New Learning

䊏 What can we do in supervision to deal with the frustration you feel when this cli-
ent does not follow through?
䊏 How do you evaluate your ability to understand your client’s behavior?
䊏 What have you learned working with this client that might help you with the
other clients we discuss?
䊏 How will you begin your next session with this client?
䊏 What homework can you do to gain more knowledge about this client’s addic-
tion?
䊏 What techniques will you use with this client?
䊏 What are the options and possible outcomes you have considered?

䊏 Evaluating the Work of the Counselor

One of the roles that a counselor supervisor must assume is that of an evaluator.
Evaluation in supervision can be defined this way:

Evaluation: The “objective appraisal of the supervisee’s performance based

on clearly defined criteria that are realistic and attainable” (Kadushin, 1992).

In the collaborative model of supervision, the process of evaluation can still be pro-
moted as a collaborative process and a shared responsibility. There is no question
that supervisors have the authority and ethical responsibility to evaluate counsel-
ors’ effectiveness and fitness for the professional practice of counseling (Bernard &
Goodyear, 2004; Borders & Brown, 2005). However, that does not preclude the use
of collaborative methods to discharge this functional duty.

Characteristics of Effective Coevaluation

in a Collaborative Supervisory Relationship
䊏 Coconstructed evaluation agendas, goals, and targets (What will be learned?).
䊏 Jointly selected performance criterion (How well will it be learned?).
䊏 Mutually agreed-on observable samples and products of performance (What
will be the evidence of learning?).
CHAPTER SIX Collaborative Supervision for the Novice Supervisor 107

This disposition toward evaluation promotes the explicit intention and reasons for
the assessment of the supervisee’s level of competency demonstration. It invites
supervisees to claim their level of competency by comparing evidence of their per-
formance to the competencies they have helped to construct. This approach to eval-
uation fosters the use of self, peer, and expert data collection and behavioral assess-
ment in formulating a conclusion about the effectiveness of the work. The use of a
written supervision agreement, mutually developed, fosters growth of the super-
visee and provides critical documentation of the supervision.

EXAMPLE

The Case of Marquel: Coevaluation and Feedback

Marquel (supervisee) is working with a 27-year-old woman who is engaged to be married. She
entered counseling to deal with anxiety she has been experiencing. The client recently re-
ported she was sexually abused as a child. Because the client feared no one would believe her,
she never disclosed this to anyone before, but she feels she is not able to keep it in any longer.
The perpetrator was a neighbor and the abuse occurred when she was 7 years old. The client
reports that she feels okay and believes this experience will not affect her relationship with her
fiancé, although she is worried that her fiancé may have difficulty with her past sexual abuse
and leave her. She wonders whether or not to tell him. Marquel has worked with other survi-
vors of sexual abuse, but he is concerned about this client and unable to stop thinking about
this situation. Marquel seeks supervision from his supervisor to help him with this case and
deal with his concerns for his client.

䊏 Using the FERA Inquiry Model for Evaluating the Work of the Supervisee

The first step in using the FERA process, again, is to focus, this time on the coun-
selor’s performance in both the counseling and supervisory relationships.

Probes That Help Focus on the Counselor’s Performance

䊏 What are your goals for supervision in this case?
䊏 What aspects of your work do you want to address?
䊏 What role do your discomfort or concerns for this client play in your work?
䊏 How do you judge if your concerns for this client inhibit or promote your effec-
tiveness with her?
䊏 What criteria do you use to evaluate your effectiveness with this goal?
䊏 How do you judge the effectiveness of your interventions with this client?
䊏 What does this client do to let you know if you are accurately empathic?
108 What Are the Primary Roles and Responsibilities of the Professional Counselor? PART ONE

The second step, exploration, encourages the counselor to frame questions, de-
velop hypotheses, and predict consequences of action that might be taken. Once
the supervisor feels the counselor is focused on an aspect of evaluation, he or she
might shift to encouraging the counselor to test the situation.

Probes That Test the Counselor’s Evaluation

䊏 What criteria should we choose to evaluate your work in supervision?
䊏 Where do you begin with your self-evaluation of your performance in this area?
䊏 What can we do differently to enhance the supervision experience for you?
䊏 What can we look at to evaluate your ability to … ?
䊏 What do you need to know next?
䊏 What skills do you want to develop next?

The third step in the FERA model, reflect, is engaged by facilitating dialogue that
promotes a shared understanding of the counseling and supervising experiences.
After exploring shared experiences regarding evaluation, the supervisor poses in-
terventions that invite the counselor to derive new meaning from these experi-
ences.

Probes That Add New Meaning for the Supervisee

in Relation to Evaluation
䊏 What does my evaluation of your work mean to you?
䊏 What have you learned about yourself today?
䊏 What have you learned about how you use or ignore your theoretical orienta-
tion?
䊏 How much do you trust your self-evaluation of your effectiveness with this cli-
ent?
䊏 What might you want to do differently with this client?
䊏 How have your goals for working with this client changed?
䊏 Tell me what you have learned about yourself working with someone from a dif-
ferent or similar culture.
䊏 Do you see this client differently?
䊏 How congruent has your behavior been with the goals you set with this client?

The final step, apply, calls on the supervisor to monitor the implementation of new
learning in the counseling and supervision.

Probes That Enhance the Use of New Learning About Evaluation

䊏 I am going to do … to improve my supervisory skills.
䊏 What outside work will you do for professional development in this area?
䊏 What are you going to do to improve your counseling skills?
CHAPTER SIX Collaborative Supervision for the Novice Supervisor 109

䊏 How will you gain the needed knowledge?

䊏 How will you integrate new learning into supervision? Counseling? Other areas?
䊏 What are your plans for your new learning with your client?
䊏 How can this supervision support your professional or career goals?

SUMMARY

It was our intent in this chapter to provide novice supervisors with a framework to
begin the formal professional development training needed if they are to become
ethical and effective supervisors. The collaborative model of supervision, like all
attempts to model complex human interactions, is a simplistic attempt to explain
the intricate process of supervisor development. However, it has been proposed as
one way to establish the essential elements of a map to guide the journey toward
supervisor maturity. The model suggests the needed knowledge acquisition, a
strategy for skill development, and the promotion of a collaborative disposition to-
ward the work of a supervisor. The model incorporates the application of an in-
quiry learning cycle, from focus through exploration, to reflection and application,
as a strategic approach to the tasks of supervision: building the therapeutic alli-
ance, constructing meaning, and evaluating the work of the supervisee.
It is through the application of a tangible model of supervision, in this case, the
collaborative model of supervision, that novice supervisors can begin to chart a
course of professional development that will promote their sense of self-as-super-
visor (Alonso, 1983; Hess, 1986). The concrete structure of this model allows begin-
ning supervisors to move quickly through the mechanical operations of acting like
a supervisor to a more fully integrated and autonomous supervisor, representative
of a more advanced stage of supervisor development (Stoltenberg et al., 1998). Al-
though the model may only be an outline for the first few steps on a much longer
and continuing journey, it provides clear indicators to ensure that the novice super-
visor gets off on the right foot and in the right direction.

Chapter 6: Key Terms

䉴 Therapeutic working 䉴 Focus 䉴 Apply
alliance 䉴 Explore 䉴 Critical friend
䉴 Evaluation 䉴 Reflect
 part two

What Are the Essential Elements

of Counseling With Which All
Counselors Must Be Familiar?
 chapter Understanding Human Growth
and Development
7
Kimberly Blair
University of Pittsburgh

Stephen P. Kachmar
Duquesne University

In This Chapter

䉴 Prenatal Development 䊏 Cognitive Development in Middle Child-

䊏 Influences on Prenatal Development hood
䊏 Genetic Makeup 䊏 Social-Emotional Development in Middle
䊏 Prenatal Developmental Periods Childhood
䊏 Risks During Prenatal Development

䉴 Adolescence: Transition From Childhood

䉴 Infancy: The First 2 Years of Life to Adulthood
䊏 Physical Development in Infancy 䊏 Physical Development in Adolescence
䊏 Cognitive Development in Infancy 䊏 Cognitive Development in Adolescence
䊏 Social-Emotional Development in Infancy 䊏 Social-Emotional Development in Adoles-

cence
䉴 Early Childhood: The Preschool Period
䊏 Physical Development in Early Child- 䉴 Adulthood
hood 䊏 Physical Development in Adulthood
䊏 Cognitive Development in Early Child- 䊏 Cognitive Development in Adulthood

hood 䊏 Social-Emotional Development in Adult-

䊏 Social-Emotional Development in Early hood
Childhood
䉴 Death, Dying, and Bereavement
䉴 Middle Childhood: Elementary School Years 䊏 Death and the Young
䊏 Physical Development in Middle Child- 䊏 Theory of Dying Process

hood 䊏 Grief and Bereavement

112
CHAPTER SEVEN Understanding Human Growth and Development 113

PRENATAL DEVELOPMENT

The study of human growth and development begins before an infant is ever born,
and, indeed, the development that occurs during prenatal periods has a significant
impact on a person’s health and well-being. Our aim in this chapter is to highlight
the significant physical, cognitive, and socioemotional gains that are part of the life
stages, beginning with the prenatal period and concluding with old age.

䊏 Influences on Prenatal Development

An individual’s genetic makeup and environmental influences combine to deter-

mine physical and behavioral characteristics and course of development. Reaction
range (Gottesman, 1963) and canalization (Waddington, 1957) are concepts that at-
tempt to explain the degrees of genetic and environmental influence on develop-
ment. These concepts are defined along with two other terms—genotype and phe-
notype—that are key to understanding prenatal development.

Genotype: The underlying genetic makeup of an organism.

Phenotype: An organism’s manifest physical and psychological characteris-

tics, which are determined by both genetic makeup and environmental factors.

Canalization: Refers to situations in which the environment has little impact

on inherited characteristics.

Reaction range: The range of possible phenotypes for a particular genotype

across all environmental influences (Scarr, 1984).

To understand development, it is necessary to know about the basic building

blocks of growth, such as genotypes and phenotypes. Additionally, one must un-
derstand something about the developmental process. Two terms that address the
’how’ of development are critical period and sensitive period, defined as followed:

Critical period: A limited time frame in which an organism is biologically

predisposed to acquire certain behaviors in the presence of the appropriate
environmental stimuli.

Sensitive periods: In humans, the periods that are optimal, but not exclusive,
for certain aspects of development.

䊏 Genetic Makeup

Genes are the basic unit of heredity and are carried on rod-shaped structures called
chromosomes. Each normal human has 46 chromosomes or 23 pairs of chromosomes,
114 What Are the Primary Roles and Responsibilities of the Professional Counselor? PART TWO

with each pair having one chromosome from each parent. Of the 23 chromosomal
pairs, 22 are matched pairs called autosomes; the 23rd pair is the sex chromosome.
Genes also come in matched pairs (one from each parent), but may have different
forms called alleles. If the alleles from each parent are alike, that trait is homozygous;
if the alleles are different, then the trait is heterozygous. Heterozygous pairings can
be dominant–recessive, in which the dominant gene determines the pattern of ge-
netic inheritance, or codominant, in which both alleles influence genetic inheritance.
Many traits appear to be polygenetic, a pattern of genetic inheritance in which many
genes affect the characteristic in question. Genetic mutations and chromosomal ab-
normalities are major causes of serious developmental problems.

䊏 Prenatal Developmental Periods

Prenatal development can be divided into three periods:

1. During the period of the ovum (Weeks 1–3 of pregnancy) implantation occurs
and the neural tube forms.
2. During the period of the embryo (Weeks 4–8 of pregnancy) most organ systems
develop, moving in cephalocaudal (from head to feet) and proximodistal
(from center of the body to extremities) directions.
3. During the fetal period (Week 8–birth) the reproductive system forms and
other systems mature.

䊏 Risks During Prenatal Development

During the prenatal stage of life, disruptions known as teratogens can occur that
have adverse effects on development. The term teratogen can be defined as follows:

Teratogens: Environmental agents capable of causing developmental abnor-

malities in utero.

Examples of teratogens that may cause immediate structural damage during pre-
natal development include drugs, alcohol, environmental pollutants, and infec-
tious diseases, as well as other maternal factors such as diet and stress. Some health
problems or neurological impairments caused by teratogens may not become evi-
dent until later in development.

INFANCY: THE FIRST 2 YEARS OF LIFE

Once an infant is born, the developmental domains expand beyond the largely bio-
logical aspects. Beginning with this section on infancy, we look at the physical, cog-
nitive, and socioemotional developmental domains in which changes and transi-
tions occur across the life span.
CHAPTER SEVEN Understanding Human Growth and Development 115

䊏 Physical Development in Infancy

When infants are born, they enter the world with a number of reflexes in place.
Some of these reflexes are necessary for survival and adaptation, and others do not
have apparent survival value and disappear during the first few months of life. A
number of survival and primitive reflexes are provided in the lists that follow.

Survival Reflexes
䊏 Breathing.
䊏 Rooting.
䊏 Sucking.
䊏 Papillary.
䊏 Eye blink.
䊏 Primitive Reflexes
䊏 Moro (startle).
䊏 Palmar.
䊏 Plantar.
䊏 Babinski.
䊏 Stepping.
䊏 Swimming.

As in prenatal development, physical and motor development in infancy contin-

ues to follow cephalocaudal and proximodistal patterns of development. Gross mo-
tor development generally follows a specific sequence. Some of the major accom-
plishments in gross and fine motor development during infancy are outlined here.

Gross and Fine Motor Skills Development in Infancy

䊏 Following a proximodistal pattern, infants first raise their heads and chest, and
then turn over, sit, crawl, stand, and walk.
䊏 Between 11 and 15 months of age, infants typically can walk unaided.
䊏 Fine motor skills such as uncoordinated reaching and grasping with the palm
(ulnar grasp) are initially evident and later transform into more coordinated pin-
cer grasping using thumb and forefinger.

In addition to making gains in motor ability, infants’ physical development in

the areas of vision and hearing also is significant. Infants are sensitive to a wide
range of sounds and can be soothed, alerted, or distressed depending on the fre-
quency or rhythm of the tones.

Facets of Auditory Development in Infancy

䊏 Infants can discriminate between speech and nonspeech sounds.
䊏 Infants show a preference for human voices.
116 What Are the Primary Roles and Responsibilities of the Professional Counselor? PART TWO

䊏 Infants tend to prefer their mother’s voice as compared to other voices by 4

months of age.

Vision also improves dramatically early in infancy. Some of the more prominent
gains are listed here.

Facets of Visual Development in Infancy

䊏 Infants develop abilities for focusing, color discrimination, and visual acuity
during the first few months.
䊏 Depth perception develops early in infancy, and studies using the “visual cliff”
demonstrate that infants can interpret spatial cues for depth.
䊏 Infants show a preference for human faces as compared to objects.

䊏 Cognitive Development in Infancy

Two of the more well-known approaches to understanding cognitive development

are the Piagetian theory of child development and the information processing per-
spective.
Piaget termed the developmental period of early infancy the sensorimotor stage.
This stage is characterized primarily by reflexive learning; one of the most impor-
tant achievements children make in this stage is known as object permanence.

Object permanence: The understanding that objects continue to exist even

when out of sight.

A number of other achievements that appear during the sensorimotor stage are
listed next.

Sensorimotor Stage: Cognitive Learning Gains in Infancy

䊏 Learning is reflexive and occurs through exploration with eyes, ears, hands, and
other sensorimotor equipment.
䊏 Toddlers become goal-oriented and capable of symbolic thought.
䊏 Young children achieve object permanence.
䊏 Infants develop the ability to categorize objects first perceptually, then conceptu-
ally during play.

By the second year of life, young children have achieved a number of cognitive
gains that require more than just reflexive learning. Some of the more salient con-
cepts promoted by the information processing perspective include deferred imita-
tion, habituation, and dishabituation. These are defined as follows:

Deferred imitation: An infant’s ability to imitate an adult’s sounds or behav-

iors after a delay of several hours or days.
CHAPTER SEVEN Understanding Human Growth and Development 117

Habituation: An infant’s waning interest in a stimulus that is repeatedly pre-

sented.

Dishabituation: An infant’s restored interest in a known stimulus.

A range of information processing developments are listed next.

Information Processing: Key Learning Gains in Infancy

䊏 Infants’ ability to understand and process information includes speed of habitu-
ation and dishabituation, visual novelty preference, and cross-modal transfer.
䊏 Infants become increasingly able to sustain and shift attention.
䊏 Toddlers are capable of recognition early in infancy and are able to engage in re-
call by the end of the first year.

Another aspect of cognitive development is communication and linguistic abil-

ity. Prior to the use of words, babies’ communication is prelinguistic and includes
crying, cooing, babbling, and imitating language sounds. Two theories of language
development have tried to explain how infants move from a prelinguistic to lin-
guistic stage. The first, learning theory, emphasizes the influence of reinforcement
and imitation, whereas the second, nativism, maintains that the ability to learn lan-
guage is innate. Today, both genetic and environmental influences on language de-
velopment are recognized, and early communication between caregivers and chil-
dren, such as motherese or child-directed speech, is seen to play a crucial role.
Between 9 months and 3 years, a significant amount of linguistic development
occurs.

Timeframe for Linguistic Development in Infancy

䊏 Babies are able to understand meaningful speech around 9 or 10 months of age.
䊏 Between 10 and 14 months of age, a baby typically says the first word that is often
considered holophrastic, or the expression of a complete thought as a single
word.
䊏 Between 16 and 24 months a child’s vocabulary explodes.
䊏 Between 18 and 24 months the emergence of two-word sentences, or telegraphic
expressions, generally occurs.
䊏 By age 3, grammar and syntax are fairly well developed; however, they are char-
acterized by the overregularization, underextending, and overextending of
word meanings.

䊏 Social-Emotional Development in Infancy

The foundation of early social-emotional development is built on the concepts of

temperament and attachment.
118 What Are the Primary Roles and Responsibilities of the Professional Counselor? PART TWO

Temperament: A child’s typical way of behaving and responding to the envi-

ronment.

Attachment: The bond between a child and the primary caregiver.

Although there are several theories of temperament, three patterns are typically
described.

Temperament Patterns (Santrock, 1999)

1. Easy tempered children usually respond positively to the environment.
2. Difficult tempered children typically respond negatively to the environment.
3. Slow-to-warm-up tempered children often have low activity levels.

Temperament characteristics appear to be largely innate but can be affected by

environmental circumstances. The goodness of fit between a child’s temperament
and the environment provided by caregivers is important for early emotional ad-
justment and the development of emotional bonds or attachments. As well, the re-
sponsiveness of a child’s primary caregiver predicts the quality of early attach-
ment. Three main patterns of attachment (Ainsworth, 1979) have been identified as
follows:

1. Secure attachment.
2. Anxious-ambivalent (resistant) attachment.
3. Avoidant attachment.

A secure attachment is generally evident when parenting is warm and nurturing,

resulting in a child who trusts that his or her needs will be met.

Characteristics of Children With Secure Attachments

䊏 Show distress at separation from their mother.
䊏 Can be easily comforted on the mother’s return.
䊏 Use the primary caregiver as a secure base from which to explore their world.

Ambivalent attachments are a type of insecure attachment often found to be associ-

ated with inconsistent caregiving.

Characteristics of Children With Ambivalent Attachments

䊏 Show distress at separation.
䊏 Cannot be easily comforted.
䊏 Alternate between approaching and resisting the mother.
CHAPTER SEVEN Understanding Human Growth and Development 119

In the case of avoidant attachment, also considered an insecure attachment, care-

givers typically show less warmth and affection to their babies as compared to
other mothers.

Characteristics of Children With Avoidant Attachments

䊏 Do not appear distressed by separations from the mother.
䊏 Actively avoid or ignore the mother.

A fourth pattern of attachment, called disorganized (Main & Solomon, 1986), is

thought to be the most insecure and most likely to be related to later social-emo-
tional adjustment difficulties.
During the second half of the first year, the issue of attachment becomes strik-
ingly prominent with the emergence of separation and stranger anxiety, which is
most intense around 18 months of age.
General emotional development is thought to be externally influenced by the re-
sponsiveness of parents during infancy and, over time, self-regulation becomes in-
ternalized. Self-awareness also emerges during the first few years of life; a few key
gains are noted here.

Sense of Self: Developmental Gains

䊏 Infants learn that they have their own existence, separate from others.
䊏 Infants begin to discover that their actions can have predictable effects on the
world around them.
䊏 During toddlerhood children become aware of their own physical features.

EARLY CHILDHOOD: THE PRESCHOOL PERIOD

Early childhood typically refers to the period between 3 and 5 years of age. In gen-
eral, children’s physical as well as cognitive and social-emotional gains are quite
outstanding. In this section, we look at the physical, cognitive, language, and so-
cial-emotional development.

䊏 Physical Development in Early Childhood

The general growth curve reflects rapid growth during infancy and adolescence
and slower, although noticeable gains in body size in early and middle childhood.
Some of the typical physical changes that occur in children from ages 3 to 5 are
mentioned here.
120 What Are the Primary Roles and Responsibilities of the Professional Counselor? PART TWO

Gross Motor and Fine Motor Gains in Early Childhood

䊏 Skeletal development includes the gradual hardening of bones through ossifica-
tion.
䊏 Individual differences in body size, including height and weight, become more
apparent.
䊏 Gross motor skills advance and become better coordinated with a shift of the
center of gravity toward the trunk.
䊏 Gaits become smooth and rhythmic, and gross motor skills show signs of auto-
maticity.
䊏 Fine motor skills also begin to show automaticity.

EXAMPLE

Gross Motor and Fine Motor Skill Development: Age 3 to 5

The gross and fine motor gains that girls and boys make in early childhood are manifested in
the new abilities that emerge on the scene. Preschoolers gradually begin to dress and feed
themselves with more ease. Children’s drawings show more complexity and realism and their
writing becomes more controlled. Handedness emerges during early childhood and children
begin to utilize a typical pencil grip for writing.

䊏 Cognitive Development in Early Childhood

Cognitive development in early childhood reflects what Piaget termed the pre-
operational level of thinking. Young children display thought processes that are
characterized by animism, reification, and egocentrism. These concepts can be un-
derstood in this way:

Animism: Attributing live characteristics to inanimate objects.

Reification: Treating concepts or abstractions as if they were real, concrete

things.

Egocentrism: A self-centered view of the world in which everything is per-

ceived in relation to oneself.

Some generalizations can be made about thought processes during the preopera-
tional level of cognition in early childhood.

Preoperational Stage: Cognitive Learning Gains in Early Childhood

䊏 Symbolic thinking, which began during infancy, continues to be refined.
䊏 Because thinking is not yet logical, children’s problem solving is concrete.
CHAPTER SEVEN Understanding Human Growth and Development 121

䊏 Thinking is characterized by centration and irreversibility, which leads to diffi-

culties with conservation and hierarchical classification.

In addition to the important contributions Piaget made about thought and

thought processes in early childhood, there are also gains in the information pro-
cessing abilities of young children. Around age 4, children are beginning to con-
struct a “theory of mind” and are becoming knowledgeable of their own meta-
cognitions. Metagcognition can be defined in this way:

Metacognition: The process of monitoring one’s own process of thinking and

memory.

Some highlights of development relative to information processing include the fol-

lowing.

Information Processing Achievements in Early Childhood

䊏 Although preschool-age children are considered to have relatively short atten-
tion spans, sustained and selective attention continues to advance during this
period of development.
䊏 Memory capacities improve, although recall memory is less well developed than
recognition memory at this age.
䊏 Episodic memory is well developed.
䊏 Young children become able to approach challenging tasks by trying out a vari-
ety of strategies, interpreting the individual success of different strategies, and
eventually selecting strategies that will work best in similar situations.

Vygotsky’s sociocultural theory also has applications to early childhood.

Vygotsky considered language to be the foundation of cognition, and private
speech to be important for helping children master challenging tasks within the
zone of proximal development. The processes known as fast mapping, syntactic
bootstrapping, and semantic bootstrapping (Gleitman, 1990) are explanations for
the explosion in language and vocabulary development that occurs in pre-
school-age children. These processes can be understood this way:

Fast mapping: The ability to build vocabularies very quickly by learning to

connect new words with their underlying concepts after only brief encounter.

Syntactic bootstrapping: The process of discovering the meaning of words

by observing how the words are used in syntax.

Semantic bootstrapping: A process of relying on word meanings to learn

grammatical rules.

A number of other important linguistic gains that appear in early childhood are
noted here.
122 What Are the Primary Roles and Responsibilities of the Professional Counselor? PART TWO

Linguistic Gains in Early Childhood

䊏 Grammar and syntax are fairly well developed by age 3.
䊏 Young children become more skilled at pragmatics, appropriately adapting their
speech to their listeners as the situation demands.

䊏 Social-Emotional Development in Early Childhood

The social-emotional development in early childhood begins to expand as the child

develops, including not just gains in the sense of self, but also influences from peer
relations and parenting styles.

Sense of Self: Early Childhood Advances

䊏 Preschoolers’ self-concepts primarily reflect observable characteristics and
beliefs.
䊏 Self-esteem, which is high in preschool, begins to differentiate or become associ-
ated with emerging skills.
䊏 Children feel good about themselves for having successfully accomplished cer-
tain tasks and judge themselves poorly for failures in performing other tasks.

Along with the development of self-understanding, the emergence of emotions

such as empathy, shame, and guilt reflect a child’s developing self-consciousness
and emotional and social competence. As children’s self-understanding and emo-
tional understanding improves, and, as children become more self-conscious, their
social behavior is affected. Empathetic emotional experiences, combined with the
influence of temperament and parenting styles, promote the expression of sympa-
thy and prosocial behavior.
A child’s propensity to exhibit prosocial behavior is often observable in peer in-
teractions. During early childhood, social interactions with peers primarily occur
in the context of play. Parten (1932) described the process of increasing social inter-
action in the context of five types of play. These categories of play include solitary
play, onlooker play, parallel play, associative play, and cooperative play; each type
of play is described briefly.

Types of Play
䊏 Solitary play involves children playing by themselves.
䊏 Onlooker play involves children who are playing passively while watching and
talking to other children.
䊏 Parallel play refers to instances where the child is playing alongside or in the
midst of other children, but remains engaged in his or her own independent play
activity.
CHAPTER SEVEN Understanding Human Growth and Development 123

䊏 Associative play is interactive, yet not coordinated with regard to play objectives.
䊏 Cooperative play refers to play interactions between children that are organized
and have specific goals, as in the case of games.

Positive peer interactions exhibited during children’s play may reflect their so-
cial problem-solving ability, whereas negative peer interactions may involve some
form of aggressive behavior. During early childhood, instrumental aggression de-
clines, whereas hostile aggression tends to increase. Hostile aggression may be in
the form of overt aggression or relational aggression.

Relational aggression: More common in girls and involves the act of damag-
ing social relationships and status.

Overt aggression: More common in boys and involves physically aggressive

acts.

Parents directly and indirectly influence a child’s early peer relationships and
socially competent behavior. Four parenting styles are commonly recognized: au-
thoritative, authoritarian, permissive, and uninvolved.

Parenting Styles
䊏 Authoritative parents tend to be highly accepting and involved, setting clear lim-
its and appropriate control techniques that help children observe the conse-
quences of their behavior in the emotional reactions of others.
䊏 Authoritarian parents tend to be cold and rejecting and adopt a coercive approach
to controlling child behavior.
䊏 Permissive parents are warm and accepting, but may exert little control on their
children, opting instead to be overindulging or inattentive.
䊏 Uninvolved parents (Maccoby & Martin, 1983) are emotionally detached, inatten-
tive, and indifferent to their children’s behavior.

According to Baumrind (1971) authoritative parents are the most successful, pro-
moting empathy and prosocial behavior as well as psychological adjustment.
Authoritarian, permissive, and uninvolved approaches to parenting are likely to
increase the possibility of maladaptive psychological adjustment in children, in-
cluding behaviors that are oppositional, anxious, or unhappy.

MIDDLE CHILDHOOD: ELEMENTARY SCHOOL YEARS

Middle childhood refers to the period of development that typically ranges from
ages 6 to 11. This period is marked especially by more sophisticated advances in
cognitive development and increasingly greater influences from the peer and so-
cial spheres.
124 What Are the Primary Roles and Responsibilities of the Professional Counselor? PART TWO

䊏 Physical Development in Middle Childhood

Physical development in middle childhood reflects slowed rates of body growth;

however, there are wide differences in growth rates that vary based on genetics, nu-
trition, emotional health, ethnicity, and culture. Marked improvements are ob-
served in gross and fine motor skills, strength, and agility. Gender differences in
physical development are apparent during this period.

䊏 Cognitive Development in Middle Childhood

During middle childhood, children enter Piaget’s concrete operational stage of

cognitive development. The ability to understand conservation is a major gain in
middle childhood. Conservation can be defined as follows:

Conservation: The ability to understand an object’s stability despite a change

in appearance.

Some other advances in cognitive ability noted by Piaget for this stage are provided
here.

Concrete Operational Stage: Cognitive Gains in Middle Childhood

䊏 Children are beginning to be able to engage in logical thinking to solve problems.
䊏 Reasoning is concrete and limited to tangible objects or concepts.
䊏 With the ability to think logically comes the ability to solve conservation prob-
lems, which includes identity conservation, reversibility, and decentration.
䊏 Children advance in their understanding of classification and class inclusion.
䊏 Children are not only better able to organize objects and concepts into logical
groups or categories, but they are beginning to understand seriation and transi-
tivity, demonstrated by their ability to compare objects and organize them ac-
cording to logical hierarchies or levels.

From an information processing perspective, middle childhood signals a time of

growth for children in their ability to learn new and more efficient strategies for
processing information.

Advances in Information Processing in Middle Childhood

䊏 Selective and sustained attention continues to improve.
䊏 Older children are better able to filter out irrelevant information to focus on what
is necessary.
䊏 Although children may begin using memory strategies in early childhood, they
do not begin using strategies such as rehearsal and organization efficiently until
middle childhood.
䊏 Children have a more advanced understanding of how learning and memory
occur.
CHAPTER SEVEN Understanding Human Growth and Development 125

An enhanced understanding of metacognition benefits the school-age children by

aiding them in academic skill development, such as reading, comprehension, writ-
ing, and problem solving. A sense of metacognition also helps developing children
become better at approaching problems and critical thinking.
By middle childhood, children demonstrate a comprehensive knowledge and
use of language. During this period there continue to be significant gains in vocab-
ulary, grammar, and pragmatic skills.

Refinements in Linguistic Ability in Middle Childhood

䊏 Children expand the number, richness, and complexity of the words available to
them.
䊏 Grammatical mistakes made in early childhood such as overregularization are
corrected.
䊏 Pragmatic skills increase in early childhood.
䊏 Children begin to understand how best to communicate with others given the
context.
䊏 Code switching is utilized as children learn to adapt their language to the indi-
vidual with whom they are speaking (Shatz & Gelman, 1973).

EXAMPLE

Code Switching in Middle Childhood

Interactions with peers may call for a restricted code or informal speech, whereas communica-
tions with adults may call for a more formal or elaborated code. Older children are able to pro-
cess hidden meanings in communications (i.e., idioms) as opposed to just the literal meaning
of words.

䊏 Social-Emotional Development in Middle Childhood

Children’s self-concepts continue to be refined and move beyond observable char-

acteristics and beliefs to include psychological traits. Some of the salient gains in
self-understanding are noted here.

Self-Concept: Developmental Gains in Middle Childhood

䊏 Children begin to make social comparisons, interpreting their own abilities and
behaviors in relation those around them.
䊏 The high self-esteem typical during early childhood drops to a more realistic
level as older children begin to incorporate feedback about their own skills and
competencies in comparison to the skills and abilities of others.
䊏 Self-esteem also differentiates in middle childhood, yielding at least four sepa-
rate categories including academic competence, social competence, physical and
athletic competence, and physical appearance.
126 What Are the Primary Roles and Responsibilities of the Professional Counselor? PART TWO

Emotionally, older children’s experience of self-conscious emotions is associated

with personal responsibility and occurs without adult prompting. Gains in cogni-
tive development and emotional understanding make possible better developed
social perspective taking. Children become able to interpret what others are think-
ing and feeling. Gradually, they become able to understand another’s perspective
and subsequently engage in third-party perspective taking.
Children make significant gains in their ability to self-regulate emotions during
middle childhood. Emotion regulation has been linked to numerous aspects of so-
cial functioning in preschoolers, including socially appropriate behavior, popular-
ity with peers, adjustment, shyness, empathy, sympathy, and prosocial behavior
(Eisenberg, Fabes, Guthrie, & Reiser, 2002). Two general strategies are outlined as a
way to cope with stress and regulate negative emotions.

Strategies for Emotional Regulation in Middle Childhood

(Lazarus & Lazarus, 1994)
1. Problem-centered coping suggests that children appraise the situation causing
the distress and, through problem solving, identify ways in which to change
the situation.
2. Emotion-centered coping strategy occurs within the individual.

By middle childhood, peer groups become increasingly important. Children

tend to choose friends who are similar to themselves in terms of age, gender, race,
ethnicity, socioeconomic status, popularity, achievement, and social behavior. Re-
search in which children report which peers they like and dislike suggests that peer
acceptance is organized into four basic groups of children: those who are popular,
rejected, controversial, and neglected.

Children tend to choose friends who are similar

to themselves in terms of age, gender, race,
ethnicity, socioeconomic status, popularity,
achievement, and social behavior.

Common Classifications of Peer Groups in Middle Childhood

1. Popular children are typically well liked by other children; two subtypes of
popular children reflect behavior that is popular-prosocial or popular-antiso-
cial. The popular-prosocial children tend to be socially competent, whereas
popular-antisocial children, although accepted by peers, tend to be highly ag-
gressive boys.
2. Rejected children are actively disliked and also tend to fall into two subtypes:
rejected-aggressive and rejected-withdrawn. Both groups often experience ad-
justment problems. The rejected-withdrawn group consists of children who
CHAPTER SEVEN Understanding Human Growth and Development 127

tend to be socially awkward, passive, and are often victims of peers’ aggres-
sion.
3. Controversial children, who are liked by some peers and disliked by others, of-
ten engage in both prosocial behavior and bullying of peers to maintain social
dominance.
4. Neglected children are typically not reported as liked or disliked by peers and,
although they appear to have limited social contacts, are often well adjusted
and socially skilled.

ADOLESCENCE: TRANSITION FROM CHILDHOOD

TO ADULTHOOD

The transition from middle childhood to adolescence begins to occur around age 12
and continues through age 19. This often tumultuous time is a period of great ad-
vancement, particularly in adolescents’ physical development and social-emo-
tional development as they strive to form their sense of identity.

䊏 Physical Development in Adolescence

The beginning of adolescence is marked by puberty. Growth hormone released

from the pituitary gland stimulates the release of other hormones by other glands.
Two basic types of physical pubertal changes occur as a result of the hormone
changes that direct puberty: sexual maturation and body growth.

Aspects of Sexual Maturation

䊏 Estrogens and androgens are released and trigger sexual maturation.
䊏 Bodily changes affect primary sexual characteristics such as the reproductive or-
gans and secondary sexual characteristics, such as external physical changes.
䊏 Menarche in girls and spermarche in boys are signals of sexual maturation.

Physical changes not directly related to sexual maturation also occur in adoles-
cence and tend to reflect a trend in reverse of the cephalocaudal growth characteris-
tic of childhood. When thyroxine is released by the thyroid gland, rapid gains in
height and weight take place. Some of the salient physical gains related to adoles-
cence are noted here.

Aspects of Physical Maturation in Adolescence

䊏 Adolescents grow 10 to 11 inches and gain 50 to 75 pounds.
䊏 Hands, legs, and feet grow first.
䊏 Boys’ shoulders broaden and girls’ hips broaden.
128 What Are the Primary Roles and Responsibilities of the Professional Counselor? PART TWO

䊏 Boys add more muscle and girls add more fat.

䊏 Gross motor skills improve, with boys demonstrating larger gains than girls.

The timing of maturation can have psychological effects. Early-maturing boys and
late-maturing girls tend to have more positive body images and psychological ad-
justment. Early-maturing girls and late-maturing boys tend to experience more
emotional and social difficulties.

䊏 Cognitive Development in Adolescence

With adolescence comes the capacity for abstract, scientific thinking, or what
Piaget called formal operations. Although not all adolescents or adults become ca-
pable of logical and abstract thought, a majority show the cognitive abilities de-
scribed next.

Formal Operations: Cognitive Learning Gains in Adolescence

䊏 Adolescents are able to engage in complex problem solving with hypothesis test-
ing, or hypothetico-deductive reasoning.
䊏 Adolescents are able to engage in propositional thought, reasoning without the
need for real-world evidence.

The information processing perspective is consistent with Piaget’s view of ado-

lescent cognitive development. Although other aspects of information processing,
such as attention, strategy use, knowledge, cognitive self-regulation, and process-
ing speed continue to advance, metacognition is thought to be central to the devel-
opment of abstract thought and scientific reasoning (Kuhn, 1999).
Adolescent argumentativeness, self-consciousness, and idealism appear to be
related to their newfound capacity for abstract thought. Two terms that describe
teenagers’ self-consciousness and self-centeredness are imaginary audience and
personal fable (Elkind & Bowen, 1979; Inhelder & Piaget, 1958).

Imaginary audience: A form of egocentrism that describes an adolescent’s

impression that he or she is the center of everyone’s attention and judgment.

Personal fable: Adolescents’ inflated opinion of themselves and their impor-

tance.

Although with adolescence often comes the advanced capacity of abstract think-
ing, adolescents also may have difficulty with everyday planning and decision
making (Berk, 2004).
CHAPTER SEVEN Understanding Human Growth and Development 129

䊏 Social-Emotional Development in Adolescence

As in other stages of development, adolescents make some characteristic strides in

self-concept.

Gains in Self-Concept During Adolescence

䊏 Adolescents begin to use qualifiers to describe themselves and their self-con-
cepts become more organized.
䊏 They begin to recognize that their self-concepts may change depending on the
situation.
䊏 Most adolescents lose some of the confidence and high self-esteem characteristic
of childhood.
䊏 Self-esteem continues to expand and differentiate to include dimensions such as
close friendship, romantic appeal, and job competence (Harter, 1999).

Adolescence is typically a time when teenagers search for their identity by ex-
ploring their values and life goals. The search for identity is classified into four cat-
egories of identity status: identity achievement, moratorium, identity foreclosure,
and identity diffusion.

Categories of Identity Status (Marcia, 1980)

1. Identity achievement reflects a commitment to self-chosen values and future
goals.
2. Identity moratorium refers to adolescents who have not yet made a commit-
ment—they are exploring possibilities and roles to find those that best fit them.
3. Identity-foreclosed adolescents have accepted another’s values and goals, of-
ten those of their parents.
4. Identity diffusion is characterized by a lack of direction; the identity-diffused
adolescents have not committed to any goals and are not actively trying to de-
termine what their future goals are to be.

Of the four identity statuses, identity achievement and moratorium are most indic-
ative of psychological well-being and a healthy search for a sense of self.
The influence of peers becomes increasingly significant during adolescence as
teenagers search for their sense of identity and belonging to a larger group. Some of
the more important manifestations of peer relations in adolescence are noted here.

Aspects of Peer Relations in Adolescence

䊏 Generally, adolescent friendships foster self-concept, perspective taking, iden-
tity, and the capacity for intimate relationships (Connolly & Goldberg, 1999).
䊏 Girls tend to place more emphasis on emotional bonds, whereas boys tend to em-
phasize status and mastery.
130 What Are the Primary Roles and Responsibilities of the Professional Counselor? PART TWO

䊏 Cliques are small groups of five to seven members who tend to resemble one an-
other in family background, interests, and social status, and form.
䊏 With the increased importance of peer affiliation, peer pressure and conformity
increases.
䊏 Adolescent romantic relationships serve as practice for the more mature bonds
of adulthood, although most dating relationships established during adoles-
cence dissolve or become less satisfying after identity formation occurs (Shaver,
Furman, & Buhrmester, 1985).

Adolescent emotional development includes the search for autonomy. As noted,

part of this search typically involves a shift away from the influence of the family to
include the greater influence of peers. However, parent–child relationships con-
tinue to be important. Parent–child conflict during adolescence is not unusual, but
serious relationship difficulties tend to have their roots earlier in childhood, rather
than being a product of adolescent turmoil.

EXAMPLE

Parenting Through Adolescence

Parenting styles and cultural identity can affect self-esteem. Adolescents with authoritative
parents tend to have higher self-esteem and are more able to resist unfavorable peer pressure.
African American culture, which benefits from large, warm, extended families and a sense of
ethnic pride tend to produce adolescents with higher self-esteem (Gray-Little & Hafdahl,
2000).

ADULTHOOD

The longest period of development, adulthood begins in the early 20s and extends
into late life and eventually to the point of death. Highlights of physical develop-
ment and decline, as well as facets of cognitive and social-emotional development
in adulthood are presented.

䊏 Physical Development in Adulthood

Body structures reach maximum capacity and efficiency in the teens and 20s. After
this period, biological aging or senescence, which refers to genetically influenced
declines in the performance of organs and systems, begins to occur (Cristofalo,
Tresini, Francis, & Volker, 1999). Individual variation in biological aging is great
CHAPTER SEVEN Understanding Human Growth and Development 131

and is influenced by many factors such as genetics, lifestyle, and living environ-
ment. Some of the genetic factors related to aging are mentioned here.

Genetic Factors Contributing to Aging

䊏 Biological aging may result from a complex blend of both the programmed ef-
fects of specific genes and the random events that may cause cells to deteriorate.
䊏 Age-related damage to DNA is thought to be due to the release of highly reactive
free radicals.
䊏 Genetic and cellular deterioration also affects organs and tissues when, over
time, protein fibers form links and become less elastic, producing declines in
many organs.
䊏 Endocrine and immune system declines may also contribute to aging.

Most of the gradual sensory changes that occur in adulthood begin around age
30, whereas other gradual changes in physical health begin to take place in early
adulthood and later accelerate. Some examples of common declines seen in adult-
hood are mentioned next.

Common Physical Declines in Adulthood

䊏 Athletic gross motor skills requiring speed, strength, and coordination peak in
the early 20s and begin to decline gradually.
䊏 Skills requiring endurance peak in the late 20s and early 30s before showing
gradual declines.
䊏 When tendons and ligaments stiffen with age, speed and flexibility of movement
diminishes.
䊏 Presbyopia, a major change in vision, results in diminished color discrimination,
night vision, and visual acuity of marked decline between ages 70 and 80.
䊏 Hearing loss, or presbycusis, usually affects a person’s ability to detect higher
frequencies first. Age-related hearing loss appears to begin earlier and show
more rapid declines for men than for women.
䊏 Reduced capacities of cardiovascular and respiratory systems occur, particularly
in late adulthood, as stiffening takes place in the connective tissues of the lungs,
chest muscles, and heart muscle.
䊏 After age 35, women’s reproductive capacity declines significantly and ends
with the occurrence of menopause.
䊏 For men, a gradual decrease is observed in the concentration and motility of
sperm after age 40 and reproductive capacity declines rather than ends.

䊏 Cognitive Development in Adulthood

A focus on intellectual ability is common to an examination of cognitive ability in

adulthood. Some theories of intelligence include the following.
132 What Are the Primary Roles and Responsibilities of the Professional Counselor? PART TWO

Understandings of Intelligence in Adulthood

䊏 A classic pattern of intelligence suggests that intelligence increases until early
adulthood and then declines through late adulthood in an inverted U-shaped
pattern (Botwinick, 1977).
䊏 Crystallized intelligence shows fewer age-related declines than fluid intelli-
gence.
䊏 Schaie’s (1996) Seattle Longitudinal Study has shown that intellectual declines in
adulthood do not occur significantly until late in life or evenly across intellectual
abilities.

Information processing continues to be a relevant area of interest in adulthood. For

example, speed of cognitive processing slows with age. Also, different memory
systems reflect differences in cognitive aging effects.

Effects of Aging on Memory

䊏 Episodic memory typically shows declines with advancing age, although some
research indicates that lifestyle may have an impact on how much decline occurs.
䊏 Semantic memory shows little in the way of age-related declines; in fact, research
has often discovered that the vocabulary of older adults is often better than
younger adults, although they may access the information more slowly.
䊏 Procedural memory appears to be relatively unaffected by aging.
䊏 Working memory for brief and simple tasks shows less in the way of age-related
declines than does working memory for tasks that involve processing more com-
plex information.

䊏 Social-Emotional Development in Adulthood

Adult development theorists describe social-emotional development throughout

adulthood in similar ways. Like Erikson, Levinson’s seasons of life theory (1978)
and Valliant’s (1977) psychosocial theories describe early adulthood as a time when
development is focused on the search for intimacy. Middle adulthood is character-
ized by generativity—reaching out to others by giving to and guiding the next gen-
eration, as well as becoming guardians of their culture (Valliant, 1977). During late
adulthood, the goal for individuals becomes looking back on their lives and com-
ing to terms with and being satisfied with their achievements.

Theories of Adult Development

䊏 Levinson described adult development in terms of a person’s life structure—
with the underlying design of life consisting of relationships with significant
others.
䊏 Valliant also explained development as being shaped by the quality of relation-
ships with important people.
CHAPTER SEVEN Understanding Human Growth and Development 133

䊏 Sternberg (1987, 1988) proposed a triangular theory of romantic love in which

there are three components that shift in emphasis as relationships develop: inti-
macy, passion, and commitment. The passionate love presents at the beginning
of a relationship giving way to intimacy and commitment, and forming the basis
of companionate love.

Another important influence on adult development is the social clock (Neu-

garten, 1968, 1979), which refers to life events such as marriage, a first job, a first
child, and so on, that follow age-graded patterns based on societal and cultural ex-
pectations. According to the family life cycle, the development of families pro-
gresses in a series of phases that is consistent in most families around the world.
Marriage, childbearing, and rearing occur in early adulthood. Children leave
home, diminishing parenting responsibilities in middle age. Retirement, growing
old, and the death of one’s spouse characterize late adulthood (Framo, 1994;
McGoldrick, Heiman, & Carter, 1993).
The changes that occur in our social networks as people age may be referred to
as the social convoy. Some bonds become closer, others are added, and still others
become more distant. There are a number of psychosocial theories that describe the
aging process. A few of these are briefly described next.

Psychosocial Theories of Aging

䊏 Disengagement theory describes this social withdrawal as a result of the desires
of the elderly to withdraw from society in anticipation of death (Cumming &
Henry, 1961).
䊏 Activity theory states that social barriers cause the decline in social interaction
late in life (Maddox, 1963).
䊏 Socioemotional selectivity theory proposes that social interaction does not sud-
denly decline in late adulthood, but that it is the physical and psychological
changes that occur over time that lead to changes in social interaction (Lang,
Staudinger, & Carstensen, 1998).

Overall, the goal of adult development is successful aging, which is defined as

maximizing gains and minimizing losses.

DEATH, DYING, AND BEREAVEMENT

Like all other phases of life, death and dying have physical, cognitive, and emo-
tional implications for the dying person and for that person’s loved ones. From a
physical perspective, there are generally three phases to the dying process:

1. The agonal phase refers to the initial moments in which the body can no longer
sustain life.
134 What Are the Primary Roles and Responsibilities of the Professional Counselor? PART TWO

2. Clinical death refers to a short interval in which resuscitation is still possible al-
though circulatory, respiratory, and brain functioning have stopped.
3. Mortality refers to death that is final and without possibility of resuscitation.

䊏 Death and the Young

To grasp the cognitive component of death, dying, and bereavement, it is helpful to

consider the age-related differences that exist with regards to understanding con-
cepts of and attitudes toward death. Young children typically rely on the magical
thinking characteristic of early childhood to make sense of death. However, be-
tween the ages of 7 and 10 (Kenyon, 2001), most children have mastered the three
primary concepts related to death.

Major Concepts Related to Death and Dying

1. The concept of permanence emerges first.
2. Children next come to the understanding of universality, or an acceptance that
all things eventually die.
3. Nonfunctionality emerges last, as children come to the understanding that all
living functions cease at death, including thought, feeling, and movement.

Although these three primary concepts are mastered during childhood, adoles-
cents often fail to apply their understanding that death can occur to anyone at any
time. Adolescents tend to not apply the possibility of death to their own personal
experiences, choosing instead to embrace ideas about life after death or reincarna-
tion.

䊏 Theory of Dying Process

Kübler-Ross (1969) developed a five-stage theory through which dying individuals

typically pass: denial, anger, bargaining, depression, and acceptance. These stages
should not be viewed as a fixed sequence and not all individuals display each re-
sponse.

䊏 Grief and Bereavement

The grief and bereavement process is a highly emotional one. Bereavement refers to
the experience of losing a loved one. Many theorists have concluded that the griev-
ing process usually unfolds through several phases. One phase is characterized by
avoidance, shock, or disbelief, which may last for hours, days, or weeks. Another
phase involves the individual’s confronting the loss and experiencing a number of
emotional reactions, which may include but are not limited to anxiety, sadness, an-
ger, depression, and yearning for the lost loved one. As grief subsides, the individ-
CHAPTER SEVEN Understanding Human Growth and Development 135

ual adjusts to life without the loved one and begins to engage again in the normal
processes of daily life.

Chapter 7: Key Terms

䉴 Genotype 䉴 Dishabituation 䉴 Semantic bootstrapping
䉴 Phenotype 䉴 Motherese 䉴 Relational aggression
䉴 Canalization 䉴 Holophrastic 䉴 Overt aggression
䉴 Reaction range 䉴 Telegraphic 䉴 Conservation
䉴 Critical period 䉴 Temperament 䉴 Imaginary audience
䉴 Sensitive periods 䉴 Attachment 䉴 Personal fable
䉴 Cephalocaudal 䉴 Animism 䉴 Cliques
䉴 Proximodistal 䉴 Reification 䉴 Senescence
䉴 Teratogens 䉴 Egocentrism 䉴 Presbyopia
䉴 Object permanence 䉴 Metacognition 䉴 Presbycusis
䉴 Deferred imitation 䉴 Fast mapping 䉴 Social clock
䉴 Habituation 䉴 Syntactic bootstrapping 䉴 Social convoy
chapter Counseling Across the Life Span

8 Stephen P. Kachmar
Duquesne University

Kimberly Blair
University of Pittsburgh

In This Chapter

䉴 Perspectives in Human Growth and Development

䊏 Nature and Nurture

䊏 Continuity and Discontinuity

䊏 Developmental Domains

䉴 Psychodynamic Theories of Human Development

䊏 The Psychoanalytic Approach

䊏 The Psychosocial Approach

䉴 Behavioral and Learning Theories of Human Development

䊏 Classical Conditioning

䊏 Stimulus–Response Model

䊏 Law of Effect

䊏 Skinnerian Approach

䊏 Social Learning Theory

䉴 Cognitive Theories of Human Development

䊏 Piagetian Theory of Cognitive Development

䊏 Theory of Moral Development

䊏 Sociocultural Theory of Development

䉴 Ethological and Maturational Theories of Human Development

䊏 Konrad Lorenz

䊏 Attachment Theory

䊏 Theory of Genetic Determination

䉴 Humanistic Theories of Human Development

䊏 Maslow’s Hierarchy of Needs

136
CHAPTER EIGHT Counseling Across the Life Span 137

PERSPECTIVES IN HUMAN GROWTH AND DEVELOPMENT

Understanding human growth and development is a blend of scientific study and

human reflection on the process of life-span development. This chapter highlights
some long-held, and at times opposing, opinions about development, describes the
main developmental domains, and, finally, outlines key tenets of various theories
of human development.

䊏 Nature and Nurture

One of the longest standing debates in the study of human development is the the-
oretical nature and nurture controversy. This debate reflects competing notions
about which forces drive development. Listed here are some of the assumptions
held by strict naturists and nurturists.

Assumptions of Naturists
䊏 Individual development is dictated by inherent genetic composition.
䊏 Development occurs unwaveringly, neither hastened nor thwarted by environ-
mental interactions.
䊏 People achieve developmental milestones at a similar pace, as prescribed by ge-
netic composition.

The naturist position contrasts with that held by nurturists and can be summarized
as follows.

Assumptions of Nurturists
䊏 Environmental interactions are the main force in determining development.
䊏 The types of interactions one has with the environment have an impact on an in-
dividual’s simple and complex behaviors.

An environmental factor that plays a significant role in explaining variations in de-

velopment is sociocultural context, which can be defined in this way:

Sociocultural context: A precise set of cultural, physical, socioeconomic, and

historical circumstances that have an impact on variations in human develop-
ment.

The variety of influences that are encompassed in a socio-cultural context includes

(a) interactions with parents, guardians, and caregivers, (b) interactions with soci-
etal institutions such as schools, religious entities, and community organizations,
and (c) compliance with cultural norms such as sleeping rituals.
Generally, theorists today believe that both genetic elements and environmental
interactions act in concert to shape development across the life span. Additionally,
138 What Are the Essential Elements of Counseling? PART TWO

the overall impact of individual differences is of colossal importance to development

across the life span. Variations in lived experience, individual genetic predisposi-
tion, and personal characteristics ultimately lead to differences in development.

EXAMPLE

Twins in the Nature–Nurture Debate

Identical twins are always of interest to researchers. Apart from having the same genetic
makeup, one might expect identical twins to share cultural background and socioeconomic
status and to be exposed to similar environmental factors. Yet, development of identical twins
is itself never absolutely identical. If one considers the phenomenon of twins from inside the
debate between nature and nurture, the role of individual differences is very powerful; ulti-
mately, the individual’s physical abilities, intellectual propensities, and quality of environ-
mental exposures must be taken into account.

See Chapter 7 for more information on genetics.

䊏 Continuity and Discontinuity

Related to the nature–nurture debate is the discussion about continuous and dis-
continuous development. Whether or not development happens fluidly or in dis-
tinct stages is summed up in the contrasting beliefs in continuous and discontinu-
ous development.

Continuous development: Development that occurs gradually over the

course of the life span in a fashion that may be thought of as cumulative or
quantitative in nature.

Discontinuous development: Development that occurs in distinct stages

throughout the life span.

EXAMPLE

Continuous and Discontinuous Development

The gradual growth that characterizes continuous development is exemplified in a child’s
ability to speak. When a child says a first word, it may be thought of as part of a continuous
process that has included listening to others, babbling, and making many attempts to vocalize.
Although such an event is monumental to parents and caregivers, it is, in fact, the result of
years of auditory processing, cognitive growth, and physical maturation.
CHAPTER EIGHT Counseling Across the Life Span 139

On the other hand, developmentalists often use the example of a caterpillar changing into a
butterfly to point to discontinuous development. Each stage of change in the butterfly’s evolu-
tion is different from that of the previous stage, and, as such, may be viewed as qualitative
rather than quantitative.

䊏 Developmental Domains

Across the life span, development occurs in physical, cognitive, and socioemo-
tional domains.

Physical development: Involves growth of a physical nature, including gains

in muscular strength and fine and gross motor skill development.

Cognitive development: Involves changes in inherent intellectual and lin-

guistic abilities through stimulating interactions with the surrounding envi-
ronment.

Socioemotional development: Involves changes in the ability to initiate and

maintain interactions with others, changes in personality, and emotional reg-
ulation.

Cognitive development is a lifelong process that is enhanced by environmental in-

teractions; however, stimulation in early childhood is essential to overall lifetime
achievement. Likewise, physical development is a long-term process; gains are
seen in the main areas of fine and gross motor skills. Fine motor skills are physical
abilities that require the use of small muscles and are needed for activities such as
reaching and grasping in infancy and early childhood and skills such as typing in
later development. Gross motor skills are physical abilities that require the use of
large muscles; these skills are necessary in infancy for crawling and are required for
walking from early childhood through adulthood. Socioemotional development is
central to a person’s ability to form new and lasting relationships with other as well
as to respond appropriately to the ups and downs of life experiences.

PSYCHODYNAMIC THEORIES OF HUMAN DEVELOPMENT

Psychodynamic approaches to human development include Freud and Erikson’s

psychoanalytic and psychosocial theories. Both theorists conceptualized develop-
ment in terms of stages and, thus, represent discontinuous approaches to develop-
ment. Developmental progress is determined by the degree of success one has in re-
solving intrapersonal, unconscious conflicts germane to each stage.
140 What Are the Essential Elements of Counseling? PART TWO

䊏 The Psychoanalytic Approach

Freud’s psychoanalytic or psychosexual theory of development proposed that chil-

dren progress through a series of distinct developmental stages in which they must
manage disparity between societal expectations and their own biological drives
and sexual energy. How an individual resolves these dilemmas ultimately deter-
mines development.
Three structures—the id, ego, and superego—comprise the personality in the
psychoanalytic perspective. Zimbardo, Weber, and Johnson (2000) understood
these systems this way:

Id: Structure of personality that is present at birth and may be considered the
primitive, unconscious segment of personality that motivates individuals to
seek immediate gratification of inherent desires (sexual, physical, emotional)
without regard for potential consequences.

Ego: Component of personality that relies on the reality principle to weigh the
desires of the id against the demands of the superego and the external world.

Superego: Structure of personality that serves as an individual’s conscience,

represents a moral code handed down from parent to child, and guides be-
havior to reflect rules that closely resemble societal norms or expectations.

In the psychoanalytic approach, emphasis is placed on parental management of

children’s sexual and aggressive drives. Freud suggested that parents are responsi-
ble for moderating the degree of gratification a child receives at each stage of devel-
opment. Becoming stuck in a developmental stage is possible; the terms fixation
and arrestment explain how stagnation in development occurs (Berk, 1997).

Fixation: Inability to move to a higher level of development because of exces-

sive gratification.

Arrestment: Inability to move to a higher level of development because of in-

adequate gratification.

Balance in gratification is the key to preventing fixated or arrested development.

Indeed, healthy development is a function of successful navigation through the
five stages of psychosexual personality development. Key tenets of each stage are
outlined here.

Oral Stage (Birth–1 Year)

䊏 The child is focused on the oral cavity and receives gratification through sucking,
babbling, eating, and crying.
CHAPTER EIGHT Counseling Across the Life Span 141

䊏 Oral fixation, or arrestment, manifests in habits including nail-biting and smok-

ing and interpersonal conflicts such as lack of trust and difficulty forming close
relationships.

Anal Stage (Ages 1–3)

䊏 Stimulation and function of one’s bowels and bladder provide gratification.
䊏 Too many or too few parental discipline demands related to toilet training and
bodily self-control can cause fixation or arrestment.
䊏 Excessive demands contribute to anal-retentive tendencies, whereas an absence
of discipline leads to anal-expulsive traits, such as messiness, reckless, and disor-
derliness.

Phallic Stage (Ages 3–6)

䊏 Gratification centers on the genital area and is characterized by finding pleasure
in stimulation of this bodily region and great interest in the genitals of others.
䊏 The child experiences incestuous desire for the opposite-sexed parent and
wishes for the removal of the same-sexed parent (known as the Oedipus complex
in males, Electra complex in females).
䊏 To remedy the Oedipus or Electra complex, the child abandons sexual desires
and adopts the characteristics and values of the same-sexed parent (Berk, 1997),
allowing the superego to form.

Latency Stage (Ages 6–11)

䊏 Sexual desires that were present in the phallic stage recede.
䊏 The primary focus turns away from the stressful conflicts of the phallic stage to
asexual pursuits such as school, athletics, and friendships.

Genital Stage (Ages 11–18)

䊏 Patterns of behavior that emerged as a result of the resolution of previous stages
are apparent.
䊏 Sexual desires that were repressed during the phallic stage reemerge to help fur-
ther mature sexual relationships, marriage, and the parenting of children.

Full development ultimately allows individuals to pursue the goals of love and
work and only can be attained if the dilemmas in each stage are successfully re-
solved.

For more information on the id, ego, and superego, and the application of this approach to
counseling, see Chapter 9.
142 What Are the Essential Elements of Counseling? PART TWO

䊏 The Psychosocial Approach

Erikson accepted the general principles underlying psychoanalytic personality

theory. However, he expanded the framework to emphasize the importance of
psychosocial aspects of human development. Additionally, Erikson conceptual-
ized personality development as extending beyond adolescence into a lifelong
phenomenon marked by crises needing to be resolved.
The psychosocial approach includes eight stages, the first five of which parallel
those proposed by Freud, especially with regard to the approximate age of engage-
ment. Individuals acquire new skills at each stage that allow them to be active, produc-
tive members of society (Berk, 1997). Adescription of the psychosocial stages follows.

Erikson’s Psychosocial Stages of Development

1. In the Basic Trust Versus Mistrust stage, children learn to trust the world
through warm and responsive interactions with caregivers, particularly
through maternal relations; mistrust forms from unresponsive and cold care-
giver relationships.
2. In the Autonomy Versus Shame and Guilt stage, a sense of autonomy is formed
when parents allow children to use newly developed gross and fine motor skills
to explore the surrounding world; shame and guilt results when parents stifle
free choice by fostering dependency or by shaming children for their behavior.
3. In the Initiative Versus Guilt stage, initiative is fostered when parents support
experimentation of newly developed skills through self-initiated activities;
however, when such actions are met with parental scolding due to a lack of
self-control, the child may form a sense of inadequacy or guilt (Zimbardo,
Weber, & Johnson, 2000).
4. In the Industry Versus Inferiority stage, a sense of industry forms when, in the
context of home or school environment, children employ skills that allow them
to complete tasks collaboratively with others; however, if such attempts are
coupled with negative experience, feelings of inferiority or incompetence may
emerge.
5. In the Identity Versus Identity Diffusion stage, teenagers attempt to define them-
selves in relation to society, test limits, and form an identity; unsuccessful reso-
lution of identity development leads to identity confusion.
6. In the Intimacy Versus Isolation stage, young adults attempt to establish mean-
ingful, intimate relationships with others; failure to establish such relation-
ships may result in a sense of isolation and a lack of meaningful interactions.
7. In the Generativity Versus Stagnation stage, adults strive to give to the next gen-
eration through productive work (Berk, 1997); a sense of stagnation or self-ab-
sorption occurs when an individual fails to achieve a sense of meaningful ac-
complishment.
8. In the Integrity Versus Despair stage, older adults who can identify value and
significance in their existence develop a sense of integrity, whereas adults who
believe their lives were dissatisfying or without value may develop a sense of
despair.
CHAPTER EIGHT Counseling Across the Life Span 143

BEHAVIORAL AND LEARNING THEORIES

OF HUMAN DEVELOPMENT

Unlike Freud and Erikson, who advocated a psychodynamic approach to under-

standing human development, some psychologists viewed mental structures and
intrapersonal conflicts as arbitrary. Behaviorists assumed that because personality
structures cannot be observed, their existence neither can be validated nor sup-
ported as a legitimate influence on human development. Subsequently, theorists,
such as Pavlov, Watson, Thorndike, Skinner, and Bandura, advocated for ap-
proaches that utilized the scientific method as a means to gather tangible—and
largely behavioral—data for observation, analysis, and interpretation about hu-
man growth and development. Some of the most well-known behavioral theories
of development briefly are described here.

䊏 Classical Conditioning

Pavlov is famous for the experiment in which he conditioned dogs to salivate at the
sound of a bell after the bell was repeatedly paired with the presence of meat pow-
der. Pavlov’s classical conditioning theory posited that when an unconditioned
stimulus (UCS) is presented, that stimulus elicits a response or reflex. If such a re-
sponse-provoking stimulus is paired with a nonprovoking stimulus over repeated
trials, the second, conditional stimulus will elicit an identical response when the
UCS is removed.

Unconditioned stimulus (UCS): Stimulus that evokes an unconditioned re-

sponse.

Conditioned stimulus (CS): Stimulus that is paired with the UCS with the
goal of evoking the same response as the UCS.

Unconditioned response (UR): The natural response an organism makes to

the UCS.

Conditioned response (CR): The response that is elicited in the presence of

the CS.

䊏 Stimulus–Response Model

Following Pavlov, Watson’s work in the early 1900s launched a new behavioral
movement in psychology that focused primarily on the use of objective, scientific
methods to explain human behavior. Watson’s stimulus–response model (S–R) to
human behavior and development is based on the premise that all human action,
even the most complex behavior, is a response to particular stimuli. Stimuli and be-
144 What Are the Essential Elements of Counseling? PART TWO

havior are inextricably linked in the S–R model, which almost wholly negated the
influence of mental phenomena.

䊏 Law of Effect

Thorndike conducted numerous experiments on animal intelligence over the early

half of the 20th century that led him to conclude that behavior is learned by trial
and error. Thorndike is known for describing the law of effect and the law of
exercise.

Law of effect: Behavior has a higher propensity to be repeated if the conse-

quence of that behavior is positively reinforcing.

Law of exercise: A behavior will occur more frequently if connections be-

tween the behavior and reinforcer or consequence routinely are practiced;
conversely, failure to support connections between the behavior and rein-
forcer through practice will result in weaker associations and a decreased
likelihood of reoccurrence.

䊏 Skinnerian Approach

Skinner used operant conditioning procedures to explain how people respond to

the environment and how behavior changes. A key component of Skinner’s theory
of development is operant conditioning, which can be defined this way:

Operant conditioning: Learning that relies on consequences that follow be-

havior.

Skinner suggested that learning occurs only through the presence of a reinforcing
stimulus that follows arbitrary behavior. Reinforcers, which can be either positive
or negative, increase the likelihood that a behavior will be repeated.

Positive reinforcement: Provision of a valued stimulus following a desired

behavior.

Negative reinforcement: The application of a desirable stimulus to decrease

a behavior.

Skinner proposed five schedules of reinforcement. These are described briefly

next.
CHAPTER EIGHT Counseling Across the Life Span 145

Skinnerian Reinforcement Schedules

1. A continuous schedule provides constant reinforcement, which tends to elicit a
high frequency of the preferred behavior.
2. A fixed-interval schedule provides reinforcement only after a predetermined
time interval has elapsed, despite the frequency of behavioral displays.
3. Fixed ratio schedules use a reinforcing stimulus only after a predetermined fre-
quency of the behavior has been demonstrated.
4. A variable interval schedule involves the constant alteration of reinforcing
time intervals.
5. A variable ratio schedule involves the adjustment of the behavior frequency re-
quired for the provision of the reinforcing stimulus.

Skinner is well known for his conceptualization of positive and negative rein-
forcement, which increase the probability of certain behavioral occurrences. Along
with other behavioralists, Skinner proposed several other methods of behavioral
modification, including extinction, shaping, and aversive conditioning.

Extinction: Withholding reinforcement from a formerly reinforced behavior.

Shaping: Reinforcing behaviors that increasingly resemble the desired be-

havior until the desired behavior is attained.

Aversive conditioning: An undesirable stimulus is presented after a target

behavior to decrease the probability that such behavior will happen again.

EXAMPLE

Behavioral Techniques in Practice: Using Extinction Methods

Consider the example of a first-grade teacher who has a student who continually gets out of
her seat to wander around the classroom. The teacher’s initial responses were either to lead the
child back to her seat or verbally to request that the child sit down. When these tactics failed to
work, the teacher began to implement the behavioral technique known as extinction. The
teacher consciously chose not to reinforce the child’s misbehavior with verbal or behavioral at-
tention. Eventually, the teacher’s approach of not reinforcing the behavior led the child to stop
wandering around the classroom.

See Chapter 9 for more information about behavioral modification.

146 What Are the Essential Elements of Counseling? PART TWO

䊏 Social Learning Theory

Bandura believed that early childhood experiences have a profound influence on

personality development (Mazur, 2002). To explain these influences, Bandura de-
veloped social learning theory, which suggests that learning occurs not only
through classical and operant conditioning, but also as a result of observational
learning or imitation. Observational learning is based on vicarious reinforcement,
which can be understood as follows:

Vicarious reinforcement: Learning that occurs vicariously or as a result of

watching someone model a particular behavior.

Bandura’s theory of social learning and vicarious reinforcement is linked closely to

studies he conducted on childhood aggression. The famous Bobo doll studies in-
volved a scenario in which a young woman treated an inflatable doll aggressively
and received favorable consequences. Bandura discovered that children who
watched the woman imitated her behavior by treating the doll similarly. Because
the children did not receive reinforcement for their behavior, Bandura concluded
that learning took place as a result of their observing how the young woman acted
and by noting the consequences of her behavior.
Bandura identified the following four factors that are essential to imitative be-
havior (Mazur, 2002):

1. Attention to what is being modeled.

2. Retention or the ability to remember what was demonstrated.
3. Ability to reproduce the behavior.
4. Motivation or drive to reproduce modeled behaviors.

COGNITIVE THEORIES OF HUMAN DEVELOPMENT

Cognitive theories of human development focus primarily on the development of

mental and verbal abilities. Piaget, Kohlberg, and Vygotsky’s theories have been
extremely influential in the fields of education and related sciences.

䊏 Piagetian Theory of Cognitive Development

Piaget viewed the developing child as an active organism who is constantly trying
to make sense of the world. Learning begins when children engage in a process of
either assimilation or accommodation. Both processes help children adjust to and
understand new experiences. As well, when they are adapting to new knowledge,
children form new schemas that promote learning by helping them understand
CHAPTER EIGHT Counseling Across the Life Span 147

new experiences. Assimilation, schemas, and accommodation are described as

follows:

Assimilation: Process of using preexisting knowledge to make sense of new

experiences.

Schemas: New ways of thinking that change with age, experience, and expo-
sure to new environmental circumstances.

Accommodation: Process of altering current ways of thinking or creating

new ways of thinking to understand new knowledge.

Through research and observation, Piaget determined that the development of

increasingly complex cognitive structures corresponds with four distinct, age-re-
lated stages of cognitive development:

1. Sensorimotor stage.
2. Preoperational stage.
3. Concrete operational stage.
4. Formal operational stage.

Cognitive gains in which children learn to think qualitatively differently about the
world characterize the movement through the four developmental stages.

Sensorimotor Stage (Birth–2 Years)

䊏 Understands the world primarily through physical and sensorimotor experi-
ences.
䊏 Begins to recognize familiar faces, coordinate simple movements, and engage in
goal-directed behavior.
䊏 Exhibits capacity for forming mental representations of objects and events and
forging primary memory.
䊏 Exhibits evidence, at the end of the stage, of grasping object permanence, or the
understanding that an object continues to exist even when it is out of sight.
䊏 Shows capacity for symbolic substitution, or the utilization of a word or other
symbol in the place of a specific action.

Preoperational Stage (Ages 2–7)

䊏 Exhibits monumental advances in the ability to make mental representations of
objects and events and to use those representations to solve simple problems.
䊏 Shows signs of being able to distinguish himself or herself from others.
䊏 Manifests increased language skills.
䊏 Remains limited by preoperational egocentrism, a self-centered view of the
world in which everything is perceived in relation to oneself; animistic thought,
148 What Are the Essential Elements of Counseling? PART TWO

or the belief that inanimate objects possess living qualities; and centration, or a
narrow topical focus.

Concrete Operational Stage (Ages 7–11; Berk, 1997)

䊏 Employs increasingly organized and logical thought processes.
䊏 Displays an understanding of conservation, or the ability to recognize that an
object’s physical properties remain constant despite alteration to the object’s ap-
pearance.
䊏 Exhibits the ability to use mental operations to solve problems through mental
manipulation.
䊏 Comprehends the concept of seriation, or the arrangement of items on a quan-
titative dimension, and uses cognitive maps, or mental representations of
large-scale spaces.

Formal Operational Stage (Ages 12 and up)

䊏 Develops the ability to think about complex concepts abstractly and determine
potential outcomes through hypothetico-deductive reasoning.
䊏 Exhibits egocentric qualities by believing that he or she is the focus of attention.
䊏 Displays a sense of personal importance that extends beyond realistic levels,
thus intensifying the experience of success and failure.

䊏 Theory of Moral Development

Kohlberg’s theory of moral development is very similar to Piaget’s cognitive-de-

velopmental stage theory in that both theories recognize the developing child’s at-
tempt to reason through new situations by applying experienced ethical conven-
tion. However, Kohlberg believed that the development of just, fair, and moral
reasoning was more complex than the process proposed by Piaget, a belief reflected
in his more intricate theory of moral development.
Kohlberg’s theory identifies three levels of moral development, each of which is
comprised of two distinct stages. Preconventional morality, conventional morality,
and postconventional morality, the three broad levels of moral development, can
be described as follows:

Preconventional morality: The first level of moral development in which

moral judgments reflect considerations for personal needs, but place little
emphasis on societal needs.

Conventional morality: The second level of moral development in which

ethical decision making is based on societal expectations and necessities for
the purpose of maintaining social norms.
CHAPTER EIGHT Counseling Across the Life Span 149

Postconventional morality: The third level of moral development in which

moral conclusions are internalized, and individuals make moral choices
based on their evaluation of alternate moral codes and ultimate subscription
to a personal moral code.

Six Stages of Moral Development (Green & Piel, 2002)

1. Heteronomous morality emphasizes compliance to rules and norms established
by authority figures, and decisions characteristically are made to avoid punish-
ment.
2. Individualistic morality reflects a level of development in which moral decision
making is based on fulfilling personal needs and desires.
3. Morality of interpersonal expectations, relations, and interpersonal conformity re-
flects a value on maintaining peer expectations and, therefore, decisions are
made to please others, despite consequences.
4. Morality of social systems and conscience is characterized by moral decisions
made in consideration of the universal social system and with the aim of better-
ing society, and not simply of fulfilling individual desires or those of an imme-
diate peer group.
5. Morality of social-contract, utility, and individual rights is a developmental level at
which individuals recognize and obey societal norms and rules and, concur-
rently, are capable of evaluating law in light of the individual, inherent rights,
such as life and liberty.
6. Morality of ethical principles is the highest level of development in which an indi-
vidual recognizes and abides by social laws but also is willing to break those
laws if they violate ethical standards.

䊏 Sociocultural Theory of Development

Vygotsky suggested that cognitive development is a product of the interaction be-

tween a child and the environment. By accounting for the dual influences of inher-
ent ability and the environment, Vygotsky differentiates his theory from that of
Piaget, in which inherent ability is believed to be the most influential variable in de-
velopment.
From a sociocultural perspective, once the child forms the ability mentally to de-
pict objects and events and develops language, the child actively can engage his or
her environment and further cognitive development. Vygotsky’s concept of the
zone of proximal development highlights the degree of the importance he placed
on social influences to development (Thomas, 1992).

Zone of proximal development: The dynamic and interactive process be-

tween what a child is capable of doing by him or herself and what a child can
do with the assistance of a parent, teacher, or mentor.
150 What Are the Essential Elements of Counseling? PART TWO

By completing tasks with the help of skilled individuals, children become more ca-
pable of independently completing demanding enterprises. Two other constructs
are related to the skilled assistant–child interaction learning partnership. Inter-
subjectivity is the process through which two individuals with differing views
modify their views to come to a mutual understanding. Scaffolding reflects the al-
tering degree of assistance that a child receives from the skilled adult to suit his or
her level of competence (Berk, 1997).

ETHOLOGICAL AND MATURATIONAL THEORIES

OF HUMAN DEVELOPMENT

Ethological theories of human development, such as those of Lorenz and Bowlby,

are based on Darwinian evolutionary theory and propose that behavior is the di-
rect result of biological factors. Maturational approaches to human development,
like that of Gesell, also focus primarily on growth trends that are dictated by biol-
ogy. Maturational approaches adequately describe the behaviors that may be ex-
pected by an individual at a particular developmental stage, however, they are
void of information relevant to how or why the changes in one’s development
occur.

䊏 Konrad Lorenz

Through studies with the greyleg goose, Lorenz is credited with discovering the
phenomenon of imprinting, a specialized learning process that occurs extremely
early in life (Schwartz, 1989).

Imprinting: A learning process driven by innate propensities to establish so-

cial bonds in the form of permanent attachments with the first living, moving
organisms a young animal or human notices and shadows.

Lorenz’s research showed that once initial bonds are formed with the first organ-
ism, even if it is of a varying species, the relationship with the imprinting organism
is irreversible. Additionally, Lorenz pioneered the concept of a critical or sensitive
period, defined as follows (Green & Piel, 2002; Lafreniere, 2000):

Critical period: Brief stage of development during which a developing child

is predisposed to learn a specific ability or function because of heightened
susceptibility to particular environmental stimuli.

Critical periods are crucial to a child’s development. In the presence of learning

opportunities, children can experience tremendous gains that prepare them for
greater cognitive, social, and emotional advances in later stages of development.
CHAPTER EIGHT Counseling Across the Life Span 151

䊏 Attachment Theory

Bowlby incorporated ideas from a number of distinct fields and his own work with
children and families to formulate attachment theory. Attachment theory empha-
sizes the importance of positive child–mother relations to healthy development. To
become a well-adjusted adolescent and adult, a child and mother must bond
through warm, intimate interactions that satisfy both the parent and child.

Attachment theory emphasizes the importance

of positive child–mother relations to healthy
development. To become a well-adjusted
adolescent and adult, a child and mother must
bond through warm, intimate interactions that
satisfy both the parent and child.

Although Bowlby emphasized the place of attachment in development, he did

so primarily with regard to the mother–child bond. Paternal relations are consid-
ered second in importance to the relationship between a mother and child. Etholog-
ical research out of which the concept of separation anxiety grew supported his
views about the mother–child bond. Separation anxiety can be defined as follows:

Separation anxiety: Extreme stress experienced by infants or young children

when they are separated from their mother.

The result of separation is infant or child protest or behavioral tantrums, a response

that suggests that the concept of attachment is viable. Bowlby also posited the con-
cept of despair as an elevated separation and grief response that occurs prior to de-
tachment.

䊏 Theory of Genetic Determination

A maturational approach, Gesell’s theory of genetic determination suggests that bi-

ology determines natural maturation and is considered the greatest force directing
one’s development. He posited that the development of all humans occurred in a
relatively predetermined fashion, allowing for developmental comparisons to be
made. Further, Gesell proposed that a child’s development might be viewed as cy-
clical, with children continuously alternating between better and worse stages,
with the better implying a balance between the child and his or her environment,
and worse implying the child’s unhappiness and confusion in relation to the physi-
cal and social realms (Thomas, 1992).
152 What Are the Essential Elements of Counseling? PART TWO

HUMANISTIC THEORIES OF HUMAN DEVELOPMENT

Humanistic theories of human development are based on the premise that people
are intrinsically good and make decisions that are in their best interest.

䊏 Maslow’s Hierarchy of Needs

Maslow proposed a needs hierarchy based on the notion that the drive to respond
to individual needs motivates behavior. The highest level in the hierarchy is self-ac-
tualization, which Maslow considered the goal of human existence. However, be-
fore people can achieve self-actualization, they must satisfy their most primitive
needs, which have the greatest influence and serve as the strongest motivating
force on behavior. Once basic needs are satisfied, the individual may move to
higher levels of the hierarchy in an effort to satisfy the needs at those respective lev-
els.

Levels of Maslow’s Hierarchy (Maslow, 1943)

䊏 The most primitive needs identified by Maslow are biological or physiological
needs, such as the need for sustenance, relaxation, and sex.
䊏 The second tier of Maslow’s hierarchy is safety, which may be characterized as an
individual’s need for security or an absence of danger.
䊏 Once physiological and security needs are met, people seek love and compan-
ionship with others to fulfill the need for love and belongingness.
䊏 Esteem needs emerge next and are characterized by an individual’s desire to
view himself or herself in a positive light and to be seen positively by others.
䊏 The highest level of need is self-actualization, or the drive to develop one’s full-
est potential and do what one must do to experience happiness.

Chapter 8: Key Terms

䉴 Sociocultural context 䉴 Id 䉴 Law of exercise
䉴 Continuous development 䉴 Ego 䉴 Operant conditioning
䉴 Discontinuous develop- 䉴 Superego 䉴 Positive reinforcement
ment 䉴 Fixation 䉴 Negative reinforcement
䉴 Cognitive development 䉴 Arrestment 䉴 Extinction
䉴 Physical development 䉴 Unconditioned stimulus 䉴 Shaping
䉴 Socioemotional develop- 䉴 Conditioned stimulus 䉴 Aversive conditioning
ment 䉴 Unconditioned response 䉴 Vicarious reinforcement
䉴 Fine motor skills 䉴 Conditioned response 䉴 Assimilation
䉴 Gross motor skills 䉴 Law of effect 䉴 Schemas
CHAPTER EIGHT Counseling Across the Life Span 153

䉴 Accommodation 䉴 Conservation 䉴 Conventional morality

䉴 Object permanence 䉴 Seriation 䉴 Postconventional morality
䉴 Symbolic substitution 䉴 Cognitive maps 䉴 Zone of proximal develop-
䉴 Egocentrism 䉴 Imprinting ment
䉴 Centration 䉴 Critical period 䉴 Intersubjectivity
䉴 Animistic thought 䉴 Preconventional morality 䉴 Separation anxiety
 chapter Major Forces Behind
Counseling Approaches
9
Paul Bernstein
Carol Thomas
Duquesne University

In This Chapter

䉴 Psychodynamic Approaches: 䉴 Psychodynamic Approaches:

Psychoanalysis Transactional Analysis
䊏 View of Human Nature 䊏 View of Human Nature

䊏 Theory of Personality 䊏 Theory of Personality

䊏 Key Theoretical Concepts 䊏 Key Theoretical Concepts

䊏 Goals of Therapy 䊏 Goals of Therapy

䊏 Therapeutic Techniques 䊏 Therapeutic Techniques

䊏 Role of Therapist 䊏 Role of Therapist

䊏 Strengths and Limitations 䊏 Strengths and Limitations

䉴 Psychodynamic Approaches: 䉴 Cognitive-Behavioral Approaches:

Analytic Psychology Behaviorism
䊏 View of Human Nature 䊏 View of Human Nature

䊏 Theory of Personality 䊏 Theory of Personality

䊏 Key Theoretical Concepts 䊏 Key Theoretical Concepts

䊏 Goals of Therapy 䊏 Goals of Therapy

䊏 Therapeutic Techniques 䊏 Therapeutic Techniques

䊏 Role of Therapist 䊏 Role of Therapist

䊏 Strengths and Limitations 䊏 Strengths and Limitations

䉴 Psychodynamic Approaches: 䉴 Cognitive-Behavioral Approaches:

Individual Psychology Neo-Behaviorism
䊏 View of Human Nature 䊏 View of Human Nature

䊏 Theory of Personality 䊏 Theory of Personality

䊏 Key Theoretical Concepts 䊏 Key Theoretical Concepts

䊏 Goals of Therapy 䊏 Goals of Therapy

䊏 Therapeutic Techniques 䊏 Therapeutic Techniques

䊏 Role of Therapist 䊏 Role of Therapist

䊏 Strengths and Limitations 䊏 Strengths and Limitations

154
In This Chapter (continued)

䉴 Cognitive-Behavioral Approaches: Cognitive 䊏 Goals of Therapy

Therapy 䊏 Therapeutic Techniques
䊏 View of Human Nature 䊏 Role of Therapist
䊏 Theory of Personality 䊏 Strengths and Limitations
䊏 Key Theoretical Concepts

䊏 Goals of Therapy 䉴 Existential-Humanistic Approaches:

䊏 Therapeutic Techniques Person-Centered
䊏 Role of Therapist 䊏 View of Human Nature

䊏 Strengths and Limitations 䊏 Theory of Personality

䊏 Key Theoretical Concepts

䉴 Cognitive-Behavioral Approaches: 䊏 Goals of Therapy

Rational-Emotive Therapy 䊏 Therapeutic Techniques

䊏 View of Human Nature 䊏 Role of Therapist

䊏 Theory of Personality 䊏 Strengths and Limitations

䊏 Key Theoretical Concepts

䊏 Goals of Therapy 䉴 Existential-Humanistic Approaches:

䊏 Therapeutic Techniques Gestalt
䊏 Role of Therapist 䊏 View of Human Nature

䊏 Strengths and Limitations 䊏 Theory of Personality

䊏 Key Theoretical Concepts

䉴 Cognitive-Behavioral Approaches: 䊏 Goals of Therapy

Reality Therapy 䊏 Therapeutic Techniques

䊏 View of Human Nature 䊏 Role of Therapist

䊏 Theory of Personality 䊏 Strengths and Limitations

䊏 Key Theoretical Concepts

䊏 Goals of Therapy 䉴 Existential-Humanistic Approaches:

䊏 Therapeutic Techniques Logotherapy
䊏 Role of Therapist 䊏 View of Human Nature

䊏 Strengths and Limitations 䊏 Theory of Personality

䊏 Key Theoretical Concepts

䉴 Cognitive-Behavioral Approaches: 䊏 Goals of Therapy

Multimodal Therapy 䊏 Therapeutic Techniques

䊏 View of Human Nature 䊏 Role of Therapist

䊏 Theory of Personality 䊏 Strengths and Limitations

䊏 Key Theoretical Concepts

155
156 What Are the Essential Elements of Counseling? PART TWO

PSYCHODYNAMIC APPROACHES: PSYCHOANALYSIS

In 1856, Sigmund Freud was born to a lower-middle-class Jewish couple. Spending

most of his life in Vienna, Freud excelled in academics and, in 1811, earned a medi-
cal degree. During this time, he married Martha Bernays, with whom he eventually
had six children. Freud began to formulate psychoanalysis while working with
Josef Breuer, a pioneer in hypnosis and talk therapy. Freud’s career exploded with
the publication of a book on dream interpretation, which ultimately lead to his
foundational contributions to the psychology field and Western culture. In 1938,
under Nazi occupation, Freud fled Vienna for London, England, where he died a
year later.

䊏 View of Human Nature

In the first 6 years of life, individuals progress through libidinally induced psycho-
sexual stages of development.

Freud’s Stages of Development

1. Oral stage: 0 to 12 months.
2. Anal stage: 12 months to 3 years.
3. Phallic stage: 3 to 4 years.
4. Latency period: 6 years to puberty.
5. Genital stage: Puberty to death.

One’s success in progressing through these early stages determines the quality of
psychological health throughout life (Seligman, 2006). People utilize various de-
fense mechanisms to block the unconscious because its drives are socially unac-
ceptable and, at times, dangerous (Gladding, 2000).

䊏 Theory of Personality

In the Freudian tradition, the personality has three segments; these are briefly out-
lined.

Three Essential Structures of Personality

1. Id includes the unconscious, primal urges motivated by unmitigated libido and
a demand for pleasure regardless of consequence.
2. Ego is the conscious, rational conduit for healthy behavior influenced by both
id and superego.
3. Superego is the socially constructed body of internalized rules and approved
behaviors, thoughts, and feelings that motivates guilt and shame.
CHAPTER NINE Major Forces Behind Counseling Approaches 157

An individual who is psychologically healthy has an ego that safely can regulate
the pressures of the selfish demands of the id and the perfectionistic ideals of the
superego to achieve a logic-based balance between the two (Seligman, 2006).

䊏 Key Theoretical Concepts

To conduct psychoanalysis, the analyst understands that humans are driven by un-
controllable, unconscious forces—libido—directed by psychosexual crises in the
first 6 years of life (Corey, 2005). By using techniques to work through the repres-
sion of the unconscious, the analysand (i.e., patient or client) becomes conscious of
the unconscious forces and, thereby, resolves the symptoms that brought him or
her to therapy. Thus, therapy revolves largely around two key ideas: the conscious
and the unconscious. These terms can be defined this way:

Conscious: The smallest part of the mind that contains the thoughts and feel-
ings of which a person is aware.

Unconscious: The largest part of the mind that contains thoughts and feelings
of which a person is unaware or has repressed.

䊏 Goals of Therapy

The goal of psychoanalysis is to make the unconscious conscious (Gladding, 2000).

Analysis increases the patient’s awareness of his or her uncontrollable, uncon-
scious drives and allows the patient to relive incomplete resolutions of the psycho-
sexual stages through transference. As the analyst explains the basis for the behav-
ior, the patient gains the cognitive understanding and actual experience, via
transference, of a more satisfying resolution to the past, thus gaining the skills to
deal with unresolved psychosexual issues (Prochaska & Norcross, 2003).

䊏 Therapeutic Techniques

The psychoanalyst uses the following four techniques to raise the patient’s aware-
ness. For effective technique use, the patient must be completely honest.

Techniques Common to Psychoanalysis

䊏 Free association occurs when the analyst encourages the patient to talk without
censorship about whatever comes to his or her mind (Corey, 2005).
䊏 Dream interpretation in classic psychoanalysis is the primary means to encounter-
ing the unconscious and revealing otherwise-repressed experiences. Dreams
158 What Are the Essential Elements of Counseling? PART TWO

have manifest content, the obvious narrative of the dream, and latent content,
the unconscious meaning hidden behind the manifest meaning.
䊏 Transference allows the patient to work through his or her symptoms by reliving
past situations through the current relationship with the analyst. The patient
chooses new coping skills instead of repeating damaging unconscious behavior
patterns (Corey, 2005).
䊏 Analysis of resistance requires the analyst to examine a patient’s reluctance to
work toward unconscious awareness. Denial of the analyst’s interpretations and
self-censorship are common forms of resistance (Gladding, 2000).

EXAMPLE

Working in Free Association

A patient who is free associating may begin by talking about a conversation he had with his fa-
ther about music. The patient then mentions a time in childhood when his uncle made a simi-
lar comment to him, which the patient then explores further. The analyst uses this unconscious
guidance to search for clues about the repression blocking the patient’s awareness. The tech-
nique’s challenge is ensuring the uncensored flow of unconscious-inspired information.

䊏 Role of Therapist

The analyst approaches the client tabula rasa to focus singularly on the client. One
way the analyst focuses on the client is to sit behind the client, who is physically re-
laxed, to eliminate visual cues that may create bias. There are a number of other
stances that characterize the role of the psychoanalyst; a few are listed here.

Tasks of the Analyst (Prochaska & Norcross, 2003)

䊏 Reflect to the patient the truth about himself or herself and remain personally un-
involved.
䊏 Assume most of the work in the course of treatment.
䊏 Analyze and interpret the patient’s revelations.
䊏 Educate the patient about his or her condition in psychoanalytic terms.

䊏 Strengths and Limitations

The greatest strength of classical psychoanalysis is recognizing the importance of

the early years of life in creating a “blueprint” for emotional development and at-
tachment. Its most crippling limitation is the outmoded belief that people are pas-
sive observers of their own lives, waiting for either an unconscious urge or an ana-
lyst’s insight to decide their fate.
CHAPTER NINE Major Forces Behind Counseling Approaches 159

PSYCHODYNAMIC APPROACHES: ANALYTIC PSYCHOLOGY

Carl Gustav Jung was a Swiss psychiatrist who began his professional career in
1900 at the Burgholzi Mental Hospital, working under the tutelage of the eminent
psychiatrist, Eugene Bleuler. In 1909, Jung traveled with Sigmund Freud to Clark
University in Worcester, Masssachusetts, and introduced psychoanalysis to the
American intelligentsia. Before his personal and professional break with Freud in
1911 to 1913, Jung was considered the successor and crown prince of the psycho-
analytical movement (Nystul, 2003).

䊏 View of Human Nature

Jung believed the individual, the culture, and the human species can find positive
values in their nature (Jung, 1928; Nystul, 2003). Some other thoughts central to
Jung’s view of human nature are provided here.

Jungian Assumptions About Human Nature (Nystul, 2003)

䊏 People follow a natural path of development that promotes psychological and
spiritual health.
䊏 The psyche is viewed as a dynamic system that is used to discover meaning in
and find solutions to life’s conflicts.
䊏 Humankind not only attempts to fulfill instinctual desires, but establishes a
healthy relationship with the world by increasing self-understanding.

Despite his optimistic outlook, Jung was no apologist for humanity. He opined that
unless the race confronts the psychological causes of its pathological behavior, it
will continue to enact cruelty on its own members.

䊏 Theory of Personality

Believing nature has as much to do with nurture in the creation of the person, Jung
suggested the following ideas about the personality.

Key Assumptions of Jungian Personality Theory

䊏 Basic, common personality traits exist in the culture, transhistorically.
䊏 Jung initially believed that people are extroverted or introverted and later ex-
panded the typology to include such types as sensate, thinker, and intuitive.
䊏 Psychological types underscore the manner in which individuals experience and
relate to the world.
160 What Are the Essential Elements of Counseling? PART TWO

Jung’s typology became the foundation of the Myers–Briggs Personality Inventory,

an instrument in popular use today. Jung’s term personality is descriptive of more
than typology and is elaborated on later in this overview.

䊏 Key Theoretical Concepts

Arguably, the most important contribution to theoretical psychology was Jung’s

formation of the archetypes of the collective unconscious.

Archetypes: A priori structures in the psyche that form the building blocks of
psychological reality; they are primordial images that contain psychic energy
and assign meaning to experience.

Collective unconscious: The unconscious memories and common images,

such as mother, earth, or death, shared by all of humanity that are inherited
from the ancestral past.

Client narratives, life scripts, and most basic values conform to archetypal patterns.
Archetypes propose a broad sweeping claim about the nature of awareness. Hu-
man experience is understood by life motifs that appear historically in symbol and
myth, carrying a remarkable similarity to one another (Hall & Lindzey, 1978).

䊏 Goals of Therapy

A goal of Jungian analysis is to help clients understand how their maladaptive be-
haviors are attempts to gain personal autonomy and well-being. Jung named the
uncovering of the unique self individuation.

Individuation: The movement of the personality toward its fullest creative

potential.

A natural process, individuation occurs throughout life. The goals of Jungian anal-
ysis are similar to the goals of pastoral counseling. Each emphasizes the concept of
soul and self. One is moved along the individuation process by uncovering uncom-
fortable truths and understanding latent unconscious personality structures (per-
sonal and archetypal). By discovering the tensions, conflicts, and opposites in their
myths, clients may achieve an individuated sense of self.

䊏 Therapeutic Techniques

Although there are a number of techniques that Jungians can use to encourage the
individuation process, one important technique is dream interpretation. Dreams
contain archetypes that underlie the client’s reality and, if correctly interpreted, the
dream’s meaning and symbols can hasten individuation. Other techniques also are
mentioned here.
CHAPTER NINE Major Forces Behind Counseling Approaches 161

Common Jungian Techniques

䊏 Dream interpretation.
䊏 Art therapy.
䊏 Bibliotherapy.
䊏 Play therapy.
䊏 Free association.

䊏 Role of Therapist

When Jung practiced, there were few systems of psychotherapy aside from Freud’s
talking cure, a process through which the analyst related past experiences to present
conflicts. The model of exploration into the unconscious was something Jung never
abandoned. He, however, altered the paradigm to fit his understanding of uncon-
scious material and its relation to a healthy self.

Tasks of the Jungian Analyst

䊏 Aid the client in the individuation process.
䊏 Return the client to unconscious material by helping him or her to face uncom-
fortable, personal truths that, although denied, are part of the unconscious.

䊏 Strengths and Limitations

A strength of the Jungian system is its completeness. Jung accounted for the devel-
opment of personality, past conflicts, and present experience; treatment is tailored
to the client. Jung’s theory reaches deep within the client’s life to provide a
transformative experience. Jungian analysis allows for the promotion of natural
life processes (e.g., aging), and, as in the existential school, personal meaning
through experience is identified. Limitations of the Jungian system are its length of
treatment, expense, and the vigorous training of its practitioners.

PSYCHODYNAMIC APPROACHES: INDIVIDUAL PSYCHOLOGY

Alfred Adler was born in Vienna, Austria, in 1870 to a middle-class Jewish family.
His life and work were, in part, shaped by an unhappy childhood. After receiving a
medical degree from the University of Vienna, Adler went into practice as an oph-
thalmologist. It was through his research in neurology that, in 1899, Adler met
Freud. Because of significant theoretical differences with psychoanalysts, in 1912,
Adler left Freud’s inner circle to found the Society of Individual Psychology. After
Hitler’s rise to power, Adler settled in New York City, where his work with immi-
grants gave rise to the creation of settlement houses; he was instrumental in initiat-
ing the field of social work. On May 28, 1937, while lecturing in Aberdeen, Scot-
land, Adler died of a heart attack.
162 What Are the Essential Elements of Counseling? PART TWO

䊏 View of Human Nature

Individual psychology presumes a holistic view of human beings. A number of key

tenets characterize this tradition’s view of humanity.

Themes in Individual Psychology’s View of Humanity

䊏 People are complete, integrated, complex beings, not merely a cluster of psychi-
atric symptoms identified by a diagnosis.
䊏 Many facets comprise a person’s life, including early experiences, beliefs, and fu-
ture aspirations.
䊏 Much of one’s personality is formed in early childhood; however, people are con-
tinually creating themselves.
䊏 With maturity, opportunities to choose one’s own beliefs and behaviors exist
through transcending the past, becoming more aware of the present, and estab-
lishing goals for the future.

䊏 Theory of Personality

In his conceptualization of personality, Adler emphasized the holistic nature of the

human person. Unlike his predecessor, Freud, who proposed that personality is
comprised of the three major components—id, ego, and superego—Adler de-
scribed a unified personality that emerges within a specific familial and cultural
context and that develops through the process of striving for a valued life goal
(Corey, 2005). The role of the social context is especially important to development
and cannot be understood apart from social influences. Thus, the role of human re-
lationships in the formation of personality is more important than that of the
intrapsychic dimension (Corey).

䊏 Key Theoretical Concepts

Adler’s contributions to counseling are extensive; a few of his more salient ideas
such as social interest, birth order, family constellation, and the creative self are de-
scribed here (Nystul, 2003).

Social interest: The need humans have to experience a sense of belonging

and to emphasize overall concern for humanity.

Birth order: A child’s chronological or psychological birth position that influ-

ences the child’s behavior and eventual perception of his or her world.

Family constellation: Variables such as personality, developmental issues,

family attitudes and values, and structural factors that influence a child’s in-
CHAPTER NINE Major Forces Behind Counseling Approaches 163

teraction with and perception of the family compilation, and the ways in
which a child views himself or herself outside of the family.

Creative self: Each person’s ability to overcome his or her limitations and use
personal attributes, abilities, and talents to contribute positively to society.

䊏 Goals of Therapy

The primary goal of individual psychology is to help clients become well-function-

ing individuals. There are also a number of ancillary goals, some of which are men-
tioned here.

Ancillary Goals of Individual Psychology (Adler, 1963)

䊏 Gain insight.
䊏 Establish realistic goals.
䊏 Prevail over feelings of inferiority.
䊏 Overcome neurotic symptoms and irrational cognitions.
䊏 Increase client’s motivation to contribute positively to society.

䊏 Therapeutic Techniques

Adlerian therapy is flexible, providing clients with support and encouragement.

Encouragement builds self-confidence and stimulates courage. The techniques of
this tradition correspond to four phases of therapy that the client and counselor use
fluidly and revisit if necessary (Corey, 2005).

Phases of Adlerian Therapy

䊏 Establish a therapeutic relationship by making contact with the client and at-
tending to the client’s experience.
䊏 Explore client dynamics by gathering subjective information about the key is-
sue(s) and objective data including family background, medical history, activat-
ing events.
䊏 Encourage self-understanding and insight that leads clients to find purpose in
their struggle.
䊏 Assist clients in acting on their insights by encouraging new behaviors.

䊏 Role of Therapist

Adlerian therapists typically are attributed with having positive attitudes, encour-
aging demeanors, and helpful stances in helping clients establish clear, attainable
goals. Other tasks of the therapist are provided here.
164 What Are the Essential Elements of Counseling? PART TWO

Tasks of the Adlerian Therapist (Corey, 2005)

䊏 Explore the client’s dynamics by using a Lifestyle Assessment to determine how
the client is dealing with life tasks, to assess birth order and family constellations,
to examine priorities and behaviors, and to analyze early recollections.
䊏 Encourage, offer interpretation, and gently confront the client.
䊏 Help reorient or clarify client goals related to solving existing problems.
䊏 Provide emotional support in the therapeutic alliance.

䊏 Strengths and Limitations

The strength of individual psychology is its focus on mental health, not mental ill-
ness. Group counseling, parent education, and family systems therapy are rooted
in Adler’s theory. Individual psychology helped humanize education and contrib-
uted to the community mental health movement (Ansbacher, 1974). Adlerian ther-
apy is flexible, integrative, and offers brief therapeutic approaches. Limitations of
Adlerian therapy include its rigid birth order stereotypes, which may prove to be
more harmful than helpful. This system is limited to those willing to openly exam-
ine their lifestyle. Normal intelligence is required, as this approach involves logic
and insight.

Check out the North American Society of Adlerian Psychology for

more information on this approach to therapy and for other links to
useful sources:
䉴 www.alfredadler.org

PSYCHODYNAMIC APPROACHES: TRANSACTIONAL ANALYSIS

In 1910, Eric Berne was born in Canada to Dr. David and Mrs. Sara Gordon
Bernstein. Berne’s father died of a heart attack at age 38, leaving Berne and his
younger sister to be raised by their mother. Berne attended McGill University, and
in 1935 received his medical degree. Transactional analysis (TA) was developed in
an attempt to simplify psychoanalysis so that it could be easily understood by the
lay person.

䊏 View of Human Nature

TA emphasizes the influence of childhood experiences to describe human nature.

However, the theory also posits that if people want to change and are given the
CHAPTER NINE Major Forces Behind Counseling Approaches 165

tools and assistance to do so, change will occur. According to TA, people develop
and live out life scripts that are first formed from parental or societal messages.

䊏 Theory of Personality

Berne (1964) believed that individuals begin life in an autonomous state (i.e., capa-
ble of awareness, spontaneity, and intimacy). He believed people were influenced
by the messages of their parents and their childhood experiences. These messages
and experiences have an impact on one’s decisions and personality throughout life,
unless the person chooses to change. Emotional disturbances result from negative
messages, lack of messages, or negative early childhood experiences. Berne also be-
lieved that emotional problems could be successfully treated if one desired to
change and if necessary tools for change were provided.

䊏 Key Theoretical Concepts

The basic concepts of TA revolve around what Berne termed the ego state, defined
in this way:

Ego state: “A system of feelings accompanied by a related set of behavior pat-

terns” (Berne, 1964, p. 23).

Berne identified three distinct ego states—parent, adult, and child. Each of these
states exists within all individuals and can be observed in clients’ dynamic interac-
tions with others (Gladding, 2000). The three ego states are defined as follows:

Parent ego state: Consists of the critical parent and the nurturing parent. The
critical parent acts to protect and is filled with values, shoulds, and ought to’s.
The nurturing parent acts as a nurturer and caregiver.

Adult ego state: Acts much like a computer, taking in and regulating informa-
tion from the parent, the child, and the environment. This ego state is the logi-
cal and realistic part of a person and makes the best possible decision in a
given situation.

Child ego state: Consists of the adapted child and the free child (or natural child).
The adapted child conforms to the rules and wishes of the parent ego state
and basically is compliant. The free child is spontaneous, fun, creative, and
curious, caring for its needs without regard for others.

In addition to the three ego states, there are four life patterns recognized in TA.
166 What Are the Essential Elements of Counseling? PART TWO

Life Patterns in TA
䊏 I’m not OK, you’re OK.
䊏 I’m not OK, you’re not OK.
䊏 I’m OK, you’re not OK.
䊏 I’m OK, you’re OK.

These patterns explain the strengths and weaknesses of interpersonal relationships

and are developmental in nature.

䊏 Goals of Therapy

An important goal of TA is for the client to develop greater autonomy, become more
independent of parental messages, and become more spontaneous and capable of
intimacy. The individual, with the help of therapy, rewrites a more positive life
script to become more balanced and healthy (Gladding, 2000).

䊏 Therapeutic Techniques

TA assumes that people are born with positive tendencies to grow and develop, but
this potential must be nurtured if it is to become a reality. The emphasis of TA work
is on participatory learning and cognition through the utilization of homework as-
signments, structural analysis, life script analysis, transactions analysis, and analy-
sis of games people play.

䊏 Role of Therapist

The role of the therapist in TA is to help clients become autonomous and self-aware
of the games they play with others in their transactions that either help them or hin-
der them in their lives. Some approaches TA therapists might engender are men-
tioned here.

Goals of the TA Therapist

䊏 Help clients learn how to communicate positively with others by giving strokes,
or genuine, positive feedback.
䊏 Help clients become aware of the games they play with others.
䊏 Increase clients’ awareness of their preferred ego state.
䊏 Aid clients in rewriting their life scripts to meet their personal life goals.
CHAPTER NINE Major Forces Behind Counseling Approaches 167

䊏 Strengths and Limitations

TA is partner to the client and flexible enough to adapt to individual needs. Clients
are perceived as good and capable of change. Occasionally, therapists will assume
the role of parent and assist clients in recapturing past experiences. By so doing, cli-
ents may transcend former experiences and be better positioned to make improved
choices. TA, according to Berne, simplified and modernized psychoanalytic con-
cepts. Limitations of TA include its narrow application. Clients must be able to
grasp its terms and concepts for therapy to be effective. TA sometimes is misused
because of its simplistic nomenclature (Corey, 2005).

COGNITIVE-BEHAVIORAL APPROACHES: BEHAVIORISM

A graduate of Harvard College, B. F. Skinner had a profound impact on the psycho-

logical landscape in the mid-20th century as a chief proponent of behaviorism. Be-
haviorism, although a largely deterministic, historical movement, is dramatically
different from the psychodynamic understanding of human behavior. Troubled by
his psychodynamic predecessors’ emphasis on the past, unconscious drives, and
intrapsychic dynamics, Skinner attempted to simplify the panorama by focusing
on objective, measurable phenomena—a return, in fact, to scientific respectability.

䊏 View of Human Nature

Skinner’s view of human nature can be reduced to that of a fine-tuned machine.

The complexity and mystery of the individual is traded for a behavioral mecha-
nism that can be controlled strictly through the efficacy of environmental titillation.
Human nature succeeds insofar as it can learn to survive and adapt to its environ-
ment. In a Skinnerian paradigm, human nature is a passive agent in that the locus
of control is placed outside the individual, relegating one’s destiny as utterly con-
tingent on external stimuli (Skinner, 1953).

䊏 Theory of Personality

Behaviorists are not interested in personality theory, per se, but rather in how peo-
ple learn.

Key Assumptions in Behaviorism About Human Learning

䊏 The person is a fluid construct dependent on the environment for one’s function-
ing.
䊏 For change to occur, one must change the contextual forces in a relevant way.
168 What Are the Essential Elements of Counseling? PART TWO

Notwithstanding the behaviorist’s reluctance to venture into the client’s past, a be-
havioral therapist may inquire about the past, but only to explore the behavioral
repertoires that one has learned to apply environmental implications to the here
and now.

䊏 Key Theoretical Concepts

Skinner’s most widespread influence on the field is the result of his theory of oper-
ant conditioning. Skinner posited that one can shape behavior by way of conse-
quences that take form in two ways: reinforcement and punishment (Skinner,
1959).

Reinforcement: Increases the probability that a behavior will occur through a

desirable consequence.

Punishment: Applies an aversive stimulus to diminish the likelihood of oc-

currence of a behavior.

Positive reinforcement: Increases a behavior by introducing a desired stimulus.

Negative reinforcement: The application of a desirable stimulus to decrease

a behavior.

Thus, desired behavior can be brought to fruition through environmental modu-

lation.

䊏 Goals of Therapy

The primary goal of behaviorism is to modify behavior. The system does not repu-
diate feelings, thoughts, or choices—all of which Skinner (1971) referred to as
mentalism. Conversely, behavioral change is the precursor to altering one’s
thoughts or feelings. The behaviorist’s notion of change posits that by changing an
individual’s behavior, changes in thought and affect are imparted (Skinner, 1971).

䊏 Therapeutic Techniques

Therapy utilizing behaviorism includes the following well-known techniques.

Common Therapeutic Behavioral Tools

䊏 Flooding is an intentional overexposure to an aversive stimulus to decrease the
stress associated with that stimulus. This technique is effective in treating client
phobias.
CHAPTER NINE Major Forces Behind Counseling Approaches 169

䊏 Shaping is the modification of behavior by means of incremental steps toward a

desired end behavior, or to reword, successive approximations toward the de-
sired goal (Skinner, 1953).
䊏 Extinction is the removal of stimuli that sustains an undesirable behavior that, in
turn, will diminish that behavior (Skinner, 1953).

Many other therapeutic techniques exist under this model, all of which are de-
signed to change behavior. Some of these techniques include relaxation training,
systematic desensitization, and assertion training.

䊏 Role of Therapist

The role of the therapist in behavioral therapy is pivotal to the point that client out-
comes hinge on the therapist’s competence. A few qualities and tasks of behavioral
helpers are noted here.

Characteristics of Behavioral Therapists

䊏 Therapists are highly directive.
䊏 Therapists model appropriate behavior for their clients.
䊏 The therapist rewards desired behavior with appropriately positive stimuli, in-
creasing the probability that the desired client behavior will increase.

䊏 Strengths and Limitations

The primary strength of this approach is its proven effectiveness in bringing about
change in behavior. Due to the quantifiable nature of the theory, there is a prepon-
derance of scientific evidence substantiating the behavioral system as a viable ther-
apeutic option. Limitations of this approach to therapy include the lack of encour-
agement for clients to express their emotions; the lack of focus on client insights,
which has been deemed critical to outcome; and the control and manipulation of
clients by the therapist.

COGNITIVE-BEHAVIORAL APPROACHES: NEO-BEHAVIORISM

Albert Bandura was born in 1925 in a small town in northern Alberta, Canada. He
received his bachelor’s degree in psychology from the University of British Colum-
bia in 1949. He went on to the University of Iowa, where he received his PhD in
1952. There, he came under the influence of the behaviorist tradition and learning
theory. In 1953, Bandura started teaching at Stanford University. While there, he
170 What Are the Essential Elements of Counseling? PART TWO

collaborated with his first graduate student to write his first book on adolescent ag-
gression.

䊏 View of Human Nature

Bandura’s view of human nature is grounded in the behaviorists’ perspective on

human nature.

Neo-Behaviorist Assumptions of Human Nature

䊏 An individual is the producer and the product of his or her environment (Corey,
2005).
䊏 Individuals have a capacity to affect their own environments.

䊏 Theory of Personality

Bandura’s theory of personality consists of an interaction among three things: the

environment, behavior, and the person’s psychological processes. Self-regula-
tion—controlling one’s own behavior—is the other “workhorse” of human person-
ality. Bandura suggests that three steps that comprise self-regulation.

Steps in Self-Regulation
1. Self-observation entails looking at one’s behavior and keeping mental notes of it.
2. Judgment suggests that people compare what they see with a standard. For ex-
ample, people can compare their performance with traditional standards, such
as rules of etiquette, or create arbitrary standards, like “I’ll read a book a
week.”
3. Self-response is the reaction that people make to their standards. If people do
well in comparison with their standards, they give themselves rewarding
self-responses. If they do poorly, people give themselves punishing self-re-
sponses.

䊏 Key Theoretical Concepts

A key theoretical concept of the behavioral approach is that all behavior, emotions,
and cognitions have been learned, and all behaviors can be changed or modified by
new learning. Change occurs through acquisition of new behavior or modification
of existing behavior. As this happens, emotions and attitudes also are shifted. Two
other important concepts developed by Bandura (1986) are those of reciprocal de-
terminism and self-efficacy.
CHAPTER NINE Major Forces Behind Counseling Approaches 171

Reciprocal determinism: An individual’s behavior both is influenced by and

influences an individual’s personal factors and the environment.

Self-efficacy: People’s judgments of their capabilities to organize and execute

courses of action required to attain designated types of performances.

Just as behavior is determined reciprocally, the same is true of the relation between
personal factors such as cognitive skills or attitudes and behavior or the environ-
ment. Each can have an impact on and be influenced by the other.

䊏 Goals of Therapy

At the outset of therapy, clients, with the assistance of a therapist, determine

specific goals that they would like to meet throughout the therapeutic process.
Throughout the counseling process, the therapist and client continually assess the
client’s goals to determine which goals are being met. The therapist has a strong
role in helping the client formulate specific, measurable treatment goals. These
goals drive the counseling process as the therapist and client work toward meeting
the goals through discussion, creating the circumstances that best facilitate change,
and creating a plan of action (Corey, 2005).

䊏 Therapeutic Techniques

Several techniques are utilized that incorporate what Bandura termed self-control
therapy and what today is known as social learning theory. These techniques have
been quite successful in treating problems, such as smoking, overeating, and poor
study habits.

Common Neo-Behavioral Techniques

䊏 Behavioral charts are self-observations that clients use to keep close tabs on their
behaviors, both before beginning changes and as change occurs.
䊏 Environmental planning evolves out of behavioral charts and diaries and allows
clients to begin to alter their environment by, for example, avoiding some of the
cues that lead to bad behaviors.
䊏 Self-contracts are explicitly written contracts by which clients arrange to reward
themselves when they adhere to the plan and, possibly, punish themselves when
they do not.

Other people may be involved in the rewards and punishments if clients are not
strict enough with themselves.
172 What Are the Essential Elements of Counseling? PART TWO

EXAMPLE

Behavior Charts: A Pathway to Change

Behavior charts can be as simple as counting how many cigarettes are smoked in a day and as
complex as keeping detailed behavioral diaries. With the diary approach, clients keep track of
the specifics of their problem in question. This allows them to make a connection between the
kinds of cues that are associated with the habit. For example, they note if they are smoking
more after meals, with coffee, with certain friends, in certain locations, and so on. The specific-
ity of the contract enhances the chances of the client becoming aware of and changing the iden-
tified behavior.

䊏 Role of Therapist

Bandura (1969, 1971) maintained that most learning that occurs through direct ex-
periences also can be learned indirectly through the observation of others. There-
fore, the role of the therapist centers around a number of tasks related to the as-
sumption that modeling is a central part of learning.

Key Tasks of the Neo-Behaviorist (Corey, 2005)

䊏 Act as a role model that the client can imitate and, thereby, alter their behaviors.
䊏 Exhibit values, beliefs, attitudes, and behaviors of high integrity that clients can
observe.
䊏 Approach counseling with caution and be aware of the potential for abuse of the
influence that counselors may have over their clients.

䊏 Strengths and Limitations

Strengths of this theory include its ease of comprehension and implementation.

Clients can grasp fairly easily the concepts of behavior charts, action plans, and
self-contracts. Yet, there must be some level of cognition for this to occur. Limita-
tions include the possibility for cultural insensitivity with regard to goal planning.
For some ethnically diverse clients, it is difficult to separate behavioral problems
from the cultural environment in which they live, and they may have difficulty
viewing therapeutic issues as being individualistic.

COGNITIVE-BEHAVIORAL APPROACHES: COGNITIVE THERAPY

Aaron Temkin Beck was born in Rhode Island in 1921 to Russian immigrant par-
ents who were devout Jews. Beck graduated from Brown University and pursued a
CHAPTER NINE Major Forces Behind Counseling Approaches 173

medical degree at Yale University, where he abandoned his first interest, neurology,
for studies in psychiatry. While studying depressed patients, Beck observed that
clients often had a negative bias against themselves and in the foresight of their fu-
tures. He termed these negative biases cognitive distortions. In the early 1960s, Beck
termed his system of psychotherapy cognitive therapy, which primarily deals with
logical errors in client thinking.

䊏 View of Human Nature

Cognitive theorists believe that the most prominent and influential aspect of the
human person is the cognitive component (Beck, 1976). A concise review of cogni-
tive theory’s assumptions about humankind is provided here.

Key Assumptions About Human Nature in the Cognitive Tradition

䊏 Basic human needs, including preservation, reproduction, dominance, and so-
ciability are controlled by cognitions or thoughts.
䊏 People have a biological tendency toward creating distorted perceptions.
䊏 Improvements in mental health are related to people’s ability to change their
thinking.

䊏 Theory of Personality

Cognitive theory views personality as reflecting the individual’s cognitive organi-

zation and structure—based both on genetic endowment and social influences.
Emotions and behavior are determined by how we perceive, interpret, and place
meaning on our experiences, all of which, according to Beck (1976), are cognitive
functions. Psychological distress develops when one creates maladaptive cognitive
structures known as schemas, beliefs, or modes.

䊏 Key Theoretical Concepts

Cognitive therapy emphasizes recognizing and changing negative thoughts and

maladaptive beliefs that, ultimately, lead to dysfunctional behavior. Some of the
central concepts to cognitive therapy that are used to describe dysfunctional be-
haviors or, more specifically, cognitive distortions, are defined here (Corey, 2005).

Arbitrary interferences: The conclusions that people make about situations

without due cause.

Overgeneralization: The tendency to apply conclusions or beliefs about a

specific instance to other nonrelated instances.
174 What Are the Essential Elements of Counseling? PART TWO

Personalization: Interpreting events and reactions as related to oneself even

if there is no evidence of the connection.

Polarized thinking: The tendency to view events as either completely nega-

tive or positive, or thinking that is dualistic and characterized by either–or
traits.

Another concept of Beck’s theory is that thought processing exists in three do-
mains: the automatic or preconscious, the conscious, and the metacognitive (Corey,
2005). The term automatic thoughts is defined here because it is so integral to this
perspective.

Automatic thoughts: Deep-seated, personal beliefs that are triggered by the

environment and typically result in maladaptive feelings and behaviors.

䊏 Goals of Therapy

There are a number of goals that characterize cognitive therapy. Corey (2005) sum-
marizes them this way.

Aims of Cognitive Therapy

䊏 Help clients unravel their distortions in thinking and learn more realistic ways to
formulate healthy cognitive experiences.
䊏 Aid clients in distinguishing between false perceptions and accurate beliefs.
䊏 Alter automatic or preconscious thoughts that lead to undesirable behaviors and
feelings.
䊏 Provide relief of symptoms.
䊏 Deal with current issues.
䊏 Support the client in the prevention of relapse.

䊏 Therapeutic Techniques

Therapeutic techniques are employed to assail dysfunctional thoughts in an ap-

proach called cognitive restructuring. The center of attention is placed on altering
dysfunctional schemas and beliefs, regardless of the domain in which they exist.
The following techniques are used in cognitive therapy.

Therapeutic Practices Germane to Cognitive Therapy

䊏 Homework assignments.
䊏 Questioning.
䊏 Thought recording.
CHAPTER NINE Major Forces Behind Counseling Approaches 175

䊏 Behavioral experiments.
䊏 Imagery and role playing.
䊏 Problem solving.

䊏 Role of Therapist

The role of the therapist involves a series of structured steps incorporated into each
session.

Primary Therapist Tasks in Sessions

䊏 Create a session agenda and administer a test of mood.
䊏 Allow clients to present their problems.
䊏 Establish agreed-on goals.
䊏 Educate the client about the cognitive model.
䊏 Develop a diagnosis and give homework assignments.
䊏 Provide a summary of the session and feedback for the client.

To meet the goals of therapy and for the therapeutic alliance to be successful, a ther-
apist must first develop trust with the client as well as a positive rapport. To aid in
the development of this alliance, the counselor employs empathy, warmth, and
genuineness.

䊏 Strengths and Limitations

One of the major strengths and contributions of cognitive therapy is its focus on
thinking. Cognitive therapy sparked a movement by taking a scientific approach to
understanding cognition and behavior. Research has proven the use of this form of
therapy in the treatment of depressed clients. One limitation is that, for one to be a
competent and effective practitioner, extensive training, skill, and hard work are
necessary. Also, many debate the effectiveness of focusing solely on thinking as a
means of altering one’s behavior and question the reliance on the power of positive
thinking as a primary function of change (Corey, 2005).

Check out the Web site for the Association for Cognitive and Behav-
ioral Therapies for more information on practitioners’ issues and
research:
www.aabt.org
176 What Are the Essential Elements of Counseling? PART TWO

COGNITIVE-BEHAVIORAL APPROACHES:
RATIONAL-EMOTIVE BEHAVIOR THERAPY

Albert Ellis was born in 1913 in Pittsburgh, Pennsylvania, and has lived the major-
ity of his life in rural New York. Originally trained in psychoanalysis, Ellis eventu-
ally came to experience it as a superficial and unscientific treatment method. In the
mid-1950s, Ellis combined physiological, humanistic, and behavior therapy to cre-
ate rational-emotive therapy (now known as rational-emotive behavior therapy
[REBT]). He is known around the world as the grandfather of cognitive behavior
therapy.

䊏 View of Human Nature

A number of presuppositions characterize REBT. Key assumptions about REBT’s

perspective on human nature are summarized here.

Assumptions About Human Nature in REBT

䊏 Humans are born with two potentials: one for rational thinking and one for irra-
tional thinking.
䊏 All people have inherent tendencies toward growth and self-actualization (Ellis,
1999, 2000).
䊏 Emotional disturbance is primarily self-inflicted, born out of the continued repe-
tition of irrational thoughts and beliefs about the self.
䊏 Blame is the cause for the propensity of humans to internalize negative thoughts
and beliefs.

According to REBT, people must learn to accept themselves despite any imperfec-
tions that may exist and stop blaming others for any experienced unhappiness.

䊏 Theory of Personality

REBT explains personality through the A-B-C theory. Corey (2005) described this
theory as follows:

A-B-C model of personality: Suggests that A (the activating event) does not
cause C (the emotional consequence). Instead, B, which is the person’s belief
about A, largely causes C, the emotional reaction.

Thus, humans are responsible for creating their own irrational beliefs and reac-
tions. According to Corey (2005), philosophical restructuring needs to occur to
change dysfunctional personalities. The steps of this process are detailed next.
CHAPTER NINE Major Forces Behind Counseling Approaches 177

Steps in Philosophically Restructuring Dysfunction (Corey, 2005)

1. Fully acknowledge that we create our own emotional problems.
2. Accept that we have the ability to change these problems.
3. Acknowledge that emotional disturbances stem from irrational and negative
beliefs.
4. See value in disputing irrational and negative beliefs.
5. Accept that change can only occur through hard work directed at changing ir-
rational and negative beliefs.
6. Utilize REBT methods as a life practice.

䊏 Key Theoretical Concepts

The main premise of REBT is that a person’s thinking about an event or situation,
not the events or situations themselves, produces feelings. REBT posits that per-
sons who have irrational and negative thoughts become emotionally unbalanced
and behave in nonproductive ways; persons who think rationally tend to have
calmer thoughts and behave in productive ways. Therefore, for people to behave
productively, they must first control their thoughts. If people are successful at con-
trolling their thoughts, they feel happy and are able to enjoy their lives (Ellis, 1973).

䊏 Goals of Therapy

The main goals of REBT theory are threefold and can be summarized as follows:

1. Assist clients in learning to separate the evaluation of their behaviors from the
evaluation of their self-worth.
2. Encourage clients to accept themselves in totality and in spite of any imperfec-
tions that may exist.
3. Help clients replace irrational beliefs and behaviors with rational ones.

䊏 Therapeutic Techniques

Techniques utilized in REBT combine cognitive and emotive practices; a few com-
mon techniques are described here.

Cognitive Techniques
䊏 Disrupting irrational beliefs entails therapists actively disputing irrational
thoughts in an effort to help clients learn how to do the same.
䊏 Doing cognitive homework is used to help clients become aware that they often cre-
ate negative, self-fulfilling prophecies. Homework may include making lists of
178 What Are the Essential Elements of Counseling? PART TWO

problems, identifying absolute (usually irrational) beliefs, or completing the

REBT Self Help Form.
䊏 Changing one’s language encourages clients to replace shoulds, oughts, and musts
with their personal preferences, in an effort to think, behave, and, eventually, feel
differently.

Emotive Techniques
䊏 Rational-emotive imagery is a technique wherein clients imagine themselves think-
ing, feeling, and believing in exactly the way they wish they were thinking, feel-
ing, and behaving. This assists in client development of new emotional patterns.
䊏 Role playing allows clients to rehearse certain behaviors for productive feedback
from a therapist.
䊏 Use of force and vigor is meant to help clients use forceful internal dialogues with
themselves to eradicate self-defeating thoughts.

Behavioral techniques, such as assertiveness training and skill building, also can be
employed when utilizing REBT.

䊏 Role of Therapist

Consistent with the assumptions about human nature and the A-B-C model out-
lined in this approach, therapists embrace a number of roles to help clients:

䊏 Help clients understand how their shoulds, oughts, and musts contribute to irra-
tional thinking.
䊏 Aid clients in understanding how their own unrealistic and illogical thought pat-
terns contribute to their dysfunctional behaviors and emotional turmoil.
䊏 Support clients in shedding irrational thoughts and replacing them with produc-
tive, rational thinking in an effort to break the cycle of a nonproductive and nega-
tive thought process.
䊏 Educate the client in an effort to elucidate understanding around how one’s irra-
tional thoughts contribute to one’s emotional state of unrest.

䊏 Strengths and Limitations

A strength of REBT is its emphasis on putting newly acquired insights into action.
Here, it is not enough just to experience new insights; rather, the focus is on apply-
ing what has been learned in a productive, health-promoting way. Comprehensive
and eclectic techniques make REBT a useful tool for therapists and allows them to
draw from cognitive, behavioral, and emotive techniques, depending on the situa-
tion at hand. A limitation of REBT can be its confrontational nature. Not all clients
respond well to a confrontational style and some may be frightened off by this type
CHAPTER NINE Major Forces Behind Counseling Approaches 179

of therapy. Similarly, REBT therapists can misuse their power with clients by im-
posing their own ideas on the client. Clients must not feel pressured to assume the
beliefs and values of the therapist. A cooperative, trusting, and balanced cli-
ent–therapist relationship is essential for a beneficial outcome.

COGNITIVE-BEHAVIORAL APPROACHES: REALITY THERAPY

Born in 1925 in Cleveland, Ohio, William Glasser was first trained as a chemical en-
gineer and later received graduate degrees in clinical psychology and medicine
from Case Western Reserve University. Board certified in psychiatry in 1961, Glas-
ser worked in private practice until 1986. In 1965, Glasser’s objections to psycho-
analysis led him to develop reality therapy, expounded on in his work, Reality Ther-
apy (Glasser, 1965). In 1967, Glasser established the Institute for Reality Therapy,
and, in 1998, he expanded on his earlier ideas and termed his new concept choice
theory.

䊏 View of Human Nature

Glasser (1965, 2000) contended that people are born with fundamental needs but
are not endowed necessarily with the ability to fulfill these needs.

Five Basic Human Needs Recognized in Reality Therapy

1. Survival.
2. Power.
3. Love and belonging.
4. Freedom.
5. Fun.

If, at an early age, people learn to fulfill their needs in a healthy, responsible way,
they will be positioned better to form strong relationships. Failure to fulfill the five
needs results in conflict and pain (Corey, 2005; Glasser, 1965). Glasser believed that
love and belonging are paramount to positive mental health.

䊏 Theory of Personality

According to Glasser (1998), personality is partially fixed at birth. The five basic
needs dictate what Glasser termed total behavior, the elements of which are listed
next.
180 What Are the Essential Elements of Counseling? PART TWO

Four Elements of Total Behavior

䊏 Acting.
䊏 Thinking.
䊏 Feeling.
䊏 Physiology.

Glasser believes that people can control how they act and think, which then affects
how people feel. What people want from life and from the significant relationships
they form are encompassed in what Glasser (1998) termed a quality world. This
quality world—although often idealized—is a person’s view of how life would be
if all human needs were sufficiently fulfilled. Conflict is seen as an inconsistency
between the quality world (how things should be) and reality (how things are).

䊏 Key Theoretical Concepts

Reality therapy is an active and directive model that stresses a person’s present be-
havior and an individual’s personal responsibility (Glasser, 1984).

Personal responsibility: The concept that people have no power over others’
behaviors, but they do have control over their own behavior, for which they
are responsible.

Reality therapy is grounded in the assumption

that people create their inner worlds, which is
more important than the “real” world.
Thus, therapy focuses on the way people
perceive the world to exist.

The focus of reality therapy, therefore, is behavior, not attitude, insight, feelings,
one’s past, or unconscious motivation. Reality therapy is grounded in the assump-
tion that people create their inner worlds, which is more important than the “real”
world. Thus, therapy focuses on the way people perceive the world to exist. Glasser
(1984) believed that “all behavior is generated within ourselves for the purpose of
satisfying one or more basic needs” (p. 323). Glasser further suggested that strug-
gles arise when individuals are not able to meet one or more of the five psychologi-
cal needs.

䊏 Goals of Therapy

The primary goal of reality therapy is to help clients learn more productive ways to
fulfill their needs (Glasser, 2000). Clients are encouraged to evaluate their needs
CHAPTER NINE Major Forces Behind Counseling Approaches 181

and behaviors and clarify what it is that they want. By establishing (or reestablish-
ing) satisfying relationships, clients choose to take charge of their lives (Glasser,
1965, 1998, 2000).

䊏 Therapeutic Techniques

For clients to evaluate themselves effectively and accurately discern their needs, a
therapeutic alliance must first be established. This alliance will model satisfying re-
lationships (Corey, 2005). In addition to building a strong relationship, reality ther-
apy uses a number of therapeutic techniques or guides to practice; some are listed
next.

Techniques Germane to Reality Therapy

䊏 Little attention is given to the past.
䊏 Present concerns and behaviors are addressed (Glasser, 1965, 1998, 2000).
䊏 Questions focus on what the clients are doing, not why they are doing it (Glasser,
1965, 1998).
䊏 The therapist guides the clients’ self-evaluations, although it is ultimately the cli-
ents’ responsibility to determine if their behavior helps fulfill their needs.
䊏 The therapist helps clients develop a plan that will allow for acquisition of thera-
peutic goals (Corey, 2005; Glasser, 1965, 1998).

䊏 Role of Therapist

The primary role of the therapist is to establish a satisfying relationship with the cli-
ent (Corey, 2005; Glasser, 1965). Glasser rejected the objective role of the Freudian
analyst, believing that the client is more amenable to self-evaluation if judgment
does not exist. The therapist helps the client behave realistically by focusing on the
present and learning to satisfy responsibly his or her needs (Glasser, 1965, 1998,
2000).

䊏 Strengths and Limitations

Strengths of realty therapy include the attention paid to the present, client account-
ability, and the brevity of treatment (Corey, 2005; Glasser, 1998). Failure to appreci-
ate the influence of the past, rejection of unconscious determinants, objection to
psychotropic medication, and denial of neurologically influenced mental disor-
ders, such as schizophrenia, bipolar disorder, and personality disorders are some
of the system’s limitations.
182 What Are the Essential Elements of Counseling? PART TWO

COGNITIVE-BEHAVIORAL APPROACHES:
MULTIMODAL THERAPY

Arnold A. Lazarus earned a PhD in clinical psychology from the University of the
Witwatersrand in Johannesburg, South Africa, and after 6 years as a private practi-
tioner, immigrated to the United States. He has taught at Stanford University, Tem-
ple University Medical School, Yale University, and Rutgers University, where he
has held the rank of Distinguished Professor of Psychology since 1972. Currently
the Executive Director of The Lazarus Institute in New Jersey, Lazarus has main-
tained an active psychotherapy practice since 1959. As a graduate student in psy-
chology, Lazarus first developed a therapy based on behavioral psychology. In the
1980s, he expanded this into cognitive behavior therapy, and later into a multifac-
eted system of therapy called multimodal therapy.

䊏 View of Human Nature

Multimodal therapy views human nature from a behaviorist perspective. That is, at
birth, each person is like a blank slate with no presumed innate drives, motives,
needs, or tendencies, except the aptitude to learn behavior. All behaviors are
learned in response to environmental contingencies. According to Fall and Holder
(2003), behaviorists consider personality to be “the sum total and the interaction of
voluntary and involuntary behaviors in one’s response repertoire at any given
time” (p. 275).

䊏 Theory of Personality

This theory suggests that humans are all fallible and have both limitations and as-
sets. Other key tenets of the approach’s view of personality are mentioned here.

Assumptions About Personality in Multimodal Therapy

䊏 Personality is the result of an interaction between genetic makeup, the physical
environment in which an individual was raised, and an individual’s social learn-
ing history (Fall & Holder, 2003).
䊏 All people are equal to one another, regardless of social status or notoriety in the
world.
䊏 People with superior skills in certain areas are not viewed as superior human
beings.

Lazarus described human personality through the BASIC I.D. model, comprised of
seven specific modalities, described next.
CHAPTER NINE Major Forces Behind Counseling Approaches 183

䊏 Key Theoretical Concepts

Multimodal therapy is a comprehensive, systematic, and holistic approach to be-

havior therapy. It is based on the idea that humans are biological beings who think,
feel, act, sense, imagine, and interact and that all seven modalities should be ad-
dressed in treatment. Treatment is built around the BASIC I.D. framework (Laza-
rus, 1989). The BASIC I.D. acronym represents the following concepts.

BASIC I.D.
䊏 Behavior refers to all that we say or do, including our actions, reactions, and re-
sponses.
䊏 Affect refers to all emotions that humans experience.
䊏 Sensation refers to all five senses: touch, taste, smell, sight, and hearing.
䊏 Imagery refers to thoughts born out of dreams and other auditory images.
䊏 Cognition refers to thoughts, values, attitudes, beliefs, and ideas.
䊏 Interpersonal relationships refers to all of our social experiences, including those
with family, peers, coworkers, and friends.
䊏 Drugs/biology refers to all aspects of physical well-being, including diet, health,
sleep, exercise, fitness, as well as any physical ailments.

If change takes place within any one of the seven modalities, the functioning of the
remaining modalities is affected; therefore, for optimal development and change to
occur, all seven modalities must be addressed.

䊏 Goals of Therapy

The overall goals of multimodal therapy include a reduction of psychological diffi-

culties and a promotion of personal growth (Fall & Holder, 2003). Problems within
each of the seven modalities are examined in conjunction with a client’s wishes for
change within each modality. Multimodal therapists assist clients in setting obtain-
able goals so that hope can be instilled and success can be reached. Vague or obtuse
goals are discouraged in favor of specific, concrete goals.

䊏 Therapeutic Techniques

Unlike many other forms of therapy, multimodal therapy does not assume that the
client will fit the therapy; rather, it draws from a wide repertoire of techniques to
ensure that the client’s needs are being met. Thus, a key idea in this approach is
technical eclecticism.
184 What Are the Essential Elements of Counseling? PART TWO

Technical eclecticism: The idea that treatment can and should consist of tech-
niques from a variety of theoretical perspectives without the therapist neces-
sarily adopting a theoretical basis for those techniques.

Because individuals bring a wide variety of problems to therapy, it is appropriate

for the therapist to bring a variety of treatment strategies. Multimodal therapy is
psychoeducational in nature and contends that many client problems arise from ei-
ther misinformation or missing information.

Sampling of Techniques Used in Multimodal Therapy

䊏 Bibliotherapy.
䊏 Assertiveness and communication training.
䊏 Social and cognitive learning techniques.

䊏 Role of Therapist

Multimodal therapists tend to be very active and participatory during sessions

with clients, as well as very flexible and adaptable. A description of the roles and
tasks is provided here.

Variety of Mulitmodal Therapist Roles

䊏 Therapists act as consultant, educator, trainer, and role model.
䊏 Therapists draw from a wide range of techniques and therapeutic styles depend-
ing on the differing styles, personalities, and needs of the client.
䊏 Therapists, usually in concert with the client, determine which specific problems
across the BASIC I.D. framework are most salient and then focus attention on
those specific issues.
䊏 Therapists determine the relationship style that best fits for a particular client.

䊏 Strengths and Limitations

A strength of multimodal therapy is that it requires the client to do something, al-

lowing therapists to draw from many behavioral strategies to assist the client in
formulating a plan of action toward change. Behavior models have been re-
searched well, are applicable to a wide variety of settings, and are easily under-
stood by many clients. Given that multimodal therapy is behaviorally based, feel-
ings are generally not dealt with as part of the overall treatment plan—a limitation
of this therapeutic system. A second limitation is the amount of manipulation and
control that the therapist might be perceived as having over the client, given their
directive involvement in treatment.
CHAPTER NINE Major Forces Behind Counseling Approaches 185

EXISTENTIAL-HUMANISTIC APPROACHES: PERSON-CENTERED

Born in 1902 in a suburb of Chicago to parents who were strict Christian fundamen-
talists, Carl Rogers grew up lacking social skills and was isolated and self-con-
tained until his first year of college. Rogers was educated at the University of
Wisconsin in Madison and, after marrying, moved to New York City to attend Co-
lumbia University’s Union Theological Seminary, where he changed his major area
of study from theology to psychology. In 1931, Rogers earned a PhD in psychology
from the Teachers College of Columbia University and accepted a position at a
child guidance center in Rochester, New York. Rogers became known around the
world for originating and developing the humanistic approach to psychotherapy.

䊏 View of Human Nature

The person-centered view of human nature is one of the most optimistic among the
range of counselor theories. A few of the central assumptions of humankind made
by Rogers are presented here.

Person-Centered Assumptions of Human Nature (Corey, 2005)

䊏 Humans inherently have within themselves all of the assets needed to move for-
ward in a positive, constructive manner.
䊏 People are trustworthy, resourceful, able to make constructive changes, and ca-
pable of living useful and productive lives.
䊏 People naturally move toward health if they believe a pathway is open for them
to do so.

䊏 Theory of Personality

The person-centered theory of personality mirrors its view of human nature. That
is, Rogers believed that humans have within themselves, as part of their inherent
makeup, everything necessary for them to move forward in their lives.

䊏 Key Theoretical Concepts

Unlike earlier methods of therapy that largely were directive, Rogers’s (1961, 1980)
form of counseling was nondirective. Three fundamental concepts define Rogers’s
person-centered theory: genuineness, unconditional positive regard, and empathy,
defined as follows:

Genuineness: The congruence or “realness” of the therapist that increases the

likelihood of growth and change in the client.
186 What Are the Essential Elements of Counseling? PART TWO

Unconditional positive regard: The nonjudgmental, caring, and accepting

attitude of the therapist toward the client.

Empathy: Ability of the therapist both to enter the world of the client without
being influenced by his or her own personal values or beliefs and to commu-
nicate understanding genuinely and effectively.

䊏 Goals of Therapy

Essentially, the goals of person-centered therapy are twofold; the dual aims are pre-
sented next.

Aims of Person-Centered Therapy

1. Providing a climate conducive to helping clients shed the “masks” or facades
they wear and become fully functioning people.
2. Assisting clients in their growth process so they are able to cope better with
current and future problems that may arise in their lives.

䊏 Therapeutic Techniques

Person-centered therapy does not utilize specific techniques. Rather, it posits that
the quality of the therapeutic relationship, not the administration of specific tech-
niques, is the primary agent of growth for the client. Person-centered therapists
rely heavily on the reflection of clients’ feelings. This does not mean simply restat-
ing what a client has shared. Rather, according to Corey (2005), there exists the be-
lief that the “relational attitudes and fundamental ways of being with the client
constitute the heart of the change process” (p. 174).

䊏 Role of Therapist

Because of the foundational belief in the client’s ability to move toward growth un-
der the proper conditions, the role of the therapist reflects a radical departure from
the traditional (i.e., psychoanalytic and behavioral) approaches to treatment.

Tasks of the Client-Centered Clinician

䊏 Create an environment of emotional safety, warmth, and understanding in an ef-
fort to facilitate client growth and change.
䊏 Avoid giving advice, making suggestions, and interpreting the meaning of client
disclosure.
䊏 Listen and reflect back the client’s sharing.

With unconditional positive regard comes client insight and positive action. Reflec-
tive listening increases insight and self-regard.
CHAPTER NINE Major Forces Behind Counseling Approaches 187

䊏 Strengths and Limitations

Strengths of the person-centered approach to therapy include its focus on the thera-
pist–client relationship—not specific techniques. This allows the therapy to be pro-
ductive in a variety of settings, including individual, couples, families, and groups.
Research consistently shows that empathy, one of person-centered therapy’s hall-
marks, is the most powerful predictor of client progress. However, a limitation of
the approach emerges when person-centered therapists focus primarily on empa-
thy and support and not on challenging the client. Additionally, therapists may be
challenged to remove their hopes for the client from the therapeutic process and al-
low clients to chart their own course, even when therapists feel choices are being
made that are not in the best interest of the clients.

EXISTENTIAL-HUMANISTIC APPROACHES: GESTALT

Frederick (Fritz) Perls was a native of Berlin, Germany, and in his youth, a student of
psychoanalysis. After moving to the United States in 1964, Perls began to create his
approach to therapy, known as Gestalt therapy. The impact of his work is seen in that
it continues to be studied and practiced today at the Gestalt Institutes in New York
and Cleveland, among other places. Two of Perls’s most well-known works are enti-
tled Gestalt Therapy Verbatim (1969a) and In and Out of the Garbage Pail (1969b). Perls
died in 1970 while preparing to open another institute of Gestalt study in British Co-
lumbia.

䊏 View of Human Nature

A basic tenet of Gestalt therapy is that clients are capable of self-regulation within
their environments when they are fully aware of what is happening both internally
(within themselves) and externally (in the surrounding environment). Perls be-
lieved that clients only make productive change when they become aware, and that
knowledge is the product of what immediately is evident in the clients’ perceived
experiences.

䊏 Theory of Personality

The Gestalt view of personality largely is influenced by existential philosophy and

highlights such concepts as living in the here and now, increasing self-awareness,
and integrating all aspects of one’s way of being into a gestalt or whole.

䊏 Key Theoretical Concepts

The main objective of Gestalt therapy is for an individual to gain awareness, a nec-
essary component in the process of integration into a whole (gestalt). According to
188 What Are the Essential Elements of Counseling? PART TWO

Latner (1973), there are four fundamental principles of Gestalt therapy: the princi-
ple of holism (integration), the principle of awareness, the principle of figure/
ground, and the principle of polarities. These principles drive the work one does in
Gestalt therapy and lead to self-actualization.

Principle of holism: Clients experience a sense of completeness when they tie

up problematic situations, or loose ends, from the past that cause anxiety and
prevent integration (Perls, Hefferline, & Goodman, 1951).

Principle of awareness: Clients gain insight when they become aware of and
take responsibility for their sensations, thoughts, and behaviors in the
here-and-now (Perls et al., 1951).

Principle of figure/ground: Clients address their most pressing needs first

and as these are resolved, previously less evident needs emerge to be dealt
with.

Principle of polarities: Clients acknowledge the opposite or hidden aspects

of a problematic situation to promote resolution of conflicts.

䊏 Goals of Therapy

The fundamental goal of Gestalt therapy is for clients to gain awareness. Only
when clients become aware can they be positioned to make selective choices. Other
specific goals of therapy include those listed here.

Aims of Gestalt Therapy

䊏 Assuming ownership of one’s experiences.
䊏 Developing skills necessary for the satisfaction of needs without violating the
rights of others.
䊏 Developing a heightened awareness of one’s senses.
䊏 Learning to accept responsibility and consequences for one’s actions.
䊏 Moving from reliance on external supports to reliance on internal supports.

䊏 Therapeutic Techniques

Gestalt techniques rely heavily on experiments, identified by Corey (2005) as “use-

ful tools to help the client gain fuller awareness” (p. 210). Some of the more com-
mon experiments are mentioned next.
CHAPTER NINE Major Forces Behind Counseling Approaches 189

Gestalt Therapeutic Experiments (Corey, 2005)

䊏 Internal dialogue exercise is used to promote integration between the polarities
of conflict that exist in everyone, bringing a new sense of awareness to the
client.
䊏 Making the rounds happens in group settings when a client approaches each
member and speaks or does something to experiment with new behavior.
䊏 The reversal exercise involves the client in playing the role opposite of what is nor-
mal for that individual. By clients doing the very thing that causes anxiety, they
might gain attributes they have denied in the past.
䊏 Staying with the feeling happens at a point when a client experiences an unpleas-
ant or negative feeling, and he or she is encouraged to stay with the feeling to
make way for higher levels of personal growth.

Many techniques exist in the Gestalt therapy that all aspire to bring a greater
awareness to the client.

䊏 Role of Therapist

The role of the Gestalt therapist is to help clients develop awareness by learning to
express what it is they are experiencing in the present moment. A few other
methods Gestalt therapists use to heighten awareness are noted here.

Tasks of the Gestalt Therapist

䊏 Notice for the clients what is in the foreground and what is in the background of
their experiences.
䊏 Point out notable body language.
䊏 Challenge clients with interventions aimed at awareness of their language pat-
terns.

䊏 Strengths and Limitations

Gestalt therapy allows for a high level of creativity. A client’s past can be reenacted
in the present in very creative and lively ways. A key strength of this approach, ac-
cording to Corey (2005), is Gestalt therapy’s attempt to integrate practice, theory,
and research. A criticism of Gestalt therapy is that it focuses too heavily on emotion
and too little on cognition. Also, there is potential for abuse of power by the thera-
pist who is typically highly active and directive. Because of its complexity, Gestalt
therapy requires adequate training and supervision of therapists if it is to help peo-
ple lead healthier and more fulfilling lives.
190 What Are the Essential Elements of Counseling? PART TWO

EXISTENTIAL-HUMANISTIC APPROACHES: LOGOTHERAPY

Viktor Frankl was born in Vienna, Austria, in 1905 and died there in 1997. Under
Nazi rule, his immediate and extended family was taken to concentration camps
where, although Frankl and one sister survived the 3-year ordeal, his entire family
was murdered. Postliberation, Frankl reclaimed his career as a neurologist and
psychiatrist and founded The Third Vienna School of Psychotherapy: Logotherapy.
Over the span of his life, Frankl published more than 30 books, lectured across the
globe, and received 29 honorary degrees.

䊏 View of Human Nature

Frankl’s view of human nature includes a couple of core ideas that are mentioned
here.

Tenets of Human Nature Proposed in Logotherapy

䊏 Individuals have the capacity to accept fate (that which is presented and con-
fronted in its immediacy of life experiences) and give it meaning and con-
nectedness to one’s memories, environment, and other individuals with whom
there exists a relationship of love and care.
䊏 A sense of humor although grim in the face of hardship helps people to momen-
tarily escape life’s burdens and find an attitude of meaning.

䊏 Theory of Personality

This existential theory does not offer a particular theory of personality. One of
Frankl’s most poignant awarenesses about personality was the identification of
love as the ultimate and highest goal to which humans can aspire (Corey, 2005).

䊏 Key Theoretical Concepts

With respect to logotherapy, three key propositions summarize the basic dimen-
sions of the human condition.

Key Philosophical Concepts in Logotherapy

1. Will to meaning is the fundamental driving force of humanity and is character-
ized by the search for meaning in all situations, especially in times of pain and
suffering.
2. Freedom of will suggests that despite circumstances, people always have the
ability to choose how they will interpret and respond to their situations.
CHAPTER NINE Major Forces Behind Counseling Approaches 191

3. Meaning in life is the proposition that life is fundamentally a meaningful en-

deavor and existence that calls people to respond to it in the most responsible
and productive ways they can.

䊏 Goals of Therapy

Clients often are not living full and meaningful lives. Therefore, the logotherapist
and client work at accomplishing some of the following therapeutic goals.

Aims of Logotherapy
䊏 Discern the meaning of the past, present, and future.
䊏 Accept the freedom and responsibility to act.
䊏 Move toward personal authenticity and become aware of how and when one is
deceiving oneself.
䊏 Relinquish a victim role for a freer sense of existence.

䊏 Therapeutic Techniques

As in other types of existential therapy, therapeutic techniques are secondary to the

establishment of a trusting relationship that allows the therapist to challenge the
client. However, logotherapy employs the following two techniques.

Two Techniques Used in Logotherapy

1. Paradoxical intention is used to encourage the client to manifest or desire what
he or she fears.
2. Dereflection diverts the client away from problems toward something meaning-
ful.

䊏 Role of Therapist

The logotherapist helps clients discern the meaning of past and present experi-
ences in an effort to help them uncover new understandings and options. A central
task of the therapist is to help clients uncover ways in which they are living re-
stricted experiences and remaining “stuck.” In this way, the therapist helps move
clients toward accepting their personal responsibility for future changes.

䊏 Strengths and Limitations

Frankl’s theory offer a foundation for understanding universal human concerns,

provides a new conceptualization of death as holding meaning, and focuses on the
human quality of the therapeutic relationship. Criticisms of Frankl’s work include
192 What Are the Essential Elements of Counseling? PART TWO

its vagueness and lack of empirical support. Philosophical insights may not be ap-
propriate for some clients, and social factors that cause human problems may be ig-
nored because the interventions are wholly individualistic.

Visit the Web site of the Viktor Frankl Institute for more information
on logotherapy at:
䉴 http://logotherapy.univie.ac.at/e/indexe.html

Chapter 9: Key Terms

䉴 Conscious 䉴 Adult ego state 䉴 A-B-C model of personality
䉴 Unconscious 䉴 Child ego state 䉴 Personal responsibility
䉴 Manifest content 䉴 Reinforcement 䉴 Technical eclecticism
䉴 Latent content 䉴 Punishment 䉴 Genuineness
䉴 Archetypes 䉴 Positive reinforcement 䉴 Unconditional positive
䉴 Collective unconscious 䉴 Negative reinforcement regard
䉴 Individuation 䉴 Reciprocal determinism 䉴 Empathy
䉴 Social interest 䉴 Self-efficacy 䉴 Principle of holism
䉴 Birth order 䉴 Arbitrary interferences 䉴 Principle of awareness
䉴 Family constellation 䉴 Overgeneralization 䉴 Principle of figure/ground
䉴 Creative self 䉴 Personalization 䉴 Principle of polarities
䉴 Ego state 䉴 Polarized thinking
䉴 Parent ego state 䉴 Automatic thoughts
 chapter Individual and Social Aspects
of the Helping Relationship
10
Jocelyn Gregoire
Christin M. Jungers
Duquesne University

In This Chapter

䉴 The Helping Relationship 䉴 Training Models for Interpersonal

䊏 Why Bother With Theories? Skills Development
䊏 Theory Defined 䊏 Skilled Helping: Problem Management
䊏 Theories With Which Helpers Need to Be Model
Familiar 䊏 Relationship Enhancement Therapy Model
䊏 A Word About Eclecticism 䊏 Microskills Counseling Model
䊏 Helping Defined 䊏 Interpersonal Process Recall
䊏 The Helping Process 䊏 Human Resources Development Model
䊏 Frameworks Within Which the Helping 䊏 The Politics of Giving Therapy Away: Lis-

Process Occurs tening and Focusing

䊏 Helping Helpees Meet Their Needs

䉴 Social-Psychological Approaches to Helping

䉴 What Constitutes Effective Helping? 䊏 Symbolic Interaction
䊏 Professional Helpers as Growth 䊏 Role Theory

Facilitators 䊏 Social Exchange

䊏 Personal Characteristics of Effective 䊏 Cognitive Consistency

Helpers 䊏 Dissonance Theory

䊏 Helpers’ Skills 䊏 Heider’s Balance Theory
䊏 Helpers and Diversity Issues 䊏 Congruity Theory

䊏 Newcomb’s A-B-X Model of Interpersonal

䉴 Training Models for Coping Skills Attraction

Development 䊏 Attributions

䊏 People-in-System Model

䊏 Life Skills Education Model

䊏 Structured Learning Therapy Model

䊏 Social Skills

194
CHAPTER TEN Individual and Social Aspects of the Helping Relationship 195

THE HELPING RELATIONSHIP

People embrace a helping profession such as counseling for a wide variety of rea-
sons. Underpinning their motives for entering the field of counseling also are their
diversity of views and concepts about the nature of the helping process (Seligman,
2004). However, the practice of counseling and psychotherapy requires that profes-
sional helpers possess both the core skills and the experience necessary to become
effective therapists (Sperry, Carlson, & Kjos, 2003).

䊏 Why Bother With Theories?

A common question that most potential helpers ask revolves around why they
need to bother learning about or applying theories, because all they really want to
do is help people. In response, professional helpers point both to their years of per-
sonal experiences and to research in the field of helping to testify to the importance
of studying and functioning within conceptual frameworks (Kottler, 2000; Parsons,
2004). Other compelling reasons that attest to the value of theories are mentioned
here.

Support for Theories

䊏 They help organize data.
䊏 They provide frameworks for actions.
䊏 They help affirm credibility of the helpers.
䊏 They are landmarks for the helpers’ work.

䊏 Theory Defined

Santrock (1999) defined theory generically and also provided a definition of coun-
seling theory as follows:

Theory: A set of principles that helps to explain a group of facts or a phenom-

enon and is used to make predictions.

Counseling theory: A framework for observing and understanding human

behavior that allows for making predictions about the concerns, actions, per-
ceptions, emotions, and motivations of human beings. It is also the basic plat-
form from which counselors operate to make interventions.

䊏 Theories With Which Helpers Need to Be Familiar

Although it is not an easy task to master every single theory about helping that
populates the field of counseling, there are still some basic frameworks helpers
should grasp. Having theoretical frameworks at their fingertips helps counselors
196 What Are the Essential Elements of Counseling? PART TWO

understand the ways people learn, grow through their life’s experiences, and de-
velop problems; additionally, theories aid counselors in deciding which path to fol-
low to help people get back on their feet. Kottler (2000) proposed that helpers be fa-
miliar with following basic conceptual models.

Core Counseling Theories

䊏 Developmental theories.
䊏 Learning theories.
䊏 Theories of intervention.
䊏 Psychoanalytic theories.
䊏 Client-centered theories.
䊏 Existential theory.
䊏 Gestalt theory.
䊏 Adlerian theory.
䊏 Behavioral theory.
䊏 Cognitive-behavioral theory.
䊏 Reality theory.
䊏 Structural or systemic theory.
䊏 Strategic or problem-solving theory.
䊏 Narrative theory.

䊏 A Word About Eclecticism

Numerous helpers describe their therapeutic approach as eclectic. Kottler (2000)

defined eclecticism this way:

Eclecticism: Borrowing “from a variety of approaches depending on the pre-

senting problem; the client’s most important needs at a moment and time;
how much time is available to initiate change; what objectives and goals have
been agreed upon, the preferences, styles, and mood of the helper; and the
philosophy of the organization” (pp. 26–27).

䊏 Helping Defined

Young (2001) defined helping in these terms:

Helping: “[A] broad term that encompasses all the activities we use to assist
another person, whether we have a professional relationship or not” (p. 24).
CHAPTER TEN Individual and Social Aspects of the Helping Relationship 197

Helping requires a person seeking help (a client), another person who has the abil-
ity, as well as the desire, to give help (the helper), and an appropriate setting where
the helping process can take place (Cormier & Hackney, 2005).

䊏 The Helping Process

The main elements that constitute the helping process can be summarized as the
personality of the helpers, which, when coupled with their use of specific skills,
produce growth conditions that have an important impact on the helpees, the help-
ers, and society as a whole. More specifically, the process of helping is aimed at a
number of goals.

Goals of the Helping Process (Brammer & MacDonald, 1999)

䊏 Promoting changes in behaviors and lifestyle.
䊏 Transforming thoughts and self-perceptions.
䊏 Developing awareness and understanding.
䊏 Bringing relief from suffering.

Parsons (2004) viewed helping as a special kind of interpersonal process and re-
sponse that implies the involvement of at least two persons. He proposed the fol-
lowing as the operational elements of this special process.

Elements of the Helping Process

䊏 The helping dynamic.
䊏 The helping participants.
䊏 The helping relationship.
䊏 The helping focus.
䊏 The helping outcome.

䊏 Frameworks Within Which the Helping Process Occurs

Skovholt and Rivers (2004) postulated that the helping process generally takes
place within the following simple framework in spite of the variability that exists in
helping.

Skovholt and Rivers’s (2004) Conceptualization of the Helping Process

1. Beginning.
2. Maintenance.
3. Ending.
198 What Are the Essential Elements of Counseling? PART TWO

Parsons (2004) seemed to concur with this conceptualization when he declared,

“[T]heorists may differ in their opinions about the specific number of stages, but
most will agree that helping proceeds through at least three fundamental stages”
(pp. 20–21).

Parsons’s (2004) Description of the Helping Process

1. Coming together or developing and building a helping alliance.
2. Exploring together or reconnaissance.
3. Acting together or intervention.

Although recognizing that the course of psychotherapy comprises a beginning,

middle, and end point, Sperry et al. (2003) offered a four-phase model of the help-
ing process.

Sperry et al.’s (2003) Phases of Helping

1. Engagement.
2. Assessment.
3. Intervention.
4. Maintenance and termination.

Finally, Young (2001) proposed a five-stage structure as a road map for the helping
process, which is described here.

Young’s (2001) Stages of Helping

1. Relationship building and opening up.
2. Assessment and planning information.
3. Treatment planning and goal setting.
4. Intervention and action.
5. Evaluation and reflection.

䊏 Helping Helpees Meet Their Needs

To provide help means to set up the necessary conditions that will assist helpees to
meet their needs. These needs can be understood by considering the work of
Maslow (1962), who offered a five-level hierarchy of needs that has to be satisfied to
attain optimum development or actualization. The classification of these human
needs suggests that higher order needs only will emerge when the lower ones have
been reasonably satisfied.

Maslow’s Hierarchy of Human Needs

1. Physiological and biological needs.
2. Safety needs.
CHAPTER TEN Individual and Social Aspects of the Helping Relationship 199

3. Love needs.
4. Self-esteem needs.
5. Self-actualization needs.

See Chapter 8 for more information on Maslow’s needs hierarchy.

WHAT CONSTITUTES EFFECTIVE HELPING?

The 1995 annual survey of Consumer Reports about the effectiveness of helping con-
cluded that, regardless of modality, most people benefited greatly from therapy
(Seligman, 1995). Research findings on the effectiveness of helping indicate that
“the personal qualities of helpers are as significant for positive growth of helpees as
are the methods they use” (Brammer & MacDonald, 1999, p. 26). What follows are
some of the criteria that define the role of professional helpers as growth facilitators
and the personal characteristics that contribute to making helping effective.

䊏 Professional Helpers as Growth Facilitators

Rogers (1980) saw the following personal characteristics as essential for helpers’ ef-
fectiveness.

Rogers’s (1980) Characteristics of Effective Helpers

䊏 Congruence is the ability to be genuine with the client or the ability of the helper to
maintain a consistency among personal feelings, thoughts, and behavior.
䊏 Unconditional positive regard is the counselor’s ability to accept and respect each
client as a person and to believe in the inherent worth of every individual.
䊏 Empathy is the helper’s ability to understand another person’s feelings and
frames of reference and to suspend personal judgment while entering into the
subjective worldview of the client.

Expanding on Rogers’s theoretical framework, Carkhuff and Berenson (1967),

Truax and Carkhuff (1967), Carkhuff (1968), and Combs (1982) all identified the fol-
lowing facilitative traits in which helpers can be trained to influence helpees’
growth.

More Traits of Effective Counselors

䊏 Empathy: Helpers attempt to view the world with the eyes of their helpees, by
stepping into their internal frame of reference.
200 What Are the Essential Elements of Counseling? PART TWO

䊏 Warmth and caring: Helpers attempt to express friendliness and consideration to-
ward their helpees and to show compassion and genuine concern about their
helpees’ welfare.
䊏 Openness: Helpers are willing to disclose their own personal views to their
helpees in a genuine and honest way as a means to gain the trust of their helpees.
䊏 Respect and positive regard: Helpers not only communicate deep concern for their
helpees’ welfare, but also manifest toward them respect for their individuality
and worth as persons.
䊏 Concreteness and specificity: Helpers attempt to be unambiguous and precise in-
stead of general and vague while communicating with their helpees.
䊏 Communication competence: Helpers are able to communicate to their helpees
better ways to describe themselves as well as provide them with clearer descrip-
tive insights about their problems and are able to function within the multicul-
tural verbal and nonverbal language framework of their helpees.
䊏 Intentionality: Helpers are capable of navigating through and choosing from a
wide range of possible responses to their helpees’ situations.

Seligman (2001) viewed the following as essential conditions of effective therapeu-

tic relationships.

Conditions of Successful Therapeutic Relationships (Seligman, 2001)

䊏 Empathy.
䊏 Trustworthiness.
䊏 Caring.
䊏 Genuineness and congruence.
䊏 Persuasiveness.
䊏 Hope.

Finally, according to Parsons (2004), the effective helpers are those that display the
following characteristics.

Qualities of Effective Helpers (Parsons, 2004)

䊏 Self-aware.
䊏 Exhibit facilitative attitudes and values.
䊏 Maintain emotional objectivity.
䊏 Employ an investigative approach to helping.

䊏 Personal Characteristics of Effective Helpers

Combs (1982) coined the term self as instrument to “indicate that our principle help-
ing tool is ourselves acting spontaneously in response to the rapidly changing in-
CHAPTER TEN Individual and Social Aspects of the Helping Relationship 201

terpersonal demands of the helping relationship” (Brammer & MacDonald, 1999,

p. 36). The following are personal helpers’ characteristics that determine the nature
of this relationship.

Traits of Helpers That Influence the Counseling Relationship

䊏 Awareness of self and values.
䊏 Awareness of cultural experiences.
䊏 Ability to analyze personal feelings.
䊏 Ability to serve as model and influencer.
䊏 Altruism and compassion.
䊏 Strong sense of ethics.
䊏 Responsibility.
䊏 Ability to empower others.

Regardless of the settings and the theoretical framework from which they operate, ef-
fective helpers embody certain, basic qualities. Cormier and Hackney (2005) identi-
fied the following personal qualities of successful counselors.

Personal Qualities of Transformative Helpers

䊏 Self-awareness and understanding.
䊏 Good psychological health.
䊏 Sensitivity to and understanding of racial, ethnic, and cultural factors in self and
others.
䊏 Open-mindedness.
䊏 Objectivity.
䊏 Ability to promote the welfare of the client.

Moreover, Okun (2001) suggested the following characteristics as important to the

success of the helping relationship.

Skills and Characteristics That Make Good Helpers (Okun, 2001)

䊏 Helpers can operate easily with a multitude of approaches and strategies.
䊏 Helpers are self-aware of their personal beliefs and values to help their clients be-
come familiar with their own belief and value systems.
䊏 Helpers are able to instill trust within the helping relationship through proper
use of emphatic communication skills.
䊏 Helpers are sensitive to multicultural variables in their choice of strategies and
interventions when working with culturally diverse clients.
䊏 Helpers are familiar with strategies that will address the affective domain (feel-
ings and emotions), the cognitive domain (thoughts and intellectual processes),
and the behavioral domain (actions and deeds) of the clients.
202 What Are the Essential Elements of Counseling? PART TWO

Based on a study conducted by Jennings and Skovholt (1999) of peer-nominated

outstanding therapists, Seligman (2004) reported the nine qualities that character-
ize effective clinicians.

Recognized Qualities of Effective Clinicians (Seligman, 2004)

1. They are eager to learn.
2. They draw heavily on their extensive experience.
3. They value and can deal with ambiguity and complex concepts.
4. They can recognize and accept people’s emotions.
5. They are emotionally healthy and nurture their own emotional well-being.
6. They are self-aware and can assess the impact their own emotional health has
on their work.
7. They have strong interpersonal skills.
8. They believe in the importance of and value in the therapeutic alliance.
9. They can use their good interpersonal skills to develop a positive therapeutic
alliance.

䊏 Helpers’ Skills

Corey (1995) proposed a list of skills that group leaders need to be familiar with to
be effective; these skills are equally necessary in individual therapy. The following
list outlines the skills that professional helpers need to master to be successful.

Skills of Effective Helpers (Corey, 1995)

䊏 Active listening.
䊏 Restating.
䊏 Clarifying.
䊏 Summarizing.
䊏 Questioning.
䊏 Interpreting.
䊏 Confronting.
䊏 Reflecting feelings.
䊏 Supporting.
䊏 Empathizing.
䊏 Facilitating.
䊏 Initiating.
䊏 Setting goals.
䊏 Evaluating.
䊏 Giving feedback.
䊏 Suggesting.
CHAPTER TEN Individual and Social Aspects of the Helping Relationship 203

䊏 Protecting.
䊏 Disclosure.
䊏 Modeling.
䊏 Terminating.

䊏 Helpers and Diversity Issues

Neukrug and Schwitzer (2006) pointed out that research has consistently sup-
ported the view that minority clients with non-White backgrounds often are
misdiagnosed, shun counseling, terminate counseling prematurely, and find ther-
apy of little or no help. Arredondo (1999) saw clinicians’ biases, stereotypes, and
lack of genuine information about clients from minority groups as one of the rea-
sons for these situations. Neukrug and Schwitzer (2006) offered a number of coun-
selors’ negative attitudes that contribute to the failure of counseling with minority
non-White clients.

Helpers’ Negative Attitudes Influencing “Minority Clients”

䊏 Holding onto the melting pot myth.
䊏 Having different expectations about counseling than the client.
䊏 Not understanding the impact of social forces.
䊏 Maintaining an ethnocentric worldview.
䊏 Being ignorant of one’s own racist attitudes and prejudices.
䊏 Not understanding differences in the expression of symptomatology.
䊏 Not realizing that assessment and research instruments may be culturally insen-
sitive.
䊏 Being unaware of institutional racism.

For more on diversity issues in counseling, see Chapters 4, 11, 14, and 16.

TRAINING MODELS FOR COPING SKILLS DEVELOPMENT

At one time, psychological knowledge, skills, and strategies were the sole property
of expert psychologists. However, a paradigm shift started to occur within the
mental health field when helpers discovered that for psychology to be of any rele-
vance to human welfare, it must be given away (Larson, 1984). With this revelation,
the professional helping field began to witness the conversion of psychological
principles and approaches into skills that were teachable and propagated through
systematic methods and programs. In the next two sections, we present some of the
models that have been developed over the years to train both professionals and
nonprofessionals.
204 What Are the Essential Elements of Counseling? PART TWO

In this section, we present models that constitute coping skills that are taught di-
rectly to clients. These include the following:

䊏 People-in-system model.
䊏 Life skills education model.
䊏 Structured learning therapy model.
䊏 Social skills model.

䊏 People-in-System Model

The people-in-system model, pioneered by Egan and Cowan (1979), is based on the
equation HD = f [(P × S) × (S × S)], to signify that “human development (HD) is a
function of (f) the interaction between (×) people (P) and the human systems (S) in
which they are involved, and this interaction system (P × S) is in turn affected by (×)
other systems in the environment (S × S)” (Larson, 1984, p. 25). The three elements
that constitute the model are the same basic elements of the equations.

Central Elements of the People-in-System Model

(Egan & Cowan, 1979, p. 7)
1. People (P): Individuals journeying through the stages of life, facing lifelong and
developmentally appropriate tasks and crises.
2. Human systems (S): Refer to the groups of which the individuals are members
and in which they undergo life development experiences.
3. Interaction (×): A two-way interaction between individuals and the system and
between the systems themselves.

For individuals in the systems to achieve a positive outcome from these interac-
tions, they must possess a combination of working knowledge and skills. The peo-
ple-in-system model offers the following framework from which counselors can be
trained.

Elements of the Training Framework for Counselors

䊏 A working knowledge of developmental processes across the life span.
䊏 A working knowledge of the major human systems that affect people’s lives.
䊏 The kinds of life skills needed for individuals to effectively cope with develop-
mental tasks within the social settings of their lives.

䊏 Life Skills Education Model

Working within a developmental and psychoeducational framework, Adkins

(1984) developed the Life Coping Skills Program, which focuses on helping people
CHAPTER TEN Individual and Social Aspects of the Helping Relationship 205

learn how to become more aware of and perceptive about life crises as well as more
educated and behaviorally competent to cope with these crises. The programs are
designed to help the learners “clarify feelings and values, make decisions and
choices, resolve conflicts, gain self-understanding, explore environmental oppor-
tunities and constraints, communicate effectively with others, and take personal re-
sponsibility for their actions” (Larson, 1984, p. 44). Central to the life skills ap-
proach to counseling are the four stages Adkins proposed for learning.

Learning Stages in the Life Skills Approach

1. In the stimulus stage there is a dramatic presentation of an emotionally loaded,
provocative video vignette aimed at stimulating and focusing discussion.
2. In the evocation stage, the life skills educator (LSE) uses a structured pattern of
questions to draw out elements of the problem presented from the group mem-
bers, help them recognize the important issues, and invite them to identify
with similar experiences they have had.
3. During the objective-inquiry stage, the LSE finds out through various activities
what others know about the problem and how they relate to it.
4. In the application stage, the learner is encouraged to transfer the new under-
standing, insight, feelings, and knowledge into actual behavior in a simulated
or real-life situation.

䊏 Structured Learning Therapy Model

Designed by Goldstein, Gershaw, and Sprafkin, the structured learning therapy

model seeks to “meet the needs, lifestyles, and environmental realities of the lower
class, since traditional methods of treatment have proved grossly inadequate and
inappropriate for this population” (Larson, 1984, p. 70). The designers proposed
two prescriptive approaches for the client from a lower socioeconomic back-
ground, which they termed conformity presecription (Goldstein, 1973).

Conformity prescription: Seeks to make clients fit the therapy by trying to

enhance in them a positive appreciation for the therapeutic relationship.

Reformity prescription: Seeks to make the therapy fit the client through
structured learning therapy so that it can be more consistent with the client’s
styles.

The following techniques are used in structured learning therapy.

Techniques of Structural Learning Therapy

䊏 Modeling.
䊏 Role playing.
206 What Are the Essential Elements of Counseling? PART TWO

䊏 Performance feedback.
䊏 Transfer of training.

䊏 Social Skills

Developed by Gambrill, social skills training is grounded in a transactional model

that acknowledges that people are active creators of their social environments and,
in turn, are influenced by it (Larson, 1984). Social competence is achieved when in-
dividuals can use cognitive processes to discern and perform appropriate behav-
iors relevant to specific situations. A process model of social skills is comprised of
cognitive, psychological, and overt behaviors as major components. Any defi-
ciency that occurs in any of these components can influence the following behav-
ioral skills.

Components of Behavioral Skills

䊏 Goals/plans/feedback suggests that social situations allow for pursuit of various
goals attainable in different situations.
䊏 Perception suggests that effective social behavior requires one to be particularly
attentive to and make accurate observation of other people.
䊏 Translation implies that although one must have accurate perception of the be-
havior of others, one also must interpret their behavior correctly.
䊏 Taking the role of others implies that skilled observers of other people’s point of
view perform their social tasks more effectively than those who are less skilled.
䊏 Situations are the specific contexts in which every effective social behavior oc-
curs.
䊏 Verbal and nonverbal behaviors suggest that socially effective behavior includes the
implicit facility to begin, continue, and finish conversations.
䊏 Self-presentation implies that information about our role, status, and claim for so-
cial identities is given to others by us.
䊏 Feedback suggests that socially effective people make good use of feedback, are
attentive to others’ responses to their actions, and utilize these reactions to adjust
subsequent behaviors.
䊏 Rewardingness and reinforcement implies that when small reinforcements are of-
fered through approval or disapproval and through pleasure or displeasure,
people’s lives are influenced.
䊏 Flexibility, creativity, and coping skills suggest that effective social behavior is char-
acterized by the ability to be flexible in choosing from a variety of options, as well
as the skill to create new options and skills in specific situations.

Social skills training is designed to enhance observational, performance, and cogni-

tive skills related to effective social behaviors in particular situations, and consists
of a variety of components that include the following.
CHAPTER TEN Individual and Social Aspects of the Helping Relationship 207

Components of Social Skills Training

䊏 Guidance refers to instructions, prompting, and programming of change.
䊏 Demonstration refers to modeled presentation and rehearsal.
䊏 Practice suggests that participants practice the modeled behavior.
䊏 Constructive feedback is the positive feedback offered after each rehearsal.
䊏 Homework assignments are new behaviors that are tried out in real-life settings
through assignments.

TRAINING MODELS FOR INTERPERSONAL

SKILLS DEVELOPMENT

The following models have been developed to enhance interpersonal skills in help-
ers for effective helping and living:

䊏 Skilled Helping: Problem Management Model.

䊏 Relationship Enhancement Therapy.
䊏 Microskills Counseling Model.
䊏 Interpersonal Process Recall.
䊏 Human Resources Development.
䊏 Listening and Focusing.

䊏 Skilled Helping: Problem Management Model

Egan (2002) proposed a three-stage problem management framework for helping

and helper training. The model also consists of a nine-step process that can be
taught to clients so that they can become more effective in managing crisis situa-
tions in their lives. An “instrument for systematic and integrative eclecticism”
(Larson, 1984, p. 133), the model can be used by all helpers, irrespective of their the-
oretical approach or school, as a tool to help clients identify, create, and utilize envi-
ronmental resources to manage their problems.

Egan’s Stages of the Helping Process

䊏 Stage I asks, “What’s going on?” and guides helpers to identify, clarify, and ex-
plore key issues and unused opportunities by reviewing the current scenario.
䊏 Stage II asks, “What solutions make sense for me?” and suggests that helpers
identify and determine outcomes for a better future or a preferred scenario.
䊏 Stage III asks, “What do I have to do to get what I need or want?” and guides
helpers to develop strategies for accomplishing therapeutic goals.
208 What Are the Essential Elements of Counseling? PART TWO

Each of the three stages Egan identified is further divided into three steps. These
steps are outlined next.

Steps Within Stage I

1. Help client tell their stories.
2. Help clients break through blind spots in themselves, their problems, and
missed opportunities.
3. Help clients choose the right issues to work on.

Steps Within Stage II

1. Help clients discover for themselves possibilities for a better future.
2. Help clients select realistic and challenging goals.
3. Help clients find the incentives for commitment to change.

Steps Within Stage III

1. Help clients see the multiplicity of ways for accomplishing goals.
2. Help clients opt for strategies that are the best fit for them.
3. Help clients craft a plan.

All three stages are rooted in action, as they are only the planning for change, not
change itself. In describing action, Egan (2002) asked how helpers can aid clients in
making changes and implementing their plans. In other words, clients need to do
something for themselves right at the onset of the helping process to promote
change. Egan also proposed three basic communications skills he saw as necessary
for the helping process.

Egan’s (2002) Communication Skills

䊏 Attending: The skill of visibly tuning to clients summarized in the acronym
SOLER (squarely facing the client, open posture, leaning toward each other, eye
contact is maintained, and relaxed appearance).
䊏 Active listening: Paying attention both to verbal behavior and nonverbal behavior
to really understand what clients are saying.
䊏 Empathy: Ability to draw from personal experiences, emotions, and behaviors
and to respond in ways that express to clients that their experiences, emotions,
and behaviors are being understood.

䊏 Relationship Enhancement Therapy Model

Guerney (1977) is considered the father of relational enhancement therapy (RET).

Influenced by the theoretical orientation of Rogers, Horney, Sullivan, Anna Freud,
Skinner, and Bandura, this integrative model can be used as a therapy, a means of
problem prevention, and a program that can enhance personal and vocational life
(Guerney, 1977). Single individuals, family members, and organizational groups
can benefit from the skills of RET to achieve their goals and improve their personal
CHAPTER TEN Individual and Social Aspects of the Helping Relationship 209

and interpersonal transformation. The following are some skills taught to clients in
RET.

RET Therapist Skills

䊏 Expressive skills enhance clients’ awareness and knowledge of their own self-con-
cept, emotions, conflicts, and issues, and increase their ability to communicate
these effectively to others.
䊏 Empathic skills increase clients’ capacity to understand others’ behaviors, feel-
ings, conflicts, problems, needs, and goals.
䊏 Mode switching increases clients’ ability to move from empathic mode to expres-
sive mode at the appropriate time and in relevant situations.
䊏 Interpersonal conflict or problem resolution increases clients’ capacity to solve con-
flicts and problems with self and with others.
䊏 Facilitation increases clients’ ability to trigger in others interpersonal reactions
that can contribute to conflict and problem resolutions, enrichment of relation-
ships, and personal growth.
䊏 Generalization and maintenance enhances clients’ capability to utilize RET in daily
life situations on a permanent basis.

䊏 Microskills Counseling Model

Designed by Ivey and Galvin, the microcounseling program takes its roots in social
learning theory and teaches specific interviewing skills (Larson, 1984). Because the
model is transtheoretical, counselors can be effectively trained in it independent of
their therapeutic orientations. The format for the microcounseling training is as fol-
lows:

䊏 Brief introduction to the skill.

䊏 Viewing of brief video vignette of the skill being demonstrated by an expert.
䊏 Presentation of literature that elaborates on the concept just viewed.
䊏 Group practice of skills with audiovisual equipment.

Several skills needed for the microcounseling model, taken from “Ivey’s
Microskill Hierarchy” (Larson, 1984, p. 210) are presented next.

The Microskills Hierarchy

䊏 Attending behavior.
䊏 Client observation skills.
䊏 Open and closed questions.
䊏 Encouragement, paraphrasing, and summarization.
䊏 Reflection of feeling.
䊏 Reflection of meaning.
䊏 Focusing.
䊏 Influencing skills.
210 What Are the Essential Elements of Counseling? PART TWO

䊏 Confrontation.
䊏 Skill sequencing and structuring the interview.
䊏 Skill integration.

See Chapter 5 for more information on how microskills are used in supervision.

䊏 Interpersonal Process Recall

The interpersonal process recall (IPR) model was developed by Kagan (1980) pri-
marily as a means to improve the reliability of training programs for mental health
workers. The method consists of reviewing a videotape or audiotape to recall and
increase counselor awareness of covert thoughts and feelings of client and self,
practice expressing covert thoughts and feelings in the here and now without nega-
tive consequences, and, consequently, to deepen the counselor–client relationship.

Phases of IPR
1. Facilitating communication.
2. Affect simulation.
3. Counselor recall.
4. Inquirer training.
5. Client recall.
6. Mutual recall.
7. Transfer of learning.

䊏 Human Resources Development Model

The human resources development (HRD) model takes its roots from the work of
Carkhuff, who, in the early 1960s, expanded on Rogers’s core conditions of em-
pathic understanding, unconditional positive regard, and genuineness to include
many facilitative therapist skills (Cash, cited in Larson, 1984). Characteristics
added to Rogers’s core concepts are concreteness, confrontation, and immediacy.
The three stages of Carkhuff’s counselee model and the helping skills employed
to facilitate this process are as follows:

1. Self-exploration includes prehelping and responding.

2. Understanding involves personalizing the issue.
3. Action involves initiating, problem solving, and program development.

Additionally, HRD is a training program that is comprised of the six modules iden-
tified here.

The HRD Training Program

䊏 Module I: Introduction to and overview of the training program.
䊏 Module II: Prehelping skills.
䊏 Module III: Responding skills.
CHAPTER TEN Individual and Social Aspects of the Helping Relationship 211

䊏 Module IV: Personalizing skills.

䊏 Module V: Problem-solving processes.
䊏 Module VI: Program-development steps.

䊏 The Politics of Giving Therapy Away: Listening and Focusing

Gendlin, pupil of the late Rogers, attempted to demystify the process of therapeutic
change by treating it as a teachable skill. He defined focusing as the technique of
“attending to the physically sensed border zone between the conscious and uncon-
scious” (cited in Larson, 1984, p. 287). In other words, when the client actually can
sense the change occurring in his or her body, the individual then can begin to rec-
ognize when change is occurring and act in ways that foster change.

Listening: “[R]eceiving what someone wishes to convey and saying it back to

the person exactly as it was meant” (p. Larson, 1984, p. 288).

Focusing: Paying attention to a problem as a whole within one’s body, as

these bodily shifts and responses to problems or solutions often go unrecog-
nized.

Listening on the part of the helper, then, serves as the precursor for the helpee to
focus.
Preliminary steps to focusing include placing one’s attention in the middle of the
body and sensing the concerns that the body is carrying and imagining what the
body would feel like without those concerns.

The Six Movements of Focusing

1. The preliminary space-making.
2. The felt sense coming.
3. The quality “handle.”
4. The resonating.
5. The asking.
6. Protecting the little step that came.

SOCIAL-PSYCHOLOGICAL APPROACHES TO HELPING

Many of the training models and approaches mentioned thus far focus on the indi-
vidual person in the helping relationship. In the final section, we highlight the so-
cial context that is important to change in the helping process by providing an over-
view of several key approaches to understanding human relationships from the
viewpoint of social psychology. Social-psychological examinations of the human
experience are grounded largely in sociological movements that long have been in-
terested in the interactions of people with their environments. In line with the pur-
poses of the chapter, in this section we look at how an appreciation of people-in-re-
lation can be useful to professional counselors.
212 What Are the Essential Elements of Counseling? PART TWO

䊏 Symbolic Interaction

Symbolic interaction is a sociological theory of human behavior proposed by phi-

losopher George Mead and more fully developed by Blumer in reaction to behav-
iorist explanations of human interaction (Slawski, 1981). From this perspective, hu-
man behavior is explained as indirect reactions to stimuli; that is, interactions are
initiated on the basis of the interpretations (symbols) that one assigns to a behavior.
Symbolic interactionism theorizes that individuals form their self-identity based
on their interpretations of others’ reactions to them in a social context. Thus, the hu-
man self is primarily a social construction rather than a biological creation or a
product of unconscious drives as suggested by psychoanalysis. The following are
core concepts in symbolic interaction.

Key Assumptions of Symbolic Interactionism

䊏 Social acts are the core process of interaction between individuals and are the
processes from which meaning is derived over a period of time and interactions.
䊏 Symbols and language are a central part of communication.
䊏 Humans are distinguished in the social world because of their ability to assign
meaning to events and objects and to communicate through symbols.
䊏 Change and adjustment is constant, therefore, people continually are reacting to
others and redefining who they are based on interpersonal interactions.

To illuminate the power of symbols, it might be helpful to consider the impact the Di-
agnostic and Statistical Manual of Mental Disorders IV–TR (DSM–IV–TR; American
Psychiatric Association, 2000) has had on the counseling profession and on clients.

EXAMPLE

Connecting Symbolic Interactionism to Counseling

The DSM–IV–TR is used widely in the human services field as a way of characterizing and cat-
egorizing mental disorders. From a symbolic interactionist perspective, the labels that are ap-
plied to individuals who display peculiar behaviors or ways of thinking encourage and sup-
port those behaviors because the label is a symbol that the individual internalizes, and the
label influences the self to the extent that the self becomes the label.

See Chapter 19 for further critique of the DSM–IV–TR from a social constructivist
perspective.

䊏 Role Theory

J. L. Moreno, founder of the group therapy intervention, psychodrama, is one of the

early pioneers of role theory. Role theory developed out of symbolic interactionism
and is based on the assumption that behavior is influenced by socially imposed role
CHAPTER TEN Individual and Social Aspects of the Helping Relationship 213

obligations, assuming social roles are a distinguishing characteristic of human be-

ings (Slawski, 1981). Moreover, social roles constantly are changing over the course
of a lifetime; as individuals enter new life stages with different expectations and as
they develop varying significant relationships, they adopt new roles to fit their life
stage and personal interactions. From this perspective, behavior is rewarded or
punished based on evaluation of role performance.

䊏 Social Exchange

The social exchange approach has its roots in the behaviorist movement and posits
that people consciously or unconsciously account for the exchange of costs and
benefits in relationships and favor relationships with the greatest benefits (Slawski,
1981). Embedded in exchange theory is the law of reciprocity, which can be under-
stood this way:

Law of reciprocity: Suggests that resource outputs must be balanced by

inputs.

The principal concepts that characterize social exchange theory were summarized
by Call, Finch, Huck, and Kane (1999) and Koper and Jaasma (2001) this way:

䊏 The exchange of gains and losses perceived to be connected to an interaction in-

fluences decisions about social involvement.
䊏 Individuals create and maintain social involvements based on rewards they receive.
䊏 Exchange of costs and benefits should be balanced over time.
䊏 People in positions of power can demand greater benefits than people who are
not in positions of power.
䊏 People act in ways that increase the chance of receiving items they value and de-
crease the chance of receiving items they devalue.

The power of social exchange theory is seen in the many day-to-day applications it
has to human experiences. The example of caregiving for older parents is just one
case of social exchange in action.

EXAMPLE

Looking at Caregiver Burden From Exchange Theory

One highly stressful experience for family members is caring for aging and ill parents. Call and
colleagues (1999) used exchange theory to propose that the burden of caring for older relatives
can be perceived as part of a natural give and take that occurs in long-term family relationships.
From the viewpoint of exchange theory, caregiving for the elderly is part of an ongoing relation-
ship with a history of exchanges, rather than a time-limited intervention. Furthermore, caregiv-
ing is an art of a reciprocal exchange in which the individual being cared for adds benefits to the
relationship throughout the caregiving process, rather than being the sole recipient of benefits.
214 What Are the Essential Elements of Counseling? PART TWO

䊏 Cognitive Consistency

Written about by a number of theorists including Heider (1958), Newcomb (1953),

and Osgood and Tannenbaum (1955), cognitive consistency suggests that people
strive to make their thoughts, attitudes, and behaviors consistent with each other.
The theory proposes that inconsistency results in psychological distress, which be-
comes a primary motivator for attitudinal or behavioral change. Cognitive consis-
tency is developed more fully by dissonance theory.

䊏 Dissonance Theory

The theory of cognitive dissonance states that related cognitions exist in a state of
consonance or dissonance. Festinger (cited in Forsyth, 1987) suggested that indi-
viduals experience psychological discomfort when they are aware of dissonance
and, therefore, are motivated to resolve the conflict among ideas or beliefs to rees-
tablish a state of consistency (Slawski, 1981). Dissonance theory, as a model for ex-
plaining motivation as well as attitude change, continues to be adjusted and dis-
puted in research.
Terms that are central to an understanding of dissonance theory are defined
here:

Dissonance: Occurs when there is inconsistency between two thoughts.

Consonance: Exists when two cognitions are aligned or consistent with one
another.

The likelihood that dissonance will increase is related to several characteristics of

the thoughts that are at odds with one another. Some of these factors are identified
here.

Factors Increasing Dissonance

䊏 Relative importance of the subject.
䊏 Extent to which the thoughts are in conflict.
䊏 Individual’s capacity to ally discordant thoughts.

When cognitive dissonance occurs, psychological discomfort is relieved by taking

one of several actions.

Ways to Relieve Dissonance (Slawski, 1981)

1. Increasing the number of thoughts that are consistent with the primary cogni-
tion.
CHAPTER TEN Individual and Social Aspects of the Helping Relationship 215

2. Reducing the number of thoughts that are dissonant with the primary cogni-
tion.
3. Increasing the importance of the consonant thoughts.
4. Decreasing the importance of the dissonant thoughts.
5. Changing the environment that promotes dissonance.

Interpretations of cognitive dissonance imply that our beliefs about something be-
come stronger after we are disproved because it is a way of protecting our self-image
as well as compensating for the lack of consistency between what we believe to be
true and what has been shown to be true in real-life situations when these two differ.

EXAMPLE

Applying Cognitive Dissonance to Help Stop Smoking Addiction

Counselors can apply dissonance theory as a motivator for change with clients by helping
them become aware of inconsistencies in their thoughts and behaviors. According to disso-
nance theory, the discomfort of this inconsistency is an instigator for change. One common ex-
ample is the inconsistency in smoking and the public knowledge that smoking is a health risk.
The unknown factor, however, with which counselors have to deal is the varying levels of dis-
sonance that different clients can absorb.

䊏 Heider’s Balance Theory

In the social sciences, Heider’s (1958) balance theory offers one way of understand-
ing how interpersonal relationships maintain stability. Relationships in which two
individuals have either an explicit or perceived agreement about a third object are
balanced. Interactions in which partners disagree about a third object or issue are
less stable due to the cognitive dissonance that results from the imbalanced rela-
tionship. Several concepts characterize balance theory.

Assumptions of Balance Theory

䊏 The perceived agreement about an object or issue can be as powerful as an actual
agreement in maintaining a cognitively balanced relationship.
䊏 Assimilation occurs when partners overestimate actual agreement to ensure a
balanced interaction.
䊏 Individuals are inclined to inflate the level to which they believe they are under-
stood by others to achieve a higher level of cognitive balance.
216 What Are the Essential Elements of Counseling? PART TWO

䊏 Congruity Theory

Congruity theory is a further development of Festinger’s dissonance theory and

Heider’s balance theory. The concern of Osgood and Tannenbaum’s (1955) congru-
ity theory is the attitudes that an individual has toward two objects that are juxta-
posed. Based on the same principle of congruency, the congruity theory proposes
that people experience inner pressure to reconcile conflicting attitudes toward re-
lated objects.

Assumptions of Congruity Theory

䊏 The relative strength or weakness of an attitude can be quantified.
䊏 Weaker attitudes will be subject to change before stronger attitudes about objects.

䊏 Newcomb’s A-B-X Model of Interpersonal Attraction

Newcomb’s A-B-X model attempts to explain the processes involved in interper-

sonal attraction. Of primary importance in this model is the role of values, beliefs,
and interests (Forsyth, 1987). Newcomb postulated that people with similar inter-
ests and backgrounds are more likely to form close relationships than those with
dissimilar characteristics, backgrounds, or values. Furthermore, the stronger the
bonds between two people, the more effort they will exert to reconcile differing at-
titudes toward an identified object (Psychology 200, 2005).
In the A-B-X model, A represents a person of primary interest, his or her ideas
and behavior open to change. In the same model, B represents a second person in
the triangle. The X in Newcomb’s model represents the attitude object, which may
be a value, norm, idea, or issue at hand. The terms symmetry and dissymmetry are
used to talk about the relationship among the three components of Newcomb’s
model; they can be understood this way (Slawski, 1981):

Symmetry: The state of balance among A, B, and X (two individuals and an

object).

Dissymmetry: Exists when either A and B have contradictory attitudes to-

ward X; when dissymmetry exists, A and B change intensity of their attitudes
toward X or their attraction toward one another until symmetry is reestab-
lished.

䊏 Attributions

Attribution theories are a social-psychological attempt to explain the causes of

people’s behavior (Forsyth, 1987). Attributions or explanations for why people act
in the ways they do are broadly classified as either internal or external influences
CHAPTER TEN Individual and Social Aspects of the Helping Relationship 217

(Bemmels, 1991). Internal attributes suggest that motivation for a particular behav-
ior is located within a person, whereas external attributes assign causation for be-
havior to outside forces. According to Kelley (1967), attribution is assigned based
on three factors.

Factors Associated With Assigning Attributes

1. Consensus is the degree to which a behavior is exhibited only by an individual
or by a larger contingent of individuals. The more a behavior is displayed only
by an individual, the greater the likelihood that the behavior will be considered
internally motivated.
2. Distinctiveness is the extent to which a behavior is situation specific or related
to a particular entity.
3. Consistency is the frequency with which the behavior in question has been
present over a period of time. A behavior that an individual exhibits with great
frequency is likely to be attributed to the individual rather than to the environ-
ment.

EXAMPLE

Attribution Theory and Career Counseling

In dealing with a client who is seeking career counseling, a therapist may have to help the cli-
ent resolve affective responses to work-related issues. From the perspective of attribution the-
ory, the client who is frustrated by not receiving a promotion may evaluate the situation by
making the following conclusions or attribution assignments to the boss:

1. The boss buys into a company mentality in which employees are not promoted.
2. The boss does not promote any employee in his or her division—the client is not the only
person whose contribution to the company is underappreciated.
3. The boss consistently fails to give promotions to employees.

Chapter 10: Key Terms

䉴 Theory 䉴 Reformity prescription 䉴 Dissonance
䉴 Counseling theory 䉴 Transactional model 䉴 Consonance
䉴 Eclecticism 䉴 Listening 䉴 Symmetry
䉴 Helping 䉴 Focusing 䉴 Dissymmetry
䉴 Conformity prescription 䉴 Law of reciprocity
 chapter The Cultural Kaleidoscope:
Eyeing Diverse Populations
11
Maura Krushinski
Duquesne University

In This Chapter

䉴 Opening up to Multicultural Realities 䊏 Stereotypes

in Counseling 䊏 Communication Styles
䊏 Implications of a Multicultural Worldview 䊏 Mental Health Issues
to Counselors’ Training
䊏 Implications of a Multicultural Emphasis 䉴 African American Population
for Counselor Educators 䊏 Historical and Demographic Factors
䊏 Implications of Multicultural Counseling 䊏 Value Orientations

for Program Development 䊏 Family Characteristics

䊏 Cross-Cultural Differences in 䊏 Communication Styles

Counselor–Client Relationships 䊏 Mental Health Issues

䊏 What Is Cultural Context? 䊏 Considerations When Counseling

䊏 A Model for Understanding Differences

䊏 Avoiding “Preferred” Clients Only 䉴 Asian American Population

䊏 The Notion of White Privilege 䊏 Historical and Demographic Factors
䊏 Family Values

䉴 Challenges for Children of Specific 䊏 Common Stereotypes

Populations 䊏 Mental Health Issues

䊏 Examining the Influence of Ethnicity 䊏 Communication Styles

on Children 䊏 Effective Counseling Approaches

䊏 Additional Concerns When Working With

Children of Different Ethnic Groups 䉴 Latin American Population

䊏 Historical and Demographic Factors
䉴 Native American Populations 䊏 Family Characteristics

䊏 Historical and Demographic Factors 䊏 Communication Styles

䊏 Family Characteristics 䊏 Value Orientations

䊏 Value Orientations 䊏 Mental Health Issues

I would like to acknowledge Dr. Tom Petrone for his highly insightful suggestions as well as for his time and ef-
forts in reviewing this chapter.

218
In This Chapter (continued)

䉴 Arab American Population 䉴 Ableism and Disability

䊏 Historical and Demographic Factors 䊏 Demographics
䊏 Family Characteristics 䊏 Stereotypes

䊏 Value Orientations 䊏 Rehabilitation Counseling

䊏 Stereotypes 䊏 Counseling Issues

䊏 Counseling

䉴 Gay, Lesbian, Bisexual, and Transgendered

䉴 Elderly Population Population
䊏 Demographic Factors 䊏 The Process of “Coming Out”
䊏 Stereotypes 䊏 Counseling Issues
䊏 Mental Health Issues

䊏 Approaches to Counseling 䉴 Conclusion

219
220 What Are the Essential Elements of Counseling? PART TWO

OPENING UP TO MULTICULTURAL REALITIES IN COUNSELING

At its beginning, the counseling field was dominated primarily by White theorists of
European descent. Although these theorists provided the field with the strong theo-
retical foundations still taught in counselor education programs today, they, none-
theless, had a rather narrow view of cultural diversity that is reflected in their
theories. The impact of such a narrow worldview on the counseling profession is
that, at one time, it was appropriate to avoid acknowledgment of cultural differ-
ences, establish therapeutic neutrality, and counsel everyone as if they were of the
same background. Gradually, minority groups began to proclaim their differences,
which compelled the counseling profession to begin embracing the challenges of
having an increased awareness of multicultural realities and making a determined
effort to acknowledge and honor the cultural makeup of the client’s experience.
As the profession continues to evolve, increasing attention is being paid to the
need to adjust counseling approaches and methods to facilitate therapeutic work
with clients from specific cultural and ethnic groups. The counseling ethics state
purposefully that our primary concern is “the welfare of the client”; this means not
some clients, but all clients. Therefore, in an attempt to help counselors increase
their cultural competence, this chapter concentrates on the following specific pop-
ulations that counselors likely are to encounter during their professional careers:
Native Americans; African Americans; Asian Americans; Latin Americans; Arab
Americans; elderly individuals; disabled persons; and gay, lesbian, bisexual, and
transgendered persons.

䊏 Implications of a Multicultural Worldview to Counselors’ Training

The fact that some counselors choose to ignore their obligation to multicultural
competence and lack exposure to differing cultures has become a concern. Often,
counselor trainees’ greatest exposure to populations different than their own is not
through direct contact but, rather, through the media. In a field where multicultural
competence is essential, trainees must adhere to ethical and professional
responsibilities.

How Counselor Trainees Can Build Multicultural Competence

䊏 Develop the skills necessary to work with specific populations and incorporate
them into all aspects of their counseling program.
䊏 Recognize and honor clients’ diverse cultural values and heritage.
䊏 Assume an attitude of openness to the multicultural aspect of counselor training
by acknowledging any lack of awareness or limited exposure to populations dif-
ferent than their own.

䊏 Implications of a Multicultural Emphasis for Counselor Educators

Expectations for providing a multiculturally sensitive learning experience for stu-

dents also are placed on counselor educators.
CHAPTER ELEVEN The Cultural Kaleidoscope 221

How Counselor Educators Respond to Emphases on Multicultural Values

䊏 Heighten their own awareness and examine their own experiences and attitudes
with regard to multiculturalism.
䊏 Present a wide array of available materials on counseling specific populations.
䊏 Teach all aspects of culture, such as classism, racism, stereotypes, biases, issues
with gender, age, religion, sexual preference, and ethnicity.
䊏 Ensure that racial development models, the experience of race, and the experi-
ences of the culturally different in the United States are seriously examined in the
classroom.

䊏 Implications of Multicultural Counseling for Program Development

Until recently, multicultural issues and strategies were considered a specialized

field in counselor education (Pedersen, Draguns, Lonner, & Trimble, 2002), and
courses on multiculturalism often were offered as 1 credit hour electives. Recently,
professional organizations such as the ACA, CACREP, The National Council for
the Accreditation of Teacher Education (NCATE), the NBCC, and state licensing
boards have defined the development of multicultural competence as an integral
part of the counseling curriculum. Course requirements and standards for counsel-
ing diverse clients have been infused into counseling programs and appear on na-
tional counselor certification examinations, as well.

Check out CACREP’s (2001) standards for accredited counselor

education programs on social and cultural diversity:
䉴 http://www.cacrep.org/2001Standards.html

䊏 Cross-Cultural Differences in Counselor–Client Relationships

Cross-cultural and cross-class counseling implies that there are differences be-
tween the counselor and the client. Awareness of these differences may help the
counselor avoid the many pitfalls that negatively influence good contact and effec-
tive helping in the counseling relationship. The Association for Advanced Training
(AAT, 1991) recommends the following considerations for counselors to increase
their multicultural awareness.

Recommendations for Increasing Cultural Awareness

䊏 The counselor must acknowledge awareness of differences to the client in a sup-
portive way.
䊏 The counselor must be aware of factors that contribute to the client’ s orientation
and values such as language, degree of assimilation, and socioeconomic status.
222 What Are the Essential Elements of Counseling? PART TWO

䊏 The counselor must respect differences and avoid reference to negative stereo-
types.
䊏 The counselor must be aware of supportive referral sources for the client.
䊏 The counselor must recognize that social, economic, and political discrimination
and prejudice are real issues for minority groups in the United States.
䊏 The counselor must avoid generalizations about all clients who belong to a par-
ticular group.

䊏 What Is Cultural Context?

All attitudes, behaviors, and feelings are learned within a cultural context. Cultural
context was defined as follows by Pedersen et al. (2002):

Cultural context: the totality of the context in which people live, “including
ethnographic, demographic, status and affiliation variables” (p. 3).

Effective counseling interventions depend on an understanding of how variables

that make up a cultural context blend with the counseling process. Indeed, “the
search for professional excellence in counseling is closely linked with the search for
multicultural competence” (Pedersen et al., 2002, p. 3). Cultural bias, intentional or
unintentional, on the part of the counselor potentially can lead to inappropriate
counseling goals and process for the culturally different client.

For more information on multiculturalism as well as cultural context, see Chapter 4.

䊏 A Model for Understanding Differences

Sue and Sue (1990) described the Kluckhohn and Strodtbeck (1961) model as “one
of the most useful frameworks for understanding differences among individuals
and groups” (p. 138). Their model presumes that there is a set of core human ques-
tions that are present for all cultures.

Core Human Orientations for Clients of All Cultures

䊏 Perception of time: Some cultures emphasize the past, some the present, and
some are future oriented. History and tradition, the here and now, and plan-
ning for the future are all value orientations related to time (Sue & Sue, 1990).
䊏 Attitudes toward activity: Some cultures value doing over being, believing
self-worth is determined by accomplishment.
䊏 Definitions of social relationships: Relationships with others are a dimension of
importance in all cultures (Sue & Sue, 1990). In some cultures, relationships are
CHAPTER ELEVEN The Cultural Kaleidoscope 223

authoritarian and hierarchical, whereas in other cultures equal or balanced rela-

tionships are important.
䊏 The nature of people: Human nature is seen either as good or evil, and people
generally are socialized into trusting or suspicious modes.

The model also discusses the ways in which cultures make assumptions about
how their members relate to nature. Some cultures see themselves as “harmoni-
ous with Mother Earth” (Sue & Sue, 1990, p. 140), whereas some attempt to con-
trol nature.

䊏 Avoiding “Preferred” Clients Only

Skillful counselors understand that each worldview must be valued and that their
role is to help the client integrate aspects of each worldview in a way that will maxi-
mize their psychological and physical well-being. They also recognize the potential
biases that exist in their preferences for certain client populations. Hence, counsel-
ors working with clients different than themselves may embrace Schofield’s con-
cept that counselors prefer to work with the “YAVIS” client, that is, “one who is
young, attractive, verbal, intelligent and successful” (cited in Sue & Sue, 1990, p.
33). Sue and Sue (1990) also discussed Sundberg’s view that “therapy is not for the
‘QUOID’ client, that is, one who is seen as quiet, ugly, old, indigent and dissimilar”
(p. 33).

䊏 The Notion of White Privilege

While working with culturally different clients, the counselor also must take into
account the presence of privilege, especially privilege of the dominant culture.
McIntosh (1988) described one type of privilege, White privilege, this way:

White privilege: “[A]n invisible knapsack of special provisions, unearned as-

sets that put certain cultures at an advantage over others” (p. 1).

McIntosh pointed out a colleague’s statement that “Whites are taught to think of
their lives as morally neutral, normative and average, and also ideal, so that when
we work to benefit others, this is seen as work which will allow ‘them’ to be more
like ‘us’” (p. 1). Counselors who have lived with the reality of invisible privileges
are encouraged to be aware of their privilege, especially when working with clients
who are or have been underprivileged.

For more on the concept of privilege, see Chapter 4.

224 What Are the Essential Elements of Counseling? PART TWO

CHALLENGES FOR CHILDREN OF SPECIFIC POPULATIONS

The issue of children of diverse populations is a topic that deserves special men-
tion. Because their ethnic or social class backgrounds are different from those of the
majority, children sometimes face challenges related to being rejected, receiving
unfair treatment, being ridiculed, and being subjected to lower expectations.
Juntunen, Atkinson, and Tierney (2003) described a 1998 study that identified
stress from racial and ethnic discrimination and stress from the acculturation pro-
cess as two major types of stress faced by children from differing ethnic groups.
Additional stressors include those mentioned next.

Because their ethnic or social class backgrounds

are different from those of the majority, children
sometimes face challenges related to being
rejected, receiving unfair treatment, being
ridiculed, and being subjected to lower
expectations.

Stressors for Children From Differing Ethnic Groups

䊏 They may experience difficulties in combining the roles and values of their spe-
cific culture with those of the dominant culture.
䊏 They may incorporate roles and values from another culture more quickly than
other family members, thereby creating clashes at home.
䊏 They may have to contend with more limited opportunities to succeed.
䊏 The adolescent’ s struggle for identity will include the variable of cultural differ-
ence as they struggle with defining self and meaning of life.
䊏 They may be subjected to verbal rejection, discrimination, and even physical at-
tacks.
䊏 They may suffer social isolation and derisive labels.

䊏 Examining the Influence of Ethnicity on Children

There are three perspectives to consider when examining the influence of ethnicity
on children:

1. A developmental perspective helps the counselor to consider the role an ethnic

group has on a child’ s life.
2. An ecological perspective provides the counselor with the means to investigate
the interaction of systems such as family, school, government, social and eco-
nomic policies, and the impact on available risks and opportunities for the child.
3. A cross-cultural perspective compares the child’s culture of origin to the domi-
nant culture.
CHAPTER ELEVEN The Cultural Kaleidoscope 225

䊏 Additional Concerns When Working With Children

of Different Ethnic Groups

Counselors must consider potential concerns of cultural variation when working

with children of different ethnic groups. Those variations include the following:

䊏 Country of origin.
䊏 Immigration status.
䊏 Languages spoken.
䊏 Knowledge of English.
䊏 Sleeping and eating patterns.
䊏 Cultural expectations.
䊏 Level of acculturation.
䊏 Important holidays or celebrations.
䊏 Family attitudes about play.
䊏 Playmates.
䊏 Toys.
䊏 Discipline.

NATIVE AMERICAN POPULATION

The remainder of this chapter is dedicated to examining relevant aspects of specific

cultural groups, beginning with Native Americans. Native Americans represent
one of the most ethnically diverse cultural groups in the United States (Harper &
McFadden, 2003). This population consists of numerous tribal groups that reside in
cities or on reservations. Although many tribes encompass similar values and be-
liefs, the cultural practices, traditions, and social organization of Native American
tribes vary and are influenced by such factors as geographic location and historical
trauma experienced (Harper & McFadden, 2003).

䊏 Historical and Demographic Factors

The Native American population is 2,475,956, and represents 0.9% of the total U.S.
population (U.S. Census, 2000). This group of individuals is organized into 561
American Indian and Alaskan native tribes that speak more than 252 different lan-
guages. Their history is characterized by military defeat, ethnic demoralization,
and forced displacement, which resulted in the loss of millions of lives, land confis-
cation, and tribal dispersion. Historically, Native American children were removed
from their families and placed in boarding schools so that they might be assimi-
lated into the European culture. Furthermore, the Native American family often is
226 What Are the Essential Elements of Counseling? PART TWO

faced with overwhelming poverty, unemployment, and family dissolution that is

due, in part, to federal government policies and educational failures.

䊏 Family Characteristics

Although family values vary among the Native American population and are de-
termined by the particular tribe, band, or clan to which the members belong, the
family, including extended family, is still the center of Native American culture.
Hence, “cousins are referred to as brother and sister and the primary relationship is
not the parents but rather that of the grandparents” (McGoldrick, Giordano, &
Pearce, 1996, p. 36). There are no distinctions made between natural family mem-
bers and those who enter the family system through marriage. However, because
each tribe has its own worldview, it is inappropriate for the counselor to view the
Native American population as a homogeneous group.

䊏 Value Orientations

The Native American population is historically characterized as a “thriving,

self-governing people living in harmony with nature” (Harper & McFadden, 2003,
p. 66). Additionally, a number of other things can be said to be generally reflective
of Native American value systems.

Commonly Held Values in Native American Populations

䊏 They demonstrate deep reverence for the land and for their relationship with
wildlife.
䊏 They manage the environment with respect and great adaptability.
䊏 They are a holistic and spiritual people, giving thanks for their blessings (Harper
& McFadden, 2003).
䊏 Religion, medicine men and women, spiritual forces, and traditional religious
practices are essential in their lives.

䊏 Stereotypes

Historical stereotypes portray Native Americans as villains (Harper & McFadden,

2003) and violent savages whose aim was to slaughter White settlers. The culture
was seen as inferior in comparison to the European lifestyle and culture. Current
stereotypes portray this population as having a higher than normal incidence of al-
coholism.
According to Harper and McFadden (2003), there are three things that make Na-
tive Americans dissimilar from other ethnic minority groups.
CHAPTER ELEVEN The Cultural Kaleidoscope 227

Dissimilarities Between Native Americans and Other Minority Groups

1. Each tribe holds power and authority over the people that reside on its lands.
2. Federally recognized tribes have a government-to-government relationship
with the federal government.
3. Tribes that surrendered lands were relocated to reservations and were pro-
vided with housing, health care, food subsidies, and educational opportuni-
ties.

䊏 Communication Styles

Counselors working with the Native American population must be aware of some
of the unique elements related to Native American communication styles.

Key Awarenesses About Native American Communication Styles

䊏 Different tribal dialects exist.
䊏 Time orientation to the present is common.
䊏 Nonverbals and intuition are emphasized.
䊏 The desire to satisfy present needs by understanding the world through mystical
stories and folklore is important.
䊏 Listening is highly valued.
䊏 Long periods of silence indicate respect, the search for finding the right words to
say, or waiting for the right time to speak, and must not be misconstrued as resis-
tance.

䊏 Mental Health Issues

The most prevalent mental health issues of the Native American population are
suicide and alcohol abuse. Essential treatment approaches are holistic and inte-
grate indigenous and Western healing techniques. The therapeutic relationship
must view healing as a spiritual journey and be open to including the tribal healer
in the therapeutic process. Language, class, and cultural values are generic aspects
of counseling that can interact with the characteristics and values of Native Ameri-
cans and disrupt the therapeutic relationship.

Recommendations for Counselors Working With Native Americans

(Richardson, cited in AAT, 1991)
䊏 Use nondirective counseling approaches, specifically silence, acceptance, re-
statement, and verbal summarization.
䊏 Be contained and focused on what the client is saying.
䊏 Show openness to the client’s thoughts and feelings.
228 What Are the Essential Elements of Counseling? PART TWO

䊏 Repeat the client’s statements for the purposes of clarification.

䊏 Ask questions intended to clarify issues for the client.
䊏 Summarize verbally what has been worked on in various sessions over an ex-
tended period of time.
䊏 Acknowledge one’s lack of experience or cultural understanding when appro-
priate.
䊏 Approach sensitive topics such as alcoholism, history, suicidal tendencies, trea-
ties, boarding schools, and reservations with caution.
䊏 Honor the role of the medicine person in the counseling process.
䊏 Appeal to the traditional healer as a cocounselor in the process, and treat elders
and healers with respect.
䊏 Make use of cognitive-behavioral interventions rather than psychodynamic or
client-centered therapy because it can be adapted to the culture and the commu-
nity.
䊏 Include respected community and traditional leaders in the helping process.

In summary, counselors who provide counseling services to the Native American

population must show respect for their history, current socioeconomic status, and
the many varied aspects of the culture.

AFRICAN AMERICAN POPULATION

The African American population is among the largest minority groups in the
United States. Coupled with the longevity of their presence in the United States as
well as their history of oppression, it is imperative that counselors are well-edu-
cated on working with this group.

䊏 Historical and Demographic Factors

Although it is virtually impossible to fully describe the historical perspective of any

culture, it is important to recognize that the history of African Americans is charac-
terized by slavery. As a result, this population has struggled to develop a strong
cultural identity, experienced adverse effects of racism and inappropriate value
judgments, and has been unable to overcome the perception of being a problem in
society.
The African American population numbers approximately 33.9 million people
and 9 million families, representing 12% of the total U.S. population (U.S. Census,
2000). Nearly 80% of African Americans earn a high school diploma and 17% earn
an undergraduate or graduate degree (Harper & McFadden, 2003). Despite educa-
tional achievement, the African American population continues to suffer from pov-
erty-related challenges.
CHAPTER ELEVEN The Cultural Kaleidoscope 229

䊏 Value Orientations

African Americans share a strong sense of collective identity, kinship, or collective

unity (AAT, 1991). Although all immigrant groups have had acculturation prob-
lems, African Americans continue to fight social, economic, and political hardships
because of racial discrimination. They place less emphasis on childhood experi-
ences as contributors to mental health, even though therapeutic philosophies often
stress the role of childhood experiences in the development of personality and be-
havior. Concurrently, they value the role of family and church more than counsel-
ing when dealing with problems.

䊏 Family Characteristics

African Americans have a strong sense of family. Interactions with extended family
members tend to get more intensive as African Americans turn toward each other in
times of crisis. Discussion of family problems outside of the family generally is con-
sidered to be a breach of family ethics, which is an area of consideration for counsel-
ors trying to get African American clients to open up. Although it was believed at one
time that African American families tended to be matriarchal, with the father taking
a lesser, or absentee role, this notion has been disproved, as African American fathers
are no less involved with the family than fathers of other cultures.

䊏 Communication Styles

Although therapists often view African American clients as being nonverbal and
concrete (AAT, 1991), it is important to realize that the nonverbal African American
client may actually be speaking a different language or using a lack of verbal clarity
as a defense. Other common attributes of African American communication styles
are mentioned next.

Emphases in African American Communication Styles

䊏 Nonverbal communication.
䊏 Lack of eye contact.
䊏 High levels of emotional expressiveness.
䊏 Brief, to-the-point communication.

See Chapter 14 for more information about African American communication styles.

䊏 Mental Health Issues

Providing counseling services to African Americans has raised concerns about

therapist–client match, counselor preference, influence of racial identity develop-
ment, and the most effective approaches to employ when working with the African
230 What Are the Essential Elements of Counseling? PART TWO

American population (Harper & McFadden, 2003). Working effectively with Afri-
can Americans requires an awareness and recognition of the reality of the African
American experience, which includes oppression and lack of privilege in the
United States. Discussing the invisibility syndrome, Franklin (cited in Harper &
McFadden, 2003) pointed out that the life of an African American is characterized
by “chronic confrontations with racist, dehumanizing experiences” referred to as
“microagressions” (p. 83). Consequently, the willingness to seek counseling ser-
vices must be understood as a desire to heal “psychic abrasions” (p. 83).

䊏 Considerations When Counseling

The language, class values, and cultural values that may emerge in the counseling
relationship with African American clients include the use of nonstandard English,
emphasis on short-range goal planning, and utilization of nonverbal behaviors and
reactions to oppression (Sue & Sue, 1990). They are more likely to be active and
self-destructive when depressed; somatic complaints are more likely to be due to
real physiological problems; and threats of homicide are more likely to be expres-
sions of anger, not intent to kill (Block, 1981).
According to C. B. Block (1981), counselors typically make three mistakes when
counseling the African American population.

Some Counselor Mistakes When Working With African Americans

1. Many non-Black counselors try to maintain the notion of color blindness,
which avoids the importance of race to the African American client.
2. Counselors also may limit their effectiveness by assuming that issues of the Af-
rican American client necessarily are related to historical and current oppres-
sion, and that oppression has produced permanent damage to the basic func-
tioning of the African American population.
3. Counselors who display a patronizing attitude toward the client may mis-
communicate the power differential, which may lead the African American cli-
ent to mistrust the counselor.

Given potential mistakes counselors can make when working with African Ameri-
can clients, there are a number of suggestions professional helpers can follow to
make the counseling experience positive and useful to this population.

Counseling Strategies for Counselors Working With African Americans

䊏 Use a socioecological approach that emphasizes an understanding of how eco-
nomic status, education, health care, housing, racism, and other ecological fac-
tors affect the African American population.
CHAPTER ELEVEN The Cultural Kaleidoscope 231

䊏 Avoid a medical model approach because it may focus on weaknesses and defi-
cits and, as a result, cause counseling to be perceived as a punishment rather than
a helpful process.
䊏 Provide specific guidance to the client and assume a directive and active stance
in the process within a time-limited, problem-solving approach.

Research (Griffith & Jones, cited in AAT, 1991) has indicated that client race is a fac-
tor in counseling and psychotherapy. Studies have found that African American
clients often disguise their real problem to see if the counselor is able to see beyond
the disguise. African American clients also may deny their need for help or the seri-
ousness of the problem. This prevents the African American client from appearing
dependent or helpless in the counseling relationship. To treat an African American
client effectively, the counselor must pay careful attention to nonverbal behaviors
and implied meanings to understand the client’s problems (AAT, 1991).

ASIAN AMERICAN POPULATION

Asian Americans and Pacific Islanders include 43 ethnic groups with more than
100 languages and dialects. This population may have roots in countries including
China, Japan, Korea, Vietnam, Cambodia, and the Philippines. Even though they
are from differing countries, this population primarily is influenced by Old World
and religious traditions passed down through generations.

䊏 Historical and Demographic Factors

According to the U.S. Census (2000), there are 10.2 million Asian Americans who
represent 3.6% of the U.S. population, and 399,000 Pacific Islanders that account
for 0.1% of the population. All Asian American groups have a complex immigra-
tion experience to the United States (McGoldrick et al., 1996) and are seen as a
specific minority group with unique characteristics, values, needs, and chal-
lenges. Several of these groups have immigrated to the United State from
war-ravaged countries seeking political asylum, and many may have to deal
with lingering issues over World War II internment and other historical wartime
concerns. Prior to coming to the United States, a good number of Asian Ameri-
can immigrants were exposed to losses, separation, torture, and other forms of
trauma (McGoldrick et al., 1996). “Perceived discrimination, fear, stress from cul-
ture shock, perceived hate, homesickness and guilt” are major factors that con-
tribute to the “acculturative distress” for new immigrants (Harper & McFadden,
2003, p. 101).
232 What Are the Essential Elements of Counseling? PART TWO

䊏 Family Values

The traditional Asian American family is patriarchal, where the father’s authority
is unchallenged and power is usually transferred from father to son. Females tradi-
tionally have been less valued than males, and their role is primarily domestic. It is
common for Asian Americans to live with several generations in a single house-
hold. Additionally, Asian American families value the family unit over the individ-
ual, who usually is seen as the product of generations of the family. Thus, individ-
ual members’ actions reflect not only on themselves, but also on their extended
family and ancestors (McGoldrick et al., 1996).

䊏 Common Stereotypes

Stereotypes include the belief that all adults are hard working and successful and
that all children are high academic achievers. However, the reality is that for many
in this population, poverty is a concern, and failure is shaming; seeing a counselor
may be embarrassing. The result is that the number of clients from the Asian Amer-
ican population in treatment is low, and research on effective therapeutic interven-
tions is limited. Research suggests that for Asian Americans, certain coping mecha-
nisms that were effective in their home country may appear dysfunctional in the
new country.

䊏 Mental Health Issues

McGoldrick et al. (1996) reported six predictors of mental health problems for
Asian Americans. These factors are outlined here.

Predictors of Mental Health Problems

1. Employment or financial status.
2. Gender (Asian women appear to be more vulnerable than men).
3. Old age.
4. Social isolation.
5. Recent immigration.
6. Refugee trauma and adjustment.

Although the need for counseling services is not less than for other populations, the
process of going to counseling is not easy for Asian Americans. Because of some of
the following factors, Asian Americans tend to use counseling resources as a last
option.
CHAPTER ELEVEN The Cultural Kaleidoscope 233

Contributing Factors for Underutilization of Counseling

by Asian Americans
䊏 Lack of familiarity with Western mental health concepts.
䊏 Problem-solving approaches that are internally oriented because using resources
outside of the family can be seen as shameful.
䊏 Social stigmatism with regard to the status of the family.

䊏 Communication Styles

Asian Americans traditionally have been taught to utilize nondirective styles of

communication and to avoid direct confrontations. The counselor must avoid ap-
pearing too direct or insensitive to this communication style. An expression of little
emotion must not be mistaken for denial or a lack of affect.

䊏 Effective Counseling Approaches

Asian American clients typically underutilize mental health resources because of

cultural values related to privacy and nondisclosure of problems outside the family
system. According to Sue and Sue (1990), the cultural conflicts Asian Americans ex-
perience in life may be mimicked in the counseling session. Specifically, Asian
American clients may suppress emotional expressions, tend to focus more on edu-
cational and vocational complaints than emotional ones, and manifest a dislike of
unstructured counseling processes. For counseling effectiveness with Asian Amer-
ican populations, the following recommendations are proposed.

Recommendations for Counseling Asian Americans

䊏 Include the family in the counseling process, when appropriate, and allow the
client to determine which family members may be included.
䊏 Incorporate Asian values and characteristics in the counseling process and guard
against using traditional Western counseling approaches such as self-disclosure
and long-term counseling, as these approaches are likely to counter the
Asian American values of self-repression and short, result-oriented solutions
(McGoldrick et al., 1996).
䊏 Be aware of how to facilitate self-disclosure of clients who highly value privacy.
䊏 Explain the counseling process in such a way that the Asian American client feels
confident.
䊏 Use a counseling approach that provides a structured counseling situation (AAT,
1991).
234 What Are the Essential Elements of Counseling? PART TWO

Many members of this population are survivors of war, political unrest, and transi-
tions. As with clients from all cultures, the Asian American must be understood
and respected from this context.

LATIN AMERICAN POPULATION

The Latino American population is one of the fastest growing ethnic groups in the
United States. McGoldrick et al. (1996) reported that the words Hispanic or Latino
have been used to describe this group of people who come from many different
countries, cultures, and religions, and who would never describe themselves using
those terms. The use of Hispanic by the U.S. Census may be interpreted as an at-
tempt to take away the Latinos’ nationality. Latino or Latina is more accepted be-
cause this label allows for gender.

䊏 Historical and Demographic Factors

The history of Latinos in the United States is characterized by experiences of con-

quest, oppression, defeat, and struggle for freedom. For Latinos, the United States
represented an opportunity to be free. Yet, they have become victims of discrimina-
tion and disrespect in the midst of their many contributions to the United States
(Harper & McFadden, 2003).
According to the U.S. Census (2000), 13% of the U.S. population, or approxi-
mately 13.3 million people, are Latino. These numbers, however, do not reflect ac-
curately the number of undocumented migrants that come into the United States
daily. Moreover, the growing Latino population has not resulted in higher eco-
nomic or political power; rather, Latinos, especially those who have come to the
United States illegally, experience increased oppression. Indeed, the U.S. Census
(2000) reported that this group is the most underinsured of all cultural groups in
the United States. As a result, their access to medical and mental health services has
been limited.

䊏 Family Characteristics

Latino American families, mostly patriarchal, are characterized by respect for and
obedience to the father, who dominates and rules the household. The mother is ac-
corded loyalty and love as she acts as the unifying force in the system. In this tradi-
tion, gender roles tend to be rigid. Latina females are seen as passive, dependent,
and needing to be protected, whereas Latino males are permitted greater freedom
and have higher expectations placed on them. Latino men also are expected to dis-
play dignity, love for their family, and respect for others (AAT, 1991).
CHAPTER ELEVEN The Cultural Kaleidoscope 235

䊏 Communication Styles

Most Latinos value cooperation rather than competition. Many Latino Americans
tend to speak quietly, avoid eye contact when encountering those they see as hav-
ing a higher status, and rarely interrupt others. Their manner of expression is often
considered low key and indirect (Sue & Sue, 1990).

䊏 Value Orientations

Robinson (2005) outlined the primary Latin American cultural orientation and val-
ues system as noted next.

Primary Latin American Values

䊏 Personalismo (intimacy).
䊏 Dignidad (personal honor).
䊏 Familism (faith in friends and family).
䊏 Respeto (respect).
䊏 Confianza (the development of trust).
䊏 Simpatia (gentleness and simplicity).
䊏 Carino (demonstration of endearment in verbal and nonverbal communication).
䊏 Orgullo (pride).
䊏 Loyalty of family.
䊏 Collectivism.
䊏 Service to others.
䊏 Education as a means of development.

䊏 Mental Health Issues

Researchers have concluded that Latino Americans significantly underutilize

counseling services. This tendency can be attributed to several factors.

Contributing Factors for Underutilization of Counseling

by Latino Americans
䊏 Lack of bilingual counseling programs.
䊏 Traditional counseling models do not address the needs of Latino American cli-
ents.
䊏 Latino Americans often perceive mental health problems as manifestations of
physical problems.
䊏 The Latino culture discourages self-referral to counseling services.
236 What Are the Essential Elements of Counseling? PART TWO

For counseling effectiveness with Latino American populations, the following rec-
ommendations are proposed.

Recommendations for Counselors Working With Latino Americans

䊏 Establish rapport by utilizing small talk, first names, and personal greetings.
䊏 Take an active, goal-oriented approach that will lead to a rapid solution to the
presenting problem.
䊏 Recognize the importance of differentiating the variety of ethnic identities and
emphasizing values related to spirituality, family unity, welfare, and honor
(McGoldrick et al., 1996).
䊏 Understand and incorporate the strong sense of family commitment, obligation,
and responsibility into counseling interventions for effective treatment.
䊏 Solicit and listen to stories about the impact of living in the United States.
䊏 Validate the strengths and positives elements of the culture to help reduce feel-
ings of shame, promote dignity, and build a stronger sense of community.

As with any group, the Latin American population wants to improve their lives in
this country. Many experience intense feelings of loss for family left behind. Feeling
isolated and pressured to change may cause disruption and conflict.

ARAB AMERICAN POPULATION

As with other minority populations, the culturally competent counselor must com-
mit to respect the customs, traditions, history, and values of the Arab American
population. Some cultural, social, and historical factors related to the Arab Ameri-
can population are mentioned in this section.

䊏 Historical and Demographic Factors

In the 2000 U.S. census, Arab Americans are reported to number fewer than 1.5 mil-
lion. The Arab American Institute (AAI) believes that more than 3.5 million people
in the United States have Arab ancestry. The AAI (2006a) reported that Arab Amer-
icans are underreported on the U.S. Census due to lack of understanding of the im-
portance of the census or concerns about confidentiality.
Arab Americans living in the United States include descendants from
Arabic-speaking countries of southwestern Asia and North Africa and have been
settling in the United States since the 1880s. According to the AAI (2006b) more
than 80% are U.S. citizens. The Arab heritage reflects a culture that is thousands of
years old and includes 22 Arab countries such as Egypt, Lebanon, Morocco, Yemen,
Tunisia, and Palestine. The majority of Arab Americans are Christian.
CHAPTER ELEVEN The Cultural Kaleidoscope 237

䊏 Family Characteristics

The Arab world is complex in its social, religious, and political culture and tradi-
tions. One of the most important aspects in this culture is the role of family.

Cultural Influences on the Arab American Family

䊏 Family is seen as more important than the individual and more influential than
the nationality. Traditionally, large Arab families are an issue of pride and the
larger the family, the more economic security is provided (AAI, 2006a).
䊏 Birth order is important; the firstborn is closest to the parents, and individuation
that separates family members is not encouraged.
䊏 Arab Americans see family honor and status as an important goal.
䊏 Patrilinearity, a system of descent where rights are inherited through the father,
supports the man as the head of the household. Women are influential in the
family and, contrary to stereotype, are not severely dominated by their husbands
and fathers.
䊏 Extended family is valued, and two or three generations of Arab Americans may
reside in the same household.
䊏 Immigration of other family members is encouraged and often paid for by the
families in the United States.

䊏 Value Orientations

The Arab American population values collectivism, the good of many over the
good of one. They respect authority and their elders, expect their children to be
obedient, and value modesty and obedience as important traits in females. Arab
Americans value harmony within their homes and communities and strive to work
hard.

䊏 Stereotypes

Arab Americans are the victims of negative stereotypes. This population often is
seen as oil-rich, fanatical, keeping their women in harems, or oppressive to women.
The predominant view of Arab Americans in the United States is influenced by
post-9/11 concerns of terrorism.

䊏 Counseling

Jaschik (2005) reported that when counseling the Arab American population, the
counselor should be visible outside of the counseling office to encourage a higher
comfort level for those seeking help. Carmichael (2004) recommended that the
238 What Are the Essential Elements of Counseling? PART TWO

counselor not focus on insight-oriented strategies that may create more anxiety in
members of this population. Because this culture is a collective or tribal-based cul-
ture, emphasis on the individual may create conflicts in the family or community
system.
Carmichael (2004) cited Nassar-McMillan and Hakim-Larson in determining
the factors that contribute to successful counseling, especially when working with
Arab American children.

Recommendations for Counseling Arab American Children

䊏 Build a relationship with the family system, which may include home visits or at-
tendance at social gatherings.
䊏 Use religious leaders as consultants.
䊏 Request a reasonable fee for services so that the Arab American views the service
as worthwhile.
䊏 Thoroughly explain the therapeutic process, especially aspects of confidential-
ity.
䊏 Carefully provide professional advice so it is not seen as a challenge to patriar-
chal authority.
䊏 Do not confront or criticize in front of family or community members, especially
when silence is present. Silence may not mean agreement.
䊏 Rather than offend the family or individual, ask what items or assessment tools
are permitted. Some systems that adhere to Islamic faith may not allow use of
items or drawings that reflect human figures.

The American-Arab Anti-Discrimination Committee (1993) educational guide

references Jackson, who recommended that group counseling be utilized with this
population because it supports the Arab value of collectivism and that the group be
comprised of the same gender. A cognitive approach is suggested because it allows
the client to refrain from discussing personal feeling with a counselor who may be
perceived as a stranger. The counselor must continuously demonstrate respect for
the sanctity of the nuclear and extended family. Inviting the family to be part of the
process can be very useful. Treating Arab Americans in a way that minimizes
shaming or loss of face is important, as is helping the client or the family cope with
issues related to acculturation, language differences, and acclimation.
Lastly, it is important for the counselor to demonstrate a respect for and ac-
knowledgment of the differing Arabic populations and especially to be prepared to
discuss the ways in which anti-Arab biases have affected the client. Arab Ameri-
cans may express stress over the conflicts in their home countries and worry about
extended family members living there. Adolescents trying to fit into the U.S. cul-
ture may deny their heritage as a way of avoiding discrimination. Conflict between
traditional values and contemporary realities may create anxiety in the family sys-
tem as women and children struggle with cultural restraints and men feel pressure
to keep the family system intact.
CHAPTER ELEVEN The Cultural Kaleidoscope 239

ELDERLY POPULATION

Increased numbers of older people and a continued lengthening of the life span in-
dicate the need to be aware of the special skills needed to provide counseling ser-
vices to the older adult population. Although elderly people are healthier and
better educated than ever before, there is a concern about their quality of life in
their later years.

䊏 Demographic Factors

The U.S. Census (2000) reported the following statistics about the aging population
in the United States, which provides evidence of the large and growing population
of elders in the United States.

Demographic Characteristics of Older American Adults

䊏 34,991,753 are age 65 and above.
䊏 18,390,986 are age 65 to 74.
䊏 12,361,180 are age 75 to 84.
䊏 3,902,349 are age 85 to 94.
䊏 337,238 are 95 and older.

䊏 Stereotypes

Older adults in the United States have long been subjected to negative stereotypes,
myths, and even prejudice. Schmidt (2006) described ageism this way:

Ageism: “[S]ystematic and stereotypic prejudice against people simply be-

cause they are old” (p. 143).

In general, a number of negative stereotypes and myths about American elders are
pervasive in this culture.

Stereotypical Descriptors of Older Adults

䊏 Slow movers and thinkers.
䊏 Mentally and physically impaired.
䊏 Sexually inactive.
䊏 Committed to the past.
䊏 Cranky.
䊏 Depressed.
䊏 Burden on society.
240 What Are the Essential Elements of Counseling? PART TWO

䊏 Conservative.
䊏 Judgmental.

A counselor must not hold the same mistaken stereotypes of the elderly. To be effec-
tive, the counselor must recognize the facts about older adults’ experiences and
needs and not rely on stereotypes.

䊏 Mental Health Issues

The AAT (1991) stated that, “perhaps the most critical error made by mental health
professionals when counseling elderly clients is presuming that the elderly are sim-
ply preparing to die” (p. 11). Although death may emerge as an issue in counseling,
more often elderly clients are seeking direction and meaning for this phase of their
lives. Several factors lead to an increased need for counseling services among older
Americans.

Factors Leading to the Need for Counseling Services Among Elders

䊏 Spousal death.
䊏 Retirement.
䊏 Children leaving the home.
䊏 Isolation.
䊏 Institutionalization.
䊏 Financial concerns.

䊏 Approaches to Counseling

Typical counseling issues with the elderly include identity transition, sexuality is-
sues, depression, and awareness and acceptance of death. Identity transition is
triggered by the realization that they are less physically active, their relationships
have changed, and their previous self-identity has been lost. The first objective of
the counselor is to offer empathy and provide coping skills to help the client adjust
to life changes. This may lead to acceptance of change and the creation of a new
identity, which may include goal planning for retirement and other social activities.
Other areas of focus in counseling may include attention to sexual needs, treatment
for depression, intervention related to suicidal ideations, and acceptance of death
(AAT, 1991).
Working with the elderly may include individual, family, and group counseling,
as well as social planning, advocacy, and community organization. General recom-
mendations for working successfully with the elderly client are provided next.
CHAPTER ELEVEN The Cultural Kaleidoscope 241

Strategies for Working With Elders

䊏 Help elders look for satisfaction in relationships and mentally creative activities.
䊏 Offer support through role changes and identity transitions.
䊏 Have a general respect for the elderly, a history of positive experiences with the
population, and a deep sense of caring for elderly individuals.
䊏 Understand the biological effects of aging and have a desire to learn from the el-
derly population.
䊏 Understand and have patience for the repetition of stories.
䊏 Be sensitive to older adults’ burdens and anxieties and the special biological,
psychological, and social needs of the aged.

Helping the elderly recognize that aging is a natural process can foster healthier
perspectives and lifestyles. The counselor can serve as a strong, positive force in
helping the aged client achieve this goal.

ABLEISM AND DISABILITY

Throughout time and across cultures, people with impaired physical, mental, and
emotional abilities have faced discrimination. Impaired people “have been
shunned at best and discarded at worst” (Schmidt, 2006, p. 134) by all societies.
Ableism is a term used to describe the discrimination faced by individuals who are
impaired in any way. Schmidt (2006) defined ableism this way:

Ableism: “[A] pervasive system of discrimination and exclusion that op-

presses people who have mental, emotional and physical disabilities” (p. 134).

䊏 Demographics

Smart and Smart (2006) reported that signs of disability are becoming increasingly
common in a larger portion of the U.S. population. They cite the Americans With
Disabilities Act (1990), which reported that people live longer with disabilities be-
cause of medical advances, technology, insurance, and a higher quality of living
and support. The U.S. Census (2000) reported that 49.7 million Americans are liv-
ing with a long-lasting condition or disability, and that disability has become “a
natural part of human existence” (Smart & Smart, 2006, p. 29).

䊏 Stereotypes

People with disabilities are seen as a minority group because they are treated as a
specific category of people. This leads to several stereotypes, one of the most nega-
242 What Are the Essential Elements of Counseling? PART TWO

tive of which is that disabled people are not capable of directing the course of their
lives (AAT, 1991).

䊏 Rehabilitation Counseling

The majority of clients with disabilities who seek counseling are involved in some
type of rehabilitation counseling. The AAT (1991) described rehabilitation counsel-
ing this way:

Rehabilitation counseling: “[T]he maintenance of, or the improvement in,

the physical, mental, and emotional states of a person, of any age, suffering
from the effects of congenital mishap, crippling disease, injury, accident, or
surgical intervention” (p. 15).

A client with a disability who seeks counseling should be treated from a proactive
and rehabilitative perspective. The client also must be involved in creating the
treatment plan.

䊏 Counseling Issues

Common issues with the population of disabled people include anxiety, depres-
sion, physical pain, stress, and chronic illness. Smart and Smart (2006) linked feel-
ings of inferiority with loss, physical or emotional impairment, lifestyle changes,
and the relative permanence of the disability. Pain can be a continual reminder of
what has happened to the client’s physical self. An important counseling goal with
this population is to help them find a direction in life that brings satisfaction and
feelings of self-worth, to look beyond their limitations and not sacrifice their
uniqueness. Recommendations and consideration for working with the disabled
population are described next.

Recommendations for Counselors (AAT, 1991)

䊏 Become aware of and learn to manage personal fears and attitudes toward dis-
ability.
䊏 Help clients create high expectations with appropriate measures of success.
䊏 Facilitate supportive family caregiving and appropriate referrals to ancillary ser-
vices.
䊏 Become advocates to fight discriminatory practices and programs to aid clients
in increasing self-acceptance and positive self-regard.
䊏 Become educated about clients’ specific disabilities.
CHAPTER ELEVEN The Cultural Kaleidoscope 243

GAY, LESBIAN, BISEXUAL, AND TRANSGENDERED POPULATION

Over time, a variety of theorists have attempted to attribute sexual orientation to

family structure, mental health, dysfunctional behavior, rebellion, and hormonal
imbalance (Schmidt, 2006). The oldest theory related to sexual orientation and, spe-
cifically to homosexuality, linked homosexuality to mental illness; however, this
theory was disputed by Hooker’s (1957) study. Today the Diagnostic and Statistical
Manual of Mental Disorders (4th ed., text revision; American Psychiatric Association,
2000) no longer lists homosexuality as a disorder requiring treatment. Continuing
research does indicate a possible relation between sexual orientation and certain bi-
ological factors.

䊏 The Process of “Coming Out”

Schmidt (2006) outlined several processes a member of the gay, lesbian, bisexual,
and transgendered (GLBT) population may experience when coming out, a term
that Schmidt defined this way:

Coming out: The process through which individuals have accepted and an-
nounced their homosexuality.

A person going through the coming out process can experience such stages as
these:

䊏 Awareness of confusion and conflict.

䊏 Identity comparison.
䊏 Group association and social isolation.
䊏 Exploration, tolerance, and acceptance.
䊏 Satisfaction and integration.

Finally, the process of coming out can be hindered by a society that has little toler-
ance for and is even fearful of the GLBT population. The fears, attitudes, and result-
ing behaviors of those who react negatively to the GLBT population usually are re-
lated to homophobia, a term Schmidt (2006) defined as follows:

Homophobia: The expression of “irrational fears about people who exhibit

signs of accepting or using behaviors related to same-sex forms of sexual de-
sire and orientation” (p. 106).

䊏 Counseling Issues

There are a number of mental health issues that seem to characterize the GLBT pop-
ulation encounters; these are noted here.
244 What Are the Essential Elements of Counseling? PART TWO

Potential Counseling Issues With the GLBT Population

䊏 Oppression.
䊏 Prejudice.
䊏 Fear of lifestyle disclosure.
䊏 Concerns about family and friends’ judgment.
䊏 Personal safety concerns.
䊏 Grief associated with perceived loss of a traditional lifestyle.
䊏 Drug and alcohol abuse related to the pressure of living a GLBT lifestyle.

In addition to being able to deal with some of these concerns, counselors should be
prepared to face the challenges of working with a GLBT client. They should be
aware that GLBT clients may anticipate prejudice on the part of the counselor un-
less they learn otherwise through the therapeutic relationship.
Given the variety of core issues that counselors and GLBT clients may encounter,
there are some suggestions for working effectively with the GLBT population.

Recommendations for Counselors Working With the GLBT Client

䊏 Become aware of personal biases, attitudes, and values related to the GLBT pop-
ulation.
䊏 Respect and become knowledgeable of the challenges that are faced by the client.
䊏 Create a safe and accepting environment for GLBT clients to share their concerns
and confusion, as well as their own misconceptions about homosexuality.
䊏 Separate myth from fact related to negative attitudes, including homophobia
and counselor fear or stereotypes about the GLBT population.
䊏 Focus on encouraging clients to accept and explore new beginnings.
䊏 Realize that the GLBT community exists because of the need for other GLBT peo-
ple to find support.
䊏 Help clients access community resources, especially GLBT teenagers, who are
just coming out, and those who live in rural areas where support systems are not
likely to exist.

All clients must be supported in their growth and development toward health and
life satisfaction. GLBT clients deserve encouragement as they face a society that
does not hold much tolerance for their population.

CONCLUSION

The cultures of the world are many and varied. People of diverse cultural back-
grounds who reside in the United States often are strongly connected with their
cultural roots and, concurrently, are drawn to adapt to living in the United States.
When serving the many, vital ethnic and cultural groups living in the United States,
CHAPTER ELEVEN The Cultural Kaleidoscope 245

counselors must strive to appreciate and respond to the deeply embedded cultural
traditions and values of these groups. By doing so, counselors can continue to help
diverse clients who face personal, interpersonal, and systemic challenges in the
United States live healthier lives and experience fullness of well-being.

Chapter 11: Key Terms

䉴 Cultural context 䉴 White privilege 䉴 Rehabilitation counseling
䉴 YAVIS client 䉴 Ageism 䉴 Coming out
䉴 QUOID client 䉴 Ableism 䉴 Homophobia
 chapter Approaches to Group Work

12 Carol Thomas
Duquesne University

In This Chapter

䉴 Psychoanalytic Approach to Group Work 䉴 Rational-Emotive Behavior Therapy

䊏 Key Theoretical Concepts Approach to Group Work
䊏 Goals and Stages 䊏 Key Theoretical Concepts
䊏 Therapeutic Techniques 䊏 Goals and Stages
䊏 Role of Group Leader 䊏 Therapeutic Techniques
䊏 Strengths and Limitations 䊏 Role of Group Leader

䊏 Strengths and Limitations

䉴 Adlerian Approach to Group Work
䊏 Key Theoretical Concepts 䉴 Reality Therapy Approach to Group Work
䊏 Goals and Stages 䊏 Key Theoretical Concepts
䊏 Therapeutic Techniques 䊏 Goals and Stages
䊏 Role of Group Leader 䊏 Therapeutic Techniques
䊏 Strengths and Limitations 䊏 Role of Group Leader

䊏 Strengths and Limitations

䉴 Transactional Analytic Approach
to Group Work 䉴 Person-Centered Approach to Group Work
䊏 Key Theoretical Concepts 䊏 Key Theoretical Concepts
䊏 Goals and Stages 䊏 Goals and Stages

䊏 Therapeutic Techniques 䊏 Therapeutic Techniques

䊏 Role of Group Leader 䊏 Role of Group Leader

䊏 Strengths and Limitations 䊏 Strengths and Limitations

䉴 Psychodramatic Approach to Group Work 䉴 Gestalt Approach to Group Work

䊏 Key Theoretical Concepts 䊏 Key Theoretical Concepts
䊏 Goals and Stages 䊏 Goals and Stages

䊏 Therapeutic Techniques 䊏 Therapeutic Techniques

䊏 Role of Group Leader 䊏 Role of Group Leader

䊏 Strengths and Limitations 䊏 Strengths and Limitations

䉴 Behavioral Approach to Group Work 䉴 Existential Approach to Group Work

䊏 Key Theoretical Concepts 䊏 Key Theoretical Concepts
䊏 Goals and Stages 䊏 Goals and Stages

䊏 Therapeutic Techniques 䊏 Therapeutic Techniques

䊏 Role of Group Leader 䊏 Role of Group Leader

䊏 Strengths and Limitations 䊏 Strengths and Limitations

246
CHAPTER TWELVE Approaches to Group Work 247

PSYCHOANALYTIC APPROACH TO GROUP WORK

Freud (1959) was the father of psychoanalytic counseling, however, he never utilized
groups in his psychoanalytic practice. Freud believed that groups acted as a recon-
structed family unit through which members revisit unresolved childhood experi-
ences. Alexander Wolf, a psychiatrist and psychoanalyst, is credited with adapting
the psychoanalytic approach to groups in 1938. Generally, individual therapy within
a group context is the most commonly practiced form of psychoanalytic group work.

䊏 Key Theoretical Concepts

The psychoanalytic approach to group work incorporates the tenets of classic psy-
choanalytic theory, utilizing specific techniques, such as free association, transfer-
ence, and interpretation in aiding to free unconscious thoughts and make the un-
conscious more conscious. Unlike in individual psychoanalytic work, processes
such as transference can be much more intense in group settings because of the in-
teractions among group members. Even in a group setting, the focus of the psycho-
analytic approach is generally on the individual, and the analysis of the individ-
ual’s unconscious is a goal of psychoanalytic group work (Whitaker & Lieberman,
1965).

See Chapter 9 for more detail on theoretical concepts germane to psychoanalytic therapy.

䊏 Goals and Stages

Because psychoanalytic practitioners believe that people spend their lives trying to
work out childhood experiences, both unresolved psychosexual and psychosocial
issues are addressed. Additional goals of psychoanalytic group work include the
following:

䊏 Bringing the unconscious into conscious.

䊏 Restructuring the group members’ personalities.
䊏 Strengthening egos through analysis of transference and resistance.

Unlike many types of therapeutic groups that concentrate on the development

and process of the group, psychoanalytic groups emphasize development of the in-
dividuals within the group. Six stages of treatment characterize psychoanalytic
group therapy.

Stages of Psychoanalytic Group Therapy

1. Preliminary individual analysis is used to screen out overly anxious indi-
viduals.
248 What Are the Essential Elements of Counseling? PART TWO

2. Free association about dreams and fantasies is used to establish rapport among
members.
3. Analysis of client resistance and defense mechanisms is used to facilitate thera-
peutic growth.
4. Analysis of transference helps uncover members’ projections of feelings onto
the group leader, other members, or significant others.
5. Translating insights into actions occurs when group members challenge each
other to promote growth.
6. Reorientation and social integration occurs when group members effectively
and appropriately are able to manage anxiety and deal with the realities and
pressures of life.

䊏 Therapeutic Techniques

To allow members’ unconscious processes to surface, techniques such as free asso-

ciation, dream work, interpretation, and the analysis of transference and resistance
are utilized. A description of each of these techniques follows.

Purposes of Psychoanalytic Techniques

䊏 Free association or “free floating discussion” (Foulkes & Anthony, 1965) allows
members to give and receive personal perceptions, an important aspect of the de-
velopment of the human personality.
䊏 Dream analysis allows members to learn more about one another and become
more concrete in handling any feelings associated with their dreams.
䊏 Interpretation is utilized in the early stages of group work to help group members
gain insight into their behaviors and to model what members should be doing in
later stages.
䊏 Resistance is confronted immediately—usually first by the group leader but later
by group members—to ensure that the group continues making progress.
䊏 Transference is an effective technique that leads to individual and group insights.

䊏 Role of Group Leader

The primary role of the leader is to help group members work through issues of
transference and bring repressed memories to conscious awareness. The group
leader recognizes each member’s potential to contribute positively to the good of
the group and attempts to transfer leadership from the leader to group members,
when appropriate (Wolf & Schwarz, 1962). Generally speaking, psychoanalytic
group leaders should be warm, objective, and relatively anonymous (Corey,
2004b).
CHAPTER TWELVE Approaches to Group Work 249

䊏 Strengths and Limitations

Advantages of psychoanalytic groups include their ability to help members experi-

ence and work through transference feelings toward the leader and other group
members. Working through the broad range of feelings that are generated within a
group can help members learn more about themselves than they might otherwise
have an opportunity to do. Group members resolve current problems by working
within the group on past issues—helping progress more quickly to occur.
A limitation of psychoanalytic group work is that group leaders are encouraged
to be in therapy or to have completed a lengthy analysis. Likewise, psychoanalytic
groups typically run longer than other forms of therapeutic groups, which can in-
volve much time, energy, and cost to members. Finally, because the emphasis in a
psychoanalytic group is often on childhood trauma, social, cultural, and interper-
sonal self-responsibility factors may be ignored.

ADLERIAN APPROACH TO GROUP WORK

In the early 1900s, Adler ended a 9-year association with Freud and Jung to develop
his own theory of psychology. His contributions were brought to the United States
in the late 1930s by Dreikurs (1950; Terner & Pew, 1978), who refined Adler’s con-
cepts into a clear, teachable system applicable to a variety of educational and men-
tal health settings.

䊏 Key Theoretical Concepts

Unlike his predecessor, Freud, Adler emphasized social aspects of human develop-
ment. The more well-known concepts associated with Adlerian therapy include
birth order, the creative self, inferiority and superiority, and social interest. More-
over, Adler suggested that the human person is an individual whole and was inter-
ested in how the person integrates the various facets of his or her experience.

See Chapter 9 for more detail on Adlerian theoretical concepts.

䊏 Goals and Stages

Goals of Adlerian counseling include overcoming feelings of inferiority, nurturing

social interests, identifying mistaken goals, changing faulty assumptions, and en-
couraging clients to become contributing members of society. Adlerian groups,
likewise, have several common factors (Corey, 2004b).
250 What Are the Essential Elements of Counseling? PART TWO

Aims of Adlerian Group Therapy

䊏 Establishing and maintaining a quality relationship between the counselor and
group members.
䊏 Identifying and clarifying members’ individual “styles of life” and personal
goals.
䊏 Interpreting a person’s early history to encourage insight.
䊏 Reorienting members’ perceptions, thoughts, and feelings.

According to Sonstegard and Bittner (1998), Adlerian groups typically have four
stages.

Stages of Adlerian Group Work

1. Developing and maintaining the proper therapeutic relationship between
leaders and members.
2. Assessing the dynamics that operate within individual members.
3. Working toward increasing individual insight and self-understanding.
4. Assisting the individual to discover new alternatives and make new choices.

Working through these stages should result in group members overcoming feel-
ings of inferiority, reducing levels of discouragement, identifying mistaken goals,
changing faulty assumptions that group members may have about themselves,
and helping group members to become contributing members of society.

䊏 Therapeutic Techniques

The following Adlerian techniques are not limited to any one stage of the group
process and can aid the leader in the development and growth of the group mem-
bers throughout the life of the group.

Adlerian Group Techniques

䊏 Modeling appropriate social skills.
䊏 Showing interest to demonstrate acceptance.
䊏 Utilizing active listening skills such as reflection, summarization, and restate-
ment.
䊏 Eliciting early recollections to aid in the identification of problematic emotional
patterns and feelings that have been carried from childhood into adulthood.
䊏 Assessing members’ goals and translating them into individual lifestyles.
䊏 Observing members’ social interactions within the group as an interpretation of
how members potentially behave outside of the group.
CHAPTER TWELVE Approaches to Group Work 251

䊏 Role of Group Leader

Based on Adlerian concepts, the group leader should provide the following:

䊏 A working relationship that promotes equality between leader and members.

䊏 Communication based on mutual trust and respect.
䊏 Assistance in the exploration of personal goals, feelings, beliefs, and motives that
are determining factors in members’ “styles of life.”
䊏 Assistance in gaining insight into self-defeating behaviors that impede the for-
mulation of effective and attainable goals.
䊏 Assistance in the practice of self-acceptance with all the assets and liabilities that
comprise the self.
䊏 Assistance in exploring new insights and encouragement to test new behaviors.

The Adlerian group leader uses gentle confrontation, self-disclosure, interpreta-

tion, and analysis of regular behavior patterns to challenge members’ beliefs and
goals. The Adlerian group leader pays close attention to the social context of mem-
bers’ behaviors. Finally, the Adlerian group leader encourages members to trans-
late behaviors and insights learned within the group to behaviors and insights out-
side the group.

䊏 Strengths and Limitations

One of the strengths of Adlerian group counseling is that it encourages growth by

giving members concrete ways to handle specific, problematic situations. This ap-
proach encourages democratic participation—useful for promoting openness and
conversation. Another strength of Adlerian therapy is its eclectic nature (Corey,
2004b). Adlerian groups stress the value of social interests, the importance of fam-
ily constellations, and the usefulness of goal-directed behaviors without being
tied to a particular method or procedure.
A limitation in Adlerian group work may be its use of a detailed interview about
family background. Adlerian group leaders must be sensitive to cultures where
disclosing personal family information is divergent and must respect a member’s
right to forego disclosure concerning family matters. Additionally, for Adlerian
group work to gain prominence, more research must document the effectiveness of
this therapy (Manaster & Corsini, 1982).

TRANSACTIONAL ANALYTIC APPROACH TO GROUP WORK

Transactional analysis (TA) began during World War II when its founder, Eric
Berne, developed his cognitive therapeutic model while working with soldier pa-
tients in discussion groups. Although Berne was trained as a psychoanalyst, his TA
252 What Are the Essential Elements of Counseling? PART TWO

approach to group work differed from psychoanalytic group work in a number of

ways.

Points of Differentiation Between TA and Psychoanalysis

䊏 The “unconscious” is a concept not utilized in TA.
䊏 Much less time is required with TA then with psychoanalysis—groups meet once
a week for weeks or months, not every day for a year or more.
䊏 The group leader is considered equal among group members, although he or she
must know more about TA than group members.
䊏 TA can be used with a broad range of clients, including children, mentally handi-
capped, and persons with a drug or alcohol addiction.

䊏 Key Theoretical Concepts

More than his predecessors, Berne stressed the importance of interpersonal com-
munication or transactions to mental health. Transactions are influenced by a per-
son’s ego state. Berne defined three ego states—parent ego state, adult ego state,
and child ego state—that, respectively, reflect Freud’s personality constructs of the
superego, ego, and id. Additionally, Berne identified four life stances.

Life Stances in TA
1. I’m OK, you’re OK.
2. I’m not OK, you’re OK.
3. I’m OK, you’re not OK.
4. I’m not OK, you’re not OK.

See Chapter 9 for more detail on theoretical concepts germane to TA.

䊏 Goals and Stages

The goal of TA group work is for members to let go of harmful critical parent mes-
sages and self-defeating child scripts (Gladding, 2002b), become more capable of
responding to others from the adult ego state, and adopt the I’m OK, You’re OK
stance. For these goals to be met, group members must get in touch with their feel-
ings, the structure of their personality, and their transactions with others. Group
members accomplish this through gained awareness of their own ego states and
understanding which ego state they are operating out of at any given moment. This
awareness empowers group members to assess the interactions they most likely
are to have and take corrective action, if needed.
The group process as described by Woollams and Brown (1979) involves seven
stages or steps of development.
CHAPTER TWELVE Approaches to Group Work 253

Steps of Development in TA Groups

1. Trust in others.
2. Trust in self.
3. Integration into the group.
4. Work.
5. Redecision.
6. Reintegration.
7. Termination.

These steps in development are sometimes overlapping and intermingle with each
other so that they are not always distinct.

䊏 Therapeutic Techniques

TA group techniques include the concepts of games, life scripts, and therapeutic
contracts to aid group members in understanding the complexities of the three ego
states and the four life patterns.

Games: “[A]n ongoing series of complementary ulterior transactions pro-

gressing to a well-defined, predictable outcome” (Berne, 1964, p. 48).

Life scripts: Plans for life developed in early childhood that are reinforced by
parents. Members are encouraged to rewrite their programmed scripts into
scripts that offer more productive interactions.

Therapeutic contracts: Contractual forms completed by group members who

indicate what it is they wish to accomplish as a result of participating in the
group. Goals must be concretely defined so that group members can take re-
sponsibility for working toward them.

When either the group leader or a member notices that a game is being played, he
or she will bring it to the attention of the group, who then will attempt to analyze it.

䊏 Role of Group Leader

The group leader in a TA therapeutic group should be a well-trained professional

who has a good understanding of group dynamics and a mastery of the terminol-
ogy used in TA. Operating from an “I’m OK” life position also is essential for a
leader to be able to build rapport with members and teach them how to recognize
and understand self-destructive messages or behavior patterns. Additionally, the
TA group leader has four other duties.
254 What Are the Essential Elements of Counseling? PART TWO

Tasks of the TA Group Leader (Berne, 1966; Gladding, 1992)

䊏 Protecting the group from physical or psychological harm.
䊏 Giving permission to group members to behave against the directives of their
parent ego.
䊏 Acting with potency, or appropriate counseling techniques in certain situations.
䊏 Using operations or very specific techniques that include interrogation, specifi-
cation, confrontation, and illustration.

䊏 Strengths and Limitations

A strength of TA is its stress on intellectual insight as the basis for doing things dif-
ferently. TA can help group members become aware of how they function interper-
sonally and intrapersonally and how their life decisions were made. The language
used to explain the TA concepts is very clear and offers a highly structured ap-
proach to group work. Groups can be tailored to include many cultural differences
and value systems. TA offers a short-term approach to group counseling, and its
concepts can be very effective in group communication processes, such as those be-
tween employer and employees and those among coworkers (Nykodym, Ruud, &
Liverpool, 1986).
A criticism of the TA approach to group work is its reliance on cognitive con-
cepts. Persons of limited cognitive ability might not flourish in a group that utilizes
TA concepts and language. Another limitation is the lack of attention to the group
process (Yalom, 1985). TA groups are usually member–leader centered and often
ignore the importance of other group dynamics such as interpersonal learning, co-
hesiveness, and universality.

PSYCHODRAMATIC APPROACH TO GROUP WORK

Psychodramatic therapy was founded in Vienna in 1921 by Jacob Moreno. After re-
flecting on the reactions of the actors and the audience to his “Theatre of Spontane-
ity,” Moreno recognized that people experienced a release of pent-up feelings after
the performances. Thus, Moreno developed a theory of psychology around the ca-
thartic use of dramatic performance. In 1925, Moreno moved to New York and be-
gan utilizing his ideas of spontaneous drama with hospitalized individuals, and in
1942, Moreno founded the American Society of Group Psychotherapy and Psycho-
drama.

䊏 Key Theoretical Concepts

The psychodramatic method of therapy consists of the following five components:

the director, a protagonist, the auxiliary egos, the audience, and the stage.
CHAPTER TWELVE Approaches to Group Work 255

Director: The psychodramatic group leader, who encourages intense emo-

tional participation by a protagonist, helps delineate what occurs after the
psychodramatic enactment and helps the protagonist gain insight and emo-
tional resolution through group feedback.

Protagonist: The group member who has chosen to enact a life situation or re-
lationship in an effort to experience a cathartic release of emotions, gain in-
sight, and learn new and productive ways of managing future situations or
relationships.

Auxiliary ego: Group members selected by the protagonist to represent inan-

imate objects, pets, or persons who are dead, alive, real, or imagined.

Audience: Remaining group members who witness an enactment and hope-

fully experience a release of feelings and increased insight into their own
struggles while observing the performance.

Stage: The formal stage area or large open room in which the enactment takes
place.

䊏 Goals and Stages

Facilitating the release of pent-up feelings, providing insight, and assisting clients
in developing innovative and more effective behaviors all are goals of psycho-
dramatic therapy. By enacting a situation or relationship, the protagonist and ob-
serving group members will gain insight, experience a cathartic emotional release,
and learn new ways of behaving in similar future situations (Gladding, 1999).
There are three distinct phases of psychodramatic therapy.

Phases of Psychodramatic Therapy

1. The warm-up phase prepares members through various techniques for the expe-
rience as well as fosters feelings of security and trust.
2. The action phase occurs when the protagonist, directed by the group leader, acts
out a situation, relationship, or other concern.
3. The discussion or sharing phase involves constructive and emotion-based feed-
back from group members, discussion about the entire experience, and closing
remarks by the group leader.

䊏 Therapeutic Techniques

The nature of psychodramatic therapy supports a multitude of techniques. A num-

ber of the most common techniques are listed next.
256 What Are the Essential Elements of Counseling? PART TWO

Common Techniques in Psychodrama

䊏 Creative imagery is a warm-up exercise that invites group members to imagine
neutral or pleasant objects or scenes (Ohlsen, Horne, & Lawe, 1988).
䊏 The magic shop is an exercise that utilizes the idea of a magic shop where items
can be bartered for (e.g., if one wishes for better relationship skills, he or she may
have to give up irrational anger in exchange for the desired skills).
䊏 Sculpting occurs when group members arrange one another into physical config-
urations of persons with whom they have issues, such as family members, peers,
or coworkers.
䊏 The soliloquy technique encourages the protagonist to daydream out loud by giv-
ing a monologue about his or her situation as he or she is acting it out.
䊏 Role reversal occurs when the protagonist switches roles with another person on
stage as a way to view his or her situation from another perspective.
䊏 The mirror technique entails an auxiliary ego mirroring the protagonist’s posture,
gestures, and words while the protagonist watches from offstage.
䊏 The double technique requires an auxiliary ego to stand behind the protagonist
and act with or speak for him or her as a way to help the protagonist gain aware-
ness of internal processes.

䊏 Role of Group Leader

The primary role of the group leader or the director is to encourage emotional par-
ticipation by group members. According to Moreno (1964), the director takes on the
roles of producer, catalyst or facilitator, and observer or analyzer.

Functions of the Director (Haskell, 1975)

䊏 Planning the session so various group members have an opportunity to be the
protagonist.
䊏 Creating a tolerant atmosphere that leads to spontaneous expression.
䊏 Providing support and direction for the protagonist.
䊏 Asking for clarity when necessary.
䊏 Ensuring that the roles are being properly enacted.
䊏 Protecting the protagonist from being verbally attacked by other group members
or from being subjected to simplistic directives or advice.
䊏 Leading a group discussion that encourages supportive feedback.
䊏 Providing closure by summarizing the protagonist’s experience on the basis of
feedback.

There are several personal qualities that enhance the effectiveness of the psycho-
dramatic group leader’s work.
CHAPTER TWELVE Approaches to Group Work 257

Characteristics of Psychodramatic Leaders

䊏 Creative.
䊏 Courageous.
䊏 Innovative.
䊏 Improvisational.

䊏 Strengths and Limitations

Corey (2004b) appreciated the use of psychodramatic therapy for individuals who
cannot see alternatives for dealing with the significant people in their lives. Acting
out alternative responses allows people to gain a different perspective on relating
to problematic individuals or situations. When used correctly, this action-oriented
form of therapy has group members doing something, rather than endlessly talk-
ing about problems in a detached, story-telling fashion.
A principal limitation of psychodrama is that the expression of feelings through
cathartic theatrics and the enacting of past problems can be extremely threatening.
Group leaders must use caution when encouraging members to display intense
feelings in the group context. The danger of leaders using psychodramatic therapy
to gratify their own psychological needs also exists. Therefore, it is crucial that
leaders be aware of their own needs to prevent them from interfering with the
group process.

Check out the American Society on Group Psychotherapy and Psy-

chodrama for more information at:
䉴 www.asgpp.org

BEHAVIORAL APPROACH TO GROUP WORK

The behavioral approach to individual and group counseling is attributable to the-

orists such as Watson (1913), Bandura (1969), and Skinner (1974). Behavior theories
began to emerge at the beginning of the 20th century (Wilson, 1989) and generally
emphasize overt processes, learning, ways to change nonproductive actions, and
goal definition.

䊏 Key Theoretical Concepts

A key theoretical concept of the behavioral approach to group work is that all be-
havior, emotions, and cognitions have been learned, and all behaviors can be
changed or modified by new learning. Change occurs through acquisition of new
258 What Are the Essential Elements of Counseling? PART TWO

behavior or modification of existing behavior. As this happens, emotions and atti-

tudes are also shifted.

Methods to Encourage Change in Behavioral Group Work

(Berkowitz, 1982)
䊏 Behaviors that need to be changed are identified.
䊏 Specific behavioral alterations are discussed.
䊏 Events in the environment that maintain the behavior are studied.
䊏 Intervention strategies for behavior modification are employed.
䊏 Plans for maintaining and generalizing new behaviors are created.

䊏 Goals and Stages

The primary focus in behavioral groups is behavior, and the ultimate goal of ther-
apy is to change nonproductive behaviors. Rose (1977, 1983) and Hollander and
Kazaoka (1988) named seven specific stages that are universal to behavioral groups
and support the goal of behavior modification.

Seven Stages of Behavioral Group Work

1. Forming the group and addressing organizational details.
2. Establishing group attraction and identity through the leader’s determination
of members who exhibit similar goals and potential connectedness (Rose,
1980).
3. Promoting openness and sharing through the leader’s ability to model appro-
priate group behavior as well as through the discussion of members’ expecta-
tions.
4. Creating behavioral frameworks that members can use as tools to evaluate and
monitor their behavioral modifications.
5. Establishing and implementing behavioral models that address specific mem-
bers’ individual goals for group therapy.
6. Transferring treatment outside of the group is the beginning of the end of a
working group (Wilson, 1989).
7. Maintaining behavior change and fading out of the need of the group’s sup-
port.

At the final stage, a group leader may ask members to self-monitor by keeping re-
cords of behaviors or psychological reactions (Wilson, 1989). This allows members
to chart their progress once they have departed from the group environment.

䊏 Therapeutic Techniques

Therapeutic techniques utilized in behavioral groups focus on group members’ un-

productive or unwanted behaviors. Behavior therapists believe that if they under-
CHAPTER TWELVE Approaches to Group Work 259

stand the group members’ presenting problems, they can select a technique for
changing the behavior. Techniques specific to behavioral therapy include the fol-
lowing:

Systematic desensitization: The gradual exposure to an aversive stimulus

that eventually allows a person to overcome a specific fear.

Assertion training: Training that increases individuals’ behavioral repertoire

so they are better able to choose whether or not to behave more assertively in
a given situation.

Modeling: A group leader or members exhibit behaviors and social skills that
other group members can observe and then apply to their own lives.

䊏 Role of Group Leader

At the beginning stages of a behavioral group, the leader takes on a directive and
active role, but eventually becomes a participant-observer, allowing the other
group members to assume more responsibility as the group proceeds (Hansen,
Warner, & Smith, 1980; Rose, 1983).

Leader Responsibilities in Behavioral Group Therapy (Corey, 2004b)

䊏 Screening group members.
䊏 Teaching members about the group process.
䊏 Assessing members’ progress within the group.
䊏 Reinforcing group members’ achievement of specific goals.
䊏 Determining the effectiveness of techniques.
䊏 Instructing members to use a particular social skill.
䊏 Providing positive or negative feedback to members who use new skills.
䊏 Giving homework assignments.

䊏 Strengths and Limitations

The primary strength of a behavioral approach to group work is its focus on help-
ing members learn new ways of functioning (Corey, 2004b). Behavioral groups are
relatively short term and focused (Hollander & Kazaoka, 1988), allowing specific
goals to be met in a manageable amount of time. Additionally, behavioral group
work is a well-researched way to treat alcoholism, drug addiction, and juvenile de-
linquency. Finally, behavioral groups can be integrated into many cultural settings.
Limitations of the behavioral approach to group work include the possibility
that members can become overly dependent on the group for support, the limited
260 What Are the Essential Elements of Counseling? PART TWO

attention given to past experiences, and the lack of attention given to group mem-
bers’ feelings (Rose, 1977).

RATIONAL-EMOTIVE BEHAVIOR THERAPY APPROACH

TO GROUP WORK

Rational-emotive behavior therapy (REBT) is an extension of Ellis’s A-B-C-D-E

model first known as rational emotive therapy (RET). REBT groups are cognitively
based and assume that group members have the potential to become rational think-
ers.

䊏 Key Theoretical Concepts

The underlying premise of REBT is that irrational cognitions result in mental health
issues or general unhappiness. Ellis proposed that a person’s illogical cognitive in-
terpretations about events, rather than the events themselves, produce negative
feelings and are people’s core problem.

See Chapter 9 for more on the A-B-C-D-E model.

䊏 Goals and Stages

There are two primary goals of REBT—challenging members’ irrational thoughts

and helping members realize that reactions to events, and not necessarily the
events themselves, cause consternation. Ellis identified at least 15 irrational
thoughts; a sampling is listed here.

Irrational Thoughts Identified in REBT

䊏 It is a “dire necessity” for an adult to be loved or approved of by every important
person in the community.
䊏 A person needs to have someone stronger than himself or herself on whom to de-
pend.
䊏 A person’s past behavior is a determinant of present behavior, and past experi-
ences should continue to effect the present.
䊏 Unhappiness is externally based, and a person has little control over his or her
pains.
䊏 There is one correct answer and one solution to a problem, and, if it is not found,
trauma will ensue.
䊏 The world should be fair, just, and impartial.
CHAPTER TWELVE Approaches to Group Work 261

There are two primary stages in REBT group work. In the first stage, group
members learn the difference between irrational and rational beliefs. At this stage,
known as intellectual insight, members’ convictions about their rational beliefs
stay at the level of intellectual understanding because the beliefs are not suffi-
ciently strong to influence how members feel and act. During the second stage,
known as emotional insight, group members’ convictions about their rational be-
liefs are influential enough to alter how members feel and act.

䊏 Therapeutic Techniques

Therapeutic techniques of REBT group work are similar to those utilized in many
other cognitive or behavioral types of group work; the aim of these techniques is to
teach members how to become more rational thinkers.

REBT Interventions
䊏 Persuasion.
䊏 Challenges.
䊏 Role playing.
䊏 Confrontation.
䊏 Group discussion.

Group leaders listen for irrational beliefs and dispute them. Group members are
taught how to identify the irrationality of shoulds, musts, and oughts, and group
leaders help address any irrational thoughts that may arise.

䊏 Role of Group Leader

The REBT group leader’s role primarily is to encourage rational thinking. This is
accomplished in several ways:

䊏 The group leader teaches members about the origin of emotions.

䊏 The group leader is active in the group process by challenging members to look
at their irrational thought patterns.
䊏 The group leader encourages other members to assist each other thinking ratio-
nally.
䊏 The group leader assigns homework and performs activity-based experiences.

The group leader acts as a positive role model and reveals how he or she practices
REBT in his or her daily life. Additionally, the group leader looks to other group
members to act as auxiliary counselors once a member has shared a problematic is-
sue (Ellis & Dryden, 1987).
262 What Are the Essential Elements of Counseling? PART TWO

䊏 Strengths and Limitations

REBT groups stress members’ capacity to control their own destiny. The approach
works well in multicultural groups by helping members of any ethnicity examine
their beliefs. Through the utilization of the A-B-C-D-E system, Ellis has demysti-
fied the process of REBT group therapy. Members have a clear system from which
to work and can apply it to their own issues, as well as issues of fellow group mem-
bers. Finally, homework assignments between group sessions promote action.
Limitations to REBT groups are their attention to the individual, not the group
(Wessler & Hankin, 1988). Members learn the importance of controlling their own
thoughts, emotions, and behaviors but learn little about the group process or about
group dynamics. Another limitation is that group leaders may exert too much
power or control over the group members in determining what they believe to be
irrational thinking. Also, because REBT is cognitively based, this type of counsel-
ing would not be appropriate for persons of limited cognitive ability.

REALITY THERAPY APPROACH TO GROUP WORK

Glasser developed reality therapy while working at the Ventura School for Girls in
California during the late 1950s and early 1960s. There, Glasser utilized reality ther-
apy (originally called control theory) in group settings with inpatient adolescent
girls and eventually began using reality therapy in his work with individuals. The
essence of reality therapy is that people all are responsible for what they choose to
do. The basic assumption of reality therapy is that people only can control their
lives in the present moment. Reality therapy, then, is a behavioral approach that fo-
cuses on what clients do, not what they feel.

䊏 Key Theoretical Concepts

Underlying Glasser’s approach to therapy are the concepts of personal responsi-

bility and choice. By emphasizing a client’s ability to choose to meet his or her own
needs, Glasser simultaneously deemphasizes blaming behaviors that prevent per-
sonal responsibility. Positive choices help people create their quality world in
which needs for love, survival, belonging, power, and freedom are met.

䊏 Goals and Stages

Reality therapy assumes that change does not come from insight alone. Rather,
group members have to act differently if they wish to experience change. The goal
of therapy is to identify what members can do about their own behaviors, assum-
CHAPTER TWELVE Approaches to Group Work 263

ing that they cannot change the behavior of others. By challenging noneffective
ways of thinking and acting, group leaders are able to aid members in developing
plans of action for new ways of thinking and behaving that are productive and use-
ful.

Individual Goals in Reality Therapy

䊏 Giving up nonproductive and self-defeating behaviors for productive and at-
tainable action plans.
䊏 Gaining control of one’s life and acquiring realistic behaviors.

These goals can be achieved when group leaders practice a series of eight basic
steps (Glasser, 1984; Glasser & Zunin, 1973):

1. Make friends or establish a meaningful relationship with group members.

2. Emphasize present behaviors by asking, “What are you doing now?”
3. Question whether or not clients’ actions are getting them what they want.
4. Assist clients in making a positive plan to do better.
5. Get a commitment to follow the positive plan.
6. Accept no excuses—responsibility lies with each group member.
7. Deliver no punishment—consequences occur naturally.
8. Never give up! Group members are assured continual support.

The use of open-ended questions and a focus on positive behaviors support

group members in achieving their goals. Eventually, group members come to ac-
knowledge their own basic needs and develop successful ways of meeting those
needs.

䊏 Therapeutic Techniques

The main technique utilized in reality therapy is the encouragement by group lead-
ers for group members to face reality, to discontinue behaviors that are not produc-
tive or are self-defeating, and to help group members find alternative ways of be-
having that are productive. This is accomplished through the eight-step process
outlined above.

䊏 Role of Group Leader

The role of the group leader, according to Glasser (1965), is fourfold and includes
the following responsibilities.
264 What Are the Essential Elements of Counseling? PART TWO

Tasks of Reality Group Therapists

1. Group leaders must be responsible persons who are aware of and able to fulfill
their own needs.
2. Group leaders mentally must be strong individuals who can resist pleas for
sympathy and excuses for nonproductive behavior from group members.
3. Group leaders must practice acceptance of all group members.
4. Group leaders must be supportive and emotionally involved with each group
member and, at the same time, use gentle confrontation to move members to-
ward responsible living.

Reality therapy group leaders continue to explore and challenge their own values
in an effort to strive toward their own personal growth.

䊏 Strengths and Limitations

Realty therapy has a short-term focus, making it an appropriate and effective ther-
apy under today’s health care system. Additionally, it relies heavily on accountabil-
ity, which allows the group process to be member driven. Finally, the straightforward
and clear approach characteristic of reality therapy makes it appropriate for parent
groups, children’s or adolescents’ behavior management groups, teacher groups,
addiction groups, groups for incarcerated men and women, and crisis intervention.
Austin (1999) criticized reality therapy as being more of a “process model” or
technique rather than an actual theory. Other criticisms suggest that reality therapy
is too simplistic and discounts valuable tactics, such as gaining insight and dream
interpretation and analysis. Also, because reality therapy is very value laden, a ma-
nipulative group leader easily can disregard a group member’s goals and impose
his or her own values and beliefs. For change to be successful and permanent,
group members need the opportunity to struggle with issues and reach their own
conclusions (Corey, 2004b).

For further information on reality therapy, visit William Glasser’s Web

site:
䉴 www.wglasser.com

PERSON-CENTERED APPROACH TO GROUP WORK

Person-centered group work is linked directly to the counseling theory the Rogers
(1967, 1970, 1980) developed; he termed his groups basic encounter groups. Rogers’s
interest in group work evolved in the early 1950s, during the proliferation of group
CHAPTER TWELVE Approaches to Group Work 265

experiences. Hobbs (1951) and Gordon (1951) developed Rogers’s approach to

therapy and applied it to specialty groups, including those for physically and men-
tally handicapped children and their parents, mothers requiring government assis-
tance, persons receiving individual counseling, and mental-health professionals
(Raskin, 1986a).

䊏 Key Theoretical Concepts

One of the most important concepts in person-centered therapy is indicated in its

name—person-centered. The therapist best can understand and help the client
by trying to comprehend the client’s frame of reference or worldview. The
well-known adage, “The client knows best,” is an accurate representation of Rog-
ers’s approach to therapy. Additionally, there are three conditions for the therapeu-
tic relationship that advance its effectiveness; namely, the counselor’s uncondi-
tional positive regard toward the client, empathic stance, and genuineness.

See Chapter 9 for more information on Rogers’s theoretical concepts.

䊏 Goals and Stages

Rogers believed that clients are the experts of their own lives and improve faster
when they direct their actions. Goals of person-centered group counseling may in-
clude such things as enhancing self-esteem, reducing conflict with others, and in-
creasing the overall productive functioning of group members. After gaining in-
sight through experiencing the three fundamental conditions of person-centered
therapy, members should be able to set their own goals and work toward achieving
those goals.
Rogers (1970) defined 15 stages of the group process that include the following
patterns.

Client Behaviors in Group Therapy Development

1. Milling around.
2. Resisting.
3. Revealing past feelings.
4. Expressing negative feelings.
5. Expressing personally meaningful material.
6. Communicating immediate personal feelings.
7. Developing a healing capacity in the group.
8. Accepting oneself.
9. Cracking facades.
10. Giving feedback.
11. Confronting.
12. Helping relationships outside the group.
266 What Are the Essential Elements of Counseling? PART TWO

13. Making a basic encounter.

14. Expressing closeness.
15. Changing behavior.

These group stages do not always occur in a clear-cut sequence and vary from
group to group.

䊏 Therapeutic Techniques

Little emphasis is placed on specific techniques when conducting person-centered

groups. Because the therapeutic process is relationship based, not technique cen-
tered, a group leader must display genuineness, unconditional positive regard,
and empathy in addition to practicing good listening skills, possessing a positive
outlook, and demonstrating effective interpersonal responses within the group set-
ting. Rogers (1970) believed that the group environment leads to self-exploration
and self-acceptance that eventually results in change.

䊏 Role of Group Leader

The person-centered group leader is known as the facilitator, which may be under-
stood as follows:

Facilitator: A leader who participates genuinely in the group process as a

member of the group without using gimmicks or planned procedures
(Bozarth, 1981).

Skills of the Person-Centered Facilitator

䊏 Active listening.
䊏 Supporting.
䊏 Reflecting.
䊏 Sharing.
䊏 Affirming.
䊏 Clarifying.
䊏 Summarizing.
䊏 Engaging.

Person-centered facilitators must maintain an optimistic and positive view—core

qualities that are intervention tools for self-exploration, personal growth, and posi-
tive group experiences.
CHAPTER TWELVE Approaches to Group Work 267

䊏 Strengths and Limitations

Personal encounter groups can help people enhance their interpersonal relation-
ships and communication skills. Because the emphasis of a person-centered group
is on relationship building, this theory is especially effective with expressive peo-
ple and those who need to feel understood.
Limitations of person-centered groups include their tendency to discount the
impact of past experiences on behaviors, values, and feelings. Because there are no
techniques to guide members, the group may stagnate. The lack of structure and di-
rection make encounter groups less useful for persons with mental disabilities, se-
vere brain damage, or serious emotional disabilities.

GESTALT APPROACH TO GROUP WORK

Gestalt group work is attributed to Perls, who was trained as a psychoanalyst in

his native Germany. In the early 1930s, Perls fled to South Africa during the Nazi re-
gime. There, Perls refined his theory and, after immigrating to the United States,
coauthored his first book, Gestalt Therapy (Perls, Hefferline, & Goodman, 1951),
which outlined the fundamental tenets of Gestalt theory. The German word gestalt
means a complete pattern or configuration. A gestalt is a perceived whole; as such,
Gestalt therapy is rooted in Perls’s belief in perceptual holism.

䊏 Key Theoretical Concepts

Grounded in an existential perspective, Gestalt group work is characterized by an

effort to encourage clients to put meaning to their lives. Specifically, Perls advo-
cated helping people become a gestalt or fully integrated by bringing to awareness
their hidden or shadow side. To facilitate increased awareness, Gestalt therapy fo-
cuses primarily on the here and now.

䊏 Goals and Stages

Goals in Gestalt therapy address both the needs of individual group members and
the group as a whole.

Individual Goals for Gestalt Group Members (Zinker, 1978)

䊏 Integrating polarities within oneself.
䊏 Learning to provide self-support instead of looking to others.
䊏 Becoming aware of what one is sensing, feeling, thinking, fantasizing, and doing
in the present.
268 What Are the Essential Elements of Counseling? PART TWO

䊏 Defining one’s boundaries with clarity.

䊏 Translating insights into action.
䊏 Learning about oneself by engaging in creative experiments.

Group Process Goals for Gestalt Groups

䊏 Learning to ask clearly and directly for what members want or need.
䊏 Learning how to deal with one another in the face of conflict.
䊏 Learning how to give support and energy to one another.
䊏 Being able to challenge one another to push beyond the boundaries of safety and
what is known.
䊏 Learning how to make use of resources within the group rather than relying on
the group leader as the director.

There are three basic stages that occur in Gestalt groups:

1. Identity and dependence.

2. Influence and counterdependence.
3. Intimacy and interdependence.

During the first stage, identity and dependence, the group leader outlines the pur-
pose and expectations of the group, and group members learn about contracting
and boundary setting and develop relationships. In the second stage, influence and
counterdependence, the primary issues are power, influence, authority, and con-
trol; members are encouraged to challenge group norms. During the second stage
members also begin to take on roles, such as the “scapegoat” or the “victim,” and
learn to separate the role from the individual. In the third stage, intimacy and inter-
dependence, group members begin to take risks of an interpersonal nature and use
one another, as well as the leader, for support and understanding. After the group
has moved through these three stages, there is a closing process that allows mem-
bers to begin thinking about leaving the group.

䊏 Therapeutic Techniques

Gestalt therapy utilizes a wide variety of action-based techniques designed to in-

tensify the experience of the present moment and increase awareness. Gestalt
group work is unique in that the group leader’s primary focus and interaction is
with one group member at a time—someone who is willing to work. While the
group leader is working with a particular member, other group members act as ob-
servers, gaining awareness through witness of another’s experience. Two
well-known techniques used in Gestalt group work are the following:

Empty chair technique: A technique designed to help members work

through unfinished business. A member sits directly across from and speaks
CHAPTER TWELVE Approaches to Group Work 269

to an empty chair that he or she envisions holding the person with whom he
or she is in conflict.

Paradoxical intention: A technique used to aid group members to exaggerate

or magnify the behaviors that are causing concern for the purpose of bringing
awareness to the underlying feelings related to distressing behaviors.

Other techniques that a group leader may utilize to achieve awareness include role
playing, projection, dream interpretation, guided imagery and fantasy, and en-
couragement to focus on here-and-now feelings.

EXAMPLE

Using the Empty Chair Technique

Maria’s mother died when she was only a child, and for years, Maria has been unable fully to
face the grief of not having had the chance to grow up with her mother’s presence. After sev-
eral months of participating in a Gestalt-oriented personal growth group, during which time
Maria talked extensively about her mother’s death, she was challenged by a group member
who noticed that Maria seemed angry when she talked about her mother. To facilitate a mo-
ment in which Maria might deal with unresolved anger at her mother for having passed away,
the therapist asked Maria to imagine that her mother was sitting in a chair that he positioned
in front of her. Although timid at first, Maria closed her eyes and began conversing to the chair
as if her mother were sitting there in front of her. Guiding the process, the therapist supported
Maria’s release of sadness and anger at her mother for having left her alone during her child-
hood, teen, and adult years. At the close of the exercise, the group was invited to respond to
Maria and to their own feelings at watching the exercise.

䊏 Role of Group Leader

To help group members focus on the here and now and more intensely experience
their feelings, the Gestalt group leader asks “how” and “what” questions and
rarely asks “why” questions.

Group Leader Questions

䊏 “What are you experiencing now?”
䊏 “What’s going on inside you as you’re speaking?”
䊏 “How are you experiencing your anxiety in your body?”
䊏 “What’s your feeling at this moment—as you sit there and try to talk?”

Gestalt group leaders help members fully utilize their senses by focusing attention
on their posture, voice, hand gestures, language patterns, and interactions with
270 What Are the Essential Elements of Counseling? PART TWO

others. Sharing immediate experiences that are felt either by the group member or
the group leader helps to raise awareness.

䊏 Strengths and Limitations

Gestalt therapy is particularly effective when used by counselors who have a hu-
manistic, existential approach to helping others. Gestalt therapy allows for a high
level of creativity on the part of the group leader and puts responsibility for per-
sonal growth on group members—more so than other forms of group therapy.
A criticism of Gestalt therapy is that it focuses too heavily on emotion and too lit-
tle on cognition. There is also a danger of misusing Gestalt techniques, which can
have detrimental effects if misused with volatile clients. Additionally, if techniques
are used in a mechanical or gimmicky way by an inexperienced or untrained
leader, the group may become passive, and the goals of creating self-supporting in-
dividuals may be defeated.

Check out the following Web sites for more information about Ges-
talt therapy:
䉴 www.gestaltreview.com
䉴 www.gestaltcleveland.org

EXISTENTIAL APPROACH TO GROUP WORK

Kierkegaard, a 19th-century Danish theologian and philosopher, was the first to

develop a philosophy based on the formulation of “truth” as a guide to becoming a
whole individual. German and French theorists Martin Heidegger and Jean Paul
Sartre later named Kierkegaard’s approach existentialism. Swiss psychiatrist Lud-
wig Binswanger is credited with moving existentialism from a philosophy to a
therapeutic process. Prominent contemporary contributors to existential therapy
include Frankl, May, Bugental, and Yalom.

䊏 Key Theoretical Concepts

Existential therapy is a philosophical approach to counseling that stems from the

fundamental belief that people are not victims of circumstance and always have a
choice. Existential therapy also views people as constantly changing, emerging,
and developing. Philosophical questions such as “Who am I?,” “What can I hope
for?,” and “Where am I going?” are central to therapy under this model. According
CHAPTER TWELVE Approaches to Group Work 271

to the existential therapeutic model, there are six basic dimensions to the human
condition (Corey, 2005).

Basic Dimensions of the Human Condition

䊏 The capacity for self-awareness.
䊏 Freedom and responsibility.
䊏 Establishment of identity and meaningful relationships.
䊏 The search for meaning, purpose, values, and goals.
䊏 Anxiety as a condition of living.
䊏 Awareness of death and nonbeing.

With the help of the group leader, the existential group members work toward de-
veloping clear understandings of these human conditions and their own meaning
for life. Group members also develop a healthy awareness of the barriers prevent-
ing them from reaching their ultimate life goals.

䊏 Goals and Stages

The primary goal of existential therapy groups is to provide members with condi-
tions that maximize self-awareness and reduce blocks to personal growth. This is
done by helping group members discover and see freedom of choice in any situa-
tion and enabling members to assume responsibility for their own choices, thereby
giving them the responsibility to act. May (1981) stated, “the purpose of psycho-
therapy is not to ‘cure’ the clients in the conventional sense, but to help them be-
come aware of what they are doing and to get them out of the victim role” (p. 210).
The existential approach to groups, unlike many other styles of group therapy,
does not include specific stages of development.

Unlike most other models of group work,

existential group therapy does not utilize
techniques. Group leaders employ interventions
based on their philosophical views about the
fundamental nature of humanity.

䊏 Therapeutic Techniques

Unlike most other models of group work, existential group therapy does not utilize
techniques. Group leaders employ interventions based on their philosophical
views about the fundamental nature of humanity. Van Deurzen-Smith (1990) em-
phasized that the existential approach is well known for its deemphasis on tech-
niques. This does not mean that techniques never are used; rather, the group
272 What Are the Essential Elements of Counseling? PART TWO

leader’s self becomes the core of the group therapy. The group leader is free to draw
from other therapeutic models if a particular technique proves useful.

䊏 Role of Group Leader

The role of the group leader in existential therapy groups is to view each group
member as a “total person,” who is the product of his or her choices, rather than of
external circumstances (Austin, 1999).

Leader Tasks in Existential Group Work

䊏 Helping group members see where, when, and how they have failed to realize
their potential.
䊏 Assisting members in identifying and clarifying their assumptions about the
world and how it works.
䊏 Encouraging members to examine their beliefs, values, and assumptions in an ef-
fort to determine their validity.
䊏 Helping group members transform their new understanding into concrete ac-
tion, which ultimately should result in group members’ living a purposeful exis-
tence.

䊏 Strengths and Limitations

Existential therapy allows group members to view themselves honestly and with
an understanding that their concerns are universal. According to Corey (2005), one
of the main strengths of existential therapy is “its emphasis on the human quality of
the therapeutic relationship” (p. 155). A second strength of this therapeutic model
is the freedom that is given to group members to redesign their lives based on their
awareness of choice.
A limitation to existential therapy is its perceived vagueness. Some critics find
terms such as self-actualization, authenticity, and being-in-the-world unclear and elu-
sive. As such, it becomes difficult to research the process or the outcomes of existen-
tial therapy. Another limitation is that the philosophical insight that is necessary for
growth may not be appropriate for some group members. People with serious
emotional disturbances may not be able to understand an approach that primarily
is insight based.

For further information on existential therapy visit

䉴 www.go.to/existentialanalysis
CHAPTER TWELVE Approaches to Group Work 273

Chapter 12: Key Terms

䉴 Social interest 䉴 Empty chair technique 䉴 Parent ego state
䉴 Birth order 䉴 Paradoxical intention 䉴 Adult ego state
䉴 Family constellation 䉴 Personal responsibility 䉴 Child ego state
䉴 Genuineness 䉴 Director 䉴 Games
䉴 Unconditional positive 䉴 Protagonist 䉴 Life scripts
regard 䉴 Auxiliary ego 䉴 Therapeutic contracts
䉴 Empathy 䉴 Audience 䉴 Systematic desensitization
䉴 Facilitator 䉴 Stage 䉴 Assertion training
䉴 Gestalt 䉴 Ego state 䉴 Modeling
 chapter Fundamentals of Group Work

13 Rex Stockton
Leann Terry
Indiana University

Dan-Bush Bhusumane
University of Botswana

In This Chapter

䉴 History of Group Counseling 䊏 Characteristics of Culturally Competent

䊏 Theoretical Influences Leaders
䊏 Uses of Groups 䊏 Benefits of Multicultural Awareness
䊏 Ethical and Legal Considerations

䉴 Pregroup Planning
䉴 Fundamentals of Group Work 䊏 Logistics
䊏 Definition of Group Work 䊏 Site Considerations

䊏 Types of Group Work 䊏 Defining the Group’s Purpose

䊏 Group Member Activities 䊏 Selection of Members

䊏 Leader Interventions

䉴 Beginning Phase
䉴 Group Dynamics 䊏 Structure
䊏 Group Processing 䊏 Group Norms

䊏 Group Conflict 䊏 Role of the Leader in the Beginning Phase

䊏 Group Cohesiveness 䊏 Goal Setting

䊏 Therapeutic Factors in Groups 䊏 Feedback in the Beginning Phase

䊏 Group Typology

䉴 Middle Phase
䉴 Group Leadership 䊏 Conflict in the Middle Phase
䊏 Leadership Styles 䊏 Group Interactions

䊏 Group Leader Attributes 䊏 Role of the Leader in the Middle Phase

䊏 A Framework for Intervention 䊏 Feedback in the Middle Phase

䊏 Concerns of Beginning Group Leaders

䊏 Coleadership 䉴 Final Phase

䊏 Final Phase Resistance
䉴 Cultural Considerations for Group Leaders 䊏 Generalization of Learning

䊏 Influences on Diversity 䊏 Role of the Leader in the Final Phase

䊏 Non-Western Values in Group Work

274
CHAPTER THIRTEEN Fundamentals of Group Work 275

HISTORY OF GROUP COUNSELING

In 1905, Joseph Pratt inadvertently started the counseling group when he brought
patients together who suffered from an infectious disease (Gazda, Ginter, & Horne,
2001). His intention was to save time by not seeing each patient individually. These
groups, however, turned into a valuable addition to typical treatment due to their
interpersonal focus and support (Hadden, 1955). Pratt’s group intervention gener-
ally is thought of as the start of formal group counseling, which today is set up for
specific therapeutic purposes.

䊏 Theoretical Influences

Over the years, group work has evolved in several dimensions and through vari-
ous theoretical approaches. The development of group work has been influenced
by theoretical contributions from psychoanalysis to psychodrama and by method-
ologies ranging from empirical to anecdotal (Barlow, Fuhriman, & Burlingame,
2004). The work of social psychologists such as Lewin (1951) and his students also
have had an impact on the development of group work. Social psychologists’ inter-
est in group work has cycled through various levels of interest, but it always has
been one of the foci in the discipline. Since this original inception of group work,
the field has grown tremendously and several professional societies have formed
to support group therapy.

Professional Organizations for Group Work

䊏 American Psychological Association, Group Psychology and Group Psychother-
apy (Division 49).
䊏 American Society of Group Psychotherapy and Psychodrama.
䊏 American Group Psychotherapy Association.
䊏 Association for Specialists in Group Work (ASGW).

Check out these Web sites from the APA, the American Society of
Group Psychotherapy and Psychodrama, the American Group Psy-
chotherapy Association, and the ASGW:
䉴 www.apa49.org
䉴 www.agpa.org
䉴 www.asgpp.org
䉴 www.asgw.org
276 What Are the Essential Elements of Counseling? PART TWO

䊏 Uses of Groups

Since Pratt’s time, the use of groups has expanded exponentially into a wide range
of populations, problems, and settings. As a testament to the wide application of
groups, the Handbook of Group Counseling and Psychotherapy (DeLucia-Waack,
Gerrity, Kalodner, & Riva, 2004) discusses in depth more than 32 types of therapeu-
tic groups, including specialized approaches for different cultural groups, settings,
client difficulties, and client demographics. For example, task groups increasingly
are used in industries and large governmental organizations; Forsyth (1998) stated
that 80% of large organizations use group work. With the demonstrated efficacy, ef-
ficiency, and applicability of therapeutic groups and with the advent of managed
care, it is reasonable to conclude that groups will continue to be a major mode of
counseling and psychotherapy.

䊏 Ethical and Legal Considerations

Rapin (2004) stated, “One of the defining tenets of a profession is that it has a code
of ethics” (p. 151). Ethical guidelines that normally correspond with the law (al-
though not in every case) are considered to be the province of the respective profes-
sional organization. However, it is not unusual for courts of law to be guided by the
published code of ethics from the relevant professional organization.
In the case of counselors, the relevant organization is the ACA with its Code of
Ethics and Standards of Practice (ACA, 2005a). Just as in any other form of counsel-
ing, ethical and legal considerations in group work are extremely important. In-
deed, the unique nature of groups, in which therapists work with multiple clients,
makes ethical and legal considerations all the more crucial. Each state has its own
laws concerning practice, and it is the responsibility of the practitioner to be famil-
iar with those laws. The group work division of ACA, the ASGW (2000), offers
guidelines that assist in the training of group leaders in a document entitled Profes-
sional Standards for the Training of Group Workers.

See Chapter 2 for more on ethics in counseling.

FUNDAMENTALS OF GROUP WORK

The impact that groups have on human beings is tremendous. Even in an individ-
ualistically oriented society such as the United States, groups serve important func-
tions. Whether people gather in informal groups for purposes such as exercising,
celebrating special occasions, and grieving, or in formal groups such as mental
health agencies, schools, and a large variety of other organizations, groups serve as
a means of satisfying the need people have to feel accepted and part of a larger
community.
CHAPTER THIRTEEN Fundamentals of Group Work 277

䊏 Definition of Group Work

The ASGW (2000) defined group work in the following way:

Group work: A broad professional practice involving the application of

knowledge and skill in group facilitation to assist people in reaching mutual
goals, which may be intrapersonal, interpersonal, or work-related.

In addition to providing professional counselors with an understanding of group

work, the ASGW also outlined some basic goals of group work, as listed next.

Goals of Group Work (ASGW, 2000)

䊏 Accomplishment of work-related tasks.
䊏 Education.
䊏 Personal development.
䊏 Personal and interpersonal problem solving.
䊏 Remediation of mental and emotional disorders.

䊏 Types of Group Work

There have been a number of attempts to classify types of professional group work.
Perhaps the most relevant and widely accepted classification is the division of
group work into four specific areas: task, psychoeducational, counseling, and
psychotherapeutic groups. A brief description of these groups based on the ASGW
(2000) definitions follows.

Four Classifications of Group Work

1. Task groups are used to accomplish group tasks and goals.
2. Psychoeducational groups are based on educational and developmental strate-
gies and often are used for personal growth to prevent future difficulties.
3. Counseling groups promote personal and interpersonal methods for growth
and often use a here-and-now interactional focus.
4. Psychotherapeutic groups focus on personal and interpersonal difficulties sim-
ilar to counseling groups and also can be used to address dysfunctional behav-
ior and cognitive distortions.

These four categories are not mutually exclusive, and, at times, there is consider-
able overlap in the problems addressed, populations served, group leadership
styles, skills, interventions, and strategies used for each type of group.
278 What Are the Essential Elements of Counseling? PART TWO

䊏 Group Member Activities

Stockton and Toth (2000) described effective counseling groups as providing mem-
bers with a number of important experiences, opportunities for exploring the activ-
ities of life, and the chance to learn authentic ways of relating. In effective groups,
members engage in basic but necessary activities.

Common Group Member Tasks

䊏 Meet other members.
䊏 Share their lives.
䊏 Learn about rules for membership.
䊏 Learn to trust and confront one another.
䊏 Share a variety of feelings.
䊏 Say goodbye.

䊏 Leader Interventions

Basic therapeutic skills used in individual counseling are also important for coun-
selors who engage in group work. These skills include, but are not limited to the
following:

䊏 Active listening.
䊏 Reflection.
䊏 Clarification.
䊏 Summarizing.
䊏 Questioning.
䊏 Paraphrasing.

However useful these are, they are not the only interventions available to group
leaders. Because of the nature of groups, a variety of other tasks need to be consid-
ered by group leaders.

GROUP DYNAMICS

The dynamics of groups are ever evolving; they have a substantial impact on group
members and represent the interdependence among all members in a group.
Marcus (1998) described group dynamics this way:

Group dynamics: The way “in which the members interact with each other
and mutually influence one another’s perceptions and behavior” (p. 230).
CHAPTER THIRTEEN Fundamentals of Group Work 279

Two concepts that are fundamental to a discussion about group dynamics are con-
tent and process. Understanding the difference between content and process is an
important task of counselors who work as group leaders. The distinction has been
described by Yalom (1995) this way:

Group content: The words that are spoken between individuals in a group.

Group process: “Nature of the relationship between interacting individuals”

(p. 130).

Working with content and process, leaders focus on the relationship between mem-
bers, or the process, as well as what is directly said, or the content, that might influ-
ence the relationship. In addition to referring to content and process, the umbrella
concept of group dynamics encompasses a number of other key ideas in the study
and practice of group work; these are addressed in this section.

䊏 Group Processing

It is important to differentiate the group process from the act of processing that oc-
curs in group. The content and process of the group provide fodder for the process-
ing, which usually is facilitated by the leader. Ward and Litchy (2004) described the
activity of processing this way:

Processing: “[A]n activity in which individuals and groups regularly exam-

ine and reflect upon their behavior in order to extract meaning, integrate the
resulting knowledge, and thereby improve functioning and outcome”
(p. 104).

Although processing may be a spontaneous intervention, it is always a purposeful

attempt to derive meaning from the group. Stockton, Morran, and Nitza (2000) de-
scribed a “cognitive map” for processing that contains four interrelated steps.

Cognitive Map for Processing

1. Identify critical incidents that are important to the group members.
2. Examine the event and the group member reactions.
3. Derive meaning and self-understanding from the event.
4. Apply the new understandings for personal change outside the group.

䊏 Group Conflict

According to Boulding (1962), conflict is found in almost all situations of life and,
“in an actual conflict situation, then, there must be awareness, and there must also
be incompatible wishes or desires” (p. 6). Thus, group leaders should not be sur-
280 What Are the Essential Elements of Counseling? PART TWO

prised that conflict inevitably occurs, but, rather, should use their skills to manage
the conflict so it can be used for the benefit of the group.

䊏 Group Cohesiveness

When members begin to feel like they are a part of the group and want to remain in
the group, they are more likely to overcome any potential conflict and other issues
that might motivate members to drop out. Given the complexity of cohesion in a
group, the leader’s role is crucial in understanding, balancing, and facilitating the
development of cohesion.

Group cohesiveness: The attractiveness of a group to the members that can

be developed between individual group members, between the member and
the group, and between the members and the group leader (Burlingame,
Fuhriman, & Johnson, 2001).

䊏 Therapeutic Factors in Groups

Understanding the factors that help people develop as a result of therapeutic

groups is exceedingly important. Yalom (1975, 1985, 1995), the premier figure in
therapeutic factor theory and research, and a number of others (e.g., Crouch, Bloch,
& Wanlass, 1994; Kivlighan & Mullison, 1988; MacKenzie, 1987) have tackled the
subject of therapeutic factors in groups. Bloch and Crouch (1985) provided a useful
definition of a therapeutic factor:

Therapeutic factor: “[A]n element of group therapy that contributes to im-

provement in a patient’s condition and is a function of the actions of the
group therapist, the group members, and the patient himself” (p. 4).

Throughout a group experience, the therapeutic factors take on more or less sa-
lience depending on the stage of the group’s development. Yalom (1995) listed 11
therapeutic factors or elements that contribute to member improvement.

Therapeutic Factors in Group

1. Instillation of hope.
2. Universality.
3. Imparting information.
4. Altruism.
5. Corrective recapitulation of the primary family group.
6. Development of socializing techniques.
7. Imitative behavior.
8. Interpersonal learning.
9. Group cohesiveness.
CHAPTER THIRTEEN Fundamentals of Group Work 281

10. Catharsis.
11. Existential factors.

䊏 Group Typology

Kivlighan and Holmes (2004), utilizing cluster analysis, analyzed numerous stud-
ies that focused on the importance of therapeutic factors and developed “a
typology of groups based on their therapeutic mechanisms” (p. 26). The analysis
resulted in two dimensions—affective/cognitive and support/insight—that
emerge in groups and that operate to create four types of group experiences.

Four Typologies of Group Experiences (Kivlighan & Holmes, 2004)

1. Affective support.
2. Affective insight.
3. Cognitive support.
4. Cognitive insight.

GROUP LEADERSHIP

Achieving positive outcomes from group therapy relies in large part on the skills,
style, and personality of the group leader. When skills, style, and personality of the
leader are combined appropriately with the aims of the group, a helpful atmo-
sphere is created for member growth.

䊏 Leadership Styles

Leadership is one of the most studied areas in social psychology. It has implications
for all who work with groups, whether they are military psychologists who are
concerned with group dynamics at the squad level, organizational psychologists
who focus on understanding how to make groups more effective in large organiza-
tions, or, more relevant to our purpose, counselors and researchers who wish to un-
derstand therapeutic small group leadership.
According to Napier and Gershenfeld (1993), leadership style simply is another
word for “a collection of behaviors in a particular situation” (p. 241). In therapeutic
group work the task is for members freely to discuss their concerns. To do this, they
must feel secure enough to risk telling others their inner thoughts and concerns.
Thus, leaders need to tailor their behaviors to the task.
One of the most quoted, as well as replicated, classic leadership research studies
was conducted by Lewin, Lippitt, and White (1939) who investigated the effect of
282 What Are the Essential Elements of Counseling? PART TWO

different styles of leadership on the social climate of three groups of 10-year-old

boys in a camp setting. The leadership styles were divided into three categories.

Types of Leadership Styles (Lewin et al., 1939)

䊏 Autocratic.
䊏 Democratic.
䊏 Laissez faire.

The study demonstrated major differences in the members’ ability to deal effec-
tively with a number of issues, most prominently stress. The democratic style
clearly was best suited for the situation.
In yet another classic study directly related to counseling groups, Lieberman,
Yalom, and Miles (1973) examined different leadership styles used in college stu-
dent personal growth groups. The four styles of leadership were:

䊏 Executive function (limit setting, time management, establishment of norms).

䊏 Emotional stimulation (facilitation of expression of feelings and personal be-
liefs).
䊏 Caring (demonstration of warmth and concern for group members).
䊏 Meaning attribution (interpretation and providing framework for change pro-
cesses).

Results of the study indicated that the most effective leaders are “moderate in stim-
ulation, high in caring, utilize meaning-attribution, and are moderate in expression
of executive functions” (Lieberman et al., 1973, p. 240). Readers will find a wealth of
information on leadership styles in a variety of texts, including the Handbook of
Group Counseling and Psychotherapy (DeLucia-Waack, Gerrity, et al., 2004).

䊏 Group Leader Attributes

Corey and Corey (2006) identified characteristics of group leaders that contribute
to positive group experiences.

Effective Group Leader Attributes

䊏 Courage.
䊏 Willingness to model.
䊏 Presence.
䊏 Goodwill, genuineness, and caring.
䊏 Belief in the group process.
䊏 Openness.
䊏 Nondefensiveness in coping with criticism.
䊏 Self-awareness.
CHAPTER THIRTEEN Fundamentals of Group Work 283

䊏 A Framework for Intervention

Stockton developed a tripartite framework for effective group leadership (Morran,

1992). The three dimensions are described next.

Dimensions of Effective Group Leadership

1. Perceiving refers to understanding the processes of the group, acquiring coun-
seling group training, and possessing general human development knowl-
edge.
2. Selecting refers to choosing appropriate interventions from a repertoire of pos-
sibilities.
3. Risking refers to having the courage to intervene even when there is the poten-
tial for less than successful results.

䊏 Concerns of Beginning Group Leaders

Novice group leaders usually are concerned about what will happen if no one talks
and wonder how they will handle silence. Conversely, some novice leaders worry
about what they will do with members who dominate the discussion or become
confrontational. Some leaders may worry about actual physical violence.

EXAMPLE

Responding to Beginning Leaders’ Fears

To respond to the trepidations of beginning group leaders or leaders in training, one can ask
leaders at the beginning of a workshop or class, to make a list of their fears about group leader-
ship. Typically, there is a great deal of universality in their fears that can be discussed. When
the catastrophic fears are known, they can then be exorcized by having the leaders simulate
anxiety-provoking situations, which detoxifies the expectations. The use of role play and sim-
ulations is one of the most powerful training techniques.

䊏 Coleadership

Coleaders are professionals who share the responsibility of facilitating a group ex-
perience. This approach to leadership offers many benefits, a few of which are
listed here.
284 What Are the Essential Elements of Counseling? PART TWO

Benefits of Coleadership
䊏 Beginning group leaders can learn from being paired with a more experienced
leader.
䊏 The knowledge, skills, and capabilities of two leaders are available to the group.
䊏 Group members have a greater chance of being compatible with one of the lead-
ers (Jacobs, Masson, & Harvill, 2002).
䊏 The group can be more efficient and continue to run even if one leader is not
present.

Although there are a number of benefits of coleadership to facilitators and mem-

bers, there are also potential challenges worth mentioning.

Challenges of Coleadership
䊏 Leaders may have different ways of resolving group differences (Riva, Wachtel,
& Lasky, 2004).
䊏 Different styles of leadership from the coleaders, such as one focusing on the pro-
cess and the other focusing on content, can lead to tension and frustration in the
group (Jacobs et al., 2002).

To deal with the challenges of coleadership, facilitators might want to interview

each other before the group begins to identify their intrapersonal strengths and
weaknesses and to share with each other their approaches to group counseling.
Research demonstrates that the relationship between the coleaders influences
their effectiveness as a team (Okech & Kline, 2005). Thus, Okech and Kline encour-
aged coleaders to discuss their relationship, perceptions, and experiences of each
other throughout the course of the therapeutic group. Supervisors can be particu-
larly helpful in assisting coleaders to discuss their working relationship.

CULTURAL CONSIDERATIONS FOR GROUP LEADERS

There is a growing body of literature associating self-awareness with counselor ef-

fectiveness because it calls leaders to broaden their understanding of multicultural
and diversity issues. In this section, we address a number of issues relevant to
multiculturalism in group work.

䊏 Influences on Diversity

Culturally competent group leaders appreciate diversity and the difficulties associ-
ated with dealing with people from other cultures and cultural backgrounds (Sue
& Sue, 1990). Cultural competence is necessary even when working with clients
from the same culture because of differences related to subcultures (Vontress &
CHAPTER THIRTEEN Fundamentals of Group Work 285

Jackson, 2004). Literature on multicultural counseling attributes cultural differ-

ences to a number of factors that play a role in the therapist–client relationship and,
likewise, in the effectiveness of therapy (Goh, 2005).

Factors Associated With Cultural Differences

䊏 Social orientation.
䊏 Ethnicity.
䊏 Race.
䊏 Gender.
䊏 Economic status.
䊏 Social status.
䊏 Family orientation.
䊏 Sexual orientation.
䊏 Religious affiliation.
䊏 Spirituality.
䊏 Language.
䊏 Communication systems.
䊏 Individual qualities.
䊏 Mental and physical challenges.

䊏 Non-Western Values in Group Work

In group work, differences in traditional Western beliefs and non-Western values

likely are to be found in communication styles, perception of power relations, con-
cept of time, and other behaviors. These differences challenge the appropriateness
of using the Western worldview as a yardstick for all acceptable behaviors. Accord-
ing to Pope (1999), various studies describe individualistic cultures as supporting
winning in competition, achievement, freedom, autonomy, fair exchange, and chal-
lenging authority. Morris and Robinson (1996) argued that a critical examination of
the traditionally accepted views may assist professionals in providing enhanced
counseling experiences to members of diverse populations. Some of the non-West-
ern ideals of which group leaders should be aware are listed here.

Common Non-Western Values

䊏 Interdependence.
䊏 Simplicity.
䊏 Obedience.
䊏 Hierarchy.
䊏 Duty.
䊏 Group survival.
䊏 Nonlinearity of time.
286 What Are the Essential Elements of Counseling? PART TWO

䊏 Group welfare.
䊏 Family.
䊏 Community.

䊏 Characteristics of Culturally Competent Leaders

Effective group leaders strive for cultural competence by developing expertise in

handling multicultural and diversity issues (Goh, 2005). As the need for cultural
competence continues to occupy center stage in group work, counselors face the
challenge of learning new skills that enhance their cultural effectiveness and ap-
propriateness in responding to experiences of group members. The following qual-
ities define culturally competent group leaders.

Qualities of Culturally Competent Group Leaders

䊏 Strive for self-awareness of personal assumptions about human behavior, biases,
values, beliefs, and cultural heritage.
䊏 Appreciate that one’s worldview and that of the client inevitably are different.
䊏 Acknowledge one’s tendencies and views about other cultures and value the im-
portance of acquiring sufficient knowledge about possible barriers to participa-
tion, family systems, and cultural practices of the members.
䊏 Have the right attitude in terms of respect for members’ religious beliefs, cultural
values, and communication styles.
䊏 Respect the different ways in which individuals and people from diverse cul-
tures express feelings (Ivey & Ivey, 2003).
䊏 Have training to work with cultural diversity and know when to individualize
and generalize about characteristics of a client’s cultural group, thereby develop-
ing a culture-specific expertise (Goh, 2005).
䊏 Possess a working knowledge of members’ cultures and reflect appreciation of
the client’s cultural experience and background.
䊏 Use culturally relevant and appropriate intervention strategies (Sue & Sue,
1990).
䊏 Exhibit openness to multiple methods or approaches to group facilitation and
recognize that one’s facilitation styles and approaches may be culture-bound.
䊏 Anticipate and ameliorate the negative impact a culture-bound facilitation style
may have by drawing on other culturally relevant skill sets (ASGW, 1998b).

For more on characteristics of multiculturally competent group workers, see Chapter 14.

䊏 Benefits of Multicultural Awareness

There are significant benefits of cultural competence in leading a group. A Univer-

sity of Notre Dame Counseling Center (2003) Web page lists the following benefits
of becoming multiculturally aware.
CHAPTER THIRTEEN Fundamentals of Group Work 287

Benefits of Cultural Competence to the Group Leader

䊏 Increased self-awareness.
䊏 Increased awareness of other cultures.
䊏 Improved interpersonal communication.
䊏 Improved likelihood of making appropriate interventions on stereotyping and
prejudices.
䊏 Increased openness to emotionally charged issues.
䊏 Enhanced sensitivity to others’ experiences.
䊏 Minimized imposition of ones’ own values and beliefs.
䊏 Increased ability to promote living effectively in a diverse world.

Group members, especially those from a different cultural background, are likely
to welcome the leader’s interest in and appreciation for their culture. Cultural ap-
preciation is only one of the benefits to members of a multicultually aware leader.
Some of the other advantages to members include the following.

Benefits of Cultural Competence to Group Members

䊏 Members feel safe and respected when their culture is appreciated.
䊏 Members are likely to be able to forgive the leader when the leader makes honest
mistakes in addressing their issues.
䊏 Members are valued when leaders avoid stereotyping and instead highlight
their uniqueness regardless of cultural backgrounds (Vontress & Jackson,
2004).

See Chapter 14 for more on multiculturalism in group work.

PREGROUP PLANNING

Before meeting with group members, leaders need to do preliminary planning.

Dealing with basic logistics and site considerations, defining the purpose of the
group, and selecting participants are some important tasks that leaders have to face
in the preparation phase.

䊏 Logistics

Before any group begins to meet, the leader must address logistical issues. Seeking
and receiving the required administrative approvals is one such issue that must be
navigated. Administrators and other colleagues (e.g., nurses on a ward; teachers,
counselors, and other nonteaching personnel in a school; or agency personnel)
should know about the group and, more important, believe in the benefits offered.
288 What Are the Essential Elements of Counseling? PART TWO

In any organization, it is easy to hinder a good effort when individuals do not sup-
port the group as an important tool in responding to the needs of the clients. En-
suring that administrators support the activity and know necessary details facili-
tates easier resolution if any problems or outside questions arise.

䊏 Site Considerations

Basic but essential to a successful group experience are commodities such as a

pleasant room, comfortable chairs, and a temperate environment. Ensuring that
the space is private and free from interruptions is also crucial and cannot be taken
for granted. There are numerous horror tales where any one of these important fac-
tors have not been met and later resulted in an untherapeutic situation.

䊏 Defining the Group’s Purpose

One of the most important tasks of a leader is to define the focus of the group. In
some settings, that already is done for the leader. Whether the leader or a larger en-
tity, such as an agency, defines the goal of the group, there must be a good match
between the leader’s experience, knowledge, and skills and the proposed group
purpose.

䊏 Selection of Members

Pregroup preparation entails providing information to prospective group mem-

bers about the nature of the group and the likely course of activities before the first
group meeting. In addition to providing information to prospective members, the
leader also must obtain information about the members, and in some cases, decide
not to select certain individuals for the group. The ACA (2005a) Code of Ethics re-
quires that group leaders “to the extent possible … select members whose needs
and goals are compatible with the goals of the group, who will not impede the
group process, and whose well-being will not be jeopardized by the group experi-
ence” (Section A.8). The importance of preparing group members for their experi-
ence has received a great deal of empirical attention. The periodic reviews of
Bednar and Kaul (1978, 1994) have demonstrated the importance of this concept.
Burlingame et al. (2001) included pregroup preparation as one of the principles of
the therapeutic relationship that empirically has been supported.

BEGINNING PHASE

A number of individuals have articulated stages of group development (e.g.,

Borgatta & Bales, 1953; Hare & Naveh, 1984), but the classic theoretical formulation
was proposed by Tuckman (1965), who identified four stages: forming, storming,
CHAPTER THIRTEEN Fundamentals of Group Work 289

norming, and performing. Tuckman and Jensen (1977) later added a fifth stage of
adjourning, thus giving importance to the affect that the members feel and express
at the end of a group. Tuckman (1965) provided a definition of these stages that
counselors can use:

Forming: The initial stage during which members are getting to know each
other, the group leader, and the group boundaries.

Storming: The stage of group work characterized by inevitable conflict, mild

disagreements, and resistance that can have positive or negative implica-
tions.

Norming: The stage in group work when the members develop “ingroup
feeling and cohesiveness … new standards evolve, and new roles are
adopted” (p. 396).

Performing: Period of group work when the members have reconciled many
of their differences and have developed enough trust and cohesion to exam-
ine themselves and their relationship to the group. During this stage “roles
become flexible and function, and group energy is channeled into the task”
(p. 396).

Adjourning: Refers to the termination stage when members may feel a sense
of loss and a need to make sense of what has happened in the group.

There is no clear line between the various stages; however, the stages present a use-
ful, metaphorical way of understanding the development of groups.
The focus of this section on the beginning phase corresponds to Tuckman and
Jensen’s (1977) stages of forming, with some characteristics of storming and
norming. Typically, group members and beginning leaders are anxious in the be-
ginning phase. Thus, in the early stages of a group, universality and the instillation
of hope are two of the more prevalent therapeutic factors (Kivlighan & Holmes,
2004). They can be understood as follows:

Universality: Group members come to understand that others have similar

problems, and they are not alone in their dilemma.

Instillation of hope: Members have a sense of hope about receiving help and
learning how to better deal with their problems.

䊏 Structure

The beginning of a group is a crucial time not only for working with the anxiety
that likely is to be present, but also for setting the tone and establishing the thera-
peutic ground rules. One of the main tasks of the leader in response to the begin-
290 What Are the Essential Elements of Counseling? PART TWO

ning group issues is to provide an optimum amount of structure. Riva et al. (2004)
defined structure this way:

Structure: “[E]ncompasses many different techniques and interventions that

have as their primary goal the development and maintenance of a healthy
therapeutic group” (p. 40).

Techniques or interventions that provide structure can involve simple guidelines

such as when the group will start and stop; structure also can refer to the leaders’
interventions that help people feel safe.

EXAMPLE

Research Considerations for Group Structure

There was a period of time, especially in the early 1960s, when some theoreticians believed
that the structure of a group should evolve with minimal input from the leader. Whitaker and
Lieberman (1964) hypothesized that for a natural group culture to emerge, clients should be
allowed to have their issues surface without interference, which would include leader-struc-
tured activities. However, Bednar, Melnick, and Kaul (1974) demonstrated that leaders can
safely and beneficially provide structure. Researchers later supported the conclusion that an
optimum amount of structure provides a facilitative atmosphere, whereas too much structure
can be detrimental because it arouses resistance (Stockton, Rohde, & Haughey, 1992).

䊏 Group Norms

One of the variety of ways that a leader can create structure is through norm set-
ting. Every group establishes its own set of norms, some of which are formal and
others of which are informal; a succinct definition of these terms is provided here:

Group norms: Informal and formal beliefs about group behavior, such as lan-
guage, attendance, confidentiality, degree of self-disclosure, punctuality, con-
tent shared, and processes, expected to occur (Corey & Corey, 2001; Stockton
& Toth, 2000).

Informal norms: Group norms that influence individuals without the indi-
viduals necessarily being able to communicate the existence of the norms.

Formal norms: Group norms that are communicated and agreed on.

Norms are the “rules of the game” (Stockton & Toth, 2000) established both by the
members and the leaders of groups. The role of the leader in facilitating therapeutic
norms at the beginning of any group experience, however, is extremely important.
CHAPTER THIRTEEN Fundamentals of Group Work 291

One set of norms that leaders must address, for example, has to do with confidenti-
ality. Establishing norms about confidentiality helps create structure and safety,
both of which are important in the beginning phase of a group. A few generaliza-
tions about norms related to confidentiality are noted here.

Norm of Confidentiality
䊏 The norm of confidentiality must be made explicit with the group members.
䊏 Rather than instructing members to maintain confidentiality, the leader has to
enlist their support in facilitating an understanding about why confidentiality is
needed.
䊏 Although the norm of confidentiality is established best through group discus-
sion and consensus, the leader shapes this process by initiating and making his
or her position clear.

EXAMPLE

Creating Appropriate Norms for the Setting

Students in a graduate classroom usually take their seats with a minimum of disruption and
wait for the instructor to initiate a lecture or discussion. The same behavior would not be the
norm for a group of small children entering a first-grade classroom. These both are examples
of informal or implicit norms that reflect their own sense of appropriateness and their inter-
pretations of societal expectations.

䊏 Role of the Leader in the Beginning Phase

In the beginning phase of groups, members have to feel safe before they can talk
freely, and they need to be energized to share. The important aspects of leadership
during the initial period are related directly to these member needs. Some of these
are provided here.

Tasks of Group Leaders in the Beginning Phase

䊏 Leaders work with the members to form a therapeutic milieu and establish opti-
mum structure that encourages members to discuss issues.
䊏 Leaders facilitate an environment of safety and encouragement so that members
can feel secure in examining themselves freely and at their own pace.
䊏 Leaders facilitate the process of members getting to know each other, by provid-
ing a structure that allows group members to feel relaxed and to begin talking
about themselves in a safe way.
292 What Are the Essential Elements of Counseling? PART TWO

䊏 Leaders use the intervention known as protecting, which is intended to protect

the member from too much self-disclosure and subsequent feelings of regret, as
well as pressure from others in the group to reveal more than that with which
they may be comfortable.

䊏 Goal Setting

During the beginning sessions of a group, an important task for members is setting
personal goals related to what they want to gain from the group experience. Espe-
cially in organizational literature (Locke & Latham, 1990; Mento, Steele, & Karren,
1987), research has found that task performance is increased when clear and chal-
lenging goals have been set. Discussion for goal setting can revolve around why the
member is in the group and what he or she requires for making progress (Stockton
& Toth, 2000). When a group member struggles with setting goals, the leader can
paraphrase and narrow the focus of the member’s goal as a way to operationalize
the desired change.

䊏 Feedback in the Beginning Phase

Feedback is a very important part of therapeutic groups. The following is a defini-

tion of feedback that counselors can adopt:

Feedback: A group member or leader’s shared observations and reactions to

another member’s expressed feelings, thoughts, or behaviors.

Leaders help members understand the value of feedback by modeling appropriate

feedback, which is especially important in the beginning stages of a group. A func-
tional group has members who actively interact and provide feedback to each
other and does not rely solely on a leader to give feedback to members. Initially,
positive feedback is a useful technique to reinforce appropriate behavior. Correc-
tive feedback is better accepted in the later stages of a group or sandwiched be-
tween two positive feedback statements (Morran, Stockton, Cline, & Teed, 1998).

MIDDLE PHASE

The middle period of a group corresponds to Tuckman’s (1965) phases of storming

and performing and also is considered the transition or working stage of a group.
There are numerous characteristics of a group in the working stage.
CHAPTER THIRTEEN Fundamentals of Group Work 293

Characteristics of a Group in the Working Stage

䊏 Member-to-member interactions increase.
䊏 Group members self-disclose more often and at a deeper level.
䊏 Interpersonal feedback is appropriate and valued by the members.
䊏 Members develop insight and create meaning from the process as they reflect on
their experience.

䊏 Conflict in the Middle Phase

Storming is characterized by conflict between the members or directed toward the

leader. The level of conflict ranges greatly depending on the situation and the per-
sonality of the individuals. How a group uses conflict influences whether it is
viewed either positively or negatively. However, conflict in this phase can be
thought of as inevitable in a freely evolving group. Indeed, it is very difficult for
groups to move forward into a performing (working) phase without resolving con-
flicts.
The leader has a key role in facilitating the resolution of conflict. When done
therapeutically, the resolution of conflict has a number of positive outcomes.

Outcomes of Positively Resolved Conflict

䊏 Members learn to be more trusting of each other.
䊏 Cohesion is strengthened.
䊏 Members are better able to examine their values and concerns (Stockton & Toth,
2000).
䊏 Members come to understand that disagreement is tolerated, and they still are
accepted as valuable members of the group, even if they disagree with others.

䊏 Group Interactions

Interactions are especially important in therapeutic groups, where the task primar-
ily is to examine oneself in relation to others. Thus, one of the leader’s major tasks is
to facilitate member-to-member interaction. When conflict is resolved appropri-
ately, the members develop the cohesiveness and trust to risk sharing personal dis-
closures. Interactions among group members promote the development of facili-
tative relationships, a crucial ingredient for the efficacy of group work (Dies, 1983).
Ideally, as the group develops, the members begin interacting with other members,
and the leader plays a lesser role in the interactions. In this way, the group leaders
facilitate interactions between members to foster the development of the necessary
therapeutic factors (Yalom, 1995).
294 What Are the Essential Elements of Counseling? PART TWO

䊏 Role of the Leader in the Middle Phase

Some useful techniques that help group leaders to further interaction among group
members are linking, drawing out, and blocking.

Linking: An intervention used by group leaders to connect the concerns or

behaviors of one member with those of one or more other members (Morran,
Stockton, & Whittingham, 2004).

Drawing out: The leader invites group members who find it difficult to share
or who only share at a superficial level to participate at a level of involvement
of the member’s own choosing (Morran et al., 2004). It is important for the
leader to identify possible reasons for a member’s silence before deciding to
intervene (Morran et al., 2004).

Blocking: “[A] specific type of protection that is used to stop a member from
storytelling, rambling, or otherwise talking in a manner that runs counter to
the purposes of the group” (Morran et al., 2004, p. 94). Blocking also can be
used to stop members from scapegoating another member. A small hand ges-
ture can serve to block a member from continuing without adding undue em-
barrassment.

In addition to using the interventions such as linking, drawing out, and blocking,
group leaders will focus their attention on processing the group dynamics.
Through the activity of processing, leaders “capitalize on significant happenings in
the here-and-now interactions of the group to help members reflect on the meaning
of their experience; better understand their own thoughts, feelings, and actions;
and generalize what is learned to their life outside the group” (Stockton et al., 2000,
p. 345).

䊏 Feedback in the Middle Phase

Feedback in the middle phase takes a different slant than in the beginning stages of
a group. Leaders help members to give and receive more constructive feedback.
Leaders guide members to provide feedback that reflects other characteristics that
promote growth and self-reflection.

Characteristics of Feedback in the Working Stage (Stockton & Toth, 2000)

䊏 Feedback should be relevant to members’ individual goals.
䊏 Feedback should reflect how members behave in the group.
䊏 Feedback should deal with what members say about their actions outside the
group to create a connection between insight into themselves and their personal
growth within and outside the group.
䊏 Feedback should help members learn more about themselves and how they are
perceived by others.
CHAPTER THIRTEEN Fundamentals of Group Work 295

FINAL PHASE

The final phases of group work are Tuckman and Jensen’s (1977) stages of perform-
ing and adjourning. Leader and member tasks during this phase focus on summing
up the learning of the group experience and saying goodbye.

䊏 Final Phase Resistance

To the degree that the group has played a meaningful role in the members’ lives,
they will experience loss at the conclusion of the group. One notable reaction to the
loss is resistance, which may manifest in members reverting to earlier, maladaptive
behavior. Leaders need to recognize and accept the resistance as well as process it
to help the group make sense of their experience and to understand the inevitabil-
ity of the end of the group.

Approaches to Dealing With Loss and Resistance

䊏 Help members learn how to mourn and experience their sadness.
䊏 Create an opportunity for members to talk about what they wished they had ac-
complished but did not accomplish.
䊏 Honor what members have learned and can carry on in the future.
䊏 Assist members in a process of letting go, as well as looking forward to new ex-
periences.

䊏 Generalization of Learning

Generalization of learning is the summing up and making meaning of the learning

that has taken place and how it can be applied to life outside the group. Trans-
ferring new knowledge, skills, and behaviors outside the group is a key process for
the group members. Thus, the leader’s task is to help the members discuss what
they have learned and how they might use it beyond the life of the therapeutic
group. In this way, a bridge to the future is constructed. Although the generaliza-
tion of learning is particularly important to the final phase, it is also facilitative to
engage members in such reflection at various points throughout the life of the
group.

䊏 Role of the Leader in the Final Phase

The primary task of the leader in the termination or adjourning stage is to help the
members make meaning of the experience. One intervention that assists leaders in
this task is the go around.
296 What Are the Essential Elements of Counseling? PART TWO

Go around: A procedure during which members are asked either spontane-

ously or sequentially to discuss what they learned, what they wish they had
accomplished but did not, and how they will use their new knowledge in the
future.

To assist in the expression of feelings regarding the termination of a group, the

leader may make a self-disclosure, which occurs when “therapists reveal their per-
sonal feelings, experiences, and here-and-now reactions to group members”
(Morran et al., 2004, p. 98). They can share their reactions to what is happening in
the group, model how to deal directly with conflict, or help members understand
more about how they are perceived in a group. It is important to evaluate the pur-
pose of a self-disclosure and to observe the group members’ reactions afterward for
a follow-up assessment. Leaders always must remember that the purpose of the
group is to work on members’ issues, not those of the leader. Any self-disclosure
that does not facilitate this is self-serving and therefore not helpful.
In summary, group leaders do well to be aware of the characteristics of
Tuckman’s (1965) stages of group therapy to effectively lead counseling and
psychotherapeutic groups. A grasp of other, key concepts that comprise the foun-
dation of group interactions (e.g., group dynamics, processing, multicultural com-
ponents, etc.) also is required of all good group leaders.

Chapter 13: Key Terms

䉴 Group work 䉴 Storming 䉴 Informal norms
䉴 Group dynamics 䉴 Norming 䉴 Formal norms
䉴 Group content 䉴 Performing 䉴 Protecting
䉴 Group process 䉴 Adjourning 䉴 Feedback
䉴 Processing 䉴 Universality 䉴 Linking
䉴 Group cohesiveness 䉴 Instillation of hope 䉴 Drawing out
䉴 Therapeutic factor 䉴 Structure 䉴 Blocking
䉴 Forming 䉴 Group norms 䉴 Go around
chapter Multicultural Components of Group Work

14 Sherlon P. Pack-Brown
Bowling Green State University

In This Chapter

䉴 History of Multicultural Group Work

䊏 Goals of Group Work

䊏 Culture and Group Work

䊏 Multicultural Group Work Defined

䊏 Multicultural Group Work and Ethical Practice

䉴 Core Competencies of Multicultural Group Work

䊏 Individual Competencies of Multicultural Group Workers

䊏 Principles for Diversity-Competent Group Workers

䉴 Theory and Multicultural Group Work

䊏 Diversity and Multicultural Framework

䊏 Failure to Recognize Diversity Issues in Theory

䊏 Flexibility to Operate Within Multicultural Worldviews

䉴 Assessment and Group Ideologies

䊏 Assessment in Multicultural Group Work

䊏 Process of Assessment

䊏 Delivery of Assessment Decisions

䊏 Communication Styles

䊏 Thematic Communication in Assessment

䊏 Individual and Cultural Values in Assessment

䉴 A Diversity-Competent Model of Multicultural Group Work

䊏 How to Choose a Model of Multicultural Group Work

䊏 Images of Me: An Afrocentric Approach to Group Work

298
CHAPTER FOURTEEN Multicultural Components of Group Work 299

HISTORY OF MULTICULTURAL GROUP WORK

This chapter is intended to be a resource for group leaders by addressing the com-
petencies of multicultural group work and offering a model sympathetic to multi-
cultural group work. The foci will be (a) the history of group work, (b) core compe-
tencies, (c) culturally intentional assessment, and (d) a diversity-competent model
of group work.

䊏 Goals of Group Work

Group work emerged to address the shortcomings of individual counseling. Three

central aims of group work were and continue to be:

1. Sharing experiences among group members.

2. Bringing issues to the surface.
3. Building trust as group members collectively work to accomplish life tasks.

䊏 Culture and Group Work

Although the primary intentions of group work have remained the same over time,
the process has evolved. Today, the culture and worldview of the leaders and mem-
bers are recognized as important factors in successful group work. The terms cul-
ture and worldview can be defined in this way:

Culture: A combination of learned behaviors, thoughts, and beliefs as well as

the results of learned behaviors, thoughts, and beliefs whose components and
elements are shared and transmitted by the members of a particular society.

Worldview: A group worker’s or member’s presuppositions and assump-

tions about the makeup of her or his world.

More and more, researchers, scholars, and clinicians are giving voice to issues of
multiculturalism and their effect on group process, dynamics, and training
(Delucia-Waack & Donigian, 2004; Pack-Brown & Fleming, 2004). Professional as-
sociations, too, recognize the impact of culture on group work. The ASGW (1999),
in the Preamble to its Principles for Diversity Competent Group Workers, stated its
commitment to understand how issues of diversity affect all aspects of group work.

ASGW (1999) Areas of Commitment to Diversity in Group Work

䊏 Training diversity-competent group workers.
䊏 Leading research efforts into group work with diverse populations.
䊏 Understanding how diversity affects group process and dynamics.
300 What Are the Essential Elements of Counseling? PART TWO

䊏 Assisting group facilitators to increase their awareness, knowledge, and skills as

they work with groups of diverse membership.

䊏 Multicultural Group Work Defined

Among the body of literature addressing group work, a solid definition of the prac-
tice of multicultural group work is lacking (DeLucia-Waack & Donigian, 2004;
Pack-Brown & Fleming, 2004).

Factors Limiting an Understanding of Multicultural Group Work

䊏 Traditional literature regarding group approaches has been slow to emphasize
theoretical and assessment standards established with a select group of client
characteristics, such as multiculturalism, diversity, and culture.
䊏 Counseling professionals have diverse definitions of key terminology, such as
multicultural, the meaning of which can vary depending on context.

In this chapter, the word multicultural emphasizes race and ethnicity, but also in-
cludes other human differences, such as age, gender, and sexual orientation. In
spite of limiting factors, a definition of multicultural group work is offered here:

Multicultural group work: The expansion of personal and group conscious-

ness of “self-in-relation” by providing intentional, competent, and ethical
helping behaviors that promote the mental health of group members.

䊏 Multicultural Group Work and Ethical Practice

Recent trends reflect the multicultural revolution to the degree that professional as-
sociations are updating their codes of ethics and standards of practice to guide
group work professionals in this direction.

Multicultural Group Work in ACA Ethical Codes

and ASGW Ethical Guidelines
䊏 Section A.8.b. of the ACA (2005a) Code of Ethics states that in a group setting,
counselors take reasonable precautions to protect clients from physical, emo-
tional, or psychological trauma.
䊏 Section 8.a., Equitable Treatment, in the ASGW Ethical Guidelines for Group
Counselors states that group counselors recognize and respect differences (e.g.,
cultural, racial, religious, lifestyle, age, disability, gender) among group mem-
bers (Capuzzi & Gross, 1992).
CHAPTER FOURTEEN Multicultural Components of Group Work 301

Although the ACA code is less explicit than the ASGW guidelines, the standard for
group workers can be interpreted through a cultural lens. Given the inherent na-
ture of culture to behavior, worldviews, and life experiences, group workers can
understand Standard A.8.b. to mean that counselors use their cultural sensitivities
as a tool to assist them in taking reasonable precautions to protect clients from
physical, emotional, or psychological trauma.
The ethical guidelines of the ASGW are more explicit; group workers are en-
couraged to behave in a culturally intentional and ethical manner not only by rec-
ognizing but also by respecting diversity within the group setting to provide equi-
table treatment of all group members.

CORE COMPETENCIES OF MULTICULTURAL GROUP WORK

Multicultural group workers are guided by competencies that provide a basis for
meeting group expectations and facilitating group process in the most professional
manner possible. Applied to multicultural group work, competency can be defined
this way:

Multicultural group worker competency: A framework used by group

workers to anchor group goals, expectations, and processes that support and
promote culturally relevant and sensitive group work.

䊏 Individual Competencies of Multicultural Group Workers

As they prepare for, lead, and evaluate groups, culturally competent group work-
ers look beyond their own worldview and value system to those of their clients by
asking questions such as, “Through whose lens am I looking?” They recognize
characteristics of multicultural group work that will help them facilitate effective
process and dynamics.

Characteristics of Multicultural Group Workers

䊏 Aware of personal biases, stereotypes, and prejudices that will affect their leader-
ship.
䊏 Knowledgeable of the cultural values, life experiences, and worldviews of group
members.
䊏 Skilled at identifying interventions that are more in line with the cultural pur-
view of group members.

䊏 Principles for Diversity-Competent Group Workers

The 1999 Principles for Diversity-Competent Group Workers established by the ASGW
serve a multitude of purposes, including helping group workers enhance their
302 What Are the Essential Elements of Counseling? PART TWO

ability to be attentive to group members’ verbal and nonverbal expressions and to

factor in cultural connotations undergirding their communication. This ability is a
skill that competent group workers exhibit. Competency, as outlined in the 1999
Principles, addresses not only the area of skill, but those of personal awareness and
knowledge as well.

Awareness Competencies
䊏 Diversity-competent group workers engage in activities to enhance personal
awareness, knowledge, and skill of multicultural group work.
䊏 Group workers reflect a high level of comfort in acknowledging the influence of
realities, such as racial, ethnic, and cultural heritage; gender; socioeconomic sta-
tus; sexual orientation; and religious and spiritual beliefs on group process and
dynamics.
䊏 Group workers are willing to value and respect (rather than ignore) differences
among group members and between group workers and group members.

Knowledge Competencies
䊏 Diversity-competent group workers are knowledgeable of the multicultural
populations comprising their groups.
䊏 Group leaders have knowledge of the thematic (common) life experiences, cul-
tural heritage, and sociopolitical backgrounds of the members comprising their
groups.
䊏 Group workers possess information about identity development and subse-
quent effects on group process and dynamics in areas such as sexual orientation
and physical, mental, emotional, and learning disabilities.

Skill Competencies
䊏 Diversity-competent group workers offer a variety of verbal and nonverbal help-
ing behaviors that parallel the diversity and development of group members.
䊏 Leaders send and receive verbal and nonverbal messages within a culturally ac-
curate context.
䊏 Group leaders are not limited to one group approach and recognize that helping
approaches may be culture bound.

Of significance is that group workers appreciate that diversity competencies, as a

framework for securing group goals, expectations, and processes, are shaped by
theory. That is, the facts, propositions, and principles analyzed in relation to each
other and used to explain group work not only shape the competencies but also
provide directives for performance. The skills and attributes inherent to the compe-
tencies are guided by theory.
CHAPTER FOURTEEN Multicultural Components of Group Work 303

Check out the Web site for the Association for Multicultural Coun-
seling and Development for more information on diversity in counsel-
ing practice.
䉴 http://www.bgsu.edu/colleges/edhd/programs/AMCD/

THEORY AND MULTICULTURAL GROUP WORK

Over the years, theoretical foundations for group work have been developed and
tested. Until recently, few theories or theorists decisively have included culture in
their theoretical tenets or considered the influence of cultural beliefs, values, life ex-
periences, and worldviews on assessment and treatment.

䊏 Diversity and Multicultural Framework

Today group workers increasingly are directed to look at culture and the influence
of both difference and similarity on group process and dynamics. Group workers
operating within a multicultural framework embrace group work best practices re-
lated to diversity.

1998 ASGW Best Practice Guidelines on Diversity

䊏 Group workers are sensitive to client differences, including but not limited to,
ethnic, gender, religious, sexual, psychological maturity, economic class, family
history, physical characteristics or limitations, and geographic location.
䊏 Group workers become informed about the cultural issues of the diverse popula-
tion with whom they are working, both by interaction with participants and
from using outside resources.

One of the competencies outlined by the Principles for Diversity-Competent Group

Workers (ASGW, 1999) is that a leader should be aware of the limits of a single theo-
retical approach to address the needs of all group members. In that vein, group
workers should consider the following when choosing and evaluating theoretical
approaches to group work.

Application of Multicultural Competencies to Group Theory

䊏 Multiple worldviews exist among group members.
䊏 Theories have underlying rules, ideas, principles, and techniques that may or
may not be in line with those held in esteem by group members.
䊏 Group workers must be able to discern how theory and practice merge within a
cultural context and accept responsibility for aligning the values and world-
304 What Are the Essential Elements of Counseling? PART TWO

views of a theoretical orientation with those of group members to determine

which theory and helping behaviors are more appropriate.
䊏 Rather than being guided by one theoretical orientation, group workers investi-
gate the accuracy of their theoretical approach by asking questions such as,
“What are the cultural values of group members?” and “Are theoretical interven-
tions commensurate with the cultural values of group members?”

䊏 Failure to Recognize Diversity Issues in Theory

Multiculturally competent group workers strive to appreciate the interrelatedness

of traditional theory and culture and to understand that theories inherently rely on
cultural values, assumptions, and worldviews to explain behavior and promote
change. However, if group workers are insensitive to potential discrepancy be-
tween their espoused theoretical approach and the worldview of their clients, cer-
tain consequences may arise.

Implications of Insensitivity to Group Members’ Worldview

䊏 The group worker may unconsciously impose personal or theoretical values, be-
liefs, and attitudes on members.
䊏 Group members holding a different worldview and value system may not be
empowered to live life more fully.
䊏 The group member(s) holding a different worldview and value system may
physically or psychologically leave the group or get little to nothing from the
group experience.

EXAMPLE

Person-Centered Approach From a Multicultural Framework

A group worker operating from a person-centered theoretical perspective is likely to be
individualistically oriented and to operate from the assumption that group members should
assume responsibility for their destinies and come to perceive “self” as a powerful change
agent. Person-centered group process and dynamics, likewise, are guided by an individualis-
tic worldview. Under the leadership of the person-centered group worker, members take con-
trol of their own lives to live life more fully by enhancing the member’s self-concept and in-
creasing their ability to see the power of the “self” to reach goals. If the group worker is
facilitating a group comprised of diverse members and one or more of the members values a
collectivistic worldview (i.e., “self-in-relation” approach to life), a leader may have to adjust
his or her approach to meet those members in their own worldviews. Failure to do so can lead
to miscommunications between leader and members, lack of trust, and a sense of alienation on
the part of group members.
CHAPTER FOURTEEN Multicultural Components of Group Work 305

See Chapter 13 for more information on adverse effects of cultural insensitivity to group
members.

䊏 Flexibility to Operate Within Multiple Worldviews

Depending on the cultural worldviews and value systems of group members, the
worker may transition between working from individualistic and collectivistic
worldviews and value systems. At times, the group worker may need to encourage
group members to assume responsibility for their destinies and perceive self as an
individual. At other times, the group worker may need to encourage group mem-
bers to perceive self in relation to others and promote interdependence as a tool to
live life more fully.

Advantages of Flexibility in Approaches to Group Work

䊏 Group workers who are flexible with knowledge and skill are less apt to impose
personal or theoretical values, beliefs, and attitudes on members of varying cul-
ture, values, belief, and attitudinal systems.
䊏 Flexible group workers are positioned better to empower group members.
䊏 Group members are positioned better to feel welcomed and appreciated, remain
in-group, and get something from the group experience.

Group workers operating within a multicultural context are skilled at determining

the effect of values, assumptions, and worldviews not only on theory selection and
group membership but also on assessment and group ideology. In moving theory
to practice, multicultural group workers pose and respond to the question, “How
do assessment and group ideology intertwine?”

ASSESSMENT AND GROUP IDEOLOGIES

Assessment refers to a series of helping behaviors group workers use to determine

the effectiveness of group work. The assessment process occurs at multiple levels
and looks at the appropriateness of interventions, effectiveness of group workers,
and issues and progress of group members.

䊏 Assessment in Multicultural Group Work

Multicultural group work assessment is challenging in that group workers are

faced with questions about how the reality of culture has an impact on the group
process. Assessment must address the screening process for group members, plan-
ning for sessions, and leading of groups. Much of the culturally related work
306 What Are the Essential Elements of Counseling? PART TWO

around assessment involves a leader’s ability to avoid cultural bias and send accu-
rate messages about decisions made regarding the effectiveness or appropriateness
of group work.

Bias: A preference, tendency, or inclination toward particular ideas, values,

people, or groups.

EXAMPLE

Assessment Questions for Multicultural Group Work

During assessment of the group process, group workers may pose a number of questions.
When evaluating factors leading to effective screening, workers may ask, “During screening,
how do we predetermine the potential influence of diverse worldviews on group dynamics?”
Group leaders examining plans for group sessions may ask, “What do we look for in group
members to identify their cultural values?” Group workers determining leadership behaviors
may ask, “What influence will members’ cultural belief systems have on the way we lead the
group?”

䊏 Process of Assessment

The process of assessment is culture bound and requires constant examination on the
part of the group leader. For example, group workers must be skilled at identifying
cultural biases underlying professional beliefs and assumptions about the process
and dynamics of groups comprised of multicultural members. Pedersen (1987)
shared 10 culturally biased assumptions that counselors exhibit in their work.
Knowledge of these biases may help group workers diminish their potential for cul-
tural bias during assessment. Following are two examples based on Pedersen’s as-
sumptions that are modified for group work and workers. Each assumption has rec-
ommendations to assist group workers in decreasing their cultural bias.

EXAMPLE

Diminishing Culturally Biased Assumptions in Group Work

Assumption 1: Some constant measure of “normal” behavior exists in groups.
Group workers can diminish cultural bias by recognizing that the norm for group members
may or may not parallel their definition of normal behavior. To illustrate, an African American
CHAPTER FOURTEEN Multicultural Components of Group Work 307

group worker observes a White group member expressing emotion with controlled affect. The
worker assesses this behavior as abnormal and encourages the member to speak with more af-
fect. A cultural bias may be evident if the African American group worker is unaware of the
group member’s cultural preference for expressing feelings. To diminish cultural bias, the
group worker may ask himslef or herself, “Through whose lens am I looking as I assess normal
behavior?” To respond effectively to this question, the group worker must possess knowledge
of the cultural dictates about the expression of feelings within the African American and
White communities.
Assumption 2: Neglect of support systems evident in the lives of group members has the poten-
tial for being culturally biased.
Group workers can diminish this bias by being aware of the effects of social support systems
within some cultures. They can enhance the accuracy of assessment by intentionally factoring
in the healing effects of support systems. To illustrate, a 25-year-old Chinese group member
voices her desire to live with her parents while she is married. She expresses comfort in the
support and knowledge her parents share with her husband and her. The group leader as-
sesses that, within a cultural context, the group member is behaving in a culturally appropri-
ate manner. The intervention chosen to help the member promotes interdependence and the
healing power therein.

䊏 Delivery of Assessment Decisions

The delivery of assessment decisions during the group process necessitates that
group workers send messages in a way that will be heard rather than resisted.
Delivery can be challenging because group workers make decisions related to
disputed, controversial, or doubtful matters on a regular basis. Communication
under circumstances of controversy and doubt is difficult. When factoring in
culture, communicating decisions becomes more daring. Group workers accu-
rately must hear and understand the cultural values, communication styles, and
worldviews of group members. They must determine how what was heard
influences the dissemination of decisions and identify a way to get the informa-
tion out.

䊏 Communication Styles

It is crucial that group workers who facilitate multicultural groups recognize and
understand the communication styles of group members during assessment pro-
cesses. If a group worker is unaware of the cultural communication dictates, a
group member may physically, emotionally, or psychologically withdraw from the
308 What Are the Essential Elements of Counseling? PART TWO

group. Even more critical, a group member may be denied the possibility of for-
ward movement and growth if inappropriate assessment of communication be-
haviors is made. Finally, not to communicate well, on the same level, or in ways
considered appropriate or respectful of group members may inhibit members from
clearly understanding assessment decisions.

䊏 Thematic Communication in Assessment

Group workers operating within a culturally intentional, ethical, and competent

framework pay close attention to communication style and values when assess-
ing group members, process, and dynamics but also when determining how to
deliver assessment decisions. Extensive research has been done to ascertain
themes relevant to the values, beliefs, and worldviews of multicultural popula-
tions. Although no one population is homogeneous, group workers can use the
themes to construct helping foundations that will (a) assist in more accurate com-
munication with group members, and (b) facilitate the process of sharing assess-
ment decisions. Group workers possessing knowledge of culturally thematic
communication styles may use this information to guide them in transmitting de-
cisions so that they are clearly heard and understood. Thematic communication
styles can be understood as follows:

Thematic communication: Frequently observed styles of communication

that are used within a particular ethnocultural community.

Table 14.1 reflects thematic communication styles of select ethnocultural popula-

tions.
The following example highlights the importance of understanding thematic
communication styles to the delivery of assessment decisions.

TABLE 4.1
Select Communication Style Differences
for Four Ethnocultural Populations

American Indians Asian Americans

African Americans (Native Americans) and Latino Americans White Americans

Direct eye contact Indirect gaze when Avoidance of eye contact Greater eye contact
(prolonged) when listening or speaking when listening or when listening
speaking, less when speaking to high-status
listening persons
Affective, emotional Manner of expression is Low key, indirect Objective, task oriented
interpersonal low key, indirect
CHAPTER FOURTEEN Multicultural Components of Group Work 309

EXAMPLE

Relevance of Thematic Communication Styles to Screening Assessment

With the goal of assessing factors that will lead to the selection of members, group workers
might pose the question, “During screening, how do we predetermine the potential influence
of diverse worldviews on group dynamics?” The importance both of awareness and knowl-
edge of communication styles is highlighted by the example of an African American, female,
60-year-old, PhD group worker who values prolonged, direct eye contact when speaking and
diminished eye contact when listening. This group worker is screening a Chinese American
woman who values avoidance of eye contact, particularly when speaking to high-status per-
sons, such as elders. The group worker notices that the Asian American woman avoids eye
contact with her throughout the screening process. She assesses the nonverbal language to re-
flect shyness and unassertive behavior. The group worker decides that the potential group
member may be overpowered during a group if allowed to become a member. She concludes
that the young woman is not ready for a group and recommends individual counseling to pre-
pare the potential member to behave more assertively, thereby ensuring her success in a future
group.
In this scenario, the group worker was not aware of the potential cultural communication style
of the person being screened and made a decision about group membership based on her as-
sessment of what might have been a cultural factor. Communication was blocked in that the
group member believed she was behaving in a respectful manner and was punished by the
group worker for her respectful behavior.

See Chapters 4 and 11 for more on communication styles with diverse populations.

䊏 Individual and Cultural Values in Assessment

Group workers are often familiar with ways to identify members’ individual val-
ues. Many, however, are challenged when identifying cultural values. The differ-
ence between these two types of values can be described this way:

Individual values: The worth, importance, or usefulness of something to an

individual group member. Group members share individual values when
talking about self as the building block for living life more fully.

Cultural values: The worth, importance, or usefulness of something to a

group member that is aligned with the member’s cultural background. Cul-
tural values contain a historical component in that they are passed from one
generation to another and are highly esteemed by the individual as well as
the community from which the individual comes.
310 What Are the Essential Elements of Counseling? PART TWO

TABLE 14.2
Select Thematic Cultural Values for Four Ethnocultural Populations

African American Asian American White American Latino American

Group oriented Group oriented Individual oriented Group oriented

Present oriented Past oriented Future oriented Present oriented

Although no ethnocultural population is homogeneous, common cultural val-

ues exist among multicultural populations (Ivey, D’Andrea, Ivey, & Simek-Mor-
gan, 2002; Pack-Brown & Whittington-Clark, 2002; Sue & Sue, 1999). Leaders can
use their knowledge of these values, first, as a tool for discerning cultural under-
pinnings that may be significant to group assessment, process, dynamics, and plan-
ning, and, second, as a guide for deciding how to share assessments in a way that is
likely to be heard and readily understood by group members. By acting on cultural
knowledge, group workers enhance their flexibility in acquiring information about
the group environment, process, and dynamics. Flexibility allows group workers
to increase the potential for more accurate assessment of problems, issues, and life
experiences expressed by multicultural group members. Table 2 reflects thematic
values of select ethnocultural populations.
The following example is an illustration of how group leaders can identify and
use cultural values in the assessment process.

EXAMPLE

How to Use Cultural Values in Assessments

An important task for group workers is assessing cultural values held by group members rather
than making assumptions about values that are esteemed. Envision an African American adult
group member by the name of Sadie sharing her thoughts about how adults behave. The mem-
ber says, “It is important to me that my mother and I attend church together, even though I am
married. She can join my husband and me.” Another adult group member, Judy, who self-identi-
fies as White states, “I think adults ought to be independent. For me, it is important to be able to
stand on my own and not be dependent on my parents, whether it relates to religion or any other
area of my life.” The group worker listens to both members’ thoughts about adult behavior. The
worker hears that both self-identify as a member of a particular ethnocultural (racial and ethnic)
population. Sadie self-identifies as African American and Judy self-identifies as White. The
worker is familiar with thematic values of both populations and hears Sadie’s values (culturally
and individually) regarding a family orientation to life and Judy’s values (culturally and indi-
vidually) regarding an independent orientation to life. The worker understands that both orien-
tations are viable and important to accurately assessing cultural values. The leader shares her as-
sessment by stating that there are cultural definitions related to how each member identifies
their orientation to life. Sadie appears to value an African American family-oriented approach
to life. Judy appears to value a White independence orientation approach to life.
CHAPTER FOURTEEN Multicultural Components of Group Work 311

Using the knowledge gained from looking at the history of group work, core
competencies associated with multicultural group work, and culturally intentional
assessment, a model for a diversity-competent approach to group work is pro-
posed.

A DIVERSITY-COMPETENT MODEL OF MULTICULTURAL

GROUP WORK

Models of group work describe ways in which the group worker operates during
group process and dynamics. Models address interpersonal processes, whereas
theories provide an ideological structure for understanding group work. Although
sparse, models of multicultural group work are emerging as the profession and
professionals focus on culturally competent, intentional, and ethical group work.
Estrada, Garrett, Pack-Brown, Molina, Monteiro-Leitner, and Torres-Rivera are
among the clinicians and educators breaking ground in the area of diversity-com-
petent group work.

䊏 How to Choose a Model of Multicultural Group Work

When choosing a model of multicultural group work, group workers must con-
sider factors such as communication styles, cultural values, life experiences, and
worldviews inherent to the members comprising their groups.

䊏 Images of Me: An Afrocentric Approach to Group Work

Images of Me (Pack-Brown, Whittington-Clark, & Parker, 2002) is a diversity-com-

petent model of multicultural group work from an Afrocentric approach. Initially
proposed by Pack-Brown in collaboration with Whittington and Parker, the model
integrates theory of culture and group process and dynamics. Although the title
suggests that this approach is applicable only to group work with African Ameri-
can women, it also may be useful for other populations. The Afrocentric approach
to group work is built around the principles of the Nguzo Saba and includes four
values.

Values Inherent to the Images of Me Diversity Model

1. Unity (Umoja, pronounced oo-MOH-jah).
2. Collective responsibility (Kujichagulia, pronounced Koo-ji-cha-goo-Lee-ah).
3. Faith (Imani, pronounced ee-MAH-nee).
4. Creativity of a new reality (Kuumba, pronounced koo-OO-Mbah).
312 What Are the Essential Elements of Counseling? PART TWO

A focus of the Afrocentric approach is to assist group workers in expanding their

worldviews and building self-esteem as well as group pride among group mem-
bers. There are three basic tenets of the Afrocentric approach to group work.

Tenets of the Afrocentric Approach

1. Spirit permeates everything, and everything in the universe is interconnected.
2. The collective (the group, the community) is the most significant element in ex-
istence.
3. Communal self-knowledge is the key to mental health.

Guided by these three tenets, group workers operate, first, from the assump-
tions that multicultural group work is grounded in the spirit, and everything in the
group is interconnected. Second, group workers facilitate from the premise that
multicultural group work is built on a foundation that is grounded in the unity
within the group. Group workers believe that the group is the most significant ele-
ment, and members are there to help each other (self-in-relation) live life more fully.
Finally, group workers view multicultural group work as built on a foundation that
purports that self-knowledge is informed by a communal stance. Group workers
believe that communal self-knowledge is the key to mental health.
Techniques and strategies to assist group members in identifying and achieving
goals are those that embrace the spirit, collectivity, and communal self-knowledge.
The following is an example of a therapeutic approach to group work (drumming)
that embraces these elements.

EXAMPLE

Drumming: An Afrocentric Diversity Model Technique

Drumming is a technique used in an Afrocentric approach to group work. Drumming integrates
a therapeutic tool that serves multiple purposes, including, but not limited to, the following.
Eliciting emotional connections among group members.
Group members, via experiencing the beat of the drum, are able to feel their heartbeats con-
nect with the beat of the drum. One way to accomplish this connection is to offer a drum call;
that is, the group leader or a group member (skillful in drumming) singularly and rhythmi-
cally beats the drum while group members are encouraged to experience (be exposed to and
become aware of the drum) and feel (to have a physical or emotional sensation) the beat of the
drum.
Cultivating group identity and unity among group members.
As members feel connected to the heartbeat of the drum, they are encouraged to join the group
leader or member who is drumming. In this case, the beat played by the skillful drummer is
less complicated than the beat of the drum call although still rhythmic, so that group members
CHAPTER FOURTEEN Multicultural Components of Group Work 313

each can beat their drums. Their task is to find the beat that the leader or member is playing
and connect with the beat. As members work to identify the beat and simulate it, they find that
there are struggles. Some are readily able to identify and play the beat. In this case, members
readily unify. In other cases, members struggle with identifying and playing the beat. Their
struggle may symbolically represent their abilities or inabilities to join the group, connect with
the group, or maintain their own identify while in the group.
Strengthening the experience of the “here and now” among group members.
The sheer fact that group members are invited to play the drum collectively, experience the
beat of the drum collectively, and find their places in the group via identifying the individual
and collective beats forces them to focus on what is going on within them in the present. For
example, they are in touch with the feelings, thoughts, and behaviors in the moment. Group
workers can use this experience to help members who struggle with experiencing the “here
and now” to get out their cognitive struggles and focus on other dimensions such as their feel-
ings and behaviors.

Chapter 14: Key Terms

䉴 Culture 䉴 Multicultural group worker 䉴 Thematic communication
䉴 Worldview competency 䉴 Individual values
䉴 Multicultural group work 䉴 Bias 䉴 Cultural values
 chapter Counseling in the World of Work

15 Ellen Swaney
KSM Consultants

Barbara Keaton
Keaton Resources

In This Chapter

䉴 Career Counseling Overview 䉴 Process of Career Counseling

䊏 Historical Development of Career Coun- 䊏 Stage 1: Dealing With Change
seling 䊏 Stage 2: Developing Career Focus

䊏 Nature of Career Counseling 䊏 Stage 3: Exploring Career Options

䊏 Important Terminology in Career Coun- 䊏 Stage 4: Preparing for Job Search

seling 䊏 Stage 5: Obtaining Employment

䉴 Career Development Theory 䉴 Use of Assessment Tools in Career

䊏 Frank Parsons: Trait and Factor Theory Counseling
䊏 John Holland: Theory of Vocational Choice 䊏 History of Assessment: Trait and Factor

and Adjustment Model

䊏 Eli Ginzberg: Developmental Career 䊏 Interest Inventories

Theory 䊏 Personality Inventories

䊏 Donald Super: Life-Span Theory 䊏 Values/Lifestyle Inventories
䊏 Anne Roe: Needs Theory 䊏 Qualitative Tools
䊏 E. Bordin: Psychoanalytic Career Theory

䊏 Tiedeman and O’Hara: Choice and Adjust- 䉴 Special Issues in Career Counseling
ment Theory 䊏 Job Loss
䊏 Gottfredson: Theory of Circumscription 䊏 Dual-Career Considerations

and Compromise 䊏 Displaced Homemakers

䊏 John Krumboltz: Social Learning Career 䊏 Individuals With Disabilities

Theory 䊏 Midlife Career Changes

䊏 Socioeconomic Career Theories

䊏 Career Theories for Women 䉴 Technological Competencies for Career

䊏 The Lifecareer®/New Career Theory Counselors
䊏 ACES Technology Competencies

䊏 Need for Technological Skills

314
CHAPTER FIFTEEN Counseling in the World of Work 315

CAREER COUNSELING OVERVIEW

A 1999 survey conducted by the Gallup Organization revealed that 1 in 10 adults

seek assistance annually to support career-related changes. As the need for career
counseling increases, counselors entering the field must be familiar with the theo-
retical constructs supporting the field, the nature and process of career counseling,
the various assessment tools available to help counselors support clients, the
psychoemotional concepts that can enter into the career counseling process, and
the technical skills necessary for supporting clients in today’s technological envi-
ronment. Each of these areas is addressed in this chapter. First, however, a brief his-
torical sketch of career counseling and vocational guidance is provided.

䊏 Historical Development of Career Counseling

The history of career counseling stretches back three centuries to the late 1800s,
when a few pioneers began to implement their ideas about assisting individuals
with vocational choice. Events from the evolutionary development of career
counseling that signify the growth of the field are highlighted here.

Guidance Begins: The Late 19th Century

䊏 In 1883, Richards advocated for vacophers (career counselors) to be placed in ev-
ery town.
䊏 In 1898, J. B. Davis instructed high school students in the world of work and later,
as a principal, asked teachers to relate subject matter to particular vocations.

The turn of the century brought the posthumous publication of Parsons’s (1909)
Choosing a Vocation, in which he presented the first theoretical model for career
choice; this publication signified the birth of vocational counseling and is one of
Parsons’s contributions that solidifies him as the “father of guidance.” Other signif-
icant events that occurred during the 1900s are listed next.

Vocational Guidance Develops: The 20th Century

䊏 In 1913, the National Vocational Guidance Association (NVGA) was established
as the first counseling-related professional association in the United States.
䊏 In 1939, the first Dictionary of Occupational Titles was published.
䊏 Ginzberg, Ginsberg, Axelrad, and Herma (1951) published the first theory of
career development in their book Occupational Choice: An Approach to a General
Theory.
䊏 Super (1953) published “A Theory of Vocational Development” in the American
Psychologist.
䊏 Roe (1956) published The Psychology of Occupations.
316 What Are the Essential Elements of Counseling? PART TWO

䊏 Holland (1959) published “A Theory of Vocational Guidance” in the Journal of

Counseling Psychology.
䊏 In 1983, the NVGA established the National Certified Career Counselor Certifi-
cation (Amundson, Harris-Bowlsbey, & Niles, 2004).
䊏 In 1985, the NVGA became the National Career Development Association
(NCDA), a branch of the ACA.
䊏 In 1994, Congress enacted the Americans With Disabilities Act.

By the 21st century, the distinction between career counseling and the other coun-
seling fields was solidified.

Career Counseling Continues to Evolve: The 21st Century

䊏 In 2000, the National Board for Certified Counselors opted to decommission the
National Certified Career Counselor Program.
䊏 In 2001, the NCDA established the Master Career Counselor membership cate-
gory as a means of credentialing career counselors.
䊏 In 2006, NCDA supports research on career development and acts as a consultive
body for government policies on career issues.

Visit the NCDA Web site for complete information on career coun-
seling history, membership, ethical standards, and competencies.
䉴 www.ncda.org

䊏 Nature of Career Counseling

Despite its role as the cornerstone on which the counseling field was built, career
counseling acquired a stereotype as being devoid of psychological process—a view
that places the career counselor in a second-class category as compared to a per-
sonal-emotional counselor. Gysbers, Heppner, and Johnston (2003) refuted this ste-
reotype, quoting Swanson’s (1995) definition of career counseling:

Career counseling: “[A]n ongoing, face-to-face interaction between coun-

selor and client with the primary focus on work or career related issues; the
interaction is psychological in nature, with the relationship between coun-
selor and client serving an important function” (p. 3).

The bottom line in terms of the nature of career counseling is that the per-
sonal-emotional and career development realms intimately are connected. It is im-
possible to attend effectively to a client’s career problems without exploring and re-
CHAPTER FIFTEEN Counseling in the World of Work 317

solving the client’s specific personal-emotional issues, which influence the career
development process.

䊏 Important Terminology in Career Counseling

For any counselor who wishes to practice competently in the career counseling
field, basic proficiency in career-related concepts is required. The NCDA (2006) de-
fined some key terms applicable to the career development field, including these:

Leisure: Relatively self-determined activities and experiences that are avail-

able because of discretionary income, time, and social behavior; activities
may be physical, social, intellectual, volunteer, creative, or some combination
of all five.

Career: The totality of work and leisure experiences one has in a lifetime.

Work: A conscious effort aimed neither at coping or relaxation that produces

benefits either for oneself or for others.

Career development: The total constellation of psychological, sociological,

educational, physical, economic, and chance factors that combine to shape
the career of any given individual over the life span.

CAREER DEVELOPMENT THEORY

Career development theory has emerged over the course of the last century, begin-
ning with Parsons’s trait and factor theory. Today, career theories continue to be re-
vised to account for new awarenesses, such as the need for multicultural ap-
proaches. In this section we outline the central tenets of classic theories of career
counseling.

䊏 Frank Parsons: Trait and Factor Theory

Isaacson and Brown (2000) described the heart of trait and factor theory this way:
“Trait and factor theories stress that individuals need to develop their traits, which
include their interests, values, personalities, and aptitudes, as well as select envi-
ronments that are congruent with them” (p. 21). As the major proponent of trait
and factor theory, Parsons developed a conceptual framework in 1908 that ignited a
national interest in career guidance. Three main components characterize Par-
sons’s (1909) approach to helping an individual select a career.
318 What Are the Essential Elements of Counseling? PART TWO

Goals of Trait and Factor Theory

䊏 Create a clear understanding of oneself and one’s aptitudes, abilities, interests,
resources, and limitations.
䊏 Increase the knowledge of the requirements and conditions of success, advan-
tages and disadvantages, compensations, opportunities, and prospects in differ-
ent lines of work.
䊏 Utilize “true reasoning” on the relations of these two groups of facts.

䊏 John Holland: Theory of Vocational Choice and Adjustment

One of the most prominent theorists in the career counseling field, Holland be-
lieved that an individual’s heredity and experience lead to preferences for activi-
ties. These preferences in turn become interests that the individual pursues. As
people pursue their interests, they develop necessary competencies for success.
There are a number of assumptions on which Holland built his career theory. Un-
derstanding these principles helps illuminate the core of Holland’s approach.

Assumptions of Holland’s Career Approach (Isaacson & Brown, 2000)

䊏 The individual’s personality is the primary factor in vocational choice.
䊏 Interest inventories are, in fact, personality inventories.
䊏 Stereotypical views of occupations play a major role in occupational choice.
䊏 Daydreams about occupations often are precursors to occupational choices.
䊏 The clarity of an individual’s perceptions of his or her goals and personal charac-
teristics is related to having a small number of focused vocational goals.
䊏 To be successful and satisfied, it is necessary to choose an occupation in which
others in the work environment have similar characteristics as one’s own.

Evident in the assumptions of Holland’s theory is the connection between per-

sonality and career choice. Holland proposed that people can be grouped into six
different personality types that correspond to careers and environments. When
people place themselves in environments and careers that are similar or congruent
to their personality type, they are likely to be satisfied with their choice. To assess
personality types, Holland developed the Self-Directed Search (SDS; Holland,
1994), which is still one of the most frequently used career assessment tools today.

Holland’s Six Personality Types

䊏 Realistic.
䊏 Investigative.
䊏 Artistic.
䊏 Social.
䊏 Enterprising.
䊏 Conventional.
CHAPTER FIFTEEN Counseling in the World of Work 319

Besides the SDS, Holland developed other, easy-to-administer assessment tools

including The Occupations Finder and the My Vocational Situation tools. These instru-
ments widely have been applied in the career counseling field. Additionally, his
personality typology has been adjusted to fit the development of many other as-
sessment instruments.

䊏 Eli Ginzberg: Developmental Career Theory

Developmental theories are based, first, on the belief that career development is a
process that takes place over the life span (Zunker, 1998) and, second, on the as-
sumption that biological, psychological, sociological, and cultural factors influence
career choice, career changes, and career withdrawal across the stages of develop-
ment. Ginzberg et al. (1951) proposed the first developmental theory in which they
suggested that career choices span three chronological stages in an individual’s
lifetime.

Chronological Stages of Career Development

䊏 The fantasy stage involves role playing and imagination.
䊏 The tentative stage reflects a person’s growing awareness of interests and abilities.
䊏 The realistic stage entails the identification of a career choice.

Furthermore, the theory identified four factors that shape an individual’s career
decisions.

Factors That Have an Impact on Career Development

䊏 Individual values.
䊏 Emotional factors.
䊏 Amount and kind of education.
䊏 Effect of reality through environmental pressures.

䊏 Donald Super: Life-Span Theory

Like Holland’s theory of personality–career fit, Super’s (1953, 1990, 1992, 1994)
life-span, life-space theory, which is both developmental and humanistic in nature,
has been extremely influential in the career development field (Weinrach, 1996).
Super viewed career development as a lifelong process occurring within the indi-
vidual’s psychosocial development, societal expectations, and occupational oppor-
tunities. Super defined three key components of career development:

Life-span: Career development is lifelong and occurs throughout five major

life stages: growth, exploration, establishment, maintenance, and disengage-
320 What Are the Essential Elements of Counseling? PART TWO

ment. Each stage has a unique set of career development tasks and accounts
for the changes and decisions that people make from work entry to retire-
ment.

Life-space: People have skills and talents developed through different life
roles, making them capable of a variety of tasks and numerous occupations.

Self-concept: Understanding one’s interests and skills is a key to career

choice and satisfaction as people seek career satisfaction through work roles
in which they can express themselves and implement and develop their
self-concepts.

Super continued to rework and revise his career theory throughout his life, which
is one reason the life-span, life-space model has sustained viability. One example of
Super’s adjustments is seen in his conceptualization of the life career rainbow. Ori-
ginally based in a stage model suggesting that career mirrors a person’s matura-
tion, Super re-created the rainbow so that career exploration was seen as one facet
of the overall human life exploration experience and to account for social and psy-
chological factors (Blustein, 1997).

䊏 Anne Roe: Needs Theory

Roe (1956) developed a needs theory approach to career choice within which she
conceptualized a two-way occupational classification system that involves per-
son-oriented and non-person-oriented careers (Zunker, 1998). She identified the
combination of early parent–child relations, environmental experiences, and ge-
netic features as determinants in the need structure of the individual. Person-ori-
ented and non-person-oriented careers can be understood this way:

Person-oriented career: The individual satisfies needs primarily through in-

teractions with people.

Non-person-oriented career: The individual satisfies needs primarily by act-

ing on things or ideas independently.

Two widely recognized components of Roe’s theory are the eight categories of oc-
cupational groups and the six levels of complexity that exist within each grouping.
These are listed here.

Roe’s Occupational Groups

䊏 Service.
䊏 Business contact.
䊏 Organizational.
CHAPTER FIFTEEN Counseling in the World of Work 321

䊏 Technology.
䊏 Outdoor.
䊏 Science.
䊏 General cultural.
䊏 Arts and entertainment.

Roe’s Levels of Complexity

䊏 Professional and managerial I.
䊏 Professional and managerial II.
䊏 Semiprofessional and small business.
䊏 Skilled.
䊏 Semiskilled.
䊏 Unskilled.

EXAMPLE

Identifying Some Person-Oriented and Non-Person-Oriented Careers

A client who is person-oriented would be encouraged to explore career options where the pri-
mary tasks and processes followed involve communicating and working collaboratively with
others or where the results of the work have a direct impact on people. Examples of such ca-
reers are sales or teaching. A client who is non-person-oriented would be encouraged to ex-
plore career options where the work is self-involved, for example, an engineer or pet groomer.

䊏 E. Bordin: Psychoanalytic Career Theory

Bordin’s psychoanalytic model related career choice to Freud’s psychosexual

stages with an emphasis on the role of play in adult work (Bordin, Nachmann, &
Segal, 1963). Play is viewed as an important activity that brings about satisfaction.
Bordin saw individuals as seeking to derive joy from their work. “This desire for
satisfaction or joy in one’s work will lead a person to select, unconsciously, an occu-
pation that satisfies the need for enjoyment” (Sharf, 1997, p. 266).

䊏 Tiedeman and O’Hara: Choice and Adjustment Theory

Tiedeman and O’Hara (1963) described the stages of career decision from an indi-
vidualistic perspective. Their approach includes two periods of decision making:
anticipation and implementation. The anticipation stage of career decision is di-
vided into four basic developmental phases.
322 What Are the Essential Elements of Counseling? PART TWO

Steps in the Anticipation Period of Career Development

䊏 During the exploration phase, the client’s focus is on understanding himself or her-
self in terms of career needs.
䊏 In the crystallization phase, the client begins to develop options for career choice.
䊏 In the choice phase, career options are defined and narrowed.
䊏 During the clarification phase, the career choice is validated.

Based on the choices made in the anticipation phase, the client conducts a job
search in the implementation phase. These phases form the foundation of many de-
scriptions of the career development process today.

䊏 Gottfredson: Theory of Circumscription and Compromise

Gottfredson’s (1981) theory of circumscription and compromise focuses on the de-

velopment of career aspirations or how individuals become attracted to occupa-
tions. The theory of circumscription and compromise suggests that career choices
are made in response to one’s social and psychological self-image. Perhaps more
than other theories, Gottfredson’s approach to career development identifies gen-
der roles and prestige as important parts of career development in childhood and
adolescence. To understand the core of this theory it is necessary to define some key
terms.

Circumscription: The process by which individuals gradually restrict the oc-

cupations they consider acceptable, based on their developing self-concept.

Compromise: The process by which individuals choose among available but

imperfect occupational alternatives by compromising some needs for others.

Several generalizations highlight the groundwork of Gottfredson’s theory.

Assumptions of the Theory of Circumscription and Compromise

䊏 The career development process begins in childhood.
䊏 Career aspirations are attempts to implement one’s self-concept.
䊏 Career satisfaction is dependent on the degree to which the career is congruent
with self-perceptions.
䊏 People develop occupational stereotypes that guide them in the selection pro-
cess.

Gottfredson’s theory proposes four stages of cognitive development that guide the
way people match their self-concept with occupation. These stages are briefly out-
lined here.
CHAPTER FIFTEEN Counseling in the World of Work 323

Gottfredson’s Stages of Cognitive Development

1. Orientation to size and power (ages 3–5) refers to children’s classification of
people as big and powerful or small and weak. During this stage, children
make simple distinctions about people and their jobs and eliminate career pos-
sibilities that are incompatible with their gender.
2. Orientation to sex roles (ages 6–8) refers to a the stage of development during
which children make classifications of jobs based on concrete distinctions, such
as gender and eliminate vocations that are not gender appropriate.
3. Orientation to social valuation (ages 9–13) refers to the stage during which so-
cial class and prestige emerge as important factors in career choice, and voca-
tions that are not class appropriate are eliminated.
4. Orientation to inique, internal self (ages 14 and older) refers to a level of cognitive
development marked by adolescents’ greater insight into vocational aspirations
and how these match with the view of themselves, gender roles, and prestige.
Adolescents begin to eliminate occupations that do not fit their self-image.

䊏 John Krumboltz: Social Learning Career Theory

Learning theories emphasize individualized learning processes that eventually

lead to career interests and career choices. These theories differ from trait and factor
and developmental theories in that they are more concerned with the impact of so-
cial influences on career choice than with the role of traits, values, or developmen-
tal stages. A proponent of learning theory, Krumboltz developed a theory of career
selection based on Bandura’s behavioral theory and reinforcement theory. A few
assumptions characterize Krumboltz’s view about the individual and, by exten-
sion, the career development process.

Assumptions of Social Learning Career Theory (Isaacson & Brown, 2000)

䊏 People are born with certain factors that cannot be changed, such as genetic char-
acteristics, race, gender, physique, and special abilities or disabilities.
䊏 Learning over time occurs from encounters with the world and results in devel-
opment of self-esteem and task skills that are applied to new situations.
䊏 People select or avoid repetitive encounters that allow them to build skills in spe-
cific areas that lead to career choice through the reinforcement experienced in
these encounters.

Krumboltz identified four factors that influence career decisions; these are men-
tioned next.

Factors Influencing Career Choice in Social Learning Theory

1. Genetic endowment and special abilities.
2. Environmental conditions and events.
324 What Are the Essential Elements of Counseling? PART TWO

3. Learning experiences.
4. Task approach skills.

䊏 Socioeconomic Career Theories

Numerous social and economic theorists have had an impact on the career counsel-
ing field. Their theories propose that institutional and impersonal market forces re-
strict decision making, which hinders the individual’s career aspirations. Although
socioeconomic theories place importance on the intellect as a factor in career
choice, the theories’ main focus is on the individual’s socioeconomic status and the
influence of sociological and economic factors on the choice.

Research Areas of Socioeconomic Career Theories (Sharf, 1997)

䊏 Status hierarchy of occupational structure.
䊏 Power and authority in the workplace.
䊏 Work socialization processes.
䊏 Labor unions and collective bargaining.
䊏 Operation of the labor market.
䊏 Sociology of professions.
䊏 Race and gender effects.
䊏 Family effects.
䊏 Chance encounters.

䊏 Career Theories for Women

Career self-efficacy theory, which is rooted in Bandura’s social learning theory, em-
phasizes cognitive processes and focuses primarily on the effects of prior learning
experiences on later learning experiences and, eventually, on career choice.
Bandura (1986) gave this explanation of self-efficacy:

Self-efficacy: The individual’s “judgments of their capabilities to organize

and execute courses of action required to attain designated types of perfor-
mances” (p. 391).

Hackett and Betz (1981) recognized the role that environmental forces play in
shaping women’s beliefs about their ability to master certain types of knowledge
and career areas. They suggested that a restricted range of options and
underutilization of abilities hinder women’s beliefs about the likelihood of their
success in some career areas (Zunker, 1998). Hackett and Betz made the following
recommendations for career counselors working with women.
CHAPTER FIFTEEN Counseling in the World of Work 325

Recommendations for Career Counseling With Women

䊏 Help the female client understand how low self-esteem with regard to math and
other areas is part of their socialization as women.
䊏 Help the client explore how low self-esteem negatively affects interest in certain
areas.
䊏 Direct the client to observe female role models in the feared career to encourage
pursuit of nontraditional academic courses or work.
䊏 Reinforce clients’ belief in their underused capabilities.
䊏 Offer to guide clients through anxiety-reduction techniques.

䊏 The Lifecareer®/New Careering Theory

Miller-Tiedeman (1999) offered another perspective in her approach known as The

Lifecareer®/New Careering Theory, which came out of her observation that career
development should not be a 911 event. The theory suggests that a decision as im-
portant as a career path should not be forced on students in high school or even col-
lege but rather, should be supported as it naturally evolves over time as people dis-
cover their life mission. The best strategy for career counseling, therefore, is to offer
principles for individuals to use as their life missions unfold. The job of the helper
then becomes supporting individuals as they make their way for life.

PROCESS OF CAREER COUNSELING

Two widely accepted perspectives on the structure of career counseling are the cli-
ent–counselor relationship and the career development process (Gysbers et al.,
2003). As the career development process unfolds, so, too, does the client–coun-
selor relationship. The following five stages describe a general approach to the ca-
reer counseling relationship:

䊏 Dealing with change.

䊏 Developing career focus.
䊏 Exploring career options.
䊏 Preparing for job search.
䊏 Obtaining employment.

Like any counseling process that proposes stages of movement or development,

those described for the career counseling process also must be viewed as recursive.
Counselors may have to revisit certain tasks in the counseling process and attend to
the client’s unique needs and development as they emerge in the counseling rela-
tionship. Whereas some clients need extra support in discovering new career op-
tions, other clients require additional help in following through on a job search.
326 What Are the Essential Elements of Counseling? PART TWO

In each stage of career counseling, there are three areas of focus: exploration,
task, and developmental outcomes. A brief description of the stages of career coun-
seling is provided with a focus on the explorations, tasks, and outcomes relevant to
the stage.

䊏 Stage 1: Dealing With Change

During the first stage, the counselor builds the counseling relationship by provid-
ing unconditional positive regard, listening to the client’s expressed needs, explor-
ing the personal-emotional issues related to the career development process, and
uncovering possible resistances to career exploration.

Foci of Stage 1 in Career Counseling

䊏 Exploration revolves around understanding the client’s reaction to the change
process, personal career identity, and locus of control or resistances.
䊏 Tasks include evaluating the client’s wants, needs, and resistances, processing
feelings, and identifying and implementing strategies for overcoming obstacles.
䊏 Developmental outcomes of the first stage are realistic understandings of the
challenges and opportunities for personal career change and the client’s commit-
ment to the career development process.

䊏 Stage 2: Developing Career Focus

When some of the outcomes of the first stage are achieved, the counselor begins to
help the client develop career focus. The counselor guides the client in selecting
and completing assessments and activities that help the client to pinpoint choices
for career exploration.
The counselor builds the relationship during the second stage by guiding the cli-
ent to gain insight into the relation between their personal wants and needs and the
outcomes of their self-exploratory activities. The counselor also provides per-
sonal-emotional support to continually address and overcome resistances and
builds client confidence by highlighting client strengths and accomplishments.

Foci of Stage 2 in Career Counseling

䊏 Exploration centers on career accomplishments, relevant experience, career im-
plications of personality traits, career implications of interest codes, values and
lifestyle preferences, practical and financial considerations, and spiritual consid-
erations.
䊏 Tasks of the second stage include completing appropriate standardized and
nonstandardized assessments, writing a personal career profile, writing or up-
dating the résumé, and developing a plan for exploring career options.
CHAPTER FIFTEEN Counseling in the World of Work 327

䊏 Developmental outcomes are a general preparation of the client for researching

career options.

Once the client believes he or she adequately is prepared to explore career options,
the career counselor focuses on building the client’s confidence and helping the cli-
ent overcome resistance to career exploration.

䊏 Stage 3: Exploring Career Options

At the third stage, the counselor takes on the added role of educator and helps the
client gain a realistic understanding of the tasks involved in career exploration.
This includes personal instruction and directing clients to other resources such as
books, Web sites, or job search groups and clubs.

Foci of Stage 3 in Career Counseling

䊏 Exploration focuses on clarifying myths and realities of the job search and the job
market by using job advertisements and internet postings and agencies. Also job
market resources are helpful in conducting research about career possibilities,
and networking aids in uncovering potential positions.
䊏 Tasks of the third stage involve reading about the job market and job search strat-
egies, writing a personal job search plan, joining networking or job search clubs
or chat groups, developing a list of target contacts for research, and conducting
informational meetings with target contacts.
䊏 Developmental outcomes related to the exploration phase are the development
of an internal locus of control such that clients believe they have the ability to
take action that will result in a positive career change, an understanding of the fit
between personal career profile and job opportunities, and the completed target
position and organization contact list.

䊏 Stage 4: Preparing for Job Search

While helping the client prepare for a job search, the career counselor continues in
the role described in the third stage; however, it becomes important, again, for the
counselor to support the client in interpreting career exploration experiences, gain-
ing additional insight into his or her career identity, and fine-tuning career devel-
opment goals. The counselor also continues to provide practical assistance to de-
velop the client’s job search skills. As well, the counselor begins to shift focus to
necessary skills development that will aid the client in preparing for and obtaining
employment.
328 What Are the Essential Elements of Counseling? PART TWO

Foci of Stage 4 in Career Counseling

䊏 Skills development center on letter writing, e-mail and phone skills, and net-
working strategies.
䊏 Tasks include conducting informational meetings with target position and orga-
nization contacts, and implementing job search plans to identify interviewing
opportunities.
䊏 Developmental outcomes are evidenced in a clear focus on appropriate job op-
portunities and interviews with potential employers.

䊏 Stage 5: Obtaining Employment

As the client begins to interview for specific positions, the counselor continues in
the roles of supporter, educator, and practical helper as determined by the client’s
specific experiences and obstacles.

Foci of Stage 5 in Career Counseling

䊏 Skills to be enhanced include interviewing and negotiating techniques.
䊏 Tasks of the counseling process include practicing responses to difficult inter-
viewing situations and determining compensation parameters.
䊏 Developmental outcomes are very tangible and include job offers and negotia-
tion of fair compensation.

The stages of the career counseling process depict a start-to-finish scenario. It is

atypical, however, for a client to require full counseling support through the entire
process. Most clients seeking a career counseling relationship do so for the same
reasons clients seek any counseling relationship—to help them overcome per-
ceived roadblocks and deal with the personal-emotional issues related to these
roadblocks. Once clients have a clearer career focus and some degree of confidence,
they usually can navigate the latter stages of the process independently using the
vast array of published and online resources that are available to the job searching
public. Although a career counselor cannot practice without the practical knowl-
edge and skills found in the tasks of the latter stages of the career counseling pro-
cess, the greatest value of the counselor to the client lies in the counselor’s ability to
help the client navigate the personal-emotional aspects of career development by
providing support and insight and by nurturing a trusting, helping relationship.

USE OF ASSESSMENT TOOLS IN CAREER COUNSELING

Assessment tools are used in career counseling to gather diagnostic information

about the client and to promote client self-awareness and exploration. There are a
variety of tools that can be used in the beginning stages of the career counseling
CHAPTER FIFTEEN Counseling in the World of Work 329

process to gather information about the client. After providing a brief historical
look at career assessment, we focus in this section on three different types of assess-
ment tools and inventories commonly used in career counseling:

䊏 Interest inventories.
䊏 Personality inventories.
䊏 Values inventories.

䊏 History of Assessment: Trait and Factor Model

The use of assessment tools as part of career counseling originated with the work of
Parsons, who was the first to emphasize the importance of personal analysis in ca-
reer counseling. Parsons initiated a theoretical path that led to the trait and factor
model of vocational development that the military used for intelligence testing
during World War I. Utilizing assessment as part of the job selection process was
firmly established by the military during World War II, when testing was used as
an efficient way to match military personnel to jobs (Seligman, 1994). Additionally,
the trait and factor model of vocational development focused the science of psy-
chology on the development of tests and inventories to promote personal analysis.
These tests had a pervasive influence on vocational counseling and became inextri-
cably linked to the field of career counseling.
Since Parsons’s innovative work around career testing, a variety of assessment
tools have emerged in the field of career counseling. One simple way to categorize
these career assessment tools is by their attention either to cognitive or affective
variables.

Facets of Cognitive Tests

䊏 Cognitive tests measure cognitive variables, such as aptitude or skills and typi-
cally pose questions that have correct or incorrect answers.
䊏 Cognitive tests primarily are used for educational and placement purposes by
school counselors, the military, and employers.

Facets of Affective Tests

䊏 Affective tests measure ideas, preferences, self-descriptors, and opinions.
䊏 The vast majority of diagnostic assessments in use by adult career counselors are
affective tests that focus on self-awareness and discovery.
䊏 Because there are no correct responses, affective tests more properly might be
called inventories (Seligman, 1994).

䊏 Interest Inventories

Interest inventories identify an individual’s self-reported interests, likes, dislikes,

and preferred activities. Research into the connection between job choice and the
330 What Are the Essential Elements of Counseling? PART TWO

interests of people in those jobs have suggested that employees of specific jobs of-
ten share similar interests. Interest inventories use shared interests as an indicator
of potentially satisfying career fields.

Common Interest Inventories

䊏 Strong Interest Inventory (SII; Campbell, Strong, & Hansen, 1991).
䊏 SDS (Holland, 1994).
䊏 Career Occupational Preference Survey (Knapp & Knapp, 1992).
䊏 Career Decision-Making System (Harrington & O’Shea, 1992).
䊏 Kuder Career Search with Person Match (Zytowski & Kuder, 1999).
䊏 Jackson Vocational Interest Survey (Jackson, 1991).
䊏 O*Net Interest Profiler (United States Employment Service, 2002).

O*Net, formerly The Dictionary of Occupational Titles, published by the federal gov-
ernment and the most widely used reference of job descriptions in the United
States, is organized by Holland codes.
Among these inventories, the SII and the SDS frequently are used. Both invento-
ries are based on Holland’s six types, represented by the acronym RIASEC (realis-
tic, investigative, artistic, social, enterprising, and conventional). The reports gen-
erated by these instruments provide three levels of detail.

Results of Interest Inventories

䊏 General occupational themes summarize the client’s interests by assigning a
three-letter RIASEC type code (e.g., SEC) representing the top three types for
which the client reported interest.
䊏 Basic interest scales identify the top occupational categories, within their type
code, for which the client reported interest.
䊏 Occupational scales provide a detailed report of the client’s interests in specific
occupations within each of the RIASEC types.

The results of these inventories can be used to help the client think about the rela-
tion between his or her interests and job choice and to identify specific jobs that
match the client’s interests.

䊏 Personality Inventories

There are several well-known personality inventories used in career counseling, in-
cluding the Sixteen Personality Factor, the Vocational Preference Inventory (Hol-
land, 1985b), and the Myers–Briggs Type Inventory (MBTI; Myers & Briggs, 1993).
Of these, the most commonly used inventory in adult career counseling is the
MBTI, developed by Briggs-Myers and Briggs, and based on Jung’s theory of per-
CHAPTER FIFTEEN Counseling in the World of Work 331

sonality. The goal of the MBTI is to help people discover, understand, and appreci-
ate their natural styles (Seligman, 1994).

Advantages of the MBTI

䊏 The premise of the MBTI is that all personality preferences equally are valuable;
therefore, the test eliminates the trepidation some clients may have about taking
a personality test.
䊏 A vast array of support literature about MBTI is available to the career counselor
and client.
䊏 There are numerous career self-help books based on the MBTI that clients can use
on their own.

The MBTI yields scores about personality type on four dimensions. Combinations
of these scores are translated into 16 personality types.

MBTI Personality Types

䊏 Introversion–extroversion.
䊏 Sensing–intuition.
䊏 Thinking–feeling.
䊏 Judging–perceiving.

䊏 Values/Lifestyle Inventories

As the current trend for adult career counseling moves toward a more integrated
approach to working with clients, an array of affective inventories are being used
by career counselors to help clients search for personal meaning and career fit.
Values inventories are an affective tool used to help match the client with a suitable
job choice. Values inventories consider a client’s intrinsic and extrinsic values. In-
trinsic values are related the work and its contribution to society, whereas extrinsic
values are related to the physical and environmental aspects of the job or earning
potential. There are a number of values inventories available to career counselors;
those that assess career maturity, self-concept, and self-esteem frequently are used.
Examples of specific lifestyle inventories are listed next.

Commonly Used Values Inventories

䊏 The Work Values Inventory (Super, 1964).
䊏 Minnesota Importance Questionnaire (Rounds, Henly, Dawis, Loftquist, &
Weiss, 1981).
䊏 Work Importance Locator (2001).
䊏 Work Importance Profiler (2002).
䊏 Life Values Inventory (Crace & Brown, 1996).
332 What Are the Essential Elements of Counseling? PART TWO

䊏 Qualitative Tools

Qualitative tools aid the counselor and client in exploring the vast array of per-
sonal, social, spiritual, and economic factors that affect the client’s career focus.
Some of the most popular qualitative tools in use today include the following.

Common Qualitative Tools

䊏 Genograms.
䊏 Career-o-grams.
䊏 Card sorts.
䊏 Role plays.
䊏 Assessments of career achievement.
䊏 Assessments of transferable skills, knowledge, and ability.

The career counselor can develop or modify the qualitative tools to meet the needs
of the particular client. In general, qualitative tools have three uses.

Applications of Qualitative Assessment Tools

䊏 Help clients develop self-awareness.
䊏 Assist in career decision making.
䊏 Help in the development of a résumé or other job search communications.

SPECIAL ISSUES IN CAREER COUNSELING

Just as career counseling represents a niche in the counseling profession, there are
some special issues that career counselors may face that require them to use extra
sensitivity and a specialized knowledge base. We describe a few of these cases in
this section.

䊏 Job Loss

Men and women experience the same degree of distress following the loss of a
job; however, it appears that middle-aged men are more vulnerable to negative
effects of job loss (Zunker, 1998). Physical and psychological effects of job loss are
numerous.

Negative Effects of Job Loss

䊏 Withdrawal.
䊏 Decline of self-respect.
CHAPTER FIFTEEN Counseling in the World of Work 333

䊏 Loss of identify and affiliation.

䊏 Disruptive behavioral reactions.
䊏 Depression.
䊏 Suicidal ideations.

It is critical for career counselors to play a supportive role with individuals who
have suffered the loss of a job, especially when the individual does not have a solid
or extensive support system. Brammer and Abrego (1981) suggested some coping
skills that assist individuals in managing transitions.

Counselor Skills for Coping With Job Loss (Zunker, 1998)

䊏 Skills concerning perception and response to transitions such as developing
self-control and a style for responding to change.
䊏 Skills relating to assessing, developing, and utilizing external support systems as
well as internal support system, such as attitudes and personal strengths.
䊏 Skills relating to the reduction of psychological and emotional stress through re-
laxation exercises and the expression of feelings related to the distress.

䊏 Dual-Career Considerations

During the last 15 years, there has been a notable trend in the number of dual-career
families. Families in this category can experience both positive and negative out-
comes of a two-partner working household.

Positive Aspects of Dual-Career Families

䊏 With both partners financially providing for families, one partner can take the
opportunity to pursue other job interests, different career paths, or return to the
educational arena while the other partner acts as the primary financial support.
䊏 Families can enjoy the benefits of a higher socioeconomic position resulting from
the combined income of the partners.

Although there are a number of benefits to dual-career families, there also may be
some potential drawbacks to this lifestyle.

Potential Drawbacks of Dual-Career Families

䊏 One spouse may lose job opportunities if the other partner is unwilling to resign
from employment to relocate.
䊏 Some dual-career families live in long-distance relationships because the
spouses are employed in different parts of the country.
䊏 Dual-career families can face problems with child care, finding time together, al-
location of household chores, and parenting.
334 What Are the Essential Elements of Counseling? PART TWO

䊏 Displaced Homemakers

Displaced homemakers are people who are forced to replace their primary respon-
sibility of taking care of the home and children with outside, paid work. Sudden or
unexpected events that cause homemakers to become displaced include divorce,
death of a spouse, abandonment, employment termination of a partner, and signifi-
cant medical needs of children or elderly parents. Because of the often unexpected
nature of the displacement, homemakers may benefit from personal counseling
prior to career counseling to deal with issues that would have distracted them from
their career exploration or search. Some displaced homemakers, however, quickly
will jump into an employment relationship to avoid dealing with their emotional
distress. Apart from dealing with mental health issues, the career counselor can ad-
dress situational concerns presented by the displaced homemaker.

Counselor Responses to Situational Concerns of Displaced Homemakers

䊏 Referral to financial professionals to deal with short-term or long-term financial
problems.
䊏 Exploration of support systems, including the expansion of those systems.
䊏 Modification of self-concept to prepare individuals to assume responsibility for
decisions perhaps previously made with a partner.
䊏 Addressing day-to-day problems (e.g., yard care, car maintenance, cooking, etc.)
so the client can afford to focus on career planning.

In addition to responding to the practical, contextual concerns that displaced

homemakers may have, career counselors also need to explore a number of key is-
sues that can have an impact on the client’s job search.

Key Concerns in Counseling Displaced Homemakers

䊏 Education about the world of work and the local labor market.
䊏 Development of reasonable expectations as displaced homemakers sometimes
set their work goals too low due to self-esteem issues.
䊏 Consideration of immediate employment versus entry into a preparatory pro-
gram.
䊏 Assessment of the individual’s energy.

䊏 Individuals With Disabilities

Career development issues frequently are the same for all individuals. However,
“individuals with disabilities face specific barriers and challenges in their career
development” (Feller & Walz, 1997, p. 243). Thus, special career development
themes and issues need to be addressed with individuals with disabilities.
CHAPTER FIFTEEN Counseling in the World of Work 335

Career Counseling Issues for Persons With Disabilities

䊏 Improving self-esteem.
䊏 Accepting their disability.
䊏 Implementing strategies for educating employers regarding accommodations.
䊏 Developing interviewing skills equipping the individual to effectively answer
questions related to his or her disability.
䊏 Developing the ability to deal with insensitive questions during the selection
process.
䊏 Deciding when and how to disclose the disability to a prospective employer.

Counselors involved in the delivery of career development services also must

review their own service delivery system. Although not exhaustive, counselors can
use the following list of questions to begin reflecting on the accessibility of their ser-
vices.

Questions for Evaluating Accessibility of Services for Disabled People

䊏 Is the counselor’s office accessible to the physically challenged individual?
䊏 Is the restroom in the counselor’s office adapted to meet the needs of individuals
with disabilities?
䊏 Does the career resource center include information about accommodations?
䊏 Is the counselor aware of the Americans With Disabilities Act and its impact on
the client and potential employers?

EXAMPLE

Americans With Disabilities Act and Counseling

Congress passed the Americans With Disabilities Act (ADA) to end discrimination against
people with disabilities in the employment sector. The act states that “Employers must pro-
vide reasonable accommodations to qualified individuals with disabilities to enable them to
do the essential functions of a job, unless the changes impose undue hardship upon the em-
ployer.” Career counselors need to be aware of this law and need to educate their clients re-
garding protection afforded by the law. Subsequently, counselors will find their clients with
disabilities pursuing positions often unexplored in the past.

䊏 Midlife Career Changes

At the midpoint of life, many people often question the purpose of their life and
work and evaluate what they want to accomplish in their lifetime. Bradley (1990)
noted that approximately 10% of adults between the ages of 30 and 44 transition
from one job to another. Given the developmental issues relevant to midlife and the
336 What Are the Essential Elements of Counseling? PART TWO

frequency with which people in this stage make job transitions, career counseling
issues during the midlife stage often are intertwined with life issues. While pursu-
ing career counseling, clients are encouraged to assess their values, goals, and life
mission. To bring together the developmental and career issues that are so impor-
tant to midlife career counseling, some specific questions can be asked.

Questions to Prompt Developmental and Career Reflection in Midlife

䊏 What does the individual want to do with his or her life now?
䊏 What are the dreams, vision, and interests that the client wants to pursue in the
coming years?
䊏 What are the most vital concerns related to midlife?
䊏 How can the individual stop living to work and start working to live?
䊏 How can the person bring a sense of balance to his or her life?
䊏 In what ways can the individual use skills and abilities in new ways?
䊏 What opportunities are available to individuals within their organization or with
their current employer?

Four options available to individuals who wish to make a career change during
their midlife stage (Feller & Walz, 1997) are encapsulated in the concepts of down-
shifting, moving sideways, moving up, and enriching the status quo. An under-
standing of these midlife career choices that can be adopted follows:

Downshifting: Individuals receive more for less by seeking positions within

their present organizations, outside the organization, or in temporary posi-
tions that are challenging but pose less responsibility and fewer time de-
mands than their current jobs.

Moving sideways: Individuals pursue lateral moves within their organiza-

tion to positions providing them with more excitement and challenges.

Moving up: Individuals seek promotions or external positions with more re-
sponsibility and interest that can satisfy their needs.

Enriching the status quo: Individuals explore ways to live differently with
what they have to resolve the conflict experienced by some adults during
their midlife career development phase, including working flex time and
carpooling or taking the bus to save money.

TECHNOLOGICAL COMPETENCIES FOR CAREER COUNSELORS

Today, career counselors cannot practice without competence in the use of the
Internet and computer-based career resources and information. Technology related
to Internet services and computer-assisted services has a direct impact on key com-
ponents of the practice of career counseling.
CHAPTER FIFTEEN Counseling in the World of Work 337

Areas of Career Counseling Influenced by Technology

䊏 Dissemination of career information.
䊏 Career development assessment.
䊏 Continuing education of workers.
䊏 Job searches.
䊏 Worker recruitment.

䊏 ACES Technology Competencies

The Association of Counselor Education and Supervision (ACES) established the

following list of minimum technological competencies needed at graduation by
counselor education students.

Technology Competencies for Professional Career Counselors

䊏 Use productivity software to develop Web pages, presentations, résumés, letters,
and reports.
䊏 Use audiovisual equipment for presentations.
䊏 Use computerized testing, diagnostic, and career decision-making programs
with clients, on the Internet, in computer-assisted career guidance systems, and
in career counseling centers.
䊏 Use e-mail to contact employers and develop job-hunting networks.
䊏 Help clients search for counseling-related information via the Internet, including
information about careers, employment opportunities, educational and training
opportunities, financial assistance and scholarships, treatment procedures, and
social and personal information.
䊏 Help clients prepare online résumés and conduct virtual job interviews.
䊏 Subscribe to and participate in counseling-related listservs.
䊏 Access and use counseling-related CD-ROM or DVD databases.
䊏 Apply legal and ethical standards related to counseling services via the Internet.
䊏 Identify the strengths and weaknesses of career development services offered on
the Internet, including assessment and job placement services.
䊏 Surf the Internet to find and use continuing education services.
䊏 Use integrated technological systems.

To obtain more details about ACES, check out their Web site:
䉴 www.acesonline.net
338 What Are the Essential Elements of Counseling? PART TWO

䊏 Need for Technological Skills

Although competence in the use of computers and the World Wide Web is becom-
ing increasingly important for all counselors, it is evident that professionals who
enter the field of career counseling must have a very high level of technological
skill. Some reasons for necessary technological competence are provided here.

Why Counselors Must Be Technologically Competent

䊏 In 2005, the vast majority of information, resources, and job postings were ac-
cessed through the Internet.
䊏 Web sites evolve rapidly and there are no quality controls in place to protect cli-
ents from misinformation or even fraud.
䊏 It is incumbent on those in the career counseling field to stay up to date and
aware of the frequent advances and changes in career-related technology.

Today’s successful career counselor will gain and utilize expertise in a wide array
of competencies including theoretical knowledge, assessment, research, and tech-
nology. As with all counseling fields, however, the counselor’s effectiveness is de-
termined by the development of a trusting counseling relationship, and the coun-
selor’s ability to support and guide the client through the stages of the counseling
process.

Chapter 15: Key Terms

䉴 Career counseling 䉴 Compromise 䉴 Downshifting
䉴 Americans With Disabilities 䉴 Self-efficacy 䉴 Moving sideways
Act 䉴 Displaced homemakers 䉴 Moving up
䉴 Career 䉴 Interest inventories 䉴 Enriching the status quo
䉴 Career development 䉴 Leisure 䉴 Life span
䉴 Person-oriented career 䉴 Vacophers 䉴 Life space
䉴 Non-person-oriented career 䉴 Work 䉴 Self-concept
䉴 Circumscription
 chapter Multicultural Issues in Career
and Lifestyle Counseling
16
Frederick T. Leong
Michigan State University

Erin E. Hardin
Texas Tech University

Arpana Gupta
University of Tennessee

In This Chapter

䉴 Understanding Cultural Issues 䉴 Culture-Specific Variables

in Career Counseling 䊏 Acculturation
䊏 Historical Approaches to Multicultural 䊏 Racial and Cultural Identity Development

Career Counseling 䊏 Racial Salience

䊏 Important Terminology: Cross-Cultural 䊏 Loss of Face

and Multicultural
䉴 Culturally Appropriate Career
䉴 Multicultural Career Development: Counseling Models
Traditional Theoretical Approaches 䊏 Integrative Sequential Model of Career

䊏 Holland’s Person–Environment Fit Theory Counseling Services

䊏 Roe’s Theory of Occupational Classifica- 䊏 Culturally Appropriate Career Counseling

tions Model
䊏 Super’s Life Span–Life Space Theory 䊏 Developmental Approach: Career-Devel-

䊏 Gottfredson’s Theory of Circumscription opment Assessment and Counseling

and Compromise 䊏 Integrative Multidimensional Model

䊏 Social Cognitive Career Theory

䊏 Theories Summary 䉴 Future Research and Theory Development

䊏 Key Concepts in Career Counseling
Research
䊏 Recommendations for Future Research

340
CHAPTER SIXTEEN Multicultural Career and Lifestyle Counseling 341

UNDERSTANDING CULTURAL ISSUES IN CAREER COUNSELING

Multicultural issues are given increasing attention in the mental health field; the
specialty area of career counseling is no exception. In light of the growing diversity
of most societies, Western-based models of career counseling are being challenged;
culturally appropriate career theories and models are being developed; and career
counseling approaches are beginning to reflect issues of ethnicity, language, values,
communication style, and time orientation (Fouad & Arbona, 1994; Leong, 1993),
all in an effort to better serve culturally diverse clients. Because ethnic minorities
also are most likely to seek counseling services that are related to career and educa-
tional issues (Sue & Sue, 1990), acknowledging the cultural context of the client is
an important step in improving the process and outcome of career counseling for
racial and ethnic minorities (Fouad & Bingham, 1995; Leong, 1993; Leong & Brown,
1995; Leong & Hartung, 1997).

䊏 Historical Approaches to Multicultural Career Counseling

Two approaches to ethnic minority development have arisen from vocational psy-
chology and, today, influence multicultural career counseling and research. The
first, cross-cultural counseling, has anthropological roots; the second, ethnic mi-
nority counseling, has a sociological foundation. Understanding the assumptions
that underlie each approach is helpful to the discussion of multicultural career
counseling.

Assumptions of Cross-Cultural Counseling

䊏 The country of interest (e.g., the United States) and its majority population are
the first unit of analysis in theory and research.
䊏 Findings about the behaviors of people of the majority population (e.g., individ-
uals of European American descent) are generalized to people of other cultures
(Berry et al., 1992).
䊏 An etic perspective that is concerned with universal laws that govern behavior
across cultures is assumed.

Just as the cross-cultural approach is based on a set of assumptions, so the ethnic

minority counseling approach is grounded in its own presuppositions.

Assumptions of Ethnic Minority Counseling

䊏 Racial and ethnic groups are the first unit of analysis in theory and research.
䊏 Racial and ethnic minority group behavior is not compared explicitly to that of
the majority population.
䊏 An emic perspective that focuses on culturally unique behaviors particular to
certain groups is assumed.
342 What Are the Essential Elements of Counseling? PART TWO

䊏 Important Terminology: Cross-Cultural and Multicultural

It is important to clarify terminology relevant to the aims of this chapter, and specif-
ically, the terms multicultural and cross-cultural, which often are used interchange-
ably. The career development literature suggests that both approaches are neces-
sary. Leong and Brown (1995) understood the differences in terminology this way:

Multicultural career counseling: “[T]he study of career counseling in many

cultures” (p. 145).

Cross-cultural career counseling: The study of how racial and ethnic minor-
ity groups adjust to European American majority work environments.

Both perspectives contribute valuable insights and can answer different questions
about career counseling from a cross-cultural perspective. More frequently than
not, though, researchers are interested in looking at cross-cultural career counsel-
ing, which can answer such questions as “To what extent do the predictions of es-
tablished theories apply to minority groups?” or “What is the best way for a White
counselor to work with a client of Asian American descent?”

The absence of a comprehensive model for

cross-cultural or multicultural career counseling
suggests that scholars need to conceptualize
career theories in ways that are more culturally
appropriate, relevant, and effective.

MULTICULTURAL CAREER DEVELOPMENT:

TRADITIONAL THEORETICAL APPROACHES

Vocational counseling and psychology scholars have begun to examine existing ca-
reer theories and models from a multicultural context or with diverse clients in
mind (e.g., Fitzgerald & Betz, 1994; Fouad, 1995; Leong, 1995; Savickas, 1995a,
1995b). A clear criticism that has arisen from these investigations is that most of the
early research in career development relied on White undergraduate college partic-
ipants and, thus, has limited applicability to career counseling with diverse popu-
lations. The absence of a comprehensive model for cross-cultural or multicultural
career counseling suggests that scholars need to conceptualize career theories in
ways that are more culturally appropriate, relevant, and effective. Although some
scholars have made efforts to identify and describe variables that are specific to the
career counseling of particular ethnic groups, such as African Americans
(Cheatham, 1990) or Native Americans (Johnson, Swartz & Martin, 1995), no com-
prehensive career model exists. A number of both the traditional and more contem-
CHAPTER SIXTEEN Multicultural Career and Lifestyle Counseling 343

porary career theories have been modified to accommodate cultural variables im-
portant to diverse individuals (e.g., Gottfredson, 2002; Holland, 1985a; Lent,
Brown, & Hackett, 1994, 2000; Roe & Lunneborg, 1991; Super, 1991). In this section,
we summarize some traditional career development theories with specific empha-
sis given to cross-cultural criticisms as well as recommendations. Two theories—
Gottfredson’s theory of circumscription and compromise and the social cognitive
career theory—are described in greater detail because they include elements that
make them somewhat more sensitive to cultural issues in career counseling.

See Chapter 15 for more detail about career counseling theories.

䊏 Holland’s Person–Environment Fit Theory

Holland’s (1985a) person–environment fit theory emphasizes the impact of hered-

ity and the environment on career choice and is among the most popular career the-
ories. The cultural validity of the theory appears limited, however, when it is exam-
ined from a multicultural context. According to some researchers (Day & Rounds,
1998; Day, Rounds, & Swaney, 1998) Holland’s hypothesized structure of interests
(with, e.g., artistic interests being more similar to investigative than conventional
interests) has been shown to be culturally appropriate among certain racial and
ethnic groups. However, some cautions must be made.

Cross-Cultural Critique of Holland’s Theory

䊏 Research into the cultural validity of Holland’s theory has produced mixed re-
sults for the theory’s predictions about the relation between career interests and
career choices.
䊏 Among Asian Americans (Tang, Fouad, & Smith, 1999) and Mexican American
girls (Flores & O’Brien, 2002), career interests were found not to be accurate pre-
dictors of career choice.
䊏 The theory’s concepts of congruence, the match between personal interest and
work environment; differentiation, the difference between the highest and lowest
interest; and consistency, the similarity between the top few interests, all showed
differing degrees of validity with various ethnic and racial groups (Leong &
Brown, 1995).

A number of recommendations need to be considered to increase the cross-cultural

validity of Holland’s career theory.

Recommendations for Holland’s Career Theory

䊏 Career counselors should be careful not to assume that a client’s career interests
are an accurate indicator of appropriate careers for the client (e.g., Asian Ameri-
cans and Mexican American girls).
䊏 A client’s career should not be taken as evidence of the client’s underlying
interests.
344 What Are the Essential Elements of Counseling? PART TWO

䊏 Roe’s Theory of Occupational Classifications

Roe (1956; Roe & Klos, 1972; Roe & Lunneborg, 1990) proposed a career theory that
is based on a psychological classification system of occupations. She surmised that
the evolution of one’s personality eventually influences a career choice. Roe herself
(Roe & Lunneborg, 1990) suggested that the occupational classification system
does not address minorities or their cultural issues. One’s family background, up-
bringing, family history, and genetic endowment all affect occupational choice. Be-
cause culturally based social and experiential factors are important in determining
career choice, the generalizability of Roe’s theory across various cultural, ethnic,
and racial groups is limited by certain factors.

Cross-Cultural Critique of Roe’s Theory

䊏 Cultural concepts, although addressed by the theory, are in reality very difficult
to measure accurately within the various ethnic groups.
䊏 Differences in inherited abilities such as intelligence and temperament are diffi-
cult to interpret within cultural groups and need to be done with caution to avoid
ethical dilemmas (Edwards & Polite, 1992; Helms, 1992).

Some recommendations can be made to strengthen this approach from a multicul-

tural perspective.

Recommendations for Roe’s Theory

䊏 Roe’s occupational classification system should be used with caution, if at all,
with members of most racial and ethnic minorities because it fails to account for
occupational segregation, or the tendency for members of particular groups to
be overrepresented in some occupations and underrepresented in others.
䊏 Counselors carefully should consider how external barriers and limited oppor-
tunities, rather than inherent deficiencies, might influence a client’s apparent
abilities and career choices.

䊏 Super’s Life Span–Life Space Theory

Another highly influential career theory is that of Super (1990), who proposed that
one’s self-concept and the development of that self-concept over the life span are
important factors in determining career choices. Super introduced the concept of
career maturity, which he defined as follows:

Career maturity: The ability to perform the developmental tasks of life stages.

Critics argue that important factors influencing the development of the self-con-
cepts of racial and ethnic minorities are unaccounted for in Super’s theory
CHAPTER SIXTEEN Multicultural Career and Lifestyle Counseling 345

(Arbona, 1995, 1996; Carter & Cook, 1992). From a cross-cultural perspective, sev-
eral other critiques of this theory can be made.

Cross-Cultural Critique of Super’s Theory

䊏 The life-span approach neither addresses the effects of disabling determinants
such as poverty, socioeconomic status, and discrimination on self-concept, nor
does the theory consider the restriction such determinants make on real and per-
ceived occupational choices.
䊏 The concept of career maturity has not been studied or validated with various
cultural groups.
䊏 A hallmark of career maturity in adolescence is the process of exploring career in-
terests and crystallizing a vocational choice independent of the influence of sig-
nificant others, such as family. The emphasis on independence is culturally inap-
propriate for members of many cultural groups that value collectivism and
interdependence, such as Asian Americans (Hardin, Leong, & Osipow, 2001).
䊏 The life-span theory may be most fitting to middle-class White men, who tend to
have more educational and economic advantages than do members of other eth-
nic and racial groups who experience more limited opportunities due to institu-
tional and individual discrimination (Arbona, 1995, 1996).

Several modifications to Super’s model help to make it more cross-culturally

relevant.

Recommendations for Super’s Theory

䊏 Counselors should explore with clients—especially those from lower socioeco-
nomic backgrounds—how experiences of discrimination and poverty have af-
fected their self-concept or led to restricted educational and vocational opportu-
nities.
䊏 Counselors should recognize that clients from more collectivist, family-oriented
cultures (e.g., Asian Americans and Latinos) do not necessarily exhibit problem-
atic dependence when they describe the importance of satisfying their family’s
wishes as part of choosing a career.
䊏 Counselors should explore the preferences of significant others with clients
rather than ignore them.
䊏 Conflicts between a client’s individual interests and those of his or her family
should be handled in a way that respects both the client and family (Hardin et al.,
2001).

䊏 Gottfredson’s Theory of Circumscription and Compromise

According to Arbona (1995), Gottfredson’s (2002) theory of circumscription and

compromise, which proposes that the self-concept evolves as people pass through
346 What Are the Essential Elements of Counseling? PART TWO

their own set of unique life stages, is a career model that accounts for cultural dif-
ferences such as gender and social class. This theory posits that people develop per-
ceptions over time of both the accessibility of certain jobs and the compatibility of
those jobs with their values and roles. Two terms are key to understanding the ten-
ets of this theory.

Circumscription: The process by which individuals gradually restrict the oc-

cupations they consider acceptable based on their developing self-concept.

Compromise: The process by which individuals choose among available but

imperfect occupational alternatives by compromising some needs for others.

To further describe these terms, consider the example of an individual faced with
two career choices: one that is gender “appropriate” but less prestigious and one
that is more prestigious but gender “inappropriate.” Of these two options,
Gottfredson’s theory predicts that the individual will choose the gender “appropri-
ate” career.

Cross-Cultural Strengths of Gottfredson’s Theory

䊏 Gottfredson’s (2002) reformed theory embraces a nature–nurture partnership
theory in which both environment and heredity are important factors in individ-
uals’ career choices and decisions.
䊏 Gottfredson’s theory uses an understanding of the processes of circumscription
and compromise to investigate whether individuals prematurely or unrealisti-
cally may have limited their career options. For example, the model explicitly ac-
knowledges that one’s perceptions of accessibility and one’s self-concept are de-
veloped, in part, as a function of prevailing racial attitudes and discrimination.

The theory of circumscription and compromise accounts for environmental factors

that strengthen its cross-cultural validity; however, several shortcomings—espe-
cially with regard to research results—still are evident.

Cross-Cultural Critique of Gottfredson’s Theory

䊏 The predictions made by the model of circumscription and compromise are diffi-
cult to test empirically, which has limited research on this theory.
䊏 The few studies that have been conducted exhibited mixed results (Leung, 1993;
Leung, Ivey, & Suzuki, 1994; Vandiver & Bowman, 1996).

Adjustments to Gottfredson’s theory can build on its strengths as a culturally ap-

propriate career model.
CHAPTER SIXTEEN Multicultural Career and Lifestyle Counseling 347

Recommendations for Gottfredson’s Theory

䊏 Counselors can help clients understand the role of environmental barriers in the
processes of circumscription and compromise by exploring, for example, how
experiences of discrimination, rather than their interests or abilities, may have
led them to reject certain occupations as unacceptable or inaccessible.
䊏 Continuing development on Gottfredson’s theory should address issues of eth-
nic identity and socioeconomic class.

The practical applications of Gottfredson’s theory continue to make it relevant to

understanding the career development of culturally diverse individuals despite
the lack of empirical evidence.

EXAMPLE

Research Considerations for Gottfredson’s Career Model

Leung (1993) found that Asian Americans would compromise gender for prestige, which is
contrary to Gottfredson’s original predictions, but consistent with other research (Leong, 1995;
Leung et al., 1994) that has demonstrated the importance of prestige to career decision making
among Asian Americans.

䊏 Social Cognitive Career Theory

Social cognitive career theory (SCCT) builds on Bandura’s (1977, 1986) work on
self-efficacy, Krumboltz’s (1996) social learning theory, and Hackett and Betz’s
(1981) application of self-efficacy theory to vocational psychology. Of the career
theories discussed to this point, Lent et al.’s (1994) SCCT offers the most promise
with regard to application to diverse cultural groups because it accounts for impor-
tant culturally specific variables missing from many of the previously discussed ca-
reer theories. Numerous studies in the literature focus on the cultural validity of
this theory (e.g., Byars & Hackett, 1998; Hackett, Betz, Casas, & Rocha-Singh, 1992).
Additionally, the theory focuses on other constructs that determine the extent of
vocational choice within many groups, such as career interests, self-efficacy, and
outcome expectations. Self-efficacy and outcome expectations are understood as
follows:

Career self-efficacy expectations: Beliefs about one’s own ability to perform

occupationally relevant behaviors successfully; these expectations determine
one’s actions, effort, and persistence in regard to career behaviors.
348 What Are the Essential Elements of Counseling? PART TWO

Outcome expectations: Personal beliefs about the results of performance that

are viewed as operating independently from efficacy expectations and de-
pendent on actual performance.

Self-efficacy and outcome expectations are thought to be affected by learning expe-

riences, which are, in turn, shaped by various background and personal factors, in-
cluding race and ethnicity (see Lent et al., 1994, for more detailed discussion of the
theory).

Cross-Cultural Critique of SCCT

䊏 There is limited empirical evidence to support the theory’s claim that career in-
terests predict occupational choice for some ethnic groups (e.g., Asian Ameri-
cans and Mexican American girls).
䊏 Contextual variables such as barriers and outcome expectations still are under-
studied constructs, so their validity within various ethnic and racial cultures is
difficult to evaluate (Lent et al., 2000).

To improve the cultural sensitivity of this approach, some recommendations can be

made.

Recommendations for SCCT

䊏 Career counselors should distinguish between collectivist and individualist cul-
tural values and be aware of the role they may play in career behavior (Leong &
Serafica, 1995).
䊏 Counselors should acknowledge that variables such as acculturation can play a
part in determining career choice (Leong & Chou, 1994), which is inconsistent
with the original SCCT that suggests the effects of acculturation at the most are
indirect (Lent et al., 1994).

EXAMPLE

Research Considerations for SCCT

Based on early work of Hackett and Betz (1981), numerous studies have tested the cultural va-
lidity of the hypothesis that self-efficacy beliefs influence interests and career choice (e.g.,
Dawkins, 1981; Hackett et al., 1992; Post, Stewart, & Smith, 1991; Post-Kammer & Smith, 1986).
The general conclusion of these studies is that, “the extant research does suggest that career
and academic self-efficacy significantly predict the academic achievement and career choice of
people of color” (Byars & Hackett, 1998, p. 256).
However, in light of limitations of SCCT, Lent and his colleagues more recently have stated
that “contextual factors may assert a direct influence on choice making or implementation. For
CHAPTER SIXTEEN Multicultural Career and Lifestyle Counseling 349

example, particularly in collectivist cultures and subcultures, the wishes of influential others
may hold sway over the individual’s own personal career preferences,” (Lent et al., 2000, p.
38). They went further, noting that “In individualistic cultures, as well, career interests or goals
often need to be subjugated to economic or other environmental presses. Thus, SCCT posits
that, when confronted by such presses, an individual’s choice behavior may be guided less by
personal interests than by other environmental and person factors” (p. 38).

䊏 Theories Summary

A review of some of the more key career models makes evident that, with the ex-
ception of SCCT, most models fail to consider seriously the cultural variables that
influence career decisions and choices. Therefore, where traditional theories either
are limited or not appropriate, new, more culturally sensitive career theories need
to be developed and investigated. Before moving directly to a discussion about
those theories, relevant, culture-specific variables that have been absent in tradi-
tional theories and that have attempted to be addressed by culturally appropriate
career models will be examined.

CULTURE-SPECIFIC VARIABLES

A look at emic, or culture-specific variables that are germane to ethnic minority

groups, can deepen the awareness of the impact of culture on career development,
as well facilitate understanding of the processes involved when counseling cultur-
ally different individuals. A few of these variables are mentioned only briefly here
due to space limitations. More information may be found in Leong and Brown
(1995).

䊏 Acculturation

Acculturation is an important variable in understanding the process of career de-

velopment among various ethnic minorities. Acculturation is understood as
(Arbona, 1995; Johnson et al., 1995; Leong & Tata, 1990; Padilla, 1980):

Acculturation: The degree of identification an individual from an incoming

cultural group makes with the host culture.

The following research about acculturation needs to be considered.

350 What Are the Essential Elements of Counseling? PART TWO

Key Areas of Research Around Acculturation

䊏 Acculturation has been found to be related to work values (e.g., salary, task satis-
faction, self-realization, object orientation, solitude, group cohesiveness and
preference, or ideas–data orientation).
䊏 Researchers have argued that different acculturation stages (i.e., separationist,
assimilationist, integrationist, and marginalist) predict differing career outcomes
(see Leong & Chou, 1994, for a detailed discussion of particular hypotheses re-
garding the relation between specific career outcomes and stage of acculturation
for Asian Americans).

䊏 Racial and Cultural Identity Development

Racial and cultural identity development is another culture-specific variable that

significantly influences career development. The process of racial and cultural
identity development can be understood as follows:

Racial and cultural identity development: The processes used by individu-

als of minority groups and oppressed peoples to understand their own iden-
tity in light of their culture, the culture of dominant groups, and the conver-
gence of the two cultures.

Two of many racial identity models include the system Helms (1993) described for
African Americans and a similar model Sue and Sue (1990) formulated for Asian
Americans. Additionally, racial and cultural identity development models also ex-
ist for people of European descent (Helms, 1984, 1995). The career literature
(Brown, 1995; Helms & Piper, 1994), provides evidence that racial identity can af-
fect the vocational process, including career maturity, the perception of work envi-
ronment and opportunities, work satisfaction, and satisfactoriness and racism at
work (Parham & Austin, 1994).

See Chapter 4 for more information on racial identity development models and White
racial identity development.

䊏 Racial Salience

A related factor that can influence the vocational process is racial salience, which
can be understood as follows:

Racial salience: The degree to which an individual perceives race as a factor

affecting workplace options.
CHAPTER SIXTEEN Multicultural Career and Lifestyle Counseling 351

䊏 Loss of Face

Finally, the concept of loss of face or reputation must be considered and understood
by counselors attempting to provide competent career interventions for numerous
ethnic groups, and especially Asian Americans (Redding & Ng, 1982). This is a sa-
lient variable not only for understanding social behavior of the Asian American
population, but also for shedding some light into the world of work for this popu-
lation.
Emic approaches to career counseling that address these culturally specific vari-
ables can help counselors better understand the world of work for racial and ethnic
minorities. Adjusting existing Western career models to incorporate multicultural
elements will be helpful to a limited degree. For a more comprehensive under-
standing of vocational development for different ethnic and racial groups, these
culturally specific, non-European constructs also will have to be thoroughly inves-
tigated on their own.

CULTURALLY APPROPRIATE CAREER COUNSELING MODELS

New career counseling models that are sensitive to cultural variables and issues are
being developed. Four models that can guide career counseling with various
groups and research efforts include the following:

䊏 Integrative sequential model (ISM).

䊏 Culturally appropriate model.
䊏 Developmental approach.
䊏 Integrative multidimensional approach.

䊏 Integrative Sequential Model of Career Counseling Services

The ISM is an ordered, comprehensive career model that accounts for the cultural
context in which career counseling occurs (Leong & Hartung, 1997).

Characteristics of ISM
䊏 Emphasizes the importance of culture, especially with regard to occupational is-
sues.
䊏 Includes four stages: problem emergence, help seeking, evaluation of vocational
problems, and career intervention resulting in some counseling outcomes.
䊏 Takes a sequential stage approach to career counseling that allows counselors to
adjust their approach depending on the client’s culture, preferences, and history.
䊏 Highlights the role natural cultural history plays before, during, and after the ca-
reer counseling process.
352 What Are the Essential Elements of Counseling? PART TWO

The following is a description of salient aspects of the stages of the ISM approach to
career counseling.

First Stage of ISM: Emergence of the Career Problem

䊏 The conceptualization of the career problem inextricably is linked to culture.
䊏 Cultural values and ideals determine what is considered to be a normal work life
and what is or is not a career problem.
䊏 Counselors must approach career problems within clients’ ethnic frameworks to
avoid making faulty assumptions about clients and their career problems.
䊏 Some cultures consider work to be a central part of one’s identity, whereas other
cultures view work primarily as a source of income. Individuals from these two
cultures, therefore, are likely to conceptualize job satisfaction differently.

Clients may be reluctant to seek career counseling, may wait until the problems are
serious, and may present their problems in the context of their impact on the family
system.

Second Stage of ISM: Help Seeking

䊏 The degree to which a particular racial and ethnic group seeks counseling, in
general, is reflective of extent to which individuals in that group will seek career
counseling services.
䊏 Factors that increase reluctance to seek help include language barriers between
counselors and clients and the traditional structure of therapy (i.e., self-disclo-
sure by client) that is in opposition to values held by collectivistic cultures.
䊏 Culturally diverse clients frequently seek services at the suggestion of family,
friends, or clergy.
䊏 Counselors are encouraged to discover how the referral source and other people
close to the client influence the client’s career options.

After clients have decided to seek assistance through career counseling, the coun-
selor can begin to assess the vocational problems.

Third Stage of ISM: Evaluation of Vocational Problems

䊏 Counselors conduct an intake to assess the nature of the career problem.
䊏 Counselors may use career and personality tests to make a more accurate assess-
ment of the client’s career problems.
䊏 Evaluation of career problems leads to career counseling if it is determined that
the individual is in need of services.

In the final stage, the counselor uses assessment data and client input to make cul-
turally appropriate interpretations of the problem and create interventions.
CHAPTER SIXTEEN Multicultural Career and Lifestyle Counseling 353

Fourth Stage of ISM: Career Intervention

䊏 Counselors select traditional career assessment tools that help clarify clients’ vo-
cational needs as well as talk to clients about their subjective work needs that are
influenced by cultural heritage.
䊏 Accurate assessment is related to the counselor’s multicultural competence.
䊏 Interpretation of assessment data is made best by preparing the client for the re-
sults, presenting the results, and asking for client input about how the data fits
with subjective experiences.

To illustrate the application of this career model across its various stages, we use an
example about Asian Americans.

EXAMPLE

Using ISM With an Asian American Client

The first stage in career counseling from the ISM approach involves understanding the cul-
tural and ethnic framework inside of which career problems emerge. When considering the
situation of Asian Americans who seek career counseling, some basics about the culture must
be recognized. First, because of the collectivistic, interdependent attitudes held by many Asian
Americans, which lead to a sense of obligation to society and family, and because of cultural
norms and values that stigmatize discussing problems outside the family, Asian Americans
may be less comfortable than their White counterparts in discussing their career problems
with others. Second, Asian Americans also are more likely to view their problems as compli-
cated and connected to other members of their family or community. Recognizing and validat-
ing these cultural traits help counselors to appreciate the courage it may have taken the client
to decide to seek services.
Asian Americans who eventually seek services often encounter counselors who use ap-
proaches in the second stage that stress autonomy and independence. For example, counsel-
ors may encourage clients to explore their personal career interests without regard for their
parents’ wishes. Such counselors are likely to be perceived by more interdependent Asian
American clients as unhelpful and culturally inappropriate.
During the third stage, care must be taken not to interpret culturally appropriate interdepen-
dence as a sign of career immaturity or being too dependent on others. Research has demon-
strated that this is an erroneous assumption with Asian Americans (Hardin et al., 2001).
Because many Asian American clients, particularly those with lower acculturation, expect a
more directive and expert counselor, a nondirective and egalitarian counselor may cause fur-
ther discomfort, puzzlement, and dissatisfaction. Thus, unfavorable outcomes may be ob-
tained, the client may return to the community without resolving his or her problem and
perceive the counseling process negatively. Counseling issues can be resolved from the per-
spective and values of the Asian American client. This means practicing within multi-
culturally competent ways specific to the client’s culture.
354 What Are the Essential Elements of Counseling? PART TWO

䊏 Culturally Appropriate Career Counseling Model

The culturally appropriate model was introduced by Fouad and Bingham (1995) as
an extension of Ward and Bingham’s (1993) model for women from minority cul-
tures. The underlying assumption of this model is that culture is an integral part of
career counseling, so much so that it should be infused into every aspect of the
counseling experience. Moreover, in response to the increasing amounts of
cross-cultural and multicultural literature in the counseling field (e.g., Sue & Sue,
1990), the theory pays particular attention to factors such as racial identity develop-
ment, discrimination, family role expectations, gender role expectations, and other
worldview dimensions. Fouad and Bingham (1995) proposed seven steps to their
culturally appropriate career counseling model; these are listed here.

Seven Steps of the Culturally Appropriate Model

1. Establish a culturally appropriate relationship with the client.
2. Identify career issues.
3. Assess the effects of cultural variables.
4. Set career counseling goals.
5. Design culturally appropriate counseling interventions.
6. Make career-related decisions.
7. Implement decisions and follow-up.

Each step of the model varies depending on the racial and ethnic identity of the cli-
ent and needs to be adjusted to fit the culture of the client.

䊏 Developmental Approach: Career-Development Assessment and Counseling

The Career-Developmental Assessment and Counseling Model (C-DAC; Super,

1983) is a promising approach to career counseling because contextual and multi-
cultural concepts, such as work role importance and values, are inherent to life
span–life space theory from which the C-DAC model emerged. Hartung et al.
(1998) proposed two modifications of the C-DAC model to increase its cultural rel-
evance: (a) formally assessing the client’s cultural identity in the first stage of the
model, and (b) considering cultural identity throughout the process of implement-
ing the C-DAC model. Because cultural identity is a key component of the C-DAC
model, it is important to understand what is meant by this term. Hartung et al.
(1998, p. 281) gave this definition:

Cultural identity: “[I]nvolves taking account of cultural differences that may

overlay … other components and influence individual career development
and vocational behavior. These differences typically surface in attitudes and
discriminatory practices in the current job market and world of work.”
CHAPTER SIXTEEN Multicultural Career and Lifestyle Counseling 355

Characteristics of C-DAC
䊏 The C-DAC model is especially beneficial for career counselors whose theoreti-
cal orientation is developmental in nature.
䊏 Components of differential, developmental, and phenomenological theories
(e.g., elements from Parsons’s and Holland’s theories, Super’s theory, and narra-
tive therapies, respectively) are blended into a comprehensive approach in
C-DAC.
䊏 C-DAC is implemented in a four-step process, a major component of which is as-
sessment through a battery of career assessment tools that provides data about a
client’s career knowledge, values, and interests.
䊏 The Multicultural Career Counseling Checklist (Bingham & Ward, 1996, 1997;
Ward & Bingham, 1993) and the Career Counseling Checklist (Bingham & Ward,
1996, 1997; Ward & Bingham, 1993) are two recommended instruments.
䊏 C-DAC is traditionally comprised of five dimensions that lead counselors to ex-
plore work and nonwork roles, understand career values and interests, identify
life stages and tasks, assess career knowledge, and create plans of action.

Implementing the C-DAC model typically calls on the counselor to follow four
main steps.

Four-Step Process of the C-DAC Model

1. Conduct initial interview to evaluate client’s needs, review client records, as-
sess the importance of work roles relative to other life roles, and create a pre-
liminary plan.
2. Ask client to complete a battery of tests to determine the client’s readiness,
adaptability, interests, and values in making career decisions.
3. Review all the information gathered via formal and informal assessment tech-
niques.
4. Begin the career counseling process in which data are explored and inter-
preted.

The C-DAC model intentionally is adjusted for cross-cultural validity; however,

several recommendations can improve this approach’s cultural competence.

Recommendations for Increasing Cultural Validity of the C-DAC

䊏 Incorporate a sixth dimension to C-DAC that evaluates the cultural identity de-
velopment of clients so that culture is recognized as a core component of the
model. This modification would give consideration to such important cultural
variables as acculturation, cultural value orientation, external career barriers
such as racism, discrimination, and special racial group career development
stages and behaviors.
356 What Are the Essential Elements of Counseling? PART TWO

䊏 Conceptualize the developmental approach from universal (e.g., mainstream

culture), group (e.g., specific cultural group), and individual (e.g., personality
and behavior) levels.
䊏 Encourage counselors to reflect on their own cultural values, beliefs, and behav-
iors, as well as examine their own career development from a culturally sensitive
model such as C-DAC (Hartung et al., 1998).

䊏 Integrative Multidimensional Model

This model is an adaptation of cross-cultural counseling to the career counseling

process. The integrative multidimensional model (IMM) was initially developed
by Leong (1996) and then was extended to career counseling situations (Leong &
Hardin, 2002; Leong & Hartung, 2003).

Characteristics of IMM
䊏 IMM is based on the tripartite approach that considers and integrates career is-
sues within the context of the individual, group, and universal dimensions.
䊏 IMM increases the validity of the intervention and also provides a complete,
comprehensive, and dynamic insight into the client’s world.
䊏 IMM is based on an eclectic style of therapy and can be applied to any career the-
ory or model already established.

Past cross-cultural research efforts have focused only on one of these three dimen-
sions, ignoring the others (Leong, 1995); the IMM is an attempt to address this
shortcoming.
Emic or culture-specific approaches can be used to help explain anomalies
within some of the older Eurocentric-based career models. However, it cannot be
assumed that all variance observed with racial or ethnic minorities is due to cul-
tural factors. Thus, care must be taken in making assumptions and in examining all
three dimensions (individual, group, and universal) and how they interact to pro-
duce certain outcomes. Utilizing the IMM bodes well for cross-culturally compe-
tent career counselors.

FUTURE RESEARCH AND THEORY DEVELOPMENT

It appears from the preceding discussions that unless some significant strides are
made to modify or develop culturally appropriate career models and theories,
career counseling with racially and ethnically diverse clients will be both difficult
and ineffective. It is obvious that there is still much that needs to be done in
CHAPTER SIXTEEN Multicultural Career and Lifestyle Counseling 357

the investigation and creation of culture-specific factors and variables with re-
gard to the career development and vocational behavior of various cultural pop-
ulations.

䊏 Key Concepts in Career Counseling Research

A number of concepts have been identified by various scholars (Arbona, 1995;

Brown, 1995; Leong, 1995, 1998; Leong & Serafica, 1995; Johnson et al., 1995) as im-
portant to future research on culturally appropriate career models.

Concepts of Relevance to Career Counseling Research

䊏 Experiences of discrimination.
䊏 Poverty (socioeconomic status).
䊏 Acculturation.
䊏 Gender.
䊏 Cultural values.
䊏 Ethnic identity.
䊏 Cultural history.
䊏 Reputation or loss of face.
䊏 Migration status.
䊏 Region or country of origin.
䊏 “Colorism.”
䊏 Tribal identification and reservation versus nonreservation status of tribes.

䊏 Recommendations for Future Research

Once these culturally sensitive theories and models have been developed they
need to be taken to the next level by being tested with various cultural groups. Sug-
gestions for future research may address the following:

䊏 Sufficiently documented studies that contribute to the growth of career litera-

ture.
䊏 Attention to adequate sample sizes to obtain significant results.
䊏 Between-group and within-group studies that apply across a wide range of ra-
cial and ethnic groups.
䊏 Longitudinal and cross-sectional studies utilizing diverse cultural groups.
䊏 Outcome studies that investigate new or modified career models.
358 What Are the Essential Elements of Counseling? PART TWO

Chapter 16: Key Terms

䉴 Multicultural career coun- 䉴 Consistency 䉴 Acculturation
seling 䉴 Occupational segregation 䉴 Racial and cultural identity
䉴 Cross-cultural career coun- 䉴 Career maturity development
seling 䉴 Circumscription 䉴 Racial salience
䉴 Etic perspective 䉴 Compromise 䉴 Cultural identity
䉴 Emic perspective 䉴 Career self-efficacy expecta-
䉴 Congruence tions
䉴 Differentiation 䉴 Outcome expectations
 chapter Fundamentals of Professional
School Counseling
17
Mariellen Kerr
Duquesne University

Carol Dahir
New York Institute of Technology

In This Chapter

䉴 Foundations of Professional 䉴 The Transforming School

School Counseling Counseling Initiative
䊏 What Is School Counseling? 䊏 Implications for School Counselor Practice

䊏 Brief Historical Background 䊏 The Counseling Process

䊏 Professionalism for School Counselors 䊏 Consultation

䊏 Coordination of Services

䉴 ASCA National Standards 䊏 Leadership

䊏 Domain 1: Academic Development 䊏 Advocacy

䊏 Domain 2: Career Development 䊏 Collaboration and Teaming

䊏 Domain 3: Personal and Social Develop- 䊏 Managing Resources

ment 䊏 Use of Data

䉴 ASCA National Model 䉴 School Counseling in the 21st Century

䊏 The Foundation 䊏 Functions and Responsibilities of the
䊏 The Delivery System School Counselor
䊏 The Management System 䊏 The Transformed School Counselor

䊏 The Accountability System

䊏 Programmatic Approach: A New Para-

digm for School Counseling

䊏 Collaboration and Systemic Support

360
CHAPTER SEVENTEEN Fundamentals of Professional School Counseling 361

FOUNDATIONS OF PROFESSIONAL SCHOOL COUNSELING

Entire semesters and textbooks are devoted to presenting detailed discussions of

the various fundamental elements of school counseling. The purpose of this chap-
ter is to present an overview of the major tenets of school counseling in a simple
and concise manner for easy reference. Additionally, in this chapter we provide in-
sight into the evolution of the profession and the recent initiatives that have signifi-
cantly influenced the direction of professional school counseling in the 21st cen-
tury.

䊏 What Is School Counseling?

The American School Counselor Association (ASCA) Governing Board adopted

the following definition of school counseling (ASCA, 1997):

Counseling is a process of helping people by assisting them in making decisions and

changing behavior. School counselors work with all students, school staff, families,
and members of the community as an integral part of the education program. School
counseling programs promote school success through a focus on academic achieve-
ment, prevention, and intervention activities, advocacy and social-emotional and ca-
reer development.

This definition shifted the focus of school counselors from the traditional approach
of reactive and responsive services to one that influences the entire school commu-
nity.

䊏 Brief Historical Background

Throughout time, young people have sought the counsel of elders regarding life is-
sues. The roots of school counseling, arguably the oldest form of systematic coun-
seling in the United States, if not the world, can be traced back to European research
into individual differences, assessment techniques, psychological classifications,
and explanations for behavior (Herr, 2003). The social and political climate in the
United States during the late 19th century heightened awareness of human rights
issues in response to massive immigration and the exploitation of children during
the Industrial Revolution. These conditions spurred the need for a school-based
professional to take an active role in child welfare and vocational guidance and set
the stage for the emergence of systematized counseling within the schools. The
birth and growth of school counseling thus has been influenced by many socio-
political and professional occurrences. The following timeline represents some of
these major events.
362 What Are the Essential Elements of Counseling? PART TWO

Timeline of Major Events and Legislative Acts

in the Development of School Counseling
䊏 1895: George Merrill develops first vocational guidance program in San Francisco.
䊏 1898: Jesse B. Davis encourages Detroit English teachers to include guidance les-
sons in character education, interpersonal relationships, and vocational inter-
ests.
䊏 1905: Alfred Binet develops first intelligence test to spearhead the testing move-
ment and shape the content and methods of school counseling throughout the
century.
䊏 1908: Frank Parsons, considered the father of vocational guidance, establishes
the Bureau of Vocation in Boston. The term vocational guidance is first used and ac-
tions from this meeting launched vocational decision making in the schools
(Zeran, Lallas, & Wegner, 1964).
䊏 1909: Parsons’s book Choosing a Vocation is published posthumously. Parsons’s
most notable contribution may be his trait and factor approach to the vocational
guidance process.
䊏 1930s: The Great Depression results in massive unemployment and the U.S. Em-
ployment Service and Bureau of Labor Statistics are established. Demand for ca-
reer information prompts the publication of the Dictionary of Occupational Titles
in 1939.
䊏 1940s: Expansion of testing was a hallmark of this decade, the result of the need
for job classification in the armed forces. School counseling jobs continue to
grow.
䊏 1952: American Personnel and Guidance Association (APGA) is formed.
䊏 1953: ASCA is established as a division of APGA, increasing credibility and ad-
vocating standards of practice and ethical guidelines for school counselors.
䊏 1957: Russia launches Sputnik. The U.S. education system is faulted for failing to
produce students whose math and science skills were superior to Russian stu-
dents.
䊏 1958: Considered to be the most important event in the history of school counsel-
ing, the National Defense Education Act (NDEA) is passed, providing federal
funding for the training of secondary counselors, resources to establish and sup-
port guidance programs for the purpose of identifying students talented in math
and science, and the guidance and advisement to pursue higher education.
䊏 1960s: In a decade of peak legislative support, the Elementary and Secondary Ed-
ucation Act (ESEA) is enacted in 1965, designating funding for guidance and in
particular, for the training of elementary counselors. Along with amendments to
NDEA and ESEA, amendments to the Vocational Education Act of 1963 expand
funding for focus on career guidance for the disadvantaged, disabled, and the
expansion into elementary schools.
䊏 1970s: Federal legislation continues support of guidance with specific focus on
career and vocational education. Career Education Incentive Act of 1976 solidi-
fies career guidance in schools by infusing it into the curriculum as part of the
teaching and learning process. The 1976 amendment to ESEA includes major
CHAPTER SEVENTEEN Fundamentals of Professional School Counseling 363

support for guidance and counseling in the schools. Also in 1976 the National
Occupation Information Coordinating Committee (NOICC) is established to
provide career development resources to K–12 counselors.
䊏 1980s: Passage of the Carl D. Perkins Vocational Education Act in 1984 and sub-
sequent amendments are the major source of funding and support for guidance
in the schools during this decade.
䊏 1990s: The Perkins Act continues to provide major funding. The School to Work
Opportunities Act of 1994 supports career and guidance counseling to assist stu-
dents transitioning from school to the workplace. The Elementary School Coun-
seling Demonstration Act of 1995, reauthorized in 1999 and 2001, provides fund-
ing to expand counseling programs and provide greater access for students by
decreasing the counselor-to-student ratio, which was 1 school counselor to 561
students nationally in 1999.
䊏 1997: ASCA National Standards, content standards for student academic, career,
and personal and social development are published as a proactive response to
the GOALS 2000: The Educate America Act of 1994, which advocates for high ex-
pectations for all students regardless of race, ethnicity, and socioeconomic status.
䊏 1997: The Education Trust De Witt-Wallace Reader’s Digest Transforming School
Counseling Initiative defines a new vision for school counseling that emphasizes
leadership, advocacy, use of data, and a commitment to support high levels of
student achievement. This initiative also supports six institutions of higher edu-
cation to develop a new model of school counselor preparation.
䊏 2001: No Child Left Behind (NCLB) Act passes to continue the work of school im-
provement in GOALS 2000 (1994), emphasizing accountability and high-stakes
testing.
䊏 2002: National School Counselor Training Initiative is established by the Educa-
tion Trust and the MetLife Foundation with the vision that school counselors are
ideally situated in schools to serve as advocates for programs to promote success
for all students.
䊏 2003: The ASCA National Model: A Framework for School Counseling Programs
is published. ASCA collaborated with the Education Trust to infuse the themes of
the Transforming School Counseling Initiative—advocacy, leadership, and sys-
temic change—throughout the document.

䊏 Professionalism for School Counselors

The premier professional association for school counselors, the ASCA is a division
of the American Counseling Association (ACA). This worldwide organization was
founded in 1952 and represents more than 18,000 professional school counselors
from pre-K to the college campus. With a motto of “One Vision, One Voice,” the
ASCA mission is to promote professionalism and ethical practices while focusing
on professional development and researching effective practices aimed at improv-
ing school counseling programs (ASCA, 2004a).

See Chapter 3 for more information about professionalism in school counseling.

364 What Are the Essential Elements of Counseling? PART TWO

Check out the ASCA Web site for more information about this pro-
fessional organization:
䉴 www.schoolcounselor.org
䉴 Or call (703) 683-ASCA (2722).

ASCA NATIONAL STANDARDS

The ASCA National Standards were developed in response to the GOALS 2000
(1994): Educate America Act and serve as the “single most legitimizing document
in the [school counseling] profession” (Bowers, Hatch, & Schwallie-Giddis, 2001).
The standards define what students should know and be able to do as the result of
participating in a comprehensive, developmental K–12 school counseling program
(Campbell & Dahir, 1997). Additionally, the National Standards served as the
groundwork for the development of a national, comprehensive model for school
counselor programs that today is known as the ASCA National Model. The goals of
the National Standards include the following:

1. Promote equitable access to school counseling programs and services for all
students.
2. Establish similar goals and expectations for all students.
3. Identify and prioritize the key content components for school counseling pro-
grams.
4. Position school counseling as an integral component of the academic mission
of the school.
5. Identify the knowledge and skills that all students should acquire as a result of
the pre-K through Grade 12 school counseling programs.
6. Ensure that school counseling programs are comprehensive in design and de-
livered in a systematic fashion for all students (Campbell & Dahir, 1997).

The ASCA National Standards address three domains of student development: ac-
ademic development, career development, and personal and social development.
Within each domain, three specific standards outline student competencies and in-
dicators expressed as specific knowledge, attitudes, or skills obtainable as a result
of participating in the school counseling program.

䊏 Domain 1: Academic Development

The program standards for academic development guide the school counseling
program to implement strategies and activities to support and maximize each stu-
dent’s ability to learn (Campbell & Dahir, 1997). Academic development helps stu-
dents achieve the attitudes, knowledge, and skills necessary to negotiate the land-
scape and landmines to succeed in schools.
CHAPTER SEVENTEEN Fundamentals of Professional School Counseling 365

Standards for Academic Development

1. Standard A: Students will acquire the attitudes, knowledge, and skills that con-
tribute to effective learning in the classroom.
2. Standard B: Students will complete school with the academic preparation es-
sential to choose from a wide variety of substantial postsecondary options, in-
cluding college.
3. Standard C: Students will understand the relation of academics to the world of
work, and to life at home and in the community.

EXAMPLE

Putting Domain 1 Standards Into Practice

Sample activities to address the standards for academic development include the following.

䊏 Elementary: A classroom lesson focusing on development of a “Can do” attitude utilizing the
book The Little Engine That Could by Watty Piper and age-appropriate activities meets Stan-
dard A.
䊏 Middle school: A classroom lesson developed collaboratively with the math teacher estimat-
ing, calculating, and graphing present levels of time spent devoted to academic enhance-
ment activities compared with leisure activities, including analysis and discussion of the re-
sults, meets Standards A and C.
䊏 High school: Individual academic advisement and credit review sessions with students to de-
termine course selection in accordance with postsecondary plans meets Standard B.

䊏 Domain 2: Career Development

The program standards for career development guide the school counseling pro-
gram to provide the foundation for the acquisition of skills, attitudes, and knowl-
edge that enable students to make a successful transition from school to the world
of work, and from job to job across the life span (Campbell & Dahir, 1997).

Standards for Career Development

1. Standard A: Students will acquire the skills to investigate the world of work in
relation to knowledge of self and to make informed career decisions.
2. Standard B: Students will employ strategies to achieve future career success and
satisfaction.
3. Standard C: Students will understand the relation among personal qualities, ed-
ucation and training, and the world of work.
366 What Are the Essential Elements of Counseling? PART TWO

EXAMPLE

Putting Domain 2 Standards Into Practice

Sample activities to address the standards for career development include the following.

䊏 Elementary: A classroom lesson focusing on the relation between personal qualities and the
world of work utilizing the book How Santa Got His Job by Stephen Krensky meets Standards
A and C.
䊏 Middle school: A program in which students complete interview forms by choosing three
presenters at the school’s career exploration day meets Standard A and C.
䊏 High school: The completion of a career portfolio over 4 years meets Standards A, B, and C.

䊏 Domain 3: Personal and Social Development

The program standards for personal and social development guide the school
counseling program to provide the foundation for personal and social growth as
students progress through school and into adulthood (Campbell & Dahir, 1997).

Standards for Personal and Social Development

1. Standard A: Students will acquire the attitudes, knowledge, and interpersonal
skills to help them understand and respect self and others.
2. Standard B: Students will make decisions, set goals, and take appropriate action
to achieve goals.
3. Standard C: Students will understand safety and survival skills. (All standards
are reprinted by permission of the ASCA.)

EXAMPLE

Putting Domain 3 Standards Into Practice

Sample activities addressing the standards for personal and social development include the
following.

䊏 Elementary: A classroom lesson focusing on strategies to deal with teasing utilizing the book
Simon’s Hook by Karen Burnett meets Standards A, B, and C.
䊏 Middle school: School-wide adoption of a peer mediation program for resolving conflicts be-
tween students meets Standards A and B.
䊏 High school: Collaboration with English teachers to develop a unit on effective communica-
tion skills focusing on active listening and “I” messages meets Standards A and B.
CHAPTER SEVENTEEN Fundamentals of Professional School Counseling 367

The complete National Standards for Students are available from

ASCA:
䉴 www.schoolcounselor.org

ASCA NATIONAL MODEL

The ASCA National Model was created to assist school districts in designing
school counseling programs that support the academic success of every student.
The model itself serves as a framework for the development of a comprehensive
school counseling program, taking into account individual state and local needs.
The concept of the comprehensive school counseling program was developed by
Gysbers and Moore (1981) and refined over the past 20 years by Gysbers and
Henderson (2000). The ASCA National Model supports the overall mission of
schools by promoting student achievement, career planning, and personal and so-
cial development for every student. In this model, the school counselor is defined
as the program coordinator with an emphasis on counselor advocacy, collabora-
tion, and leadership skills to effect systemic change. Finally, the design, develop-
ment, implementation, and evaluation of a school counseling program are accom-
plished through effective collaboration with students, parents, faculty,
administrators, and community, business, and higher education partners.

The ASCA National Model was created to assist

school districts in designing school counseling
programs that support the academic success of
every student. The model itself serves as a
framework for the development of a
comprehensive school counseling program,
taking into account individual state and
local needs.

To operationalize the overall goals of school counseling programs, the compre-

hensive model has an organizational structure that consists of four components
(Gysbers & Henderson, 2000) adopted in the ASCA National Model (2003, 2005a).
The four interrelated components that are the core of the model are foundation, de-
livery system, management system, and accountability. The model also accounts
for the skills of leadership, advocacy, collaboration, and working toward systemic
change as key philosophies and transformed skills (Education Trust, 1997), all criti-
368 What Are the Essential Elements of Counseling? PART TWO

FIGURE 17.1 ASCA National Model. Reprinted by permission of the ASCA.

cal to the new mission of school counselors. See Figure 17.1 for a depiction of the
National Model as developed by the ASCA (2003, 2005a).

䊏 The Foundation

The component of the model called the foundation addresses the belief and mis-
sion that every student will benefit from the school counseling program; it also
houses the National Standards for School Counseling Programs, the foundation of
the counseling program.

䊏 The Delivery System

The aspect of the model known as the delivery system defines several ways in
which counselors can implement a standards-based program with students, such
as teaching through a counseling curriculum, individual planning with students,
CHAPTER SEVENTEEN Fundamentals of Professional School Counseling 369

and utilizing intervention, prevention, and responsive services. There are a num-
ber of components that comprise the delivery system.

Components of the Delivery System

1. Guidance curriculum is developmental, systematic programming delivered in
classroom or small-group format and includes parent workshops. The sug-
gested time for counselors to devote to guidance curriculum is 35% to 40% in
an elementary school, 25% to 35% in a middle or junior high school, and 15% to
25% in a high school.
2. Responsive services include individual and group counseling, crisis intervention
counseling, consultation, referral, and peer facilitation. The suggested time for
counselors to devote to responsive services is 30% to 40% in an elementary
school, 30% to 40% in a middle or junior high school, and 25% to 35% in a high
school.
3. Individual student planning for individuals or groups of students includes ad-
visement, assessment, placement, and evaluation of individual learning and
attainment of academic, career, and personal and social competencies. The sug-
gested time for counselors to devote to individual planning is 5% to 10% in an
elementary school, 15% to 25% in a middle or junior high, and 25% to 35% in a
high school.
4. System support is the establishment, maintenance, and evaluation of the school
counseling program, including professional development of self and staff,
community and public relations, district committees, consultation, and collab-
oration. Leadership and advocacy skills are used to promote systemic change.
The suggested time for counselors to devote to system support is 10% to 15% in
an elementary school, 10% to 15% in a middle or junior high school, and 15% to
20% in a high school.

䊏 The Management System

The management system is the part of the national model that deals with organiza-
tional processes and tools needed to deliver a comprehensive school counseling
program. Included in this component are activities such as principal–counselor
partnership plans, annual calendar, advisory council, and time and task analysis. It
is the “who” and “when” of the counseling program.

Components Addressed by the Management System

䊏 Management agreements.
䊏 Action plans.
䊏 Advisory council.
䊏 Use of time.
䊏 Use of data.
䊏 Calendars.
370 What Are the Essential Elements of Counseling? PART TWO

䊏 The Accountability System

The accountability system is the facet of the national model that addresses the eval-
uation of the effectiveness of the school counselor’s work in measurable terms,
such as impact over time, performance evaluation, and a program audit. It answers
the question, “How are students different as a result of the school counseling pro-
gram?”

Some Measurable Means of Evaluating Counselors’ Effectiveness

䊏 Results reports—impact over time.
䊏 Program audits.
䊏 School counselor performance standards.

䊏 Programmatic Approach: A New Paradigm for School Counseling

The national model has shifted the focus of counseling from a student-by-student
system of service delivery to a programmatic approach that is comprehensive and
developmental. Through system support and collaboration with other profession-
als in the school building, school counselors influence policies and practices, and
they advocate for students and the counseling program.

䊏 Collaboration and Systemic Support

School counselors are most successful when they engage others in the process of
supporting every student in achieving his or her academic, career, and personal
and social development. Furthermore, how successful a school or district is in
reaching its improvement goals is highly dependent on the degree to which all
school members collaborate and work as a team toward those goals. In a district
with a comprehensive school counseling program, administration, faculty, staff,
families, and community partners understand they have explicit roles and respon-
sibilities in the program to ensure that every student benefits. Everyone interacts to
assist students in achieving their goals.

Roles and Responsibilities of School Organization Personnel and Students

䊏 School counselors provide proactive leadership to ensure that every student can
succeed. They manage the comprehensive program and coordinate strategies
and activities with others (teachers, support staff, parents, community agencies,
business representatives) to meet the stated goals, standards, and competencies.
䊏 Teachers are partners with school counselors. They develop and infuse guidance
activities that are integral to good learning rather than extraneous, disconnected,
or added material into the instructional program. Teachers can team or coteach
CHAPTER SEVENTEEN Fundamentals of Professional School Counseling 371

with counselors in the classroom. They may also serve as advisors or mentors to
students.
䊏 Students participate actively and assume responsibility for meeting the counsel-
ing standards and competencies. They can identify the skills, knowledge, and at-
titudes that they have gained in structured counseling sessions. Students and
their families, working individually with counselors, develop learning plans for
school and plan for life after high school.
䊏 Pupil personnel services collaborate and team with the school counselors to en-
sure that school psychologists, school social workers, school nurses, student as-
sistance counselors, and other support personnel are actively involved in sup-
porting each student’s academic, career, and personal and social development.
They assist students with mental, physical, and social issues. They support stu-
dents and families by providing in-school services, or referrals or information re-
garding outside agencies.

Specific counselor attitudes, knowledge, and skills facilitate the school coun-
selor’s positive impact on classrooms, schools, and families that most affect student
development. School counselors must demonstrate strong communication, consul-
tation, and leadership skills to effect systemic change. Together, the comprehensive
program and the “new vision” skills of the school counselors will transform the
school counseling program.

For a more detailed description of the National Model visit the ASCA
Web site at:
䉴 www.schoolcounselor.org

THE TRANSFORMING SCHOOL COUNSELING INITIATIVE

The Education Trust, with support from the Dewitt-Wallace Reader’s Digest Fund,
began work in 1996 to identify what school counselors need to know to help all stu-
dents succeed academically. A group of universities were funded to partner with
the Education Trust to redesign counselor education programs to prepare school
counselors as advocates, leaders, and systemic change agents in school improve-
ment. The goals of the Transforming School Counseling Initiative (Education
Trust, 1997) include those listed next.

Goals of the Transforming School Counseling Initiatives

䊏 Point counselors in the direction of improving academic achievement and elimi-
nating the achievement gap.
372 What Are the Essential Elements of Counseling? PART TWO

䊏 Connect school counseling to each school district’s mission and goals of school
improvement.
䊏 Provide school counselors with the tools to develop school counseling programs
that include student competencies and outcomes based on the national stan-
dards (Campbell & Dahir, 1997) and aligned with state and district curriculum
standards.
䊏 Encourage school counselors to use data to develop measurable student out-
comes. School counselors use school-based data to work collaboratively toward
the goals of school improvement (Stone & Dahir, 2006a).

䊏 Implications for School Counselor Practice

In 2003, the Education Trust and MetLife Foundation established the National Cen-
ter for Transforming School Counseling to deliver focused professional develop-
ment to practicing school counselors and help all students achieve at high aca-
demic levels of success. The Transforming School Counseling initiative, with its
more systemic approach to school counseling, resulted in a number of practical
changes in the day-to-day practice of school counseling. Table 17.1 summarizes
these changes.
Transformed school counselors deliver comprehensive school counseling pro-
grams by applying these skills in a “new vision” manner. In the following sections
we provide a concise overview of the transforming role of school counselors as un-
derstood from the Transforming School Counselors Initiative.

TABLE 17.1
Differences in Traditional and Transformed School Counselor Practices

The Practice of the Traditional School Counselor The Practice of the Transformed School Counselor
(Service-Driven model) (Data-Driven and Standards-Based Model)

• Counseling • Counseling
• Consultation • Consultation
• Coordination of services • Coordination of services
• Leadership
• Advocacy
• Collaboration and teaming
• Managing resources
• Use of data
• Use of technology

Education Trust (1997) and Stone and Dahir (2006b).

䊏 The Counseling Process

Counseling in schools is the process of assisting a student in understanding, assess-

ing, and making a change in behavior. Students learn to make decisions to further
CHAPTER SEVENTEEN Fundamentals of Professional School Counseling 373

improve their ability to achieve academic, career, and personal and social success
in school (Stone & Dahir, 2006a). The combination of individual and group counsel-
ing increases the total number of student and counselor interactions.

䊏 Consultation

Consultation with teachers, administrators, and parents provides powerful solu-

tions to improve the educational experience for all students. Whether in the class-
room or in the conference room, collaboration offers a structure to identify issues
and a team to find answers.

䊏 Coordination of Services

Coordination of services allows school counselors to manage and access resources

for all students and families. Through community outreach, school counselors col-
laborate with agencies to provide a variety of services and opportunities to stu-
dents and their families. These include mental health support, family counseling,
wellness workshops, employment, volunteer positions, and service learning place-
ments.

䊏 Leadership

Leadership encourages school counselors to examine the climate of a school to en-

sure a positive environment where all students can achieve academic, career, and
personal and social success. As leaders, they have the primary responsibility for
the comprehensive school counseling program. By participating in the School Im-
provement Team, district advisory boards, school safety teams, curriculum com-
mittees, or other decision-making bodies, school counselors help ensure that all
district plans include school counseling programs.

䊏 Advocacy

Advocacy is a way of life. School counselors advocate for the students they serve. All
students need advocates, especially those who do not have the skills to self-advocate
and who are at risk for dropping out of school. School counselors work diligently for
systemic change to eliminate practices that inhibit or stratify student opportunity.

䊏 Collaboration and Teaming

Collaboration and teaming is important with all school community members.

Counselors collaborate most closely with teachers to deliver the school counseling
curriculum to all students. In-service days or faculty meetings are the perfect ven-
374 What Are the Essential Elements of Counseling? PART TWO

ues to present information on the many aspects of the comprehensive school coun-
seling program, including topics such as preventing bullying and sexual harass-
ment. Teaming and collaboration demonstrates to members of the school
community that the school counseling program supports each student in achieving
her or his goals.

䊏 Managing Resources

Managing resources requires school counselors to serve as liaisons among teach-

ers, parents, support personnel, and community resources to facilitate successful
student development. School counselors secure the appropriate and necessary ser-
vices and supports that are essential to every student’s ability to achieve.

䊏 Use of Data

Use of data creates a picture of student needs and provides an accountable way to
align the school counseling program with the school’s academic mission. NCLB
asks school counselors to demonstrate accountability and the impact of their work
on student achievement (Stone & Dahir, 2006a). In this climate of accountability,
connecting the work of school counselors to school improvement data is the most
powerful indicator of the success of the school counseling program.

SCHOOL COUNSELING IN THE 21ST CENTURY

Professional school counselors play a vital role in maximizing student achievement

and helping every student achieve success that ultimately will lead to high school
graduation and the availability of a wide variety of postsecondary options on grad-
uation (Campbell & Dahir, 1997).

䊏 Functions and Responsibilities of the School Counselor

The complex scope of practice of the professional school counselor encompasses a

variety of functions and responsibilities. These include, but are not limited to, the
responsibilities mentioned here.

Tasks of School Counselors

䊏 Individual and group counseling.
䊏 Classroom guidance lessons.
䊏 Individual educational planning.
CHAPTER SEVENTEEN Fundamentals of Professional School Counseling 375

䊏 Career exploration and planning.

䊏 Crisis intervention.
䊏 Advocacy for special-needs students.
䊏 Assessment and interpretation.
䊏 Staff development.
䊏 Program planning.
䊏 Multicultural awareness training.
䊏 Consultation with parents, teachers, administrators, and mental health agencies.

Demands on time and services are often unrealistic when counselor-to-student

caseloads can exceed 1:1,500. ASCA promotes the ideal ratio of 1:100, with 1:300
considered the maximum recommended ratio and 1:250 being the standard recom-
mendation (ACA, 2001). The counselor-to-student ratio in the United States for the
2003–2004 school year was 1:488 (ASCA, 2006).

䊏 The Transformed School Counselor

ASCA and the Education Trust have called for a shift in the role of the professional
school counselor. School counselors no longer are seen simply as service providers;
rather, they are responsible for promoting optimal achievement for all students
(Clark & Stone, 2000; Martin, 1998). The transformed skills of advocacy, leadership,
collaboration and teaming, and use of data in addition to the art and science of
counseling are essential to the successful delivery of the comprehensive school
counseling program. Professional school counselors, rooted in the past, have taken
hold of the present and continue to define the future.

Chapter 17: Key Terms

䉴 ASCA National Standards 䉴 Personal and social 䉴 Transforming school
䉴 ASCA National Model development counseling
䉴 Academic development 䉴 Comprehensive school
䉴 Career development counseling program
 chapter Approaches to Family Counseling

18 Stephanie D. Helsel
Duquesne University

In This Chapter

䉴 Behavioral and Cognitive-Behavioral 䉴 Experiential Family Therapy

Family Therapy 䊏 Key Concepts in Experiential Therapy
䊏 Key Concepts in Behavioral and 䊏 Role of Therapist in Experiential Therapy

Cognitive-Behavioral Therapy 䊏 Goals of Treatment in Experiential

䊏 Role of Therapist in Behavioral and Therapy

Cognitive-Behavioral Therapy 䊏 Therapeutic Techniques in Experiential

䊏 Goals of Treatment in Behavioral and Therapy

Cognitive-Behavioral Therapy 䊏 Strengths and Limitations of Experiential

䊏 Therapeutic Techniques in Behavioral and Therapy

Cognitive-Behavioral Therapy
䊏 Strengths and Limitations of Behavioral 䉴 Feminist Family Therapy
and Cognitive-Behavioral Therapy 䊏 Key Concepts in Feminist Therapy
䊏 Role of Therapist in Feminist Therapy

䉴 Bowenian Family Therapy 䊏 Goals of Treatment in Feminist Therapy

䊏 Key Concepts in Bowenian Therapy 䊏 Therapeutic Techniques in Feminist

䊏 Role of Therapist in Bowenian Therapy Therapy

䊏 Goals of Treatment in Bowenian Therapy 䊏 Strengths and Limitations of Feminist

䊏 Therapeutic Techniques in Bowenian Therapy

Therapy
䊏 Strengths and Limitations of Bowenian 䉴 Psychodynamic Family Therapy
Therapy 䊏 Key Concepts in Psychodynamic Therapy
䊏 Role of Therapist in Psychodynamic

䉴 Constructivist Family Therapy Therapy

䊏 Key Concepts in Constructivist Therapy 䊏 Goals of Treatment in Psychodynamic

䊏 Role of Therapist in Constructivist Therapy

Therapy 䊏 Therapeutic Techniques in Psychodynamic

䊏 Goals of Treatment in Constructivist Therapy

Therapy 䊏 Strengths and Limitations of

䊏 Therapeutic Techniques in Constructivist Psychodynamic Therapy

Therapy
䊏 Strengths and Limitations of

Constructivist Therapy

376
In This Chapter (continued)

䉴 The Satir Growth Model of Family Therapy 䉴 Strategic Family Therapy

䊏 Key Concepts in the Satir Growth Model 䊏 Key Concepts in Strategic Therapy
䊏 Role of Therapist in the Satir Growth 䊏 Role of Therapist in Strategic Therapy

Model 䊏 Goals of Treatment in Strategic Therapy

䊏 Goals of Treatment in the Satir Growth 䊏 Therapeutic Techniques in Strategic Therapy

Model 䊏 Strengths and Limitations of Strategic

䊏 Therapeutic Techniques in the Satir Therapy

Growth Model
䊏 Strengths and Limitations of the Satir 䉴 Structural Family Therapy
Growth Model 䊏 Key Concepts in Structural Therapy
䊏 Role of Therapist in Structural Therapy

䉴 Solution-Focused Brief Family Therapy 䊏 Goals of Treatment in Structural Therapy

䊏 Key Concepts in Solution-Focused Brief 䊏 Therapeutic Techniques in Structural

Therapy Therapy
䊏 Role of Therapist in Solution-Focused 䊏 Strengths and Limitations of Structural

Brief Therapy Therapy

䊏 Goals of Treatment in Solution-Focused

Brief Therapy 䉴 Systemic Family Therapy

䊏 Therapeutic Techniques in 䊏 Key Concepts in Systemic Therapy
Solution-Focused Brief Therapy 䊏 Role of Therapist in Systemic Therapy

䊏 Strengths and Limitations of 䊏 Goals of Treatment in Systemic Therapy

Solution-Focused Brief Therapy 䊏 Therapeutic Techniques in Systemic Therapy

䊏 Strengths and Limitations of Systemic

Therapy

377
378 What Are the Essential Elements of Counseling? PART TWO

BEHAVIORAL AND COGNITIVE-BEHAVIORAL FAMILY THERAPY

Behavior therapy has been used in family settings since the 1970s. However, its im-
pact on the field did not become significant until the 1980s, when cognitive princi-
ples were incorporated into behavioral techniques informed by learning theory
(Nichols & Schwartz, 2004). There are few contemporary behaviorists who apply
only behavioral techniques, and most utilize a combined cognitive-behavioral ap-
proach that draws on the work of Beck and Ellis. Due to the ease with which
thoughts and behavior can be observed or rated, this approach enjoys scientific evi-
dence of its efficacy with a wide range of populations and problems.

䊏 Key Concepts in Behavioral and Cognitive-Behavioral Therapy

How people perceive their environment determines how they experience it. Be-
liefs, attitudes, and behaviors are generated based on assumptions about one’s
family and world (Mytton, 2000; Nichols & Schwartz, 2004). Some of the central
ideas in cognitive-behavioral family therapy include the following:

Reinforcement: If a behavior is immediately followed by a positive event or

experience, the likelihood of that behavior recurring is increased (Lovell,
2000).

Empirical dictates: Interventions clinically proven to alter problematic be-

havior or thoughts that are used during therapy (Kalodner, 1995).

Outcome goals: Desired changes that are clearly defined as the goals of ther-
apy. Progress toward outcome goals is often tracked by assessments that are
completed throughout treatment.

䊏 Role of Therapist in Behavioral and Cognitive-Behavioral Therapy

Therapists focus on how the problem has an impact on the family in the present
moment, even if the cause of the behavior is based on a past experience or event
(Lovell, 2000). There are a number of approaches counselors can use to help fami-
lies make concrete changes.

Therapist Strategies
䊏 The counselor works collaboratively with the family to define the problem and
determine therapeutic goals and strategies that will help achieve desired out-
comes (Lovell, 2000).
䊏 The therapist focuses on how the family reinforces problem behavior rather than
on the problematic behavior specifically (Nichols & Schwartz, 2004).
CHAPTER EIGHTEEN Approaches to Family Counseling 379

䊏 The therapist educates the family as to the role that thoughts play in behavior
and emotion and provides instructions on how to monitor thoughts and modify
beliefs or behavior (Mytton, 2000).
䊏 The therapist provides communication and problem-solving skills training as
needed (Dattilio, Epstein, & Baucom, 1998).

䊏 Goals of Treatment in Behavioral and Cognitive-Behavioral Therapy

Changing the way family members act as well as their dysfunctional attitudes or
beliefs are central to cognitive-behavioral family therapy. A number of facets char-
acterize this broad goal.

Goals of Cognitive-Behavioral Family Therapy

䊏 Facilitating the family’s ability to see patterns of behavior and to understand the
interaction among cognitions, emotions, and behavior (Kalodner, 1995).
䊏 Extinguishing problem behavior and increasing positive responses (Nichols &
Schwartz, 2004).
䊏 Improving each partner’s level of functioning to improve the overall relation-
ship (Weiss & Perry, 2002).

䊏 Therapeutic Techniques in Behavioral and Cognitive-Behavioral Therapy

To help families change their maladaptive attitudes and interactions, the following
techniques may be utilized.

Cognitive-Behavioral Techniques
䊏 Problematic behaviors or thought patterns are measured initially and through-
out the therapeutic process to mark progress (Whisman & Weinstock, 2002).
䊏 Through Socratic questioning, reframing, and reality testing, therapists chal-
lenge distorted ideas, thoughts, and behaviors and encourage families to try on
new perspectives and ideas (Mytton, 2000).
䊏 Material and social reinforcements, modeling, differential attention, and cou-
nterconditioning are used in behavioral parent training (Krumboltz & Thoresen,
1969).
䊏 Family members are challenged to take turns offering positive reinforcement for
others’ attempts at behavior change.
䊏 Couples negotiate specific behaviors that each will change (Nichols & Schwartz,
2004).
380 What Are the Essential Elements of Counseling? PART TWO

䊏 Strengths and Limitations of Behavioral and Cognitive-Behavioral Therapy

Behavioral and cognitive-behavioral techniques have been found to be effective for

the treatment of several kinds of problems, including marital discord (Lovell,
2000). Assessment and evaluation methods whose reliability and validity have
been empirically examined are also an asset in cognitive-behavioral treatment
(Whisman & Weinstock, 2002).
There are a number of limitations of cognitive-behavioral work. First, more re-
search is necessary to ascertain whether or not irrational or distorted beliefs are the
cause of emotional disturbance rather than a symptom of such feelings (Dryden,
2000). Moreover, feelings and attitudes do not always change as a result of behavior
alteration, and treatment goals may be reached without resolving underlying nega-
tive emotions (Nichols & Schwartz, 2004). Finally, cognitive-behavioral and behav-
ioral approaches have received criticism for the lack of emphasis on insight or past
experiences and because problems are addressed without understanding the con-
text within which they developed (Kalodner, 1995).

BOWENIAN FAMILY THERAPY

Bowen is known as one of the founders of family therapy. He was the fist to exam-
ine family relationships from within the context of individual family member de-
velopment (Knudson-Martin, 2002). He emphasized the importance of being emo-
tionally connected to loved ones while maintaining independence of the self
(Skowron, 2004). Bowen also examined the multigenerational nature of family dys-
function and encouraged people to investigate their family history to understand
the context within which current patterns evolved. His primary focus was the emo-
tional system within a family, and, specifically, whether or not members were too
close and involved or too separate and closed off from one another.

䊏 Key Concepts in Bowenian Therapy

In Bowenian therapy, dysfunction is thought to be passed from one generation to

the next through communication styles, ways of relating, and the degree of emo-
tional connection between family members. Understanding Bowenian therapy ne-
cessitates a general appreciation of the following concepts:

Adaptability: The degree to which a person is able to manage life stress is de-
pendent on the degree to which a person is emotionally dependent on others;
attempting to manage stress by emotional dependence can lead to predictable
problems (Bowen, 1976b).
CHAPTER EIGHTEEN Approaches to Family Counseling 381

Differentiation: The process of becoming an individual self who is not de-

fined by family roles or expectations; the outcome of this process is emotional
and intellectual clarity and low levels of anxiety (Skowron, 2004).

Triangulation: A basic, stable relationship system that can be healthy or un-

healthy; unhealthy triangles form when family members lower stress by pro-
jecting the anxiety between two people onto a third person or thing.

Sibling position: Personality characteristics that are consistent with birth or-
der and used to describe sibling position; failure to display the expected per-
sonality characteristics of birth order is attributable to family projections and
triangulations (Bowen, 1976b).

䊏 Role of Therapist in Bowenian Therapy

The primary role of the therapist is to help family members become aware of family
patterns of behavioral and emotional relating. Therapists increase awareness
through asking appropriate questions, working with genograms, and encouraging
emotional and intellectual autonomy of members.

Bowenian Therapist Characteristics

䊏 The therapist has gone successfully through a process of differentiation; that is,
the therapist has resolved his or her own family issues and is able to remain neu-
tral, objective, and rational.
䊏 Therapists are able to educate, coach, model behavior, and use Socratic question-
ing techniques.
䊏 Therapists are capable of supporting the primary dyad (the couple) and disallow
any attempts to be triangulated by them.

䊏 Goals of Treatment in Bowenian Therapy

A primary aim of Bowenian therapy is for family members to be objective and ra-
tional even in the midst of one another’s emotionality. Members work toward re-
maining connected to one another in a supportive and autonomous manner (Kerr,
1985). Other goals include those listed here.

Bowenian Treatment Goals

䊏 Gaining insight into multigenerational patterns that influence current relation-
ships.
䊏 Allowing differentiation among family members so that each individual mem-
ber can express his or her own personality and become autonomous.
382 What Are the Essential Elements of Counseling? PART TWO

䊏 Resolving projections and triangulations.

䊏 Helping family members remain calm in the face of other members’ emotionality
and resolve conflicts using intellect rather than emotional reactivity.

䊏 Therapeutic Techniques in Bowenian Therapy

One of the purposes of techniques in the Bowenian approach is to help the therapist
examine the tension between family members’ basic desire for connection and
community and the developmental process of becoming individuals. Therapists
support self-differentiation by teaching communication skills and assertiveness.
Therapy also focuses on stress management and upholding personal boundaries
(Bowen, 1985). Some of the following techniques are used during the therapeutic
process.

Bowenian Techniques
䊏 Constructing genograms that graphically represent multiple generations of the
family and the nature of the relationships between different members.
䊏 Encouraging family members to talk directly to one another rather than to the
therapist about their relationships.
䊏 Asking questions that help members differentiate between thoughts and feelings
and bring awareness to communication patterns (Bowen, 1976a).
䊏 Focusing primarily on the couple to help them become a team and calling on
other dyads or triads as needed to resolve issues affecting the family (Bowen,
1985).

䊏 Strengths and Limitations of Bowenian Therapy

A strength of Bowenian family therapy is that techniques are straightforward and

practical. Members are encouraged to investigate their families of origin and un-
derstand the genesis of family patterns as a way to create a foundation for change
and forgiveness (Gladding, 2002a). Empirical support also has been found for the
relations among key concepts in this approach such as marital satisfaction, psycho-
logical well-being, anxiety, and degree of differentiation (Miller, Anderson, &
Keala, 2004; Skowron, 2000).
A criticism of Bowen’s approach is that the emphasis on differentiation may not
be applicable to cultures in which interdependence is highly valued (McDermott,
1989). Feminist critiques posit that Bowen uses male standards to define healthy
functioning and does not value the ways in which women typically relate to others
(Knudson-Martin, 1994). Finally, there is no structure or system for developing re-
lational capacities, which falsely implies that the process of differentiation devel-
ops such abilities (Knudson-Martin, 2002).
CHAPTER EIGHTEEN Approaches to Family Counseling 383

CONSTRUCTIVIST FAMILY THERAPY

The constructivist orientation is one of several postmodern reexaminations of the

nature of knowledge, learning, and meaning making. In the constructivist perspec-
tive, the notions of scientific objectivity and external reality are rejected. Reality
consists primarily of one’s subjective experiences, interactions, cultural and lin-
guistic influences, and cognitions. Key concepts in this movement draw on Piaget’s
developmental theories and Erickson’s therapeutic techniques; philosophers such
as Kant and Husserl are also central figures.

䊏 Key Concepts in Constructivist Therapy

From the constructivist position, there is no objective reality; each person creates
his or her own worldview through experiences, memories, imaginations of the fu-
ture, and, in the case of social constructionism, interpersonal relationships. It is
through language that thoughts are conceptualized and processed. Because people
perceive rather than just observe, the distinctions that are assigned to constructs,
such as male and female, are arbitrary and not necessarily “real” in a definitive
sense (Burr, 1995). Finally, action is derived from constructed knowledge; there-
fore, behavior is believed to be influenced by perceptions, which are culture bound
(Burr, 1995).

䊏 Role of Therapist in Constructivist Therapy

A basic posture that therapists adopt in constructivist family therapy is to respect

clients while still challenging their assumptions. Two primary tasks the leader un-
dertakes are the following:

1. Creating a therapeutic alliance with the client devoid of a power hierarchy so

that the client can be a partner in solution formulation (Hoyt, 1994).
2. Examining and testing clients’ beliefs, thoughts, and language.

䊏 Goals of Treatment in Constructivist Therapy

The goals of treatment are very closely linked with the principal concepts of
constructivism; they reflect an inherent respect for the client’s worldview and real-
ity and include the following.

Goals of Constructivist Family Therapy

䊏 Supporting change through collaborative discourse that respects the client’s val-
ues and reality.
䊏 Allowing the client to dictate what changes will occur and what solutions will be
applied to problems.
384 What Are the Essential Elements of Counseling? PART TWO

䊏 Therapeutic Techniques in Constructivist Therapy

To assist clients in developing new, positive meanings that lead to change, some of
the following techniques may be used in constructivist family therapy.

Reframing: Offering a different perspective, usually a positive interpretation,

of what the client has presented (Held, 1990).

Externalization: Conceptualizing problems as separate from the family to

free members from the belief that they are problematic (Zimmerman &
Dickerson, 1994).

Narrative or dramatic reenactment: Clients tell the story of their lives and
create new ones for a desired future; couples act out scenes written by their
partners to share perspectives and create new outcomes.

Reflecting team: A team of clinicians who observe family–counselor interac-

tions and provide a “diagnosis” of family problems. The family is privy to all
of the ideas and alternative viewpoints expressed by the team and is free to
choose an interpretation that fits (Haley, 2002).

Circular interviewing: Family members are questioned about how others in

the family connect to a problematic issue to illuminate a variety of perspec-
tives and highlight the systemic nature of problems (Omer, 1996).

䊏 Strengths and Limitations of Constructivist Therapy

A positive aspect of the constructive approach is that the emphasis on multiple

perspectives shifts the focus of therapy from pathologizing to empowerment
(Minuchin, 1998). Additionally, constructive therapies have been described as so-
cially responsible and appropriate for intercultural counseling, as therapists do not
impose their worldview on clients (Hare-Mustin, 1994).
Refusing to take a dominant position, however, minimizes the expertise of the
therapist and may leave clients feeling confused about the direction of therapy
(Hoyt, 1994; Minuchin, 1998). Relational patterns of the family also can be over-
shadowed in the attempt to ensure that family members have an equal opportunity
to voice their perceptions of reality (Minuchin, 1998). Finally, the concepts of con-
structivism (e.g., there is no definitive reality) at times seem paradoxical and con-
fusing in that discussions of how therapy is best practiced are in fact making a
claim that a certain reality is “better” than another (Held, 1990).
CHAPTER EIGHTEEN Approaches to Family Counseling 385

EXPERIENTIAL FAMILY THERAPY

Psychiatrist Carl Whitaker was a very dynamic, charismatic, and unconventional

personality who first began working with families in 1945. He developed a thera-
peutic system called symbolic-experiential family therapy. Based on existential
principles and philosophy, individuation is seen as a large part of the family ther-
apy process. As his practice progressed, he began engaging multiple generations in
his interventions. Despite the fact that Whitaker’s rather idiosyncratic, intuitive ap-
proach has proven to be difficult to replicate, proponents such as Keith and Napier
continue to utilize this approach with families (Framo, 1996).

䊏 Key Concepts in Experiential Therapy

Whitaker’s approach maintains a systems perspective and views both change and
causation as a circular process. Family therapy is seen as the ideal initial treatment
response, regardless of the problem (Whitaker & Keith, 1981). Two assumptions
characterize Whitaker’s model. First, problems are dealt with in the present. All
family conflict is brought into the “here and now” of the present moment
(O’Hanlon & Weiner-Davis, 1989). Second, resistance is an expressed preference.
Reflecting a conviction that the current situation is the best one available, resistance
is dealt with by “inducing desperation” into the family by offering to end therapy
(Whitaker & Keith, 1981, p. 214).

䊏 Role of Therapist in Experiential Therapy

The therapist seeks to cajole, inspire, or guide the family toward changing their be-
havior with one another. Insight is not believed to lead to change, but rather is seen
as a result of change.

Leader Tasks in Experiential Family Therapy

䊏 Taking an active and nondirective stance.
䊏 Providing initial structure and control that lessens as therapy continues.
䊏 Following the family’s lead at all times.
䊏 Becoming less directive as the family matures.
䊏 Pointing out absurd behavior, teasing the family toward change, and confront-
ing family members in a nonthreatening manner.

䊏 Goals of Treatment in Experiential Therapy

Linked with the existential concepts of balancing interconnectedness with individ-

ual expression, goals include the following (Whitaker & Keith, 1981).
386 What Are the Essential Elements of Counseling? PART TWO

Aims of Experiential Therapy

䊏 Initiating change in the largest possible system is facilitated by inviting extended
family members to the initial visit and working with multiple generations.
䊏 Increasing family creativity, “craziness,” and flexibility in problem solving.
䊏 Maintaining intergenerational and family and community boundaries, espe-
cially between parents and children.
䊏 Learning to play together as a family as a way to deal with the existential pres-
sures of family life.

䊏 Therapeutic Techniques in Experiential Therapy

Techniques that illuminate the unconscious behavior and “life” of the family are
used and families are encouraged to apply a playful attitude toward changing their
dynamics (Gladding, 2002a).

Existential Family Therapy Techniques

䊏 Anxiety is used as a motivating factor. Symptoms are reframed as system prob-
lems and multiple issues are brought to the family’s attention (Whitaker & Keith,
1981).
䊏 Play between parents and children is used during sessions to model affectionate
behavior or draw in an isolated parent (Napier & Whitaker, 1978).
䊏 Paradoxical statements in which the therapist argues for seemingly negative
goals or offers absurd treatment suggestions are used to counter resistance
(Napier & Whitaker, 1978).
䊏 Extended family members, such as grandparents, are asked to act as “cothera-
pists” when family treatment is stalled (Whitaker & Keith, 1981).

䊏 Strengths and Limitations of Experiential Therapy

There are a number of strengths of experiential family therapy. First, multiple gen-
erations can be transformed by recognizing the importance of the multigenera-
tional aspect of families and inviting extended family members into therapy. Addi-
tionally, nuclear families can learn to enlist the help of extended family members
when crises are encountered. Families also can learn to improve their interactions
and be playful and flexible in their roles (Napier & Whitaker, 1978). Finally, family
members can become more fully individuated while enhancing their sense of be-
longing within the family (Napier & Whitaker, 1978).
A drawback of experiential therapy is that because this therapy relies heavily on
the intuition and personality of the therapist, it can be difficult to teach (Framo,
1996). Playing with the family and using humor and absurdity when confronting
members can have negative affects on individual members (Whitaker & Keith,
1981).
CHAPTER EIGHTEEN Approaches to Family Counseling 387

FEMINIST FAMILY THERAPY

Feminist therapy seeks to uncover the hidden effects of power, gender, and preju-
dice on interpersonal relationships (Corey, 2001). It is related to other postmodern
perspectives in that it examines how knowledge is defined and owned in a given
culture. Spurred by the political feminist movement of the 1960s and 1970s, female
contributions to clinical and academic work have revealed sexism in the mental
health field (Libow, Raskin, & Caust, 1982). This approach has helped to expand
understanding of how external factors such as culture and world events affect indi-
vidual well-being and functioning and the ways in which bias and counselor val-
ues can impact the counseling experience.

Feminist therapy seeks to uncover the hidden

effects of power, gender, and prejudice on
interpersonal relationships (Corey, 2001). It is
related to other postmodern perspectives in
that it examines how knowledge is defined and
owned in a given culture.

䊏 Key Concepts in Feminist Therapy

Problems that occur between couples cannot be addressed successfully unless the
underlying inequality that exists between men and women is acknowledged and
counteracted (Carter, 1992). Two assumptions are central to feminist family ther-
apy. First, traditional gender roles are considered to be limitations both to men and
women. Thus, rigid expectations regarding parenting and the division of labor
must be expanded (Goldner, 1985). Second, therapy is most effective when it is cli-
ent centered. To guard against hierarchical thinking or the misuse of authority, the
client is considered to be the expert in his or her own experiences (Enns, 1997).

䊏 Role of Therapist in Feminist Therapy

The primary role of the therapist is to act as a guide or helper, eschewing the tradi-
tional hierarchical power structure. Therapists explore economic power, authority,
and control issues within the family in an egalitarian and nonhierarchical way
(Carter, 1992).

Tasks of Feminist Family Therapists

䊏 Therapists are expected to shift family alliances and change dynamics in accor-
dance with treatment goals rather than simply support the father as having final
authority (Enns, 1997).
388 What Are the Essential Elements of Counseling? PART TWO

䊏 Therapists model nonsexist behavior by encouraging independence, self-care,

and maintenance of appropriate boundaries (Libow et al., 1982).
䊏 Therapists are expected to maintain open and direct communication with clients;
indirect or manipulative techniques are not tolerated (Libow et al., 1982).

䊏 Goals of Treatment in Feminist Therapy

A main function of feminist family therapy is to empower clients and help families
to become more assertive. Clients are encouraged to expand their awareness of role
inequities in society and become more assertive in changing society, not just adjust-
ing to it (Libow et al., 1982). Specific goals of therapy include those listed next.

䊏 Treatment aims from a feminist perspective.

䊏 Facilitating flexibility in gender construction and family roles.
䊏 Educating family members of the external social and cultural forces that dictate
traditional gender roles and the effects of those forces on them (Enns, 1997).
䊏 Supporting equality for women in the workplace and at home (Etaugh &
Bridges, 2001).

䊏 Therapeutic Techniques in Feminist Therapy

To conduct therapy in a respectful and collaborative way, some of the following

techniques may be used in feminist family therapy.

Techniques of Feminist Family Therapy

䊏 Use contracts to negotiate goals, empower clients to take an active role in their
process and keep them informed about the counseling process (Enns, 1997;
Hare-Mustin, 1978).
䊏 Reframe or relabel to help the client think beyond traditional views of symptoms
or pathologies (Libow et al., 1982).
䊏 Model egalitarian negotiation practices and nonstereotypical ways of being in
the world for the client (Hare-Mustin, 1978).
䊏 Help the family negotiate their responsibilities so that there is an equal amount
of household work and parenting responsibilities delegated to the mother and
father (Hare-Mustin, 1978).

䊏 Strengths and Limitations of Feminist Therapy

To its credit, feminist critiques of family therapy have spawned examinations of

therapist bias and prejudice toward minority populations (May, 1998). In this
model, each family member is ensured equal or appropriate degrees of power and
CHAPTER EIGHTEEN Approaches to Family Counseling 389

respect. Additionally, members may experience greater satisfaction and quality of

life as a result of challenging traditional gender roles.
However, this approach is limited in that simplistic examinations of power rela-
tionships between men and women can lead to a limited perspective of women as
victims (Goldner, 1985). Moreover, feminist family therapists traditionally have not
included the realities of minority and impoverished women in the therapeutic pro-
cess (Etaugh & Bridges, 2001). Finally, gender sensitivity training has not typically
included discussions of the traditional male gender role and its limitations (Framo,
1996).

PSYCHODYNAMIC FAMILY THERAPY

Psychodynamic family therapy grew from the psychoanalytic tradition established

by Freud. The unconscious is seen as a motivating force for behavior, along with
basic drives such as sexuality or aggression. In psychodynamic family therapy, to
understand an individual, one must take into account the context within which an
individual was raised and how this plays out in the present. The family is seen as
the primary environment within which to work to effect change. This mode of
family therapy was first developed in the 1950s by analysts Klein, Adler, Kohut,
and Ackerman. Later well-known psychodynamic family therapists include
Boszormenyi-Nagy, Kernberg, Framo, and Skynner (Gladding, 2002a).

䊏 Key Concepts in Psychodynamic Therapy

The key concepts for psychodynamic family therapy involve the role that the un-
conscious plays in childhood development and adult interpersonal functioning.

Object relations theory: A means of explaining how people relate to others

based on early attachment experiences with a caregiver. The quality of our
connection to the loved ones in our early lives influences what we expect in
later life and explains how intergenerational relationships function (McGinn,
1998).

Transference: Occurs when the feelings an individual has for one person are
attributed to another person.

Splitting: Individuals perceive people as either “good” or “bad” if their early

experiences are unresolved (Nichols & Schwartz, 2004). These projections can
be distorted and keep people from fully recognizing and dealing with the
feelings behind these perceptions.
390 What Are the Essential Elements of Counseling? PART TWO

Projective identifications: The ways in which parents project unwanted as-

pects of their personalities onto their children, who in turn accept that iden-
tity and unconsciously agree to act out in such a way as to uphold those ex-
pectations (Nichols & Schwartz, 2004).

䊏 Role of Therapist in Psychodynamic Therapy

Psychoanalytic therapists work to slowly bring to the family’s awareness the

unconscious behavior patterns that are causing difficulties, starting with
intrapersonal aspects before moving on to interpersonal family processes (Framo,
1970).

Psychodynamic Family Therapist Tasks

䊏 Face personal unresolved issues related to family relationships to experience as
little countertransference as possible (Boszormenyi-Nagy & Spark, 1973; Segal,
2000).
䊏 Increase awareness of the projective identification that is being expressed in the
family (Nichols & Schwartz, 2004).
䊏 Assume the role of an imaginary parent to protect members from “interpersonal
danger” and provide support and other elements that the members need and
may never have gotten from their own parents (Ackerman, 1965/1982, p. 371).
䊏 Focus on that which is most resisted, side with each member in turn, and become
allies with different members at different times (Boszormenyi-Nagy & Spark,
1973).
䊏 Model healthy behavior, educate clients about aspects of the unconscious, and
act as a tool for reality testing (Ackerman, 1965/1982).

䊏 Goals of Treatment in Psychodynamic Therapy

The general goal for this approach is to resolve unconscious restrictions to allow
free and meaningful interactions within the family or the couple (Nichols &
Schwartz, 2004).

Goals of Psychodynamic Family Therapy

䊏 Eradicate dysfunctional dependence or withdrawal by restructuring each family
member’s personality (Nichols & Schwartz, 2004).
䊏 Resolve distorted fantasies developed in early childhood to perceive life realisti-
cally (Segal, 2000) and release other family members from idealized and pro-
jected identities (Framo, 1970).
CHAPTER EIGHTEEN Approaches to Family Counseling 391

䊏 Therapeutic Techniques in Psychodynamic Therapy

Rapport is valued as an essential tool in psychodynamic family therapy. Therefore,

the therapist takes time to build a solid therapeutic relationship that will withstand
challenge, confrontation, and restructuring (Segal, 2000). Once trust is established
in the therapeutic relationship, the counselor may employ a number of approaches
to bring unconscious and preconscious elements to consciousness.

Psychodynamic Therapeutic Techniques

䊏 Each member is asked to discuss his or her experiences as part of the family; par-
ents are asked about their families of origin (Framo, 1965).
䊏 Parents are encouraged to identify unresolved feelings and memories of child-
hood so that they can be released and allow parents to treat their own children
differently (Framo, 1965).
䊏 Counselors reflect on preconscious feelings and defenses and use dream analysis
to point out ways in which clients’ behavior is not congruent with what is out-
wardly communicated (Framo, 1965), ways in which families exercise scape-
goating, and ways they form alliances with and rescue one another (Ackerman,
1967; Frederickson, 1999).

䊏 Strengths and Limitations of Psychodynamic Therapy

An advantage of psychodynamic family therapy is that deep-seated conflicts and

pain are transformed, resulting in a more independent and high-functioning cou-
ple or family (Segal, 2000). Removing the camouflage that couples and families em-
ploy, such as the avoidance of intimacy, can create authentic and satisfying relation-
ships (Skynner, 1976; Wynne, Ryckoff, Day, & Hirsch, 1958).
A limitation of this approach, however, is that treatment is lengthy and expen-
sive, as families are seen for a year or longer. Techniques, such as dream analysis,
can become difficult if the family being counseled is large (Gladding, 2002a). This
approach also requires that counselors and families have the intellectual capacity
to understand concepts such as the unconscious and defense mechanisms
(Gladding, 2002a). Little empirical evidence exists to support the efficacy of psy-
chodynamic therapy (Segal, 2000).

THE SATIR GROWTH MODEL OF FAMILY THERAPY

Satir, creator of Conjoint Family Therapy, originally was a member of the Mental
Research Institute and worked with schizophrenic patients and their families. The
growth model focuses on communication patterns and structures and applies a
systems perspective to the family. The therapeutic relationship is used as a model
392 What Are the Essential Elements of Counseling? PART TWO

for family members, who are expected to engage in a process of maturation to in-
crease levels of functioning. Satir’s teachings are maintained today by the Avanta
Network, a nonprofit organization that promotes personal and community
well-being.

䊏 Key Concepts in the Satir Growth Model

Satir’s model is contextual, taking into account the prescribed rules and particular
communication styles of the family (Freeman, 1999). All behavior is seen as driven
by the same basic needs of survival, connection to others, and growth (Satir, 1983).
Along with the concept of universality, the five modes of communication are cen-
tral to Satir’s model and can be understood as follows (Satir, Stachowiak, &
Taschman, 1975).

Universality: Change occurs when therapeutic work is done within the con-
text of basic human needs, such as love and acceptance (Freeman, 1999).

Placating: Denying the self to agree with someone else.

Blaming: Declaring the self as in control and having power over others.

Super reasonable: Feelings are not acknowledged within the self or in others.

Irrelevant: Distracting the self and others by responding in a way that is not
related to the context of the situation or to what is being felt, or to what has
been previously said.

Congruent: Communication reflects the reality of the self and the other in that
moment. Looks, feelings, tone of voice, and body language are all reflecting
the same message.

䊏 Role of Therapist in the Satir Growth Model

In conjoint therapy, the counselor’s use of self is the most important tool for facili-
tating change in a family. Thus, it is essential that the therapist be congruent in his
or her thoughts, feelings, and actions when working with clients (Duhl, 1995). Con-
joint therapy also stresses the importance of positive regard and empathy on the
part of the therapist, as is typical in humanistic approaches (Duhl, 1995).

Skills of the Conjoint Family Therapist

䊏 Initiating change through a leadership role in the beginning of the process (Satir
et al., 1975).
CHAPTER EIGHTEEN Approaches to Family Counseling 393

䊏 Modeling honest and healthy communication.

䊏 Allowing all subjects to be equally addressed in therapy.
䊏 Interpreting and responding to action appropriately (Satir, 1983).
䊏 Using communication models to inform the therapy process.

䊏 Goals of Treatment in the Satir Growth Model

Once universal needs such as acceptance and connection are met, family members
will have greater self-esteem and the ability to function in a healthier manner. An
aim of therapy is to help family members communicate in a way that is congruent
(Satir et al., 1975). Additionally, therapists and families work together to create a
family system that is more open and operates with fewer internalized rules
(Bandler, Grinder, & Satir, 1976).

䊏 Therapeutic Techniques in the Satir Growth Model

Some techniques of conjoint therapy are similar to those used in other therapies
and require counselors to restate, reframe, and repeat clients’ statements to chal-
lenge beliefs and communication styles in the family. There are also a number of
recognized techniques that are specific to conjoint therapy. The aims of these tech-
niques are to illuminate hidden agendas and rules of the family system to create
freedom to change, and include the following (Gladding, 2002a; Satir, 1983).

Family map: A visual representation of three generations of the “star” or

identified client’s family that records adjectives to describe each person’s per-
sonality or relationship to the larger family as well as general demographic
information.

Life fact chronology: A detailed history of the family, including the history of
the parents’ romantic relationship, their respective family histories, any pre-
vious unions and divorces or deaths, a history of extended family members
living with the family, or others who contribute financially or in other ways
and figure prominently. Rates of contact with members who no longer live
with the parents are obtained, and daily household schedules and regular ac-
tivities are discussed (Satir, 1983).

Wheel of influence: A visual representation of all the influential people in the

client’s life.

Family time inventory: Members track their activities throughout the day to
facilitate the scheduling of family time for at least 1 hour per day (Bandler et
al., 1976).
394 What Are the Essential Elements of Counseling? PART TWO

䊏 Strengths and Limitations of the Satir Growth Model

Satir’s approach to family therapy enables the family to use new communication
styles to maintain healthy relationships after therapy has been completed (Bandler
et al., 1976). Families have a renewed sense of their own value and appreciate the
unique aspects of each of their members (Bandler et al., 1976).
Despite Satir’s social contextual approach, it has been criticized for failing to ac-
count for the culturally prescribed roles of family members (Freeman, 1999). The
existential goals of wholeness and increased enjoyment in one’s family life may be
vague and hard to conceptualize (Gladding, 2002a).

SOLUTION-FOCUSED BRIEF FAMILY THERAPY

There is no distinct founder of brief therapy, as counselors of all theoretical orienta-

tions have applied short-term techniques. Haley’s strategic approach and the ther-
apeutic concepts used by Erickson are strong influences of brief therapy and solu-
tion-focused therapy as it is practiced today (Stalker, Levene, & Coady, 1999).
Solution-focused therapy, developed by former Mental Research Institute member
Steve deShazer in 1986, shifts the clinical focus away from gaining insight into
problems to creating preferred futures (O’Connell, 2003). Other brief therapy fig-
ures include Berg, Weiner-Davis, and O’Hanlon.

䊏 Key Concepts in Solution-Focused Brief Therapy

Brief and solution-focused therapy draws on systems and constructivist theories

with an emphasis on language, perception, and the way in which changing one ele-
ment in the family system often can transform the system itself (de Shazer &
Molnar, 1984). With its deemphasis on problems, solutions become key, and differ-
ent kinds of problems can be solved with the same solution (de Shazer & Molnar,
1984). When problems are recognized, they are attributed to flawed perceptions
and understandings (O’Hanlon & Wilk, 1987). Therefore, a main concept in this ap-
proach is that perceptual changes—more than insight or emotional expression—
contribute to solutions and ultimately to transformation (Cade & O’Hanlon, 1993).

䊏 Role of Therapist in Solution-Focused Brief Therapy

The therapist is singularly attentive to the negotiation of a specific definition of

what the solution to the family or couple’s problem will be (O’Hanlon & Wilk,
1987).
CHAPTER EIGHTEEN Approaches to Family Counseling 395

Tasks of the Solution-Focused Therapist

䊏 Join in the family system as a way to influence clients (de Shazer, 1984; Stewart &
Anderson, 1984).
䊏 Take a collaborative stance by refraining from giving expert opinions or diagnos-
ing the family’s problems (O’Connell, 2003).
䊏 Reframe the family situation positively by highlighting strengths, normalizing
problems, and helping the family members see themselves in a new, more pro-
ductive way (O’Hanlon & Weiner-Davis, 1989).

䊏 Goals of Treatment in Solution-Focused Brief Therapy

The specific goals of treatment are unique to the solutions that each family deter-
mines with the help of the therapist. Thus, success easily can be measured against
the implementation of the solution into the family system (O’Hanlon & Weiner-Da-
vis, 1989). Generally, though, therapy is aimed at helping families to make minimal
initial changes. An assumption of solution-focused work is that subsequent, more
substantial changes naturally follow the initial changes and are generated by the
family itself (de Shazer & Molnar, 1984).

䊏 Therapeutic Techniques in Solution-Focused Brief Therapy

There are several techniques that are unique to the solution-focused approach.

Common Techniques in Solution-Focused Therapy

䊏 Counselors identify strengths by asking the family to take note of the family dy-
namics they value and want to maintain (de Shazer & Molnar, 1984).
䊏 Counselors look for exceptions to the problem by asking the family to recount
times when the problem did not occur, and to account for why, to formulate a so-
lution and highlight strengths (O’Hanlon & Weiner-Davis, 1989).
䊏 Counselors use the “miracle question,” which consists of asking the family or
couple how they would know that the problem was gone. Specifically, they are
asked, “If the problem were to be miraculously erased, what would be differ-
ent?” (Berg & DeJong, 1996).

䊏 Strengths and Limitations of Solution-Focused Brief Therapy

One of the most beneficial aspects of brief therapy is that families experience
change in a short period of time and benefit from the positive attitude of the thera-
pist. In contrast to many therapeutic approaches, solution-focused therapy recon-
ceptualizes clients’ problems to allow for more healthy relationships. Finally, this
limited time approach is complementary to the goals of managed care.
396 What Are the Essential Elements of Counseling? PART TWO

A limitation of this approach is that research done on this modality has been
methodologically flawed; evidence exists that brief therapies are not effective in
supporting lasting changes (Stalker et al., 1999). Also, solution-focused work does
not account for the fact that some clients may not be able to resolve their problems
without exploring their past (Nylund & Corsiglia, 1994).

STRATEGIC FAMILY THERAPY

Devised by Haley and Madanes, strategic family therapy is heavily influenced by

the work of Erickson and focuses on problem solving rather than insight. The term
strategic, coined by Haley, signifies interventions designed to influence clients to in-
terrupt their problem behavior cycle, to promote a new perception of the problem,
and to create an environment that encourages growth and change (Duncan &
Solovey, 1989). Haley joined with clinician Madanes in 1976 to form the Family
Therapy Institute in Washington, DC. Madanes added a gentle, playful element to
creating change in families that expanded on Haley’s more directive style (Corey,
2001).

䊏 Key Concepts in Strategic Therapy

The concepts of strategic family therapy reflect the assumptions of the strategic
family therapeutic approach to change. The assumptions that underlie this ap-
proach are listed next.

Assumptions of Strategic Family Therapy

䊏 The social context within which the presenting problem occurs is the primary
focus.
䊏 Symptoms or problematic behaviors are believed to stabilize the family (Braver-
man, 1986) and are seen as resulting from the interrelated actions of several peo-
ple (Haley, 1987).
䊏 Emotionally cathartic experiences are not necessarily helpful in meeting the ther-
apeutic goals of resolving symptoms or problems (Haley, 1980).

䊏 Role of Therapist in Strategic Therapy

Therapists take on a leadership role, devising specific treatment strategies for each
problem. Other responsibilities include those outlined as follows.

Responsibilities of Strategic Family Therapists

䊏 Capitalizing on the family’s desire for change by intervening during the initial
session rather than spending time on fully understanding family dynamics or
making diagnoses (Haley, 1973).
CHAPTER EIGHTEEN Approaches to Family Counseling 397

䊏 Influencing the family to try new solutions and to conceptualize their problems
in a new way.
䊏 Working with emotions only when they can help inform treatment goals
(Kleckner, Frank, Bland, Amendt, & Bryant, 1992).
䊏 Treating the family as a whole rather than focusing on the symptomatic individ-
ual as a way to address the organizational nature of family dysfunction (Haley,
1973).

䊏 Goals of Treatment in Strategic Therapy

Reflecting the basic premise that the function of therapy should be to fix specific
problems rather than heal deep emotional wounds or issues, the goals of treatment
include the following:

䊏 Recognizing the structure or hierarchy of family relationships so that no symp-

toms are needed to maintain it, and there is appropriate equity and authority
(Braverman, 1986).
䊏 Helping the family in perceiving problems as manageable and able to be solved
(Haley, 1980).

䊏 Therapeutic Techniques in Strategic Therapy

This is a technique-laden approach, and many interventions exist for different

problems. Ericksonian techniques such as the use of paradox are typical. The thera-
pist may utilize prior coping strategies, observed patterns of behavior, and past at-
tempts to solve problems as the foundation for treatment strategies (Coyne &
Biglan, 1984). Other common techniques are described next.

The ordeal: Entails changing the family structure in a way that is beneficial by
prescribing a difficult activity that is more severe than the problematic behav-
ior. The technique is useful in creating negative consequences for problem be-
havior and in reinforcing appropriate boundaries and authority roles (Stone
& Peeks, 1986).

Reframing: Describing problems in a positive or constructive way to enable

the therapist to present interventions using language that promotes change
(Coyne & Biglan, 1984).

Pretending: Performing the problematic behavior or symptom in the session

and practicing coping skills (Madanes, 1981).
398 What Are the Essential Elements of Counseling? PART TWO

䊏 Strengths and Limitations of Strategic Therapy

Strategic family therapy may have cross-cultural implications because the ap-
proach is nonsexist (Braverman, 1986) and appears to be effective with clients from
different cultures and ethnicities (Richeport-Haley, 1998). Strategic therapists do
not pathologize the problems of their clients, which creates a nonthreatening and
respectful environment (Braverman, 1986). Because success is measured distinctly
by behavioral goals, improved functioning easily is charted and achieved.
However, the use of strong direction and influence to create changes in clients
has been criticized as manipulative and disrespectful of clients (Duncan & Solovey,
1989). Also, strategic therapy’s exclusion of intrapersonal variables such as early
childhood experiences has been criticized as incomplete and limiting (Duncan,
1992).

STRUCTURAL FAMILY THERAPY

Structural family therapy, developed during the 1960s and 1970s by Minuchin,
helped to bring family therapy to the attention of the larger psychological commu-
nity. This approach is very technique driven and requires the therapist to take an
active, dynamic role. The diagnostic process is very prominent, unlike other modes
of therapy, and ingenious techniques have been devised to this end, such as family
tasks that are observed through one-way mirrors (Elbert, Rosman, Minuchin, &
Guerney, 1964). Restructuring family interactions is seen as a way to create healthy
alliances and appropriate generational and relational boundaries.

䊏 Key Concepts in Structural Therapy

Structural family therapy maintains a systems perspective. Symptoms are seen as

occurring within both an internal and external context (Minuchin, 1974). Dys-
functionality, additionally, is believed to result when family members of different
generations form subsystems. Symptoms can be relieved by changing the family
structure or patterns of relating that support or cause such behavior (Minuchin,
1974). Working through dysfunction is related to the two concepts of joining and
accommodating.

Joining: The process through which the therapist enters the family system to
diagnose the source of dysfunction, understand the way the family perceives
reality, and form therapeutic goals (Minuchin, Colapinto, & Minuchin, 1998).

Accommodation: The process through which the therapist adapts to enter the
family system, and the process that the family undergoes to make changes.
CHAPTER EIGHTEEN Approaches to Family Counseling 399

䊏 Role of Therapist in Structural Therapy

The attitude of the therapist is an essential element in structural family therapy.

Adapting to the family’s style and designing interventions that reflect each particu-
lar family is a key role.

Tasks of the Structural Family Therapist

䊏 Joining the family system (Minuchin et al., 1998).
䊏 Shifting attention to different subsystems, family members, and family dynam-
ics either to draw attention to them or to maintain them as a family strength.
䊏 Creating disequilibrium within the family to free up family dynamics and allow
for the formation of new, healthy alliances between subsystem members
(Minuchin, 1974).
䊏 Stopping automatic responses by using interventions designed to disarm reac-
tions that are triggered by existing structures or dynamics (Minuchin &
Montalvo, 1967).

䊏 Goals of Treatment in Structural Therapy

One of the primary goals of structural family therapy is to create appropriate

boundaries and hierarchies within the family (Gladding, 2002a). Changing un-
healthy transactional patterns of the family and replacing inappropriate alliances
and subsystems in favor of healthy ones is accordingly necessary (Minuchin, 1974).
Finally, structural therapy aims at diminishing symptoms of family dysfunction,
such as substance abuse or delinquency (Minuchin, 1974).

䊏 Therapeutic Techniques in Structural Therapy

To properly diagnose problematic relational patterns and change family structures,

some of the following techniques are used in structural family therapy.

Structural Family Therapy Interventions (Minuchin et al., 1998)

䊏 Constructing family maps.
䊏 Restructuring the family.
䊏 Enforcing boundaries.

䊏 Strengths and Limitations of Structural Therapy

As a very action-oriented therapy, stuctural therapy is usually successful in bring-

ing about change (Minuchin et al., 1998). It is effective when working with a wide
400 What Are the Essential Elements of Counseling? PART TWO

variety of families, including multicultural populations and families of all socio-

economic levels (Gladding, 2002a). This approach easily can be learned and under-
stood due to the clear and concise nature of the theory and techniques of which it is
comprised (Minuchin & Fishman, 1981).
There is a possibility of oversimplifying the family subsystems when making
family maps, as there is little emphasis on family development or past history. This
can result in the therapist joining or aligning with some rather than all subsystems
(Minuchin, 1974). Feminist therapists have pointed out that Minuchin’s idea of a
healthy family is based on a traditional hierarchy, where the father has the most
power and authority (Hare-Mustin, 1986). Because joining is such an integral part
of structural family therapy, there is the possibility that the therapist will become
pulled into the family dynamics and not regain the distance necessary to properly
diagnose problems or formulate treatment goals (Minuchin, 1974).

SYSTEMIC FAMILY THERAPY

The systemic approach significantly has influenced the way in which family ther-
apy is currently practiced. The popularity of systems concepts has caused a shift in
the way behavior is understood. Rather than being motivated by inner drives, as
traditional psychoanalytic theories contend, the systems view describes behavior
as being influenced by social and relational forces. Utilizing a contextual perspec-
tive, this approach encompasses elements of structural and strategic therapies and
the work of Erickson and anthropologist, Bateson. Systemic therapy originally was
developed by clinical research teams at the Mental Research Institute in California
and at the Institute for Family Studies in Milan, Italy. As one of the first approaches
to examine the nature of meaning, thought, and reality, systems theory laid the
foundation for many of the postmodern perspectives that are being applied to ther-
apy today.

䊏 Key Concepts in Systemic Therapy

Behavior is seen from within the context of the individual’s relationships and fam-
ily roles. Major concepts address the dynamic of family systems and communica-
tion within the family. First, systems are seen as self-regulating and are maintained
by the particular way that characterizes that family. Whether or not a system inter-
acts with the environment outside of itself determines whether or not it is open or
closed (Nichols & Everett, 1986). Communication occurs through feedback, or the
movement of information into and out of the system and either creates stability or
change. Changes in the system alter the information that comes into the system,
creating a recursive feedback loop (Nichols & Everett, 1986).
CHAPTER EIGHTEEN Approaches to Family Counseling 401

䊏 Role of Therapist in Systemic Therapy

The therapist recognizes that his or her presence alters the family system, and so
presents a supportive, neutral face to the family. At times, teams of therapists work
together to treat a family. In either case, the individual therapist or team of thera-
pists adopt certain behaviors.

Behaviors of Systemic Family Therapists (Nichols & Everett, 1986)

䊏 Taking a directive stance.
䊏 Using specific strategies and interventions tailored to each family’s circum-
stances.
䊏 Setting goals.
䊏 Determining which elements of the system require change (Martin, 1985; Watz-
lawick, Weakland, & Fisch, 1974).
䊏 Defining symptoms as useful (Campbell & Draper, 1985).

䊏 Goals of Treatment in Systemic Therapy

Changing behaviors or eliminating symptoms are seen as the primary goals of

therapy and come before the work of gaining insight (Nichols & Everett, 1986). This
is accomplished by the following:

䊏 Helping families to understand their interconnected nature.

䊏 Enhancing families’ communication skills and conflict resolution strategies.
䊏 Teaching families to solve future problems with the interventions they have
learned (Gladding, 2002a).

䊏 Therapeutic Techniques in Systemic Therapy

Competing subsystems and hierarchies within the family system are illuminated
and the family is given tools for managing conflict and communication more effec-
tively in the following ways.

Common Techniques in the Systemic Approach

䊏 Circular questioning is used to address all members of a family to obtain their
perspective on events and issues (Selvini Palazzoli, Boscolo, Cecchin, & Prata,
1980).
䊏 Paradoxical interventions occur when the therapist invites the family to engage
in the symptom rather than presenting a solution to a problem (Watzlawick et al.,
1974).
402 What Are the Essential Elements of Counseling? PART TWO

䊏 Reframing is used to free up the family myths or conceptualizations to make

change possible (Watzlawick et al., 1974).
䊏 Rituals are used to break the homeostasis, or balance of the system and require
every family member to participate in an activity that directly addresses the es-
sential symptom (Martin, 1985).

In addition to these techniques, longer session intervals frequently are used in sys-
temic family therapy to allow the family to practice new behaviors and guard
against the therapist becoming too integrated within the system. A characteristic of
the Milan School of family therapy, sessions often were scheduled monthly.

䊏 Strengths and Limitations of Systemic Therapy

Systemic family therapy allows specific changes to be brought about in a brief pe-
riod of time. Also, this approach helps family members themselves become capable
of dealing with problems in the future. Problems and behaviors can be recon-
ceptualized and can enable family members to be seen in a more positive light.
A drawback of the team approach sometimes adopted in systemic therapy is
that working with teams of professionals can be expensive and impractical (Jones,
1993). Moreover, the directive stance required by strategic systemic therapists is
contradictory to the premise that all members of a system co-construct all interac-
tions (Cecchin, Lane, & Ray, 1993). Finally, because systemic therapy focuses on the
resolution of one specific symptom, it might not contribute to overall insight or a
deep-seated change in the family system.

For more general information about marriage and family therapy, visit
the International Association of Marriage and Family Counselors, a di-
vision of the ACA at:
䉴 www.iamfc.com

Chapter 18: Key Terms

䉴 Reinforcement 䉴 Reframing 䉴 Transference
䉴 Empirical dictates 䉴 Externalization 䉴 Splitting
䉴 Outcome goals 䉴 Narrative or dramatic 䉴 Projective identifications
䉴 Adaptability reenactment 䉴 Universality
䉴 Differentiation 䉴 Reflecting team 䉴 Placating
䉴 Triangulation 䉴 Circular interviewing 䉴 Blaming
䉴 Sibling position 䉴 Object relations theory 䉴 Super reasonable
CHAPTER EIGHTEEN Approaches to Family Counseling 403

䉴 Irrelevant 䉴 Wheel of influence 䉴 Pretending

䉴 Congruent 䉴 Family time inventory 䉴 Joining
䉴 Family map 䉴 The ordeal 䉴 Accommodation
䉴 Life fact chronology 䉴 Reframing
 chapter Understanding and Assessing
Psychopathology
19
Tammy L. Hughes
Erinn Obeldobel
Susie McLaughlin
Jamie King
Duquesne University

In This Chapter

䉴 Understanding Psychological Disorders 䉴 Disturbances With Mood

䊏 What Is Abnormality? 䊏 Approaches to Understanding Depression
䊏 Models of Abnormality 䊏 Unipolar Depression

䊏 Bipolar Disorder

䉴 Assessment of Psychopathology 䊏 Suicide

䊏 Diagnostic Classification Systems

䊏 The Assessment Process 䉴 Disturbances Related to Eating

䊏 Gathering Information: Written, Verbal, and Weight Loss
and Observational Methods 䊏 Approaches to Understanding Eating
䊏 Assessment Results Disorders
䊏 Anorexia Nervosa

䉴 The Diagnostic System: 䊏 Bulimia Nervosa (Binge–Purge Syndrome)

Some Considerations
䊏 Uses and Advantages of the DSM Classifi- 䉴 Disturbances in Substance Use
cation System 䊏 Distinctions Between Abuse and
䊏 Limitations of the DSM System Dependence
䊏 Dimensional Diagnoses: A New Approach 䊏 Approaches to Understanding Substance

to Diagnosing Abuse
䊏 Some Drugs of Choice

䉴 Disturbances Related to Anxiety

䊏 Approaches to Understanding Anxiety 䉴 Disturbances With Sexuality
䊏 Generalized Anxiety Disorder and Gender Identity
䊏 Phobias 䊏 Approaches to Sexual Dysfunction
䊏 Panic Disorder 䊏 Sexual Dysfunction
䊏 Obsessive-Compulsive Disorder 䊏 Paraphilias
䊏 Stress Disorders 䊏 Gender Identity Disorder

䊏 Sex Therapy

404
In This Chapter (continued)

䉴 Disturbances of Psychosis, Memory, 䉴 Disturbances in Childhood

and Other Cognitive Functions 䊏 Approaches to Understanding Childhood
䊏 Approaches to Understanding Disturbances
Schizophrenia 䊏 Mental Health Problems in Childhood

䊏 Symptoms of Schizophrenia 䊏 Elimination Disorders

䊏 Dissociative Disorders 䊏 Chronic Disorders Beginning in Child-

hood
䉴 Disturbances in Personality
䊏 Approaches to Understanding Problems 䉴 Disturbances Related to Aging
With Personality and Cognition
䊏 Odd Personality Disorders 䊏 Problems With Cognition and Neurology

䊏 Dramatic Personality Disorders in Older Adults

䊏 Anxious Personality Disorders 䊏 Mood Disorders in Older Adulthood

405
406 What Are the Essential Elements of Counseling? PART TWO

UNDERSTANDING PSYCHOLOGICAL DISORDERS

Our intent in this chapter is to provide an overview of deviant behaviors and their
treatments. We touch on three main areas. The first area deals with abnormality
and the various theoretical perspectives on psychopathology. The second area de-
scribes the assessment of psychopathology, including the purpose, process, and
different types of assessment strategies used in treatment planning and progress
monitoring, as well as advantages and limitations of the current classification sys-
tems used in diagnosis and assessment. The third area deals with the main catego-
ries of psychological disorders by providing a review various theoretical perspec-
tives on the causes of disorders, and mentioning the counseling techniques used in
treating the disorder that are consistent with the causal theory.

䊏 What Is Abnormality?

Defining abnormality can be difficult. Because the meaning of specific cognitive,

behavioral, and emotional manifestations often differs according to culture and
varies across time in the same culture, the understanding of abnormality is not ab-
solute. However, most definitions of psychological abnormality emphasize the
four Ds: deviance, distress, dysfunction, and danger. Comer (2004) provided these
explanations of the underlying facets of deviant behavior:

Deviance: Thoughts, emotions, or behaviors that are different for what is ex-
pected of that time and place.

Distress: Deviant thoughts, emotions, or behaviors that cause disruption and

upset to the person experiencing them, and, at times, to others in contact with
the individual experiencing distressing symptoms.

Dysfunction: Distress is so significant that it causes impairment in important

daily activities (e.g., work or school) or relationships.

Danger: Distress may be so severe that a person becomes a danger to himself

or herself (suicide) or to others (homicide).

Deviant, distressing, dysfunctional or dangerous thoughts, emotions, or behaviors

are considered core symptoms of an abnormal psychological state.

䊏 Models of Abnormality

There are various approaches to understanding the origins of abnormal psycholog-

ical symptoms; however, none of these adequately explains all abnormal symp-
toms or disorders. At the same time, it is important to understand how causes of
CHAPTER NINETEEN Understanding and Assessing Psychopathology 407

problems are conceptualized, as these conceptualizations are used to inform treat-

ment techniques that are prescribed to address the symptoms of the abnormality. A
number of approaches to understanding abnormality, as well as the assumptions
about dysfunction that undergird the core theoretical models, briefly are described
here.

Approaches to Understanding Abnormal Behavior

䊏 Biological model: Originates from a medical perspective in which abnormal be-
havior is viewed as an illness resulting from faulty portions of the brain or body.
Depression, for example, is believed to be the result of an imbalance of brain
chemicals.
䊏 Psychodynamic model: Behavior is a result of underlying psychological forces of
which people may or may not be aware, and abnormal behavior occurs when
there is conflict between these internal forces.
䊏 Behavioral model: Experiences that occur in proximity (operant and classical con-
ditioning) result in learning, and inappropriate learning can result in abnormal
behavioral responses to the environment.
䊏 Cognitive model: Cognitive processes are at the core of behaviors, thoughts, and
emotions, and distorted thoughts precede abnormal symptoms.
䊏 Humanistic-existential model: Behavior extends from an understanding of and
comfort in the human existence, and abnormal behaviors are a result of distrac-
tion from the pursuit of philosophical goals such as self-awareness, freedom of
choice, and a sense of meaning in life.
䊏 Sociocultural model: Abnormal behavior is a result of the social and cultural forces
that influence people.

ASSESSMENT OF PSYCHOPATHOLOGY

Identifying psychological disorders begins with the important task of assessment,

which can be defined as follows:

Assessment: The process of collecting and integrating data from interviews,

case studies, observations, and psychometric tools for the purposes of in-
forming clinical decisions.

In the assessment process, clinicians interpret the results from psychological tests
and also evaluate the severity of abnormal symptoms. Factors such as age, context,
setting, and reason for referral all are considered in the assessment process. The in-
formation that is gathered during the assessment process ultimately allows clini-
cians to diagnose disorders, recommend treatment, monitor the effectiveness of
408 What Are the Essential Elements of Counseling? PART TWO

treatment services, and determine appropriate placement for clients (Sattler, 2001).
Other key concepts in the assessment process are defined here.

Diagnosing: The process of matching an individual’s observed and reported

abnormal psychological symptoms to a cluster of symptoms known as a syn-
drome or a disorder.

Disorders or syndromes: Abnormal psychological symptoms that tend to oc-

cur together, present to a marked degree, and last for a significant amount of
time.

Diagnosis: Statement made when psychological symptoms are consistent

with a known mental health disorder or syndrome.

䊏 Diagnostic Classification Systems

The two main classification systems that list known psychological disorders or syn-
dromes and that are used in making a diagnosis are the Diagnostic and Statistical
Manual of Mental Disorders (4th ed., text revision [DSM–IV–TR]; American Psychi-
atric Association, 2000) and International Classification of Diseases (ICD; World
Health Organization, 1992). A third system, the Individuals With Disabilities Edu-
cation Act (IDEA), is used in schools as the classification system for children. Each
of these systems contains lists of symptoms and criteria for determining if a symp-
tom is typical to a particular disorder.

䊏 The Assessment Process

Assessment is a dynamic process in which clinicians gather data, formulate key

questions that guide observations and data collection, make conclusions or diagno-
ses, and, at times, alter their decisions. Groth-Marnat (2003) and Sattler (2001) out-
lined eight steps to a thorough assessment.

Main Steps in the Assessment Process

1. Identify a reason for referral before beginning the assessment.
2. Obtain relevant information about physical, social, educational, and emotional
history.
3. Observe the individual in a natural setting (home or classroom) when appro-
priate or in the therapy or testing sessions.
4. Develop a working hypotheses about nature of the symptoms.
5. Select and administer an appropriate battery of tests based on the hypotheses
and the referral question.
CHAPTER NINETEEN Understanding and Assessing Psychopathology 409

6. Interpret the results in the context of all information obtained including the in-
dividual’s history, the clinician’s observations, test data, and information pro-
vided by others.
7. Reject, modify, or accept hypotheses.
8. Summarize the findings in a written report and make recommendations based
on assessment results.

For more information on the assessment process, see Chapter 21.

䊏 Gathering Information: Written, Verbal, and Observational Methods

Counselors who are conducting assessments have at their disposal a variety of

methods for gathering information. Two of the primary methods are written as-
sessments, which commonly include paper-and-pencil questionnaires, and obser-
vational and verbal methods. Turning first to the written tools, counselors need to
understand some basics of the written tools that they may use. In particular, coun-
selors should be able to differentiate between broadband and narrowband instru-
ments and have a working knowledge of these various types of tools.

Written Methods: Broadband and Narrowband Instruments

䊏 Broadband tools simultaneously measure a wide range of characteristics, be-
haviors, and symptoms that can be used to diagnose one or several disorders
(e.g., depression and anxiety). Broadband tools typically are used for initial diag-
nosis to rule out or simultaneously consider other disorders that may have over-
lapping symptoms. An example of a broadband instrument is the Minnesota
Multiphasic Personality Inventory (MMPI; Butcher, Dahlstrom, Graham,
Tellegen, & Kaemmer, 1989a).
䊏 Narrowband tools measure a specific set of characteristics of only one disorder
or syndrome (e.g., depression). Although they may be used for diagnosis, these
instruments routinely are used for monitoring symptom severity once a diagno-
sis is established (e.g., the Beck Depression Inventory [BDI; Beck, Steer, & Brown,
1996]).

Not only should counselors understand the purpose and aims of a test, but they
also need to know how the test was developed to determine its usefulness. Most
tests that clinicians use are norm referenced; however they also may be criterion
referenced.

Differences Between Norm-Referenced and Criterion-Referenced Tests

䊏 A norm-referenced test is one that has been given in a standardized manner to a
specific sample (group) of individuals, called the norm group. The sample is de-
scribed in test manuals. Scores obtained represent performance ranks based on
410 What Are the Essential Elements of Counseling? PART TWO

the studied norm group. The examiner compares the individual’s scores to those
of the representative group.
䊏 A criterion-referenced test is one that is used to determine if an individual dem-
onstrates a predetermined standard of performance.

Although tests are an integral component in accurate assessments, there are other
forms of measuring behavior that can be equally effective. Interviews and observa-
tions offer crucial, dynamic, and contextual information about an individual. Drum-
mond (2004) recommended clinical interviews to gather the following information.

Components of the Clinical Interview Assessment

䊏 Demographic information includes age, education level, gender, and income sta-
tus of clients.
䊏 The chief complaint or the presenting symptom should be recorded in the client’s
words, and the clinician should note the client’s insight into his or her problems,
as well as the degree to which the client is prepared to accept help.
䊏 Mental status is a record of individuals’ functioning at the time of assessment, in-
cluding observed cognitive functioning, emotional responsiveness and expres-
sion, social reciprocity, and stability of mood.
䊏 Developmental and social history provides a detailed look into the family and
developmental history, with emphasis on delays in development or maladaptive
patterns of behavior that may be contributing to current difficulties.
䊏 Past psychiatric history details difficulties experienced in the past and efforts
taken to reduce symptoms and effectiveness of previous treatment.

The pieces of information just mentioned are all integral to making a sound assess-
ment. Gathering this information, however, does not have to follow one standard
method. In fact, there are several approaches that interviewers can use when con-
ducting an evaluation.

Common Clinical Interview Styles for Making Assessments

䊏 Structured interviews are characterized by a predetermined set of questions, fol-
lowed sequentially, and often are symptom oriented.
䊏 Semistructured interviews include a list of predetermined questions that are
modified throughout the interview process based on an individual’s reported
experiences.
䊏 Unstructured interviews have a flexible format, do not include a predetermined
list of questions, and rely on observations as part of the information gathering
process.
䊏 Natural setting interviews occur in environments where the individual is com-
fortable and familiar, often without clients’ foreknowledge that they are being
observed.
䊏 Therapeutic setting interviews occur in the context of the clinical relationship.
CHAPTER NINETEEN Understanding and Assessing Psychopathology 411

䊏 Assessment Results

Assessment results are the end product of the investigations into the referral ques-
tion, initial and modified hypotheses, interview, observation, and test data that are
considered in the context of an individual’s life experience. In short, the assessment
is a broad picture of an individual’s thoughts, feelings, and behaviors that is inter-
preted in light of how most groups of people would act, think, or feel.

See Chapter 21 for more information on testing and assessment.

THE DIAGNOSTIC SYSTEM: SOME CONSIDERATIONS

The DSM has been a standard in the helping professions for years, and the organi-
zation of the manual, as well as its approach to describing the symptomatology that
ultimately leads to diagnoses, is well known. Recently, new thought is emerging in
the helping field with regard to this tool’s approach to disorder diagnosis that
raises questions about categorical diagnosis and introduces the idea of dimen-
sional diagnosis, in which symptoms are understood as part of a continuum from
health to problematic behavior.

䊏 Uses and Advantages of the DSM Classification System

The DSM classification system most widely is used by mental health professionals
to describe psychological disorders. For a practicing clinician, the DSM provides a
mechanism for categorizing behaviors into classification systems that are succinct
in description, allowing for a more universal understanding of the kind of pathol-
ogy experienced by patients. Diagnostic categories facilitate communication be-
tween mental health providers, assist in the process of securing access to mental
health services (i.e., insurance), and also provide practitioners with a schema for
understanding requisite symptom presentations for defining syndromes (e.g., de-
pression). Additionally, the aim of the current diagnostic system is to offer clini-
cians a method for determining the presence and severity of the presenting prob-
lems for the purpose of identifying possible treatments to effectively alleviate
symptoms.

䊏 Limitations of the DSM System

Although categorical classifications of symptoms and disorders can be helpful in

understanding and working with clients with various difficulties, there are limita-
tions to this approach. Difficulties inherent in the current diagnostic systems in-
clude (a) symptoms that are not specific to a single type of disorder (i.e., attention
412 What Are the Essential Elements of Counseling? PART TWO

or concentration difficulties), (b) excessive comorbidity (co-occurring disorders),

and (c) the limited ability to identify and characterize individuals with subclinical
forms (failing to meet threshold for diagnostic criteria) of psychopathology
(Widiger, 2005; Widiger & Samuel, 2005). Additionally, it should be noted that al-
though diagnoses serve an important purpose, diagnoses alone do not always lead
to effective treatment selection. In fact, many have argued that treating the under-
lying cause of the diagnosis (or presenting problems), rather than the manifesting
behaviors that classifications rely on, will improve treatment effectiveness
(McWilliams, 1999; Shirk & Russell, 1996).

䊏 Dimensional Diagnoses: A New Approach to Diagnosing

In response to difficulties found in the categorical approach to diagnosing, another

perspective has been introduced from which symptoms of psychopathology are
viewed dimensionally. From the dimensional perspective, symptoms are consid-
ered in light of a continuum of graded severity rather than as discrete clinical diag-
nostic categories. In light of the growing recognition that the current diagnostic
practices are limited, professionals increasingly are advocating for the replacement
of a categorical approach to diagnosing with a dimensional model of describing
psychopathology. Currently, however, diagnoses continue to be made using cate-
gorical decisions indicating the presence or absence of psychopathology.

In light of the growing recognition that the

current diagnostic practices are limited,
professionals increasingly are advocating for the
replacement of a categorical approach to
diagnosing with a dimensional model of
describing psychopathology.

Given the current system for diagnosing psychopathology, in the next sections,
we describe various clusters of disorders identified in the diagnostic manual and
subsequently discuss related treatment issues. As described earlier, to meet criteria
as a disorder, these symptoms must occur to a marked degree, for a long period,
and impair daily functioning. Clinicians should refer to the current DSM to deter-
mine the number of symptoms and period of distress required to meet the thresh-
old for diagnosis, as these details are subject to change.

DISTURBANCES RELATED TO ANXIETY

Anxiety disorder is a broad category that houses descriptions of specific manifesta-

tions of anxiety, such as generalized anxiety disorder, panic disorder, and obses-
CHAPTER NINETEEN Understanding and Assessing Psychopathology 413

sive-compulsive disorder, among others. The symptoms of anxiety that an individ-

ual exhibits determine the type of anxiety disorder experienced. Some of the more
common symptoms of anxiety disorders are listed here.

General Symptoms of Anxiety Disorders

䊏 Tension.
䊏 Fatigue.
䊏 Sleep interruptions.
䊏 Increased heart rate.
䊏 High blood pressure.
䊏 Perspiration.
䊏 Adrenaline.
䊏 Salivation.
䊏 Pilo-erection (hair standing up on the back of the head and arms).
䊏 Overactive startle instincts.

䊏 Approaches to Understanding Anxiety

As mentioned earlier in the chapter, there are a variety of approaches or schools of

thought as to the causation of psychological disorders. Table 19.1 summarizes
some theoretical approaches to understanding anxiety, its causes, and suggested
treatment regimens.

TABLE 19.1
Approaches to Anxiety

Theory Cause of Anxiety Treatment

Biological Not enough GABA Anti-anxiety medications,

(neurotransmitter) biofeedback
Psychodynamic Suppression /redirect (to phobic Appropriate expression of id
object) id (primary) instincts impulses
Behavioral Conditioning or learning, Exposure, systematic
modeling desensitization, relearning
(social skills training)
Cognitive Dysfunctional ways of thinking Adopt functional thinking,
relaxation
Humanists Denying true emotions, Get in touch with real or true self
thoughts, and behavior leads a
person to be out of touch with
true self
Sociocultural Environment is considered Decrease poverty, oppression
dangerous
414 What Are the Essential Elements of Counseling? PART TWO

䊏 Generalized Anxiety Disorder

Generalized anxiety disorder is characterized by severe, free-floating anxiety and

excessive worry that may have no specific content and can occur under most cir-
cumstances. Treatment usually includes a combination of medication, cognitive,
and behavioral approaches.

䊏 Phobias

Phobias are defined as persistent and unreasonable fears that can result in physical
symptoms. Treatment usually includes cognitive and behavioral approaches. Some
common types of phobias are mentioned here.

Categories of Phobias
䊏 Specific phobia is a fear of a particular object or situation (e.g., spiders).
䊏 Social phobia is the fear of embarrassment in social or performance situations.
䊏 Agoraphobia is a fear of going into public places, especially when alone.

Another aspect of phobias is the panic attack, which can be brought on by real
fears or feelings of dread, or can occur without a causal source. Symptoms of a
panic attack include heart palpitations, tingling of the hands and feet, sweating, hot
or cold sweats, shortness of breath, trembling, chest pain, choking sensations, faint-
ness, dizziness, and feelings of unreality. Treatment often includes medications and
cognitive approaches.

䊏 Panic Disorder

A panic disorder is distinguished by dysfunction in thinking or behavior as a result

of panic attacks, defined as sudden onset of anxiety symptoms that come on repeat-
edly, unexpectedly, and for no apparent reason. Panic disorder often is accompa-
nied by agoraphobia. Treatment may include medication (antidepressants to man-
age norepinephrine), cognitive, or behavioral approaches.

䊏 Obsessive-Compulsive Disorder

Obsessive-compulsive disorder is characterized by recurrent and unwanted

thoughts (obsessions), a need to perform repetitive and rigid actions (compul-
sions), or both. Compulsions are reported to reduce the anxiety associated with the
obsessive thoughts. Treatment may include a combination of medicine aimed at in-
creasing serotonin levels and cognitive approaches for stress management and life
skills training.
CHAPTER NINETEEN Understanding and Assessing Psychopathology 415

䊏 Stress Disorders

Stress disorders are characterized by lingering anxiety that continues well after a
psychologically traumatic event is over (e.g., automobile accident, rape, war).
These disorders are similar to anxiety disorders because anxiety symptoms are a
primary concern, and people with both anxiety disorders and stress disorders tend
to avoid activities associated with the anxiety. However, stress disorders also in-
clude symptoms such as flashbacks of the traumatic event, reduced responsive-
ness, and guilt. Both increased arousal (anxiety symptoms) and underarousal
(numbness) can cooccur in stress disorders.
There are two main types of stress disorder that are distinguished primarily by
time frame during which the anxiety occurs.

Types of Stress Disorder

䊏 Acute stress disorder is identified when anxiety occurs close to the time of the
event.
䊏 Posttraumatic stress disorder occurs long after the event.

Treatment options for stress disorders include medication, behavioral exposure

techniques, cognitive approaches such as insight therapy, and sociocultural inter-
ventions, in which family and group therapy are the focus.

DISTURBANCES WITH MOOD

Among the most prevalent psychological problems are those related to mood, and
especially to depression. Other problems with mood are unipolar depression and
bipolar disorder or manic depression. These diagnoses, along with suicide, which
frequently is precipitated by a mood disturbance such as depression, are addressed
in this section.

䊏 Approaches to Understanding Depression

Because depression is potentially the most common among the mood disorders,
Table 19.2 reflects various theoretical perspectives on the causes and treatment reg-
imens for depression.

䊏 Unipolar Depression

The diagnosis of depression is more specific than is depicted here, and clinicians
use the battery of symptoms to accurately distinguish among the various manifes-
416 What Are the Essential Elements of Counseling? PART TWO

TABLE 19.2
Theoretical Perspectives on Depression

Theory Causes of Depression Treatment

Biological Genetic predisposition Antidepressant drugs,

Low serotonin levels electroconvulsive therapy
(severe cases)
Psychodynamic Traumatic event triggers anger Bring underlying issues to
and sadness (becomes consciousness and work
self-directed) through
Behavioral Life is a rewards and Reintroduce pleasurable
punishments system, and activities, reward
the right behaviors are not non-depressive behavior,
being rewarded social skills training
Cognitive Pattern of thinking is irrational Recognize and change negative
and negatively oriented or irrational thought processes
Sociocultural Social structure and social roles Interpersonal therapy, couples
are oppressive therapy

tations of depression. However, unipolar depression is typified by a sad state of

mind accompanied by lack of energy, low self-worth, and guilt. Other common
symptoms of depression are provided next.

Symptoms of Depression
䊏 Feelings of worthlessness.
䊏 Apathy.
䊏 Decreased energy.
䊏 Loss of feelings of pleasure.
䊏 Thoughts of guilt and suicide.
䊏 Sleep and appetite disruptions.

Treatment for depression typically combines medication to increase serotonin lev-

els, cognitive techniques for eliminating negative self-talk, sociocultural tech-
niques to improve relationships, behavioral rewards for appropriate thoughts and
behaviors, and uncovering automatic (unconscious) triggers to self-directed ha-
tred. Single symptoms of depression may be targeted by specific therapy tech-
niques, and 70% of depression cases can remit without intervention.

䊏 Bipolar Disorder

Bipolar disorder is characterized by intermittent periods of depression and mania.

Included in the symptom profile are cycles of depressive symptoms and cycles of
manic symptoms, such as feelings of euphoria, pressured speech, and rapid flow of
CHAPTER NINETEEN Understanding and Assessing Psychopathology 417

ideas that may not be coherent. Because the cause of bipolar disorder is believed to
be related to neurotransmitter activity, ion activity, and genetic factors, medication
is typically the first line of intervention. Lithium therapy is usually the treatment of
choice, although antidepressants may be used to combat the depressive symptoms.
Additionally, family support therapy and educational training may also be re-
quired to help identify the onset of cycles.

䊏 Suicide

Suicide is understood as intentional and self-directed death. Although the motives

for suicide vary greatly from person to person and across cultures, some common
precipitative factors are identifiable.

Precipitating Factors for Suicide

䊏 Stressful events or situations (e.g., immediate loss of a loved one, natural disas-
ter, serious illness, abusive environments, occupational dissatisfaction or dis-
tress).
䊏 Changes in mood (increased sadness) and thinking (hopelessness, dichotomous
thinking).
䊏 Alcohol or drug use.
䊏 Mental disorders, such as depression.
䊏 Completed suicide by another person (e.g., in media, at work, in school).

Approaches to Suicide Prevention

䊏 Taking all talk of death seriously (to coworkers, friends, family children in
schools).
䊏 Identifying parasuicidal behaviors such as cleaning of weapons, giving away be-
longings, saying goodbye, and getting finances in order.
䊏 Conducting a suicide assessment.
䊏 Signing a no-suicide contract in which people agree to a problem-solving se-
quence such as calling a friend, counselor, or 24-hour mental health hotline when
they feel like hurting themselves.
䊏 Resorting to involuntary commitment when psychiatric stabilization is required.

Clinicians frequently use an assessment as a prevention approach for suicide inter-

ventions. A suicide assessment should include a person’s history of suicide at-
tempts (previous attempts increase the likelihood of future attempts), level of de-
tail present in his or her plans for death, access to a weapon, and lethality of the
weapon. Additionally, clinicians should determine if the person has future-ori-
ented thoughts that do not include his or her death and attempt to have the client
sign a no-suicide contract. Reports of danger-to-self require all mental health work-
ers to break confidentiality and to obtain a level of treatment that ensures the safety
of that person.
418 What Are the Essential Elements of Counseling? PART TWO

DISTURBANCES RELATED TO EATING AND WEIGHT LOSS

Eating disturbances are characterized by overt attempts to alter body weight. Risk
factors are multidimensional and include family pressures, co-occurring psycho-
logical problems (e.g., depression), and biological variables (e.g., body weight set
points).

䊏 Approaches to Understanding Eating Disorders

Understanding eating disorders is a complex endeavor, and there are a variety of

hypotheses related to the causes of this psychological issue that generally is recog-
nized to be more than just a biological problem. Table 19.3 summarizes some of the
perspectives used to explain and treat eating disorders.

䊏 Anorexia Nervosa

Anorexia is the term applied to the pursuit of thinness that results in extreme
weight loss, to the extent that a person’s health and, in severe cases, life, is jeopar-
dized. Treatment options for anorexia include behavioral weight restoration pro-
grams that combine a high-calorie diet with positive reinforcement, cognitive tech-
niques to address distorted thinking, and sociocultural techniques to increase
positive family interactions.

TABLE 19.3
Approaches to Understanding Causes
and Treatment of Eating Disorders
Theory Cause of Eating Disorders Treatment

Family environment Overinvolved families do not Increase family harmony that

allow the development of allows for individual
independence independence
Psychodynamic Ego deficiencies result in poor Appropriate ego regulation
autonomy and lack of with adequate separation
control from parents and balance
superego (society)
influences
Cognitive Reliance on the views and Adopt thinking that values
wishes of others their own thoughts
Biological Low serotonin body weight Antidepressant medications
set point (going too low
causes desire to binge eat)
Sociocultural Society overvalues thinness Increase acceptance of a
and humiliates the varied definition of female
overweight person body sizes
CHAPTER NINETEEN Understanding and Assessing Psychopathology 419

䊏 Bulimia Nervosa (Binge–Purge Syndrome)

Bulimia is characterized by a person’s engaging in repeated, uncontrollable epi-

sodes of extreme overeating followed by compensatory behaviors to avoid weight
gain, such as forced vomiting, excessive exercise, and the use of laxatives. Treat-
ment options for bulimia include a combination of individual insight therapy (cog-
nitive and psychodynamic), behavioral therapy, medication to increase serotonin,
and sociocultural support group techniques.

DISTURBANCES IN SUBSTANCE USE

Most often, substance use or addiction refers to the use of legal or illegal mood-al-
tering substances in a manner that results in negative outcomes. Another recently
recognized category of addiction in the counseling field is process addictions.
Diagnostic criteria for most process addictions, however, are not found in the
DSM–IV–TR classification system.

䊏 Distinctions Between Abuse and Dependence

The use and abuse patterns related to substances are best understood as part of a
continuum of use. The least extreme usage patterns are known simply as substance
use, and more extreme patterns of usage are considered abuse and dependence.
These are defined here.

Substance abuse: A pattern of use that is chronic and excessive resulting in

damage to relationships, work attendance or productivity, and health status.

Substance dependence: A pattern of use in which life activities are organized

around the opportunity to consume a drug, and where psychological and
physical tolerance (the need for more of the drug to get the same high) devel-
ops and withdrawal symptoms can result.

For more detailed information about substance and process addictions as well as the
use–abuse continuum, see Chapter 26.

䊏 Approaches to Understanding Substance Abuse

There are a myriad of models that describe the causes of substance abuse. As men-
tioned previously, each of these models is laden with its own assumptions about
why people become addicted and what they need to do to end their addictive be-
havior patterns. Table 19.4 summarizes just a few of these models.

For a brief description of other models of addiction and recovery, see Chapter 26.
420 What Are the Essential Elements of Counseling? PART TWO

TABLE 19.4
Theoretical Perspectives on Substance Disorders

Theory Cause of Substance Disorders Treatment

Behavioral Reinforcement is provided by Aversion therapy pairs

decreasing tensions and punishments with drug use
inhibitions
Psychodynamic Inadequate separation results in Increase awareness of
dependency underlying needs that result
in drug use
Cognitive Expectations that drug use will Self-control of thoughts
decrease tensions (changes behaviors)
Biological Increased dopamine in the brain Detoxification and antagonist
results in feelings of pleasure drugs (block brain receptors
so you do not experience a
high even if you use the drug)
Sociocultural Stress associated with poor living Support groups such as
conditions, or environments community prevention or
support drug use Alcoholics Anonymous (AA)

䊏 Some Drugs of Choice

Counselors who work in the addictions field have to be well-educated on the nu-
merous types of substances to which people can become addicted. The following
list is a brief overview of some major drug categories.

Common Classes of Drugs

䊏 Depressants such as alcohol, sedative-hypnotic drugs (e.g., benzodiazepines and
barbiturates), and opioids (derivatives are morphine and heroin) slow functions
of the central nervous system. This results in a reduction of tension and de-
creased inhibitions. Overdose decreases heart rate, slows breathing, and can re-
sult in death.
䊏 Stimulants such as cocaine, amphetamines, caffeine, and nicotine increase activ-
ity of the central nervous system. Blood pressure, heart rate, alertness, and be-
havior and thinking are increased. Overdose can cause cardiac arrhythmia and
death.
䊏 Hallucinogens or psychedelics such as LSD, mescaline, peyote, psilocybin, and
MDMA intensify sensory perception and can result in hallucinations, such as
seeing things that are not there or blending of the five senses. Flashbacks or intru-
sive reexperiencing of events when using drugs or at a time when not using
drugs can occur and may be reexperienced periodically over the course of
months or years.
CHAPTER NINETEEN Understanding and Assessing Psychopathology 421

䊏 Cannabis (e.g., hashish and marijuana) is produced from the hemp plant. The ac-
tive chemical in cannabis is tetrahydrocannabinol, which can produce hallucina-
tions.
䊏 Designer drugs intentionally combine drug categories. Ecstasy, for example, is a
combination of a stimulant and hallucinogen.

Treatment for substance users typically combines many theoretical perspectives

where biological approaches (detoxification and antagonist drugs) are initial steps
to getting sober. Cognitive-behavioral therapy can be used to address immediate
needs for self-control, followed by psychodynamic therapy to address issues that
brought individuals who are addicted to these patterns. Sociocultural support
therapy such as Alcoholics Anonymous routinely is used in concert with each of
these steps to provide daily support.

DISTURBANCES WITH SEXUALITY AND GENDER IDENTITY

Problems with sexuality encompass a wide variety of sexual dysfunctions and

paraphilias, and, additionally, touch on the area of gender identity. In this section
we outline some of the major sexual disorders and discuss sex therapy as one of the
main treatment approaches to sexual dysfunction.

䊏 Approaches to Sexual Dysfunction

As with some other psychological problems, sexual dysfunctions can have a num-
ber of causes. Counselors who work with clients who have sexual dysfunction are
encouraged to do a thorough assessment to explore the variety of attributes leading
to the sexual disturbance. Table 19.5 summarizes a few of the possibilities.

䊏 Sexual Dysfunction

Sexual dysfunction refers to the inability to enjoy or participate in sexual inter-

course or normal sexual activities. Moreover, when a sexual dysfunction is present,
sexual activities are associated with pain or discomfort. There are a number of po-
tential disorders or disturbances related to sexuality. A few are presented here.

Types of Sexual Disorders

䊏 Hypoactive sexual desire occurs when an individual loses the desire for sexual
interplay or intercourse. Sexual aversion disorder is characterized by an experi-
encing of sexual relations as aversive or unpleasant and an avoidance of genital
contact and sexual intercourse.
422 What Are the Essential Elements of Counseling? PART TWO

TABLE 19.5
Perspectives on Understanding Sexual Dysfunction

Theory Causes of Sexual Dysfunction Treatment

Biological Abnormalities in hormone levels, Medication to target the

comorbid chronic illness, pain identified difficulty (pain or
medications, alcohol, cigarette depression), often paired with
smoking, diabetes, multiple sex therapy
sclerosis, antidepressant
medications
Psychological Increase in anxiety, fears and Sex therapy, often paired with
trauma memories related to appropriate medications
sexual interplay, depression,
obsessive-compulsive
disorder, performance anxiety
Sociocultural Situational pressures and life Sex therapy, often paired with
stressors (death, new birth, job appropriate medications
status change), relationship
problems, sexual trauma,
negative attitudes and beliefs
about sex

䊏 Erectile dysfunction disorder occurs when the male is unable to attain or main-
tain physiological sexual arousal marked by the lack of an erection through sex-
ual intercourse.
䊏 Female sexual arousal disorder is characterized by a female’s inability to attain
or maintain physiological sexual arousal, which is marked by the absence of vag-
inal lubrication or genital swelling throughout sexual intercourse.
䊏 Male and female orgasmic disorders occur when the individual cannot reach
sexual climax or is very delayed in reaching orgasm after the sexual excitement
phase.
䊏 Premature ejaculation is marked by recurrent episodes of reaching orgasm with
minimal sexual stimulation and before the individual desires.
䊏 Vaginismus refers to involuntary contractions of the third layer of muscles in the
vagina leading to difficulties with sexual penetration during intercourse.
䊏 Dyspareunia refers to recurrent experiences of genital pain during sexual inter-
course for either males or females.

䊏 Paraphilias

Paraphilias are disorders typified by intense sexual urges or arousal that is associ-
ated with unconventional objects, including nonhuman objects, children, non-
consenting adults, or the experience of suffering and humiliation. A number of
common paraphilias are listed here.
CHAPTER NINETEEN Understanding and Assessing Psychopathology 423

Well-Known Paraphilias
䊏 Fetishism is marked by recurrent sexual fantasies, desire, or behaviors that in-
volve nonliving objects over all other types of stimuli.
䊏 Transvestitism is a desire to dress in clothes of the opposite sex to attain sexual
arousal.
䊏 Exhibitionism is sexual arousal obtained by exposing one’s genitals to others.
䊏 Voyeurism is a recurrent desire to view other unsuspecting individuals during
intimate moments (e.g., watching an individual undressing or having inter-
course).
䊏 Frotteurism involves experiencing recurrent urges to rub against nonconsenting
individuals to obtain sexual arousal.
䊏 Pedophila refers to sexual gratification derived from watching, touching, or en-
gaging in sexual activity with children.
䊏 Sexual masochism refers to sexual arousal that occurs when the individual is hu-
miliated or when physical pain or suffering is induced.
䊏 Sexual sadism is sexual arousal that occurs when an individual inflicts pain on
others through acts of domination, restraining, mutilating, and sometimes even
killing another person.

䊏 Gender Identity Disorder

Another facet of sexual problems is gender identity disorders (GIDs), which are de-
scribed as a person’s excessive distress at feeling that the wrong sex was assigned at
birth. Persons with this problem often are concerned with denying or getting rid of
their primary sex characteristics (Comer, 2001). Treatment modalities for GID in-
clude sex-change therapy, hormone replacement treatments, and therapy.

䊏 Sex Therapy

Sex therapy was pioneered by Masters and Johnson in 1970 as a treatment used for
most types of sexual disorders and encompasses the following principles and tech-
niques.

Aspects of Masters and Johnson’s Approach to Sex Therapy (Comer, 2001)

䊏 Evaluating the problem by gathering information on the sex history of each part-
ner, including other relevant information on past life events.
䊏 Discussing the mutual responsibility of both partners for the sexual problems in
their relationship.
䊏 Providing education about sexuality through psychotherapy, bibliotherapy, and
instructional videos.
䊏 Challenging misinformed beliefs or myths about sexuality.
424 What Are the Essential Elements of Counseling? PART TWO

䊏 Teaching methods of sexual interplay that deemphasize sexual intercourse and

orgasm and redirect the attention to sexual pleasure experienced through explo-
ration of one another’s bodies.
䊏 Increasing sexual and general communication skills.
䊏 Changing destructive lifestyles and marital interactions that may be interfering
with sexual intercourse.
䊏 Addressing physical and medical factors to sexual dysfunction.

DISTURBANCES OF PSYCHOSIS, MEMORY,

AND OTHER COGNITIVE FUNCTIONS

Schizophrenia, also known as psychosis, can be described as a loss of reality result-

ing in an inability to function at home, at work, in school, or in social relationships.
An often severe and chronic problem, schizophrenia is characterized by disturbed
thought processes, perceptions, and emotions that vary in responsiveness to treat-
ment (Comer, 2001).

䊏 Approaches to Understanding Schizophrenia

Theorists in the biological, psychodynamic, behavioral, and sociocultural schools

of thought all have considered the causes of schizophrenia, and although there
may be a case for each of their attributions for psychosis, the biological explana-
tions appear to be the best supported by research evidence (Comer, 2001). A sum-
mary of the differing perspectives on understanding this disturbance are men-
tioned in Table 19.6.

䊏 Symptoms of Schizophrenia

Symptoms of psychosis are classified by three themes, as described next.

Categories of Schizophrenic Symptomatology

䊏 Positive symptoms are bizarre additions to a person’s behavior, such as delu-
sions and hallucinations.
䊏 Negative symptoms are pathological behavioral deficits, such as blunted affect,
social withdrawal, and loss of volition.
䊏 Psychomotor symptoms include severely restricted movements such as catato-
nia.

There is general agreement that the diathesis stress model where a biological pre-
disposition combined with other psychological and sociocultural factors is the best
CHAPTER NINETEEN Understanding and Assessing Psychopathology 425

TABLE 19.6
Approaches to Explaining and Treating Schizophrenia

Theory Cause of Schizophrenia Treatment

Biological Biological predisposition Regulate dopamine (medications)

(disorder manifests only when
certain events or stressors are
present) Excessive dopamine
activity Abnormal brain
structure
Psychodynamic Regression to pre-ego state and Insight into the causes and
subsequent efforts to maintenance of symptoms
reestablish ego control due to
poor (mother) parenting in
early experiences
Behavioral Reinforcement of bizarre Token economy systems where
responses to environment rewards are given for
appropriate behaviors
Cognitive Attempts to understand Education about the symptoms of
abnormal sensations that are the disorder, insight into the
triggered in the brain causes of symptoms
Sociocultural Social labeling Social support, daily living skills
Family dysfunction supported by family and
community

explanation for the development of schizophrenia. Treatment of schizophrenia

typically involves milieu therapy where medications, psychotherapy, and socio-
cultural support (either in a facility or in the community) are provided.

䊏 Dissociative Disorders

Some people experience marked disruptions in their memory, which is the key to
knowing oneself and developing a stable identity. Interferences in memory are a
form of dissociation, meaning that parts of an individual’s memory are discon-
nected and independent from other parts of memory. There are many kinds of
dissociative disorders; a few of these are mentioned here.

Categories of Dissociative Disorders

䊏 Dissociative amnesia often appears after a trauma and is characterized by forget-
fulness and inability to access memories containing important information.
䊏 Dissociative fugue occurs when individuals forget their past and assume a new
identity after geographically relocating.
䊏 Dissociative identity disorder, formerly known as multiple personality disorder,
occurs when an individual develops two or more distinct personalities with each
subpersonality possessing different memories, feelings, and thoughts.
426 What Are the Essential Elements of Counseling? PART TWO

Although there are a number of perspectives on the causes of dissociative disor-

ders, treatment regimens generally recommended include hypnotherapy, psycho-
therapy, and medication.

DISTURBANCES IN PERSONALITY

Personality disorders are patterns of rigid thoughts, feelings, and behaviors that
differ dramatically from social norms. Disturbances with personality fall into three
clusters: odd, dramatic, and anxious personality types (Comer, 2001), each of
which is outlined in this section.

䊏 Approaches to Understanding Problems With Personality

Personality disorders of the three clusters are varied manifestations of inflexible

patterns of being that are usually personally and socially problematic. The catego-
ries of disorders that fall within each of the three clusters are also unique, and to
provide an analysis of the hypothesized causes of each disorder is beyond the
bounds of this chapter. However, it is worth mentioning that the attributes of most
of these personality disorders have not been empirically investigated and warrant
further study from a variety of perspectives.

䊏 Odd Personality Disorders

Odd personality disturbances are characterized by odd or eccentric behaviors that

are similar to those of schizophrenics. Paranoid, schizoid, and schizotypal are three
types of odd disturbances that fall under this category.

Categories and Characteristics of Odd Personality Disorders

䊏 Paranoid personality disorder is characterized by an avoidance of relationships
due to chronic distrust and suspiciousness.
䊏 Schizoid personality disorder is one in which a disinterest in and avoidance of re-
lationships, as well as a lack of emotion, are manifest.
䊏 Schizotypal personality disorder is characterized by extreme discomfort in close
relationships, odd patterns of thinking and perceiving, and eccentricity in be-
havior; this is the most severe of the disorders in this cluster.

Treatment rarely is sought by individuals with paranoid personality distur-

bances. However, when treatment is desired, object relations therapy focusing on
the importance of relationship and cognitive treatments focusing on managing dis-
CHAPTER NINETEEN Understanding and Assessing Psychopathology 427

torted thoughts are used. Likewise, treatment rarely is sought for schizoid person-
ality or schizotypal personality disorders, either. When sought, treatment for schiz-
oid personality disturbances includes cognitive interventions dealing with the
individual’s inaccurate perceptions of others and behavioral measures that reward
role playing. Treatment of schizotypal personality disorder focuses on connecting
with others, cognitive interventions to correct inaccurate perceptions of others, and
behavioral measures that reward role playing; at times, medications may be used.

䊏 Dramatic Personality Disorders

Dramatic personality disturbances are characterized by highly emotional and er-

ratic behaviors, as well as extremely dysfunctional personal relationships. Dra-
matic personality disorders include antisocial, borderline, histrionic, and narcissis-
tic personality disorders.

Categories and Characteristics of Dramatic Personality Disorders

䊏 Antisocial personality disorder is typified by persistent disregard for the rights
of others and often is accompanied by the lack of remorse.
䊏 Borderline personality disorder is characterized by ongoing instability in rela-
tionships, self-image, and mood, as well as impulsive behavior.
䊏 Histrionic personality disorder usually includes symptoms such as exaggerated,
rapidly changing moods and attention-seeking behavior.
䊏 Narcissistic personality disorder is characterized by a lack of empathy for others,
grandiosity, and an insatiable need for attention and admiration from others.

A primary obstacle to treatment for antisocial personality disorder is the limited

desire to change and lack of remorse for behaviors that usually are present in indi-
viduals with the symptoms that accompany the disorder. Most treatments are re-
ported as ineffective, and sometimes traditional therapies are contraindicated.
Treatment for borderline personality disorder usually includes a combination of
psychodynamic, cognitive, behavioral, and sociocultural interactions. Medications
may also be used. There is some evidence that sustained long-term treatment can
result in some gains. People with histrionic traits typically do seek out treatment.
However, they can quickly assimilate the therapist into their repertoire of inappro-
priate relationships. Thus, cognitive, psychodynamic, and sociocultural interven-
tions all are aimed at creating a relationship that is not based on dependency.
Narcissictic personality disorder is one of the most difficult psychological prob-
lems to treat. Psychodynamic interventions focus on recognizing and working
through insecurities and defenses, whereas cognitive interventions focus on un-
derstanding others. None has shown substantive support.
428 What Are the Essential Elements of Counseling? PART TWO

䊏 Anxious Personality Disorders

Anxious personality disturbances are characterized by anxious and fearful behav-

ior. Avoidant, dependent, and obsessive-compulsive personality disorders com-
prise this category of anxious-related disorders.

Categories and Characteristics of Anxious Personality Disorders

䊏 Avoidant personality disorder is typified by excessive discomfort and inhibition
in social situations, overwhelming feelings of inadequacy, and extreme sensitiv-
ity to negative evaluations.
䊏 Dependent personality disorder manifests in a desperate, pervasive need to be
taken care of. Individuals with this problem usually exhibit clingy behaviors and
may develop an inability to carry out even the simplest tasks for themselves.
䊏 Obsessive-compulsive personality disorder is characterized by a person’s lack of
flexibility, openness, and efficiency due to pervasive preoccupation with order,
perfection, and control.

For persons with avoidant and dependent personality traits, cognitive and psy-
chodynamic interventions focus on finding success in relationships. Additionally,
behavioral exposure therapy, sociocultural support groups, medications (anti-anx-
iety), and family interventions sometimes are used. Treatment for obsessive-com-
pulsive disorder rarely is sought, however, as individuals with this problem usu-
ally like their orderliness; that is, the symptoms are ego syntonic and cause these
individuals little distress. When treatment is sought, cognitive and psychodynamic
approaches often are combined in treatment, along with anti-anxiety and antide-
pressant medications.

DISTURBANCES IN CHILDHOOD

The varieties of psychological problems that arise in childhood include mental

health oriented issues, such as separation anxiety and conduct disorder, as well as
more biologically oriented problems, such as Down’s syndrome and mental retar-
dation. We outline a number of these disturbances in this section.

䊏 Approaches to Understanding Childhood Disturbances

There are a multitude of psychological problems that can manifest in childhood.

Table 19.7 summarizes some of the biological, behavioral, and sociocultural per-
spectives on explaining and treating mental health issues in children and young
adults.
CHAPTER NINETEEN Understanding and Assessing Psychopathology 429

TABLE 19.7
Perspectives on Childhood Mental Health Problems

Causes of Childhood
Theory Mental Health Problems Treatment

Biological Genetic inheritance, drug abuse Medications

Behavioral Learned through parent Family therapy and parent
modeling and reinforcement, training to redirect how parents
exposure to violence reinforce appropriate patterns
Sociocultural Poverty, traumatic events, Family therapy and parent
troubled parent–child training, play therapy, social
relationships, marital conflict, support groups
family hostility

䊏 Mental Health Problems in Childhood

Psychological disturbances not only are present in adulthood, but also are seen in
childhood and adolescence. Indeed, some disturbances that arise in childhood may
be indicative of potential issues in adulthood. Among the most widely recognized
of childhood disorders today is attention deficit hyperactivity disorder; however,
there are numerous other problems in childhood with which counselors should be
familiar.

Categories and Characteristics of Childhood Disturbances

䊏 Separation anxiety disorder is intense distress that occurs in a child when he or
she is separated from the caregiver or home.
䊏 Oppositional defiant disorder manifests as regular patterns of defiance, arguing,
losing one’s temper, and difficulty regulating emotions.
䊏 Conduct disorder manifests in patterns of cruelty to others, lack of respect for
authority, and repeated violations and exploitations on the rights of other
people.
䊏 Attention deficit hyperactivity disorder manifests in difficulty attending to stim-
uli, a tendency for overactivity and impulsive behaviors, or a combination of
both.

䊏 Elimination Disorders

Elimination disorders are unique to childhood and are characterized by a pattern of

behavior in which children either wet themselves or defecate in their clothing or in
other inappropriate places in the home. Two categories of disturbance are identi-
fied as elimination disorders: enuresis and encopresis.
430 What Are the Essential Elements of Counseling? PART TWO

Types of Elimination Disorders

䊏 Enuresis is marked by recurrent, involuntary episodes of bed-wetting.
䊏 Encopresis is marked by recurrent, involuntary episodes of defecating while
clothed.

Depending on the theoretical approach taken to understand this problem, treat-

ment can include play therapy, family therapy aimed at reducing family stress that
may be influencing the behavior, and medication, among other treatment regi-
mens.

䊏 Chronic Disorders Beginning in Childhood

Autism, mental retardation, and Down’s syndrome are all disorders that either be-
gin or are diagnosed in infancy or childhood; all are long term and chronic in na-
ture. Often, psychological and biological tenets explain the onset and etiological
factors associated with each disorder.

Characteristics of Autism, Mental Retardation, and Down’s Syndrome

䊏 Autism manifests as a child’s difficulty to communicate, patterns of interper-
sonal isolation, unresponsiveness to others, and repetitive and stereotypical
movements. Symptoms emerge prior to age 3.
䊏 Mental retardation is the term used for children whose cognitive functioning is
well below average and who display deficits in adaptive behaviors.
䊏 Down’s syndrome is mental retardation caused by genetic abnormality in the
21st chromosome.

A leading theory on autism asserts that a form of mind blindness (i.e., problems
with theory of the mind) interferes with the child’s capacity for understanding oth-
ers’ perspectives, severely impairing the extent to which a child can engage inter-
personally with others in the world. Research has suggested that psychoeducation,
direct instruction in the classroom, and family therapy can be effective treatments
for children with autism. Psychoeducational efforts should focus on teaching ap-
propriate behaviors, social skills, self-help skills, and communicative skills in both
the home and school environment.
For individuals with mental retardation or severe cognitive limitations result-
ing from other biological deficits or abnormalities, the main goal is to increase the
person’s capacity for independent living skills. Psychoeducation on issues associ-
ated with adaptive functioning (e.g., independent dressing, toileting, dating, sex
education, job training) has been effective for many individuals with mental re-
tardation.
CHAPTER NINETEEN Understanding and Assessing Psychopathology 431

DISTURBANCES RELATED TO AGING AND COGNITION

Perhaps the most common psychological problems associated with aging are those
related to memory and cognition. In this section, we describe a number of distur-
bances that older adults encounter with regard to their cognitive ability. However,
older adults also are susceptible to other mental health issues such as mood and
anxiety disorders. Therefore, these also are addressed.

䊏 Problems With Cognition and Neurology in Older Adults

Although most older adults experience some type of memory loss as they age,
symptoms of these disorders are recognized as more severe than what occurs in the
normal process of aging. Some of those disturbances of cognition are outlined here
along with other biopsychosocial problems.

Types of Psychological Problems Characteristic in Late Life

䊏 Delirium is marked difficulty concentrating, attending to stimuli, and focusing
leading to confusion, misinterpretations, and hallucinations.
䊏 Dementia is marked memory loss combined with decreases in cognitive func-
tioning and capacity for abstract thinking.
䊏 Alzheimer’s disease is the most common form of dementia resulting in loss of
most cognitive faculties, disorientation, and decreased capacity for communica-
tion with others.
䊏 Vascular dementia can be described as damage done to the brain subsequent to a
stroke or accident, which leads to dementia.
䊏 Pick’s disease is a disorder affecting the frontal and temporal lobes that closely
resembles Alzheimer’s disease.
䊏 Creutzfeldt–Jakob disease can be described as dementia associated with spas-
modic movements.
䊏 Huntington’s disease is characterized by memory deficits that lead to personal-
ity changes and mood deregulation.
䊏 Parkinson’s disease is a neurological disease associated with tremors, rigidity,
and dementia.

䊏 Mood Disorders in Older Adulthood

Depression and anxiety disorders are common mental health problems for older
adults. Although the symptoms do not necessarily manifest in different forms for
the elderly as compared with younger people, there are additional complications
that should be noted. For example, older people who exhibit symptoms of depres-
sion or anxiety have a variety of medical sequelae that can increase the likelihood
of suicidality. Research has suggested that individual therapies, group therapy, and
432 What Are the Essential Elements of Counseling? PART TWO

medication therapies have been helpful in reducing the severity of depression and
anxiety in older adults. At times, symptoms of depression, such as cognitive im-
pairment, can be confused with normal aging or cognitive disorders in the elderly.
In conclusion, understanding deviant behaviors and how those behaviors are
assessed, tallied for the purpose of diagnosis, and used in the tailoring of treatment
is a primary role for clinicians. Comparing various theoretical perspectives side by
side with treatments aids the clinician in clarifying intervention selections. That is,
the connections between theoretical explanations of behaviors can direct the pro-
cess of selecting treatments that correspond to the presenting problems of our cli-
ents. Through the combined use of clinical assessment and the knowledge of theo-
ries and interventions, practitioners more readily are able to identify the course of
psychopathology at an individual client level, which increases the long-term ca-
pacity for positive client outcomes and effectiveness in treatment.

Chapter 19: Key Terms

䉴 Assessment 䉴 Disorders 䉴 Criterion-referenced test
䉴 Deviance 䉴 Syndromes 䉴 Substance abuse
䉴 Distress 䉴 Diagnosis 䉴 Substance dependence
䉴 Dysfunction 䉴 Broadband tools 䉴 Ego syntonic
䉴 Danger 䉴 Narrowband tools
䉴 Diagnosing 䉴 Norm-referenced test
 part three

What Are the Fundamental

Components of Appraisal
and Research That New Counselors
Should Use in Their Practice?
 chapter Foundations of Measurement
and Psychometrics
20
Tara Greene
Jeffrey A. Miller
Nate E. Kegal
Julie Williams
Duquesne University

In This Chapter

䉴 Statistics: A Brief Introduction 䉴 Reliability

䊏 Ethics in Statistical Research 䊏 Classical Test Theory
䊏 Differentiation Between Descriptive and 䊏 Importance of Reliability

Inferential Statistics: Some Basics 䊏 Measurement of Reliability

䊏 Methods of Estimating Reliability

䉴 Descriptive Statistics 䊏 Standard Error of Measurement

䊏 Scales of Measurement 䊏 The Confidence Interval

䊏 Measures of Central Tendency: Mean,

Median, and Mode 䉴 Validity

䊏 Measures of Dispersion: Range, Variance, 䊏 Content Validity
and Standard Deviation 䊏 Face Validity

䊏 Distribution 䊏 Construct Validity

䊏 Percentile 䊏 Criterion-Related Validity

䉴 Inferential Statistics 䉴 Test Construction

䊏 Probability 䊏 Methods of Test Development
䊏 Standard Scores 䊏 Writing the Items

䊏 Tests of Significance 䊏 Item Try-Out

䊏 Normative Sample

䊏 Writing the Manual

434
CHAPTER TWENTY Foundations of Measurement and Psychometrics 435

STATISTICS: A BRIEF INTRODUCTION

Psychological measurement is based on core statistical principles that allow one to

better understand, interpret, and conduct research, as well as make decisions using
test data. Because counselors frequently are involved in testing and assessment of
clients and then making decisions based on test results, they should at least be fa-
miliar and comfortable with the basics of descriptive and inferential statistics. Also
important to the work of testing and assessment are the areas of reliability, validity,
and test construction. Each of these topics is addressed in this chapter. First, how-
ever, it is necessary to mention the importance of ethical practice in statistical re-
search.

䊏 Ethics in Statistical Research

Ethical practice is fundamental to all counseling-related endeavors, from the indi-

vidual counseling relationship to research studies that are conducted in the field of
counselor education. Adhering to high ethical standards is especially critical, be-
cause most research in the counseling field involves human participants. Thus, it is
necessary that all researchers be aware of the various principles of ethical investi-
gations. To ensure that students and professionals act within the specific guidelines
that frame ethical research, they usually are required to complete online training in
ethical practice in research, as well as secure approval from an institutional review
board that independently reviews investigative proposals. A few terms that coun-
selors who plan to conduct human-participant research may want to be familiar
with include informed consent, voluntary participation, anonymity, and risk of
harm. Trochim (2002) defined these concepts this way:

Informed consent: Participants must be made fully aware of the scope of ex-
pectations surrounding their participation in and the procedures of the study,
and then freely give their consent to participate.

Voluntary participation: Participants are not coerced, forced, or deceived

into participation.

Risk of harm: Participants will incur no physical or psychological harm as a

result of taking part in the study.

Anonymity: A facet of protecting participants from risk of harm by which

participants are ensured that their identities or any identifying information
will not be revealed or used in the study.
436 What Are the Fundamental Components of Appraisal and Research? PART THREE

To complete a tutorial on the protection of human participants in re-

search, visit the following Web site:
䉴 http://cme.cancer.gov/clinicaltrials/learning/humanparticipant-protections.asp
For a more detailed description of ethical codes surrounding research
by professional counselors, refer to the ACA Code of Ethics at this
Web site:
䉴 http://www.counseling.org/Resources/CodeOfEthics

䊏 Differentiation Between Descriptive and Inferential Statistics: Some Basics

Basic statistical procedures can be classified as descriptive or inferential; it is im-

portant to understand the distinction between these two approaches to statistical
inquiry. Rowntree (2004) made the following differentiation between these two
types of statistics:

Descriptive statistics: Statistical inquiry that uses observations to describe or

make summary statements about data.

Inferential statistics: Statistical inquiry that uses observations of a sample

population to make predictions and generalizations about the wider popula-
tion.

DESCRIPTIVE STATISTICS

This section of the chapter briefly addresses some key concepts in the area of de-
scriptive statistics, including the following:

䊏 Scales of measurement.
䊏 Measures of central tendency.
䊏 Measures of dispersion.
䊏 Distribution.
䊏 Percentiles.

䊏 Scales of Measurement

Scales of measurement are systems of ordinal or verbal descriptors that are used in
statistics to describe the characteristics of a data set based on their empirical prop-
erties. There are four types of scales of measurement: nominal scales, ordinal scales,
interval scales, and ratio scales. Because each scale measures different information,
it is important to understand the purpose of each scale and when it is required; de-
CHAPTER TWENTY Foundations of Measurement and Psychometrics 437

pending on the type of data and method of data collection, the scale of measure-
ment will vary (Sprinthall, 2003). The measurement scales can be defined this way:

Nominal scales: The simplest form of measurement that assigns numbers to

classify data into one or more categories (e.g., one type of nominal measure-
ment is gender, and numbers can be assigned to the categories of male and fe-
male) to make observations about the frequency with which data fall into
each category.

Ordinal scales: Like the nominal scales, data are classified into categories,
and they are also rank ordered. The distance between the rankings, however,
is not known and rankings are not necessarily equidistant. An example of an
ordinal scale is the order of finishing in a race (first, second, third, etc).

Interval scales: A form of measurement that also is rank ordered on a scale

that contains equal intervals between numbers on the scale. However, there is
no absolute zero point, indicating that no mathematical calculations can be
done with the data set.

Ratio scales: Scales that have all the properties as the interval scale of mea-
surement and also have an absolute or true zero point.

Increasingly more useful data are gleaned through the use of nominal, ordinal, in-
terval, and finally ratio scales, with ratio scales providing for the most complex and
valid comparisons of data. Examples of ratio scales include height, weight, speed,
time, and distance. All mathematical operations can be done with these data be-
cause there is a true zero. For example, data can be compared, saying a bag with a
weight of 40 pounds weighs twice as much as one that weighs 20 pounds.

䊏 Measures of Central Tendency: Mean, Median, and Mode

The most common measures of central tendency are the mean, median, and mode.
Each of these measures represents a way of descriptively summarizing data with-
out having to use complex methods of statistical analysis. The following are defini-
tions of mean, median, and mode that counselors can adopt (Sprinthall, 2003):

Mean: A measure of central tendency that is represented by the mathematical

average of a set of test scores from interval or ratio data. Symbolized by M, the
mean is calculated by dividing the sum of all of the scores in a distribution
(ΣX) by the total number of scores (N).

Median: The measure of central tendency that represents the midpoint in the
distribution of data arranged either in ascending or descending order. The
median is the point above which half of data lie and below which half of the
data lie.

Mode: The measure of central tendency that represents the most frequently
occurring score.
438 What Are the Fundamental Components of Appraisal and Research? PART THREE

EXAMPLE

Calculating the Mean

The formula for finding the mean can be expressed this way: (ΣX/N). As an example, imagine
that four students take a math test and their scores are 85, 90, 70, and 75. To find the average or
mean score of the four students, it is necessary to add the scores together and divide the sum
by the total number of scores. Expressed mathematically, the mean of the students’ scores is:
(85 + 90 + 70 + 75) / 4 = 80.

䊏 Measures of Dispersion: Range, Variance, and Standard Deviation

In addition to the measures of central tendency, measures of dispersion are another

set of descriptive statistics that researchers have at their disposal for describing
their data. Three of the most useful of these measures are range, variance, and stan-
dard deviation.

Range: Provides a quick assessment of the variability in the data by describ-

ing the uppermost and lowermost scores among the data.

Variance: Describes the spread of a distribution of scores by indicating how

much variation there is in a set of scores from the mean. Variance is computed
as the average squared deviation of each number from its mean.

Standard deviation (SD): The most commonly used measure of test score
spread, also utilized in a wide variety of other, more complicated statistical
analyses. Standard deviation is scaled in raw score terms and indicates how
far individual scores are from the mean.

EXAMPLE

Calculating the Variance and Standard Deviation

Mathematically, s2 is the variance, X is the observed score, M is the mean, and N is the total
number of scores. The variance is calculated using the following equation:
Formula: s2 = Sum (X – M)2 / N
Example: [(1 – 2)2 + (2 – 2)2 + (3 – 2)2 ] / 3 = .667
Standard deviation is calculated by taking the square root of the variance. The formula for the
standard deviation is as follows:
SD = Σ (X)2 / N
Example: [(1 – 2)2 + (2 – 2)2 + (3 – 2)2 ] / 3 = .667 = .817
CHAPTER TWENTY Foundations of Measurement and Psychometrics 439

䊏 Distribution

Descriptive statistics, such as the mean, median, and mode, as well as measures of
variance, help researchers begin to make sense of their data. Pictorial representa-
tions of distribution also are useful in providing an initial understanding of the
data. Normally distributed data for a large group of test takers look like a
bell-shaped curve (see Figure 20.1). The normal curve has several properties that
allow for the standardized interpretation of individual test scores. The area under-
neath the normal curve is described using the mean, standard deviation, and per-
centiles.

Properties of the Normal Curve

䊏 In the normal distribution curve, the mean is in the middle at the highest eleva-
tion of the curve.
䊏 One standard deviation from the mean in both directions is found at the inflec-
tion point (the point where the curve changes from concave to convex).

FIGURE 20.1 A normal distribution curve. From Psychological testing and assessment:
An introduction to tests and measurements (5th ed., p. 97), by R. J. Cohen and M. E.
Swerdlik, 2002, Boston: McGraw-Hill. Copyright 1999 by McGraw-Hill Company.
Reprinted with permission.
440 What Are the Fundamental Components of Appraisal and Research? PART THREE

䊏 The normal curve is asymptotic (i.e., it never touches the x axis). All of the scores
are represented under the curve, but there is no maximum or minimum score
due to its asymptotic property.
䊏 The normal curve is symmetrical, with 50% of the scores falling above the mean
and 50% falling below the mean.
䊏 Sixty-eight percent of the scores in a normal distribution fall within 1 standard
deviation, and 95% of the scores fall within 2 standard deviations of the scores
(see Figure 20.1).

The bell-shaped curve describes normally distributed data. However, in not all in-
stances is the distribution of data symmetrical, and in these instances, data are con-
sidered to be either positively or negatively skewed. When data are skewed, most
of the scores are found at one or the other end of the range of scores (Sprinthall,
2003).

Positively skewed data: Data contain few high scores and are comprised
mostly of low scores. In this distribution, the tail of the curve goes out to the
right.

Negatively skewed data: Data contain few low scores and are comprised
mostly of high scores. In this distribution, the tail of the curve goes out to the
left.

A final characteristic that researchers use to describe the distribution of data is

kurtosis, which is defined by Abrami, Cholmsky, and Gordon (2001) this way:

Kurtosis: “[T]he extent to which a frequency distribution of scores is bunched

around the center or spread toward the endpoints” (p. 99).

When data are clustered in the center, there is less variability, and when data are
more widely spread to the endpoints (which results in a flat rather than a peaked
distribution curve), there is greater variability in the distribution.

䊏 Percentile

The normal distribution can be thought of as a cumulative distribution of mea-

sured scores ranging from the lowest score at the left to the highest score at the
right. Any score or point in this cumulative distribution can be described as a per-
centile, and in the normal distribution there are 100 percentiles. Percentiles are a
way of organizing norm-referenced test results that provides information on how
one person scored in relation to a group of people who took the same test.

Percentiles: Describe the percentage of people whose score falls at or below a

particular raw score.

For example, if a child is at the 75th percentile, this child performed as well as or
better than 75% of those that comprise the normal distribution.
CHAPTER TWENTY Foundations of Measurement and Psychometrics 441

EXAMPLE

Using Percentiles in Test Interpretation

The normal curve can be broken down into percentiles to help identify where a score falls on
the normal distribution relative to other scores and the frequency of those scores. Ultimately,
percentiles assist in score interpretation. Typically, test scores that fall between the 0 and 34th
percentile represent below-average scores, those that fall above the 34th percentile and below
the 84th percentile are classified as average, and those that are at the 84th percentile or above
are above average. This is important information, especially for school counselors who have to
interpret the aptitude, achievement, or intelligence tests they administer. If a student had a
perfectly average intelligence score of 100 (M = 100, SD = 15) this student would be at the 50th
percentile. The percentile allows the counselors to know that the person’s score falls within the
average range and is equal to or better than 50% of the scores that comprise the normal distri-
bution.

INFERENTIAL STATISTICS

As already mentioned, inferential statistics are different from descriptive statistics

in that they allow researchers to make predictions about a population based on a
representative sample of that population. Additionally, inferential statistics allow
researchers to test whether or not an experimental treatment has a significant effect
on an identified dependent variable.

䊏 Probability

When utilizing inferential statistics, one of the basic building blocks researchers
must be able to understand is probability. Abrami et al. (2001) defined probability
in statistics as follows:

Probability: the likelihood that an occurrence will take place given all other
chance factors.

All researchers in and outside of human science investigations must decide how
much chance for error they will allow in their study. Typically, in human science re-
search, such as in the field of counseling, experts set the probability level or signifi-
cance level at least at p = .05. This simple equation can be interpreted to mean that
the researcher is willing to accept a 5% chance that the differences in sample means
are due to chance factors. Expressed differently, the researcher is 95% certain that
the differences are real and not due to chance factors.
442 What Are the Fundamental Components of Appraisal and Research? PART THREE

䊏 Standard Scores

To deal with the reality that there is diversity among the means found in normal
distributions from different tests, statisticians settled on one normal distribution
that is considered the standard, with a mean of 0 and a standard deviation of 1.
Values on the standard normal distribution are known as standard scores and are
derived from the conversion of a raw or measured score from its original measure-
ment scale to a new standard measurement scale. Standard scores remove negative
scores and decimal points and are used because they more easily are interpreted
than raw scores. Commonly used standard scores include the Graduate Record Ex-
amination (GRE), Scholastic Assessment Test (SAT), deviation IQ, ACT, T score,
scaled score, and z score; each of the means and standard deviations for these stan-
dard scores are listed in Table 20.1 and are briefly described next.

Characteristics of the Z score

䊏 The z score represents the number of standard deviations above or below the
mean.
䊏 The z score, or zero plus or minus one scale, is the primary standard score, and it
precedes the construction of other standard scores.
䊏 The z score is equal to the difference between a particular raw score and the mean
divided by the mean standard deviation.
䊏 The z score has a mean of 0 and a standard deviation of 1 and is calculated with
the following equation: x – M / s (Example: 75 – 80 / 15 = –0.33).

Aspects of the GRE and SAT

䊏 The GRE and SAT are two examples of tests that provide standard scores.
䊏 These tests are commonly used for college and graduate school admission and
have a mean of 500 and a standard deviation of 100.

Aspects of the Deviation IQ

䊏 Deviation IQ is the standard measure for the intelligence quotient or IQ.
䊏 Tests that use deviation IQ as their standard score have a mean of 100 and a stan-
dard deviation of 10.

Table 20.1
Scale Scores

Scale Name Mean SD

GRE, SAT 500 100

Deviation IQ 100 15
ACT 20 5
T-score 50 10
Scaled score 10 3
Z score 0 1
CHAPTER TWENTY Foundations of Measurement and Psychometrics 443

䊏 The deviation IQ scores sometimes are referred to as standard scores, and so, the
term standard score is used to describe both the general class of transformed
scores and the specific instance of scores set to a mean of 100 and standard devia-
tion of 15. If this is the case, 95% of deviation IQ scores fall between 70 and 130, or
2 standard deviations below and above the mean.
䊏 Commonly used qualitative classifications used for deviation IQ scores include
the following: > 129 = very superior; 120–129 = superior; 110–119 = high average;
90–109 = average; 80–89 = low average; 70–79 = below average; < 70 = well below
average.

Aspects of the ACT

䊏 The ACT is a standard score measure.
䊏 Like the SAT, the ACT is used for college admission.
䊏 The ACT has a mean set at 20 with a standard deviation of 5.

Aspects of the T Score

䊏 The T score is another example of a standard score and should not be confused
with the t test in statistics.
䊏 The T score, which has a mean set at 50 and a standard deviation of 10, is a mea-
sure of how far a person’s score is from the mean (Sprinthall, 2003).
䊏 Traditionally, the T score was the measure used in reporting personality test
scores such as the Minnesota Multiphasic Personality Inventory (MMPI;
Hathaway & McKinley, 1983).

Aspects of the Scaled Score

䊏 The scaled score has a standard deviation of 3 and a mean of 10.
䊏 The scaled score often is used for subtest scores that are combined into composite
scores.

EXAMPLE

Converting a Raw Score Into the Deviation IQ

This transformation of a raw score into a deviation IQ may be done because it is easier to un-
derstand and explain scores as well as compare scores from different tests when a standard
score is used. In this example an individual has a raw score of 25. The test raw score mean is 18,
and the raw score standard deviation is 5. It is necessary to compute the z score first, then the
deviation IQ standard score.
z = (X – M) / SD
z = (25 – 18) / 5 = 1.4
444 What Are the Fundamental Components of Appraisal and Research? PART THREE

Deviation IQ Standard score = Deviation ZQ M + (Deviation IQ SD * z score)

Example: Deviation IQ M = 100, Deviation IQ SD = 15, z score = 1.4
Deviation IQ Standard score = 100 (15 * 1.4)
Deviation IQ Standard score = 121
This individual would be classified in the superior range for deviation IQ.

䊏 Tests of Significance

Tests of significance, in inferential statistics, are the methods employed to compare

two or more samples to determine whether or not true differences exist in the sam-
ple means. In other words, researchers want to see if the differences are big enough
to indicate a true difference in sample means (Rowntree, 2004; Trochim, 2002). Tests
of significance are chosen specifically to fit the research designs that investigators
apply to their studies. Research designs can be categorized broadly as experimen-
tal and quasi-experimental designs and nonexperimental designs. Experimental
and quasi-experimental designs typically deal with ordinal data and rely on para-
metric statistics, whereas nonexperimental designs usually involve categorical
data (e.g., gender, educational level, etc.) and require nonparametric statistics, the
most common of which is the chi-square test of significance. Although the statisti-
cal procedures that underlie each approach to analysis are not explored here, the
following list identifies basic statistical procedures that researchers utilize.

Types of Parametric and Nonparametric Statistical Analysis

䊏 The t test is a statistic that is used to determine whether or not there are true dif-
ferences in two sample means for the same dependent variable.
䊏 One-way analysis of variance (ANOVA) is statistically equal to the t test, but it
can be used to test for true differences in two or more sample means on the same
variable.
䊏 The repeated measures ANOVA is used to analyze a single factor (independent
variable) and a single dependent variable when the sample is the same for each
treatment condition. The most common occasion in which this test is used is
from pretest to posttest.
䊏 Analysis of covariance (ANCOVA) also is used to test for statistically significant
differences in sample means of three or more groups; however, by combining the
ANOVA with a correlation, it also statistically removes the effects of identified
covariates or confounding variables that potentially can influence the depend-
ent variable.
䊏 Tests of linear regression or correlations are used to indicate the strength of the
relationship between two variables and to determine the extent to which the be-
CHAPTER TWENTY Foundations of Measurement and Psychometrics 445

havior of one variable can predict that of another variable. A strong correlation
does not mean that one variable causes another, but rather, suggests that the rela-
tionship between two variables is strong and one variable may be used to make
predictions about another.
䊏 Factor analysis is used to analyze the effects of more than one independent vari-
able as well as the interaction effects of the independent variables on a depend-
ent variable.
䊏 The chi-square statistic is a measure of goodness of fit or independence. It al-
lows researchers to infer if two nominal variables are independent of one another
or are related. The chi-square is a nonparametric statistic.

RELIABILITY

When deciding to use a testing instrument, practitioners need to evaluate two im-
portant factors: test reliability and validity. Validity is addressed in the next section,
while some key aspects of reliability are described in this section. Reliability can be
defined as follows:

Reliability: An indication of the consistency of test scores over repeated test

administrations.

A test that is highly reliable provides about the same score for the same person
when given repeatedly, whereas an unreliable test yields quite different scores for
the same person when repeatedly administered (Abrami et al., 2001; Sprinthall,
2003). The reason reliable tests yield consistent results is because they primarily
measure individuals’ true scores as opposed to error. This reasoning is explained
further by the classical test theory.

A test that is highly reliable provides about the

same score for the same person when given
repeatedly, whereas an unreliable test yields
quite different scores for the same person when
repeatedly administered.

䊏 Classical Test Theory

According to the classical test theory, tests measure two things: (a) the attribute be-
ing measured, also called true score, and (b) random error. The combination of the
values of the true score and the random error is known as the observed score. The
classical test theory is represented in the equation, x = T + E, in which x is the ob-
446 What Are the Fundamental Components of Appraisal and Research? PART THREE

served score, T is the true score or the reliability coefficient, and E is the random er-
ror. The sum of T and E is 1. In the absence of error, x = T, and the test score is said to
be perfectly reliable. T and E, therefore, can be described as a percentage variance
in the observed score accounted for by either the true score or error. The reliability
coefficient ranges from 0 to 1, and tests with satisfactory reliability have reliability
coefficients greater than .8. Stated differently, in tests that are adequately reliable, at
least 80% of the observed score is due to the attribute being measured, or the true
score.

䊏 Importance of Reliability

When a test has little error, the same approximate score will be observed for re-
peated administrations. On the other hand, when there is a lot of error, repeated ad-
ministrations of the test will result in quite different scores because error contrib-
utes heavily to the observed score and the error is random. Researchers in the field
of counselor education who choose to conduct quantitative investigations always
will be interested in the reliability of the instruments they choose to use. The
greater the reliability of the instrument, the more certain they can be of their test re-
sults and the more able they will be to draw strong conclusions about their out-
comes.

䊏 Measurement of Reliability

Reliability can be described by the reliability coefficient, which is, fundamentally,

the correlation of the test with itself. The reliability coefficient can be estimated
through a variety of strategies, including test–retest, alternate forms, split half, and
internal consistency. Despite the method used, in each case, the goal is to obtain
two administrations or versions of the test that perfectly correlate. Mathematically
stated, a perfect correlation is equal to 1.
The correlation of the test with itself provides a direct measure of variance; that
is, the reliability coefficient derived from the correlation analysis can be interpreted
as a percentage of true score variance when multiplied by 100. This is not the case
for a normal correlation coefficient, in which it must be squared first (coefficient of
determination) before being multiplied by 100 to indicate variance. Further, two
administrations of the test should correlate perfectly because the same people took
the test and, except for error, they should provide the same results for each admin-
istration. Any deviation from a perfect correlation is considered error.

䊏 Methods of Estimating Reliability

There are several methods used to estimate reliability. Each method has its
strengths and weaknesses, and these should be considered when evaluating the re-
CHAPTER TWENTY Foundations of Measurement and Psychometrics 447

liability coefficients. Methods of estimating reliability include test–retest, alternate

forms, split half, and internal consistency.

Test–Retest Reliability
䊏 The test–retest method involves administering a test to a group of people and
then readministering the same test to the same group of people at a later time.
The correlation of the test results from both administrations provides a measure
of reliability for the instrument.
䊏 This method is limited by the practice effect (people may score better on the sec-
ond administration because of taking the test before) or fatigue (people may lose
interest in the test if it is given too soon after the first administration).

Alternative Forms Reliability

䊏 The alternate forms method involves giving two equal (e.g., in difficulty, kinds of
items, etc.) but different versions of the same instrument with limited time be-
tween administrations and then computing a correlation of the two tests.
䊏 Shortcomings of this method are that it is costly and time consuming to produce
two versions of the same test, and it is difficult to establish equivalence between
two forms of the test for some constructs.

The split-half method of computing reliability mitigates some of the problems with
the alternate forms method and yields about the same results. This procedure is de-
scribed next.

Odd–Even Split-Half Reliability

䊏 The odd–even split-half method uses an odd–even split of items to create two
composite scores for a test that can be correlated.
䊏 By applying the odd–even split approach, an equal number of items from the be-
ginning, middle, and end of the test are represented in each form of resulting
tests.
䊏 A limitation of this method is that by decreasing the number of items on the test
by half, the reliability also is reduced because, generally, reliability increases
when the number of items on a test is increased and decreases when the number
of test items is reduced.

To correct for the shortcoming of the split-half method that arises from splitting the
test, researchers use the Spearman–Brown formula. After correlating the odd items
of the test with the even items of the test, the Spearman–Brown formula is used to
increase the value of the reliability coefficient and to find out what the reliability co-
efficient would have been if the number of items were doubled.
448 What Are the Fundamental Components of Appraisal and Research? PART THREE

Internal Consistency
䊏 The internal consistency method of calculating reliability provides an estimate of
the consistency with which the test items measure their purported construct and
the correlations among all of the test items.
䊏 Internal consistency is computed by using the number of items on the test and
the mean intercorrelation of these items.
䊏 The results of the test are a standardized estimate of reliability known as
Cronbach’s alpha, which is a method of establishing internal consistency for test
items that are not scored dichotomously, such as questionnaires (Abrami et al.,
2001).

䊏 Standard Error of Measurement

Once the reliability coefficient is derived, the degree of consistency in the test is
known. However, it is also important to know how the level of reliability affects the
accuracy of an individual measured score. To determine this, the statistic known as
the standard error of measurement (SEM) is used.

Standard error of measurement: An estimate of how accurate the observed

scores are at approximating the true score.

More specifically, SEM is an indication of the variability of all possible true scores
around the observed score due to error. If a test produces reliable scores, then the
SEM should be relatively small, indicating less variability around the score. How-
ever, if the test does not produce reliable scores, SEM is larger, indicating more vari-
ability around the observed score and less certitude that the score is an accurate re-
flection of an individual’s true score. The SEM can be explained using the normal
distribution. The individual’s observed score forms the center of a normal distribu-
tion of all possible true scores. The SEM works just like a standard deviation with
68% of possible true scores for an individual falling within 1 standard deviation.
The observed score is only one point on the distribution of all possible true scores.
There is no way of knowing the individual’s true score; however, using the SEM
deviation of the score, one can estimate the range of scores that likely includes the
individual’s true score. SEM is calculated using the formula SD 1 – rxx, where SD is
the standard deviation of the measured score and rxx is reliability.

䊏 The Confidence Interval

SEM can be applied in practice through the use of the confidence interval (CI).

Confidence interval: the range of scores that represents some percentage of

confidence of including a person’s true score.
CHAPTER TWENTY Foundations of Measurement and Psychometrics 449

The CI can be demonstrated using the normal distribution of all possible true
scores where the center of the distribution is the observed score. One then deter-
mines the level of confidence that is acceptable for the current use of the test. The
level of confidence is described as percentage of area under the normal distribution
around the observed score. Common percentages that are used include 68%, 90%,
95%, and 99%. The CI is derived by multiplying a number (z score) representing the
percentage of confidence by the SEM and then adding and subtracting the resul-
tant value from the observed score to form a lower and upper limit. So the equa-
tions for common confidence intervals are 68% CI = ± 1 * SEM, 90% CI = ± 1.65 *
SEM, 95% CI = ± 1.96 * SEM, and 99% CI = ± 2.58 * SEM. If the CI was set at 95%, one
would be 95% confident that the true score lies within a range ± 1.96 * SEM of the
observed score.

EXAMPLE

Calculating the Confidence Interval

Observed score = 85, SEM = 2.6, 95% CI = ± 1.96 * SEM
Observed score ± 1.96 * SEM
85 ± 1.96 * 2.6 =
85 ± 5.1 =
CI = 79.9 – 90.1 or about 80–90.
One is 95% confident that the true score lies between 80 and 90.

VALIDITY

Validity is a term used colloquially to refer to something that is well grounded or

evidenced. For example, a journalist who supports a newspaper column with
relevant, factual evidence provides valid information. In the realm of psychologi-
cal assessment, validity is the most important factor of consideration when
evaluating the construction of a good instrument. Tests that measure what they
claim to measure are said to have strong validity (Abrami et al., 2001; Sprinthall,
2003).

Validity: Evidence that the psychological test measures the attribute or ability
it purports to measure in the test manual.
450 What Are the Fundamental Components of Appraisal and Research? PART THREE

From a practical standpoint, a test is considered valid when it provides useful in-
formation for the decision that will be made based, in part, on the test results. Ulti-
mately, psychological tests should provide helpful information for making sound
decisions about the person taking the test. Therefore, a test selected to assist in deci-
sion making for a client must provide a valid measurement of the attribute or abil-
ity that has bearing on the decision. Finally, one can say that validity is a property of
both the test and the context in which the test is used.
Just as there are numerous approaches to determining test reliability, there are
also several ways of verifying test validity, namely, content validity, face validity,
construct validity, and criterion-related validity. Each of these types of validity
yields a particular type of evidence that, when aggregated, indicates whether the
test confidently provides valid information.

䊏 Content Validity

Content validity of a psychological test is established by showing that the test

items on an instrument are representative of the attribute being measured (Abrami
et al., 2001). Assessing the content validity of a test does not require sophisticated
statistics, but rather, is established through a review of the test’s content by a con-
tent expert. A test with high content validity covers not only a breadth of material,
but also sufficient depth in each identified subject area.

EXAMPLE

Establishing Content Validity

Imagine that a professor who teaches an introduction to psychology course wants to give a cu-
mulative final examination at the end of the semester. To establish content validity for the
exam, the professor must ensure that any and all of the subject matter that was covered during
the semester potentially can appear on the final exam. This is known as the universe of con-
tent. Because the professor is testing for comprehension with regard to psychological con-
cepts, the professor would restrict the items on the exam to those that deal directly with the
subject matter at hand and would not, for example, ask questions related to other fields of
study such as mathematics, sociology, or business.

䊏 Face Validity

Face validity is similar to content validity in that both involve judgments concern-
ing the content of a test. However, face validity generally is determined from the
point of view of the person being tested and is a less formal assessment of what the
CHAPTER TWENTY Foundations of Measurement and Psychometrics 451

test appears to measure (Sprinthall, 2003). Judgments made based on face validity
often have implications on a test’s perceived effectiveness or an individual’s will-
ingness to participate in testing. Ultimately, face validity represents a testing in-
strument’s apparent validity and should be used only as an initial indicator of the
test’s content validity.

䊏 Construct Validity

Establishing construct validity begins with a clear understanding of the construct

that the instrument is intended to measure. Construct can be defined broadly this
way:

Construct: An abstraction or concept inferred from the observation of regu-

larly occurring patterns of behavior.

Constructs define naturally occurring mental phenomenon and include such ex-
amples as extraversion, intelligence, depression, awareness, or self-esteem. A com-
mon feature of psychological constructs is that they are either directly or indirectly
related to a behavior or experience. For example, intelligence is a construct associ-
ated with one’s verbal behavior. Those with sophisticated vocabularies and the
ability to reason well with language are considered to have high intelligence. Of
course, one can never see or touch intelligence because it is an abstraction, but one
can infer the existence of intelligence from a person’s regular behavior patterns
such as vocabulary and reasoning behaviors.
Construct validation is a determination of how well test scores are indicative of
the characteristics of the construct being measured (Abrami et al., 2001). Construct
validity is demonstrated when test scores evidence, through correlation analysis,
patterns indicative of the construct. There are several ways to assess and obtain evi-
dence for construct validity, namely, factor analysis and the multitrait–multimethod
approach.

Procedures for Determining Construct Validity

䊏 Factor analysis involves a sophisticated correlation analysis designed to identify
interrelations between measured variables that emerge as factors. The factors are
not directly measured but are inferred based on the relation among the observed
variables. In this way, the factor represents the construct, and the variables repre-
sent the observed behaviors.
䊏 The multitrait–multimethod approach involves a number of different methods of
measuring several different constructs, also known as traits. The chosen con-
structs should be theoretically unrelated to emphasize the correlations among
different measures of the same construct.
452 What Are the Fundamental Components of Appraisal and Research? PART THREE

EXAMPLE

Using Factor Analysis

A test developer is attempting to validate the construct validity of an instrument purported to
measure mathematics ability. Using factor analytic techniques, the developer tries to ensure
that all of the individual items that measure mathematics skills, such as addition and subtrac-
tion problems, are correlated and “load” on a single factor labeled mathematics. Through fac-
tor analysis, questions about world history, for example, that may have been included on the
test would not correlate well with the mathematics questions and, therefore, would be identi-
fied as not supporting the construct of interest.

䊏 Criterion-Related Validity

Criterion-related validity is demonstrated when there is a high association or cor-

relation between the test score and some other measure of interest (Abrami et al.,
2001). This measure of interest is called the criterion. In psychological assessment, a
criterion can include such things as behavior, speed, or ability. For example, deci-
sions made using college placement examinations are based on a predicted correla-
tion between the test score and the future success with the subject. There are two
types of validation strategies contained under the category of criterion-related va-
lidity: concurrent and predictive validity. The basic difference between the two has to
do with the time frame in which the criterion is measured relative to the adminis-
tration of the test. Concurrent means the test and the criterion are measured at
about the same time and predictive means the criterion is measured after the test
and typically after a decision, such as hiring, was made about the person.

Aspects of Concurrent Validity

䊏 Concurrent validity is a measure of the relation between the criterion measure of
a test and test scores that are obtained at the same time.
䊏 Concurrent validity is useful in determining how test scores may be used to esti-
mate an individual’s present performance on the selected criterion (e.g., when
scores obtained on a depression inventory are validated against established di-
agnostic criteria for depression, there is strong concurrent validity).
䊏 Concurrent validity also can be used when comparing one test with another.
When prior research supports the validity of one test, we can use that test as the
validating criterion and compare other tests to it to establish their concurrent va-
lidity.
䊏 Conducting a concurrent validity study in this way also provides evidence of the
construct validity of a test (i.e., if there is a high correlation between the test of de-
CHAPTER TWENTY Foundations of Measurement and Psychometrics 453

pression described earlier and the outcomes of a rigorous diagnostic process, the
test is said to be a valid measure of the construct of depression).

Aspects of Predictive Validity

䊏 Predictive validity involves making decisions based on correlations between
previously obtained test scores, and yet-to-be-obtained criterion scores.
䊏 Predictive validity allows for prediction of the criterion based on how well an in-
dividual’s score on a test will correlate with a criterion established after the test
has been administered.

EXAMPLE

SAT and Predictive Validity

A modern example of predictive validity is the use of standardized tests, such as the SAT, for
admission to college. The notion behind using such tests is that they predict a student’s aca-
demic performance in college. In this case, predictive validity is established by examining the
correlation between a student’s scores on the SAT and their grade-point average as a fresh-
man, the criterion. A strong, positive correlation indicates that the SAT has strong predictive
validity.

TEST CONSTRUCTION

Test construction is a process that must be done carefully and correctly to ensure
that a test is a reliable, valid, and nonbiased psychometric measure. The steps that
should be taken to ensure a test meets these requirements include the following:

䊏 Determine the method of test development.

䊏 Write the items.
䊏 Select items through the item try-out process.
䊏 Norm the test on a representative sample.
䊏 Write the test manual.

䊏 Methods of Test Development

The first step of test construction is to choose from among several systems of test
development, including the rational-theoretical approach, the empirical approach,
and the internal consistency approach. Each method considers validity from a dif-
454 What Are the Fundamental Components of Appraisal and Research? PART THREE

ferent perspective, which, therefore, results in various processes of test question

development.

Approaches to Test Question Development

1. The rational-theoretical approach assumes that the items created for the test are
indicative of a specific theory of the construct being measured and primarily
focuses on content validity of the test items.
2. The empirical or empirically keyed approach focuses on criterion-related validity
and assumes that good test questions are correlated with a criterion.
3. The internal consistency approach uses factor analysis to determine if items load
together to support the construct being measured by the test and, thus, con-
struct validity. Items that load on the factor indicative of the construct of inter-
est are included in the test.

In modern test construction, a combination of all three approaches often is invoked

for developing the test items. Establishing the internal consistency of the item set
through factor analysis as well as concurrent or predictive validity, is achieved
through the comparison of the test results to external criteria.

EXAMPLE

Empirical Approach to Test Construction

If people with schizophrenia tend to endorse a particular item as true and those without
schizophrenia tend to endorse the item as false, the item would be included on a test of schizo-
phrenia because the item is correlated with external criterion of being diagnosed with schizo-
phrenia.

䊏 Writing the Items

After a method of test development is chosen, the next step in test construction is
writing the items for the test. Several guidelines characterize this part of the test de-
velopment process. First, all test items need to be written clearly so they are only as-
sociated with the construct of interest. Second, developers always want to write
more items than are necessary because some items may be thrown out during the
item try-out phase of test construction. Finally, when writing questions for a test,
the test developers have many choices in the types of items for the test and must de-
cide which types of items are most suitable to the instrument and construct being
tested. A few of the test item formats are mentioned next.
CHAPTER TWENTY Foundations of Measurement and Psychometrics 455

Common Types of Items Used by Test Developers

䊏 True–false.
䊏 Multiple choice.
䊏 Short answer, completion, or closed.
䊏 Essay.
䊏 Rating or Likert scales.

䊏 Item Try-Out

After the test items are written, they need to be examined for bias, reliability, and
validity through a process known as item try-out. The item try-out process is both
rigorous and complex. The main steps in this process are summarized only briefly
here.

Steps in the Item Try-Out Process

䊏 Administer the test to a representative sample population.
䊏 Conduct a bias analysis to see if systematic errors in measurement or prediction
were made. Bias can be detected by using statistical procedures, such as factor
analysis and regression techniques. Additionally, expert reviewers can detect
bias in test language, content, and format.
䊏 Select the best items by the process of item analysis, which includes examina-
tions of item difficulty and item discrimination. Analysis of item difficulty yields
a value that describes the proportion of individuals that got an item right or en-
dorsed an item in a particular way. Analysis of item discrimination allows test
developers to determine how closely an item tests for the construct of interest.
䊏 Examine the test’s reliability and validity.

䊏 Normative Sample

An important aspect of test construction is developing a normative sample that is

representative of the target population for the test. To obtain a representative sam-
ple, the sample must be standardized on a number of factors. Sample factors on
which tests commonly are normed include geographic location, gender, income,
ethnicity, age, and level of education. After the sample is chosen, there are a num-
ber of steps that need to take place, namely, administering the test to the sample,
computing standard scores based on the sample’s results, creating percentiles
through area transformations to determine what percentages of individuals in the
sample population obtain certain scores, and setting the standard error of measure-
ment to provide confidence intervals around the measured scores.
456 What Are the Fundamental Components of Appraisal and Research? PART THREE

䊏 Writing the Manual

The last step of the test construction process is writing the manual. The manual pro-
vides an overall summary of the test construction and recommended procedures to
the test administrator. The test manual provides information regarding the quality
of the test, the sample intended, and administration and scoring procedures.

Chapter 20: Key Terms

䉴 Analysis of covariance 䉴 Inferential statistics 䉴 Range
(ANCOVA) 䉴 Informed consent 䉴 Ratio scales
䉴 Anonymity 䉴 Interval scales 䉴 Reliability
䉴 Chi-square statistic 䉴 Kurtosis 䉴 Repeated measures
䉴 Confidence interval 䉴 Mean ANOVA
䉴 Construct 䉴 Median 䉴 Risk of harm
䉴 Construct validation 䉴 Mode 䉴 Standard deviation (SD)
䉴 Content validity 䉴 Negatively skewed data 䉴 Standard error of measure-
䉴 Correlations 䉴 Nominal scales ment
䉴 Covariate 䉴 One-way analysis of vari- 䉴 Tests of linear regression
䉴 Criterion-related validity ance (ANOVA) 䉴 t test
䉴 Cronbach’s alpha 䉴 Ordinal scales 䉴 Validity
䉴 Descriptive statistics 䉴 Percentiles 䉴 Variance
䉴 Face validity 䉴 Positively skewed data 䉴 Voluntary participation
䉴 Factor analysis 䉴 Probability 䉴 z score
 chapter Testing and Assessment
in Counseling Practice
21
Jeffrey A. Miller
Tara Greene
Nate E. Kegal
Julie Williams
Duquesne University

In This Chapter

䉴 Overview of Assessment 䉴 Educational Assessment

䊏 Uses of Assessments 䊏 Achievement Tests
䊏 Professional Organizations Supporting As- 䊏 Aptitude Tests

sessment 䊏 Psychoeducational Test Batteries

䉴 Personality Assessment
䉴 Assessment Process 䊏 Rorschach Psychodiagnostic Test
䊏 Review Referral Information
䊏 Thematic Apperception Test
䊏 Decide Whether to Take the Case
䊏 Minnesota Multiphasic Personality
䊏 Obtain Background Information
Inventory
䊏 Consider Systematic Influences
䊏 MMPI–A
䊏 Observe the Client in Several Settings
䊏 NEO Personality Inventory–Revised
䊏 Select and Administer an Appropriate Test

Battery 䉴 Behavioral Assessment

䊏 Interpret Results 䊏 Self-Report
䊏 Develop Intervention Strategies 䊏 Direct Observation

䊏 Document the Assessment 䊏 Behavior Rating Scales

䊏 Meet With Concerned Individuals

䉴 Neuropsychological Assessment
䊏 Follow Up on Recommendations
䊏 The Mini Mental State Examination
䊏 The Wechsler Memory Scale–Third Edition
䉴 Cognitive Assessment 䊏 The Halstead–Reitan Neuropsychological
䊏 Nature of Intelligence
Battery
䊏 Stanford–Binet Intelligence Test

䊏 Wechsler Scales 䉴 NEPSY

䊏 Woodcock–Johnson Scales

458
In This Chapter (continued)

䉴 Interest in Employment 䉴 Assessment of Organizational Culture

䊏 Strong Interest Inventory 䊏 Discussion of Organizational Culture
䊏 Armed Services Vocational Aptitude 䊏 Job Descriptive Index

Battery 䊏 Minnesota Satisfaction Questionnaire

䊏 General Aptitude Test Battery 䊏 Organizational Commitment

䊏 Myers–Briggs Type Indicator Questionnaire

459
460 What Are the Fundamental Components of Appraisal and Research? PART THREE

OVERVIEW OF ASSESSMENT

Assessments provide information about clients’ strengths and weaknesses to help

counselors and helping professionals decide on a course of treatment. Specifically,
assessment refers to the process of collecting and integrating data from interviews,
case studies, observations, and psychometric tools for the purposes of guiding
treatment.

䊏 Uses of Assessments

Assessment is useful for psychologists and counselors because it provides a stan-

dard method to obtain information about a client. Not only is assessment beneficial
for counselors, but it is also beneficial for clients as it improves the chances of suc-
cessful treatment and increased quality of life.

䊏 Professional Organizations Supporting Assessment

There are several professional organizations that support and promote assess-
ment in counseling. These professional bodies work to enhance and ensure the
quality of the work of teachers, researchers, and practitioners in the area of as-
sessment, as the integrity and quality of assessment is vital to treatment success.
Some of the professional organizations of interest to counselors are provided
next.

Professional Associations for Assessment

䊏 Association for Assessment in Counseling and Education (AACE).
䊏 American Education Research Association (AERA).
䊏 National Center for Research on Evaluation Standards, and Student Testing
(CRESST).
䊏 Joint Committee on Standards for Educational Evaluations (JCSEE).
䊏 Joint Committee on Testing Practices (JCTP).
䊏 National Council on Measurement in Education (NCME).

The AACE is a division of ACA. Check out the Web site of AACE for
more information on testing:
䉴 http://aac.ncat.edu/
CHAPTER TWENTY ONE Testing and Assessment in Counseling Practice 461

ASSESSMENT PROCESS

To treat clients effectively, counselors need to make accurate assessments of clients’

core issues. Sattler (2001) described 11 steps to conducting a good assessment. Each
step within the assessment process is essential to understanding the client and the
referral question. The referral question is a statement given by the client or other
parties close to the client about the area of concern. The referral question guides
counselors in making informed decisions to ensure proper treatment. All of the in-
formation that is gathered in interviews, observations, and tests should be consid-
ered when making interpretations on which the treatment will be based. The 11
steps to a comprehensive assessment are as follows:

1. Review referral information.

2. Decide whether to take the case.
3. Obtain background information.
4. Consider systematic influences.
5. Observe the client in several settings.
6. Select and administer an appropriate test battery.
7. Interpret results.
8. Develop intervention strategies.
9. Document the assessment.
10. Meet with concerned individuals.
11. Follow up on recommendations.

䊏 Review Referral Information

The referral should be carefully considered to help the client clearly communicate
the concern. Vague and incomplete referral information should be clarified. Based
on the client’s report of referral and subsequent clarifications, the refined referral
question guides subsequent assessment-related decisions.

䊏 Decide Whether to Take the Case

The case should be accepted only if the assessment professional has the necessary
training and experience to answer the referral question and provide useful infor-
mation for decision making.

䊏 Obtain Background Information

Counselors should ask for relevant information that pertains to the problem and its
treatment. Medical, educational, and developmental histories should be recorded
and used.
462 What Are the Fundamental Components of Appraisal and Research? PART THREE

䊏 Consider Systematic Influences

Each person who is related to the client may view the problem differently. It is im-
portant to keep in mind that the client’s problem may be activated only in certain
situations. By interviewing multiple people, counselors and psychologists become
more certain about what situations trigger the problem, what the consequences are,
and what maintains the occurrences. Others also may provide information about
how they attempt to alleviate the problem. The treatment then can be based on suc-
cessful past techniques.

See Chapter 26 for more information on using multiple people or key informant inter-
views in the assessment of addictions.

䊏 Observe the Client in Several Settings

By observing the client, professionals may notice antecedents and consequences to

behaviors that are overlooked by others. These predictors or triggers to behavior
can be situation specific and, as such, provide valuable information to clinicians.

䊏 Select and Administer an Appropriate Test Battery

Many tests are available for use, and counselors must decide which ones are appro-
priate to administer. Published literature, conference presentations, and colleagues
can provide information about appropriate tests. The chosen tests should measure
the nature of the referral question and possess high reliability and validity. Before
administering the tests, psychologists and counselors should carefully read the
testing manuals. The administration and scoring directions in the manuals must be
followed completely and correctly for the score to be properly calculated.

䊏 Interpret Results

The referral information, interviews, observations, and test scores are all necessary
to make an interpretation. The interpretation should not be based on any one factor
alone.
All of the information from the previous steps is integrated to find reoccurring
patterns and to view the person as a whole. If the information is conflicting or un-
clear, more interviews, observations, and tests are needed.

䊏 Develop Intervention Strategies

The interventions should take into account the strengths and weaknesses of the
client. Interventions should be directly linked to the assessment data and include
only resources that are reasonably available to the client.
CHAPTER TWENTY ONE Testing and Assessment in Counseling Practice 463

䊏 Document the Assessment

The report should be written immediately after the evaluation. It should clearly
and concisely discuss the findings, interpretations, and recommendations.

䊏 Meet With Concerned Individuals

When discussing the conclusions of the assessment, professionals should avoid jar-
gon and confusing language. The concerned individuals should be encouraged to
ask questions about the process.

䊏 Follow Up on Recommendations

Both short-term and long-term follow-ups are necessary to monitor the treatment
integrity and effectiveness. Follow-up is crucial to providing ethical services and a
continuum of care to clients.

COGNITIVE ASSESSMENT

As is evidenced in Sattler’s (2001) description of the assessment process, a client

evaluation is a comprehensive look at a person’s life—the process involves much
more than simply administering an appropriate test. However, knowing which as-
sessment instrument to administer and how to administer, score, and interpret the
test is a crucial part of the assessment process. One type of assessment that counsel-
ors may employ is the cognitive assessment.

Cognitive assessment: The gathering of information about an individual’s

overall cognitive ability and functioning.

Intelligence tests make up the better part of cognitive assessment. These evaluative
tools have been developed largely from the original Binet scales, published begin-
ning in 1905. Central to all intelligence scales is the construct intelligence, which the
tests purport to measure. Therefore, in this section we provide a cursory under-
standing of what is meant by intelligence. Additionally, there are three families of
cognitive scales that frequently are used today that are discussed:

1. Stanford–Binet scales.
2. Wechsler scales.
3. Woodcock–Johnson scales.
464 What Are the Fundamental Components of Appraisal and Research? PART THREE

䊏 Nature of Intelligence

Creating tests that measure cognitive abilities, and specifically intelligence, re-
quires a clearly defined understanding of the construct called intelligence. One def-
inition that can be adopted is as follows:

General intelligence: A construct used in the field of psychology that mea-

sures what is common to the scores of all cognitive intelligence tests (abbrevi-
ated g).

To further define intelligence, Cattell and Horn (Catell, 1963; Horn, 1968) described
two characteristics of intelligence, called fluid intelligence and crystallized intelli-
gence.

Fluid intelligence: Abilities such as reasoning and concept formation that are
related to mental operations and processes that decline over time.

Crystallized intelligence: Acquired skills and knowledge such as verbal abil-

ities and general information that increase over time.

Carroll (1993) proposed an update of Cattell and Horn’s work called the three-stra-
tum theory of cognitive abilities. Each of the three components of Carroll’s theory is
briefly summarized.

Carroll’s Three-Stratum Theory of Cognitive Abilities

1. The first stratum consists of narrow, more specific abilities like perceptual
speed, spatial relations, and lexical knowledge.
2. The second stratum consists of broad factors like fluid and crystallized intelli-
gence, as well as visual processing, auditory processing, and processing speed.
3. The third stratum is represented by a single factor of general intelligence (often
referred to as g).

Cattell, Horn, and Carroll’s work represents several ways of characterizing intelli-
gence. Modern theories of cognitive assessment also are supported with further ev-
idence obtained using factor analytic techniques that identify different types of in-
telligence or facets of intelligence.
Additional factor analytic work led those interested in psychoeducational as-
sessment to integrate the Cattell–Horn theory with Carroll’s theory in what is
known as the Cattell–Horn–Carroll (CHC) model of cognitive abilities, consisting
only of a narrow stratum and a broad stratum. These models, along with other
recent multiple factor models such as Gardner’s (1999) theory of multiple
intelligences, have had a considerable impact on the current direction of cognitive
assessment.
CHAPTER TWENTY ONE Testing and Assessment in Counseling Practice 465

䊏 Stanford–Binet Intelligence Test

At the end of the 19th century, Binet, Henri, and Simon developed methods of cog-
nitive assessment in France. In 1905, their efforts resulted in the development of the
first intelligence test, known as the Binet–Simon Scales.

Uses of the Binet–Simon Scales

䊏 Identifying school-aged children with mental retardation.
䊏 Determining if a child is performing at an average level for children of the same
age.

In 1916, the Binet–Simon Scales were revised as part of a collaborative effort led by
Terman at Stanford University and became known as the Stanford–Binet. This test
was the first to use the IQ, or intelligence quotient. The Stanford–Binet Intelligence
Scales (5th edition [SB5]; Roid, 2003) is the most current version of the test and is
substantially different from previous editions of the test. It is appropriate for
examinees aged 2 to 85 years and older.

Components of the SB5 Scales

䊏 The test yields a Full-Scale IQ based on all 10 subtests, and Verbal and Nonverbal
IQ scores based on 5 subtests each.
䊏 There are two routing subtests (Object Series/Matrices and Vocabulary) that can
be used to determine the starting point for the examinee on the Verbal and Non-
verbal subtests and serve as a subtest for the Verbal (Vocabulary) and Nonverbal
(Object Series/Matrices) scales.
䊏 The five Verbal and Nonverbal subtests are based on the five cognitive factors
measured by the SB5.
䊏 The cognitive factors measured by the SB5 are fluid reasoning, knowledge, quan-
titative reasoning, visual-spatial processing, and working memory.

䊏 Wechsler Scales

Binet and his colleagues were not the only individuals to develop tests of cognitive
ability. The most frequently used tests of cognitive ability and general intelligence
are the Wechsler scales. Originally developed by David Wechsler, the Wechsler
scales have gone through revisions since his death, but still bear his name. The first
versions of Wechsler’s intelligence tests were developed on the premise that intelli-
gence is both a global construct and an entity comprised of unique abilities. The
most current versions of the Wechsler scales apply modern theories of cognitive
ability and psychometrics. Psychometrics can be understood as follows:

Psychometrics: Any form of mental testing or the branch of counseling and

psychology that deals with testing.
466 What Are the Fundamental Components of Appraisal and Research? PART THREE

There are several Wechsler tests of intelligence that have been created and
adapted for various populations.

Wechsler Tests of Intelligence

䊏 The Wechsler–Bellevue Intelligence Scale was developed in the 1930s and had 11
subtests believed to accurately comprise general intellectual ability.
䊏 The Wechsler Adult Intelligence Scale (WAIS; Wechsler, 1955) was developed in
the 1950s.
䊏 The Wechsler Intelligence Scale for Children (WISC; Wechsler, 1949) incorpo-
rated many of the original subtests in the measurement of intelligence.

The Wechsler Adult Intelligence Scale (Wechsler, 1955) is perhaps the most widely
used tool for assessing intellectual functioning; its current version is the Wechsler
Adult Intelligence Scale–Third Edition (WAIS–III; Wechsler, 1997b).

Key Characteristics of the WAIS–III

䊏 Measures cognitive ability of individuals aged 16 to 74 years.
䊏 Contains 11 core subtests and 3 supplementary subtests.
䊏 Provides a Verbal IQ score (range = 48–155), a Performance IQ score (range =
47–155), and a Full-Scale IQ score (range = 45–155) based on the 11 core subtests.
䊏 Provides a set of index scores based on the supplementary subtests.

There are six components of the verbal tests and five components of the perfor-
mance tests on the WAIS–III; additionally, there are three supplementary scales.
The areas measured are listed next.

Components of the Verbal IQ Score on the WAIS–III

䊏 Vocabulary.
䊏 Similarities.
䊏 Arithmetic.
䊏 Digit Span.
䊏 Information.
䊏 Comprehension.

Components of the Performance IQ Score on the WAIS–III

䊏 Picture Completion.
䊏 Digit-Symbol Coding.
䊏 Block Design.
CHAPTER TWENTY ONE Testing and Assessment in Counseling Practice 467

䊏 Matrix Reasoning.
䊏 Picture Arrangement.

Supplementary Subtests of the WAIS–III

䊏 Symbol Search.
䊏 Letter–Number Sequencing.
䊏 Object Assembly.

The Wechsler Intelligence Scale for Children–Fourth Edition (WISC–IV; Wechs-

ler, 2003) is the most current version of this popular test of cognitive ability for chil-
dren ages 6 to 16 years. The WISC–IV is similar to the WAIS–III in many ways, par-
ticularly in its use of subtests, many of which are identical to the WAIS–III.
However, there are several areas in which the two tests differ.

Points of Difference Between the WISC–IV and the WAIS–III

䊏 The subtests on the WISC–IV contribute to a Full-Scale IQ score and four index
scores (Verbal Comprehension, Perceptual Reasoning, Working Memory, and
Processing Speed).
䊏 The WISC–IV does not provide for the calculation of a Verbal or Performance IQ
score.
䊏 The WISC–IV is made up of 10 core subtests and 5 supplemental subtests.

䊏 Woodcock–Johnson Scales

The Woodcock–Johnson III Tests of Cognitive Abilities (WJ III COG; Woodcock,
McGrew, & Mather, 2001) is another individually administered battery of tests of
cognitive abilities.

Key Characteristics of the WJ III COG

䊏 Used with individuals ages 2 to 90 years and older.
䊏 Incorporates many aspects of the CHC model of cognitive functioning, including
its division of tests into seven CHC clusters (Comprehension-Knowledge,
Long-Term Retrieval, Visual-Spatial Thinking, Auditory Processing, Fluid Rea-
soning, Processing Speed, and Short-Term Memory).
䊏 Contains 10 tests in the Standard Battery and 10 tests in the Extended Battery.
䊏 Yields an overall score known as the General Intellectual Ability (GIA).

The WJ III COG can be scored only by computer and the test scores that comprise
the GIA are differentially weighted based on the age of the examinee. Various em-
pirically and theoretically derived composite scores also can be computed.
468 What Are the Fundamental Components of Appraisal and Research? PART THREE

EDUCATIONAL ASSESSMENT

Another testing area that may offer important information to counselors besides
cognitive ability is educational assessment, which can be defined this way:

Educational assessment: Methods for obtaining information relating to a stu-

dent’s overall academic progress and informal and formal learning.

There are a number of contexts and situations when the use of educational assess-
ment is deemed appropriate.

General Uses of Educational Assessments

䊏 Results from educational assessments allow counselors and others who work in
schools to make decisions regarding a student’s academic advancement to
higher grades.
䊏 Educational assessments play a role in identifying learning disabilities.
䊏 With adult populations, educational assessments can be used to recommend re-
medial education to allay employment stress related to academic underachieve-
ment.

The major areas of educational assessment include achievement, aptitude, and

psychoeducational testing. Each of these areas are addressed individually in the
following sections; examples of tests of achievement, aptitude, and psycho-
education also are described.

䊏 Achievement Tests

Achievement batteries measure accomplishment related both to specific and gen-

eral academic areas. Achievement tests can be understood as follows:

Achievement tests: Measures of the effects of learning from specific, con-

trolled experiences such as academic courses or programs of instruction.

These tests allow for the identification of learning difficulties and the monitoring of
achievement levels. In addition, the achievement batteries measure the amount of
learning that takes place at certain academic-based or age-based levels. Two exam-
ples of achievement measures are the Wechsler Individual Achievement Test–Sec-
ond Edition (WIAT–II; Wechsler, 2001) and the Wide Range Achievement Test–3
(WRAT–3; Wilkenson, 1993).
CHAPTER TWENTY ONE Testing and Assessment in Counseling Practice 469

Key Characteristics of the WIAT–II

䊏 Provides a measure of general ability.
䊏 Able to be administered to individuals ages 4 to adult.
䊏 Yields information that is helpful in developing individualized academic inter-
vention plans.

The WIAT–II is composed of nine subtests that measure the areas of specific learn-
ing disabilities described in the Individuals With Disabilities Educational Act
(IDEA, 1997).

Subtests of the WIAT–II

䊏 Oral Expression.
䊏 Listening Comprehension.
䊏 Written Expression.
䊏 Spelling.
䊏 Word reading.
䊏 Pseudoword Decoding.
䊏 Reading Comprehension.
䊏 Numerical Operations.
䊏 Mathematics Reasoning.

Scoring of the WIAT–II can be done using either age-based or grade-based norma-
tive comparisons, and computer scoring software also is available.
Another measure of general achievement is the WRAT–3 (Wilkenson, 1993).
Some important elements of the WRAT–3 are provided next.

Key Components of the WRAT–3

䊏 Able to be administered individually or in groups.
䊏 Used appropriately with individuals between the ages of 5 and 75 years old.
䊏 Provides a rapid screening of academic skills.

There are three main subtests that comprise the WRAT–3, listed here.

Subtests of the WRAT–3

䊏 Reading.
䊏 Spelling.
䊏 Arithmetic Subtests.

Administration typically takes 15 to 30 minutes, and scoring takes approximately 5

minutes. Scoring is done using age-based norms, and grade-equivalent scores are
available.
470 What Are the Fundamental Components of Appraisal and Research? PART THREE

䊏 Aptitude Tests

Aptitude tests generally are distinguished from achievement tests. An understand-

ing of aptitude testing that counselors can adopt is as follows:

Aptitude tests: Measure informal learning from a variety of uncontrolled ex-

periences and are said to measure innate potential, as well as predict future
academic performance.

Unlike the individually administered cognitive tests described earlier (e.g., Wechs-
ler scales), aptitude tests tend to be group administered and are associated with
readiness testing and entrance into academic programs.
There are several aptitude tests that are designed for different age levels. The
Metropolitan Readiness Test (MRT) frequently is used at the elementary level. The
test was normed on 30,000 children throughout the United States and was stan-
dardized on the following factors: geographic regions, socioeconomic factors, prior
school experience, and ethnic background. The MRT was tested for reliability and
validity measures.

Key Elements of the MRT

䊏 Contains two divisions: Level I for beginning and middle kindergarteners, and
Level II for end of kindergarten to first grade.
䊏 Represents a group-administered battery.
䊏 Assesses the beginning reading and math skills of early learners.
䊏 Administration typically takes 90 minutes.

An aptitude measure that commonly is used for secondary students entering col-
lege is the SAT. The SAT is a psychometrically sound instrument and has been re-
ported as a very reliable and valid measure of aptitude.

Key Elements of the SAT

䊏 Contains three main sections: critical reading, writing, and math.
䊏 Includes additional subtests that measure the subject areas of English, math, his-
tory, science, and languages that may be requested by college or universities on
admittance.
䊏 Provides scores for each main section on a scale of 200 to 800, with the average
score being 500.
䊏 Administration usually takes 3 hours and 45 minutes.

䊏 Psychoeducational Test Batteries

Along with aptitude and achievement tests, psychoeducational batteries are an-
other arm of educational assessments. Psychoeducatonal instruments can be un-
derstood this way:
CHAPTER TWENTY ONE Testing and Assessment in Counseling Practice 471

Psychoeducational tests: Take information from both cognitive and achieve-

ment measures to provide an overall picture of a student’s abilities related to
academic success and to measure academic achievement related to reading,
math, and writing.

Two commonly used psychoeducational test batteries are the Differential Ability
Scales (DAS; Elliott, 1990a, 1990b) and the Woodcock–Johnson III (WJ III; Wood-
cock et al., 2001).
The DAS are an adaptation of the British Ability Scales for use in the United
States. This psychometrically reliable and valid measure was standardized on
3,475 individuals for the following factors: sex, race and ethnicity, parent educa-
tion, geographic region, and preschool enrollment.

Key Characteristics of the DAS

䊏 Uses the general conceptual ability or g theory of intelligence.
䊏 Emphasizes conceptual and reasoning abilities.
䊏 Measures both ability and achievement for individuals ages 2.5 years to 17 years,
11 months.
䊏 Comprises 17 cognitive subtests divided into two overlapping age levels.
䊏 Includes three achievement subtests (similar to the WRAT–3).
䊏 Provides scores based on preschool age or school age standard scores.
䊏 Provides a Special Nonverbal Composite score that is useful for the assessment
of those for whom English is not the primary language.
䊏 Administration takes approximately 30 to 90 minutes depending on age.

The WJ III (Woodcock et al., 2001) is a psychoeducational measure that includes nu-
merous tests of ability (WJ III Tests of Cognitive Abilities) and achievement (WJ III
Tests of Achievement). The WJ III is a psychometrically valid and reliable test bat-
tery designed for individuals ages 2 to 90 and older and is based on the CHC theory
of cognitive abilities.

Tests of Cognitive Abilities Measured by the WJ III

䊏 General intelligence.
䊏 Achievement.
䊏 Scholastic aptitude.
䊏 Oral language.

The Tests of Achievement contain parallel forms, A and B, that are divided into a
standard test battery of 12 subtests and an extended battery of 10 subtests. Scoring
only can be done by computer and may be done using either age- and grade-based
norms.
472 What Are the Fundamental Components of Appraisal and Research? PART THREE

Some Areas Measured by the WJ III Tests of Achievement

䊏 Reading.
䊏 Oral language.
䊏 Mathematics.
䊏 Written language.
䊏 Knowledge supplemental.

PERSONALITY ASSESSMENT

Counselors are often very interested in personality assessment, which can be de-
fined as follows:

Personality assessment: A method that counselors use to measure a variety

of components of personality, including traits, states, identity, cognitive and
behavioral styles, and other individual characteristics.

Personality can be assessed using numerous theoretical approaches that include

psychoanalytic, cognitive-learning, behavioral, dispositional, humanistic and exis-
tential, and multicultural approaches. Common forms of personality assessment
include projective and objective measures. Projective and objective assessments
can be defined this way:

Projective measures: Allow for inferences about an individual’s personality

through responses to ambiguous or unstructured stimuli and often are used
for educational, forensic, and therapeutic assessment.

Objective measures: Tools that evaluate personality through the use of

forced choice responses to questions.

Two projective measures include the Rorschach Psychodiagnostic Test (Rorschach,

1921/1975) and the Thematic Apperception Test (TAT; Morgan & Murray, 1935).

䊏 Rorschach Psychodiagnostic Test

The Rorschach (Rorschach, 1921/1975), traditionally used for psychodiagnosis, is

commonly known as the inkblot technique of assessment. The test consists of 10 bi-
laterally symmetrical (mirror images if folded) inkblot images. Five images are
black and white; two are black, white, and red; and three are multicolored. The test
comes with the cards only, and no test manual or administration score are pro-
vided. However, Exner (2002) developed the most common system of test adminis-
tration, scoring, and interpretation. In his system, scores are organized into a Struc-
tural Summary by comparing a person’s responses to a set of norms (Exner, 2002).
CHAPTER TWENTY ONE Testing and Assessment in Counseling Practice 473

Administration of the Rorshach

䊏 Administration begins with a free association phase during which the individual
generates a list of descriptions of what he or she sees in each image.
䊏 The inquiry phase of assessment follows free association and is the period dur-
ing which the therapist examines the list of client responses one by one in an at-
tempt to interpret the individual’s responses.

䊏 Thematic Apperception Test

The TAT (Morgan & Murray, 1935) originally was developed for use in psychoana-
lytic therapy to identify drives, emotions, sentiments, conflicts, and complexes. It is
widely used now to examine aspects of interpersonal functioning, including mate
selection, interpersonal conflicts, and factors that motive behavior. The TAT relies
on pictorial techniques and consists of one blank card and 30 cards with
black-and-white pictorial scenes designed to present the test taker with classic hu-
man situations. The target population for the TAT is individuals 10 years of age and
older.

Administration of the TAT

䊏 The examinee tells a story about what is happening in the picture.
䊏 The examinee describes what happened before and after the scene of the picture.
䊏 The examinee describes what the people are thinking and feeling.
䊏 The examinee imagines a scene on the blank card and tell a story about that
imagined scene.

Interpretation of storytelling techniques such as the TAT requires extensive study

and tends to focus on cognition, emotion, object relations, and motivation (Teglasi,
2001).
Although the Rorschach and the TAT represent projective measures of personal-
ity, the same construct also can be assessed using objective measures. Two common
examples are the Minnesota Multiphasic Personality Inventory (MMPI; Butcher,
Dahlstrom, Graham, Tellegen, & Kaemmer, 1989b) and the NEO Personality Inven-
tory–Revised (NEO–PI–R; Costa & McCrae, 1993).

䊏 Minnesota Multiphasic Personality Inventory

The MMPI, first developed by Hathaway and McKinley in 1943, is the most widely
researched and used test to assess personality and psychopathology in adults 18
and older (Hathaway & McKinley, 1983). The most updated version of the test is
the MMPI–2, which was standardized on a sample of 2,600 individuals matched to
the 1980 U.S. Census data on the variables of age, gender, minority status, social
class, and education. The test contains 567 true–false items (Butcher et al., 1989b) on
474 What Are the Fundamental Components of Appraisal and Research? PART THREE

TABLE 21.1
Interpretation of High MMPI–2 Scale Scores

Scale Interpretation

1. Hypochondriasis (Hs) Concern with physical complaints

2. Depression (D) Depression and pessimism
3. Hysteria (Hy) Hysterical reaction to severe psychological stress
4. Psychopathic deviate (Pd) Social deviation, disregard for law, rights of others, and morality
5. Masculinity–Femininity (Mf) Marked interest in the opposite sex role
6. Paranoia (Pa) Paranoid thoughts and feelings
7. Psychasthenia (Pt) Anxiety, obsessive thoughts, and compulsive behaviors
8. Schizophrenia (Sc) Bizarre thoughts, social withdrawal, experience distortions of reality
9. Hypomania (Ma) Elevated mood and activity level, outgoing, and impulsive
10. Social introversion–extroversion (Si) Withdrawn from social contact, socially inhibited, and shy

10 clinical scales. There are a variety of reasons that counselors may use the
MMPI–2, including those listed here.

Uses of the MMPI–2

䊏 Examine social and personal maladjustment.
䊏 Develop treatment plans.
䊏 Inform career, marriage, and family counseling.

Table 21.1 lists the basic interpretation of high scores. However, MMPI–2 inter-
pretation typically is done by interpreting frequently observed profiles of scores.

䊏 MMPI–A

The MMPI also has a version for adolescents, better known as the MMPI–A (Wil-
liams, Butcher, Ben-Porath, & Graham, 1992) which commonly is used in clinical
and school settings. Because adolescents tended to score higher on the original ver-
sion of the test, the MMPI–A was developed for the population of teens between 14
and 18 years old. The instrument consists of 478 true–false items and was normed
on a sample of 1,620 individuals.

Uses of the MMPI–A

䊏 Assess psychopathology.
䊏 Aid in identifying personal, social, behavioral, school, and familial problems.

䊏 NEO Personality Inventory–Revised

Another objective measure used to assess personality is the NEO–PI–R (Costa &
McCrae, 1993). This battery is used to describe and measure normal personality
CHAPTER TWENTY ONE Testing and Assessment in Counseling Practice 475

based on a five-dimension model of personality, better known as the Big Five

(Costa & McCrae, 1985).

Five Domains of Personality Measured by the NEO–PI–R

䊏 Neuroticism is related to hostility, depression, and anxiety.
䊏 Extraversion measures the extent to which individuals prefer to be alone or with
others.
䊏 Openness to experience measures one’s artistic sense, originality, and knowledge.
䊏 Agreeableness measures the extent to which individuals are liked by others.
䊏 Conscientiousness is the extent one is hard working, careful, neat, and organized.

The test is made up of 243 items, 240 facet and domain items rated on a 5-point
scale, and 3 validity items. It takes approximately 40 minutes to administer. The tar-
get population for the NEO–PI–R is people over 17 years of age.

BEHAVIORAL ASSESSMENT

Behavioral assessments increasingly are used in clinical and school settings. The
following is a basic understanding of behavioral assessment that can be adopted:

Behavioral assessment: A process of systematically gathering observations

of a set of target behaviors, examining the relations between these observa-
tions and possible causes of the behavior, and applying the information to
treatment planning and progress monitoring.

There are several ways of assessing behavior, and counselors choose among these
approaches depending on the environment in which the behavior is assessed and
the goals of the observation. These approaches include behavioral analysis, ap-
plied behavioral analysis, and functional analysis.

Ways to Assess Behavior

䊏 Behavior analysis includes systematic observations of behavior within experi-
mental conditions.
䊏 Applied behavioral analysis is used to describe behavioral analysis in applied
settings.
䊏 Functional analysis is concerned with the relation between the causes of a behav-
ior and the behavior.

Regardless of which method counselors pursue for the behavioral assessment,

there are two basic procedures that are used to gather information; these are known
as the self-report and direct observation methods.
476 What Are the Fundamental Components of Appraisal and Research? PART THREE

䊏 Self-Report

One way of gathering data for behavioral assessments is self-report. This method
can be understood as follows:

Self-report: Information gathering that relies on the client’s input about be-
haviors of interest.

There are a number of ways that a self-report can be conducted, including those
listed next.

Ways to Conduct Self-Report Behavioral Assessment

䊏 Clinical interviews by a counselor.
䊏 Self-monitoring records of behaviors of interest.
䊏 Checklists and inventories.

䊏 Direct Observation

Direct observation is another way of gathering data for behavioral assessments and
can be defined as follows:

Direct observation: Systematic observation of a person in a naturalistic set-

ting in which the observer simultaneously considers the person’s behavior
and the environmental context.

Expected and deviant behaviors are recorded and tallied on an appropriate form.
Typical approaches to making systematic observations are time-sampling, fre-
quency coding, duration coding, and latency coding.

Methods of Recording Direct Observations

䊏 Time-sampling observations are made every 30 seconds to allow for examination
of the setting and context.
䊏 Frequency coding observations require the tallying of each instance of the behav-
ior throughout the observation interval.
䊏 Duration coding observations focus on the length of time the behavior spans; the
behavior is timed from start to finish.
䊏 Latency coding observations are used to determine the time between a cue and
the beginning of the behavior such as observing the time it takes a person to act
following a request.
CHAPTER TWENTY ONE Testing and Assessment in Counseling Practice 477

䊏 Behavior Rating Scales

Behavior rating scales represent an application of both self-report and direct obser-
vation methods for making determinations about behavior. Behavior rating scales
have structured questions and typically have forced choice response options, or a
scale with an even number of responses and no middle, neutral, or undecided re-
sponses so that the responder is forced to choose from the options given, such as
never, sometimes, and always. Responses are summed and compared to a normative
sample for interpretation. Behavior rating scales are useful because they give a
rapid assessment of a variety of behaviors.
A popular behavior rating scale is the Behavioral Assessment System for
Children–Second Edition (BASC–2; Reynolds & Kamphaus, 2004). The BASC–2 is a
parent, teacher, and self-report instrument used to sample the behaviors and emo-
tions of children ages 2 to 21. It can be used to assess a variety of positive and prob-
lematic behaviors.

Behaviors Assessed by the BASC–2

䊏 Aggression.
䊏 Depression.
䊏 Social skills.
䊏 Anxiety.
䊏 Attention problems.
䊏 Hyperactivity.
䊏 Leadership.
䊏 Study skills.
䊏 Somatization.
䊏 Assorted other domains.

The BASC–2 allows for input from teachers, parents, and the children being as-
sessed; there is a corresponding scale for each of these sources of information.

Scales on the BASC–2

䊏 Teacher Rating Scales (TRS).
䊏 Parent Rating Scales (PRS).
䊏 Self-Report of Personality (SRP).
䊏 Student Observation System (SOS).
䊏 Structured Developmental History (SDH).

The administration of the rating scales take approximately 10 to 20 minutes for the
TRS and PRS, and 30 minutes for the SRP. Computer scoring is available.
478 What Are the Fundamental Components of Appraisal and Research? PART THREE

NEUROPSYCHOLOGICAL ASSESSMENT

The assessments described thus far focus on psychosocial constructs such as intelli-
gence, personality traits, and behavior. Neuropsychological assessments look for
biological factors that influence behavior. This type of assessment can be described
as follows:

Neuropsychological assessment: Used to draw inferences about brain func-

tioning based on behaviors exhibited by the person under structured condi-
tions.

Process of Conducting Neuropsychological Examinations

䊏 Gather a thorough history of the examinee, including individual and family his-
tories, psychosocial history, and any past disturbances in sensorimotor function-
ing.
䊏 Evaluate the examinee’s physical appearance, including involuntary move-
ments, muscle tone and strength, and reflexes.
䊏 Use the information gathered in the initial mental status and physical examina-
tion to administer either a flexible or fixed battery of neuropsychological tests.

A flexible battery consists of specific tests tailored to the examinee’s apparent pre-
senting problem, whereas a fixed battery is an instrument consisting of a number
of standardized subtests administered in a determined fashion. Some of the instru-
ments described here are common examples of fixed batteries.

䊏 The Mini Mental State Examination

The Mini Mental State Examination (MMSE; Folstein, Folstein, & McHugh, 1975) is
a widely used method for assessing cognitive mental status in adults that typically
takes about 5 to 10 minutes to administer. The MMSE can be used to detect impair-
ment, follow the course of treatment, and monitor response to treatment.

Assessments of the MMSE

䊏 Orientation.
䊏 Attention.
䊏 Immediate short-term recall language.
䊏 Ability to follow simple verbal and written commands.

The exam itself consists of a series of questions and tasks grouped into 11 catego-
ries, for which a maximum of 30 points can be obtained if all items are answered
correctly. The authors of the test recommend that the four classifications are distin-
guished based on score.
CHAPTER TWENTY ONE Testing and Assessment in Counseling Practice 479

Scoring and Results of the MMSE

䊏 Normal (27–30).
䊏 Mild cognitive impairment (21–26).
䊏 Moderate cognitive impairment (11–20).
䊏 Severe cognitive impairment (0–10).

䊏 The Wechsler Memory Scale–Third Edition

The Wechsler Memory Scale–Third Edition (WMS–III; Wechsler, 1997a) provides a

detailed assessment of clinically relevant aspects of memory functioning in adults
using auditory and visual stimuli. The test consists of eight primary indexes (Audi-
tory Immediate, Auditory Delayed, Visual Immediate, Visual Delayed, Immediate
Memory, Auditory Recognition Delayed, General Memory, and Working Mem-
ory), and four supplementary indexes (Single-Trial Learning, Learning Slope, Re-
tention, and Retrieval). Subtests in each of the index categories are used to deter-
mine index scores.

䊏 The Halstead–Reitan Neuropsychological Battery

The Halstead–Reitan Neuropsychological Test Battery (HRB; Reitan & Wolfson,

1993) is a comprehensive, fixed assessment battery used to evaluate brain behavior
functioning of individuals. The HRB can be used to identify neuropsychological
impairments in cognitive, perceptual, and motor functioning, as well as deficits as-
sociated with learning disabilities. The test can be administered to three different
age groups (5–8, 9–14, and 15 and over), and requires up to a full day to administer.
There are seven major subtests of the HRB.

Subtests of the HRB

1. The Category test requires the examinee to identify characteristics in common
between two stimulus pictures flashed on a screen.
2. The Tactual Performance test requires examinees to complete a form board
blindfolded then draw the form board from memory.
3. The Rhythm test involves the examinee discriminating between like and un-
like pairs of musical beats.
4. The Speech Sounds Perception test refers to the playing of nonsense words via
audiotape from which the examinee must discriminate a spoken syllable.
5. The Finger-Tapping test involves the measurement of the tapping speed of the
index finger on each hand of the examinee.
6. The Strength-of-Grip test uses standard hand dynamometer that measures the
strength of both dominant and nondominant hands.
7. The Trial Making test requires the examinee to connect numbered and lettered
circles.
480 What Are the Fundamental Components of Appraisal and Research? PART THREE

NEPSY

The NEPSY (Korkman, Kirk, & Kemp, 1997) is a relatively modern neuropsycho-
logical assessment battery appropriate for ages 3 to 12 years. NEPSY assessment is
based on five functional domains.

Domains Assessed by the NEPSY

䊏 Attention and executive functioning.
䊏 Language.
䊏 Sensorimotor functioning.
䊏 Visuospatial processing.
䊏 Memory and learning.

Each domain is composed of subtests (the battery includes 27 tests) that assess pos-
sible neurobehavioral factors of a primary deficit. It is not necessary to administer
all subtests to every examinee. Specific subtests may be given based on the child’s
age, needs, time constraints, and setting. Due to the large number of subtests, it is
critical that the clinician be very familiar with the subtests prior to using the instru-
ment.

General Uses of the NEPSY

䊏 Allow clinicians to examine relative strengths of the child across domains.
䊏 Aid in developing treatment interventions based on strengths and weaknesses of
the child.

INTEREST IN EMPLOYMENT

Counselors commonly are approached with employment issues by their clients.

Problems or concerns associated with employment may be related to two areas: in-
terest in employment and organizational culture. Issues of interests or ability need
to be addressed with an employment battery, whereas issues concerned with the
organizational culture and relation to the clients require different forms of assess-
ment. Although these two areas may address different issues, they both derive
from employment and knowing which assessment tool to use in each situation is
important. The section focuses on employment batteries, while the next section ad-
dresses assessments related to organizational culture.
Career counseling competence requires counselors to know how to address and
measure clients’ career-related questions. Counselors often help their clients ad-
dress employment issues by assessing clients’ skills and interests. Career assess-
ment includes the use of interest inventories as well as tests discussed earlier, in-
cluding ability, personality, and achievement tests.
CHAPTER TWENTY ONE Testing and Assessment in Counseling Practice 481

Measures commonly used to assess job interests or the skills related to particular
jobs include the following:

䊏 Strong Interest Inventory (SII; Harmon, Hansen, Borgen, & Hammer, 1994).
䊏 The Armed Services Vocational Aptitude Battery (ASVAB).
䊏 The General Aptitude Test Battery (GATB).
䊏 The Myers–Briggs Type Indicator (MBTI; Myers & McCaulley, 1985).

䊏 Strong Interest Inventory

The SII (Harmon et al., 1994) is the most widely used career planning instrument
designed to measure human interests as it relates to occupation.

Key Elements of the SII

䊏 Assesses the fit between a person’s interests and a desired career choice.
䊏 Helps develop possible career options based on personality.
䊏 Includes four scales—the General Occupational Themes scale, the Basic Interest
scales, the Personal Styles scales, and Occupational scales—that relate to more
than 120 careers.
䊏 Used appropriately for high school and college career counseling, one-on-one
management coaching, and staff development programs.

See Chapter 15 for more information on the SII.

䊏 Armed Services Vocational Aptitude Battery

The ASVAB and corresponding program originally was used to predict future aca-
demic and occupational success in military occupations. Today, the ASVAB Career
Exploration Program is used for the purposes of predicting academic success and
occupational success in many different areas.

Main Components of the ASVAB

䊏 The ASVAB program includes a multiple aptitude test battery, an interest inven-
tory, and career planning tools.
䊏 The ASVAB is intended for use with 10th-, 11th-, and 12th-grade students, as well
as postsecondary students to help with career exploration and planning.
䊏 The ASVAB test battery is a norm-referenced test that allows clinicians to mea-
sure a person’s ability and compare the scores with others in the same peer
group.
482 What Are the Fundamental Components of Appraisal and Research? PART THREE

䊏 General Aptitude Test Battery

Another ability and aptitude measure that can be used in career assessment is the
GATB developed by the U.S. Employment Services. The GATB is composed of 12
timed tests that measure nine aptitudes in occupations.

Areas Measured by the GATB

䊏 General learning ability.
䊏 Verbal aptitude.
䊏 Numerical aptitude.
䊏 Spatial aptitude.
䊏 Form perception.
䊏 Clerical perception.
䊏 Motor coordination.
䊏 Finger dexterity.
䊏 Manual dexterity.

The battery takes approximately 3 hours to administer and is divided into

psychomotor tasks and paper-and-pencil tasks. The results are provided in three
composite scores of cognitive, perceptual, and psychomotor aptitudes.

䊏 Myers–Briggs Type Indicator

Finally, the MBTI (Myers & McCaulley, 1985) is a personality measure that com-
monly is used by employers. The aim of the MBTI is to identify individuals’ psy-
chological type and to understand how people take in information and make deci-
sions.

Key Characteristics of the MBTI

䊏 Relies on Jung’s theory of psychological types to classify people into four person-
ality categories: extraversion–introversion (EI), sensing–intuition (SN), think-
ing–feeling (TF), and judging–perceiving (JP).
䊏 Combines the four personality categories into 16 different personality types.
䊏 Describes each personality type by the letter code for each side of the dichotomy
(e.g., INTP stands for introversion, intuition, thinking, and perceiving).
䊏 Uses personality types to match careers with individuals’ personality types.

See Chapter 15 for more information on the MBTI.

CHAPTER TWENTY ONE Testing and Assessment in Counseling Practice 483

ASSESSMENT OF ORGANIZATIONAL CULTURE

Every organization has its own culture and develops traditions around how the or-
ganization is to be run and how people are to act within that organization. Organi-
zational culture is defined as follows:

Organizational culture: The “socially transmitted behavior patterns charac-

teristic of a particular organization or company” (Cohen & Swerdlik, 2004,
p. 552).

The behaviors inherent in an organizational culture include the structure and roles
of the organization, leadership style, dominant values, norms, sanctions, support
mechanisms, past traditions, and characteristic ways of interacting with people
and institutions outside of the culture (Cohen & Swerdlik). Understanding how an
organization functions and creates a culture around itself is important because, ul-
timately, the organizational structure can affect various aspects of the organization,
including health of employees, job satisfaction, and other measures.
There are a number of assessment instruments that are useful in responding to
needs related to organizational culture:

䊏 Discussion of Organizational Culture (DOC).

䊏 Job Description Index (JDI).
䊏 Minnesota Satisfaction Questionnaire (MSQ).

䊏 Discussion of Organizational Culture

One scale used to measure organizational culture is the DOC (Cohen, 2001). It was de-
vised with the intent of self-examination and self-improvement of a job environment.

Key Traits of the DOC Instrument

䊏 Identifies the strengths and weaknesses of a culture to allow organizations to uti-
lize their strengths and improve their weaknesses.
䊏 Uses the form of an interview and discussion format to cover 10 topics, such as
first impression, physical space, and prevailing values that bring understanding
of pivotal aspects of an organization.

䊏 Job Descriptive Index

The JDI (Balzer et al., 1997) is one of the most widely used measures of job satisfac-
tion. A key concept in organizations and employment needs, job satisfaction can be
described this way:

Job satisfaction: The pleasure that relates to one’s occupational experience.

484 What Are the Fundamental Components of Appraisal and Research? PART THREE

Key Characteristics of the JDI

䊏 Uses 72 items to measure work on present job, present pay, opportunities for pro-
motion, supervision, and coworkers.
䊏 Allows for testing in several different languages and dialects.
䊏 Provides a valid and reliable measure of job satisfaction (Johnson, Smith, &
Tucker, 1982; Kinicki, Mckee-Ryan, Schriesheim, & Carson, 2002).

䊏 Minnesota Satisfaction Questionnaire

The MSQ (Weiss, Dawis, England, & Lofquist, 1967) not only measures job satisfac-
tion, but also can be used to examine client vocational needs and to generate infor-
mation about a particular job’s reinforcers. The MSQ was normed on 25 representa-
tive occupations, plus employed disabled and employed nondisabled workers.
The MSQ is available in two different forms. The long version takes 15 to 20 min-
utes to administer, and the short version takes 5 minutes to administer. The longer
version measures 20 different areas of job satisfaction and gives a global job satis-
faction score. The shorter version consists of 20 items that represent the 20 different
areas examined in the longer version.

䊏 Organizational Commitment Questionnaire

The Organizational Commitment Questionnaire (OCQ; Porter, Steers, Mowday, &

Boulian, 1974) is a useful tool for measuring another employment and organiza-
tional culture concept known as organizational commitment, defined as follows:

Organizational commitment: The degree to which one identifies with a par-

ticular organization.

The OCQ is comprised of 15 items measured on a Likert scale that provides a mea-
sure of the amount of commitment both in the individual employee and the overall
organization. Questions on the organizational level address the areas of absentee-
ism, tardiness, turnover, and quality of work, whereas belongingness, security, and
opportunity for advancement and personal growth are measured by the individual
level.

Chapter 21: Key Terms

䉴 Assessment 䉴 General intelligence 䉴 Psychometrics
䉴 Referral question 䉴 Fluid intelligence 䉴 Educational assessment
䉴 Cognitive assessment 䉴 Crystallized intelligence 䉴 Achievement tests
CHAPTER TWENTY ONE Testing and Assessment in Counseling Practice 485

䉴 Aptitude tests 䉴 Self-report 䉴 Fixed battery

䉴 Psychoeducational tests 䉴 Direct observation 䉴 Organizational culture
䉴 Personality assessment 䉴 Forced choice response 䉴 Job satisfaction
䉴 Projective measures 䉴 Neuropsychological assess- 䉴 Organizational commit-
䉴 Objective measures ment ment
䉴 Behavioral assessment 䉴 Flexible battery
 chapter Quantitative Research Designs

22 Launcelot I. Brown
Duquesne University

In This Chapter

䉴 Foundations of Research Design 䊏 Pretest–Posttest Control Group Design

䊏 The Hypothesis 䊏 Posttest Only Design
䊏 Types of Research Hypotheses 䊏 Treatments and Concomitant Variables
䊏 The Null Hypothesis 䊏 Factorial Designs
䊏 Decision to Reject or Accept the Null 䊏 Solomon Four-Group Design
䊏 Alpha or Significance Level

䊏 Point Estimates and Confidence Intervals 䉴 Quasi-Experimental Designs

䊏 Hypothesis Testing 䊏 The Nonequivalent Control Group Design
䊏 Interrupted Time-Series Design

䉴 Experimental Research 䊏 Counterbalanced Designs

䊏 Manipulation 䊏 Single Case Experimental Designs

䊏 Random Assignment 䊏 Multiple-Baseline Designs

䊏 Controlling for Confounds 䊏 Alternating Treatments Design and

䊏 Treatment Integrity Changing Criterion Design

䊏 Manipulation Check

䊏 Settings for Conducting Experiments 䉴 Nonexperimental Research Designs

䊏 Classifications of Independent Variable
䉴 Experimental Validity 䊏 Purposes of Nonexperimental Research

䊏 Internal Validity Design

䊏 External Validity 䊏 Types of Nonexperimental Designs

䊏 Combining Experimental and

䉴 Basic Experimental Design Nonexperimental Designs

䊏 One Group Posttest Only Design 䊏 Interpretation of Nonexperimental Re-

䊏 Treatment–Control Posttest Only search

䊏 One Group Pretest–Posttest Design 䊏 Longitudinal Research

486
CHAPTER TWENTY TWO Quantitative Research Designs 487

FOUNDATIONS OF RESEARCH DESIGN

There are many texts written on quantitative research designs, some more technical
than others. This chapter does not attempt to serve as a replacement for these texts;
the sheer brevity of the chapter does not make that possible. Rather, information
contained herein is presented in a simple, concise manner and uses scenarios of in-
terest from the counseling field to frame the discussion around the various topics.

䊏 The Hypothesis

Research studies usually are born out of a researcher’s interest in a particular phe-
nomenon or topic. When engaging in serious study of the area of interest, one of a
researcher’s first tasks is to become familiar with the literature already written
about the chosen area and to use that literature search to narrow and clarify the spe-
cific question(s) he or she will decide to investigate. Ultimately, through careful
consideration of the literature, researchers formulate a research hypothesis, which
not only underlies the selection of the research design, but, more important, guides
and frames the research (Heppner & Heppner, 2004). There are some essential ele-
ments that are often addressed in the research hypothesis.

Components of the Research Hypothesis

䊏 The researcher’s intentions with regard to what will be observed.
䊏 The expected relationship between variables that are being observed.
䊏 The sample representing the population of interest.
䊏 The measuring instruments.
䊏 The design of the study.
䊏 The data analytic procedures.
䊏 The tentative prediction of the findings.

The hypothesis is never an educated guess. The researcher’s prediction is the alter-
native or scientific hypothesis (H1) and is based on theory or studious observa-
tions.

䊏 Types of Research Hypotheses

The research hypothesis can be directional or nondirectional.

Directional hypothesis: Specific statement about which group will exhibit

more or less of a treatment effect.

Nondirectional hypothesis: Statement that there is simply a relationship

between variables or that groups differ on the variable of interest.
488 What Are the Fundamental Components of Appraisal and Research? PART THREE

EXAMPLE

Writing Research Hypotheses

A school counselor in an urban high school wants to test the effectiveness of two counseling
techniques on increasing the self-concept of students in her school. She makes the following
nondirectional hypotheses:
There is a significant difference in the mean self-concept of urban high school students in the
cognitive therapy group and those in the behavioral counseling group.
H1 : µ1 ≠ µ2
On sharing her hypothesis with one of her colleagues she learns about two recent studies that
looked at the effectiveness of cognitive and behavioral counseling and concluded that cogni-
tive approaches have longer lasting residual effects. After reading the two articles, she
changes her hypothesis to one or the other of the following directional hypotheses:
Cognitive therapy will be significantly more effective than behavioral counseling in in-
creasing the self-concept of urban high school students.
H 1 : µ 1 > µ2
Urban high school students in the behavioral counseling group will show significantly
lower levels of self-concept than those in the cognitive therapy group.
H 1 : µ 1 < µ2
Both the directional and nondirectional hypotheses are tested against the null hypothesis (H0),
which states that both counseling methods are equally effective. In other words, there is no
significant difference between the two counseling methods with regard to the self-concept of
urban high school students. Any differences found are due to chance or sampling error.
H0 : µ1 = µ2 or H0 : µ1 – µ2 = 0

䊏 The Null Hypothesis

Generally, the null hypothesis is a statement about the population parameter and
can be understood as follows:

Null hypothesis: States that in the population, there is no change, no effect,

no difference, and no relationship due to the effect of the treatment or condi-
tion.

Stated differently, the null hypothesis says that with regard to the independent
variable (in the preceding example, the manipulated or independent variable is the
counseling technique) there is no effect on the dependent or outcome variable
CHAPTER TWENTY TWO Quantitative Research Designs 489

(self-concept). That is, the null is true. The alternative hypothesis says that there is
an effect and the null is false.

䊏 Decision to Reject or Accept the Null

Most often, the researcher hopes that the evidence collected is sufficiently incom-
patible with the null if the null was true. If the evidence supports the research hy-
pothesis, the null is said to be false and is rejected. If there is not sufficient evidence
to support the research hypothesis, the null is accepted, or as is more commonly
stated, the researcher fails to reject the null.
It is important to remember that failing to reject the null does not mean that the
null is true. It simply says that the evidence is not sufficient to support rejection of
the null. It is analogous to the concept of innocent until proven guilty. However,
there is the caveat; before a researcher rejects the condition of innocence, the evi-
dence must indicate guilt beyond a reasonable doubt.

䊏 Alpha or Significance Level

Keeping with the analogy of innocent until proven guilty, the alpha (α) or level of
significance is the criterion beyond which one determines there is reasonable
doubt. Alpha can be defined as follows:

Alpha: The predetermined probability value selected by the researcher to

make a decision about the null hypothesis.

In the behavioral sciences, that probability value (p value) is usually 5 in 100 (p =

.05) or 1 in 100 (p = .01). An alpha equal to or less than .05 or .01 indicates that there
is a 5% or 1% probability that the findings are due to chance or sampling error. Al-
ternatively, we can say there is 95% or 99% probability that the findings are due to
the effect of the independent variable on the dependent variable. Both statements
convey the same information that the findings, when considering the probability
that they might be due to sampling error, are inconsistent with the null if the null
were true.
The researcher selects the alpha level depending on how serious the conse-
quences are of rejecting the null when it is true. Errors can occur in drawing conclu-
sions about the null hypothesis, and these are known as Type I and Type II errors.

Type I error: Occurs when a researcher finds a significant difference or rela-

tionship when there is none.

Type II error: Occurs when the researcher fails to reject a false null when a sig-
nificant difference exists.
490 What Are the Fundamental Components of Appraisal and Research? PART THREE

Stated differently, Type I errors occur when the researcher rejects the null hy-
pothesis when there is no difference, and Type II errors occur when the re-
searcher fails to reject the null when actual differences exist.

䊏 Point Estimates and Confidence Intervals

Important to the interpretation of significance is an understanding of the difference

between the point estimate (calculated sample statistic) and the confidence interval
(CI).

Point estimate: One statistic in the range of possible statistics within the con-
fidence interval that estimates the population parameter.

Confidence interval: Range of values within which the true value of the pop-
ulation parameter is found.

Of critical importance is the width of the CI that supposedly captures the parame-
ter. The wider the CI, the more imprecise the point estimate calculated from the
sample, and accordingly, the less confidence one can have in the calculated statistic.
The level of confidence one has in the CI depends on the alpha level selected by the
researcher prior to conducting the research. Therefore a 95% CI (CI95) means that in
drawing an infinite number of CIs from the population of interest, 95% of the time
the population parameter will fall or be captured within the CI.
Although the CI does not give a single estimate of the population parameter, it
gives more information on the possible value of the parameter. This knowledge be-
comes important when comparing studies on the same topic. By examining the
overlap of CIs across studies (Thompson, 2002), one can get a clearer picture of the
values that can be attributed to the population parameter.

䊏 Hypothesis Testing

The information presented thus far provides an outline of some of the basic terms
and ideas necessary to conduct research. Putting this information together in the
actual process of testing hypotheses is the next step. Following is a listing of some
of the procedures that happen while testing the hypotheses.

Steps in Hypothesis Testing

䊏 State the null and alternative hypotheses.
䊏 Select the alpha level.
䊏 Select the appropriate test statistic.
䊏 Collect and summarize the sample data.
䊏 Run the test and make a statistical decision to reject or retain the null.
䊏 Draw conclusions.
CHAPTER TWENTY TWO Quantitative Research Designs 491

EXPERIMENTAL RESEARCH

The experiment is the most structured and thorough of all quantitative research
methods for testing hypotheses to determine whether the relationship between
two or more variables is due to cause and effect. A meticulously conducted experi-
ment is the only quantitative method for establishing cause-and-effect rela-
tionships. For research to be considered truly experimental, two occurrences must
take place:

䊏 Manipulation of at least one variable.

䊏 Random assignment of participants to treatment and control groups.

䊏 Manipulation

For research to be experimental, the independent variable must be manipulated

while all other variables, particularly the dependent variable, are held constant.
The independent and dependent variables can be understood in the following
way:

Independent variable: Variable that is hypothesized to be responsible for the

effect and also is called the treatment or experimental variable.

Dependent variable: Variable that is considered the consequence of the inde-

pendent variable to the extent that it is predicted by the independent variable.

Manipulation requires that the researcher create levels of the treatment, then assign
individuals to different levels. This might mean that the treatment group receives
the treatment and a control group receives no treatment or that groups are as-
signed to different levels of the treatment.

EXAMPLE

Manipulation of Intensity of Treatment Versus Type of Treatment

Imagine that a researcher wants to discover the most effective approach to tutoring. The re-
searcher may decide that one group receives 1 hour of tutoring 1 day per week, another group
receives 1 hour 2 days per week, and yet another group gets 1 hour of tutoring 3 days per
week, while a control group receives no tutoring. In this example, the researcher controls the
amount or intensity of the treatment. The same researcher may later decide she is more inter-
ested in what type of tutoring is most effective. One group receives tutoring from peers, an-
other receives online tutoring, and yet another group is assigned to instructor-led tutoring ses-
sions. In this instance, the researcher is manipulating the type of treatment.
492 What Are the Fundamental Components of Appraisal and Research? PART THREE

䊏 Random Assignment

Also important to experimental design is the concept of random assignment or ran-

domization.

Random assignment: Individuals are assigned to either the experimental

group or the control group, or some level of the treatment on the basis of
chance.

Randomization is the most effective method for ensuring group equivalence by

controlling for extraneous or confounding variables that could bias the outcome of
the study. There are always extraneous variables in research studies in the behav-
ioral sciences. However, these variables are only of concern when they influence
the independent variable, and as a result, the dependent or outcome variable. If the
extraneous variables influence the independent variable, the results of the study
can be confounded.

How Random Assignment Accounts for Extraneous Variables

䊏 Randomization capitalizes on chance assignment to the treatment condition and,
therefore, each participant has an equal chance of being assigned to any of the
treatment conditions.
䊏 Randomization as a control procedure does not remove the influence of extrane-
ous variables, but eliminates differential influence or influence that differs for
different groups in the study.
䊏 Random distribution of individuals to treatment levels also distributes in no par-
ticular order (by chance) the extraneous variables.
䊏 Random assignment equates groups by diffusing the influence of the extraneous
variables across all groups (i.e., the extraneous variables are held constant across
all groups).

䊏 Controlling for Confounds

In addition to randomization, there are a number of other methods researchers can

use to control for extraneous or confounding variables that can have an impact on
the research outcomes. Confound can be defined this way:

Confound: Variable not considered in the study (extraneous variable) that in-
fluences the outcome of the study and consequently does not allow for valid
interpretation of the results.

Methods of Controlling Extraneous Variables

䊏 Manipulation allows the researcher to control the characteristics of the inde-
pendent variable by creating of levels of the independent variable, controlling
CHAPTER TWENTY TWO Quantitative Research Designs 493

the amount or intensity of the treatment, or controlling the nature of the treat-
ment.
䊏 Elimination refers to the researcher’s decision to control for extraneous variables
by holding them constant.
䊏 Inclusion allows the researcher to control for extraneous variables by including
them in the study so their effects can be taken into account.
䊏 Statistical control allows the researcher to control for the effects of extraneous
variables through statistical analyses.

EXAMPLE

Finding Ways to Control for Confounds

There are several ways researchers can control for confounding variables. If a researcher be-
lieves that gender, for example, can make a difference in outcome, the researcher can include
both sexes in the analysis. On the other hand, the researcher may want to hold constant con-
founding variables by eliminating them from the study. A researcher may, therefore, choose to
involve only girls, only children from single-parent families, or only children with learning
disabilities in the study. Finally, researchers also can use statistics to their benefit when trying
to control for confounds. The analysis of covariance (ANCOVA) is a statistical procedure that
measures the extraneous variable as a covariate and, therefore, allows the researcher to draw
conclusions about the impact of that variable on the results.

䊏 Treatment Integrity

In preparation for beginning a research study, it is the responsibility of the re-

searcher to ensure that the treatment is administered as intended and consistently
across treatment conditions.

Treatment integrity: The extent to which the treatment is the same for all
groups across all contexts.

There are a number of precautions researchers can take to ensure treatment integ-
rity.

Ways to Maximize Treatment Integrity

䊏 Train research assistants in carrying out their functions and keeping records.
䊏 Adopt standardized procedures.
䊏 Use standardized instruments.
䊏 Create clear, well-defined instructions.
494 What Are the Fundamental Components of Appraisal and Research? PART THREE

By maintaining treatment integrity, researchers can ensure (as much as possible)

congruence in understanding among all participants as to their roles and responsi-
bilities and decrease the chances of dissimilar interpretations of the instructions
and procedures.

䊏 Manipulation Check

In addition to ensuring treatment integrity prior to launching a study, the re-

searcher also must do a manipulation check to consider what variables besides the
treatment variable might influence the dependent variable.

Manipulation check: Process of examining the impact of the treatment to de-

termine whether the outcome was expected or whether the outcome had un-
intended effects.

A thorough literature review and piloting of the instruments helps researchers

identify some of the variables that potentially could have unintended effects on the
dependent variable. Just as important is determining whether the treatment works
the same for all subgroups in the experiment.

EXAMPLE

Using the Manipulation Check

A researcher decides to give an exam for which everyone is required to do an Internet search.
In this case, computer anxiety could become an artifact that has an impact on exam scores.
Therefore, anxiety must be a consideration in the a priori planning for the study. Additionally,
if boys did better than girls on the test, the researcher needs to know whether the difference in
performance was due to the boys’ greater understanding of the content or to their being less
computer anxious. If the latter is true, then the testing format is working in favor of the boys.

䊏 Settings for Conducting Experiments

The laboratory and the field are two primary settings in which research can take
place. Laboratories are set up specifically for the study, whereas field research uses
a naturally occurring setting. There are advantages to each venue.

Advantages of the Laboratory Setting

䊏 Supports the purpose of the study by affording greater control over potentially
extraneous variables that can confound the results of the study.
䊏 Allows for greater internal validity.

The limitation of a laboratory setting, however, is that it is artificial and, therefore,

generally has lower external validity.
CHAPTER TWENTY TWO Quantitative Research Designs 495

Advantages of Field Work

䊏 Accounts for the reality of the environment.
䊏 Allows for higher external validity.

The drawback of field experiments is that in allowing for less control over extrane-
ous variables, the study is generally less internally valid.
There is always a trade-off when choosing the setting for a study. The basis for
choosing one setting over the other depends on the purpose of the study and the
importance attached to internal versus external validity.

EXPERIMENTAL VALIDITY

Experimental validity refers to the internal and external validity of the experiment.
This section outlines some of the major concerns related to experimental validity of
which researchers must be aware and able to address to the extent possible when
conducting an investigation.

䊏 Internal Validity

When an experiment has high internal validity, the results of the experiment are at-
tributable to the manipulated independent variable and cannot be explained by
other factors (extraneous variables) that have affected the outcome. There are a
number of threats to internal validity of which researchers must be aware. These
are outlined and defined next.

Threats to Internal Validity

䊏 History refers to any event that is not part of the experimental treatment but oc-
curs during the study and influences responses on the dependent variable.
䊏 Maturation is a threat in studies that occurs over time that increases the
chances that participants undergo changes during the life of the study.
䊏 Instrumentation or data collection devices must be reliable and must be consis-
tent across measuring occasions to avoid internal threats to validity.
䊏 Testing or pretest sensitization occurs when participants’ performance on a test
is improved because of having taken a pretest. The threat to internal validity is
more likely to occur when the time between the pretest and the posttest is short,
or when the test is based on factual information that can be recalled.
䊏 Mortality or attrition is a threat that occurs when participants drop out of the
study in different numbers and for different reasons and, in turn, affect the sam-
ple size and the composition of the treatment and control groups. The threat be-
comes even greater when the dropout rate is proportionally different between
groups (differential attrition).
496 What Are the Fundamental Components of Appraisal and Research? PART THREE

䊏 Selection refers to inherent differences between groups at the outset of the study
and is more likely to happen with intact groups. One cannot say that the partici-
pants are representatives of the population. There is the possibility of sample
bias.
䊏 Regression toward the mean occurs when participants scoring at the extremes
on the pretest tend to move toward the middle or mean on the posttest. This con-
cept has to do with the effects of random errors. Therefore, the correlation be-
tween two variables, or between scores on the same variables measured on dif-
ferent occasions, are not perfect. (See Pedhazur & Schmelkin, 1991, for a more
in-depth treatment of the topic.)
䊏 Diffusion or imitation of treatments occurs when the treatment or control
group becomes aware of the experimental treatment and, because of the aware-
ness, does not respond as they normally would on the dependent variable.
䊏 Compensatory rivalry or the John Henry effect is a threat related to diffusion
that occurs when the effects of the treatment are negated because one group sees
the other group as competitors and consequently works harder than usual.
䊏 Resentful demoralization occurs when the responses of the participants do not
reflect their natural behaviors.

EXAMPLE

Threats to Internal Validity: Studies Prior to and Post 9/11

A good example of the threat of history can be seen in any study about the perception of immi-
grants before and after September 11, 2001. Media coverage on terrorists and government ac-
tion to scrutinize immigrants more carefully certainly can have an impact on the way the pub-
lic views immigrants, which may, therefore, pose a threat to validity.

䊏 External Validity

High external validity refers to the generalizability of the results or the extent to
which results are replicable to other groups and contexts beyond the experimental
setting. For individuals to benefit from the results of research studies, the investiga-
tions must have high external validity. Just as there are a number of threats to inter-
nal validity, there are also threats to external validity of which researchers must be
aware (Gay & Airasian, 2003).

Threats to External Validity

䊏 Treatment by attributes interaction is a threat to the effectiveness of treatment
that emerges because of certain attributes or characteristics (e.g., gender, race,
age, educational level) of the participants.
CHAPTER TWENTY TWO Quantitative Research Designs 497

䊏 The Hawthorne effect refers to the fact that participants behave differently sim-
ply because they know they are being studied.
䊏 Treatment by setting interaction suggests that results can fluctuate depending on
the setting of the study.
䊏 Pretest sensitization suggests that the preset itself triggers a change in results.

BASIC EXPERIMENTAL DESIGN

The research design is the plan for conducting the research, and there are many re-
search designs from which researchers can choose. Some are more effective than
others for controlling threats to the validity of the study, and some are more sophis-
ticated than others, thus requiring additional resources and skill. Selection of a re-
search design is based on its appropriateness to test the hypothesis and answer the
identified research questions. This section outlines some of the various designs that
commonly are used in experimental research.

䊏 One Group Posttest Only Design

One of the simplest of all research designs, the one group posttest only design, in-
volves one group that is exposed to a treatment (X) and then tested (O2). A major
limitation of this design is that one cannot say that the measure on the outcome
variable was due to the effects of the treatment. Thus, most researchers recognize
the inadequacy of this design, and it rarely is used.

䊏 Treatment–Control Posttest Only

The treatment–control posttest only design is a variant of the one group posttest
design. In this design, one group receives a treatment, while another group is used
as a control and, therefore, does not receive any treatment. A test is given to both
groups only after the treatment is administered.

EXAMPLE

Treatment–Control Posttest Only Design

Let us consider a study that is intended to measure the effectiveness of a special teaching ap-
proach on students’ grades in math. In this design, the control group of students receives the
traditional teaching approach, whereas the experimental group gets the treatment, which is a
special approach to teaching math. At the end of the treatment administration, the students
498 What Are the Fundamental Components of Appraisal and Research? PART THREE

take a test and differences in scores are analyzed. Another example can be found in medical re-
search. One group is given medication, and the control group receives a placebo (i.e., no treat-
ment). In this design, the conditions before the test are not known.
The design can be depicted this way:
X1 O1
O2

䊏 One Group Pretest–Posttest Design

The one group pretest–posttest design is an improvement on the one group post-
test only design. In this approach, the research participants first are measured on
the dependent variable via a pretest (O1). The participants then are exposed to the
treatment (X) and tested again on the dependent variable via a posttest (O2). The ef-
fectiveness of the treatment is determined by the difference between the pretest
and posttest scores. It is tempting to believe that whatever success is observed is
due to the treatment. However, other sources of influence cannot be ruled out as ex-
planations for the differences between the pretest and posttest scores.

EXAMPLE

One Group Pretest–Posttest Design: Limitations

Consider a hypothetical study. The high school in one school district has been merged with the
middle and high school of an adjacent school district. A school counselor is concerned that the
anxiety caused by the transition to the new setting affects students’ participation in school ac-
tivities and their academic performance. To test her hypothesis, she introduces a program
aimed at addressing student anxiety. On the first day of the new term, she administers an anxi-
ety test (pretest) to the new arrivals. The students participate in the 3-week program desig-
nated as the treatment. At the end of the program she again administers the test (the posttest)
and observes a significant decline in their levels of anxiety. The counselor is pleased with the
outcome of the program.
The question is: Can the decrease in anxiety level be attributed to the program? Other factors
must be considered. For instance, the students were singled out for special treatment, and the
teacher might consider what impact being singled out might have on their test scores. Also,
the students were in school 3 weeks between testing times, and their initial anxiety naturally
may have diminished. Additionally, they may have realized that their present school setting
was not much different from their former school setting and may have started to make friends.
All these are possible reasons (extraneous variables or confounds) that can explain the de-
crease in levels of anxiety. Therefore, if this design is used, extreme caution must be applied to
any interpretation of the results.
CHAPTER TWENTY TWO Quantitative Research Designs 499

䊏 Pretest–Posttest Control Group Design

The pretest–posttest control group design does an excellent job of controlling for al-
ternative hypotheses that might explain the changes in the dependent variable. In
this design, individuals are randomly assigned to at least two groups and pretested
on the outcome variable. One group is exposed to the treatment and the other con-
tinues with the existing conditions. Both groups are posttested on the dependent
variable. Although randomization is the most effective procedure for equating
groups, it does not guarantee group equivalence. A general weakness of all designs
that use a pretest is the possibility of sensitizing participants to the posttest and the
possible interaction of the pretest with the treatment. In this design, however, the
control group controls for the effects of testing.
In all the previous designs, if the groups are equivalent on the pretest, the
posttest scores of the groups can be compared using the t test, or the analysis of
variance (ANOVA). If groups differ on the pretest, the ANCOVA is the appropriate
analysis to adopt.

EXAMPLE

Pretest–Posttest Control Group Design

In this design, there are three randomly assigned groups: two to different levels of the treat-
ment and one to the control. Pictorially, the design looks like this:
O X1 O
O X2 O
O O
There are many variations to the pretest–posttest control group design. In the following dia-
gram, the treatment effects (O) are tested immediately after treatment and again at a later date.
This variation on the original design looks like this:
O X1 O O
O X2 O O

䊏 Posttest Only Design

In the posttest only design, at least one group of participants receives a treatment
and is compared to a control group that was not exposed to the experimental treat-
ment. Both groups are posttested. The weakness of this design is that there is no
pretest to determine prior individual level of performance on the dependent vari-
able. Despite this weakness, this design controls for pretest sensitization and is use-
ful especially when it is unethical to withhold treatment from individuals.
500 What Are the Fundamental Components of Appraisal and Research? PART THREE

EXAMPLE

Posttest Only Design

The design can be extended to include any number of groups. For example, a design that in-
cludes three groups is displayed this way:
X1 O1
X2 O2
X3 O3
Groups can be compared on three different counseling strategies, such as behavioral, cogni-
tive, and Gestalt therapies. Or, as in medical research, two groups are given the treatment—
medication and a placebo—and another receives no treatment. Participants are randomly as-
signed to each group, and groups are compared one to the other or against a control group.

䊏 Treatments and Concomitant Variables

Concomitant variables are subject attributes that can influence the effects of the
treatment on the dependent variable. This design is essentially the same as the pre-
test–posttest control group design, however, instead of the pretest, the concomitant
variable C is measured.

EXAMPLE

Treatments and Concomitant Variables

A research design that accounts for concomitant variables looks like this:
C X1 O
C X2 O
C O
A study of the effects of different counseling methods on peer relationships would have to take
into consideration the concomitant variable social skills. The concomitant variable is mea-
sured before the application of the treatment and serves as the covariate in the ANCOVA.

䊏 Factorial Designs

Factorial design allows for the simultaneous study of more than one independent
variable to determine both the effects of the independent variables and the interac-
CHAPTER TWENTY TWO Quantitative Research Designs 501

tion on the dependent variable. In fact, a factorial design can consist of any number
of factors, and factors can have any number of categories. A 2 × 2 × 3 design (see
Figure 22.1) consists of three factors: two of two categories each and one of three
categories.

EXAMPLE

Factorial Design
In the factorial design, the letters refer to the independent variables or factors. The design can
be displayed like this:
A1 B1 O1
A1 B2 O2
A2 B1 O3
A2 B2 O4
Let us say A is divided into two age groups, younger and older, and B refers to two counseling
methods. The factorial design allows researchers to estimate main effects. That is, researchers
are able to determine whether the difference observed is due to (a) age A1 and A2, (b) the differ-
ence in counseling methods B1 and B2, or (c) the result of an interaction between age and
method, where one method works better than the other for one age group but not the other.

FIGURE 22.1 2 × 2 factorial design.

502 What Are the Fundamental Components of Appraisal and Research? PART THREE

䊏 Solomon Four-Group Design

The Solomon four-group design combines the pretest–posttest control group de-
sign and the treatment control posttest only design. As the name implies, the de-
sign consists of four groups, two of which are pretested and two of which are not
pretested. Individuals are randomly assigned to one of the four groups. The treat-
ment is given to one of the pretested groups and one of the groups that did not re-
ceive the pretest. All groups are then posttested.

EXAMPLE

Solomon Four-Group Design

The Solomon four-group design is depicted this way:
O1 X O2
O3 O4
X O5
O6
This design allows researchers to determine whether the pretest sensitizes individuals to the
posttest. It also determines whether the effects of the treatment are consistent when measured
in more than one way. The appropriate analysis for this design is a 2 × 2 factorial design with
treatment–control and pretest–no pretest as the independent variables.

QUASI-EXPERIMENTAL DESIGNS

Quasi-experimental design includes at least one manipulated independent vari-

able and does not use random assignment to treatment groups. A quasi-experi-
mental design is used instead of an experimental design when it is not possible to
randomly assign individuals to groups, or it is unethical to do so. There are two
types of quasi-experimental designs:

1. Nonequivalent control group.

2. Interrupted time-series.

䊏 The Nonequivalent Control Group Design

This design is exactly like the pretest–posttest control group design except that in-
stead of randomly assigning individuals to the treatment, intact groups are as-
CHAPTER TWENTY TWO Quantitative Research Designs 503

signed. The more similar the intact groups are, the stronger the study. In an effort to
equate groups, it is sometimes necessary to match individuals on the variable of in-
terest. For example, highly anxious clients are paired with other highly anxious cli-
ents. As with the experimental designs, similar variations and extensions to the
base design can be applied; similar statistical analytic procedures also are con-
ducted in quasi-experimental designs. The major drawback to the nonequivalent
control group is that the results must be interpreted with great caution because the
absence of random assignment makes it impossible to consider and control all pos-
sible extraneous variables, particularly those related to group membership.

䊏 Interrupted Time-Series Design

It is not always possible to have more than one group available for conducting a
study. In such instances, the group is pretested a number of times until the pretest
scores are stable and a baseline is established. The group then is exposed to the
treatment and posttested a number of times. If, following the treatment, there is ev-
idence of consistent improvement, the researcher is more confident in asserting
that the improvement was due to the effects of the treatment (see Figure 22.2).
Researchers must be aware that the absence of random assignment always in-
creases the possibility of rival hypotheses explaining the observed change. A varia-
tion of this design can be created by including a nonequivalent control group. The
first group is exposed to the treatment condition and the second group serves as the
control. This design is useful when the researcher wishes to determine whether the
effects of treatment or intervention persist when the treatment is terminated. A
graphical representation of an interrupted time series design is found in the follow-
ing example.

FIGURE 22.2 Possible patterns of behaviors on a study based on a time-series de-

sign. X shows the introduction of the treatment.
504 What Are the Fundamental Components of Appraisal and Research? PART THREE

EXAMPLE

Interrupted Time-Series Design

The interrupted time-series design looks like this:
Multiple pretest Treatment Multiple posttest
O1 O2 O3 O4 X O5 O6 O7 O8
The interrupted time-series design also can include a control group.
O1 O2 O3 O4 X O 5 O 6 O 7 O8

O1 O 2 O3 O4 O 5 O 6 O 7 O8

䊏 Counterbalanced Designs

The counterbalanced design is applicable to medical and pharmaceutical research,

but also should be of interest to counselors. In this design all groups receive all
treatment but in a different order. This design most often is used when it is not pos-
sible to administer a pretest and it is unethical to deprive any individual of the
treatment. The order in which the treatment is given randomly is determined to
control for the potential effects from the order of testing. The following example
provides a diagram of the counterbalanced design.

EXAMPLE

Counterbalanced Design
As shown in the following diagram, Group A receives Treatment 1 and is posttested, then
receives Treatment 2 and a posttest, Treatment 3 and a posttest, finally Treatment 4 and a
posttest. A pictorial representation of the counterbalanced design is as follows:
A X1O X2O X3 O X4 O
B X2 O X3 O X4 O X1 O
C X3 O X4 O X1 O X2 O
D X4 O X1 O X2 O X3 O
A gets Treatment 1, B receives Treatment 2, C receives Treatment 3, and D receives Treatment 4;
all groups are posttested. The effectiveness of the treatment is determined by comparing the
mean posttest score of each group on each treatment.
CHAPTER TWENTY TWO Quantitative Research Designs 505

䊏 Single Case Experimental Designs

Of interest to counselors is the single case, or single subject designs. These designs
are applicable when one individual or one homogenous group comprises the par-
ticipants of the study. Similar to the interrupted time-series design, this design en-
tails repeated measure of the dependent variable pre- and postexposure to the
treatment condition. The pretreatment responses constitute the baseline that is
compared to the posttreatment responses to determine the effect of the independ-
ent variable on the dependent variable. Having pretreatment and posttreatment
multiple measures on the dependent variable helps to control for history and matu-
ration that could confound the results.

EXAMPLE

Single Case Designs

There are two basic types of single case designs: A-B-A and A-B-A-B designs.
The A-B-A designs have a pretreatment baseline, treatment phase, and posttreatment baseline.
The A-B-A-B design simply adds a second treatment phase to the end of the process. The
A-B-A-B design is displayed this way:
Baseline A1 Treatment B1 Baseline A2 Treatment B2
OOOOO XOXOXOXO OOOOO XOXOXOXO
The addition of treatment phases and the subsequent calculation of new baselines can provide
convincing evidence that the observed effects are due to the treatment and not extraneous
variables.

䊏 Multiple-Baseline Designs

There are three basic types of multiple-baseline designs.

Categories of Multiple-Baseline Designs

1. Across behaviors design that focuses on two or more behaviors in the same in-
dividual.
2. Across participants design that focuses on two or more individuals exhibiting
the same behaviors.
3. Across settings design that focuses on a specific behavior exhibited by the same
individual in different settings.

In all three designs, baseline behavior is calculated (O) and the treatment (X) is
applied to successive individuals, settings, or behaviors. A desired change in
506 What Are the Fundamental Components of Appraisal and Research? PART THREE

each behavior or each individual that appears only after the application of
the treatment provides convincing evidence as to the effectiveness of the treat-
ment.

EXAMPLE

Multiple-Baseline Design
The multiple-baseline design graphically is represented this way:
1st individual: OOOOO XO XO XO XO XO XO XO XO XO XO XO
2nd individual: O O O O O O O O O O XO XO XO XO XO XO XO XO
3rd individual: O O O O O O O O O O O O O O XO XO XO XO XO XO
A variation of this design is the inclusion of an additional baseline phase and treatment phase
using the same successive approach to the application of the phases.

䊏 Alternating Treatments Design and Changing Criterion Design

The alternating treatments and changing criterion designs are useful to counselors.
The alternating treatments design is used in a single case context to assess the rela-
tive effectiveness of two or more treatments.

Characteristics of Alternating Treatments Design

䊏 The design requires that the researcher, on a random basis, alternate types of
treatment methods throughout the experiment.
䊏 The main weakness with this design is the potential for carryover effects (multi-
ple-treatment interference) from one treatment to another.

The changing criterion design is useful when it is necessary to set new baselines of
increasing complexity, or baselines that demand more of the behavior.

Characteristics of Changing Criterion Design

䊏 An initial baseline measure is calculated, and then the individual is exposed to
the treatment condition until the criterion is achieved.
䊏 This new level of performance becomes the new baseline, and the criterion is in-
creased.
CHAPTER TWENTY TWO Quantitative Research Designs 507

䊏 Successful achievement of the increased criterion leads to the establishment of

new minimum performance levels until the desired level of performance is
achieved.

NONEXPERIMENTAL RESEARCH DESIGNS

Nonexperimental research begins with a dependent variable (i.e., the phenomenon

of interest) and attempts to discern factors that will explain or predict it. Unlike in
experimental designs, in nonexperimental designs, the independent variable is
neither manipulated nor randomly assigned to treatment. Because of certain fea-
tures of the independent variable, the researcher has no control over the independ-
ent variable.

Features of the Independent Variable in Nonexperimental Research

䊏 Independent variables are fixed and nonmanipulable (e.g., sex).
䊏 Independent variables reflect a state of being (e.g., marital status).
䊏 Independent variables may not be ethically manipulated (e.g., drug usage).
䊏 The relation among variables is not known and needs to be discovered by re-
search (e.g., factors that motivate substance abusers to seek intervention, or peer
support and reduction in bullying in schools).

䊏 Classifications of Independent Variable

In nonexperimental design, independent variables can be described as categorical

or continuous, defined as follows:

Categorical independent variables: Participants are classified into discrete

groups (e.g., gender, race, marital status, religious affiliation, level of educa-
tion).

Continuous independent variables: Participants are placed or fall along

some continuum (e.g., age, IQ, self-esteem, persistence, goal orientation).

In most cases in which the independent variable is categorical, the researcher hy-
pothesizes that groups differ on some dependent variable. Therefore, the questions
of interest are whether or not groups differ, the extent to which groups differ, or the
direction of the difference on some dependent variable. In research in which the
primary independent variable is continuous, researchers are interested in the
strength or nature of the relationship between the independent and dependent
variables. For example, the researcher hypothesizes that there is a relationship be-
tween causal attribution and academic achievement in high school.
508 What Are the Fundamental Components of Appraisal and Research? PART THREE

䊏 Purposes of Nonexperimental Research Design

There are two major purposes of nonexperimental designs: (a) to explain some phe-
nomenon of interest on the basis of one or more variables, and (b) to predict some
phenomenon of interest on the basis of one or more variables.

EXAMPLE

Using Nonexperimental Design to Answer Research Questions

In trying to explain a phenomenon of interest, researchers might ask questions such as these:
To what extent does level of test anxiety explain differences in achievement?
Is there a relation between gender and attitude toward sex orientation?
Are there sex differences in student willingness to seek help from counselors?

When researchers are interested in trying to identify factors that predict a phenomenon of in-
terest, the research questions may look like this:
How well does the GRE predict success in graduate school?
To what extent does level of education predict willingness to seek help from counselors?
Does professional certification predict subsequent performance on the job?

䊏 Types of Nonexperimental Designs

Nonexperimental designs can be divided into three broad types, the causal-com-
parative study, correlational study, and longitudinal study. These are defined here:

Causal-comparative study: Designs that use categorical independent

variables.

Correlational study: Designs that use continuous independent variables.

Longitudinal study: Research design in which data are collected more than
once over a period of time.

In reality, most published research is a cross between causal-comparative and

correlational; in fact, the distinction between the two is artificial. By simply creating
categories of the continuous variable (e.g., above average, average, below average
intelligence) one can change a correlational study to a causal-comparative study.
Often, researchers examine the effects of categorical variables (gender and ethnic-
ity) in combination with continuous variables (self-perception and perception of
others) on the dependent variable (school climate).
CHAPTER TWENTY TWO Quantitative Research Designs 509

䊏 Combining Experimental and Nonexperimental Designs

Many designs are combinations of experimental and nonexperimental. Re-

searchers may manipulate one variable (e.g., sex of the counselor) but include an-
other variable that is not manipulated (e.g., attitude toward persons of the opposite
sex) as part of the study.

䊏 Interpretation of Nonexperimental Research

Even when there is statistical evidence of group differences or strong relations be-
tween independent and dependent variables, it is necessary to be cautious in inter-
preting the results of nonexperimental research. The major limitation to non-
experimental research is its inability to rule out extraneous and confounding
variables as alternative hypotheses for explaining the results; thus, the possibility
of other plausible explanations for the results always exist. The evidence must be
overwhelming before one can imply cause.

䊏 Longitudinal Research

Longitudinal research refers to research in which data are collected more than once
over a period of time. Two types of longitudinal research are trend studies and
panel studies.

Trend study: Type of study in which the researcher takes a new sample of per-
sons from the population of interest each year. All samples are asked the same
questions or administered the same treatment.

Panel study: A study in which the same individuals are tested at successive
points in time over the period of the study.

Like trend studies, panel studies focus primarily on questions related to change or
developmental level across time. However, panel studies are more powerful than
trend studies because in measuring the same individuals at successive time points,
sampling error is reduced. A researcher might be interested in the factors that ex-
plain the changes, or may examine present factors that predict an outcome. Panel
studies are the most effective nonexperimental design for establishing causality.
Drawbacks to panel studies include high expenses, lengthy amounts of time to
complete the study, and high levels of attrition. Additionally, analytic procedures
are usually complex for longitudinal data. Among the simplest are the repeated
measures ANOVA and variants of this analytic procedure.
510 What Are the Fundamental Components of Appraisal and Research? PART THREE

EXAMPLE

Trend and Panel Studies

A researcher wants to conduct a trend study examining counselor opinions on rehabilitation
of sex offenders. Each year for 5 years the researcher takes a sample of students entering the
graduate counseling programs and canvases their opinions on a number of variables related
to the rehabilitation of sex offenders. The research is particularly interested in the generational
change in perception and compares the perception of one cohort to a previous cohort to track
changes across time.
Panel studies have been used extensively in medical research, and these have been effective in
establishing causation. Immediate examples of such studies are those that establish a causal
relation between smoking and lung cancer and between air pollution and a variety of illnesses.

Chapter 22: Key Terms

䉴 Alternative hypothesis 䉴 Differential influence 䉴 Compensatory rivalry
䉴 Scientific hypothesis 䉴 Confound 䉴 John Henry effect
䉴 Directional hypothesis 䉴 Treatment integrity 䉴 Resentful demoralization
䉴 Nondirectional hypothesis 䉴 Manipulation check 䉴 External validity
䉴 Null hypothesis 䉴 Internal validity 䉴 Hawthorne effect
䉴 Alpha 䉴 History 䉴 Categorical independent
䉴 Level of significance 䉴 Maturation variables
䉴 Type I error 䉴 Instrumentation 䉴 Continuous independent
䉴 Type II error 䉴 Testing or pretest variables
䉴 Point estimate sensitization 䉴 Causal-comparative study
䉴 Confidence interval 䉴 Mortality 䉴 Correlational study
䉴 Independent variable 䉴 Attrition 䉴 Longitudinal study
䉴 Dependent variable 䉴 Selection 䉴 Trend study
䉴 Treatment group 䉴 Regression toward the mean 䉴 Panel study
䉴 Control group 䉴 Diffusion or imitation of
䉴 Random assignment treatments
chapter Fundamentals of Qualitative Research

23 Gary Shank
Duquesne University

In This Chapter

䉴 Roots of Qualitative Research

䊏 Cultural Anthropology

䊏 Sociology

䊏 Education

䉴 Meaning in Qualitative Research

䊏 The World Is Meaningful

䊏 Some Things Are Only Meaningful

䊏 Knowledge Depends on Understanding

䉴 How to Recognize Qualitative Research

䊏 Natural Setting

䊏 Holistic Approach

䊏 Researcher Involvement

䊏 Role of Qualitative Researcher

䉴 Basic Techniques of Qualitative Research

䊏 Observation

䊏 Interviews

䊏 Participation

䊏 Interpretation

䉴 Basic Products of Qualitative Research

䊏 Ethnography

䊏 Case Study

䊏 Portraiture

䊏 Grounded Theory

䊏 The Glaser Approach

䊏 Material Analysis

䉴 The Role and Future of Qualitative Research in Counseling

䊏 Qualitative Research Tackles Complex Questions and Issues

䊏 Counselors and Qualitative Researchers Share Similarities

䊏 Qualitative Research Provides Possibility and Freedom

512
CHAPTER TWENTY THREE Fundamentals of Qualitative Research 513

ROOTS OF QUALITATIVE RESEARCH

The goal of this chapter is to introduce a counseling audience to the fundamentals

of qualitative research in the social sciences. In one sense, qualitative research has
only been around for a few decades. In a deeper sense, however, it has an extensive
track record. That record is best understood by looking at its history within the
main content domains of its development—cultural anthropology, sociology, and
education.

䊏 Cultural Anthropology

Cultural anthropology is that branch of anthropology that seeks to study cultures

in their native habitats. At the turn of the 20th century, cultural anthropologists be-
gan developing a specialized form of field work known as ethnography. A key con-
cept in ethnography is that field work should be conducted with as few presuppo-
sitions and as few predetermined goals as possible.

䊏 Sociology

Like anthropology, sociology has a rich tradition within the qualitative domain
(Lancy, 1993). Three key developments in sociology have helped shape the nature
of contemporary qualitative research:

1. The Chicago School of Sociology introduced the concept of applied field work
to the discipline (Bogdan & Bicklen, 1998), which served as a basis for all future
qualitative research—including efforts such as action research and emanci-
patory research—that focused not just on finding out truth, but on improving
people’s lives.
2. Within the field of medical sociology, Glaser and Strauss (1967) introduced the
basic procedures of grounded theory, which provided a middle ground be-
tween experimental design on one hand and armchair theorizing on the other
hand.
3. Schutz (1932) and Berger and Luckmann (1966) advocated for field research
that did not just look at the strange, far off, and exotic, but for field work in the
study of everyday social settings and everyday lives.

Berger and Luckmann (1966) took the notion of research in the everyday realm a
step further, by suggesting that social settings were palettes for creating complex
and involved sorts of lives that nonetheless feel routine and natural to those of us
who live within, and embrace, these complex settings. They called this notion the
social construction of reality.
514 What Are the Fundamental Components of Appraisal and Research? PART THREE

䊏 Education

A final key field in qualitative research in the social sciences is that of education. At
first, educators explored the potential of qualitative research in the conduct of eval-
uation. Guba (Guba & Lincoln, 1994; Lincoln & Guba, 1985, 2000) was the pioneer
of this approach. Other key figures in qualitative approaches to education include
Patton (2002) and Fetterman (Fetterman, Kaftarian, & Wandersman, 1996). Over
the years, qualitative research has gained more and more of a foothold in educa-
tional research. A good sampling of the various areas can be found in Denzin and
Lincoln (2005).

MEANING IN QUALITATIVE RESEARCH

At its core, qualitative research can be described as an empirical inquiry into

meaning (Shank, 2002). Meaning is the key dynamic and the key area of concentra-
tion for all forms of qualitative research. There are a number of important things we
need to understand about meaning to grasp its role in qualitative research.

At its core, qualitative research can be described

as an empirical inquiry into meaning
(Shank, 2002). Meaning is the key dynamic
and the key area of concentration for all forms
of qualitative research.

䊏 The World Is Meaningful

Too often, we have been led to believe that meaning is something that we create to
understand the world and navigate within it. Although it is true that we can and do
craft meaning for these purposes, the concept of meaning goes far beyond the no-
tion of a psychological tool.

Assumptions About Meaning in Qualitative Research

䊏 Meaning seems to be part of the very fabric of reality.
䊏 Although meaning is often subtle and hidden, it is invariably present.
䊏 More often than not, we do not have to create or construct meaning; instead, we
need to be able to discern meaning.

These awarenesses lead to two very important “corrections” about meaning that
qualitative researchers often have to make in their research efforts. First, qualitative
CHAPTER TWENTY THREE Fundamentals of Qualitative Research 515

researchers have to abandon the notion that there is no meaning in situations un-
less we put that meaning there ourselves. Second, researchers have to challenge the
assumption that the world is relatively meaning poor.

䊏 Some Things Are Only Meaningful

Many times, the inquiry into meaning is the start of a path that leads to making and
testing truth claims. Hypotheses, for instance, are really nothing more than mean-
ing claims. At the same time, however, there are some things in the world that are
only meaningful. It does not matter if they are true or not. They point us toward a
deeper and richer understanding of the world as it really is.

EXAMPLE

Children’s Stories: A Way to Suggest Meaning

Think about the familiar bedtime story of the wolf and the three little pigs. Is this story true?
Was there really a wolf and were there really three little pigs? Can wolves and pigs talk, build
houses, and blow down buildings? At the level of truth, this story is nonsensical. At the level
of meaning, however, it teaches children important lessons from our culture.

䊏 Knowledge Depends on Understanding

The philosopher Peirce (1992, 1998) knew that meaning is not a game. Instead, we
are governed by a compulsion to know what things mean. The lack of this sort of
understanding is what Pierce called genuine doubt, a painful and unnerving state of
being. Based on Peirce’s suggestions, some generalizations about the relation be-
tween knowledge and meaning or understanding can be made.

Relation Between Knowledge and Understanding

䊏 Basic understanding is a standard on which knowledge can be efficiently built.
䊏 Unlike the common perception that knowledge drives understanding, it is actu-
ally the other way around.
䊏 Unless we already have some basic realm of understanding, then we do not
know where to even look for knowledge in the first place.
516 What Are the Fundamental Components of Appraisal and Research? PART THREE

HOW TO RECOGNIZE QUALITATIVE RESEARCH

Qualitative research is a markedly different approach to understanding than is

quantitative research. Over the years, the following criteria have been used to iden-
tify qualitative studies:

䊏 Qualitative research studies take place in natural settings.

䊏 Qualitative research seeks to understand things in a holistic manner.
䊏 Qualitative research often goes beyond merely studying things.

䊏 Natural Setting

Only by seeing things in the natural contexts can we really come to understand
their true natures and the impact they have on the world. Therefore qualitative
research recognizes the need to examine things ecologically—that is, in their natu-
ral settings. Also, whereas quantitative research seeks to generalize its effects, qual-
itative research considers it necessary to ground its findings in the context of
discovery.

䊏 Holistic Approach

Many forms of quantitative research employ the strategies of controlling and iso-
lating key aspects of the phenomenon under investigation. Qualitative research
takes a much different approach. In addition to studying a phenomenon in its natu-
ral environment, qualitative researchers resist the temptation to break down a phe-
nomenon into component parts and investigate how the various aspects of a phe-
nomenon work together in their natural settings.

EXAMPLE

Studying Context in Qualitative Research

Recent nutritional research seems to suggest that vitamin C works better when ingested in nat-
ural foods, like oranges, than it does when delivered as a supplement. What is it about foods,
such as oranges, that allow vitamin C to be more beneficial for us? Is it the case that the whole
is greater than the sum of the parts? Are there subtle dynamics and interactions that are lost
when the vitamin is produced in a lab and delivered in a pill?
Qualitative researchers in the social sciences are not so much interested in aspirins or vitamins,
but they study complex phenomena in complex settings every day. Preserving the ecological
nature of these phenomena within these settings is a key process in many qualitative research
efforts.
CHAPTER TWENTY THREE Fundamentals of Qualitative Research 517

䊏 Researcher Involvement

Separation is a basic activity within traditional quantitative research. Researchers

must learn to stand apart from those things that they study. They attempt to be as
objective as possible; they are there to discover, test, and report findings. How
they might feel about those tests or findings is not important. The research and
its findings need to stand on their own. Because of the holistic, contextual ap-
proach of qualitative research and because separation from the phenomenon be-
ing study is not valued in qualitative research as it is in quantitative research, the
role of the researcher is substantially different from that of the quantitative re-
searcher.

Role of the Qualitative Researcher

䊏 Qualitative researchers accept that their work often involves some degree of in-
volvement.
䊏 Researchers often find themselves to be participants in the research process itself,
engaging in routine activities with other participants or even acting as advocates
for others in the field.
䊏 Qualitative researchers are in the field to discover and illuminate our under-
standings, and sometimes that requires setting aside the “ideal” of separation
and jumping right into the mix.

BASIC TECHNIQUES OF QUALITATIVE RESEARCH

The most interesting thing about qualitative research is the fact that its basic tools
are nothing more than the ordinary skills we use every day to interact with our fel-
low human beings (Shank, 2006). In this way, qualitative research resembles coun-
seling to some degree. Like counseling, as well, these skills are refined and sharp-
ened when they are used to do actual research. In all, there are four basic human
skills that qualitative researchers identify and refine in their endeavors:

1. Observation.
2. Interviews.
3. Participation.
4. Interpretation.

䊏 Observation

Observation is one of the cornerstones to qualitative research. We are all born ob-
servers, but research observation is a particularly intense and demanding skill
518 What Are the Fundamental Components of Appraisal and Research? PART THREE

(Adler & Adler, 1994). Over the years, qualitative researchers have refined and re-
thought the dynamics of observation (Angrosino & de Perez, 2000).

EXAMPLE

Observation at Work
To help students learn the technique of observation, they can be asked to observe a quiet and
empty setting. The setting should be isolated, but safe, and one in which they can observe for
at least 30 minutes. Although newcomers to qualitative research and the technique of observa-
tion may be tempted to observe busy and interesting settings, the drawback is a feeling of be-
ing overwhelmed by the sheer volume of data. Therefore, it makes sense to keep things sim-
ple, at least at first. In fact, this is good advice for all qualitative researchers, as they begin the
observational process for any given project.

䊏 Interviews

Qualitative researchers talk and listen to people in the field. Proper interviewing
skills are difficult to learn. Too often, the novice interviewer employs ordinary con-
versational techniques, such as mutual disclosure, that actually can impede the
data gathering process. Fortunately, most counselors are well versed in interview
techniques via their therapeutic training and experience. Within the qualitative re-
search tradition, both Seidman (1991) and Kvale (1996) are excellent resources for
qualitative research interviewing techniques.

Variations in Interviewing Techniques

䊏 Informal conversational interview.
䊏 General interview guide approach.
䊏 Standardized open-ended interview.
䊏 Semistructured interview guide.

䊏 Participation

Observation, in its purest form, is the passive extreme of qualitative research. Its
counterpoint on the active side is participation. Participation can range from just
standing around to becoming an actual member and advocate of the community
under study. Most qualitative researchers opt for a middle position known as par-
ticipant observation (Bogdevic, 1999; Spradley, 1980).
CHAPTER TWENTY THREE Fundamentals of Qualitative Research 519

Participant observation: Individuals make it clear to the community that

they are researchers, but then try to partake, as much as possible and as much
as allowed, in the daily and ordinary activities within that community.

Whyte (1955) provided an early and very famous example of such participant ob-
servation when he managed to integrate himself within the everyday life of his tar-
get community.

Tips for conducting interviews and using direct observation tech-

niques can be found at the USAID Web site:
䉴 www.dec.org/partners/evalweb/resources/tipsseries.cfm

䊏 Interpretation

Interpretation in qualitative research is a rich and complex area. Qualitative re-

searchers need to learn the ins and outs, the fine details, and the subtle touches of
the art of interpretation.

Aspects of Interpretation in Qualitative Research

䊏 All interpretation starts with careful observation and a particular form of de-
scription known as thick description, which was first defined and employed by
Geertz (1973).
䊏 To help understand data and findings, researchers use an interpretive frame-
work that very often is grounded in such systems of thought as feminism, race
theory, economic theory, and the like; collectively, these theories are known as
critical theories (Geuss, 1981).
䊏 In addition to critical theories, a number of other interpretive frameworks that
often are used to incorporate and understand qualitative data include phenom-
enology (see, e.g., Moustakas, 1994) and semiotics, which is grounded in looking
for codes and patterns of meaning (see, e.g., Eco, 1990).
䊏 Interpretation involves the reporting and “telling” of the findings and results of
any qualitative study (see Van Maanen, 1988, for valuable guides on conceptual-
izing the task of writing up these “tales from the field”).

For more on the role of semiotics in qualitative research, see an arti-

cle written by Shank (1995):
䉴 http://www.nova.edu/ssss/QR/QR2-3/shank.html
520 What Are the Fundamental Components of Appraisal and Research? PART THREE

BASIC PRODUCTS OF QUALITATIVE RESEARCH

There are many different types of products that qualitative researchers generate as
they do their research. Four of the key types of products that might have broad ap-
peal and utility for counselors doing research are described next.

䊏 Ethnography

Spradley (1979, 1980) is perhaps the best guide for traditional ethnographic tech-
nique. His reflections on interviewing and participant observation are still fresh
and useful. In general, though, traditional ethnography can be characterized as
having had very few rules.

Aspects of Traditional Ethnography

䊏 The ethnographer was literally deposited into a culture with very little training
in the ways and means of that culture.
䊏 The ethnographer often did not speak the language of the people.
䊏 The ethnographer had no training in ethnographic technique.
䊏 Observation typically lasted for a year, and another year was used to gather, sort,
and report the resulting data.

The lack of cultural training and preparation prevented the ethnographer from
making presuppositions about the group of interest, thus allowing the ethnogra-
pher to view the setting with fresh eyes and ears. Also, because the ethnographer
had no formal training in research technique, he or she came into the setting with a
heightened sense of awareness. Finally, because the researcher did not know what
was important beforehand, everything was potentially important.
For a variety of reasons, the scope and nature of ethnography has changed over
the years (LeCompte, 2002). Four of the most important directions of change in eth-
nography are identified here.

Changes in Ethnographic Research

1. Whereas traditional ethnographic accounts are very objective in nature and
even a bit dry, an expansion and experimentation with ethnographic writing
style has resulted in writing that has become more literary in nature (Clifford &
Marcus, 1986, were important early trendsetters).
2. Ethnography has moved from the exploration of exotic, isolated locales to the
exploration of everyday settings (Pratt, 1986), which are a rich source of
ethnographic exploration and complement the new forms of writing.
3. Given the proliferation of chat rooms, blogs, and other communicative com-
munities online, ethnographic efforts are being extended to the Internet as an
exciting site for ethnographic exploration (see Eichhorn, 2001, and Gatson &
CHAPTER TWENTY THREE Fundamentals of Qualitative Research 521

Zweerink, 2002, for a discussion about the techniques and implications of on-
line research).
4. Through the approach of autoethnography, researchers are beginning to turn
the ethnographic lens on themselves, combining ethnographic precision with
reflexive autobiographical insights to yield a rich picture (see, e.g., Ellis &
Bochner, 2000).

䊏 Case Study

The case study is at the heart of many qualitative research projects. In its simplest
form, the case study is an examination of a single person in a natural setting, or a
single setting in terms of its basic interpersonal dynamics. There are a variety of
manifestations and permutations on this basic model. Five of the most popular and
useful varieties are presented.

Clinical Case Study

䊏 The first case studies in the social sciences were performed as clinical exercises
within the medical and mental health fields and, to this day, comprise an impor-
tant dimension of medical and mental health inquiry.
䊏 The clinical case study is almost always a detailed report on some puzzling or in-
tractable patient or situation.
䊏 Sacks (1990) is a popular and highly readable example of this form of case study.

Case Study Proper

䊏 The case study proper is the most common form found in qualitative research.
䊏 One person or a small group of people are selected carefully to explore or illus-
trate some specific point or issue.
䊏 The goal of the case study is depth, not breadth.
䊏 Stake (1995) and Merriam (1998) are two of the best introductions to the art and
science of conducting case studies in qualitative research.

Extended Case Study

䊏 The extended case study is preferred over the ordinary case study to deal with
particularly complex issues.
䊏 The extended case study has a much wider scope than the case study proper,
both in terms of participants and in terms of time and effort.
䊏 Heath (1983) is probably the most familiar example of an extended case study in
the qualitative research literature.
522 What Are the Fundamental Components of Appraisal and Research? PART THREE

Portraiture
䊏 Portraiture is intended not only to gather information and insights about the per-
sons involved, but also to give a picture of who they are (Lawrence-Lightfoot &
Davis, 1997).
䊏 Portraiture is very useful when we seek to understand the people involved as liv-
ing and breathing persons.
䊏 The use of biographical detail, and the artistic use of words and images, com-
bines to yield a rich picture of the topic in question.
䊏 Portraiture is the best resource when it is hard to separate the people from what
they do.

Focus Group
䊏 A focus group consists of a group of individuals (usually 4–8 in number) who
meet together with a moderator to answer questions and discuss a given topic.
䊏 Focus groups were first modeled after group therapy when therapists realized that
a group of clients might address a topic in greater depth than any given individual.
䊏 This propensity for depth via group participation is at the heart of the concept of
focus groups.
䊏 The use of focus groups is evolving to include computer-mediated and online
settings (Franklin & Lowry, 2001).
䊏 Morgan (1998) has been one of the pioneers in the use of focus groups in qualita-
tive research, and his work is an excellent starting place.

Each of these five case study products provides context-rich information about a
person, group of persons, or setting. Consider the example of Heath’s (1983) re-
search in which an extended case study was chosen over the case study proper to
deal with the complex issues related to race, communication patterns, and chil-
dren’s behavioral problems.

EXAMPLE

Extended Case Study

In her study, Heath (1983) was concerned about the inability of White teachers and minority
children to interact properly in a rural Southern town. The children were passively aggressive
and uncommunicative. To get to the root of the problem, Heath launched an in-depth study.
She spent time within the minority community, learning and understanding communication
patterns. As a result, she found that White teachers and minority students were operating un-
der two independent and conflicting communication models. In fact, the children were trying
their hardest to be respectful and polite with teachers who were unintentionally insulting their
intelligence and abilities. These findings would not have been found had the case study not
become as extensive as it was.
CHAPTER TWENTY THREE Fundamentals of Qualitative Research 523

For tips on running focus groups, look for the link from the USAID
Web site:
䉴 www.dec.org/partners/evalweb/resources/tipsseries.cfm

䊏 Grounded Theory

Grounded theory is perhaps the most technical form of qualitative research. In its
original form (Glaser & Strauss, 1967), grounded theory was designed as a way to
generate theory from the bottom up, so to speak. A number of steps highlight the
process of grounded theory research.

Process of Conducting Grounded Theory

1. Set aside any assumptions or presuppositions about the area of study.
2. Collect observational data.
3. Compare data as they begin to accumulate and as the rudiments of a concep-
tual framework began to take shape.
4. Place new data where theoretically appropriate.
5. Stop creating or modifying conceptual categories when it becomes apparent
that all new data can be easily placed and saturation has been reached.
6. Articulate the theory in its final form.

Grounded theory has continued to evolve and develop as a method (see Charmaz,
2000, for a general discussion on this matter). At the same time, there has been a
parting of ways between the original two founders of the method. Characteristics
of the Glaser and Strauss approaches are described next.

The Glaser Approach (Glaser, 1978)

䊏 Glaser created a theoretical and more flexible approach to grounded theory.
䊏 Grounded theory was a skill that a person developed over long years of practice,
and the acquisition of said skills and insights could not be rushed or encapsu-
lated in any sort of algorithmic manner.
䊏 Glaser emphasized the art of grounded theory.

The Strauss Approach (Strauss, 1995)

䊏 Strauss (1995) was concerned with the development of grounded theory as a
practical tool.
524 What Are the Fundamental Components of Appraisal and Research? PART THREE

䊏 Along with Corbin (Strauss & Corbin, 1998), Strauss created a handbook of clear
and precise steps that the grounded theory researcher could follow.
䊏 Although this approach has been attacked as being too mechanical, it nonethe-
less has served as the basis for an enormous amount of work in grounded theory.

䊏 Material Analysis

Qualitative researchers do not get their data just from interviews and observations.
Sometimes, they study the material products that people and cultures create. Mate-
rial sources can be classified as formal or informal. Formal sources tend to be ar-
chived and usually are official documents. Informal sources typically come from
the wealth and depth of documents and artifacts that make up popular culture.
Some of the possibilities are listed here.

Formal Sources of Qualitative Data

䊏 Birth announcements.
䊏 Death announcements.
䊏 Marriage licenses.
䊏 Real estate transactions.
䊏 Court proceedings.

Informal Sources of Qualitative Data

䊏 TV.
䊏 Comic books.
䊏 Movie posters.
䊏 Blogs.

Hill (1993) is an excellent starting place for qualitative researchers interested in ac-
cessing and using archival data in their work, and Hodder (2000) is a good intro-
duction to the exploration and study of our reservoir of material culture.

THE ROLE AND FUTURE OF QUALITATIVE

RESEARCH IN COUNSELING

The role and future of qualitative research ultimately must be decided by counsel-
ing researchers. It is up to these researchers to examine the field and apply these
methods to their areas of concern and questions of interest. In the meantime, how-
ever, here are three thoughts on how the discipline of counseling and qualitative re-
search will continue to be intertwined.
CHAPTER TWENTY THREE Fundamentals of Qualitative Research 525

䊏 Qualitative Research Tackles Complex Questions and Issues

Counselors deal with human beings, and human beings are complex creatures.
Therefore, it makes sense that research in counseling might often lean in the direc-
tion of exploring issues in depth. The ability to conduct research at such depth is
one of the main strengths of qualitative research.

䊏 Counselors and Qualitative Researchers Share Similarities

Counseling, as a field, has always been concerned with issues of meaning. There-
fore, it seems natural that a mode of inquiry that foregrounds meaning is a natural
fit with counselors seeking to do research.

䊏 Qualitative Research Provides Possibility and Freedom

Traditional research in the social sciences has been concerned with finding and iso-
lating the effects of characteristics that can be applied to a broad spectrum of per-
sons. Although this endeavor is certainly valuable, it does not address all research
needs in a field as rich and complex as counseling. Counselor researchers need to
be able to tackle not only the typical, but also the possible. They need to be able to
look at individuals as individuals and study them in real depth. It is this ability to
seek and use depth that makes qualitative research methods so potentially valu-
able to counselor researchers.

Chapter 23: Key Term

䉴 Participant observation
䉴 Ethnography
䉴 Qualitative research
 part four

What Are the Special Topics

and Important Trends
That Counselors Might Encounter?
 chapter A Look at Consultation

24 Jocelyn Gregoire
Leslie Slagel
Duquesne University

In This Chapter

䉴 Historical Evolution of Consultation 䊏 Psychodynamic Orientation of Mental

䊏 Clinical or Expert Approach Health Counseling
䊏 Organizational Consultation 䊏 Types of Mental Health Consultation
䊏 Client-Centered Consultation

䊏 Total Quality Management Approach 䉴 Behavioral Consultation

䊏 Social Work Perspective 䊏 Definition of Behavioral Consultation
䊏 Definition of Consultation 䊏 Characteristics of Behavioral Consultation

䊏 The Counselor as Consultant 䊏 Bergan and Kratochwill’s Model of Behav-

䊏 Stages in Consultation ioral Consultation

䉴 Theories of Consultation 䉴 Organizational Consultation

䊏 Person-Centered Theory of Consultation 䊏 Definition of Organizational Consultation
䊏 Learning Theory of Consultation 䊏 Use of Systems Theory

䊏 Gestalt Theory of Consultation 䊏 Diagnosing Organizational Problems

䊏 Psychoanalytic Theory of Consultation 䊏 Content and Process Consultation

䊏 Chaos Theory of Consultation 䊏 Organizational Paradigm

䊏 Paradigm Shift

䉴 The Consultation Relationship

䊏 Consultant-Centered Orientation 䉴 School-Based Consultation
䊏 System-Centered Orientation 䊏 Collaboration
䊏 Types of School Consultation

䉴 Mental Health Consultation 䊏 Theoretical Approach to School Consulta-

䊏 Definition of Mental Health Consultation tion

䊏 Basic Characteristics of Mental Health

Consultation 䉴 Chapter Summary

528
CHAPTER TWENTY FOUR A Look at Consultation 529

HISTORICAL EVOLUTION OF CONSULTATION

At its beginnings in the 1940s, consultation was a direct helping approach that oc-
curred within the dyadic consultant–consultee relationship. Although the aim of
consultation remains the same today, the process has evolved to include a triadic
interaction among the consultant, consultee, and client or client system. Recent
trends in consultation reflect the transformation of the practice. The systemic per-
spective, for example, assumes that the consultant must examine the interrelations
among all components of the client system, make suggestions for change, and as-
sist the consultee in viewing the system contextually to solidify interventions for
change. Our aims in this chapter are to provide a short historical review of the de-
velopment of consultation, address the consultation relationship, and discuss ma-
jor theories and models of consultation.

䊏 Clinical or Expert Approach

Some scholars trace the emergence of consultation to the period between 1940
and 1950 (Kurpius & Robinson, 1978), others, however, locate its earliest begin-
nings in the 13th-century doctor–patient relationship (Gallessich, 1982). This
early model of consultation, which has been widely practiced in the medical
community from the mid-19th century to the present, is characterized by a hier-
archical relationship in which the consultant controls the intervention by manag-
ing the nature of the interview and systematically reinforcing behaviors that sup-
port his or her goals (Brown, Pryzwansky, & Schulte, 2006). However, the advent
of newer approaches to consultation, coupled with the aversion of many profes-
sionals toward the authoritarian philosophy germane to this model, gradually
brought about a decline in the popularity of the clinical-expert approach (Schulte
& Osborne, 2003).

䊏 Organizational Consultation

Representing an evolution of consultation from a dyadic to a triadic process, the or-

ganizational model can be linked to Lewin’s (1951) field theory and to the system
theory of Bertalanffy (1968). In the organizational model, the consultation process
rests on the humanistic assumption that to achieve success, a relationship must
promote coequality during the change process (Brown et al., 2006).

䊏 Client-Centered Consultation

In his book The Theory and Practice of Mental Health Consultation, which now has be-
come a classic in the field of consultation, Caplan (1970) coined the term client-cen-
tered consultation. He believed that the consultant–consultee relationship should be
530 Special Topics and Important Trends That Counselors Might Encounter PART FOUR

nonhierarchical and coequal in nature. However, Caplan did not totally distance
himself from the authoritarian model because of his belief that, at times, consul-
tants might have to bypass consultees’ wishes to make sure that the consultant’s
views are reflected in the intervention (Schulte & Osborne, 2003).

䊏 Total Quality Management Approach

Championed by Deming (1993), the total quality management approach has tre-
mendously influenced management and leadership theory, as well as ideas about
organizational business and education. This approach rests on four basic princi-
ples.

Principles of Total Quality Management Consultation

1. Setting long-term goals.
2. Eliminating fear, jealousy, revenge, and anger from management and the
change process.
3. Eliminating practices that hinder self-confidence.
4. Promoting every chance that will enhance people’s pride in their work and the
improvements that take place.

䊏 Social Work Perspective

Social work is another tradition that has had an impact on the evolution of consul-
tation. One of the unique contributions that social work has offered is a systemic,
collaborative perspective to the practice of consultation. Working from this per-
spective, Homan (2004) suggested that situations of interest are examined within a
larger context, and it is through collaborative interventions that consultation takes
shape and instigates needed changes. Similar views also have been expressed by
Steffy and Lindle (1994), who emphasized the importance of a systemic approach
involving the community.

䊏 Definition of Consultation

As the brief historical review has shown, the notion of consultation differs accord-
ing to the perspective from which it is viewed. Moreover, among the body of litera-
ture addressing consultation, an authoritative definition of the practice of consulta-
tion is lacking (Kurpius & Robinson, 1978). Most definitions of consultation,
however, generally concur that (a) the goal of consultation is to solve problems; (b)
consultation is tripartite in nature; (c) consultation involves a consultant, a
consultee, and a client system; and (d) consultation is aimed at improving both the
CHAPTER TWENTY FOUR A Look at Consultation 531

client system and the consultee. Dougherty (2005) expressed this concise, widely
accepted definition of consultation:

Consultation: “[A] process in which a human service professional assists a

consultee with a work-related (or caretaking-related) problem with a client
system, with the goal of helping both the consultee and the client system in
some specified way” (p. 11).

䊏 The Counselor as Consultant

Due to their professional responsibilities, counselors provide an array of counsel-

ing services (Randolph & Graun, 1988). However, it was not until the late 1960s and
early 1970s that textbooks and journal articles began to foster the notion of consul-
tation activities as a function of counselors’ work-related activities (Caplan, 1970;
Dinkmeyer, 1973; Faust, 1968). In 1973, Congress passed the Community Mental
Center Act, which encouraged helping professionals gradually to substitute their
approach from individual and small group remediation activity to the adoption of
a more developmental and preventive one (Jackson & Hayes, 1993).

䊏 Stages in Consultation

Literature about consultation commonly portrays it as a problem-solving process

that involves a series of stages (Bergan & Kratochwill, 1990; Hansen, Himes, &
Meier, 1990, Kurpius, 1978). Brown et al. (2006) proposed an eight-stage process
that includes the following steps.

Brown et al.’s Stages of Consultation

1. Entry into the organization.
2. Initiation of the consultation relationship.
3. Assessment.
4. Problem definition and goal setting.
5. Strategy selection.
6. Strategy implementation.
7. Evaluation.
8. Termination.

Block (1981) presented five phases of the consultation process. These are described
briefly here.
532 Special Topics and Important Trends That Counselors Might Encounter PART FOUR

Block’s Five Phases of the Consultation Process

1. Entry and contracting includes an initial contact between the consultant and cli-
ent when the consultant’s skills are assessed, goals are set, the client’s strengths
are evaluated, and areas of improvement are identified.
2. Data collection and diagnosis occurs when the consultant attempts to make sense
of the problems and determines who will be participating in this phase of the
project, what information is vital, and how information will be collected.
3. Feedback and decision to act refers to the period when the consultant pays close
attention to the concerns and feedback of the consultee and mutually agrees on
the areas of change.
4. Implementation occurs when the consultant proceeds with the appropriate in-
tervention model that will foster change in the mutually agreed areas.
5. Extension, recycle, or termination follows the initial implementation of the inter-
vention, and a reevaluation is done to assess its effectiveness. The results will
determine whether a new contract should be discussed or appropriate steps to-
ward termination should be initiated.

Block’s model is one conceptualization of the stages of consultation. In an effort to

explain how a consultant enters a system, facilitates change, and leaves, Kurpius,
Fuqua, and Rozecki (1993) proposed another six-stage model of the consultation
process.

Kurpius et al.’s Stages of Consultation

1. Preentry is the first stage during which the consultant conceptualizes and artic-
ulates to self and to others what he or she has been asked to do.
2. Entry, problem exploration, and contracting takes place when the consultant
makes contact with the consulting system, explores the problem, and defines
the contract between the consultant and the consulting system.
3. Information gathering, problem confirmation, and goal setting is the period during
which the consultant collects reliable and valid data that are analyzed, synthe-
sized, and interpreted to be able to confirm, deny, or revise the initial identifica-
tion of the problem. Outcomes of this stage allow the consultant to set achiev-
able goals for the organization and to begin to examine methods for change.
4. Solution searching and intervention selection refers to the period when the consul-
tant begins to determine strategies that will push the system to make deep
changes and prevent future problems.
5. Evaluation allows the consultant to know what worked, what did not work,
and what his or her strengths and weaknesses are. Evaluation can be
summative (e.g., statistical analysis of the behaviors that were to be changed),
formative (e.g., ongoing evaluations by the members involved in the consulta-
tion process as it is happening), or both.
6. Termination occurs when the consultation relationship comes to an end either
because success is pending or because the goals were not met. In either case,
the ending of any relationship involves loss, and individuals should be given
the opportunity to share feelings about ending the consulting relationship.
CHAPTER TWENTY FOUR A Look at Consultation 533

THEORIES OF CONSULTATION

Theories of consultation provide a conceptual framework from which the consul-

tant practices. They vary depending on whether the emphasis is on the types of
interventions; the organizational context; the needs of the client; the relationship
among the consultant, consultee, and client; and the attribution of the solution or
problem. Over the past 60 years, not only has the consultative process evolved,
but the theoretical underpinnings of the practice have been developed, re-
searched, and tested. In this section we look at five theoretical approaches to con-
sultation:

䊏 Person-centered theory.
䊏 Learning theory.
䊏 Gestalt theory.
䊏 Psychoanalytic theory.
䊏 Chaos theory.

䊏 Person-Centered Theory of Consultation

The purpose of person-centered theory is to facilitate the change process in a

nondirective fashion while implementing the core conditions of empathy, genuine-
ness, and positive regard. Interventions include running groups whose aim is to
encourage individuals to more effectively hear one another’s points of view and an
underlying belief of this approach is that the natural process of the group will assist
the system in healing itself.

䊏 Learning Theory of Consultation

Learning-oriented consultation is grounded in behavioral, cognitive-behavioral,

and social learning theories. Consultants may be oriented toward one learning the-
ory more than another, which affects conceptualization of the problem and inter-
vention. Behaviorally oriented learning consultants focus on concretely defining
the problem and developing specific strategies to reduce incidence of the problem,
whereas cognitively oriented consultants look for problematic beliefs that can be
addressed through reeducation, self-observation, and cognitive restructuring. So-
cial learning consultants define the consultee’s issues in terms of behavioral, inter-
personal, and environmental factors and then identify resources that consultees
can use to manage future problems. Basic counseling skills are crucial to the begin-
ning of the process. Resistance by the consultee is believed to be a natural part of
the process and may require the consultant to adjust the goals to better meet the
consultee’s needs.
534 Special Topics and Important Trends That Counselors Might Encounter PART FOUR

䊏 Gestalt Theory of Consultation

The main goal of the Gestalt theory of consultation is to enhance the experience
of the consultee and others involved in the consultative process in an effort to de-
crease defenses and reduce neurotic behaviors. Introducing the consultant into
the system disrupts established boundaries and is, in itself, transformative. The
consultant enters the system to encourage the expression of feelings and the loos-
ening of boundaries in an effort to promote increased awareness and true en-
counter with self and others. The consultant is responsible for helping the
consultee embrace fears present in various aspects of the experience. Termination
is a naturally occurring process that begins when fears subside, awareness is in-
creased, and resistance to the initial problem has been transformed into positive
solutions.

䊏 Psychoanalytic Theory of Consultation

Implicit and unconscious aspects of a client or client system’s behavior support

manifest problems. Confrontation is not believed to be the most effective method
of intervention because consultees may not be aware of the unconscious roots of
the problem. The main goal of the psychoanalytic approach is to make sense of
the unconscious processes that underlie the problems. Exposing unconscious
processes may be accomplished through direct or triadic interventions. Direct in-
terventions involve the consultant giving feedback to an individual or a group as
a whole; triadic interventions imply that members of the system interact with
one another as well as the consultant about the problem. Problems are seen as the
projections of the individual’s unconscious processes. Resistance is an important
defense that protects the individual or the system from unnecessary stress. Ter-
mination occurs when the consultant is assured that the changes made to the sys-
tem are stable.

䊏 Chaos Theory of Consultation

Chaos theory is based on the belief that the world is largely unpredictable; error in
systems is perhaps the only predictable component. Understanding the sys-
tem-specific chaos as it exists at all levels is the first task of the consultant. Chaotic
variables present at one level may directly affect variables at another level of the
system. Consultants help consultees expect and value change. A primary goal of
consultation within the chaos theory approach is helping consultees use the unpre-
dictable nature of the system to risk new approaches to solutions. Termination oc-
curs when consultees can consistently develop positive ways of dealing with chaos
rather than resisting it.
CHAPTER TWENTY FOUR A Look at Consultation 535

THE CONSULTATION RELATIONSHIP

Styles of consultation refer to the ways the consultant operates in the consulting re-
lationship. Depending on his or her style, the consultant may choose either a con-
sultant-centered orientation or a system-centered orientation to enter into the con-
sultation process (Neukrug, 2003).

䊏 Consultant-Centered Orientation

In this orientation, the emphasis is on the consultant offering suggestions and ad-
vice for system change. Thus, the consultant is identified by the following charac-
teristics.

Roles of the Consultant in the Consultant-Centered Orientation

䊏 Expert consultant takes the responsibility to come into the system for the purpose
of finding a cure (Schein, 1969).
䊏 Prescriptive consultant gathers relevant data, makes a diagnosis of the problem,
and proposes solutions to the consultee (Kurpius, 1978).
䊏 Trainer or educator teaches or trains the staff of the system into which he or she has
been hired.

䊏 System-Centered Orientation

In the system-centered orientation, the consultant assists others to use their re-
sources for system change. The following characteristics can be observed in consul-
tants who espouse this orientation.

Roles of the Consultant in the System-Centered Orientation

䊏 Consultant as negotiator facilitates communication and understanding among in-
dividuals within the system and helps them resolve conflicts among themselves.
䊏 Consultant as collaborator uses his or her expertise and, relying on the individuals
in the system, works collaboratively with the consultee to offer input into the
problems and solutions to facilitate the change process (Kurpius, 1978).
䊏 Process-oriented consultant functions on the convictions that he or she is not in
possession of all the answers, and that at times it is necessary to withhold exper-
tise so that the consultees’ self-esteem and developed sense of ownership of the
problem can help individuals in the system find their own solution (Schein,
1969).
536 Special Topics and Important Trends That Counselors Might Encounter PART FOUR

For more information on the consultative relationship, refer to the

Journal of Educational and Psychological Consultation at
䉴 http://www.leaonline.com/loi/jepc

MENTAL HEALTH CONSULTATION

There are four major models of consultation (i.e., mental health consultation, be-
havioral consultation, organizational consultation, and school consultation), and
among them, mental health consultation is one of the most popular models of con-
sultation. This model, which is also known as psychological consultation, attempts
to promote the mental health of the community through consultants in a preventa-
tive way (Dougherty, 1990). Rooted in psychiatry, the most influential figure in the
field of psychological consultation has been Caplan, whose ideas are still pervasive
and reflect an environmental and psychodynamic perspective (Brown et al., 2006).
Main goals of a mental health model of consultation are to focus on the perfor-
mance of the client and to expand consultees’ knowledge, skill, and objectivity as
related to the remediation and prevention of the problem at hand (Gelso & Fretz,
2001).

䊏 Definition of Mental Health Consultation

According to Caplan (1970), mental health consultation can be defined this way:

Mental health consultation: “[A] process of interaction between two profes-

sional persons—the consultant, who is a specialist, and the consultee, who in-
vokes the consultant’s help in regard to a current work problem with which
he is having some difficulty and which he has decided is within the other’s
area of specialized competence” (p. 19).

䊏 Basic Characteristics of Mental Health Consultation

Mental health consultation occurs among professionals to assist in the mental

health aspects of work-related problems that concern a client or an organization.
According to Caplan, there are some basic characteristics inherent to mental health
consultation, some of which are listed here (Dougherty, 2005).
CHAPTER TWENTY FOUR A Look at Consultation 537

Characteristics of the Mental Health Consultation Relationship

䊏 Two professionals enter into a consultative relationship to deal with a men-
tal-health-related problem of a lay client or a program for such clients.
䊏 The basic relationship between the two professionals is collaborative, non-
authoritarian, and nonhierarchical.
䊏 Personal and private material is not permitted in the consultation relationship.

Characteristics of the Mental Health Consultation Process

䊏 Consultation usually is arranged in a series of two or three sessions; dependence
is not fostered with continuing contact beyond the current concern.
䊏 Consultation is expected to continue indefinitely as the consultees become more
competent and sophisticated.
䊏 The twin goals of consultation are to help consultees handle the current work dif-
ficulty and prepare them to master similar, potential problems.
䊏 Successful consultation may have a therapeutic effect by increasing consultees’
feelings of self-worth because of successful job performance.
䊏 Consultation does not require that the consultant have specialized knowledge
about the topic for which the consultee needs help.

In the collaborative, nonhierarchical approach espoused by the mental health con-

sultation approach, there are a number of implications for both the consultee and
the consultant. A few of these are mentioned next.

Responsibilities of the Consultee in Mental Health Consultation

䊏 Define the work problem as being mental-health-related.
䊏 Accept or reject the consultant’s ideas or suggestions.

Responsibilities of the Consultant in Mental Health Consultation

䊏 Accepts neither professional nor administrative responsibility for the consultee’s
work or for the outcome of the client’s case.
䊏 Does not enter the consultation process with predetermined body of information
that he or she intends to impart to a particular consultee.
䊏 Discusses personal problems only as they relate to the client’s case and work set-
ting.
䊏 Reverts to the role of psychiatrist, psychologist, or social worker and gives ad-
vice or takes action when consultee’s actions are endangering the welfare of the
client.
538 Special Topics and Important Trends That Counselors Might Encounter PART FOUR

䊏 Psychodynamic Orientation of Mental Health Counseling

Based on the belief that behavior is a product of unconscious motivation and that
most childhood experiences create issues that result in inner conflicts that affect be-
havior, Caplan assumed a psychodynamic orientation for his mental health model
of consultation. The consultant is expected to use an indirect approach to deal with
these issues. Transfer of effect and one-downmanship are key terms pertaining to
the psychodynamic orientation and are defined as follows (Dougherty, 2005):

Transfer of effect: What is learned in one situation should be transferred and

used in future similar situations.

One-downmanship: The relationship between the consultant and the con-

sultee is one of equals or peers.

䊏 Types of Mental Health Consultation

Caplan (1970) identified four categories of consultation utilized in mental health

settings: client-centered case consultation, consultee-centered case consultation,
program-centered administrative consultation, and consultee-centered adminis-
trative consultation (Mendoza, 1993). The focus, the identifiable goals, and the
roles and responsibilities of the consultant of each type are listed next.

Client-Centered Case Consultation

䊏 The focus is on developing plans and strategies that will help a specific client.
䊏 The primary goal is to help solve the client’s difficulties and subsequently to help
the consultee gain skills to handle similar future cases.
䊏 The consultee experiences the consultant as a coequal peer and collaborator and
is free to accept, adapt, or reject the consultant’s recommendations.
䊏 The consultant is viewed as a responsible expert to assess and diagnose the prob-
lems and prescribe a course of actions for the consultee’s client.

Consultee-Centered Case Consultation

䊏 The focus is on specific attributes of the consultee, such as lack of knowledge,
lack of skill, lack of confidence, and lack of objectivity that are hindering his or
her functioning with the client (Brown et al., 2006; Dougherty 2005).
䊏 The primary goal is to help the consultee remediate weaknesses in his or her per-
formance that are contributing to the difficulties with the client.
䊏 The consultee is responsible for the case while seeking to improve and enrich his
or her understanding and emotional mastery of the case.
䊏 The consultant plays the role of an expert detective who, through active listen-
ing, investigates the cognitive and emotional problem of the consultee, and who
CHAPTER TWENTY FOUR A Look at Consultation 539

also educates and trains the consultee on how to solve current and future similar
problems (Dougherty, 2005).

Program-Centered Administrative Consultation

䊏 The focus is on helping the consultee deal with a current problem of program
development or organizational functioning.
䊏 The goal is to facilitate the creation of new programs or policies that will improve
on the existing ones.
䊏 The consultee initiates the consultation process and is the primary person to
whom the consultant provides recommendations and submits the written re-
port.
䊏 The consultant acts as a data collector and an action planner who provides rec-
ommendations to the organization in the form of a written report.

Consultee-Centered Administration Consultation

䊏 The focus is on improving the professional performance of the organization’s ad-
ministrative staff as it relates to a specific program or policy.
䊏 The goal is to help the administration develop professional competency and
problem-solving skills that will enable it to deal with current difficulties in orga-
nizational planning, program development, management, and policy imple-
mentation.
䊏 The consultee, or the administrator who hired the consultant, receives the recom-
mendations of the consultant and applies, alters, or implements them as they fit.
䊏 The consultant enters the organization; promotes relationship building; exam-
ines the social climate of the institution; develops an intervention for individu-
als, groups, or the entire organization; and assesses the outcomes (Dougherty,
2005).

Check out this site for a Microsoft PowerPoint presentation on men-

tal health consultation, theory, cases, and ethics:
䉴 http://edtech.tennessee.edu/itc/grants/twt2000/modules/wconwill/
mental_health.ppt

BEHAVIORAL CONSULTATION

Behavioral consultation was founded on social learning theory and focuses on the
overt behaviors of the consultee and the client (Parsons & Kahn, 2005). The primary
540 Special Topics and Important Trends That Counselors Might Encounter PART FOUR

focus of behavioral consultation is to change specific behaviors in clients or client

systems and consultees. The method involves clearly defined steps geared toward
problem identification, analysis, plan implementation, and plan evaluation
(Brigman, Mullis, Webb, & White, 2005). The goals of consultation may include but
are not limited to the following.

Goals of Behavioral Consultation

䊏 Enhance the consultee’s professional functioning.
䊏 Help the consultee make positive changes in the client’s environment.
䊏 Change the environment to promote behavioral changes (Conoley & Conoley,
1992).

䊏 Definition of Behavioral Consultation

Combining ideas from Keller (1981), Dougherty (2005) offered the following defini-
tion of behavioral consultation:

Behavioral consultation: “[A] relationship whereby services consistent with

a behavioral orientation are provided either indirectly to a client or a system
(through the mediation of important others in the client’s environment or of
those charged with the system’s well-being) or directly by training consultees
to enhance their skills with clients or systems” (p. 222).

䊏 Characteristics of Behavioral Consultation

Broadly speaking, behavioral consultation is a problem-solving process grounded

in the scientific view of human behavior that integrates philosophies of behavioral
psychology and learning theories. Although approaches to behavioral consultation
vary according to the consultant’s preferences (Wallace & Hall, 1996), there are
some basic tenets that characterize this model of consultation. The following list
identifies those key tenets (Harrison, 2004).

Tenets of Behavioral Consultation Interventions

䊏 They are indirect services specially geared toward cases and clients even when
they take place in organizational settings.
䊏 They are most often used to solve problems as well as improve competency in
the consultee.
䊏 Interventions are aimed at altering the client’s or the consultee’s behaviors and
bringing about changes in organizations.
䊏 The length of the consulting relationship varies from minutes to months.
CHAPTER TWENTY FOUR A Look at Consultation 541

䊏 The consultant–consultee relationship ranges from collegial to hierarchical, with

the consultant having some control in the relationship.
䊏 The consultant should have a degree of expert knowledge in learning principles,
social learning theory, and behavioral technology to design, implement, and as-
sess interventions.
䊏 The consultant’s major role ranges from a facilitator to an expert who imparts
psychological information and principles to consultees.
䊏 Primary tasks of the consultant include helping the consultee problem solve and
enhancing the probability that the consultee will accept the consultant’s recom-
mendations.
䊏 The client and the consultee goals need to be defined in behavioral terms.
䊏 Most approaches emphasize direct observation techniques and focus on present
influences on overt behavior.
䊏 Interventions and evaluations lend themselves to empirical testing.

䊏 Bergan and Kratochwill’s Model of Behavioral Consultation

Bergan (1977) developed the behavioral consultation model that was later revised
and extended by Bergan and Kratochwill (1990). They observed that three elements
interact with each other during the consultation process: the consultant’s role, the
consultee’s role, and the client’s role.

The Consultant’s Role

䊏 Assess the client’s problematic behavior and its effects.
䊏 Set up and help clients walk through the various stages of the consultation pro-
cess.
䊏 Develop intervention strategies and make sure that they are implemented.
䊏 Use the authority of an expert to encourage the consultee to comply with the
goals of the consultation.

The Consultee’s Role

䊏 Explain the client’s problem that demands the consultation request.
䊏 Judge the legitimacy of suggested behavioral plans and assess their value.
䊏 Evaluate the client’s behavior or performance and execute behavioral plans de-
signed to positively alter behavior.
䊏 Monitor the client’s behavioral changes following consultation.

The Client’s Role

䊏 Cooperate and commit to the goals of the consultation.
䊏 Receive and respond to the behavioral conditions set up through the consulta-
tion process.
542 Special Topics and Important Trends That Counselors Might Encounter PART FOUR

Bergan’s problem-solving consultation model proceeds through a series of four

major stages that provide the framework and orientation for the consultation pro-
cess. Each of these stages has its own specific objectives and tasks. The stages are
the problem identification stage, the problem analysis stage, the plan implementa-
tion stage, and the problem evaluation stage (Bergan, 1977).

For more information on behavioral consultation, visit the Web site of

the International Journal of Behavioral Consultation and Therapy at
䉴 http://www.ijbct.com/

ORGANIZATIONAL CONSULTATION

An organization is constituted when a group of people decide to work together to

achieve a common goal (Hanna, 1988). There are various forces, both internal and
external, that are at work in every organization to influence its growth. Conse-
quently, most organizations are involved in an endless process of adaptation, prob-
lem solving, and planning that compels them to constantly seek the expertise of or-
ganizational consultants who embrace a variety of discipline and approaches.

䊏 Definition of Organizational Consultation

Viewing organizational consultation as a comprehensive process, Dougherty

(1990) proposed the following definition:

Organizational consultation: “[T]he process in which a professional, func-

tioning either internally or externally to an organization, provides assistance
of a technical, diagnostic/perspective, or facilitative nature to an individual
or group from the organization in order to enhance the organization’s ability
to deal with change and maintain or enhance its effectiveness in some desig-
nated way” (p. 187).

䊏 Use of Systems Theory

Embedded within every organization is the philosophical principle of systems the-

ory that views “the whole organization as one large entity or system composed of
smaller, interconnected divisions” (Wallace & Hall, 1996, p. 62). Those smaller units
have been described by Brown, Pryzwanky, and Schulte (2006) as subsystems, and
together they form part of an organizational structure, or “a strategic configura-
CHAPTER TWENTY FOUR A Look at Consultation 543

tion of organizational functions, jobs, and policies in a pattern that best serves orga-
nizational goals” (Wallace & Hall, p. 63). Consequently, organizational consultants
are well advised to take into account the systems implications of the consultation
problems.

䊏 Diagnosing Organizational Problems

Organizational diagnosis is the process through which both the consultants and
the consultees seek to grasp the dynamic, problematic, organizational situations.
The more accurate the diagnosis of the processes is the greater is the assurance of
the success of the organizational interventions (Kurpius et al., 1993). Although con-
sultants are not limited to the use of only one specific diagnostic framework and
corresponding techniques, they do need to follow some steps or guidelines for di-
agnosing organizational problems.

Steps for Diagnosing Organizational Problems

䊏 Problem recognition is an acknowledgment of the existence of a problem that
needs to be addressed.
䊏 Selecting consultants refers to the hiring of an internal or external consultant for
identification, assessment, and conceptualization of the organizational prob-
lems.
䊏 Data gathering entails initiating the collection of information about the problems
and separating casual factors.
䊏 Analyzing valid information is an exploration, synthesis, and analysis of valid data
to determine the relation between organizational problems and diagnostic dis-
coveries.
䊏 Diagnostic feedback involves analyzing and synthesizing the findings and pre-
senting them in meaningful formulations to the consultee, so that conceptual
frameworks for corrective actions can be developed and implemented.

䊏 Content and Process Consultation

According to Schein (1987), organizational consultation can be either content ori-

ented or process oriented. These two can be described as follows:

Content-oriented consultation: Implies that the consultee lacks understand-

ing and awareness and, therefore, needs the consultant to provide expertise
to successfully solve the problems.

Process-oriented consultation: “[A] set of activities on the part of the consul-

tant that help the client (consultee) to perceive, understand, and act upon the
process events that occur in the client’s (consultee’s) environment” (p. 34).
544 Special Topics and Important Trends That Counselors Might Encounter PART FOUR

Schein proposed two types of content-oriented consultation in the organizational

model: (a) the purchase of expertise model, and (b) the doctor–patient model.
Characteristics of these two types of approach are mentioned next.

Aspects of the Content-Oriented Consultation

䊏 The consultee knows what the problem is, how to solve it, and who can be of
help.
䊏 The conslutee is given information and taught skills through an education or
training approach.
䊏 The consultee knows that there is a problem, but is unable to identify it.
䊏 The consultant diagnoses the problem and prescribes a cure.

Schein’s process-oreinted model involves both consultant and consultee working

as a team to identify, assess, and define the problem; collaboratively, they also ex-
plore solutions to the problem. Several factors need to be considered when engag-
ing in process-oriented consultation.

Factors to Be Considered in Process-Oriented Consultation

䊏 Consultee must own the problem and commit to actively participating in the
problem-solving process.
䊏 Consultee’s insights and judgment must be reflected in all decisions and solu-
tions.
䊏 Consultee must be cognitively and behaviorally competent to perform consulta-
tion tasks and propose solutions.
䊏 Consultee should be able to achieve necessary skills to solve future organization
problems.

䊏 Organizational Paradigm

Most organizations function on rules and policies, operating structures and pro-
duction methods, and beliefs and values that are passed on from one generation to
another, especially when they lead to success. Sometimes, these organizational ele-
ments evolve into unchallenged rules or an organizational paradigm, which Baker
(1992) defined as follows:

Paradigm: “[A] set of rules and regulations (written or unwritten) that does
two things: (1) it establishes or defines boundaries; and (2) it tells you how to
behave inside the boundaries in order to be successful” (p. 32).
CHAPTER TWENTY FOUR A Look at Consultation 545

䊏 Paradigm Shift

When their products fail to satisfy their environments, organizations need to resort
to a paradigm shift if they wish to survive. A paradigm shift signifies a modifica-
tion in the way people used to think when they try to give meaning to their situa-
tions (Fuqua & Kurpius, 1993). Although it is not always easy for consultants to
identify obsolete paradigms and replace them with better practices, some guide-
lines can be followed to facilitate the process (Wallace & Hall, 1996).

Guidelines for Creating a Paradigm Shift

䊏 Organizational members must acknowledge outdated beliefs and be open to an
alteration of their paradigm.
䊏 Consultants and organizational members work collaboratively to identify and
analyze repetitive patterns of behavior that are inconsistent with environmental
demands.
䊏 Consultants must remember that a paradigm shift responds to predictable
events, trends, and conditions, and, therefore, must anticipate the organization’s
future.
䊏 Consultants must expect and deal with strong resistance to the paradigm shift.
䊏 Consultants must help organizations get rid of their unrealistic or fearful beliefs
that paradigm shifts are highly risky change strategies.
䊏 Consultants must help organizational members handle and integrate effectively
into the organizational infrastructure the changes brought about by the para-
digm shift.

See the following site for a listing of process consultation information

resources:
䉴 http://www.headstartinfo.org/infocenter/guides/processconsultation.htm

SCHOOL-BASED CONSULTATION

In the school systems, counselors commonly take on the dual roles of counselor
and consultant. As counselors, they help the individual student function in the
school environment, and as consultants, they work with a broader range of people,
including families, teachers, administrators, and community agencies to help
change the environment. Most consultees’ (e.g., parents, teachers, or administra-
tors) issues involve a person, system, or both (Dinkmeyer & Carlson, 2001).
Through the process of consultation, the consultant provides parents and teachers
546 Special Topics and Important Trends That Counselors Might Encounter PART FOUR

the knowledge and skills to become more objective and self-confident when work-
ing with students to achieve academic success as well as personal and social devel-
opment (Harrison, 2004). Dinkmeyer and Carlson provided four characteristics
that are inherent to school consultation.

Characteristics of School Consultation

䊏 Information, observations, and concerns about a problem are shared between the
consultant and the consultee.
䊏 Tentative hypotheses are developed to change the situation.
䊏 Joint planning and collaboration occurs between consultant and consultee.
䊏 Hypotheses or recommendations reflect and respect the uniqueness of the child,
the teacher, and the setting.

School-based consultation can be conceptualized in stages or as a process. Harrison

offered a generic blueprint of the phases of school consultation.

Generic School Consultation Stages

䊏 A request for help from the consultee to the consultant occurs and expectations of
the relationship are established.
䊏 Boundaries are determined.
䊏 The consultant determines who owns the problem.
䊏 The consultant gathers information to understand the problem.
䊏 Goals are established to meet the desired change.
䊏 Strategies must be chosen, applied, assessed, and customized as needed.
䊏 Termination occurs when all parties are in agreement.

䊏 Collaboration

According to Brown et al. (2006) there is a movement to make the consultation pro-
cess more collaborative in all stages with the exception of the intervention phase.
Collaboration parallels consultation in terms of process issues such as entry, devel-
oping relationships, and obtaining permission. In consultation, the responsibility
of the outcomes lies with the consultee. Similarly, in collaboration, consultees as-
sume primary responsibility except that accountability for the outcome is shared
between the collaborating partners (Brown et al.). In a collaborative relationship,
there is more than one person involved in the diagnosis and treatment plan. Each
participant may not share in equal parts of the decision making and roles within
the organization. However, it is imperative to have a successful working relation-
ship to produce a positive outcome (Harrison, 2004).

See Chapter 3 for more on the importance of collaboration for school counselors.
CHAPTER TWENTY FOUR A Look at Consultation 547

䊏 Types of School Consultation

School-based consultation can be conceptualized as involving direct service, indi-

rect service, or both (Dougherty, 2005). According to Dougherty, consultation is
an indirect service to a student and attempts to help others work successfully
with the student. Collaboration combines indirect and direct services to students.
Parsons and Meyers (1984) defined these four categories of school consultation.

Categories of School Consultation

䊏 Direct service to the client suggests that consultants seek to adjust the behavior, at-
titudes, or feelings of a particular client or clients who present a problem or prob-
lems. Information is gathered by the consultant using behavioral observation, in-
dividual testing, and interviewing.
䊏 Indirect service to the client suggests that consultants seek to adjust the behavior,
attitudes, or feelings of a particular client or clients who present a problem or
problems. The information needed to address the client’s issues is gathered by
the consultee to be shared with the consultant.
䊏 Service to the consultee suggests that the consultant’s goal is to change the behav-
ior, attitude, or feelings of the consultee.
䊏 Service to the system suggests that service by the consultant is to target and im-
prove the functioning of the system as a whole, resulting in improved mental
health for both client and individual consultee in the organization.

䊏 Theoretical Approach to School Consultation

Consultants within the school system often take a behavioral, cognitive, or hu-
manistic approach to consultation. Conoley and Conoley (1992) suggested that
the consultant chooses an intervention that corresponds with the theoretical be-
liefs of the consultee. When choosing an intervention that closely matches the
theoretical orientation of the consultee, the acceptability of the intervention is in-
creased.

See the following Web site for a handout outlining major approaches
to school-based consultation:
䉴 http://www.education.uiowa.edu/schpsych/handouts/
school%20consultation.pdf
548 Special Topics and Important Trends That Counselors Might Encounter PART FOUR

CHAPTER SUMMARY

Consultation continues to be an evolving discipline, and it is an increasingly popu-

lar career avenue that trained counselors in a variety of settings pursue. Under-
standing the various systems of consultation, including mental health, behavioral,
organizational, and school based, as well as the roles of the consultant, consultee,
and client, can aid counselors who wish to expand the uses of their professional
training.

Chapter 24: Key Terms

䉴 Consultation 䉴 Organizational consultation 䉴 Process-oriented consulta-
䉴 Transfer of effect 䉴 Organizational structure tion
䉴 One-downmanship 䉴 Organizational diagnosis 䉴 Paradigm
䉴 Mental health consultation 䉴 Content-oriented consulta-
䉴 Behavioral consultation tion
chapter Crisis Intervention in Counseling

25 Rick A. Myer
Duquesne University

Pam Cogdal
University of Memphis

In This Chapter

䉴 Understanding Crisis and Crisis Intervention

䊏 Definition of Crisis

䊏 Types of Crisis

䊏 Crisis in Culture

䊏 Characteristics of an Effective Crisis Counselor

䉴 Differences Among Psychological Emergency, Crisis, and Trauma

䊏 Psychological Emergency

䊏 Crisis

䊏 Trauma

䉴 Crisis Response: The Six-Step Model of Intervention

䊏 Step 1: Define the Problem

䊏 Step 2: Ensure Safety

䊏 Step 3: Provide Support

䊏 Step 4: Examine Alternatives

䊏 Step 5: Make Plans

䊏 Step 6: Obtain Commitment

䉴 Crisis Assessment: Using the Triage Assessment Form

䊏 Assessment of Crisis Reactions

䊏 Severity Scales

䉴 Trends in Crisis Intervention

䊏 Contextual Models

䊏 Strength-Based Approach

䊏 Systemic Approach

550
CHAPTER TWENTY FIVE Crisis Intervention in Counseling 551

UNDERSTANDING CRISIS AND CRISIS INTERVENTION

The catastrophic 1942 fire at Cocoanut Grove Melody Lounge in Boston that killed
492 people gave birth to the field of crisis intervention. In helping survivors cope
with the loss, Lindemann (1944) developed a model for bereavement that has
served as a practical foundation for crisis intervention. Since that time, various fac-
tors have contributed to the exponential growth of literature in the field of crisis in-
tervention. Some of these factors are noted here.

Public Events
䊏 Columbine school massacre—April 20, 1999.
䊏 Terrorist attacks on World Trade Center and Pentagon—September 11, 2001.
䊏 Washington, DC sniper shootings—October 2–24, 2002.
䊏 Red Lake school shootings—March 21, 2005.

Individual Incidents (Rudd, Joiner, Jobes, & King, 1999; Sanchez, 2001)
䊏 Domestic violence.
䊏 Sexual assault.
䊏 Climbing suicide rates (Eisler, 1995; Kreidler & England, 1990; Salter, 1988;
Walker, 1989).

Related Factors in the Mental Health Profession

䊏 Changes in the way managed health care delivers mental health services (Kolski,
Avriette, & Jongsma, 2001).
䊏 Shifting treatment approach toward specialized crisis treatment for the preven-
tion of serious psychological problems (Raphael & Wilson, 2000; Ursano,
Grieger, & McCarroll, 1996).
䊏 Expansion of community mental health services.
䊏 Advent of crisis hotlines (Kleespies & Blackburn, 1998; Seely, 1997).

䊏 Definition of Crisis

James and Gilliland (2005) defined crisis this way:

Crisis: “[T]he perception or experiencing of an event or situation as an intol-

erable difficulty that exceeds the resources and coping mechanisms of the
person, and unless the person gains relief the crisis has the potential to cause
severe affective, cognitive, and behavioral malfunctioning” (p. 3).
552 Special Topics and Important Trends That Counselors Might Encounter PART FOUR

䊏 Types of Crisis

There are a variety of contexts and precipitating events that may give rise to crises.
Four commonly recognized classifications of crises are (a) developmental, (b) situa-
tional, (c) existential, and (d) systemic (James & Gilliland, 2005). The defining as-
pects of each type of crisis are explained here.

Developmental crisis: Occurs when events in the normal flow of human

growth are disrupted by a dramatic shift that precipitates a change in the way
people function (Brammer, 1985; Myer & James, 2005).

Situational crisis: Emerges with the advent of unexpected events that lie out-
side the realm of normal functioning; individuals neither anticipate nor have
a way of controlling situational crises (Brammer, 1985; Myer & James, 2005).

Existential crisis: Occurs when individuals become aware that an important

intrapersonal aspect of their lives may never be fulfilled. This, in turn, has an
impact on self-purpose and self-worth (Brammer, 1985).

Systemic crisis: Occurs when an identifiable event ripples out into large seg-
ments of the population and the environment and has a psychological impact
not only on the immediate victims, but on people throughout the world
(James & Gilliland).

The events leading to a crisis can vary, as described in the four categories of crisis.
To clarify the distinction among developmental, situational, existential, and sys-
temic crises, consider the following examples.

Developmental Crises
䊏 Birth of a child.
䊏 Retirement.
䊏 College graduation.
䊏 Career changes.

Situational Crises
䊏 Automobile accidents.
䊏 Sexual assault.
䊏 Sudden illness.
䊏 Job loss.

Existential Crises
䊏 Failure to fulfill a lifelong dream.
䊏 Intrapersonal conflicts about a lack of meaning in one’s life.
䊏 Realization that one has not formed significant relationships.
CHAPTER TWENTY FIVE Crisis Intervention in Counseling 553

Systemic Crises
䊏 Natural disasters.
䊏 Hurricanes.
䊏 Droughts.
䊏 Wildfires.
䊏 Terrorist attacks.
䊏 School shootings.

The four types of crises can also occur in a variety of settings. Check
out the National Association for School Psychologists Web site for
useful resources for responding to crises in schools.
䉴 http://www.nasponline.org/NEAT/crisismain.html

䊏 Crisis and Culture

Crisis intervention can be identified as a specialty area in counseling; like other

branches of the profession, crisis intervention often is influenced by cultural ele-
ments. The four types of crisis outlined earlier can serve as a context for examining
the impact of culture on crisis situations. Developmental crises frequently involve a
cultural issue (Myer, 2001). For example, pregnancy out of wedlock may precipi-
tate a crisis in cultures where pregnancy outside of marriage is unacceptable or im-
moral according to religious belief; however, the same situation may be tolerated or
even widely accepted in other cultures. Unlike developmental crises, situational
crises are less likely to be tied to culture (Myer, 2001). There are few cultures in
which sexual assault, mugging, or automobile accidents are not considered crises.
Similar to developmental crises, existential crises may vary across cultures. Death
is a prime example because the meaning and occurrence of death varies according
to culture and religious belief. Finally, systemic crises—like situational crises—
tend to be universal. Large-scale disasters such as hurricanes, tsunamis, or earth-
quakes, as examples, are almost always considered crisis events regardless of
locale.

䊏 Characteristics of an Effective Crisis Counselor

Wanting to help and being able to help are two different things in crisis interven-
tion. Not all counselors are able to work with clients in crisis. Counselors who regu-
larly assist clients in crisis must flourish in the fast pace of crisis intervention, toler-
ate the lack of follow-up and long-term therapeutic relationships, and appreciate
the patience needed to work with clients who are at the end of their ropes. Al-
554 Special Topics and Important Trends That Counselors Might Encounter PART FOUR

though crisis intervention techniques and strategies can be learned, certain per-
sonal characteristics are needed to move beyond simply using appropriate skills.
The most effective crisis intervention counselors will have some combination of the
characteristics.

Poise
䊏 Counselors remain calm in the face of clients who are overwhelmed.
䊏 Counselors create an island of stability to help restore clients’ sense of equilib-
rium and activate problem-solving skills (James & Gilliland, 2005).
䊏 Counselors practice good self-care and relaxation techniques to enhance their
composure when helping clients.

Flexibility
䊏 Counselors adapt to clients’ needs.
䊏 Counselors have a repertoire of strategies that address affective, behavioral, and
cognitive reactions.
䊏 Counselors can navigate smoothly among a variety of techniques to determine
which are appropriate to clients’ reactions.

Creativity (James & Gilliland, 2005)

䊏 Counselors are willing to take risks in responding in new ways to crisis situa-
tions.
䊏 Counselors practice divergent thinking that allows them to conceptualize crises
from alternate perspectives.

Resilience (Collins & Collins, 2005)

䊏 Counselors have the ability to bounce back after helping clients through such
rough times as suicide or homicide.
䊏 Counselors make regular use of continuing education seminars and peer super-
vision.
䊏 Counselors monitor their energy levels, get enough rest, and maintain a healthy
diet.

In addition to possessing certain personal qualities, effective crisis counselors also

are adept at making appropriate referrals. Counselors are cognizant of local agen-
cies that provide a wide range of services and keep an updated phone list for ease
of use. Although technical skill is required for identifying instances when referral is
the best option, personal awareness also plays an important part in the referral pro-
cess. Counselors must recognize and accept the limitations of their own or their
agency’s ability to assist and must value the referral process as inherently impor-
tant to supporting clients’ variety of needs.
CHAPTER TWENTY FIVE Crisis Intervention in Counseling 555

EXAMPLE

Bolstering Creativity Through Role Play

Crisis workers have to be able to think outside of the box to respond to people in crisis. Coun-
selors can develop creativity through the use of role-played scenarios. One such role play in-
volves a mother whose son was just diagnosed with leukemia. To save her child from the pain
and discomfort of treatment, the mother is contemplating killing her son and then committing
suicide. In this situation counselors are called on to make many decisions quickly and muster
all the creativity they can to help the mother, who is struggling to deal with devastating news.
Role play gives counselors the opportunity to stretch the possibility of response within the
safety of an enactment and to receive feedback from peers and supervisors about their han-
dling of the situation.

DIFFERENCES AMONG PSYCHOLOGICAL EMERGENCY,

CRISIS, AND TRAUMA

James and Gilliland’s (2005) understanding of crisis is succinct and comprehensive;

however, their definition does not account for the confusing terminology often
used to describe crises (Callahan, 1994). Three terms—psychological emergency,
crisis, and trauma—are used routinely to refer to crisis, which leads to misconcep-
tions about the crisis experience. One such misconception is that the crisis experi-
ence unfolds in a linear progression that begins with an emergency, leads to a crisis,
and culminates in a trauma. However, individuals may experience an emergency
and not be in crisis, or have a traumatic experience without the presence of a crisis.
Figure 25.1 depicts the relation of psychological emergency, crisis, and trauma.
Characteristics salient to each of the three experiences overlap; yet, the experiences
described as psychological emergency, crisis, and trauma have unique features that
distinguish them from one another.
Being able to sort through the maze of similarities and differences in these terms is
important for practitioners so that they will be able to form a clear understanding of
people’s experience of catastrophic events (Silove, 2000), provide the appropriate
level and type of intervention (Callahan, 1994), and improve communication among
the many professionals (e.g., psychiatrists, psychologists, mental health counselors,
nurses, social workers; Callahan, 1998) and settings (e.g., hospital emergency room,
domestic violent shelters, rape trauma centers) involved in the treatment process.

䊏 Psychological Emergency

The defining characteristic of a psychological emergency is the presence of imme-

diate danger. Permanent damage—psychological or physical—is always a possi-
556 Special Topics and Important Trends That Counselors Might Encounter PART FOUR

FIGURE 25.1 Relation of crisis, emergency, and trauma.

bility for people experiencing a psychological emergency. An important but less

central feature of psychological emergencies is the suddenness of onset (Callahan,
1998). According to Callahan, many psychological emergencies surface with little
or no forewarning. Typically, warning signs or symptoms either were not recog-
nized or ignored (Myer & James, 2005).

Traits of People in Psychological Emergency

(Baldwin, 1978; Callahan, 1998)
䊏 Inability to function in a culturally acceptable manner.
䊏 Evidence of incompetence.
䊏 Inability to assume personal responsibility.
䊏 Defenselessness.
䊏 Incapacity to care for self or others.

Because psychological emergencies are dramatic and generally involve immi-

nent risk of psychological or physical harm, intervention needs to occur as quickly
as possible to prevent irreversible physical or psychological damage. Thus, treat-
ment is intentionally protective in nature. Voluntary or involuntary hospitalization
frequently is required to assure the safety of self or others (Myer, 2001).

Context of Treatment for Psychological Emergencies

䊏 Immediate and swift.
䊏 Straightforward.
䊏 Protective of everyone involved.
CHAPTER TWENTY FIVE Crisis Intervention in Counseling 557

䊏 Open to involuntary commitment as a means of intervention.

䊏 Open to the use of agencies as a means of protecting children and the elderly.

The following instances highlight the features of eminent danger or immediate

onset characteristic of psychological emergencies.

Potential Psychological Emergencies

䊏 An individual threatens suicide or is in the process of committing suicide.
䊏 A substance abuser loses consciousness and leaves young children to care for
themselves.
䊏 A person in the midst of a psychotic episode walks along a busy highway oblivi-
ous to the perilous situation.
䊏 A person unexpectedly overdoses on drugs.
䊏 An individual has a psychotic break or undergoes a significant personality
change and enters a dissociative state.

䊏 Crisis

The defining characteristic of crisis is a sense of disequilibrium (Myer & James,

2005). As in a psychological emergency, people in crisis are vulnerable to varying
degrees. However, the critical distinction between an emergency and a crisis is that
the vulnerability inherent in a crisis does not involve an immediate risk of harm.
Generally, people in crisis reestablish a sense of equilibrium or stability about 6
weeks after the onset of a crisis (Callahan, 1998).

Traits of People in Crisis

䊏 Likely to be overwhelmed.
䊏 Impaired in their ability to use typical coping strategies to resolve the problem.
䊏 Susceptible to long-term emotional, behavioral, and cognitive problems.
䊏 Capable of bouncing back when inner resiliencies are sought out and support
from family, friends, or professionals is received.

Treatment for people in crisis varies according to the severity of the reaction.
More severe crisis reactions may warrant very directive interventions, whereas less
serious responses may allow for more client autonomy, as in traditional counseling.
In both instances, however, the intervention is focused on resolving the crisis state,
not on remediation of a problem (James & Gilliland, 2005). If other issues surface
during the intervention process, they may be acknowledged but should not be-
come a focus of intervention unless they prevent a resolution of the crisis. After cri-
sis intervention is complete, counselors can recommend assistance for peripheral
issues.
558 Special Topics and Important Trends That Counselors Might Encounter PART FOUR

Goals of Crisis Treatment

䊏 Reestablish precrisis level of functioning (Cournoyer, 1996).
䊏 Respond to immediate needs rather than assist people in making major life or
personality changes.
䊏 Recognize that not all issues will be resolved (James & Gilliland).

The following examples highlight the sense of disequilibrium that is a key char-
acteristic of crisis situations. In both instances, the level of extreme vulnerability
probably is not severe enough to cause immediate danger to those involved.

Potential Crises
䊏 A woman diagnosed with breast cancer who is overwhelmed at the news of her
threatened health.
䊏 A man who discovers his teenage daughter is pregnant does not know how to re-
spond to the news.

䊏 Trauma

A trauma occurs when an individual experiences or perceives an enormous sense

of helplessness and physical threat that leads to the interruption of normal devel-
opment (van der Kolk & McFarlane, 1996). People also experience psychological
trauma due to episodic events that occur over extended periods of time (Pynoos,
Steinberg, & Goenjian, 1996). Van der Kolk and McFarlane (1996) speculated that
the memory of a trauma is not integrated into victims’ life experience and leads to a
disruption in development. The authors hypothesized that the memory of the trau-
matic event develops its own existence independent of coping abilities. Indeed,
people who have traumatic experiences tend to fixate on the event (Myer & James,
2005) such that it continues to intrude into their lives well beyond the 6-week
restabilization period seen in crisis (McFarlane & Yehuda, 1996).

Traits of People in Trauma

䊏 Demonstrate evidence of permanent changes in beliefs about the world
(Echterling, Presbury, & McKee, 2005).
䊏 Exhibit inability to form healthy relationships (Pynoos et al.).
䊏 Manifest a decreased ability to understand complex emotions (van der Kolk).
䊏 Exhibit changes in neurological functioning (van der Kolk).
䊏 Testify to the presence of nightmares, flashbacks, and intense emotions (e.g.,
rage, panic).
䊏 Fixate on and reenact the trauma, causing the trauma to remain rooted in the con-
temporary experience of peoples’ lives (van der Kolk & McFarlane).
CHAPTER TWENTY FIVE Crisis Intervention in Counseling 559

The general treatment goal for people who have been traumatized is overcom-
ing the trauma by coping with the memories in a way that does not force clients to
repeatedly reexperience the trauma (van der Kolk & McFarlane, 1996). Because
there is a wide range of symptoms associated with trauma, treatment greatly varies
. Care and caution in selecting interventions is advocated prior to agreeing to pro-
vide treatment for people who have been traumatized (Lohr, Montgomery,
Lilienfeld, & Tolin, 1999). These authors believe that not all interventions are help-
ful and some may cause further traumatization.
The following instances have the potential to be traumatic for individuals who
experience them.

Potential Traumas
䊏 A person witnesses a murder.
䊏 An individual gets caught in a natural disaster such as a tornado.
䊏 An individual sees a family member being killed in an automobile accident.
䊏 A person witnesses or is a victim of prolonged domestic violence.

CRISIS RESPONSE: THE SIX-STEP MODEL OF INTERVENTION

Crisis intervention focuses treatment on a single issue (Cournoyer, 1996) by target-

ing affective, behavioral, and cognitive reactions that result from an experience that
overwhelms people’s ability to cope. A key element of crisis intervention is a quick
focusing on the problem (Kleespies, Deleppo, Mori, & Niles, 1998). Taking a few
sessions to develop treatment goals and allow a therapeutic relationship to build is
a luxury not afforded to crisis intervention. Spending too much time developing
rapport leaves people feeling as if they have not been helped. Often, treatment
must begin within minutes. An action-oriented approach that rapidly engages cli-
ents is therefore essential.

Crisis intervention focuses treatment on a single

issue (Cournoyer, 1996) by targeting affective,
behavioral, and cognitive reactions that result
from an experience that overwhelms people’s
ability to cope. A key element of crisis
intervention is a quick focusing on the problem.

The six-step model used by James and Gilliland (2005) is a guide counselors can
follow in crisis intervention. What makes this model attractive is that it is neither
static nor does it need to be followed mechanically; rather, the model allows the
counselor to move back and forth through the steps to meet clients’ immediate
560 Special Topics and Important Trends That Counselors Might Encounter PART FOUR

needs. In the first three steps, the emphasis is on listening. Skills needed for the first
three steps are attending, observing, understanding, empathizing, and accepting;
being nonjudgmental, caring, respectful, and genuine is also important. The sec-
ond three steps emphasize acting. Counselors become involved in the intervention
at a nondirective, collaborative, or directive level according to the assessed needs of
the client and the availability of environmental supports and coping mechanisms
(Myer & James, 2005).
Specifically, the six-step model promotes the following actions by the counselor:

1. Define the problem.

2. Ensure safety.
3. Provide support.
4. Examine alternatives.
5. Make plans.
6. Obtain commitment.

䊏 Step 1: Define the Problem

Although time limits may compress a counselor’s ability to define the problem, a
crucial aspect of providing help is gaining as clear an understanding as possible
about what is going on with the client (James & Gilliland, 2005). Care must be taken
not to confuse a “presenting” event with the actual crisis. Take for example, a father
whose 15-year-old daughter just announced that she is pregnant. The father is ac-
tive in church, owns a business, and volunteers in the community. At first glance,
the crisis may seem to be the pregnancy, but the father also may be embarrassed
about his daughter with church acquaintances. He might be concerned about de-
creased business if his customers discover his daughter is pregnant or fear losing
his standing in the community.

Goals of Step 1
䊏 Understand the meaning given to the event by the client.
䊏 Query the client as to the source of the crisis.
䊏 Inquire about the events that have moved the client into a crisis mode.
䊏 Determine the ways in which the events have altered the client’s affect, behavior,
and cognitions from the precrisis state.

䊏 Step 2: Ensure Safety

The high potential for violence to self or others in a crisis situation suggests that
safety be assessed (Myer & James, 2005). It is absolutely paramount that crisis
workers be aware of safety considerations for their clients, others, and most impor-
CHAPTER TWENTY FIVE Crisis Intervention in Counseling 561

tant, for themselves (Hendricks, McKean, & Hendricks, 2003). This step cuts across
all other steps of crisis intervention.

Goals of Step 2
䊏 Assess safety needs from the beginning to the end of the crisis intervention.
䊏 Determine immediacy of the threat to self or others by checking for evidence of a
definite plan, means to enact the plan, and commitment to act within 4 days.

䊏 Step 3: Provide Support

Unlike traditional individual counseling where counselors guard against being too
directive for fear of breeding client dependency, in crisis intervention therapists
must communicate to clients that they are prized, accepted, and valued (Hoff,
1995).

Goals of Step 3
䊏 Assess client vulnerability as determined by defenselessness against being taken
advantage of, inability to locate and access resources to help in the crisis, and ex-
ceeding unfamiliarity with problems associated with the crisis.
䊏 Facilitate dependency when clients are too vulnerable to care for themselves.
䊏 Help clients regain their sense of equilibrium as well as their independence once
immediate client care has been provided.

䊏 Step 4: Examine Alternatives

Clients in crisis often believe they have no options left—the crisis has left them so
immobilized that they cannot resume control of their lives (Myer & James, 2005).
Examining alternatives empowers clients to overcome the sense of helplessness
that often accompanies a crisis and take steps to regain control.

Goals of Step 4
䊏 Search for situational supports.
䊏 Generate coping mechanisms.
䊏 Engage in positive thinking.
䊏 Attempt to restore control by finding past behaviors and helpful environmental
resources that the client may have forgotten or dismissed as ineffective.
562 Special Topics and Important Trends That Counselors Might Encounter PART FOUR

䊏 Step 5: Make Plans

Most counseling approaches use action plans as a means of taking what is learned
in therapy into clients’ everyday lives. Crisis intervention is no different; planning
is considered a major component of returning the client to a state of precrisis equi-
librium (Myer & James, 2005). Crisis intervention planning is unique, however, in
that planning is time sensitive. As opposed to weekly, monthly, or even lifetime
plans that are part of a traditional therapeutic regimen, crisis intervention plans are
immediate and short term, written in terms of days, hours, and sometimes even
minutes.

Goals of Step 5
䊏 Determine whether the client’s mental clarity and physical resources allow him
or her to establish a plan of action.
䊏 Work collaboratively with clients—even to the point of taking initiative—to de-
cide which supportive persons and services are needed.
䊏 Create a plan of action that responds to immediate needs with goals and out-
comes that are short term rather than long term.
䊏 As much as possible, attempt to return control to clients so they may reclaim
their autonomy.

䊏 Step 6: Obtain Commitment

Obtaining a commitment is a particularly important way of moving clients into ac-

tion (James & Gilliland, 2005). The issues of client autonomy and control are ex-
tremely relevant to the commitment stage because it does little good for the crisis
worker to force clients to commit to actions they lack the resources to carry out.
Thus, gaining a commitment should be done as empathically and collaboratively
as possible so the clients do not attempt actions that are forced on them by the crisis
worker. If planning has been effective, the commitment step should be short, con-
cise, and easily accomplished.

CRISIS ASSESSMENT: USING THE TRIAGE ASSESSMENT FORM

Assessment is a vital aspect of the six-step model that serves as an umbrella process
conducted continuously throughout treatment. Continuous assessment allows
counselors to monitor clients’ needs and modify their intervention approach where
necessary. The Triage Assessment Form: Crisis Intervention (TAF; Myer, 2001) is
particularly suited for use in the six-step model. The TAF, first introduced by Myer,
Williams, Ottens, and Schmidt (1992), is an excellent visual and verbal assessment
device for determining the seriousness of a client’s safety needs. The TAF offers a
CHAPTER TWENTY FIVE Crisis Intervention in Counseling 563

dynamic way to understand clients’ needs by dividing the impact of a crisis into af-
fective, behavioral, and cognitive reactions. Each response is further divided into
three categories. The interaction and severity of these reactions provides the infor-
mation needed for helping clients.

䊏 Assessment of Crisis Reactions

Three affective, behavioral, and cognitive responses to crises are assessed by

the TAF.

Affective Response
䊏 Anger/hostility.
䊏 Anxiety/fear.
䊏 Sadness/despair.

Affective response is a natural, almost instinctive reaction to crisis. The TAF evalu-
ates the most commonly identified emotional reactions (James & Gilliland, 2005).

Behavioral Response
䊏 Immobility.
䊏 Avoidance.
䊏 Approach.

Behavioral reactions can be either constructive or destructive. Constructive reac-

tions are those that help to resolve the situation, whereas destructive reactions neg-
atively heighten the crisis situation. For example, sometimes it might better serve a
specific client to avoid a situation rather than approach it. Approaching can be po-
tentially destructive if the client is not emotionally prepared.

Cognitive Response
䊏 Transgression.
䊏 Threat.
䊏 Loss.

Cognitive reactions are best understood through the framework of time. When the
client believes the crisis is occurring in the present moment, the cognitive reaction
is labeled transgression. If a client perceives the crisis as future oriented, it is con-
sidered a threat. When a client understands the crisis situation as located in the
past, the cognitive response is identified as loss.
564 Special Topics and Important Trends That Counselors Might Encounter PART FOUR

䊏 Severity Scales

The Severity scales used in the TAF rate clients numerically on affective, behav-
ioral, and cognitive dimensions of functioning by comparing written scale defini-
tions against the observations a crisis worker makes of the client’s words and ac-
tions. The key to assessing severity is to observe the client’s ability to control the
reaction, the intensity of the reaction, and the stability of the reaction. The more se-
vere the reaction, the less control clients have; the more intense their experience of
the reaction, the less stable the reaction.

Scoring
䊏 Each of the three scales can be scored from a range of 1 to 10, for a total possible
score of 30.
䊏 Scores ranging from 3 to 14 indicate minimum impairment, those ranging from
15 to 23 indicate moderate impairment, and scores from 24 to 30 indicate severe
impairment.
䊏 The higher end scores indicate that the client needs to be placed in a setting
where he or she will be secure and safe.
䊏 A score on a single scale of 10 also indicates that the client should be placed in a
protective setting.

Suffice it to say that few clients who are in crisis will be in the low impairment
range, and many may be angrily acting out against others or attempting to harm
themselves.

TRENDS IN CRISIS INTERVENTION

The field of crisis intervention continues to evolve. Three notable and emerging
trends include the development of contextual models, strength-based approaches,
and systemic perspectives.

䊏 Contextual Models

A recent trend in crisis intervention is toward recognizing the usefulness of contex-

tual issues to theory development in crisis work (McNally, Bryant, & Ehlers, 2003).
The contextual or ecological perspective is based on the belief that crises do not oc-
cur in a vacuum and are shaped by the social and cultural contexts in which they
occur (Deiter & Pearlman, 1998; van der Kolk & McFarlane, 1996). Promptings in
the direction of theory development are related to several factors.
CHAPTER TWENTY FIVE Crisis Intervention in Counseling 565

Factors Related to Contextual Theory Development

䊏 Issues related to the provision of aid and support, the nature of crises, and inter-
vention models that can be used to manage postcrisis reactions (Paton, Violanti,
& Dunning, 2000) have been the primary focus of crisis literature, while little at-
tention has been paid to theory development (Slaikeu, 1990).
䊏 Existing crisis theories resemble a cluster of assumptions or collection of clinical
observations more than a set of data-based principles able to explain or predict
the effect of crises (Ursano et al., 1996).
䊏 Ecological models have emerged that are suitable to theory development and
make sense of the impact of crises on individuals as well as systems (Collins &
Collins, 2005; James & Gilliland, 2005; Myer & Moore, 2006; Stuhlmiller &
Dunning, 2000a).

䊏 Strength-Based Approach

Another important movement in the field of crisis intervention is the shift from a
pathological to a strength-based treatment approach (Stuhlmiller & Dunning,
2000b). Although more research is needed about the factors that make some people
more resilient than others, some statements about the underlying beliefs and as-
sumptions of this approach can be made.

Assumptions of Strength-Based Approach

䊏 Diagnostic labels tend to be reductionistic and of limited usefulness to explain
reactions to crises (Myer, Moore, & Hughes, 2003; Silove, 2000; Stuhlmiller &
Dunning, 2000b).
䊏 Diagnostic labels are ineffective for understanding and assisting people in crisis
(Myer et al., 2003; Shalev, 1996; Silove, 2000) because most individuals do not de-
velop debilitating psychological problems after a crisis (Bonanno, 2004;
Echterling et al., 2005).
䊏 Categorizing normal or typical reactions to a crisis as pathological is not appro-
priate (Tucker, Pfefferbaum, Nixon, & Dickson, 2000).
䊏 Use of a pathological approach ignores the psychological growth that takes place
for many people who have experienced a crisis (Stuhlmiller & Dunning, 2000a).
䊏 Ingenuity, strengths, and resourcefulness are important for understanding how
people in overwhelming experiences bounce back in spite of the odds.

See Chapter 19 for further information on a critique of traditional approaches to assess-

ment and diagnosis.

䊏 Systemic Approach

Another area of crisis intervention that is beginning to flourish, particularly in the

wake of the terrorist attacks of September 11, 2001, is planned intervention at the
566 Special Topics and Important Trends That Counselors Might Encounter PART FOUR

organizational level (Myer & Moore, 2006). Literature in the area of crisis manage-
ment for businesses long has recognized the need to prepare for crises and disasters
(Mitroff, 2004); however, the impact of crises on employees either has been ne-
glected or addressed through recommendations to refer employees to outside pro-
fessionals.

Features of Systemic Perspective

䊏 Crisis intervention within organizations must shift from a clinical to a consulta-
tive model that focuses on working with organizations to make decisions in the
best interest of their employees (Braverman, 1999).
䊏 A consultation model focuses on providing support at the managerial level and
with crisis response teams.

Additional research in this area is needed to provide assessment tools that can
guide the intervention process (Myer, Conte, & Peterson, in press).
Crisis intervention is here to stay. The one constant all counselors have is that
they can count on working with clients who are in crisis. Training either through
formal course work or continuing education is needed if counselors are to be pre-
pared to provide the assistance needed to individuals in crisis. Although the ap-
proach and techniques used in traditional individual and group counseling are
helpful, counselors must apply them differently. Clinical errors in crisis interven-
tion can result in disastrous outcomes.

Chapter 25: Key Terms

䉴 Crisis 䉴 Existential crisis 䉴 Psychological emergency
䉴 Developmental crisis 䉴 Systemic crisis 䉴 Trauma
䉴 Situational crisis
 chapter Addictions Counseling

26 David L. Delmonico
Duquesne University

Elizabeth J. Griffin
Internet Behavior Consulting

In This Chapter

䉴 Fundamentals of the Addictive Process 䉴 Screening and Assessment

䊏 The Use–Dependence Continuum 䊏 Physiological and Behavioral Assessment
䊏 Classifications of Dependence 䊏 Clinical Interviewing

䊏 Progression 䊏 Psychometric Instruments

䊏 Hallmarks of Addictive Behavior 䊏 Diagnosis and Co-Occurring Disorders

䊏 Tolerance and Withdrawal 䊏 Intervention Level Assessment

䉴 Models of Addiction 䉴 Intervention and Treatment Considerations

䊏 Moral 䊏 Crisis Management
䊏 Medical and Disease 䊏 Behavioral Change

䊏 Spirituality 䊏 Treatment Modalities

䊏 Impulse Control 䊏 Beyond Addiction Management

䊏 Genetic 䊏 Dual Diagnosis

䊏 Social Learning 䊏 Pharmacological Interventions

䊏 Bio-Psycho-Social 䊏 Special Populations

䊏 Cultural Implications for Addiction 䊏 Defining Successful Treatment

Models 䊏 Legal, Ethical, and Professional Issues

568
CHAPTER TWENTY SIX Addictions Counseling 569

FUNDAMENTALS OF THE ADDICTIVE PROCESS

Our purpose in this chapter is to introduce underlying concepts and tenets that
mental health professionals need to provide even the most basic level of care to in-
dividuals struggling with addictive behaviors. We present theoretical concepts, fol-
lowed by information on basic assessment and treatment procedures. This chapter
is not focused on chemical dependency, but rather takes a broad approach by pre-
senting ideas about the process of addiction, regardless of the drug or behavior the
individual chooses to satisfy the addictive cycle. Reading this chapter will not
make you an adept addiction counselor, but you will have an understanding of
many of the concepts from which addiction counselors operate.

䊏 The Use–Dependence Continuum

Addiction is an umbrella word that encompasses many forms of behavior and a

myriad of other terms. For example, the Diagnostic and Statistical Manual of Mental
Disorders (4th ed., text revision [DSM–IV–TR]; American Psychiatric Association,
2000) outlines several types of problematic use of substances. Combined with the
recreational ways individuals use a substance, a continuum is formed ranging
from health to increasing pathology.
The initial job of the clinician is often to help the client identify where on the con-
tinuum their behavior falls. Therefore, understanding the fundamental concepts of
addiction is critical to the assessment and treatment process for those who present
with substance and behavioral concerns.

Points on the Use–Dependence Continuum

1. Use is the idea that the person using the substance or behavior does not experi-
ence any difficulties as a result of that use.
2. Misuse refers to individuals using the substance or behavior in ways that, if
continued, could develop into more problematic issues. These individuals can
manage their behavior and use except under limited times and circumstances.
3. Abuse occurs when people are experiencing difficulties as a result of the use of a
substance or behavior. They may be suffering consequences in their life as a re-
sult of the substance or behavior. This is the first point along the continuum
where we may use the word addiction.
4. Dependence is the polar opposite of use; individuals are considered dependent
if they abuse a substance or behavior and also develop tolerance and with-
drawal associated with the substance or behavior.

䊏 Classifications of Dependence

The use–dependence continuum can be used to address both substance and pro-
cess or behavioral addictions. These two types of addictive behaviors can be de-
scribed this way:
570 Special Topics and Important Trends That Counselors Might Encounter PART FOUR

Substance addiction: An addiction that requires the ingestion of a mood-al-

tering substance (e.g., alcohol, drugs, etc.).

Process or behavioral addiction: An addiction that does not require a sub-

stance to be ingested, but often presents similar problems as a substance-re-
lated addiction (e.g., shopping, sex, workaholism, etc.).

Although process addictions are not addressed specifically in the DSM–IV–TR,

many clinicians consider them equally problematic as substance addictions.

䊏 Progression

There are many models through which to view addictions; however, most clini-
cians subscribe to the idea that addiction is a process, not an event. It is often as-
sumed individuals progress through a series of stages in both their addiction and
treatment. Progression can be defined this way:

Progression: The process whereby individuals experience an ever-increasing

feeling of being out of control, increased consequences, and obsessive think-
ing related to their behavior.

The disease model subscribers believe this progression leads to one of two out-
comes: death or recovery. In many ways, it is the process of moving from use to-
ward dependence.
Although there are many theories of how individuals start and continue
through addiction and its recovery, they often follow a similar pattern. Moving
through the stages is more complex than it may first appear. Addicts may pass
through a stage, only to revisit it later in their addiction or recovery. It may be better
to consider these phases rather than stages, as the term phase suggests addicts do
not necessarily move in a consistent direction, nor does one stage need to be com-
pleted before moving to the next.

EXAMPLE

Individual Differences in Progression

Individuals may experience progression at unpredictable and varied paces. One individual
may spend his or her entire lifetime going through the stages, whereas others may never fully
progress to addiction or dependence. Additionally, individuals spend varying amounts of
time at points along the continuum. One individual may spend 6 months at one point and 6
years at another point; another person may spend his or her entire lifetime at a single point.
CHAPTER TWENTY SIX Addictions Counseling 571

䊏 Hallmarks of Addictive Behavior

In considering the continuum concept, professionals often struggle with knowing

when an individual crosses over from the use and misuse side to the abuse and de-
pendence side. Schneider (1994) provided three hallmark criteria useful in making
this decision.

Three Essential Criteria of Addictive Behaviors

1. Loss of ability to freely choose whether to stop or continue a behavior.
2. Continuation of a behavior despite adverse consequences such as loss of
health, job, marriage, or freedom.
3. Obsession with the activity.

First, the loss of ability to freely choose has been widely debated, and depending
on the model from which you conceptualize addictive behaviors (discussed later),
the belief that someone truly loses his or her ability to choose, or simply has the
feeling that he or she has lost the ability to choose, will vary. Second, the conse-
quences may or may not be identifiable by the addict. This is one reason it is impor-
tant not just to assess the addict, but also to gather information from other sources
as well. Finally, obsession is a subjective judgment, but addicts often will spend in-
ordinate amounts of time either preparing for their addictive behavior (rituali-
zations) or thinking about their addiction even when not engaged in the behavior
itself. Although there is no magic number of hours that constitute obsession, if the
thoughts are having an impact on other areas of the individual’s life, it is likely this
criteria is met.

䊏 Tolerance and Withdrawal

Tolerance and withdrawal are two additional concepts critical to consider in distin-
guishing addictive process from use or misuse. The American Psychiatric Associa-
tion (2000) made this distinction:

Tolerance: Refers to either needing more of a substance to achieve intoxica-

tion or the desired effect, or a significant decrease in the effect of the substance
when the same amount is used.

Withdrawal: Physiological symptoms associated with a physical withdrawal

(differs by substance), or the substance as used to relieve or avoid the with-
drawal symptoms.

According to the DSM–IV–TR, an individual can be substance dependent either

with or without tolerance and withdrawal; however, an individual only can be con-
sidered physiologically dependent if tolerance and withdrawal are present. One of
572 Special Topics and Important Trends That Counselors Might Encounter PART FOUR

the issues the DSM–IV–TR does not discuss directly is the concept of psychological
dependence. The differentiation in these terms can be understood this way:

Physiological dependence: Occurs when individuals experience tolerance

and withdrawal in relation to a substance.

Psychological dependence: Refers to individuals who remain dependent on

a substance or behavior for reasons other than physiological ones.

There has been growing acknowledgment, especially in the behavioral addiction

field, that tolerance and withdrawal do occur in cases of psychological depend-
ence. Consider the following example of the psychological dependence related to a
gambling addiction.

EXAMPLE

Gambling: Making the Case for Psychological Dependence

If one examines the criteria for pathological gambling in the DSM–IV–TR, it is clear there are
references to psychological and behavioral symptoms of tolerance and withdrawal. Consider
an addiction to gambling. The criteria state an individual becomes “restless or irritable when
attempting to cut down or stop gambling,” or “needs to gamble with increasing amounts of
money in order to achieve the desired excitement” (American Psychiatric Association, 2000).
Facets of these criteria reflect similar terminology and understanding of physiological de-
pendence.

MODELS OF ADDICTION

There are many models to conceptualize why individuals engage in problematic

use of behavior and substances. There are also a variety of ways to explain how in-
dividuals develop, continue, and recover from an addiction. All the models would
be too numerous to cover in this chapter, but listed here are some common models
for thinking about addictive behavior, along with a very brief description of each
(Coombs, 2005).

䊏 Moral

The moral model suggests addiction is a form of moral weakness, and if the addict
would develop healthy and culturally acceptable morals, the addiction would
dissipate.
CHAPTER TWENTY SIX Addictions Counseling 573

䊏 Medical and Disease

This model suggests addiction is a disease that if left untreated will continue to
progress and worsen and eventually result in the death of the patient. This model is
commonly subscribed to in 12-step circles (e.g., Alcoholics Anonymous, Narcotics
Anonymous, Gamblers Anonymous, etc.), but is greatly debated by medical and
mental health professionals. Critics believe it dismisses the personal responsibility
an individual must assume for his or her behaviors. Some believe addictions, espe-
cially behavioral addictions, are not diseases.

䊏 Spirituality

Although similar to the moral model, this model asserts the individual lacks spiri-
tuality, and if he or she would become more spiritual, the addiction would be
healed. Although most clinicians believe spirituality is an important component of
addiction recovery, this model does not see spirituality as one component, but
rather the only issue that needs to be addressed.

䊏 Impulse Control

This model asserts addictive behavior is due to a lack of internal “stops,” leading to
poor impulse control. Pathological gambling is one of the few behavioral addic-
tions that merited inclusion in the DSM–IV–TR, and it is included under impulse
control disorders. Treatment methods in this model include strong emphasis on
teaching individuals how to identify, manage, and control impulses. Most clini-
cians believe addicts demonstrate poor impulse control, but not all would agree
that addiction and impulse control disorders are one and the same.

䊏 Genetic

The genetic model focuses on understanding the etiology (cause of) addictive be-
haviors. The genetic model asserts addictive behaviors are genetically encoded and
individuals with addiction encoding have genetic predispositions to developing
addictive behavior. This model does not indicate that simply because one has an
“addiction” gene, he or she will automatically become an addict, but rather that
these people are vulnerable to developing addictions given the right environmen-
tal circumstances. The model has yet to explain why individuals choose one sub-
stance or behavior over another, even if an addiction gene can be identified.

䊏 Social Learning

This model suggests addiction is a learned behavior. The process of behavioral and
emotional reinforcement has encouraged the behavior to be repeated with in-
574 Special Topics and Important Trends That Counselors Might Encounter PART FOUR

creased frequency and impact. For example, feelings of pleasure associated with
chemical use can reinforce the repeated use of the substance. Addicts also may ex-
perience relief from their emotional distress as a result of a behavior and use the be-
havior in the future to medicate their stress, another form of reinforcement.

䊏 Bio-Psycho-Social

This model encompasses many of the previously described models. It suggests that
addictions are complex issues involving a myriad of variables—biological and ge-
netic, psychological, and social and environmental. It also asserts treatment meth-
ods must be holistic in their approach and include all aspects (biological, psycho-
logical, and social) to be effective.

䊏 Cultural Implications for Addiction Models

It is important to recognize there are a number of researchers, writers, and clini-

cians who believe addiction is a culturally derived term, and the addiction diagno-
sis is widely overutilized and damaging to individuals struggling with behavioral
and chemical issues (Peele, 1992). Some would argue behavioral addictions are
simply bad behavioral habits, and the term addiction or dependence should be re-
served for the physiological dependence one develops to a particular ingested sub-
stance (e.g., alcohol, heroin, etc.).

SCREENING AND ASSESSMENT

There are numerous approaches to screening for addictions and each of these ap-
proaches offers the clinician valuable information in making an accurate diagnosis.
We outline a number of these in this section along with important considerations to
screening and assessment.

䊏 Physiological and Behavioral Assessment

Assessing for the presence of an addiction is often a lengthy and complex process.
The clinician turns detective and looks for clues suggesting the individual has en-
dured a sustained pattern of out of control behavior for an extended period of time,
typically 12 months or more. A number of factors can hinder the counselor in mak-
ing an accurate physiological and behavioral assessment.
CHAPTER TWENTY SIX Addictions Counseling 575

Barriers in Physiological and Behavioral Assessments

䊏 Addicts often are not forthcoming or honest about their current or past behav-
iors.
䊏 The addict often has perfected strategies to hide his or her addiction from oth-
ers—including clinicians.
䊏 Secrecy about the addiction is valued because it has allowed the addict to sustain
maladaptive patterns.
䊏 Addiction has become an organizing principle in an addict’s life and a way to es-
cape and medicate his or her negative thoughts and feelings.

In part because of these barriers to making an accurate assessment, if possible, it is

important to interview not only the addict about his or her behavior, but also those
known as collateral informants.

Collateral informants: Individuals who are close to the situation (e.g., part-
ner, family, employer, etc.) and who are most likely to know about the addic-
tion.

The intent of engaging in collateral interviews is not to catch or punish the addict;
rather, there are a number of positive aims of this strategy, some of which are listed
here.

Goals of Using Collateral Informants

䊏 The perception of others is often enlightening not only to the clinician, but also to
the addict himself or herself.
䊏 Collateral interviews make apparent that the behavior the addict believed he or
she was concealing so well was known to others.
䊏 Collateral interviews illuminate the breadth and depth of issues with which the
addict is struggling.

Interviewing a significant other can create some professional dilemmas and be det-
rimental to the addict if not done with sensitivity and caution. It is suggested close
supervision or consultation be used should a clinician decide to conduct collateral
interviews.

䊏 Clinical Interviewing

A clinical interview is an important step in the assessment and treatment planning

process. There are a number of benefits to the interview process.
576 Special Topics and Important Trends That Counselors Might Encounter PART FOUR

Advantages of the Clinical Interview

䊏 The clinical interview can help the client clarify the problem and its history, the
first step in solution development.
䊏 It can provide a wealth of information to be incorporated into the treatment plan-
ning process, both short term and longer term.
䊏 The clinical interview is extremely useful in establishing a strong rapport with
the addict—disclosing a secret life in a safe, healthy way can create a strong,
trusting bond between a clinician and client.

A clinical interview is not a one-time event, but best occurs over a series of meet-
ings where both the client and clinician have an opportunity to process the ques-
tions and responses. There are a number of standardized clinical interview pro-
tocols published to help assess addicts, especially those who are chemically
dependent. These standardized interviews can be useful, but clinicians should not
rely on them solely. Good addiction clinicians use their intuition and help direct the
client in the moment, rather than ask a series of seemingly unrelated questions.
There are a number of areas that the clinical interview should address.

Key Components of a Clinical Interview

䊏 Complete family (past and present) history.
䊏 Educational history.
䊏 Work history.
䊏 Legal history.
䊏 Psychosocial background.
䊏 Medical history.
䊏 Drug and alcohol use history.

One interviewing method that has grown in popularity over the past several
years is called motivational interviewing (MI; Miller & Rollnick, 2002).

Motivational interviewing: An interview method in the addictions field that

is founded on a high-quality clinical interview, incorporates many basic
counseling skills (e.g., active listening, reflection of feeling and content, para-
phrasing, etc.), and has a focus on an addict’s motivation to engage in the
change process.

MI not only helps gather important information about the addict’s story, but helps
clarify the addict’s strengths and abilities, which in turn aids the addict in
becoming more motivated for change. The stages of change are addressed later in
this chapter, but suffice it to say that MI assesses motivation and helps the addict
move from thinking about change into becoming motivated to take action for
change.

For more on MI and the role and place of motivation in the change process, see Chapter 27.
CHAPTER TWENTY SIX Addictions Counseling 577

䊏 Psychometric Instruments

There are hundreds of screening and assessment instruments available to assess for
the presence and extent of addictive behavior. Most of these instruments are struc-
tured to assess for chemical or substance use. Few assess for behavioral addictions,
and those that do exist have limited validity and reliability. In cases where behav-
ioral addictions are suspected, general addiction instruments may be used, but
should be interpreted cautiously.
When deciding to use a psychometric instrument, the clinician should keep in
mind the following suggestions for interpreting results.

Recommendations for Using Psychometric Test Results

䊏 Test results should always be used in conjunction with other methods of assess-
ment, including clinical interviewing and history taking.
䊏 The results of testing should always be interpreted in the context of other infor-
mation such as demographic characteristics of the client (e.g., reading level, cul-
tural differences, age, etc.), results of clinical interviews, diagnostic criteria, col-
lateral informants, and so on.

For a comprehensive list of tests for both substance-related addictions and behav-
ioral addictions, please refer to the Coombs and Howatt (2005) text called The Ad-
diction Counselor’s Desk Reference.

䊏 Diagnosis and Co-Occurring Disorders

The official diagnosis of substance dependence or other addictive type behavior re-
quires clinicians to review multiple areas of the DSM–IV–TR to assess addicts for
co-occurring conditions that may be present with addictive disorders, substance
use and otherwise. For example, pathological gambling is included under impulse
control disorders. Impulse control disorders also may apply to other addictive be-
haviors (e.g., work, shopping, etc.), but only if they meet the basic criteria for an im-
pulse control disorder.

Although it is important to screen for major

personality issues with addicts, it is also
important to look for common co-occurring
factors such as depression, anxiety, attention
deficits, obsessive-compulsive features, and so on.
Addicts who stop their addictive behavior or
substance use are likely to relapse if these other
issues are not assessed and addressed.
578 Special Topics and Important Trends That Counselors Might Encounter PART FOUR

Although it is important to screen for major personality issues with addicts, it is

also important to look for common co-occurring factors such as depression, anxi-
ety, attention deficits, obsessive-compulsive features, and so on. Addicts who stop
their addictive behavior or substance use are likely to relapse if these other issues
are not assessed and addressed. A full psychological evaluation, including com-
mon psychological testing (e.g., Minnesota Multiphasic Personality Inventory–II)
is imperative to effective treatment planning for any type of addict.

䊏 Intervention Level Assessment

One goal of the assessment process is to determine the intervention level to best fit
the needs of the addict. Listed next is the American Society for Addiction Medi-
cine’s (ASAM, 2001) Patient Placement Criteria levels used to place patients at the
appropriate level of treatment.

Intervention Levels (ASAM, 2001)

䊏 Level .5: Early interventions include psychoeducational tasks that teach individu-
als about addictive behavior and attempt to get change to occur with little inter-
vention or treatment.
䊏 Level I: Outpatient represents a standard outpatient setting where the individual
participates in various modalities of treatment (individual, group, family, etc.)
throughout the week, but continues all other areas of his or her life as normal.
䊏 Level II: Intensive outpatient/partial is one step above an outpatient setting and al-
lows for more intensive time with the addict. Typically the individual spends
several hours each day, 5 days per week, meeting with therapists, participating
in groups, and so on. The addict typically maintains his or her schooling or em-
ployment and participates in the intensive program in the evening or on week-
ends.
䊏 Level III: Residential/inpatient requires an admission to a treatment facility for any-
where between 14 and 30 days in length. During this time the individual stays at
the treatment center. He or she participates in many individual, group, and fam-
ily sessions, while eating, sleeping, and living with other addicts struggling to
manage their own addictions.
䊏 Level IV: Medically managed intensive inpatient requires admission to a medical fa-
cility. This level of management typically is required when substance with-
drawal occurs that could place the addict into medical danger if not monitored
by a medical staff.

A well-performed, comprehensive assessment is critical in planning appropri-

ately staged interventions. Although there is no exact science to determining these
levels, some basic guidelines for assessment are suggested.
CHAPTER TWENTY SIX Addictions Counseling 579

Some Guides for Determining Level of Treatment

䊏 Begin with the least intrusive method and increase the intensity of treatment if
necessary.
䊏 Remember that the more significant the history, current crisis, and pace of pro-
gression the greater the warrant for a more intense intervention level.
䊏 Keep in mind that one goal of treatment is to help addicts function in a less re-
strictive environment.

EXAMPLE

Making Adjustments in Assessment

Initially it may appear an addict is best suited for outpatient treatment; however, if once treat-
ment begins the addict shows increased problematic signs, or it is discovered the problem is
more significant than initially believed, the treatment may be raised to a higher level. Making
necessary adjustments is important because addicts who are placed at the wrong level and re-
main there for too long actually may decline in overall health and wellness and have less
chance of long-term recovery.

INTERVENTION AND TREATMENT CONSIDERATIONS

Addiction treatment and recovery is complex and often is an individualized pro-

cess. Some of the more salient features of the intervention and treatment process
are mentioned here.

䊏 Crisis Management

Addicts often present in treatment in a state of crisis. The crisis may be precipitated
by a family discovery, legal consequences, medical issue, or the internal sense they
have “hit their bottom.” It is for this reason that good crisis management skills are
necessary in addictions counseling. Some suggestions for handling crises are pro-
vided next.

Recommendations for Responding to Crises

䊏 Triage the situation and determine a priority of interventions.
䊏 Manage immediate crises in a swift and direct manner, so other forms of treat-
ment will be successful once the crisis situation dissipates.
䊏 Adhere to a crisis assessment model to make decisions regarding crisis interven-
tion.
580 Special Topics and Important Trends That Counselors Might Encounter PART FOUR

One model that helps triage the level of crisis is the triage assessment model (Myer,
2000), and although space limits its inclusion in this chapter, it is strongly sug-
gested that clinicians use this or a similar model.

See Chapter 25 for more on crisis and the triage assessment model.

䊏 Behavioral Change

One of the most helpful concepts in understanding addiction treatment is the stages
of behavior change (Prochaska, Norcross, & DiClemente, 1995). These stages apply
to any significant change an individual makes in his or her life. Therefore, although
they are useful in addiction work, these stages also are very useful in other forms of
treatment. The stages are listed next, along with a brief explanation of each.

Stages of Behavior Change

1. Precontemplation occurs when individuals are not aware of any problems or is-
sues and are not even considering that change may be necessary.
2. Contemplation begins when individuals explore the possibility that change may
be forthcoming. They tend to be ambivalent about whether or not change is
necessary, but they are at least considering the possibility of change.
3. Preparation begins when individuals try small changes just to see how they re-
spond to the changes. This is the time when they are testing the waters just to
see what might happen if change should occur.
4. Action is noticeable when individuals have determined that change is neces-
sary and actually are making the changes in their life. To consider someone to
be in the action stage, that person has to be making behavioral changes for
more than 3 months.
5. Maintenance refers to individuals who remain in the action phase for more than
6 months and have made a commitment to sustaining the changed behavior.
6. Relapse is a normal part of the change process. As individuals learn about the
new behavior and experiment with the differences they feel as a result of the
behavior change, it is not unusual to encounter relapse. The relapse itself is of-
ten not the issue, but how the individual responds to the relapse can determine
whether he or she returns to the contemplation or the action phase.
7. Termination occurs when individuals are certain their behavior has been suc-
cessfully changed and resolved. They believe the behavior will not return, and
they need to do little to prevent any form of relapse. Most addiction profession-
als believe that this stage is not realistic in the treatment of addicts, as it is often
viewed as a lifelong issue.

䊏 Treatment Modalities

There are many ways to intervene with an addiction, and much of the process is de-
pendent on the model from which one conceptualizes addictive behavior. How-
CHAPTER TWENTY SIX Addictions Counseling 581

ever, the modalities of treatments are fairly universal. A list of common treatment
strategies is provided here.

Common Treatment Strategies

䊏 Individual treatment often is useful in early treatment to allow for a full assess-
ment and help the individual more fully understand his or her addiction.
䊏 Group therapy is another highly useful modality of treatment for addicts be-
cause other addicts can help confront and support one another under the guid-
ance of a trained group leader.
䊏 Twelve-step recovery groups often serve as an adjunct to individual and group
treatment. These groups are extremely useful in helping addicts get clarity on their
issue and develop intimate friendships with others struggling with similar issues.
䊏 Couples or family therapy is also useful, because addictive behavior typically
impacts the entire family, and everyone in the family can work together to heal
the relationships that may have been affected by the addiction.

Each modality of treatment has advantages and disadvantages, but all should be
considered in the treatment planning process.

䊏 Beyond Addiction Management

The slang term “dry drunk” is used to describe an addict who has become absti-
nent from his or her addictive drug or behavior, but continues to exhibit traits that
often accompany an addiction. For this reason, treatment of addicts goes far be-
yond simply getting them to stop their behavior.

Ways to Address Periphery Issues in Addictions

䊏 Recognize traits such as poor social skills, inability to develop intimate relation-
ships, narcissistic features, and lack of self-care as accompaniments to addiction.
䊏 Address underlying issues that led to the addiction in the first place.
䊏 Address new issues (e.g., intimacy, sexuality, spirituality, grief and loss, family of
origin, trauma or abuse) that rise to the surface as the addiction is being man-
aged.

䊏 Dual Diagnosis

Dual diagnosis is not uncommon in work with addicted clients because addictive
disorders can develop due to other disorders, and vice versa; however, it is often
overlooked and complex to treat. The term dual diagnosis can be understood this
way:

Dual diagnosis: Refers to individuals who have some form of addiction, typi-
cally a chemical addiction, and an additional Axis I diagnosis.
582 Special Topics and Important Trends That Counselors Might Encounter PART FOUR

Often the nonaddiction diagnosis requires medications carefully balanced not to

create new problems or other forms of dependence (i.e., switching addictions). Ad-
ditionally, both diagnoses must be addressed and managed to avoid creating an en-
vironment for an addictive relapse or other mental health difficulties. Some of the
more frequently seen co-occurring diagnoses are listed here.

Common Co-Occurring Disorders With Addictions

䊏 Mood disorders (e.g., depression, anxiety, etc.).
䊏 Adjustment disorders.
䊏 Impulse control disorders.
䊏 Obsessive-compulsive disorders.
䊏 Attention deficit disorder.

An individual might not meet the full criteria for a secondary mental health disor-
der (e.g., obsessive-compulsive disorder) but may have many of the characteristics
of the disorder. Clinicians often report addicts have “features” of a disorder, rather
than meeting the full criteria for a disorder. Although this technically is not a dually
diagnosed individual, the features of the other disorders must be addressed for ad-
diction treatment to have a long-lasting impact.

䊏 Pharmacological Interventions

As we learn more about the brain and addictive disorders, and the relation be-
tween various neurochemicals, the use of medications in the treatment of addic-
tions is playing a more critical role. As previously mentioned, the addiction may
be one symptom in a myriad of issues needing to be addressed with all forms of
treatment, including medications. Everything from alcohol-sensitivity medica-
tions (Antabuse) to medications for depression, anxiety, and obsessive-compul-
sive disorders has been used.

Recommendations for Clinicians Regarding

Psychopharmacological Interventions
䊏 Recognize that the use of prescription medications to treat some addictive be-
haviors often is warranted.
䊏 Use caution when discussing medications with clients.
䊏 Ensure that addicts are under the care of a qualified physician.
䊏 Remain current on the types of treatments employed by the medical profession
in treating addictive disorders.

䊏 Special Populations

There are standardized ways of approaching the treatment of addiction, often de-
pending on the addiction model being used (see addiction models). However,
CHAPTER TWENTY SIX Addictions Counseling 583

there are special populations that may require additional consideration. These
groups include addicted women; adolescents; and gay, bisexual, and lesbian indi-
viduals, just to name a few. These groups may have some unique issues to consider
in the treatment of their addiction. Given space limitations, it is not possible to dis-
cuss the unique characteristics of these and other groups, but clinicians should
know they exist and not ignore them when conducting assessments and preparing
for treatment.

䊏 Defining Successful Treatment

Success is often a subjective, not objective measure. There are objective variables
one could measure—relapse, attendance at meetings or group therapy, improve-
ment on measures of addiction, lower depression and anxiety scores, and so on—
but these measures do not necessarily measure success. For example, an individual
who has a relapse objectively may be considered a treatment failure, when in fact,
the relapse is naturally occurring part of recovery that helps the individual become
even more committed to a program of recovery, thereby, making it a subjective suc-
cess rather than an objective failure.
Another point to consider when defining success is the concept of abstinence
versus controlled (or moderated) use. Two important terms in controlled use are
moderated management and spontaneous recovery, defined as follows:

Moderated management: Models of addiction treatment that see the goal of

recovery as moderation rather than complete abstinence from the behavior or
substance.

Spontaneous recovery: The premise on which moderated management is

built; refers to the assumption that many individuals learn to manage their
“bad habit” without any type of professional intervention—it just simply
happens. Therefore, many addicts do not require lifelong abstinence, but
rather other forms of treatment that help them to not misuse a substance or
behavior.

Most chemical dependency professionals believe in the abstinence model, which is

another perspective used in assessing successful treatment.

Abstinence model: Individuals only can be considered healthy and recover-

ing if they are not using any of the substance to which they are addicted.

In this model, abstinence is seen as a lifelong goal where individuals must forfeit
their use of a substance or unhealthy behavior for the remainder of their life. This
model may work well for substance addictions that are not a necessary part of sur-
vival, but it is difficult to translate these ideas into behavioral addictions such as
food and sex, where abstinence is not the goal, but rather healthy, moderated use.
This is not to say that the food addict or sex addict may have certain behaviors or
584 Special Topics and Important Trends That Counselors Might Encounter PART FOUR

foods that are “off limits,” but it is unhealthy to assume individuals would be absti-
nent from all food or sexual behavior.
The other concept worth mentioning at this point is switching addictions.

Switching addictions: The phenomenon often seen when individuals stop or

reduce one addiction and trade it for another.

Until the addiction process is addressed, many times individuals simply bounce
from one substance or behavior to another. Outlined next are typical points in the
addiction process.

Points on the Addiction Cycle

䊏 An individual uses a substance or a behavior to experience pleasure or medicate
negative feelings.
䊏 After the effect of the behavior or substance subsides, feelings of guilt and re-
morse associated with the choice to use generate more negative thoughts and
feelings.
䊏 Unsure of how to cope with these thoughts and feelings, addicts often turn to
their drug of choice to feel better again.
䊏 The cycle feeds itself and in a well-established pattern, may repeat hundreds or
thousands of times in an addict’s life.

There is no simple way to measure an addict’s success, other than to know it is a

very individualized definition. Perhaps some chemically dependent individuals
can learn to moderate their alcohol intake, but others cannot. Perhaps one sex ad-
dict can learn to incorporate healthy masturbation into his or her life, but for an-
other, masturbation is a trigger sending him or her into an out-of-control down-
ward spiral of negative thoughts, feelings, and behaviors. Success is individually
defined, but should be done with the help of a knowledgeable, objective, and hon-
est outside person, such as a qualified addiction clinician.

EXAMPLE

Being Aware of Addiction Switching

It is not uncommon for an alcohol-dependent individual to switch to nicotine when he or she
becomes “sober” from alcohol. Or, an individual might switch his or her gambling addiction
to compulsive shopping or spending. This is one reason it is important for helping profession-
als to understand the process of addiction rather than focus on the specific behavior or chemi-
cal in question.
CHAPTER TWENTY SIX Addictions Counseling 585

䊏 Legal, Ethical, and Professional Issues

Many times when working with addicted individuals, the legal system will be in-
volved. Sometimes addicts have difficulty controlling their behaviors in other ar-
eas of their lives as well, and issues such as domestic violence, assault, and abuse or
neglect of children are not uncommon among addicted individuals. When the legal
system is involved, cases are often very complex and clinicians can easily encoun-
ter ethical and professional dilemmas.
Additionally, issues of confidentiality differ for addiction treatment agencies
and may vary by state. The professional issues that arise are complicated enough to
warrant mentioning, but too complicated to delineate in this chapter. When work-
ing with the addicted population, it is important to have good supervision, consult-
ing relationships with other medical and mental health providers, and a
well-versed attorney regarding professional issues in treating addictions in your
state.

Chapter 26: Key Terms

䉴 Substance addiction 䉴 Withdrawal 䉴 Dual diagnosis
䉴 Process or behavioral ad- 䉴 Physiological dependence 䉴 Moderated management
diction 䉴 Psychological dependence 䉴 Spontaneous recovery
䉴 Progression 䉴 Collateral informants 䉴 Abstinence model
䉴 Tolerance 䉴 Motivational interviewing 䉴 Switching addictions
chapter Ecological-Transactional and Motivational
Perspectives in Counseling
27
Martin F. Lynch
University of South Florida

Lisa Lopez Levers

Duquesne University

In This Chapter

䉴 Background to the Ecological-Transactional Model

䊏 Best Practices in Counselor Education: Emphasis on Context and Culture

䊏 Deficits of Traditional Theories in Counselor Education

䉴 An Ecological-Transactional Developmental Framework

䊏 Learning Theory: Vygotsky

䊏 Attachment Theory: Bowlby

䊏 Bioecological Human Development: Bronfenbrenner

䉴 The Ecological-Transactional Model and Professional Counseling

䊏 Developmental Psychopathology

䊏 Resilience

䊏 Assessing Risks and Protective Factors

䉴 Self-Determination Theory
䊏 Organismic and Dialectical Underpinnings of Self-Determination Theory

䊏 Basic Psychological Needs and the Social Context

䊏 Reasons for Nonintrinsic Actions

䊏 Motivation

䉴 Relating Self-Determination Theory to the Helping Professions

䊏 Blocks to Clients’ Motivation Toward Change

䊏 How Can Counselors Help Motivate Clients for Change?

䊏 Empirical Evidence for Self-Determination Theory and Autonomy Support

䊏 Recommendations for Providing an Autonomy Supportive Context

䉴 Conclusion

586
CHAPTER TWENTY SEVEN Ecological-Transactional and Motivational Perspectives 587

BACKGROUND TO THE ECOLOGICAL-TRANSACTIONAL MODEL

In this chapter, we provide a brief discussion of the ecological-transactional ap-

proach, followed by a more extensive discussion of a contemporary motivational
approach known as self-determination theory (SDT). These two perspectives share
a view of the individual-within-larger-multiple contexts, and together suggest a
useful model for understanding the process of change within counseling. Through-
out, we offer theory-based examples of counseling interventions that are compati-
ble with these perspectives.

䊏 Best Practices in Counselor Education: Emphasis on Context and Culture

Widely accepted best practices in counselor education typically promote course

work that emphasizes the importance of mediating counseling endeavors through
appropriate cultural lenses and in consideration of social contexts. A number of ar-
eas that are endorsed in these best practices include the following:

Best Practice Areas Emphasized in Counselor Education Curriculum

䊏 Diversity counseling.
䊏 Psychosocial interventions.
䊏 Systems approaches.
䊏 Developmental and integrative theoretical perspectives.

The theoretical tone that underlies these best practice areas encourages a shift from
thinking exclusively in terms of the largely decontextualized psychological per-
spective on which counselor education curricula often are based. Rather, counsel-
ing professionals are encouraged to embrace a broader paradigmatic perspective
that reflects a more interdisciplinary, and hence, psychosocial and culture-inclusive
view (see Cottone, 1992, for excellent analyses of multiple paradigms of counsel-
ing).

䊏 Deficits of Traditional Theories in Counselor Education

Some traditionally accepted psychological theories (e.g., Freud’s psychoanalytic

approach, Erikson’s psychosocial perspective, etc.) that are taught in counselor ed-
ucation programs might be critiqued as being generally necessary but not suffi-
cient. These models tend to focus necessarily on the individual, but do not account
sufficiently for important social, cultural, and contextual influences that individu-
als continually must negotiate within their environments. A few earlier psycholog-
ical models account for environmental and transactional dimensions of human ex-
istence; the term transactional implies that person and environment mutually and
reciprocally influence each other. These earlier models, however, historically have
588 Special Topics and Important Trends That Counselors Might Encounter PART FOUR

not been emphasized in counselor education programs, beyond rudimentary men-

tion in the one “womb-to-tomb” human development overview course that coun-
selor trainees are required to take within the larger counselor education curricu-
lum. These earlier models as well as two newer models are mentioned here as
examples of approaches that account for the social and cultural deficits of tradi-
tional psychological theories.

Models That Account for Contextual Influences

䊏 Bowlby’s (1973, 1980, 1982, 1988) attachment theory.
䊏 Bronfenbrenner’s bioecological model of human development (Bronfenbrenner,
1979, 2001, 2004; Bronfenbrenner & Ceci, 1994).
䊏 Developmental psychopathology (e.g., Belsky, 1993; Cicchetti & Aber, 1998;
Cicchetti & Lynch, 1993, 1995; Cicchetti & Toth, 1995; Garmezy 1993).
䊏 An ecological-transactional approach (e.g., Cicchetti & Lynch, 1993; Cicchetti &
Toth, 1995).

Both the developmental psychopathology perspective and ecological-transactional

models are theoretical approaches not typically emphasized in counselor educa-
tion programs. However, these models are of enormous utility for professional
counselors working, for example, with maltreated children, and by extension, for
working with adults who exhibit the characteristics of psychopathology often asso-
ciated with early childhood trauma.

AN ECOLOGICAL-TRANSACTIONAL
DEVELOPMENTAL FRAMEWORK

This section provides a brief background on three theoretical perspectives that

form the ecological-transactional developmental framework suggested to be of im-
portance to counselors. Summaries of the ideas posed by three key theoreticians—
Vygotsky, Bowlby, and Bronfenbrenner—are presented; applications of this frame-
work along with several salient concepts are offered.

䊏 Learning Theory: Vygotsky

Although Vygotsky originally developed his models in relation to learning theory

and child development, these theories have been incorporated usefully into adult
learning and development theory. Two of the most helpful concepts that Vygotsky
(1978, 1986, 1997) introduced are the zone of proximal development and scaffold-
ing, understood this way:
CHAPTER TWENTY SEVEN Ecological-Transactional and Motivational Perspectives 589

Zone of proximal development: The dynamic and interactive process be-

tween what a child is capable of doing by himself or herself and what a child
can do with the assistance of a parent, teacher, or mentor.

Scaffolding: The fluidity of children’s competencies on which further devel-

opment can hinge.

See Chapter 8 for more on Vygotsky and these key concepts.

䊏 Attachment Theory: Bowlby

Some developmental theorists point to the primacy of the mother–infant relation-

ship, especially early attachment (e.g., Bowlby, 1973, 1980, 1982, 1988) and infant
competency and its interactive dimensions (e.g., Belsky, Rovine, & Taylor, 1984;
Belsky, Spritz, & Crnic, 1996; Isabella, Belsky, & von Eye, 1989; Lebovici, 1995;
Osofsky, Wewers, Hann, & Fick, 1993; Vygotsky, 1978). Accordingly, development
does not result simply from how the parent acts on the child, but rather, is viewed
as evolving from the reciprocal interaction of caregiver and child. Attachment the-
ory (e.g., Bowlby) has provided a framework for understanding the human need
for security and safety and the effects on individuals of separation, loss, and
trauma.

䊏 Bioecological Human Development: Bronfenbrenner

Within the context of his bioecological model, Bronfenbrenner (2004) defined de-
velopment this way:

Human development: The “phenomenon of continuity and change in the

biopsychological characteristics of human beings both as individuals and as
groups. The phenomenon extends over the life course across successive gen-
erations and through historical time, both past and present” (p. 3).

Bronfenbrenner’s (1979) theory of human development views the individual, with

all his or her personal attributes, as affected by and interactive with multiple envi-
ronmental systems. These systems are interactive with one another and with the in-
dividual, postulating reciprocal influences between the individual and the envi-
ronment. The ecological systems of influence that Bronfenbrenner identified are
noted here.

Ecological Spheres of Human Development

䊏 Ontogenic (individual).
䊏 Microsystemic (immediate family environment).
䊏 Exosystemic (community and neighborhood).
䊏 Macrosystemic (broad cultural values and beliefs).
590 Special Topics and Important Trends That Counselors Might Encounter PART FOUR

From proximal to distal influences, environmental factors have an impact on the

person in stage-salient ways; and continual transactions within the environment,
or ecology, determine the risk or protective factors present in the individual’s ecol-
ogy. Risk and protective factors can be defined this way:

Risk factors: Those that have the potential to interrupt the individual’s nor-
mal developmental pathway or trajectory, such as exposure to violence.

Protective factors: Those that can serve to buffer the individual from the in-
fluence of risk factors, such as the presence of a caring and nurturing adult.

Bronfenbrenner also identified 10 propositions that can be viewed as intrinsic to

the model, as well as to the continuing evolution of, assessment of, and research
from the perspective of the model. Elements from a number of these propositions
are mentioned here.

Some Key Elements of Bronfenbrenner’s Model of Development

䊏 The importance of subjective experience, along with the objective perspective is
stressed.
䊏 Proximal processes (those more immediate to the person within the larger eco-
logical system), or enduring forms of interaction over extended periods of time,
are emphasized.
䊏 Involvement in progressively more complex processes is recognized.
䊏 Mutual attachments that endure over time are highlighted.
䊏 Continuity and change are integral properties of the model.

Finally, an essential characteristic of Bronfenbrenner’s model is the rich framework

it provides for clinicians in assessing risks and protective factors in the lives of cli-
ents and in constructing interventions that can minimize or eliminate risks, medi-
ate risks, or foster or enhance protective factors. This provides a vast horizon for
creative applications, both theoretically and clinically.

EXAMPLE

Bronfenbrenner’s Bioecological Theory in Clinical Practice

Using Bronfenbrenner’s model, the clinician can conduct an assessment of the risk and protec-
tive factors present within the various levels of the client’s ecological system. The clinician
might discover, for example, that a child client lives in a neighborhood where a risk factor such
as exposure to violence is common. The clinician might, however, be in a position to facilitate
access to resources, such as a university-sponsored after-school program, that could help to
offset the risk of that exposure, even though the violence itself may continue. As this example
suggests, taking an ecological perspective can sometimes mean stepping outside the confines
of the counseling office, figuratively and perhaps at times literally.
CHAPTER TWENTY SEVEN Ecological-Transactional and Motivational Perspectives 591

THE ECOLOGICAL-TRANSACTIONAL MODEL

AND PROFESSIONAL COUNSELING

A significant aspect of the theoretical models discussed here is the possibility for
constructing interventions that resonate at the individual, environmental, and sys-
temic levels. An important application of ecological and transactional models can
be seen in the rich and growing areas of developmental psychopathology (e.g.,
Cicchetti & Lynch, 1993, 1995; Cicchetti & Toth, 1995) and resiliency.

䊏 Developmental Psychopathology

Traditional educational and psychological theories regarding child and adolescent

development in normative populations, and psychiatric theories regarding psy-
chopathology in clinical populations, have fallen short of providing the much
needed ecological perspective from which to view the contextual experiences of
children coping with abuse or other types of maltreatment. Developmental psy-
chopathology has evolved in response to the need for more effective ways to help
people recover from traumatic experiences and provides a theoretical basis for con-
sidering environmental risks and protective factors. This approach can be defined
this way:

Developmental psychopathology: A combination of ecological and trans-

actional theories that studies the contributions of the person and the environ-
ment to both adaptive and maladaptive developmental outcomes. Such an
approach, for example, might identify maltreated, or at-risk children, as be-
ing deleteriously affected by abnormal events, or risk factors, that alter what
would be their otherwise relatively normal developmental pathways.

In developmental psychopathology, it is this disrupted or alternative develop-

mental trajectory that is viewed as deviant, not the child. Without intervention, the
affected children eventually may develop characteristics associated with and per-
haps leading to psychopathology, but the emphasis of the neoecological theories is
on the need for identifying protective factors to mediate environmental risks.
Developmental psychopathology (Belsky, 1993; Cicchetti & Lynch, 1993, 1995;
Cicchetti & Toth, 1995) provides a framework that accounts for some of the short-
comings of traditional approaches.

How Developmental Psychopathology Accounts

for Shortcomings in Traditional Theory
䊏 The theory understands the interplay between normal development and abnor-
mal events.
䊏 The theory provides essential clues for beginning to comprehend the effects of
chronic violence on children, especially in terms of risk factors.
592 Special Topics and Important Trends That Counselors Might Encounter PART FOUR

䊏 Developmental psychopathology accounts for distal and proximal influences

across nested systemic levels that affect children in stage-salient ways.

Importantly, in the face of multiple and interactive risk factors, some children have
emerged from “high-risk” situations exhibiting compensatory or protective factors
(Garmezy, 1993). Cicchetti and Lynch (1993) detailed an ecological-transactional
model, offering an avenue for comprehensively understanding the influence of
multiple factors, at multiple levels, on children’s development. Continual transac-
tions within the environment, or ecology, determine what constitutes risk or pro-
tective factors.

EXAMPLE

Implications of Developmental Psychopathology

for Treatment of Traumatized Adults
The transactional nature of development offered in this model is imperative to understanding
the complex, sometimes paradoxical, effects of maltreatment on children at multiple systemic
levels and then intervening effectively. Although developmental psychopathology focuses on
the developmental issues of maltreated children, as well as the possibility for mediating the
risks associated with maltreatment, there are definite implications for the development of
adults who have survived early childhood trauma. Many professional counselors are assisting
clients, across the life span, in dealing with issues of trauma. Any traumatic incident can pose
multiple risks for the individual, but by accounting for protective factors that can mediate (or
ameliorate) more intrusive risk factors, the model also allows for a productive consideration of
facilitating resiliency in the face of trauma.

䊏 Resilience

Following this developmental-ecological theoretical discourse, Garbarino (1993)

presented a “framework for understanding the developmental significance of vio-
lence-related trauma in the lives of young children” (p. 103). He posited that there
are significant developmental differences between acute trauma and chronic
trauma, as well as differing phenomenological constructions for responses and ad-
aptations to perceived danger versus responses and adaptations to actual trauma.
Interaction and competence become key factors in situations of trauma, because
the child’s competency-based development depends on having access to reliable
adults who can help interpret meaning in a protective, or at least self-efficacious,
way.
Garbarino (1995) linked the child’s “reservoirs of resiliency” to the ability of par-
ents (or other responsible caregivers) not only to “buffer” the consequences of
trauma, but beyond that, to interpret events in ways that enable children to derive a
CHAPTER TWENTY SEVEN Ecological-Transactional and Motivational Perspectives 593

sense of personal meaning reflective of self-preservation; this ability to engage in

personal meaning making (Bruner, 1990; Carlsen, 1988) can be considered a resil-
iency factor, one that contributes to a restoration or construction of a personal sense
of safety or equilibrium, as appropriate to the situation. Broadly speaking, resil-
ience can be defined this way:

Resilience: Positive or adaptive developmental outcomes, despite the pres-

ence of risk factors or adversity.

For example, a child who has been exposed to multiple or chronic risk factors,
but whose adjustment in major life domains (e.g., interpersonal relationships,
school success, and self-concept) is on the whole positive, could be said to demon-
strate a degree of resilience. Boyce et al. (1998) stated that such “contexts have mul-
tiple dimensions that add to, moderate, and mediate one another in influencing
children’s behavioral and emotional development” (p. 147). Although Luthar,
Cicchetti, and Becker (2000) cautioned that research in the area of resilience must
attend to the serious conceptual and methodological problems that have been pres-
ent in a number of studies to date, they emphasized legitimate avenues of resil-
iency research that can enhance current understandings of at-risk children.

䊏 Assessing Risks and Protective Factors

The bioecological model offers a theoretical framework for assessing the risks that
may be present across multiple systemic environments in the life of an individual.
By better understanding a person’s risk factors, a counselor may be positioned
better to identify protective factors and inner resources that also may be present,
thus opening the possibility for successful intervention and mediation. However,
important questions emerge about client motivation. In other words, when people
are experiencing the negative effects of multiple environmental or interpersonal
risks, professional counselors need to consider how to motivate them to tap into
their own existing resiliencies or to use what protection is available from the envi-
ronment. One theory of motivation that is compatible with ecological and trans-
actional theories is self-determination theory (SDT).

SELF-DETERMINATION THEORY

Self-Determination Theory (SDT) is a theory of personality development and

self-motivated behavior change that uses traditional empirical methods while em-
phasizing the application of research findings in a number of practical domains
such as education, sports, work, religion, and, importantly, counseling and psycho-
therapy (Deci & Ryan, 1985; Ryan & Deci, 2000). Deci and Ryan’s (1985) elegant the-
ory of self-determination accounts for individual, as well as environmental, moti-
594 Special Topics and Important Trends That Counselors Might Encounter PART FOUR

vational aspects of persons’ experiences. Their theory is congruent with other

ecological and transactional theories. In this introduction to SDT, three core tenets
of the theory are described:

1. Organismic and dialectical perspectives from which SDT developed.

2. The role of basic psychological needs and the environment in SDT.
3. Internal and external motivation.

䊏 Organismic and Dialectical Underpinnings of Self-Determination Theory

In its study of personality growth and development, SDT embraces a perspective

that is both organismic and dialectical. Organismic theories have roots that extend
back as far as Aristotle, and find more contemporary expression in the work of
thinkers such as Piaget, Dewey, and the humanistic psychologists. A basic assump-
tion of the organismic viewpoint is that living things are different from nonliving
things in some pretty fundamental respects (see Overton, 1976; Ryan & Deci, 2002;
Sheldon, Williams, & Joyner, 2003). Three other assumptions that are an outgrowth
of this fundamental belief and that are central to SDT are noted next.

Organismic Assumptions of SDT

1. There is a natural tendency toward growth and integration that characterizes
things that are alive, including human beings. Living things naturally tend to
integrate and organize their experience, attaining greater and greater complex-
ity over their life course.
2. Humans are by nature more active than reactive. Although we are never en-
tirely free of environmental influences, we are proactive, guided by inner mo-
tives and needs that subserve the first principle, that of growth, organization,
and integration.
3. The tendency toward growth and integration, and the tendency to be proactive
rather than reactive, are not taken for granted.

Particularly in regard to the third assumption, SDT concerns itself with the so-
cial-contextual circumstances that can either support these natural, organismic ten-
dencies, or can forestall and undermine them.
SDT thus provides an account for a wide range of developmental outcomes, sug-
gesting that growth and positive development are promoted in contexts that foster
these natural tendencies, whereas less favorable outcomes can be expected in con-
texts that prevent or inhibit them. In other words, SDT posits a kind of dialectical
tension between an active, integrating human person on the one hand, and the so-
cial environment, on the other. The classic formula or dialectic process that under-
lies SDT is summarized here.
CHAPTER TWENTY SEVEN Ecological-Transactional and Motivational Perspectives 595

Dialectical Formula
䊏 Life in the physical and social world presents challenges (theses).
䊏 The person must respond to the world’s challenges (antitheses).
䊏 Responses to theses, or life challenges, optimally lead to new levels of complexity
and integration (syntheses).

The organismic tendency, in other words, unfolds in a physical-social context in a

dialectical fashion. Its organismic-dialectical perspective thus situates SDT within
the ecological-transactional framework outlined by Bronfenbrenner (1979) and by
Cicchetti and Lynch (1993).

䊏 Basic Psychological Needs and the Social Context

Drawing on the organismic perspective, early SDT theorists recognized that living
things clearly have biological needs for things like hydration, nourishment, and
warmth (Deci & Ryan, 1985). When these needs are satisfied, the living organism
survives and thrives; when these needs fail to be satisfied, the organism suffers
and, if the deprivation is sufficiently severe or prolonged, eventually dies. These
theorists reasoned that humans, as highly social, complex, living organisms with a
prolonged period of dependency during infancy and childhood, also have evolved
basic psychological needs (Ryan, Kuhl, & Deci, 1997). Ryan and Deci (2002) defined
basic psychological needs this way:

Basic psychological needs: Inner resources with important survival value

that are held to be universal and that include the needs for relatedness, com-
petence, and autonomy.

Each of the needs serves as a source of the energy and direction characteristic of
motivated human behavior (Deci & Ryan, 1985; Reeve, 2005), in that people strive
to satisfy them in their daily lives, although the way in which needs are satisfied
may vary from person to person, situation to situation, and culture to culture.

Three Basic Psychological Needs Identified in SDT

1. Relatedness refers to a sense of belongingness with others and with one’s com-
munity; it includes the presence of relationships that are characterized by mu-
tual caring (Baumeister & Leary, 1995; Bowlby, 1979; Harlow, 1958). As such, it
is more akin to emotional intimacy than to sex, strictly speaking. People are in-
herently motivated to seek meaningful, mutual, and lasting relationships.
2. Competence reflects the capacity to feel, and indeed, to be effective in one’s in-
teractions with the physical and social environment. It includes having oppor-
tunities to exercise and expand one’s capabilities. People are motivated to seek
optimal challenges that will afford them such opportunities.
596 Special Topics and Important Trends That Counselors Might Encounter PART FOUR

3. Autonomy refers to the experience of being the initiator of one’s own behavior.
It refers to feeling that one is an origin or source, rather than a “pawn” pushed
around by external forces (deCharms, 1968; Deci & Ryan, 1985). It includes the
experience of having voice and choice in one’s activities.

SDT distinguishes between autonomy and independence, which is characterized

by a freedom from other people and lack of reliance on them. Research in the SDT
tradition has demonstrated that autonomy and independence are different and dis-
tinct constructs: Adolescents who experience a high degree of autonomy, for exam-
ple, are also characterized by a willingness to rely on (depend on) their parents for
emotional support (Ryan, 1993; Ryan & Lynch, 1989). Conceptualizing autonomy
as a basic need, SDT suggests that people are generally motivated to exercise choice
and to take initiative in their daily lives.
SDT further suggests that social contexts that afford opportunities to meet these
three basic psychological needs for relatedness, competence, and autonomy pro-
mote the organizing and integrating tendencies that are associated with optimal
development and well-being (Ryan & Connell, 1989; Ryan & Deci, 2000, 2002). So-
cial contexts can accordingly either promote or disrupt development, as noted
here.

Impact of Social Context on Development (Ryan & Deci, 2000)

1. Social contexts that are responsive to basic psychological needs provide a de-
velopmental network within which people can naturally ascend.
2. Social contexts characterized by excessive control, nonoptimal challenges, and
lack of connectedness disturb the natural actualizing tendencies, inhibit initia-
tive and responsibility, and can result in distress and psychopathology.

Attention to basic psychological needs and the contexts that either support or
thwart them is thus a central aspect of the SDT approach to counseling and psycho-
therapy.

䊏 Reasons for Nonintrinsic Actions

Human beings, from birth on, are embedded in social contexts. As such, not all of
our motives and initiatives are self-generated or intrinsic. SDT recognizes a num-
ber of reasons not all actions are motivated toward meeting the basic psychological
needs.

Explanations for Nonintrinsic or Externally Motivated Actions

䊏 We constantly are adapting and adjusting to the wishes, demands, expectations,
and hopes of others.
CHAPTER TWENTY SEVEN Ecological-Transactional and Motivational Perspectives 597

䊏 Not all external influences are in accord with our inner psychological needs,
which otherwise would serve as the primary guides for our actions.
䊏 Because of outside influences, we frequently find ourselves carrying out actions
that did not originate from within ourselves.

䊏 Motivation

Given that, because of outside influence, people are not always capable of acting on
their need for relatedness, competence, and autonomy, SDT suggests that the
motivation to carry out any action can be either more internally or more externally
motivated.

Internal motivation: Initiatives that are characterized by a sense of autonomy

and choice.

External motivation: Initiatives that are characterized by a sense of pressure,

coercion, and control.

Humans are embedded within a physical and social context, and so many of the
things we do are prompted, initially, by forces outside ourselves. SDT suggests that
the quality of our motivation for such actions is what matters most. Because initia-
tives that come from outside ourselves can be either willingly consented to or en-
acted grudgingly, and in this respect can feel more or less autonomous or con-
trolled, SDT proposes a continuum of motivation.

The Motivation Continuum in SDT

䊏 The continuum ranges from external motivation at one end to integrated or in-
ternal motivation at the other end.
䊏 Social contexts that satisfy the basic psychological needs have been shown to
promote more internal motivation, whereas contexts that thwart satisfaction of
those needs have been associated with more controlled or external forms of moti-
vation (Ryan & Connell, 1989).
䊏 The motivation continuum is not static, but rather dynamic: Motivation for any
activity can change, becoming either more or less autonomous, in response to en-
vironmental circumstances that are experienced as either more need-satisfying
or more need-thwarting, respectively.

This continuum is used to describe the (dialectical) process of internalization,

which can be understood as follows:

Internalization: An aspect of socialization in which external values, norms, and regu-

lations are taken in by the active, organismic self, and are experienced by that self as ei-
ther endorsed and congruent or alien and incongruent.
598 Special Topics and Important Trends That Counselors Might Encounter PART FOUR

According to SDT, satisfaction of the basic needs, and of the need for autonomy,
in particular, leads to greater endorsement or congruence (greater internalization)
of the value or behavior in question, and this in turn is associated with more opti-
mal psychological and developmental outcomes. In short, the process of internal-
ization is promoted by support for the basic needs.

RELATING SELF-DETERMINATION THEORY

TO THE HELPING PROFESSIONS

As noted, SDT provides a framework, based on its organismic and dialectical prop-
ositions, for conceptualizing the presenting problems that clients bring with them
to counseling. If it is indeed true that satisfying the needs for relatedness, compe-
tence, and autonomy is vital for growth and development, indeed for well-being,
then it stands to reason that the experience of serious, possibly chronic, deprivation
in any of these three areas may underlie many forms of human distress. Certainly,
such a position is consistent with the perspectives and experience of clinicians from
the humanistic (Rogers, 1959) and object relations (Basch, 1995; Miller, 1997) tradi-
tions. Accordingly, the theoretical perspective offered by SDT may serve to guide
interventions targeted to address chronic deprivation (whether historical or cur-
rent) of any of the three basic needs posited by the theory. Work in this area has thus
far been limited. Much more work has been done, however, on applying SDT’s
body of findings on human motivation to the helping process itself.

䊏 Blocks to Clients’ Motivation Toward Change

Identifying and facilitating clients’ motivation for change is a central issue faced by
counselors and other helping professionals. Any number of hindrances can stand
in the way of a client’s ability to change; a few barriers to clients’ motivation to
change that counselors may encounter are noted here.

Hindrances to the Change Process

䊏 Change can be painful and difficult.
䊏 Certain quality of motivation is required both to initiate and maintain any seri-
ous program of change.
䊏 Clients frequently come to counseling not entirely of their own will (e.g., the
spouse who is pressured to seek help by a well-meaning but exasperated partner,
or the child who is compelled to “get fixed” by the school authorities or by par-
ents).
䊏 Clients who come to counseling willingly, on their own initiative, may experi-
ence some ambivalence over the prospect of change when they are faced with the
reality of what such change may actually entail.
CHAPTER TWENTY SEVEN Ecological-Transactional and Motivational Perspectives 599

SDT acknowledges the central role of motivation in the counseling process, recog-
nizing that, as in any endeavor, the quality of motivation for counseling—whether
more internal, or more external—will have an important impact on the quality of
experience and the nature of the outcomes. When clients are more internally moti-
vated, their experience of and attitude toward counseling are expected to be more
positive, and their outcomes more favorable.

䊏 How Can Counselors Help Motivate Clients for Change?

SDT proposes a process model of change that has been tested empirically in a num-
ber of clinical settings. The main components of this change model are provided
briefly as follows.

Assumptions of the SDT Process Model of Change

䊏 Clients bring to the task of counseling a certain quality of motivation, which to
some extent may represent an individual difference in the form of a tendency to
act more autonomously or more heteronomously (i.e., with a sense of being pres-
sured and controlled by external forces).
䊏 The social context represented by the counseling relationship (or even the insti-
tutional setting in which counseling occurs) can foster movement of the client’s
motivation along the motivation continuum in the direction of either greater au-
tonomy or greater control.
䊏 Movement takes place according to whether the social context is experienced by
the client as providing either more or less opportunity to satisfy the basic psycho-
logical needs.
䊏 Under conditions of greater need satisfaction, motivation for a given domain of
activity tends to become more autonomous. Specifically, the model suggests that
when clients experience their care providers as more supportive of clients’ need
for autonomy, the clients will gradually adopt a more autonomous motivational
orientation toward the process of counseling, and will also experience greater
felt competence to participate in that process.

The experience of having an autonomy supportive care provider, in other words,

leads to more autonomous motivation and to greater perceived competence for en-
gaging in counseling. Greater autonomy and greater competence, in turn, lead to
greater actual engagement in counseling, to greater willingness to extend oneself
beyond one’s comfort zone (or perhaps to extend oneself within one’s zone of prox-
imal development, to borrow Vygotsky’s concept) and take risks by trying new be-
haviors, and indeed to measurable improvement on target outcomes and main-
tained behavioral change over time. By facilitating client choice, the model
hypothesizes that counselors can help their clients to identify and embrace their
own reasons for change; that is, whatever clients’ initial reasons for coming to
counseling, for participating or not participating, their motivation will become
600 Special Topics and Important Trends That Counselors Might Encounter PART FOUR

more internal than external, and they will accordingly experience the more positive
outcomes associated with internal motivation, when they experience their counsel-
ors as autonomy supportive.

EXAMPLE

Applying the SDT Process Model of Change to Addictions

Many clients in addictions rehabilitation centers are mandated to treatment, often by the court
system. A constant struggle for counselors in these settings is how to “reach” clients who have
not chosen treatment so that positive change (e.g., eradication of the addictive behaviors) can
occur. SDT suggests that a key to breaking through barriers to change is using the counseling
relationship as a place where the client can make autonomous or self-motivated decisions in
treatment. SDT implies that counselors who help clients make their own decisions about kinds
of involvement in treatment will be more effective in supporting clients’ change process than if
they force clients into interventions. For further discussion, see Markland, Ryan, Tobin, and
Rollnick (2005).

䊏 Empirical Evidence for Self-Determination Theory and Autonomy Support

To date, the general SDT process model has been tested in several areas.

Settings Studied for the Effectiveness of SDT

䊏 Alcohol treatment (Ryan, Plant, & O’Malley, 1995).
䊏 Weight loss (Williams, Grow, Freedman, Ryan, & Deci, 1996).
䊏 Medication adherence (Williams, Rodin, Ryan, Grolnick, & Deci, 1998).
䊏 Diabetes management (Williams, Freedman, & Deci, 1998).
䊏 Smoking cessation (Williams, Gagne, Ryan, & Deci, 2002).
䊏 Eating disorders (Vansteenkiste, Soenens, & Vandereycken, 2005).

This body of research shows a number of results linked to clients’ experiences of

their counselors and health care providers as providing autonomy support. Some
of the positive implications of autonomy support are provided here.

Impact of Autonomy Support on Client Development

䊏 Clients are more likely to endorse internal reasons for participating in the change
process.
䊏 Clients are more likely to feel competent about their internal motivation to
change.
䊏 Clients are more likely to attend sessions and to participate in the process.
䊏 Clients are more likely to initiate and to maintain targeted behavioral changes.
CHAPTER TWENTY SEVEN Ecological-Transactional and Motivational Perspectives 601

Notably, not only counselors and health care providers, but also important others
(spouse, family members, friends) have been shown to play a role in the SDT
model: When clients experience autonomy support from their important others,
aside from the support they may experience from their professional care provider,
they are more likely to endorse an autonomous motivation for change, and to expe-
rience competence to engage in the change process (Williams et al., 2006). Impor-
tantly, many of the studies cited have consisted of longitudinal, clinical trials. Al-
though most of them have been in the area of health psychology, at least one study
has demonstrated the utility of conceptualizing clients’ motivation for therapy in
SDT terms (Pelletier, Tuson, & Haddad, 1997). Indeed, the general model of how
social contexts shape the motivation of the people within them has been demon-
strated in various settings, including an inpatient psychiatric hospital for youth
(Lynch, Plant, & Ryan, 2005), a nursing home (Kasser & Ryan, 1999), educational
contexts (Reeve, 2002; Williams & Deci, 1996), and parenting (Grolnick &
Apostoleris, 2002; Niemic et al., 2006), to name a few.

䊏 Recommendations for Providing an Autonomy Supportive Context

A number of recommendations can be drawn from the SDT literature on how coun-
selors and other helping professionals can apply the SDT process model to facili-
tate greater internal motivation among their clients. A laboratory experiment (Deci,
Eghrari, Patrick, & Leone, 1994), for example, identified specific elements of the so-
cial context that constitute autonomy support. Other research in settings such as
education (see Reeve, 2002, for a summary) confirms the findings of that experi-
ment. Adapting the results of this body of research to the counseling setting leads
to the following recommendations for supporting clients’ autonomy and thus facil-
itating internalization, autonomous motivation for change, and perceived compe-
tence.

Suggestions for Counselors in Promoting Autonomous Changes in Clients

1. Provide a meaningful rationale for why a particular course of action is being
recommended, especially when a client is unsure of the need for counseling at
all. Presumably, understanding the rationale for an action for which the client
is not initially internally motivated can help to foster the experience of choice,
which is a key element in satisfying the need for autonomy.
2. Acknowledge clients’ feelings and perspectives to help them to feel under-
stood and to help to reduce defensiveness and resistance. This can be especially
important when their feelings about coming to counseling in the first place, or
about undertaking a proposed change, may not be very positive. Having the
opportunity to express one’s feelings, feeling understood, and experiencing
that one’s feelings and opinions matter, are important aspects of the experience
of autonomy.
3. Use an interpersonal style that promotes choice and that minimizes control to
help to remove some of the sense of pressure or coercion that clients can some-
602 Special Topics and Important Trends That Counselors Might Encounter PART FOUR

times experience, whether that pressure comes from sources that are external
(e.g., a pressuring partner or parent; the offer of reward for success or punish-
ment for failure) or internal (e.g., feelings of “should,” “ought,” or shame
avoidance).

Counselors, as parents, teachers, managers, and other authority figures, can pres-
ent themselves as experts who hold the reins of power, implicitly imposing their
will and demanding compliance of those under their care; or, alternatively, they can
empower clients to see that many of the choices entailed in the counseling process
are in fact theirs to make. Notably, all three of the “mini-interventions” just listed as
aspects of the counselor’s therapeutic style, are aimed at fostering the client’s expe-
rience of autonomy and, hence, at promoting internalization of the reasons for
change as well as engagement in the process of counseling. This follows from the
SDT proposition that autonomy is a basic psychological need.
Other specific interventions that are compatible with this approach may be
drawn from motivational interviewing, which Miller and Rollnick (2002) defined
as follows:

Motivational interviewing: A directive, client-centered counseling style for

eliciting behavior change by helping clients explore and resolve ambivalence.

Motivational interviewing has been shown to provide many of the social facilitat-
ing techniques that promote the organismic growth tendency that SDT theoreti-
cally articulates (Markland et al., 2005). The body of SDT research suggests that
motivational interventions that are undertaken in the dialectical context of the
counseling relationship, and that are aimed at supporting clients’ experience of sat-
isfaction for their organismic needs for autonomy, competence, and relatedness,
are likely to be the most successful in helping clients to initiate and maintain mean-
ingful change in their lives.

EXAMPLE

Using Recommended SDT Approaches With Adolescents

Imagine that an adolescent male, is brought to counseling by his mother, who is concerned
about her son’s behaviors that include being verbally disrespectful to teachers, instigating
fights with peers at school, listening to “loud and angry” music, and wearing inappropriate
clothing. Because the client was “brought” to counseling by his mother, his level of interest in
the therapeutic process is minimal and his behavior can be characterized as resistant as he of-
ten listens to his music while in session with the counselor and at times refuses to speak. In ap-
proaching the client, a counselor who tries to apply SDT recommendations might first try to
create a reasonable rationale for why his mother referred him for treatment and for any inter-
ventions in which they jointly engage. The counselor also may spend one or more sessions val-
CHAPTER TWENTY SEVEN Ecological-Transactional and Motivational Perspectives 603

idating the client’s feelings about being “brought” to therapy. Already, these approaches can
help the client to know that the counselor is interested in his experiences and wants his input
in the therapeutic process. Throughout the counseling relationship, the therapist who uses an
SDT approach also may find it effective to help the client gain a sense of ownership—and pro-
mote internal motivation—over his goals for change and not necessarily those of his mother or
the counselor.

See Chapter 26 for more on motivational interviewing as applied to addictions

counseling.

Check out this site for more information on motivational interview-

ing:
䉴 http://www.motivationalinterview.org/

CONCLUSION

Ecological-transactional and motivational theories serve to inform clinical practice

in profound ways. The organismic, bioecological, dialectical viewpoint implicit in
the approaches outlined herein suggests an active human person who is in constant
interaction with the surrounding environment. To each situation, at each moment
throughout the day, the person brings a set of basic psychological needs that he or
she is striving to fulfill within the given social and physical context, all in the ser-
vice of organismic growth, integration, and development.
This perspective provides a model for understanding how many forms of
psychopathology emerge. As previously noted, need satisfaction is a dialectical
process involving the individual in a multilayered social context. When basic
needs are thwarted or deprived within a person’s interpersonal world, ill-being
results. When they are consistently, chronically, or traumatically thwarted, more
serious forms of pathology and suffering are to be expected. The converse, how-
ever, is also true: When opportunities to satisfy basic needs are consistently avail-
able and accessible within the environment, it is expected that the natural pro-
pensities for growth and development will unfold, and well-being will ensue.
The model thus looks at both deficits and resources, within the person and
within the environment. By shedding light on both the positive and negative as-
pects of living, by providing an avenue for understanding both pathology as well
as optimal development, and by shedding light on the contributions of both the
604 Special Topics and Important Trends That Counselors Might Encounter PART FOUR

person and the environment, these insights can inform the processes of assess-
ment (understanding how the client got that way) and intervention (providing a
guide for therapeutic action) in counseling.

The model thus looks at both deficits and

resources, within the person and within the
environment. By shedding light on both the
positive and negative aspects of living, by
providing an avenue for understanding both
pathology as well as optimal development, and
by shedding light on the contributions of both
the person and the environment, these insights
can inform the processes of assessment
(understanding how the client got that way) and
intervention (providing a guide for therapeutic
action) in counseling.

Importantly, the organismic, bioecological viewpoint also suggests a model for

the counseling relationship itself. The counseling dyad, or the group, if the set-
ting is one of group counseling, is itself an environment, an interpersonal con-
text. As such, the counselor can act in such a way as to support the client’s basic
needs for autonomy, competence, and relatedness, by promoting choice, efficacy,
and genuine interpersonal contact, or the counselor can subtly or not so subtly
act to undermine the client’s psychological needs by withholding these impor-
tant resources. The goal is not for the counselor to become a surrogate need pro-
vider. Rather, by helping clients learn how to identify and begin to satisfy their
basic needs, and by facilitating autonomously motivated action on the clients’
part, first in the context of counseling, and then in their daily lives, they are likely
to see clients who are able to initiate and to maintain healthy change in their
lives, experiencing greater competence and interpersonal satisfaction in the pro-
cess. This may be especially important for clients whose prior life experience may
not have provided them with many opportunities to experience need satisfaction
at developmentally critical periods, as in the case of early childhood neglect, or
whose life experience may even have traumatically undermined or interrupted
the organismic process of integration and development that otherwise would
have naturally unfolded.
Although we have emphasized the importance of need satisfaction in this dia-
lectical model, it is essential for counselors and their clients to realize that this or-
ganismic process is not an inherently selfish or one-sided one. Indeed, recent re-
search demonstrates that, within interpersonal relationships, need satisfaction
involves a give and take, and that providing for another’s needs is at least as impor-
CHAPTER TWENTY SEVEN Ecological-Transactional and Motivational Perspectives 605

tant to one’s own well-being as receiving need satisfaction from the other person
(Deci, La Guardia, Moller, Scheiner, & Ryan, 2006). In the end, and in line with the
bioecological model, that indeed is the nature of the dialectical process, which im-
plies the reciprocal influence and interconnectedness of the members in any eco-
logical unit.

Chapter 27: Key Terms

䉴 Zone of proximal develop- 䉴 Protective factors 䉴 Basic psychological needs
ment 䉴 Proximal processes 䉴 Internal motivation
䉴 Scaffolding 䉴 Developmental 䉴 External motivation
䉴 Human development psychopathology 䉴 Internalization
䉴 Risk factors 䉴 Resilience 䉴 Motivational interviewing
 chapter Neuroscience in Psychotherapeutic Practices

28 Stacie Leffard
Duquesne University

In This Chapter

䉴 Neuroscience and Psychotherapeutic 䉴 Ensuring Lasting Neural Change

Practices 䊏 Automization of Internalized Processes
䊏 Neuroscience and Psychotherapy: Early 䊏 Monitoring Change in Client Thinking

Connections 䊏 Monitoring Change in Clients’ Executive

䊏 What Is Neuroscience and Why Is It Im- State

portant to Therapists? 䊏 Techniques for Engaging Emotional States

䉴 The Nervous System 䉴 Clients With Processing Deficits

䊏 Systems Within the Nervous System 䊏 Effectiveness of Cognitive Remediation
䊏 Neurons Therapy
䊏 Action Potential 䊏 Cautions When Using Cognitive Rehabili-

tation
䉴 The Brain
䊏 The Cerebral Cortex 䉴 Attention-Related Processing Deficits
䊏 The Forebrain 䊏 Individualizing the Length of Therapy
䊏 Midbrain Sessions
䊏 Hindbrain 䊏 Use of Cues

䉴 Facilitating Neural Change 䉴 Memory-Related Processing Deficits

䊏 How Does Neural Change Occur? 䊏 Rehearsal
䊏 Principles for Brain-Based Psychotherapy 䊏 Mnemonic Strategies

䊏 Understanding Schemas 䊏 Labels, Notebooks, and Calendars

䊏 Dealing With Problematic Schemas 䊏 Spaced Retrieval

䊏 Changing View About Incoming Stimuli

䊏 Impact of Stress on Neural Change 䉴 Executive Functions Deficits

䊏 Utilizing the Hemispheres 䊏 Goal Management Training
䊏 Other Approaches to Helping Clients With

Executive Functioning Deficits

䉴 Summary

606
CHAPTER TWENTY EIGHT Neuroscience in Psychotherapeutic Practices 607

NEUROSCIENCE AND PSYCHOTHERAPEUTIC PRACTICES

The purpose of this chapter is first to provide the reader with a basic understanding
of the brain and its functions and, second, to relate the basic principles of brain
function to the practice of psychotherapy. Neuroscience-based techniques for help-
ing individuals who have processing deficits also are described. The relation be-
tween neuroscience and psychotherapy is not based in any specific theoretical ori-
entation, and therefore, can be used by any therapist to improve the effectiveness of
psychotherapy.

䊏 Neuroscience and Psychotherapy: Early Connections

Examinations of the relation between neuroscience and psychotherapy are not a re-
cent development in the field of psychology. Freud, in the late 19th century, began
to investigate the relation between the brain and the mind. Freud observed symp-
toms in his practice of neurology that could not be explained or treated based solely
on the available understanding of the brain. Consequently, he developed psycho-
therapeutic methods to treat symptoms that, at that time, could not be explained by
neuroscience (Cozolino, 2002). Scientific advances in the area of neuroscience now
provide the opportunity not only to explain the symptoms that Freud could not ex-
plain neurologically, but also to describe the neuroscientific underpinnings of psy-
chotherapy.

䊏 What Is Neuroscience and Why Is It Important to Therapists?

Neuroscience is the study of the nervous system. Therapists are trained to under-
stand, and in some cases, modify human behavior to improve the functioning of
their clients. Each of the behaviors or cognitions therapists strive to understand
and assist their clients in understanding is the result of nervous system function-
ing. In addition to understanding the external motivations or influences on human
behavior, gaining knowledge about the internal neural underpinnings of behavior
adds an additional lens through which to understand behavior and facilitate
change.

THE NERVOUS SYSTEM

This goal of this section and the next, which is focused on the brain, is to provide a
basic structure for understanding neurological functioning. Therefore, it is neces-
sary to briefly leave the world of psychology and enter the realm of biology. Hope-
fully, this thumbnail sketch of neurology will create a frame of reference for readers
to more fully grasp the applications of neuroscience to psychotherapy. Turning
608 Special Topics and Important Trends That Counselors Might Encounter PART FOUR

now to the section at hand, the nervous system is described through the following
topics:

䊏 Systems within the nervous system.

䊏 Neurons.
䊏 Action potential reaction.
䊏 Autonomic nervous system.

䊏 Systems Within the Nervous System

The nervous system is made up of two systems, namely, the central nervous system
and the peripheral nervous system. The central nervous system (CNS), responsi-
ble for control of all major systems of the body, contains the brain and the spinal
cord. The peripheral nervous system (PNS) is comprised of nerves extending from
the spinal cord to the rest of the body (e.g., organs and muscles).
Part of the PNS, the system of nerves that connects the rest of the body to the spi-
nal cord or the CNS, also affects behavior and is known as the autonomic nervous
system. The autonomic nervous system (ANS) controls breathing, heart rate, and
sweating. The ANS is composed of two systems: the sympathetic and parasympa-
thetic nervous systems.

Systems in the ANS (Blumenfeld, 2002)

1. The sympathetic nervous system is related to the fight or flight response in that it
increases heart rate, blood pressure, and rate of breathing.
2. The parasympathetic nervous system slows heart rate, blood pressure, and
breathing rate.

䊏 Neurons

The brain, and the rest of the nervous system, is composed of cells called neurons,
which are responsible for communication within the nervous system. There are
two types of neurons, afferent and efferent neurons, defined as follows:

Afferent neurons: Sensory neurons that carry signals toward the CNS.

Efferent neurons: Motor neurons that carry signals away from the CNS.

Neurons are complex cells. It is important to have a general knowledge of the com-
position of the neuron to understand how neurons communicate by passing infor-
mation to one another.
CHAPTER TWENTY EIGHT Neuroscience in Psychotherapeutic Practices 609

Components of the Neuron

䊏 The cell body contains the nucleus of the neuron and makes up gray matter in
the brain such as the cerebral cortex.
䊏 Dendrites are branches that extend from the cell body and receive signals from
other neurons.
䊏 The axon extends from the cell body and carries output signals to other neurons.
䊏 The synapse is the area between neurons, and because neurons do not touch,
chemicals pass between neurons across the synapse (Balbernie, 2001). In the syn-
apse, information is passed from the terminal buttons at the end of one neuron’s
axon to the dendrites of another neuron.
䊏 Neurotransmitters are chemicals released by terminal buttons at the end of one
neuron and received at receptor sites on the dendrites of other neurons. Com-
mon neurotransmitters include glutamate, GABA, acetylcholine, norepin-
ephrine, dopamine, serotonin, histamine, glycine, and peptides (Blumenfeld,
2002).
䊏 Axons are insulated by a myelin sheath, a covering that increases the speed at
which signals travel. Axons insulated with myelin make up white matter in the
brain. White matter areas are responsible for communication in the brain
(Blumenfeld, 2002).
䊏 A neural pathway or pattern is formed when a series of neurons fire or release
electrical impulses in the form of neurotransmitters. If repeated enough, the se-
ries of firing forms a permanent circuit (Balbernie, 2001; Gevarter, 1982).

䊏 Action Potential

When a neuron receives enough input signals from other neurons and must send
the signal to another neuron, a chemical reaction called an action potential oc-
curs, traveling from the cell body down the axon and resulting in the release of
an output signal at the terminal buttons. This reaction occurs in approximately 1
millisecond and can travel down the axon at speeds of 60 meters per second
(Blumenfeld, 2002). The amount of stimulation it takes for an action potential to
occur is affected by stress, diet, drug use, fatigue, and emotionality (Gevarter,
1982). Neurotransmitters can affect action potentials by speeding them up or
slowing them down.

THE BRAIN

The brain, part of the CNS, is divided into two halves, the right and left hemi-
spheres. In general, the left hemisphere processes verbal and detail information,
whereas the right hemisphere processes spatial and perceptual information (Rob-
bins, 1985). These hemispheres are connected by the corpus collosum, a wide band
610 Special Topics and Important Trends That Counselors Might Encounter PART FOUR

of neural fibers (Blumenfeld, 2002; Lezak, Howieson, & Loring, 2004). The various
parts of the brain discussed in this section include the following:

䊏 The cerebral cortex.

䊏 The forebrain.
䊏 The midbrain.
䊏 The hindbrain.

䊏 The Cerebral Cortex

The outermost part of the brain is known as the cerebral cortex. The surface of the
cortex is composed of folds, the tops of which are called gyri, and the crevices of
which are called sulci. The cortex is divided into four areas, or lobes.

Four Lobes of the Cerebral Cortex

1. The frontal lobe, the front-most and largest area of the cortex, contains the mo-
tor cortex and sensory cortex. The prefrontal cortex, the frontmost part of the
frontal cortex, is related to inhibition, motivation, and sequencing. It also con-
tains working memory functions, processes for new learning, set shifting, and
selective attention (Blumenfeld, 2002). The prefrontal cortex is necessary for
self-reflection, self-evaluation, evaluation of social situations, and perspective
taking (Seltzer, 2005). Broca’s area in the left frontal lobe is responsible for lan-
guage production.
2. The temporal lobes, located on the right and left sides of the cortex in the area
around the ear, are important for language processing. Wernicke’s area in the
left temporal lobe is responsible for language comprehension.
3. The occipital lobe, at the back of the head, is responsible for visual processing.
There are two pathways of information through which information reaches the
visual cortex. The ventral pathway processes “what” information, whereas the
dorsal pathway processes “where” information (Blumenfeld).
4. The parietal lobe, found at the top of the head between the frontal lobe and the
occipital lobe, contains motor and sensory processing areas (Blumenfeld).

䊏 The Forebrain

Below the cortex is the forebrain, which is comprised of the limbic system, the
thalamus, the hypothalamus, and the basal ganglia. The forebrain contains com-
munication, motor control, memory, and emotional processing centers of the
brain.
The primary functions of the limbic system are olfaction, memory, emotions,
and homeostatic functions (Blumenfeld, 2002). Martin and colleagues (2001) found
CHAPTER TWENTY EIGHT Neuroscience in Psychotherapeutic Practices 611

that interpersonal psychotherapy resulted in activation, or increased blood flow of

the limbic system in clients with Major Depressive Disorder. Clients with medica-
tion treatment did not have changes in activation in this area of the brain. Compo-
nents of the limbic system include the amygdala, the cingulate gyrus, and the hip-
pocampus.

Components of the Limbic System: Amygdala,

Cingulate Gyrus, and Hippocampus
䊏 The amygdala is responsible largely for emotional control, and especially fear
and aggression.
䊏 The amygdala is related to ANS responses through connections with the hypo-
thalamus (Blumenfeld, 2002) such as the fight or flight response (Seltzer, 2005).
䊏 The amygdala evaluates information in terms of both survival and emotional
needs, and labels it with a degree of importance. Through this process, emotional
information is programmed to override intellectual information (Atkinson, 2005;
Tootle, 2003), serving as a protective measure so survival needs are met before all
others (Seltzer).
䊏 The cingulate gyrus is involved with attention, response selection, error detec-
tion, and emotional behavior (Lezak et al., 2004).
䊏 The hippocampus is responsible for memory function (Blumenfeld) through in-
volvement in the creation of new memories and recall of old memories.
䊏 The hippocampus processes the context in which a new memory is created; it
also relays information between short- and long-term memory and between the
limbic system and cortical areas. This transfer of information is, however, inter-
rupted when the amygdala evaluates stimuli as threatening (Seltzer).

Besides the limbic system, other parts of the forebrain include the thalamus, hypo-
thalamus, and basal ganglia, each of which are described next.

Features of the Thalamus and Hypothalamus

䊏 The thalamus is a relay center in the brain. It facilitates connections between the
cortex and limbic system (Lezak et al., 2004). Most neural pathways that connect
to the cerebral cortex pass through the thalamus (Blumenfeld, 2002).
䊏 The hypothalamus, located beneath the thalamus, is important for control of
ANS responses. It is the link between the neural and endocrine systems.
䊏 The hypothalamus uses hormone release of the pituitary gland to maintain ho-
meostasis in the body by regulating hunger, thirst, sleep–wake cycles, heart rate,
and other body functions.
䊏 The hypothalamus is also connected to the limbic system, which explains the
link between ANS responses to emotion, such as sweating when nervous
(Blumenfeld).
612 Special Topics and Important Trends That Counselors Might Encounter PART FOUR

䊏 The hypothalamus manages internal sensory information and processes infor-

mation flowing from the body to the higher brain (Tootle, 2003). The parasympa-
thetic and sympathetic systems are controlled by the hypothalamus and limbic
system.

Features of the Basal Ganglia

䊏 The basal ganglia are related to movement and disorders such as Huntington’s
disease and Parkinson’s disease characterized by involuntary or slowed muscle
movements.
䊏 It is also related to emotional control, eye movement (Blumenfeld, 2002), turning
cognition into action, and motor control (Lezak et al., 2004).

䊏 Midbrain

The midbrain is a small section of the brain between the forebrain and the hind-
brain. The primary function of this section of the brain is sensorimotor integration
(Lezak et al., 2004). Part of the midbrain, the reticular activating system (RAS), ex-
tends from the thalamus into the hindbrain. The RAS is involved with waking and
alerting mechanisms. It is linked to cognition by arousing the cerebral cortex. It also
is involved with reflexes (Lezak et al.).

䊏 Hindbrain

The hindbrain, found at the base of the brain between the cortex and the spinal
cord, is the pathway between the brain and the rest of the body (Blumenfeld, 2002).
Major sensory and motor information passes through the brain stem to the spinal
cord and the rest of the body. The brain stem itself also is involved with level of con-
sciousness, muscle tone, posture and nonvoluntary body functions such as breath-
ing (Lezak et al., 2004). The hindbrain is comprised of the medulla oblongata,
reticular formation, pons, and cerebellum.

Components of the Hindbrain

䊏 The medulla oblongata, located at the base of the brain near the spinal cord, is
the control center for essential bodily functions such as breathing, blood pres-
sure, heart rate, the gag reflex, and swallowing (Lezak et al.).
䊏 The reticular formation is important for regulating consciousness, which is a
combination of alertness, attention, and awareness (Blumenfeld). The RAS that
begins in the midbrain is also part of the reticular formation and runs through
the length of the brain stem. It controls awareness levels such as deep sleep and
alertness (Gevarter, 1982), and also is involved with posture, smoothness of mus-
cle movements, and maintenance of muscle tone (Lezak et al.).
CHAPTER TWENTY EIGHT Neuroscience in Psychotherapeutic Practices 613

䊏 The pons is involved in posture, muscle movements, and coordination (Lezak

et al.).
䊏 The cerebellum receives sensory inputs from the brain and spinal cord that are
used to coordinate movement (Blumenfeld). The cerebellum also is involved
with higher cognition through connections with the cortex (Lezak et al.).

FACILITATING NEURAL CHANGE

Psychotherapy is based on the assumption that the client can learn from the thera-
pist and others in the client’s environment. In the brain, new learning is linked to
plasticity, which Cozolino (2002) defined as follows:

Plasticity: The ability of neurons and neural networks to change.

Although the brain is more plastic in young children than adults, intervention can
result in change at any age (Tootle, 2003). Changes in behavior and cognitive pro-
cesses may lead to changes in the brain, and changes in the structure or function of
the brain may lead to changes in cognitive processes or behavior (Ilardi, 2002). The
reciprocal relation between behavior and cognition and the brain allows for effec-
tive intervention in the form of psychotherapy.

Changes in behavior and cognitive processes

may lead to changes in the brain, and changes in
the structure or function of the brain may lead
to changes in cognitive processes or behavior.
The reciprocal relation between behavior and
cognition and the brain allows for effective
intervention in the form of psychotherapy.

䊏 How Does Neural Change Occur?

Neuroscience research indicates that neural change occurs when dendrites branch
out, thereby extending the reach and connectivity of neurons. When neurons con-
nect with new neurons, or end connections with other neurons, a change occurs in
the neural network and learning takes place (Cozolino, 2002). Psychotherapy can
change neural networks based on information that environmental factors, such as
degree of stimulation, can affect the organization of neurons in the brain
(Cozolino).
614 Special Topics and Important Trends That Counselors Might Encounter PART FOUR

䊏 Principles for Brain-Based Psychotherapy

Cappas, Andres-Hyman, and Davidson (2005) suggested several principles for

brain-based psychotherapy:

䊏 Experience transforms the brain by strengthening or weakening neural connec-

tions. In psychotherapy, the therapist can provide experiences for the client that
strengthen neural connections of adaptive behaviors and cognitions and weaken
neural connections associated with maladaptive behaviors and cognitions.
䊏 Cognitive and emotional processes work together, and by understanding this re-
lation, therapists can modify behavior patterns that negatively are affecting the
client’s functioning.
䊏 Imagery can induce change in the same way actual experience can. This means
that the therapist can use imagery in the same way as actual experience to facili-
tate neural change.
䊏 The brain processes nonverbal and unconscious information, so therapists should
be aware of their nonverbal behavior, such as facial expressions, at all times.

䊏 Understanding Schemas

The brain is composed of neural systems that process information automatically

(Atkinson, 2005). Shallice (2002) described these automatic processes as schemas,
or ways of processing information for specific activities. Every time a particular ac-
tivity is completed (Shallice), the schema for that activity is activated through a
process called the contingency scheduler. When a situation arises for which the
brain does not have a process in place, another system called the supervisory atten-
tion system takes over processing and guides creation of a new schema.

䊏 Dealing With Problematic Schemas

Therapists can use information about schemas to help clients identify problematic
schemas that are triggered by a client’s contingency scheduler. Then, the therapist
can engage the supervisory attention system by presenting the client with situa-
tions in which his or her schema is not accurate or effective. By aiding the client in
constructing new schemas and helping with repeated implementation of these new
schemas, the therapist may help to ensure that change that occurs in therapy ses-
sions will last.

䊏 Changing View About Incoming Stimuli

In addition to changing schemas, another major goal of psychotherapy is to change

the view or label placed on incoming stimuli. Gevarter (1982) suggested multiple
ways of changing these labels.
CHAPTER TWENTY EIGHT Neuroscience in Psychotherapeutic Practices 615

Ways to Reframe Incoming Stimuli

䊏 Break up the client’s existing response patterns to stimuli.
䊏 Reshape the client’s existing response pattern to stimuli.
䊏 Permanently modify brain circuitry to eliminate existing response patterns.

Several models of psychotherapy including Rogers’s client-centered therapy,

Ellis’s rational emotive therapy, and Glasser’s reality therapy are based on the prin-
ciples of reshaping how information is processed (Gevarter).

䊏 Impact of Stress on Neural Change

Besides reframing, stressful situations also can stimulate the process of neural
change, or new learning, in the brain. Extreme stress, however, has been found to
inhibit new learning (Cozolino, 2002). Based on this information, Cozolino sug-
gested that stress can play a role in the success or failure of psychotherapy. He went
as far as to suggest that by inducing low levels of stress in the therapy session, the
therapist can induce new learning to improve the client’s mental health. By pro-
voking low levels of stress, neural change processes are activated, and the therapist
can use this change to promote successful psychotherapy and lasting learning.
Cozolino (2002) suggested some ways to augment neural change that are men-
tioned here.

Ways to Enhance Learning Through Stress Induction

䊏 Establish trust with the client.
䊏 Alternate between low to moderate levels of stress and calm or safety in the ses-
sion.
䊏 Induce stress in a controlled way with very specific goals in mind.
䊏 Combine conceptual understanding with emotional processing of new informa-
tion through narratives constructed with the therapist.
䊏 Teach the client to process information in this way outside of therapy to promote
further positive change

䊏 Utilizing the Hemispheres

Considering differences in processing between the two hemispheres also can facili-
tate successful psychotherapy. Therapists who find a client to be resistant can at-
tempt to tap into the right hemisphere through metaphor and symbolic language.
This helps bypass the resistance to change associated with left-hemisphere process-
ing (Robbins, 1985).
616 Special Topics and Important Trends That Counselors Might Encounter PART FOUR

ENSURING LASTING NEURAL CHANGE

Psychotherapy is considered successful when the processes used in psychotherapy

are internalized by clients, and they are able to use them on their own (Cozolino,
2002). Psychotherapists often underestimate the importance of repeated practice to
the generalization of learning and the maintenance of change after the therapeutic
relationship has ended (Atkinson et al., 2005). The only therapies that will result in
enduring change are those that result in neural change (Gevarter, 1982).

䊏 Automization of Internalized Processes

Gevarter (1982) suggested that creating automatic, desired behaviors happens

through rehearsal and applied practice. Luria (1981), however, conceptualized au-
tomatization as the gradual transition from the reliance on external support to the
emergence of autonomous, internalized processing. The movement from external
to internal processing has been used in neuropsychological intervention (Cicerone
& Giacino, 1992). The application of these ideas occurs in psychotherapy in the con-
text described here.

Context for Promoting Internal Processing

䊏 The therapist initially acts as the external agent of change who structures new
ways of thinking for the client.
䊏 As the client becomes comfortable with these new ways of thinking, the therapist
slowly allows the client to guide his or her own thinking by withdrawing struc-
ture.
䊏 When the client is able to use the new ways of thinking independently by talking
through the steps, the techniques are beginning to be internalized.
䊏 Eventually, the client no longer needs to vocalize the steps and the new ways of
thinking become completely internalized.

䊏 Monitoring Change in Client Thinking

Therapists should consider the movement from external support to internal pro-
cessing when introducing techniques to their clients. Moreover, the therapist
should evaluate where the client is in the process of internalization throughout the
therapeutic relationship. Once the therapist sees that the client’s thinking has
changed, the therapist has evidence that neural change has occurred and that
changes observed in the therapy session will be both lasting and generalized to the
client’s functioning outside of therapy sessions.
CHAPTER TWENTY EIGHT Neuroscience in Psychotherapeutic Practices 617

䊏 Monitoring Change in Clients’ Executive State

In addition to monitoring the changes in clients’ thinking, Atkinson and colleagues

(2005) recommended monitoring the executive state of the client. Seven states or
executive processes that can be used in various situations have been suggested in
the literature (Atkinson, 2002; Atkinson et al., 2005; Panksepp, 1998).

Executive Processes That Require Evaluation

1. Aggressive instinct.
2. Avoidance of danger instinct.
3. Desire for emotional contact or closeness.
4. Tenderness or care for others.
5. Spontaneous or playful social contact.
6. Sexual desire.
7. Curiosity or anticipation of learning.

Atkinson and colleagues (2005) indicated that it is imperative for the therapist to
understand the state or executive process from which a client is operating during
the session. Therapists often find that their clients have difficulty generalizing
learning in therapy sessions to other environments. Part of the difficulty may be at-
tributed to differences in the state of the client in these different environments
(Atkinson et al.).

EXAMPLE

Executive States in Therapy and at Home

A client who is in an anticipation of learning state in the therapeutic session is able both to
learn and practice techniques to diffuse frustration with a spouse; however, when the client is
at home and interacting with the spouse, any of the emotional states may be engaged. The cli-
ent is unable to engage new techniques for diffusing frustration at home because he or she is in
an emotional state rather than the anticipation of learning state. If the client practices the new
techniques in an emotional state during the therapy session, such as the moderate stress sug-
gested by Cozolino (2002), then the techniques will be practiced more easily in external set-
tings such as the client’s home.

䊏 Techniques for Engaging Emotional States

Atkinson and colleagues (2005) provided techniques for engaging the emotional
states in the therapy session and disengaging them in other environments.
618 Special Topics and Important Trends That Counselors Might Encounter PART FOUR

Recommendations for Creating Emotional States in Therapy

䊏 Make recordings of the client’s spouse repeating phrases that are typically a
source of frustration and shift the client into an emotional executive state.
䊏 Use the tape in the therapy session to practice techniques when the client is in an
emotional executive state. The opposite technique is used to diffuse emotional
states.
䊏 Provide the client with a tape on which the therapist’s voice is recorded prompt-
ing the client to use techniques from the therapy session.
䊏 Encourage the client to use this tape to change his or her executive state so that
situations can be handled with the techniques taught in therapy sessions. These
tapes, in addition to inducing a specific executive state, allow for further practice
of techniques in multiple settings.

CLIENTS WITH PROCESSING DEFICITS

If a client has a processing deficit, such as in the areas of attention, memory, or exec-
utive functioning, it may be difficult for the therapist to be effective. Therapists
who suspect that a client has a processing deficit that has not been documented
should refer the client to a neuropsychologist for assessment to ensure that process-
ing deficits are accurately identified and appropriate interventions are recom-
mended. Processing deficits can occur in many client populations.

EXAMPLE

Identifying Some Processing Deficits

Psychiatric disorders such as depression, anxiety, mania, and schizophrenia all can cause im-
paired attention (Blumenfeld, 2002). A client with attention difficulties may find it difficult to
focus for the duration of the therapeutic session. A client with memory deficits may have diffi-
culty retaining techniques learned across sessions. A client with executive functions deficits
may have difficulty initiating new thinking strategies, inhibiting old behavior patterns, or
monitoring his or her own behavior or thoughts for change.

䊏 Effectiveness of Cognitive Remediation Therapy

Fortunately, developments in the rehabilitation literature have provided interven-

tions for persons with processing deficits that improve the effectiveness of the psy-
chotherapy. Wykes and colleagues (2002) found that cognitive remediation therapy
in schizophrenic clients improved memory performance. In addition to increased
memory performance, clients that had cognitive remediation therapy also showed
CHAPTER TWENTY EIGHT Neuroscience in Psychotherapeutic Practices 619

differences in frontal lobe activation, indicating that neural change occurred.

Laatsch, Pavel, Jobe, Lin, and Quintana (1999) also found increases in cerebral
blood flow along with improvement in neuropsychological test performance after
cognitive rehabilitation therapy. These results indicate that interventions for cogni-
tive processing deficits can be effective. Glisky and Glisky (2002) discussed four ap-
proaches to intervention for cognitive processes.

Interventions for Persons With Cognitive Processing Deficits

1. Restoration of damaged function through practice and drills.
2. Optimization of residual functions or retraining normal processes by teaching
strategies.
3. Compensation of lost function by using external aids and environmental sup-
ports to bypass deficits.
4. Substitution of intact functions for damaged functions by teaching new strate-
gies for task completion.

䊏 Cautions When Using Cognitive Rehabilitation

In the context of facilitating effective psychotherapy, the therapist should deter-

mine what processing deficit is inhibiting progress in therapy and determine what
empirically supported intervention can be added to the therapy session to bypass
that processing deficit. Only therapists trained in cognitive rehabilitation should
try to rebuild lost processes. Therapists not trained in cognitive rehabilitation
should focus on bypassing the processing deficit so that psychotherapy in any con-
text can be successful.

ATTENTION-RELATED PROCESSING DEFICITS

As previously noted, a client with a processing deficit in attention may have diffi-
culty maintaining his or her focus throughout a full therapy session. There are,
however, some useful approaches to helping these individuals.

䊏 Individualizing the Length of Therapy Sessions

Wilson and Robertson (1992) implemented an intervention for a client who had dif-
ficulty reading for extended periods because of a sustained attention deficit. The
intervention consisted of the client reading for short periods of time during which
he was able to attend consistently to the material. After three successful short peri-
ods of reading, the length of each reading period was increased. This basic frame-
work can be applied to a therapeutic session.
620 Special Topics and Important Trends That Counselors Might Encounter PART FOUR

Process of Creating a Session of Appropriate Length

䊏 Determine how long the client is able to focus successfully on the session.
䊏 Break each session into shorter periods of therapy with breaks between based on
the amount of time the client can focus.
䊏 If the client consistently is able to focus for this set amount of time, an increase in
the amount of time for each therapy period may be attempted.
䊏 Monitor the ability of the client to maintain focus to ensure that an appropriate
length of session is in place for productive therapy time.

䊏 Use of Cues

Another environmental support for a client with attention difficulties is suggested

by Manly, Ward, and Robertson (2002). They presented a tone to clients at random
times while asking the client to complete a goal. The tone served as a reminder for
the client to stay on task. In the context of therapy, the processes described next can
be implemented.

How to Use Cues for Therapeutic Success

䊏 Determine what cues can be used to facilitate staying on task while not disrupt-
ing the flow of the therapy session.
䊏 Provide the client with some kind of cue for staying on task, such as playing a re-
cording with tones at random times to remind the client to stay on task.

MEMORY-RELATED PROCESSING DEFICITS

Clients who have a processing deficit in any area of memory may have difficulty re-
taining new techniques or insights from one therapy session to the next. Several
types of intervention have been suggested to improve retention in clients with
memory deficits. Interventions discussed in this section include the following:

䊏 Rehearsal.
䊏 Mnemonic strategies.
䊏 Labels, notebooks, and calendars.
䊏 Space retrieval.

䊏 Rehearsal

Repeated practice and rehearsal to learn specific pieces of information can be use-
ful (Glisky & Glisky, 2002). Therapists should practice techniques with clients mul-
CHAPTER TWENTY EIGHT Neuroscience in Psychotherapeutic Practices 621

tiple times before attempting implementation in other environments. The therapist

also may summarize what information was gained in each session at the end of
each session and the beginning of the next session to facilitate retention.

䊏 Mnemonic Strategies

Mnemonic strategies such as visual imagery, association, or acronyms (Glisky &

Glisky, 2002) can provide additional context to facilitate retrieval for the client. The
therapist can use the same image or acronym as a retrieval cue for the client.

䊏 Labels, Notebooks, and Calendars

Environmental supports such as labels, notebooks, or calendars (Glisky & Glisky,

2002; Sohlberg & Mateer, 1989) can remind clients of techniques or homework as-
signments. The therapist must take the time to teach the client how to use these ex-
ternal supports and monitor their effectiveness (Sohlberg & Mateer).

䊏 Spaced Retrieval

Spaced retrieval is a technique in which the interval between the presentation of in-
formation and the retrieval of that information gradually is increased (Landauer &
Bjork, 1978). For example, the therapist can ask the client to retrieve strategies im-
mediately after they are presented. Once the information is retained, the therapist
can ask the client to retrieve the information several minutes later. Retention inter-
vals gradually are extended until the client is able to retain information across ses-
sions.

EXECUTIVE FUNCTIONS DEFICITS

Executive functioning is a difficult domain of cognitive processing to define; how-

ever, it typically is understood to include processes such as problem solving, plan-
ning, and self-monitoring (Cicerone, 2002). Clients with executive functioning defi-
cits may have difficulty in therapy because of their impaired ability to monitor and
alter their own behavior based on changes in the environment.

䊏 Goal Management Training

Interventions in this area involve breaking problems or tasks into small steps and
learning cues to remember the steps (Alderman, Fry, & Youngson, 1995; Cicerone,
622 Special Topics and Important Trends That Counselors Might Encounter PART FOUR

2002; Levine et al., 2000). If the client has difficulty solving a problem or learning a
new task, the steps outlined by Levine and colleagues in goal management training
can be implemented to structure activities. The therapist should act as a facilitator
by prompting and providing structure at each step.

Steps of Goal Management Training

䊏 The client is first told to orient himself or herself to the task by identifying the
task.
䊏 The client defines the goal for the task.
䊏 The client breaks the task into smaller steps.
䊏 The client learns the steps.
䊏 The client completes the task using the steps identified.
䊏 The client confirms that the completed task matches the initial goal that was set.

䊏 Other Approaches to Helping Clients With Executive Functioning Deficits

If a client is having difficulty with self-monitoring, other behavioral steps have

been suggested to improve the client’s accuracy (Alderman et al., 1995).

Alternate Behavioral Steps for Aiding Clients

䊏 The therapist records an initial baseline of the behavior to be monitored.
䊏 The client monitors the behavior by using some form of recording technique
such as a counter. The client’s count is compared with the therapist’s count of the
behavior.
䊏 Next, the therapist monitors the client’s recording of the behavior and prompts
him or her to record any occurrences that are missed.
䊏 The client records the behaviors independently and is rewarded for accuracy.
䊏 When the client is able to successfully monitor the identified behavior, goals for
modifying the problematic behavior can be set and hopefully change can occur.

SUMMARY

By understanding the components of the nervous system and how they influence
behaviors, psychotherapists can gain insight as to why their clients behave as they
do and why change in these behaviors can be difficult. For behavior change to be
lasting, neural change must occur through repetition of techniques (Gevarter,
1982), low levels of stress to induce learning (Cozolino, 2002), practice in the appro-
priate executive state (Atkinson et al., 2005), or engagement of the supervisory at-
tention system (Shallice, 2002) to change existing or build new schemas. An under-
standing of the brain also can assist in facilitating effective therapy for clients with
CHAPTER TWENTY EIGHT Neuroscience in Psychotherapeutic Practices 623

processing deficits. Therapists can utilize empirically supported interventions

such as breaking the session into shorter time periods for clients with attention dif-
ficulties (Wilson & Robertson, 1992), providing environmental supports for clients
with memory deficits (Glisky & Glisky, 2002; Sohlberg & Mateer, 1989), and build-
ing structure around problem-solving tasks for patients with executive functions
deficits (Levine et al., 2000). Considering the role of neural functioning in each cli-
ent’s behavior and therapeutic progress can clarify a therapist’s understanding of
the patient and help ensure that gains made in therapeutic sessions will be retained
across sessions and across the client’s future experiences.

Chapter 28: Key Terms

䉴 Cenervous system 䉴 Frontal lobe 䉴 Forebrain
䉴 Peripheral nervous system 䉴 Temporal lobes 䉴 Amygdala
䉴 Afferent neurons 䉴 Occipital lobe 䉴 Cingulate gyrus
䉴 Efferent neurons 䉴 Parietal lobe 䉴 Hippocampus
䉴 Cell body 䉴 Medulla oblongata 䉴 Thalamus
䉴 Dendrites 䉴 Reticular formation 䉴 Hypothalamus
䉴 Axon 䉴 Pons 䉴 Basal ganglia
䉴 Synapse 䉴 Cerebellum 䉴 Midbrain
䉴 Neurotransmitters 䉴 Plasticity 䉴 Hindbrain
䉴 Myelin sheath 䉴 Schemas
䉴 Neural pathway 䉴 Cerebral cortex
 chapter Developmental Counseling and Therapy

29 Jane Myers
University of Connecticut
Thomas Sweeney
Ohio University

Sandra Rigazio-DiGilio Allen Ivey

University of Connecticut University of South Florida

In This Chapter

Historical Context of Developmental Fundamentals of Systemic Cognitive

Counseling and Therapy Developmental Therapy
Influences of Piagetian Cognitive- Defining Disorder from the Systemic Cog-
Emotional Developmental Theory nitive Developmental Therapy Perspective
Influences of Life-Span Developmental Assessment in Systemic Cognitive Devel-
Theory opmental Therapy
Influences of Postmodern Theory Treatment in Systemic Cognitive Develop-
Influences of Wellness Theory and Research mental Therapy
Impact of Traditional Theories of Coun-
Developmental Counseling and Therapy
seling and Psychotherapy
Techniques: Developmental Strategies
Influence of Multicultural Counseling
Questioning Sequence
Underlying Philosophy of Developmental Questioning Strategies in the Opening
Counseling and Therapy Presentation of Issue
Developmental Nature of Being Questioning Strategies in the
Multidimensionality in Developmental Sensorimotor-Elemental Style
Counseling and Therapy Questioning Strategies in the Concrete-
Cultural Relevancy of Developmental Situational Style
Counseling and Therapy Questioning Strategies in the Formal-
Pattern Style
Modes of Consciousness in Developmental
Questioning Strategies in the
Counseling and Therapy
Dialectic-Systemic-Integrative Style
Sensorimotor-Elemental Style
Concrete-Situational Style Role of the Therapist in Developmental
Formal-Operational Style Counseling and Therapy
Dialectic-Systemic Style Precision Matching
Active Engagement of the Therapist
Developmental Counseling and Therapy
Approach to Wellness
Evaluation of Developmental Counseling
The Indivisible Self: Evidence-Based
and Therapy
Model of Wellness
Core Factors of the Indivisible Self

624
CHAPTER TWENTY NINE Developmental Counseling and Therapy 625

HISTORICAL CONTEXT OF DEVELOPMENTAL

COUNSELING AND THERAPY

Developmental counseling and therapy (DCT) is an integrative theory that was de-
veloped within a counseling, wellness, developmental, and coconstructive frame-
work (Ivey, 1986; Ivey, Ivey, Myers, & Sweeney, 2005; Rigazio-DiGilio, Ivey, & Ivey,
1997). It is unique in that it is not only integrative, but also a well-tested counseling
model, and it is the only theory that brings all types of developmental theory into
the interview itself. It has proven effective in individual, group, family, and net-
work practice.

䊏 Influences of Piagetian Cognitive-Emotional Developmental Theory

DCT is the first theory to show how major Piagetian constructs can be used actively
in the session. There are very practical ways to use an adaptation of Piagetian con-
structs in the here and now of the interview and in treatment planning.

䊏 Influences of Life-Span Developmental Theory

An axiom of the counseling field is that helpers are “developmentalists,” but rela-
tively little attention has been given as to how counselors can integrate life-span
theory into direct practice. The basic cognitive-developmental framework of DCT
integrates well with life-span theory. By utilizing a specific set of strategies to help
clients examine their life patterns, DCT directly links developmental theories to
practice in ways that can be particularly useful in guiding developmentally tai-
lored and culturally responsive assessment and treatment.

䊏 Influences of Postmodern Theory

The coconstructivist philosophy undergirding DCT suggests that culture and con-
text permeate development and shape our worldview (Rigazio-DiGilio & Ivey,
1995). DCT emphasizes the importance of person–environment interaction and
shows how counseling can be understood through this transactional lens. Exten-
sions of DCT to families and networks provide specific guidelines for assessing and
intervening in the client’s broader life space.

䊏 Influences of Wellness Theory and Research

Drawing on the work of Myers and Sweeney (2005b), DCT rejects concepts of pa-
thology and takes a positive and holistic approach to human change that provides
a solid base of strengths on which to facilitate client positive movement.
626 Special Topics and Important Trends That Counselors Might Encounter PART FOUR

䊏 Impact of Traditional Theories of Counseling and Psychotherapy

DCT includes the key systems of helping under its concepts and practices, keeping
developmental, wellness, coconstructive, and multicultural variables in the fore-
ground of assessment and treatment planning.

䊏 Influence of Multicultural Counseling

DCT recognizes the centrality and importance of culture and context. The theory
provides practical ways to understand how clients view their world within a cul-
tural context and to construct multiculturally sensitive treatment plans tailored to
these views and cultural contexts. It holds that all counseling is multicultural in
nature.

UNDERLYING PHILOSOPHY OF DEVELOPMENTAL

COUNSELING AND THERAPY

DCT is simultaneously a theory of helping within itself. A series of questions and

treatment strategies exist to facilitate client development, even clients with severe
issues. As indicated in the brief historical evolution, DCT integrates a wide variety
of perspectives into this approach. Perhaps most striking is the developmental
foundation.

䊏 Developmental Nature of Being

The philosophy of continuous development over time is foundational to DCT, and

the evolution of consciousness is central. DCT is a counseling approach that en-
ables a client to progress to new ways of thinking, feeling, and behaving. Expan-
sion of alternatives is basic. The specific questioning sequences of DCT, coupled
with appropriate treatment strategies, help expand the potential for human devel-
opment.

䊏 Multidimensionality in Developmental Counseling and Therapy

Traditional theories of counseling tend to focus on the concrete and formal aspects
of human development. DCT is unique in that it gives special attention to the body,
including nutrition and exercise. In addition, special attention is given to strategies
such as meditation, guided imagery, and other interventions designed to bring cli-
ents to the here and now.
CHAPTER TWENTY NINE Developmental Counseling and Therapy 627

䊏 Cultural Relevancy of Developmental Counseling and Therapy

DCT, along with feminist therapy, ecosystemic therapy, and multicultural counsel-
ing and therapy, gives special attention to the cultural, contextual, and environ-
mental aspects of clients. While attending to individual issues, DCT includes a so-
cial action dimension as well. Ellis (2000) commented on this aspect of DCT as
follows:

To be sure, REBT has not emphasized dialectic/systemic counseling as much as it is

heavily encouraged in DCT and SCDT. Quite possibly, it—and most other popular
therapies—are relatively lax in this respect. The unique element of both DCT and
SCDT is the way Ivey and Rigazio-DiGilio stress this fourth process; and REBT had
better seriously consider emphasizing it more than it sometimes has done in the past,
and thereby learn from DCT and SCDT. But, as also noted above, much can be said on
the hazards as well as the advantages of stressing this aspect of therapy. It is nonethe-
less accurate, as Rigazio-DiGilio, Ivey, and Locke (1997, p. 241) note, “Theories of
counseling and practice that perpetuate the notion of individual and family dysfunc-
tion without giving equal attention to societal dysfunction and to the dysfunctional in-
teractions that can occur between individuals, families, and societies (e.g., intentional
and unintentional power differentials) may unwittingly reinforce the oppressive para-
digm.” All systems of counseling had better give serious thought to this hypothesis—
as, in fact, few of them have to date done. (pp. 101–102)

Another vital part of DCT’s cultural component is its integration with multicul-
tural counseling and therapy’s concept of cultural identity development. DCT
points out that the four styles of consciousness closely relate to the four levels of
cultural identity development. See Table 29.1 as an illustration.
In addition, DCT has proven useful in bibliotherapy, spirituality, and counsel-
ing, with early recollections in Adlerian theory, and in supervision.

TABLE 29.1
Cognitive-Emotional Developmental Change: Two Theoretical Perspectives

Developmental
Cultural Identity Theory Counseling and Therapy Actions for Change

Preencounter Sensorimotor-elemental Ask for clients to describe life

(Naiveté with acceptance experiences through stories of
of status quo) oppression
Encounter Concrete-situational Name and confront contractions
(Naming and resistance with anger between self and contextual systems
a common emotion)
Immersion-emersion Formal-reflective Support pattern recognition and
(Redefinition and reflection) self-in-system reflections
Internalization Dialectic-systemic Continue emphasis on dialogic thought
(Multiperspectival integration) and coinvestigation of reality; joint
action to transform reality
628 Special Topics and Important Trends That Counselors Might Encounter PART FOUR

For more information on cultural identity development and multicultural counseling and
therapy, see Chapter 4. See Chapter 27 for an example of an ecological, transactional the-
ory of counseling.

MODES OF CONSCIOUSNESS IN DEVELOPMENTAL

COUNSELING AND THERAPY

Four styles of consciousness are identified within the DCT model that parallel
Piagetian cognitive-emotional concepts. Each style has value. Practically speaking,
counselors who use DCT start by identifying the client’s underlying style(s) of
communication, match their style to that of the client, and develop thinking, feel-
ing, and behavior strengths in the originally presented style(s). Later, encouraging
the client to expand consciousness via other styles is important in DCT. In the fol-
lowing segments, the four styles of consciousness briefly are described:

1. Sensorimotor-elemental.
2. Concrete-situational.
3. Formal-operational.
4. Dialectic-systemic.

䊏 Sensorimotor-Elemental Style

The client whose style is sensorimotor-elemental is able to experience emotions

and cognitions holistically in the here and now and be in the moment. There is no
separation of self from experience. Counselors often will find a random expression
of thoughts and feelings in clients who exhibit the sensorimotor-elemental style.
Counselors should look for the ability to be in touch with the body, but expect a
short attention span. With the sensorimotor style, some magical or irrational think-
ing may appear. On an affective level, there are a number of characteristics related
to the sensorimotor style.

Emotional Aspects of the Sensorimotor Style

䊏 Feelings are experienced in the here and now rather than described or reflected
on.
䊏 There is an emphasis on bodily experience.
䊏 Crying, laughing, and catharsis of deep emotion represents this style.

In the sensorimotor style, clients are susceptible to a number of barriers in their de-
velopment. Some of the more salient blocks to development are mentioned here.
CHAPTER TWENTY NINE Developmental Counseling and Therapy 629

Potential Developmental Blocks in the Sensorimotor Style

䊏 Clients may have difficulty in telling a clear, linear story of what happened.
䊏 Clients will have real difficulty in reflecting on themselves and the situation.
䊏 Behavior may tend to follow the same pattern—namely, short attention span and
frequent body movement.
䊏 There may be an inappropriate impulsive expression with tears, anger, or other
emotions.

In response to the developmental blocks present in this style, counselors have a

number of treatment options at their disposal.

Treatment Recommendations for the Sensorimotor Style

䊏 Body-oriented work.
䊏 Acupuncture.
䊏 Massage.
䊏 Yoga.
䊏 Imagery.
䊏 Relaxation training.
䊏 Medication.
䊏 Psychodynamic free association.
䊏 Gestalt exercises.
䊏 Metaphor.
䊏 Hypnosis.

䊏 Concrete-Situational Style

The client whose style reflects a concrete-situational stage gives concrete, linear de-
scriptions and stories about what happened, often with a fair amount of detail.
Nonverbal clients, however, may give short “yes” and “no” responses. At the late
concrete style, the client will display some causal reasoning, which is exemplified
by if–then thinking. Moving to behavioral action is easy. The manifestation of emo-
tions in this style reflects some of the following characteristics.

Emotional Manifestations in the Concrete-Situational Style

䊏 Specific feelings will be named and described but not reflected on.
䊏 Clients typically will verbalize emotions in this way: “I feel X because … ”
䊏 Some clients will have difficulty in naming emotion, but naming is basic to con-
crete emotional experiencing. This is an important step, but nonetheless, a move
away from direct here-and-now emotional experiencing.
630 Special Topics and Important Trends That Counselors Might Encounter PART FOUR

Clients who operate from the concrete-situational mode tend to exhibit some com-
mon blocks in growth. A few are presented here.

Potential Developmental Blocks in the Concrete-Situational Style

䊏 Clients repeatedly may tell detailed stories of their problems and share many ex-
amples of the same patterned behavior, but be unable to see patterns in their be-
havior.
䊏 Clients will have difficulty in generalizing learning with one problem discussed
in the session to another that is obviously parallel to the interviewer.
䊏 Clients often have difficulty in seeing a perspective other than their own.

Treatment options for clients in the concrete-situational stage include some of the
following suggestions.

Treatment Recommendations for the Concrete-Situational Style

䊏 Concrete narrative storytelling.
䊏 Assertiveness training and many cognitive and behavioral techniques.
䊏 Social skills training.
䊏 Decision and problem-solving counseling.
䊏 Rational-emotive behavior therapy and A-B-C analysis.
䊏 Reality therapy.
䊏 Crisis intervention.
䊏 Desensitization.
䊏 Psychoeducation.
䊏 Adlerian therapy with if–then problem analysis.

䊏 Formal-Operational Style

There are a number of strengths that people in the formal-operational mode of re-
lating exhibit. These people can talk about themselves and their feelings—some-
times even from the perspectives of others. Their conversations tend to be abstract.
At the late formal style, these clients can recognize commonalities in repeating pat-
terns of behaviors or thoughts. This is the type of client many counselors feel most
comfortable with, as they are often into analyzing themselves and their own iden-
tity. The emotional manifestations of clients who operate from this style include the
following characteristics.

Emotional Experiences in the Formal-Operational Style

䊏 Feelings are reflected on and discussed rather than experienced.
䊏 Patterns of emotional experience may be discussed.
CHAPTER TWENTY NINE Developmental Counseling and Therapy 631

Clients who prefer the formal-operational mode benefit from being able to analyze
and actively reflect on their experiences. However, they are also prone to some
blocks in development, a number of which are mentioned here.

Potential Developmental Blocks in the Formal-Operational Style

䊏 Clients who present at the formal style may be good at pattern recognition, but
have difficulty in giving concrete examples.
䊏 They may reflect on themselves and situations, but they may fail to see the as-
sumptions on which their thinking is based.
䊏 They may be overly abstract and have difficulty in moving experiencing emotion
at the sensorimotor style.

To counter the developmental barriers in the formal-operational style, counselors

have a number of tools at their disposal; some of these are provided here.

Treatment Options for the Formal-Operational Style

䊏 Reflection on narratives and stories.
䊏 Most Rogerian person-centered work.
䊏 Analysis of a Beck automatic thoughts chart or REBT thought patterns.
䊏 Psychodynamic dream analysis.
䊏 Adlerian strategies.
䊏 Cognitive therapy.
䊏 Logotherapy.
䊏 Family genograms.

䊏 Dialectic-Systemic Style

Most people ordinarily do not make sense of their worlds from this perspective. A
woman who realizes that sexism is the cause of her depression is using systemic
thought. A Native American Indian or a Canadian Dene who realizes that systemic
oppression leads to individual feelings or hurt and even depression is using dialec-
tic thought. Multiple perspective-taking and many alternatives are to be expected.
The client is aware of systems of knowledge and is aware of how he or she is af-
fected by the environment. Also, the client will be able to challenge and reflect
deeply on his or her own or others’ style of thought and feeling.

Emotions Frequently Present in the Dialectic-Systemic Style

䊏 The client may be highly effective at analyzing and thinking about emotions.
䊏 Emotions are often contextualized.
632 Special Topics and Important Trends That Counselors Might Encounter PART FOUR

䊏 A client may say “I’m sad about the loss of my parents in this accident, but proud
of the life they led. In some ways I miss them terribly, but in my heart they are still
there.”
䊏 The emotions change with the perspective taken.

The dialectic-systemic style lends itself to a number of barriers to development.

Some examples are presented next.

Potential Developmental Blocks in the Dialectic–Systemic Style

䊏 The clients can “analyze it to death.”
䊏 Their ability to think constantly in new ways may result in intellectualization
and distancing from the real problems.
䊏 Some clients would rather think about the problem than do anything about it.
䊏 There may be real difficulty in experiencing emotion at the sensorimotor style or
even being able to name what they are feeling accurately.

For clients who operate out of the dialectic-systemic mode, counselors may employ
a number of treatment options.

Treatment Strategies for the Dialectic-Systemic Style

䊏 Advocacy for social justice.
䊏 Community or neighborhood action.
䊏 Community genogram.
䊏 Family dream analysis.
䊏 Multicultural counseling and therapy.

DEVELOPMENTAL COUNSELING AND THERAPY

APPROACH TO WELLNESS

Wellness theory and research are central to DCT and provide a holistic, positive con-
ceptual framework that emphasizes client strengths as the basis for change and
growth. Consistent with a developmental view of pathology, the wellness perspec-
tive fosters an understanding of clients in terms of prevention and optimization of
human development rather than merely diagnosis and remediation of dysfunction.
Clients respond readily to interventions that begin with a positive wellness base.

䊏 The Indivisible Self: Evidence-Based Model of Wellness

Myers and Sweeney (2005b) presented the indivisible self, an evidence-based

model of wellness grounded in more than a dozen years of research, that may be
CHAPTER TWENTY NINE Developmental Counseling and Therapy 633

used to better understand healthy or well behavior. This model is an alterative to

the theoretical wheel of wellness model, which was based in multidisciplinary lit-
erature (Myers, Sweeney, & Witmer, 2000; Witmer & Sweeney, 1992) and proposed
spirituality as the core characteristic of healthy persons. In contrast, structural
equation modeling revealed that no characteristic of wellness is predominant;
rather, as proposed earlier by Adler (1954), the self is truly indivisible. All compo-
nents of wellness are important and necessary for healthy functioning.

See Chapter 9 for more on Adler’s conceptualization of human nature.

䊏 Core Factors of the Indivisible Self

The indivisible self model includes a superordinate holistic wellness factor—the

self—that cannot be divided into its component parts. From a holistic vantage
point, people move toward wellness through the way they live their life, in general,
or move away from wellness through their lifestyle choices. To be optimally well,
attention to all components of one’s functioning is necessary. Such a global per-
spective is useful in understanding the impact of lifestyle choices but less useful to
clinicians in knowing where to start to help clients become more well. As a conse-
quence, a second-order factor structure depicts the self in terms of five areas that
are both independent and interactive, in that change in one area will cause or con-
tribute to changes in each of the other areas. Significantly, change can be for better
or for worse.
The five factors of the indivisible self include the creative, coping, social, essen-
tial, and physical self. Each “self” includes additional wellness factors that provide
a specific focus for wellness-enhancing interventions.

Five Factors of the Indivisible Self

1. The creative self is defined as the unique combination of individual attributes
that each of us forms that allows us to define and manage ourselves in a
proactive manner in our social interactions.
2. The coping self helps us regulate our responses to life events and when negative
circumstances occur, helps us transcend their negative affects.
3. The social self is comprised of our relationships with others on a continuum ex-
tending from friendships through love, including both family and intimate re-
lationships.
4. The essential self is the core of our beliefs and values through which we interpret
the events of our lives.
5. The physical self includes the manner in which we care for our bodies through
nutrition and activity.

Although all of the factors of wellness are salient for each individual, the impor-
tance of any one factor may vary over the life span as a function of life circum-
634 Special Topics and Important Trends That Counselors Might Encounter PART FOUR

stances and transitions. In addition, the indivisible self model is ecological, in that
contextual variables, such as schools, neighborhoods, government, and the media,
are recognized as influencing and being influenced by the wellness of individuals.
An important context, chronometrical, speaks to the life-span nature of wellness.
DCT, which emphasizes positive growth and development over the life span, thus
incorporates wellness as both a process and goal.

See Chapter 30 for more information about wellness and the indivisible self model.

FUNDAMENTALS OF SYSTEMIC COGNITIVE

DEVELOPMENTAL THERAPY

Systemic cognitive developmental therapy (SCDT; Rigazio-DiGilio, 2000) adapts

DCT constructs for work with families and wider networks. SCDT examines the in-
ternal meaning making of individuals, families, and institutional systems and the
factors that influence exchanges across these systems. Imbalances within or across
individual, family, and community environments can trigger developmental im-
passes. This system–environment transaction must be accounted for in relational
diagnostic procedures, and should attend to how factors such as culture, ethnic
heritage, contemporary social issues, family values, spiritual beliefs, community
experiences, and developmental history directly influence the current intellectual,
emotional, and behavioral lives of individuals and systems.

See Chapter 18 for other perspectives on family therapy.

䊏 Defining Disorder From the Systemic Cognitive

Developmental Therapy Perspective

Regardless of where problems are situated, they are expressed within the relation-
ships among individuals, families, and wider systems and the broader illness nar-
ratives that evolve and are maintained by these interactions. Treatment often is ini-
tiated when these exchanges lead to unifying and constraining interpretations of
problems, or to predominant interpretations that elicit dissonant or oppressive
transactions involving issues of superiority, blame, and responsibility. The goal is
to facilitate a sense of shared responsibility, mutual understanding, resource utili-
zation, and positive problem solving. Starting with the family and working inter-
nally with its members and externally with personnel from community institutions
and agencies, the counselor creates counseling and consulting environments that
are solution focused and aimed at loosening constraints and accessing under-
utilized resources.
CHAPTER TWENTY NINE Developmental Counseling and Therapy 635

䊏 Assessment in Systemic Cognitive Developmental Therapy

Relational assessment explores the worldviews of relational units, participating

systems, and cultural and societal norms, all of which are evident in the behaviors,
goals, and emotional bonds expressed by those contributing to and defining the
problem. By applying SCDT assessment strategies, counselors can identify the in-
formation processing styles held by each family member, the family as a relational
unit, and other participating groups and agency personnel. Issues of how family
members are connected to one another and the wider systems also can be classified
in terms of power.

Assessing Power in Relational Units and Systems

䊏 Issues of social and economic oppression can negatively influence the develop-
ment of individual and family resources.
䊏 Environmental demands for interactions that are outside of the family’s physi-
cal, psychological, cultural, moral, or spiritual sense of self or self-in-relationship
can cause dissonance.
䊏 Oppression that is created when the environment labels a family’s familiar ways
of perceiving and acting as substandard or deviant is particularly insidious.

Knowing who has the real or imagined means to wield the most power and influ-
ence is critical to determining the options for change. Understanding family and
systemic relatedness also can be classified in terms of embeddedness, which can be
assessed by determining the types of unanimity and conformity existing in how
problems are defined and managed.

Advantages of Accounting for Embeddedness in Assessment

䊏 Accounting for embeddedness allows the counselor to be a firsthand participant
in those systems relevant to the presenting problem and to determine where they
can intervene most flexibly to relieve unproductive meanings and exchanges.
䊏 The wider narrative becomes the point of departure to advance multiple per-
spectives regarding the presenting problem.
䊏 Embeddedness opens alternative ways for all participants to understand one an-
other and work together toward the management or dissolution of the problem.

䊏 Treatment in Systemic Cognitive Developmental Therapy

As with DCT, treatment occurs within counseling and consulting environments

that correspond with the processing styles being explored at different times and
during different encounters. Expanding on the DCT model, counselors use SCDT
questioning strategies and draw from systemic and ecosystemic approaches—or-
ganized within a developmental, coconstructive metaframework—to tailor treat-
636 Special Topics and Important Trends That Counselors Might Encounter PART FOUR

ment to these processing styles, and to evaluate the impact of any intervention, ei-
ther inside or outside the family.1

SCDT treatment is geared toward ensuring that

families take an empowered position within the
interactive system. Although the clinician works
from several intervention points, a central focus
is for the family to become an active and equal
participant in constructing and acting
on solutions.

SCDT treatment is geared toward ensuring that families take an empowered po-
sition within the interactive system. Although the clinician works from several in-
tervention points, a central focus is for the family to become an active and equal
participant in constructing and acting on solutions. SCDT treatment planning fo-
cuses on three levels, which are described next.

Aims of Treatment Planning in SCDT

1. To help relational units strengthen and master resources that had not been ef-
fectively utilized within the current worldview.
2. To assist relational units to explore new perspectives and new options associ-
ated with other styles.
3. To assist all members of the interactive system to work together on common
goals within a coherent worldview that links all members.

Using SCDT helps clinicians realize internal and external contexts and permits the
wide use of various interventions for treatment, which results in an expansion of
the possibilities of relational counseling.

DEVELOPMENTAL COUNSELING AND THERAPY TECHNIQUES:

DEVELOPMENTAL STRATEGIES QUESTIONING SEQUENCE

DCT uses a number of strategies to help clients. It is possible to identify the cogni-
tive-emotional developmental style of a client by listening to and observing lan-
guage used in the interview. After observing the cognitive-emotional level of the
client, the counselor matches the counseling or therapeutic intervention so that the
client can understand and act on what he or she has said. Mismatching interven-

1Research indicates that collective information processing styles can be identified and help
guide the treatment process (Speirs, 2006).
CHAPTER TWENTY NINE Developmental Counseling and Therapy 637

tions may be equally helpful. An overly abstract client, for example, may benefit
from an approach that focuses on concrete specifics. Similarly, a concrete client may
be helped toward an understanding of self and situations by facilitating more ab-
stract conversation. This generic approach can be used across individual, group,
and family work. It is helpful to use this system in all theories of counseling and
therapy as it enables the counselor to reach clients where they are conceptually,
emotionally, and behaviorally.
DCT offers some specific questioning strategies to facilitate expansion of con-
sciousness within and between the various styles. If a counselor works through
these questions carefully with a client, cognitive and emotional change is very
likely to occur. If one adds some behavioral methods to the mix, the change is very
likely to generalize to the client’s daily life. The questioning process also can be
used to facilitate individual understanding of herself or himself as a multicultural
being. The dialectic-systemic questions help put clients in touch with how environ-
mental and contextual issues have shaped them. Following is an abbreviated ver-
sion of the questioning strategies used for each developmental style that clients
present (Ivey, Rigazio-DiGilio, & Ivey, 2005).

䊏 Questioning Strategies in the Opening Presentation of Issue

When a client first presents the issues of concern, counselors can ask two questions
that help guide the session:

1. Could you tell me what you’d like to talk about today?

2. What happens for you when you focus on your family?

In an attempt to be brief and to the point, the counselor obtains a story of 50 to 100
words. Strategies for doing so are listed next.

Ways to Obtain a Story of 50 to 100 Words

䊏 Assess client cognitive-emotional style.
䊏 Use questions, encouragers, paraphrasing, and reflection of feeling to bring out
data, but try to influence the client’s story minimally.
䊏 Get the story as he or she constructs it.
䊏 Summarize key facts and feelings about what the client has said before moving on.

䊏 Questioning Strategies in the Sensorimotor-Elemental Style

If the assessment of the client suggests a sensorimotor-elemental style, the coun-

selor can ask either of these questions that correspond to the style:

1. Could you think of one visual image that occurs to you in that situation?
2. What are you seeing? Hearing? Feeling? Where do you locate the feeling in
your body?
638 Special Topics and Important Trends That Counselors Might Encounter PART FOUR

In obtaining some minimal information, the counselor elicits an example from the
client and asks what was seen, heard, or felt.

Strategies for Eliciting Examples and Sensory Experiences

䊏 Aim for here-and-now experiencing.
䊏 Accept randomness.
䊏 Summarize at the end of the segment.
䊏 Counselors may want to ask: “What one thing stands out for you from this?”

䊏 Questioning Strategies in the Concrete-Situational Style

For clients who operate from the concrete-situation style, counselors can ask two
questions such as these:

1. Could you give me a specific example of the situation, issue, or problem?

2. Can you describe your feelings in the situation?

The goal of the counselor who is working with concrete-situational clients is to ob-
tain a clear or logical description of the event. Some ways to achieve this goal are as
follows.

Ways to Obtain a Linear Description of the Event

䊏 Look for if–then causal reasoning.
䊏 Ask: “What did he or she do? Say? What happened before? What happened
next? What happened after?”
䊏 Possibly pose the question “If he or she did X, then what happened?”
䊏 Summarize before moving on.
䊏 For affective development, ask: “What did you feel?”
䊏 The statement: “You felt X because … ” helps integrate cognition with affect at
this level.

䊏 Questioning Strategies in the Formal-Pattern Style

When working with clients in the formal-pattern style, counselors may ask either
of these sets of questions:

1. Does this happen in other situations? Is this a pattern for you?

2. Do you feel that way in other situations? Are those feelings a pattern for you?
CHAPTER TWENTY NINE Developmental Counseling and Therapy 639

Counselors aim to help clients elucidate patterns or typical ways of feeling or be-
having. Some recommendations for achieving this goal are provided.

Suggestions for Highlighting Repeating Patterns and Situations

䊏 Ask: “What were you saying to yourself when that happened? Have you felt like
that in other situations?”
䊏 Reflect feelings and paraphrase as appropriate.
䊏 Summarize key facts and feelings carefully before moving on.

䊏 Questioning Strategies in the Dialectic-Systemic-Integrative Style

Working in the dialectic or systemic style, counselors begin by summarizing all that
has been said. Two key approaches for guiding the summary are these:

1. How do you put together/organize all that you told me? What one thing
stands out for you most?
2. How many different ways could you describe your feelings and how they
change?

Some specific approaches or tasks that aid the counselor in getting to the client’s
summation of experience are suggested next.

Process of Obtaining an Integrated Summary of the Dialogue

䊏 Enable the client to see how reality is coconstructed, not developed from a single
view.
䊏 Obtain different perspectives on the same situation and be aware that each is just
one perspective.
䊏 Note flaws in the present construction, coconstruction, or perspective.
䊏 Move to action.

ROLE OF THE THERAPIST IN DEVELOPMENTAL

COUNSELING AND THERAPY

DCT recasts the traditional superior and separate role of clinicians to that of equal
partners engaged in the coconstruction of client worldviews that are solution fo-
cused rather than problem saturated.
640 Special Topics and Important Trends That Counselors Might Encounter PART FOUR

䊏 Precision Matching

The counselor’s role is based on understanding and being with the client. Much
like person-centered therapy, DCT counselors enter the client’s world. However,
DCT favors what it terms precision matching, in which it is crucial that the thera-
pist meet the client where he or she is. Rapport needs to be based far more on the
style and worldview of the client.

䊏 Active Engagement of the Therapist

The counselor is quite active within the DCT model. Questions are generally un-
welcome in the person-centered model, but are foundational to DCT. At issue is the
educational concept of drawing out what is already in the client. Strategies used
depend on the client and may include a wide array of theories. Illustrations of vary-
ing treatment examples drawn from multiple theories are listed under each of the
information processing styles identified earlier.

EVALUATION OF DEVELOPMENTAL COUNSELING

AND THERAPY

DCT’s greatest strengths are simultaneously its greatest weaknesses. They can be
summarized as shown in Table 29.2. DCT offers a developmental, coconstructive,
and wellness-oriented integrative therapy model that can be used with individu-
als, partners, families, and wider networks. DCT and its ecosystemic extension are
models considered easy to learn, apply, and research (Borders, 1994), and they ad-

TABLE 29.2
Strengths and Weaknesses of Developmental Counseling and Therapy

Strengths Limitations

Theoretically dense, accounting for many dimensions Requires more study, thought, and practice than
of the helping process most other theoretical orientations
Multicultural issues are central There are those who resist multiculturalism
Effective with children, adolescents, and adults as well Requires fundamental understanding of counseling
as families and networks and is at an advanced level of practice
Makes possible systematic integration of multiple This may be challenging to those who wish to work
theories of helping and encourages knowledge of within a single theory
many approaches
Wellness emphasis with accompanying rejection of The dominant pathological and problem-centered
psychopathology point of view disagrees with this orientation.
CHAPTER TWENTY NINE Developmental Counseling and Therapy 641

dress the comprehensive importance of culture, family systems, and partner and
family worldviews (Arciniega & Newlon, 1994). As a true integrative theoretical
model, DCT brings together a combination of theories and approaches and forms a
new theory and treatment system that builds and improves on each of the individ-
ual approaches to form a better product. Treatment is therefore theory focused
rather than technique driven (Seligman, 2006).

Chapter 29: Key Terms

䉴 Developmental Counseling 䉴 Systemic Cognitive Devel-
and Therapy opmental Counseling
䉴 Precision Matching
chapter Counseling for Wellness

30 Thomas J. Sweeney
Ohio University

Jane E. Myers
University of North Carolina

In This Chapter

䉴 Historical Context of the Wellness Movement

䊏 Philosophical Groundwork of Wellness

䊏 Counseling-Based Approach to Wellness

䉴 Modern Definitions of Wellness

䊏 Differentiation Between Health and Wellness

䊏 Multiple Understandings of Wellness

䊏 Wellness Defined From a Counseling Perspective

䉴 Wellness Models
䊏 Wheel of Wellness Model

䊏 Indivisible Self (IS-WEL): Evidence-Based Model of Wellness

䉴 Assessment Tools for Examining Wellness

䊏 The Wellness Evaluation of Lifestyle

䊏 The Five Factor Wellness Inventory

䉴 Counseling for Wellness

䊏 Step 1: Introduction of the Wellness Model

䊏 Step 2: Assessment of the Components of the Wellness Models

䊏 Step 3: Intentional Interventions to Enhance Wellness

䊏 Step 4: Evaluation and Follow-Up

642
CHAPTER THIRTY Counseling for Wellness 643

HISTORICAL CONTEXT OF THE WELLNESS MOVEMENT

In this chapter, we review modern definitions of wellness and briefly describe

models of wellness arising from these definitions. Most of the early models evolved
from the health sciences professions are holistic in concept; in application the focus
has remained on physical aspects of functioning and how physical change affects
other components of well-being. New models of wellness are being developed
with the aim of assessing equally all aspects of physical, emotional, cognitive, and
spiritual functioning.

䊏 Philosophical Groundwork of Wellness

The Greek philosopher Aristotle, writing in the 5th century BC, is credited with be-
ing the first to write about wellness. His scientific attempts to explain health and ill-
ness resulted in a model of good health as one in which we avoid the extremes of
excess and deficiency. Stated succinctly, this philosophy is expressed as “nothing in
excess.” The son of a physician, Aristotle identified eudaemonia, a state of happiness
or flourishing, as the ultimate expression of a person’s ability to live and fare well.
The health of body and mind were linked until some centuries later when Des-
cartes (1596–1650), credited as being the father of modern philosophy, explained
human functioning based on scientific reasoning. He believed that the mind and
body were two separate entities that worked together in a mechanistic manner.
This philosophy resulted in a reductionistic and fragmented approach to human
functioning, with illness viewed as being only in the mind. Fortunately, solid re-
search in medicine as well as health-related professions is rapidly creating a new
paradigm wherein not only are the mind and body viewed as inseparable, but the
spirit is also seen as integral to understanding health and illness (Larson, 1999).

䊏 Counseling-Based Approach to Wellness

Counseling-based models of wellness that emerged over the past two decades are
holistic in nature and have a strong foundation in psychological theory as an orga-
nizing and integrative focus. The recent emergence of positive psychology, with
emotion as the central and perhaps sole focus of efforts to understand well-being, is
yet another attempt to determine how people can live in an optimal manner. So far,
such models such as positive psychology are not truly holistic in nature, however,
and have not incorporated other equally important components of health and
wellness (e.g., culture).

MODERN DEFINITIONS OF WELLNESS

Understanding wellness requires an understanding of health and how the two con-
cepts differ.
644 Special Topics and Important Trends That Counselors Might Encounter PART FOUR

䊏 Differentiation Between Health and Wellness

The World Health Organization (WHO) as early as 1947 defined health as “physi-
cal, mental, and social well-being, not merely the absence of disease” (WHO, 1958,
p. 1) and later provided the following definition of optimal health: “a state of com-
plete physical, mental, and social well-being and not merely the absence of disease
or infirmity” (WHO, 1964, p. 1). The American Heritage Dictionary of the English Lan-
guage (2000) defined wellness as “the condition of good physical and mental health,
especially when maintained by proper diet, exercise, and habits.” Both of these def-
initions imply a static state of existence.

䊏 Multiple Understandings of Wellness

In the modern wellness movement, wellness is viewed as a dynamic process and

not a static state. Indeed, high-level wellness is a deliberate state in which the pro-
cess of making choices toward greater wellness becomes self-perpetuating. From
the perspective of multiple authors, wellness can be described as both an outcome
and a process, at once an overarching goal for living and a day-by-day, min-
ute-by-minute way of being. This global concept is multifaceted and hence has
given rise to a variety of models that purport to explain both the process and goal of
optimum human functioning that is called wellness.

In the modern wellness movement, wellness is

viewed as a dynamic process and not a static
state. Indeed, high-level wellness is a deliberate
state in which the process of making choices
toward greater wellness becomes
self-perpetuating.

Key Figures Who Define Wellness

䊏 Dr. Halbert Dunn (1961, 1977), architect of the modern wellness movement, de-
fined wellness as “an integrated method of functioning which is oriented toward
maximizing the potential of which the individual is capable, [provided] that the
individual maintain a continuum of balance and purposeful direction within the
environment where he is functioning” (Dunn, 1961, p. 4).
䊏 Dr. Bill Hettler, a public health physician, and father of wellness as we now
know it, defined wellness as “an active process through which people become
aware of, and make choices toward a more successful existence,” (http://
www.hettler.com/).
䊏 Don Ardell authored 15 books about wellness and his continually evolving defi-
nitions of the concept include self-responsibility and global healing.
CHAPTER THIRTY Counseling for Wellness 645

䊏 Dr. John Travis saw health as a neutral point on a continuum that ranges from ill-
ness on one end to wellness at the other (Travis & Ryan, 1988). He described
high-level wellness as involving “giving good care to your physical self, using
your mind constructively, expressing your emotions effectively, being creatively
involved with those around you, and being concerned about your physical, psy-
chological and spiritual environments” (Wellness Associates, nd).
䊏 Psychologists Archer, Probert, and Gage (1987) conducted an extensive literature
review on wellness and concluded that wellness is “the process and state of a
quest for maximum human functioning that involves the body, mind, and spirit”
(p. 311).

From the perspective of multiple authors, we can conclude that wellness is both an
outcome and a process, at once an overarching goal for living and a day-by-day,
minute-by-minute way of being. This global concept is multifaceted and hence has
given rise to a variety of models that purport to explain both the process and goal of
optimum human functioning that we call wellness.

For more information on health and wellness visit:

䉴 http://thewellspring.com/pubs/iw_cont.html

䊏 Wellness Defined From a Counseling Perspective

Wellness also has been defined from a counseling perspective. Myers et al. (2000),
after reviewing literature from multiple disciplines, concluded that wellness can be
conceptualized in this way:

Wellness: “[A] way of life oriented toward optimal health and well-being, in
which body, mind, and spirit are integrated by the individual to live life more
fully within the human and natural community. Ideally, it is the optimum
state of health and well-being that each individual is capable of achieving”
(p. 252).

WELLNESS MODELS

Early models of wellness, as noted earlier, evolved from physical health sciences
and medicine. Notable among these are Dunn’s model of high-level wellness,
Hettler’s hexagon model, and Travis and Ryan’s illness–wellness continuum.
Ardell developed a series of three models to describe wellness. Early writings by
authors such as and Ryff and Keyes (1995) led to the emergence of the positive psy-
646 Special Topics and Important Trends That Counselors Might Encounter PART FOUR

chology movement, which does not claim an emphasis on holistic wellness, but
rather is considered to be the “scientific study of ordinary human strengths and vir-
tues” (Sheldon & King, 2001, p. 216). More recently, two models of wellness
emerged in the counseling field: the wheel of wellness model and the indivisible
self model.

䊏 Wheel of Wellness Model

Wellness models in counseling, notably the early model by Sweeney and Witmer
(1991) and Witmer and Sweeney (1992a) and the revision of this model by Myers et
al. (2000), were the first models to emerge in the mental health professions. Swee-
ney and Witmer (1991) and Witmer and Sweeney (1992a) conducted cross-disci-
plinary studies to identify correlates of health, quality of life, and longevity. The de-
velopment of the wheel of wellness was the outcome of this early thought and
research.

Characteristics of the Wheel of Wellness

䊏 With Adlerian individual psychology (Adler, 1927/1954; Ansbacher & Ans-
bacher, 1967; Sweeney, 1998) as an organizing system, the model highlights rela-
tions among 12 components of wellness depicted graphically in a wheel (see Fig-
ure 30.1).

FIGURE 30.1 Wheel of wellness. From Witmer, Sweeney, & Myers (1996). Reprinted
by permission.
CHAPTER THIRTY Counseling for Wellness 647

䊏 After early research, this model was expanded and refined to include 17 compo-
nents (Myers et al., 2000) that interact with contextual and global forces to impact
holistic well-being.
䊏 Spirituality is depicted as the center of the wheel and the most important charac-
teristic of well-being by relating the self to meaning and purpose in life.
䊏 Surrounding the center is a series of 12 spokes in the life task of self-direction that
helps to regulate or direct the self as we respond to the Adlerian life tasks of work
(and leisure), friendship, love, self, and spirit.

12 Life Tasks in the Wheel of Wellness

䊏 Sense of worth.
䊏 Sense of control.
䊏 Realistic beliefs.
䊏 Emotional responsiveness and management.
䊏 Intellectual stimulation, problem solving, and creativity.
䊏 Sense of humor.
䊏 Exercise.
䊏 Nutrition.
䊏 Self-care.
䊏 Stress management.
䊏 Gender identity.
䊏 Cultural identity.

This model is the basis of an assessment instrument for wellness, the Wellness Eval-
uation of Lifestyle (WEL; Myers, Sweeney, & Witmer, 1998), and has been used
widely in workshops, seminars, and empirical research.

䊏 Indivisible Self (IS–WEL): Evidence-Based Model of Wellness

Use of the wheel model and the WEL over a decade led to the development of a
large empirical database from which a manual and norms were developed (see
Myers & Sweeney, 2005c). Subsequently, these data were analyzed using structural
equation modeling (Hattie, Myers, & Sweeney, 2004). The outcome of exploratory
and confirmatory factor analyses resulted in a clearly defined structural model,
and led to a new, evidence-based model of wellness called the indivisible self
(IS–WEL; see Figure 30.2).

Traits of the Indivisible Self Model of Wellness

䊏 Consistent with Adlerian principles, the self is the central and indivisible core of
wellness, represented by a single, higher order factor called wellness.
648 Special Topics and Important Trends That Counselors Might Encounter PART FOUR

FIGURE 30.2 The indivisible self: An evidence-based model of wellness. From

Sweeney & Myers (2003). Reprinted by permission.

䊏 Within this core are five second-rder factors: creative self, coping self, social self,
essential self, and physical self.
䊏 Although the circumplex structure hypothesized in the theoretical wheel model
was not supported by factor analysis, each of the original 17 components of
wellness was confirmed as distinct third-order factors.
䊏 In the IS–WEL model, these factors are grouped within the five second-order fac-
tors of the self.
䊏 Contextual variables comprise an important part of this model and include local,
institutional, global, and chronometrical variables.

ASSESSMENT TOOLS FOR EXAMINING WELLNESS

To help all people work toward high-level wellness, formal assessment methods
that inform self-understanding and contribute to an emerging knowledge base of
well functioning were developed.
CHAPTER THIRTY Counseling for Wellness 649

䊏 The Wellness Evaluation of Lifestyle

The need for assessment was met initially through development and validation of
the Wellness Evaluation of Lifestyle (WEL). After 15 years of research involving
more than three dozen studies, five separate and increasingly more useful versions
of the WEL resulted in the Five Factor Wellness Inventory (5F–WEL, discussed at
length in the next section).

Elements of the WEL

䊏 The initial version (WEL–O; Witmer, Sweeney, & Myers, 1993) included 114
items designed to assess the 17 components in the wheel of wellness.
䊏 Items were statements (e.g., “I usually achieve the goals I set for myself”) that re-
spondents rated using a 5-point Likert-type scale with choices including (5)
strongly agree, (4) agree, (3) neutral or undecided, (2) disagree, and (1) strongly
disagree.
䊏 Over a period of 10 years, the instrument was field tested with a variety of adult
populations.
䊏 Extensive item and scale analyses resulted in several revisions, the most recent
being the WEL–S (Myers et al., 2000), which includes 131 items.
䊏 Convergent and divergent validity were investigated by comparing scores on
the various WEL scales to similar scales on other instruments.
䊏 As reported in the WEL Manual, Myers (1998) found that scores measuring concep-
tually similar constructs had high correlations (convergent validity) and scores
measuring different constructs had lower correlations (divergent validity).

Both scale and item scores can be examined and may be helpful in targeting specific
areas of wellness for intentional change. The lack of factor analytic studies limits
the usefulness of the WEL for research.

䊏 The Five Factor Wellness Inventory

The Five Factor Wellness Inventory (5F–WEL) grew out of factor analytic studies of
the original WEL database and measures the factors included in the indivisible self
model of wellness. Multiple versions of the 5F–WEL, including cross-cultural
translations and versions for children and adolescents as well as adults have made
this a useful instrument for clinical and research purposes.

Elements of the 5F–WEL

䊏 The paper-and-pencil instrument includes 73 items measuring the single higher
order wellness factor (total wellness), the five second-order factors (creative,
coping, social, essential, and physical selves), and the original 17 discrete scales
measured in the WEL.
650 Special Topics and Important Trends That Counselors Might Encounter PART FOUR

䊏 Most of the scales include four to six items.

䊏 An additional 19 items measure the four contexts included in the IS–WEL model
(local, institutional, global, and chronometrical).

Use of the 5F–WEL in multiple dissertation and other studies provides evidence of
both convergent and divergent validity of the scales relative to constructs such as
ethnic identity, acculturation, body image, self-esteem, and gender role conflict
(Myers & Sweeney, 2005a).

Available Forms of the 5F–WEL

䊏 The ninth-grade reading level version (for use with high school students or
adults).
䊏 The maximum sixth-grade reading level version.
䊏 The third-grade reading level version (for use with middle and elementary
school students).

In addition to its applicability to a variety of age groups, the 5F–WEL is also ad-
justed for use with clients of differing cultural backgrounds for whom English is
not a first language.

Cultural Adaptations of the 5F–WEL

䊏 The adult version has been translated into Korean (translation by C. Chang,
1998), Turkish (translation by T. Dogan, 2005), and Spanish (in progress; transla-
tion by N. Ivers and J. Myers, 2006).
䊏 The sixth-grade version has been translated into Hebrew (translation by M. Ta-
tar; See Tatar & Myers, in press).
䊏 The third-grade version translation into Spanish is in progress.
䊏 A Chinese language adaptation currently is being explored.

COUNSELING FOR WELLNESS

Suggestions for using wellness in counseling incorporate four steps that are high-
lighted in this section:

1. Introduction of one of the wellness models, including a life-span, choice-based

focus.
2. Formal assessment, informal assessment, or both, based on the model.
3. Intentional interventions to enhance wellness in selected areas of wellness.
4. Evaluation and follow-up.
CHAPTER THIRTY Counseling for Wellness 651

䊏 Step 1: Introduction of the Wellness Model

The first step in the process of wellness counseling is typically to introduce the
counselee to a different paradigm than simply symptom relief. Most counselees
want and deserve help with their presenting issues. As is often the case, the pre-
senting issues are an expression of lifestyle behaviors, attitudes, and expectations
that the counselees are not fully aware contribute to their presenting issues. No
more time is required to include an expectation that more good can be accom-
plished than symptom relief or a solution to an immediate issue. Having empa-
thized and shown interest in the presenting issues, the counselor may introduce the
idea of wellness near the end of the first session.
There are a number of ways that counselors can approach the topic of wellness,
including talking about wellness, conceptualizing wellness as a personal choice,
emphasizing the multidimensional nature of wellness, introducing wellness as
part of life-span development, and reviewing the personal meaning of wellness to
the client.

Talk About Wellness

䊏 Express a desire to encourage higher level wellness as an ultimate goal.
䊏 Provide a short definition of wellness.
䊏 Introduce one of the models (IS–WEL or wheel of wellness).
䊏 Explain how a focus on healthy living can contribute to overall well-being.
䊏 Share a copy of the model with the counselee in which each characteristic in the
model is briefly described.
䊏 Ensure clients that these characteristics are derived from across disciplines
through multiple studies over several decades.

The interaction of the indivisible components of the model is an important con-

cept when presenting the wellness model.

Conceptualize Wellness as a Personal Choice

䊏 Explain that change in any one area can contribute to or create changes in other
areas, and these changes can be for better or worse.
䊏 Define wellness as a choice.
䊏 Remind clients that each choice made toward wellness leads to greater happi-
ness and life satisfaction through enhanced well-being in the areas that contrib-
ute to wellness.

After introducing the topic of wellness and underscoring the choice clients have
to incorporate wellness into their therapeutic goals, it is helpful, when presenting
the wellness models, to emphasize the three- or even four-dimensional nature of
wellness.
652 Special Topics and Important Trends That Counselors Might Encounter PART FOUR

Emphasize the Multidimensional Nature of Wellness

䊏 Encourage counselees to view the wheel of wellness model as a sphere or globe,
the center of which is round and full when the central component is personally
satisfying. If the central component is unsatisfying, the rest of the sphere cannot
be firm and round.
䊏 Help clients visualize the tasks of self-direction as spokes in a wheel that allow
the wheel to roll along solidly through time and space when strong, but that hin-
der the wheel’s movement when they are defective.
䊏 Describe the human experience of stress holistically—from physical, spiritual,
and emotional perspectives.
䊏 Educate clients that strengthening one component of well-being has positive ef-
fects on all the others.

The wheel represents the components of wellness over the life span, and atten-
tion to each component has consequences that multiply over the course of the life
span.

Introduce Wellness as Part of Life-Span Development

䊏 Describe wellness choices as having a cumulative effect over the life span by in-
creasing wellness in all dimensions, thereby contributing to quality of life and
longevity.
䊏 Encourage counselees to take a life-span perspective on their total wellness by
reviewing the impact of prior choices in each dimension of wellness and project-
ing the future impact of choices made at this time.

Finally, counselees are asked to review the model and reflect on the personal
meaning of wellness.

Review the Personal Meaning of Wellness to the Client

䊏 Ask clients if they would like to learn how to solve the presenting issue, and ad-
ditionally, enjoy their life more.
䊏 Encourage clients to define wellness in their own words. They likely will need
help reflecting on wellness as a process rather than an outcome.
䊏 Encourage clients to study the components of the model such as the wheel and
reflect on the personal meaning of each concept.

䊏 Step 2: Assessment of the Components of the Wellness Models

Although models of wellness are useful for conceptualizing human functioning, it

is even more important that these models be used as a basis for self-understanding
and intentional decision making to enhance wellness in a positive direction. To do
so most effectively requires some means of assessing how one is doing in each of
CHAPTER THIRTY Counseling for Wellness 653

the areas of well-being. Assessment may be conducted in a variety of ways and ei-
ther informally or formally. Informal assessment methods usually rely on the use of
two simple scaling questions for which clients make ratings.

Scaling Questions
1. How well do you feel?
2. How satisfied are you with your level of wellness in this area?

A sample rating scale for spiritual wellness would look something like Table 30.1.
A global self-report assessment of a counselee’s functioning in each of the com-
ponents of the wheel similarly can be obtained in an informal assessment.

Process of Obtaining a Global Self-Report

䊏 Ask the counselee to rate his or her overall wellness in each dimension on a scale
of 1 (very low) to 10 (very high).
䊏 Honor counselees’ scores—even mid- to low levels of wellness in an area—if
they are content with their score at a particular point in time and have no desire
for change.
䊏 Encourage clients to reflect on the scores to determine themes and patterns.
䊏 Ask counselees to confirm that these ratings are accurate in terms of how they see
their wellness at this point in time.

In addition to or in place of an informal assessment, wellness in each dimension

may be assessed using the WEL (Myers et al., 1998), which is based on the wheels of
wellness model or the 5F-WEL (Myers & Sweeney, 2004), which is based on the
IS–WEL. There are a number of advantages to using formal assessment methods.
First, the WEL and the 5F–WEL provide systematic ways to evaluate the compo-
nents of the wheel of wellness or IS–WEL, respectively. Second, these tools allow
for a measurement of one’s wellness on a continuum from not well to high-level
wellness. Finally, formal assessment provides a basis for developing a personal
wellness plan that contributes to greater total wellness.
There are some guiding principles that counselors can follow when using the
WEL or 5F–WEL assessment tools.

TABLE 30.1
Sample Spiritual Wellness Rating Scale

Circle the Number That Best Reflects Your Overall Spiritual Wellness
Spirituality and Your Satisfaction With Your Spiritual Wellness.

Overall Wellness 1 2 3 4 5 6 7 8 9 10
Satisfaction 1 2 3 4 5 6 7 8 9 10
654 Special Topics and Important Trends That Counselors Might Encounter PART FOUR

Guidelines for Using the WEL or the 5F–WEL Inventories

䊏 Encourage counselees to reflect on their scores, determine how well the scores re-
flect their perceptions of their total wellness, and reflect on the pattern of their
high and low scores.
䊏 Select one or more of the low scores as areas for which the client would like to de-
velop a personal wellness plan.
䊏 Help clients choose an area in which they received a high score, and yet would
like to enhance that area of personal wellness.
䊏 Attempt to build on assets to overcome perceived weaknesses. If humor is one of
an individual’s strengths, for example, the counselor may help the counselee
find the paradox in some well-intended but self-defeating behaviors.

䊏 Step 3: Intentional Interventions to Enhance Wellness

Once wellness in each dimension has been assessed, either informally or formally,
counselees can be asked to choose one or more areas of wellness that they would
like to change and improve. It is not recommended that counselees try to affect
change in all areas simultaneously for two reasons. First, choosing to change in
more than two to three areas likely will represent an overwhelming array of tasks
for anyone. Second, because change in one area will cause changes in other areas,
awareness of wellness needs combined with change in any one area is likely to in-
crease overall wellness and wellness in specific additional areas of the model.
The two main tasks of the third step in counseling for wellness are cocon-
structing a personal wellness plan and developing a written behavioral plan. Once
the counselee identifies those dimensions that he or she would like to change in the
direction of greater wellness, the counselor and counselee work to coconstruct a
personal wellness plan in each targeted area.

Tasks of Coconstructing a Personal Plan

䊏 Restate the definition of wellness for the identified dimension followed by a rat-
ing scale consisting of the numbers 1 through 10.
䊏 Direct the counselee to circle the number reflecting his or her wellness in this
area. (For generic worksheets that can be used, see Wellness and Habit Change
Workbook [Myers & Sweeney, 2004]).
䊏 Instruct the counselee to write comments on the worksheet concerning his or her
satisfaction with the self-rating. (For some counselees with limited sight or other
impairments, the counselor records their remarks.)
䊏 Discuss concerns related to the counselee’s level of satisfaction.
䊏 Ask the counselee to complete an informal self-assessment of personal strengths
and limitations related to the wellness area targeted for change.

After the counselor and counselee create the personal wellness plan, they de-
velop a written behavioral plan that supports the personalized plan.
CHAPTER THIRTY Counseling for Wellness 655

Components of the Written Behavioral Wellness Plan

䊏 Objectives for change.
䊏 Methods to be used to effect change.
䊏 Resources that will be employed as the plan is implemented.
䊏 Involvement of key persons in the implementation of the wellness plan.

䊏 Step 4: Evaluation and Follow-Up

Finally, a discussion of evaluation procedures and timelines is an important part of

the behavioral plan.

Ways to Individualize Evaluation and Follow-Up Procedures

䊏 Encourage the counselee to use an ongoing plan for regular and systematic eval-
uation, with identified markers that signify progress in making change.
䊏 Use feedback from friends and family when possible as an indicator that efforts
to enhance wellness are being made.
䊏 Help counselees develop both short- and long-range plans to improve their
wellness.
䊏 Respond to the counselees’ level of self-directed change by allowing highly moti-
vated individuals to develop and implement their own wellness plans with
some guidelines, or by engaging in a more focused, step-by-step process with
others.
䊏 Capitalize on the areas of wellness that are popular in the media today, such as
nutrition and exercise, for which little outside intervention may be required to
help a counselee experience positive change in these dimensions.
䊏 Provide traditional counseling intervention for other areas, such as emotional
awareness and coping and realistic beliefs to facilitate change.

Use the counseling process to introduce counselees to wellness; teach tech-

niques for self-assessment, planning, evaluation, and follow-up; and encourage
them to develop a view of wellness as a lifelong process through which many
changes will occur.

䊏 Strengths and Limitations

This is a strength-based approach to helping. It is based on development over the

life span, taking into account contextual factors and influences. Dynamic in nature,
just as is human growth, the approach addresses factors of importance to all per-
sons, cultures, genders, and people of diverse races.
656 Special Topics and Important Trends That Counselors Might Encounter PART FOUR

The chief limitation of this approach is that greater empirical support and appli-
cation across generations and cultures geographically is needed. There is promis-
ing evidence from persons in this country, Korea, India, Africa, Israel, and Turkey,
but there is great need for others, including those who are of Spanish cultures and
language.

Chapter 30: Key Term

䉴 Wellness
 chapter Spirituality and Pastoral
Counseling Practices*
31
Grafton T. Eliason
California University of Pennsylvania

Colleen Triffanoff
Thomas Jefferson High School

Maria Leventis
Pace University

In This Chapter

䉴 The Importance of Spirituality in Counseling 䉴 Existential and Phenomenological Theories

䊏 Spirituality in Professional Counseling and Spirituality
and Psychology Organizations 䊏 Frankl and Logotherapy
䊏 Spirituality in American Society 䊏 May and Existentialism

䊏 Rogers and Client-Centered Theory

䉴 Pastoral Counseling and Related Ideology
䊏 Perls and Gestalt Therapy
䊏 Religion and Spirituality

䊏 Spirituality and Counseling 䉴 Behavioral Theories and Spirituality

䊏 Evolution of Pastoral Counseling 䊏 Watson and Behaviorism
䊏 Skinner and Behavioral Conditioning
䉴 Ethics, Spirituality, and Counseling
䊏 Lazarus and Multimodal Therapy
䊏 Ethical Decision-Making Criteria

䊏 Purpose of Ethical Codes 䉴 Cognitive and Cognitive Behavioral

䊏 Counselor Competence Theories and Spirituality
䊏 Supervision 䊏 Glasser and Choice Theory

䊏 Ellis and REBT

䉴 Psychodynamic Theories and Spirituality
䊏 Freud and Psychoanalysis 䉴 Conclusion
䊏 Jungian Psychology

*Sincere thanks to Springer Publishing Company and to Routledge/Taylor & Francis Group for granting permis-

sion to reprint and update two previous publications:

Copyright © 2001. From by G. Eliason, C. Hanley, & M. Leventis, The role of spirituality: Four theoretical orien-
tations. Pastoral Psychology, 50(2), 77–91. Reproduced by permission of Spring Publishing.
Copyright © 2000. From G. Eliason, Spirituality and counseling of the older adult. In A. Tomer (Ed.), Death atti-
tudes and the older adult. Reproduced by permission of Routledge/Taylor & Francis Group, LLC.

658
CHAPTER THIRTY ONE Spirituality and Pastoral Counseling 659

THE IMPORTANCE OF SPIRITUALITY IN COUNSELING

The integration of spirituality in counseling and psychotherapy is needed to treat

the individual from a holistic framework. In this chapter, we provide a basic over-
view of spirituality and counseling. Although most of the chapter can be applied to
a broad range of religious faiths, we look specifically at pastoral counseling in the
Judeo-Christian tradition. Finally, we discuss the role of spirituality in the field
from the perspective of four primary psychological schools of thought:
psychodynamic, existential or phenomenological, behavioral, and cognitive.

䊏 Spirituality in Professional Counseling and Psychology Organizations

Both the American Psychological Association (APA) and the American Counseling
Association (ACA) have professional divisions related to spirituality and religion.

Professional Associations for Spirituality and Counseling

䊏 The APA division is the Psychology of Religion.
䊏 The ACA division is the Association for Spiritual, Ethical, and Religious Values
in Counseling (ASERVIC).

For more information on ACA and spirituality and the APA division
on psychology and religion:
䉴 www.aservic.org
䉴 www.apa.org/divisions/div36/homepage.html

Each of these divisions is growing in membership. In addition, the Council for Ac-
creditation of Counseling and Related Educational Programs (CACREP) included
spirituality as a component in its 2001 standards. This speaks, on a professional
level, to the importance of spirituality in the field (ACA, 2005a; APA, 2005; Miller,
2003).

䊏 Spirituality in American Society

From its inception, the United States has been a nation steeped in religious beliefs,
spirituality, and freedom. This is no different for our contemporary society. Miller
(2003) cited a number of statistics that support this reality:

䊏 95% of Americans believe in God (Baker, 1997, as cited in Miller, 2003).

䊏 85% believe that prayer has healing power (Wallis, 1996, as cited in Miller, 2003).
660 Special Topics and Important Trends That Counselors Might Encounter PART FOUR

䊏 62% belong to religious organizations.

䊏 60% believe that religion is a very important part of their lives.
䊏 A large percentage worship close to once a week (The Harvard Mental Health Let-
ter, 2001, as cited in Miller, 2003).

Matthews and Clark (1998) pointed to extensive studies showing a positive correla-
tion between faith and good health, both physical and mental. Many studies also
show a correlation between a lack of faith and poor health or recovery.
In 1992, Gallup was commissioned by the Samaritan Institute and the American
Association of Pastoral Counselors (AAPC) to survey Americans’ attitudes toward
pastoral counseling, the importance of spirituality, and its perceived impact on
their mental health. This was followed by a second survey in 2000 conducted by
Greenburg Quinlan Research. The results showed that a large percentage of Ameri-
cans acknowledge a relation among spirituality, faith, religious values, and mental
health. They also would prefer to seek counseling from a provider who integrates
spirituality into treatment (AAPC, 2000, as cited in AAPC, 2005). A number of find-
ings were presented by AAPC.

Attitudes Toward Pastoral Counseling, Spirituality, and Mental Health

䊏 83% of respondents feel their spiritual faith and religious beliefs are closely tied
to their state of mental and emotional health.
䊏 75% of respondents say it is important to see a professional counselor who inte-
grates their values and beliefs into the counseling process.
䊏 69% believe it is important to see a professional counselor who represents spiri-
tual values and beliefs if they had a serious problem that required counseling.
䊏 77% say it would be important for an elderly parent or relative who was in need
of treatment to get assistance from a mental health professional who knew and
understood their spiritual beliefs and values.
䊏 More people mention pastoral counselors and others with religious training than
any other professionals (29%; AAPC, 2000, as cited in AAPC, 2005).

Practitioners with specific training in spirituality, religion, and counseling can offer
a valuable service to the mental health and religious communities by providing
specific skills and training that may better meet the spiritual and psychoemotional
needs of the public (AAPC, 2000, as cited in AAPC, 2005).

PASTORAL COUNSELING AND RELATED IDEOLOGY

To truly comprehend any concept, it is important to understand the context in

which that concept is situated. Differentiating religion and spirituality is important
to the field of pastoral counseling.
CHAPTER THIRTY ONE Spirituality and Pastoral Counseling 661

䊏 Religion and Spirituality

Religion differs from spirituality in that religion refers to the organized practice of
worship and ritual. Etymologically, religion stems from the Latin root religio, mean-
ing “religious scruple, conscientiousness, sense of right; religion, sect, cult, mode of
worship; object of veneration, sacred object, sacred place; divine service, worship,
religious observation” (Traupman, 1966, p. 265). The word religion also comes from
religare, meaning “to bind back, to bind together, to tie up, or to moor (a ship)”
(Traupman, 1966, p. 463). A definition of religion that can be adopted is as follows:

Religion: The belief system and ritual practices of a sect or denomination of

individuals that binds them together in worship, practice, and community.

The etymological origin of the word spirit is from the Latin spiritus, meaning
“breath, inspiration, character,” or the soul (Traupman, 1966, pp. 292–293, 497).
Spirit was literally the breath of life in Hebrew, Greek, and Roman cultures. West-
ern belief systems see the spirit, in one sense, as that which gives life, self-aware-
ness, personality, and animation. In another sense, it is that which is other than our
corporeal body (Eliason, 2000). Spirituality can be understood in this way:

Spirituality: That which allows humans to transcend the corporeal body and
to connect on many levels with that which is other.

During the 1996 Summit on Spirituality, ASERVIC, the branch of ACA that special-
izes in spirituality and counseling, expanded the definition of spirituality. The as-
sociation proposed an understanding of spirituality that included a variety of com-
ponents.

Defining Components of Spirituality (ASERVIC, 2006; Miller, 2003)

䊏 Spirituality is the drawing out and infusion of spirit in one’s life and is experi-
enced as an active and passive process.
䊏 Spirituality is a capacity and tendency that is innate and unique to all persons.
䊏 The spiritual tendency moves individuals toward knowledge, love, meaning,
peace, hope, transcendence, connectedness, compassion, wellness, and whole-
ness.
䊏 Spirituality includes one’s capacity for creativity, growth, and the development
of a value system.
䊏 Spirituality encompasses a variety of phenomena, including experiences, beliefs,
and practices.
䊏 Spirituality is approached from a variety of perspectives, including psycho-
spiritual, religious, and transpersonal.
662 Special Topics and Important Trends That Counselors Might Encounter PART FOUR

䊏 Spirituality and Counseling

From a counseling perspective, spirituality can become the unifying factor in

Buber’s (1923/1970) concept of the I and Thou experience. Humans experience rela-
tionships with self, with other, and with a higher power. Each of us maintains an in-
ternal dialogue and a perception of self. We have the ability to gain greater
self-awareness. We experience empathic encounters with other humans, both in our
personal relationships and in professional counseling relationships. Humans also
can have a personal experience with a higher power. It is the dynamic of spirituality
and the I–thou relationship that facilitates growth in pastoral counseling. “The role
of spirituality in counseling is multidimensional. On one level, the client explores her
or his own spirituality and calls upon faith and the spiritual I/Thou relationship to
act dynamically in the healing process. On another level, the counselor draws upon
her or his spiritual faith to enhance the interaction and the I/Thou experience be-
tween counselor, client, and God” (Buber, 1923/1970; Eliason, 2000, p. 244).

䊏 Evolution of Pastoral Counseling

Although pastoral counseling is becoming recognized as a unique field, it always

will be influenced by its shared history of religion, psychology, and counseling. The
AAPC (2005) defined pastoral counseling this way:

Pastoral counseling: “[A] process in which a pastoral counselor utilizes in-

sights and principles derived from the disciplines of theology and the be-
havioral sciences in working with individuals, couples, families, groups
and social systems toward the achievement of wholeness and health”
(http://www.acpe.edu).

Kelly (1995) and Strunk (1993) viewed the academic study of the psychology of
religion as the precursor to pastoral counseling. They pointed to James, Allport,
Pruyser, Johnson, and Boisen as founders of that movement and, in turn, the field
of pastoral counseling, beginning with the publication of James’s (1902/1961) The
Varieties of Religious Experience.
Two specific movements had an impact on the training of clergy and paved the
way for the development of pastoral counseling (Strunk, 1993): the Emmanuel
movement and the clinical pastoral education (CPE) movement. The efforts to
bring together the fields of medicine, psychology, and religion and the eventual
formation of the AAPC, which today regulates pastoral counseling, is highlighted
by these events.

Historical Development of Pastoral Counseling

䊏 Elwood Worchester, rector of the Emmanuel Worchester Church, and several
physicians in Boston established a clinic for spiritual healing.
CHAPTER THIRTY ONE Spirituality and Pastoral Counseling 663

䊏 By 1940, due to a lack of training, growth, and a breakdown of relationships be-

tween the religious and medical communities, the Emmanuel movement ended.
䊏 In 1925, W. S. Keller, R. C. Cabot, and A. T. Boisen started the CPE movement that
continues to be successful today.
䊏 In 1963, the first conference of pastoral counselors was held in New York City.
䊏 The AAPC held its first formal conference in 1964.
䊏 The Association for Clinical Pastoral Education (ACPE) was formed in 1967 as a
merger of four CPE organizations and has partnerships with 23 faith groups and
agencies (ACPE, 2005; Strunk, 1993).

Today, CPE offers training to help clergy effectively respond to individuals expe-
riencing crisis and to achieve overall professional competence in pastoral ministry,
and the AAPC maintains an active role in the development of pastoral counseling.
As the field of pastoral counseling continues to evolve and grow, one must consider
a wide realm of concerns involving both religious and secular issues. It is important
to understand the history of this field in relation to spirituality, religion, psychol-
ogy, and counseling, so that the most appropriate decisions can be made for the fu-
ture (Strunk, 1993).

ETHICS, SPIRITUALITY, AND COUNSELING

The focus of counseling is on individuals, couples, or families and their specific

psychological issues. Psychotherapeutic theories and interventions can enhance
our understanding of the issue while facilitating growth through awareness and
positive action. Out of respect for the client’s autonomy, it is not the counselor’s
role to evangelize the client or to subject the client to specific values or belief sys-
tems. Rather, the counselor assists the client on her or his own spiritual journey
(Browning, 1987, 1993; Capps, 1995; Eliason, 2000). Indeed, all professional coun-
selors are charged with upholding the highest ethical standards that protect a cli-
ent’s right to beneficence, nonmaleficence, autonomy, justice, and fidelity.

䊏 Ethical Decision-Making Criteria

Mental health and pastoral counselors can rely on four criteria in making appropri-
ate ethical decisions.

Considerations for Making Ethical Decisions

1. The current legal system, including federal law, state law, and court prece-
dents.
2. Membership in professional organizations and abidance to codes and stan-
dards of ethics.
664 Special Topics and Important Trends That Counselors Might Encounter PART FOUR

3. Education, including degrees, certifications, licensure, and continued training.

4. Ongoing supervision in the field (Corey, 2004a; Eliason, 2000).

䊏 Purpose of Ethical Codes

Herlihy and Corey (1996) maintained that codes of ethics serve a number of pur-
poses:

䊏 To educate the counselors and public about professional responsibilities.

䊏 To provide a measure for accountability to protect the public and counselors.
䊏 To provide a basis for reflection so that counselors might improve the quality of
practice.

See Chapter 2 for more on ethics in counseling.

䊏 Counselor Competence

Degrees, certifications, licenses, and training standards are established to maintain

a level of competency in a profession that relates to the quality of care due to clients.
Counselors also must be aware of their own beliefs, values, biases, and limitations.
Butman (1997) maintained that, “The assumption is usually made that a client’s
welfare is directly affected by whether or not the mental health professional knows
her or his limitations and weaknesses, as well as her or his strengths and skills” (p.
57). Butman succinctly defined competence this way:

Competence: A “combination of clinical expertise, high levels of self-aware-

ness and interpersonal effectiveness” (p. 57).

Secular organizations such as the APA and the ACA evaluate their professional
membership and maintain accrediting bodies such as APA accreditation or
CACREP. Other organizations such as the National Board for Certified Counselors
(NBCC) also provide standards and testing for the national certification of counsel-
ors. Licensure regulates the practice by setting standards of due care, training qual-
ifications, and designating the legal use of titles (ACA, 2005c; APA, 2005; Bullis &
Mazur, 1993; NBCC, 2005a).
Pastoral counselors, like mental health counselors, are held to a high level of
professionalism. To ensure competence, the AAPC accredits training programs
based on its standards of practice; additionally, many recognized organizations in-
cluding the AAPC require graduate-level training in both theology and pastoral
counseling to obtain certification as a pastoral counselor.

Certification Requirements of AAPC

䊏 Master of divinity or doctoral degree in theological, spiritual, or biblical studies
or a master or doctoral degree in pastoral counseling.
CHAPTER THIRTY ONE Spirituality and Pastoral Counseling 665

䊏 Religious body endorsement.

䊏 Active relationship to a local religious community.
䊏 Three years of ministry.
䊏 375 hours of pastoral counseling plus 125 supervision hours, one third of which
must be provided by an approved AAPC supervisor.

In the counseling field where the place of spirituality in the therapeutic relation-
ship increasingly is recognized, pastoral counselors have a special opportunity to
integrate traditional therapeutic approaches with their awareness of the spiritual
dimension (AAPC, 1998).

Check out the AACP Web site for more information on the AAPC
and its certification process:
䉴 www.aapc.org

䊏 Supervision

In addition to initial degrees, certifications, licensure, and training, it is important

for practicing mental health and pastoral counselors to continue their education
and to maintain clinical supervision through consultation with other professionals
concerning cases, ethics, and self-awareness. The process of personal growth con-
tinues throughout one’s professional career and directly affects the quality of care
provided to clients, as well as one’s personal satisfaction and level of competence
(Butman, 1997; Corey, 2004a).

See Chapters 5 and 6 for more on clinical supervision.

PSYCHODYNAMIC THEORIES AND SPIRITUALITY

Psychodynamic theories include a number of well-recognized approaches and the-

orists. Freud is perhaps one of the most recognized theorists due to the originality
and longevity of psychoanalysis. Jung and Adler worked closely with Freud (1943,
1969), but eventually left to pursue their own theoretical orientations. Erikson
(1963), Berne, and many other theorists have built on the basic premises of Freud
and continue to use his theory as a benchmark (Corey, 2004a). In this section, the
place of religion and spirituality in Freud and Jung’s lives and theories is high-
lighted.
666 Special Topics and Important Trends That Counselors Might Encounter PART FOUR

䊏 Freud and Psychoanalysis

Freud (1913, 1927) struggled with religious belief throughout his life, which is
readily observed in his work. A number of authors (Bakan, 1958, as cited in Merkur,
1997; Meier, Minirth, Wichern, & Ratcliff, 1997; Vitz, 1988/1993) noted that Freud
was raised in a Hasidic Jewish household with an affectionate, but strict father.
However, his Roman Catholic nanny may have had a profound influence on him in
early childhood. Freud was taken to Roman Catholic church services and taught
rudimentary concepts of Christianity. Vitz maintained that this early focus on
Christianity may have been the impetus for Freud’s interest in it throughout his
life. It is also theorized that Freud may have resorted to atheism to resolve the inter-
nal conflict between the two faiths, secularizing much of his religious tradition.
Nonetheless, as Capps (2001) shows in Freud and Freudians on Religion, Freud wrote
about religion throughout his career, from Obsessive Actions and Religious Practices
in 1907, to Moses and Monotheism: Three Essays in 1939.
In spite of Freud’s noted atheism, aspects of his religious heritage and spiritual-
ity can be noticed in psychoanalytic theory.

Aspects of Religion in Psychoanalysis

䊏 Bakan (1958, as cited in Merkur, 1997) noted that there may be similarities be-
tween the practice of Jewish mysticism known as Kabbalah and Freud’s theory
of psychoanalysis.
䊏 Kabbalah places a great emphasis on dream interpretation and human sexuality,
and Freud depicted religion as a guilt-centered neurosis and discussed the un-
conscious symbolism of dreams and human sexuality (Jacobs & Capps, 1997;
Meier et al., 1997).
䊏 Freud’s hypothesis that God and Satan represent two divergent aspects of a pri-
mal father figure shows the limitations of a static God image, an understanding
that can, in fact, expand our personal and religious construct of hope and the
ever changing I am.
Counselors may continue to glean effective theoretical applications—even spiri-
tual applications—from Freud’s model. Capps applied Freud’s (1962) idea of reli-
gious projection to the Judeo-Christian concept of God, future, and hope. Capps
(1995) concluded, first, that Freud’s understanding of God as an “enormously ex-
alted father” suggests that religion may at times serve to limit our image of God
and, second, that when God is viewed only as an enormously exalted father, the de-
velopment of religion is stunted in a childlike stage.
Psychoanalytic theory can help to explain our human and religious experiences,
and how these experiences are expressed symbolically through our unconscious
(Jacobs & Capps, 1997). Freud’s contribution of defense mechanisms in relation to
the unconscious mind can be used on a more functional level in the field of counsel-
ing. Although Freud’s view of human nature is thought to be deterministic, the client
can initiate positive change through self-awareness. Psychoanalytic techniques can
be used in a counseling setting and do not have to be limited to strict psychoanalysis.

For more on psychoanalytic goals, techniques, and role of the counselor, see Chapter 9.
CHAPTER THIRTY ONE Spirituality and Pastoral Counseling 667

䊏 Jungian Psychology

Jung was born in Switzerland in 1875 as the only surviving son of a Swiss Re-
formed church pastor; his sister was born when he was 9 years old (Engler, 1984;
Vitz, 1977/1994). Disenchanted with the experience of communion as a young
boy, Jung spent much of his life in search of religious and spiritual answers. This
search led him to his studies and theories in psychology, religion, myth, and the
occult (Jung, 1965). Although Jung did not possess a traditional view of religion,
his understanding of spirituality was able to cross many religious boundaries, in-
cluding Judaism, Christianity, and Buddhism. Jung eventually moved away from
Freud’s theory; some of the core ideas of Jung’s orientation reflect spiritual un-
dertones.

Facets of Spirituality in Jungian Psychology

䊏 The unconscious has two parts, the personal unconscious and the collective un-
conscious, which refer to experiences throughout human history.
䊏 Each person receives unconscious memories of these experiences that are
brought to light as symbols, or archetypes.
䊏 The concept of archetypes is used to help people gain deeper understanding of
life subjects and images such as God and the divine, which although seemingly
inaccessible, are nonetheless real.
䊏 Sexuality is viewed as a symbol and a creative mystery unto itself (Engler,
1984).

Jung’s use of myth, metaphor, and archetype has had a significant influence on the-
ology, psychology, counseling, sociology, and cultural anthropology, having been
originally applied to dream work and ritual theory. The theological bent is quite ev-
ident in his writings, such as in An Answer to Job. However, Jung’s ideas are also
now widely used in counseling and have been applied to human spirituality and
biblical criticism by Ricoeur (1976, 1980), Frye (1957, 1982), and other contempo-
rary authors (Meier et al., 1997). Jung’s insight into myth, metaphor, archetype, and
ritual has provided an opportunity for spiritual growth and psychic healing in the
contemporary counseling setting.

See Chapter 9 for more information on Jungian psychology.

EXISTENTIAL AND PHENOMENOLOGICAL THEORIES

AND SPIRITUALITY

Unlike other theoretical orientations, existentialism and phenomenology are

rooted in a philosophical context (Kierkegaard, Sartre, Nietzsche, Tillich), provid-
ing a framework from which one can view the world and life (Engler, 1984). At
the heart of this framework is humanity’s search for meaning. The process of liv-
668 Special Topics and Important Trends That Counselors Might Encounter PART FOUR

ing in the shadow of our finitude becomes the focus, rather than the end product
of our existence (Frankl, 1946/1984). In contemplating our own death, we can be-
gin to live more fully in the present. Existentialism refutes the psychoanalytic
concept of determinism and maintains that humans have the freedom of choice.
As such, existential counseling rejects the medical model and the ability to cure.
Rather, the goal is to facilitate self-reflection and to help the client identify op-
tions that might provide meaning in her or his life. Self-reflection is not self-ab-
sorption; rather, it points outside of the self. Needless to say, this journey is often
a spiritual one. The word existentialism is derived from the Latin exsistere, mean-
ing to “exist,” “stand out,” or to “emerge,” referring to the growth of an individ-
ual (Engler, 1984).

䊏 Frankl and Logotherapy

One of the most noted existential theorists, Frankl drew from his own past to ex-
press his theory and spirituality. Frankl’s experience as a prisoner in the Nazi death
camps of Auschwitz and Dachau profoundly shaped his existential philosophy of
life, resulting in the theory of logotherapy. Of Greek origin, logos refers to “mean-
ing,” “word,” or in a theological sense, “the Word.” As a prisoner, Frankl lost his
entire family except for one sister. He noticed that some individuals in the camps
lost hope and the will to survive, whereas others struggled to live. Those who sur-
vived carried a notion of something that gave their life meaning. Humanity’s will
to meaning is our guiding motivational force (Frankl, 1946/1984).
The search for meaning—a deeply spiritual endeavor—is a pillar of Frankl’s ap-
proach to life and therapy; indeed, the therapy in general suggests an integration
between spirituality and logotherapy (Meier et al., 1997).

Connection Between Spirituality and Logotherapy

䊏 Society generally is characterized by noogenic neurosis, or a search for meaning.
䊏 Clients are given the freedom to choose, and then are held responsible for the
choices they make.
䊏 The counselee is encouraged to deemphasize the self in favor of more ultimate
tasks in life.
䊏 Love allows people to deeply understand one another, at the innermost core of
their beings.

Frankl’s concept of love transcends the physical and sexual motivations of Freud’s
theory. It becomes the basis for our therapeutic relationship, as well as our relation-
ship with others in this world. Frankl saw love as one of the most meaningful aspi-
rations of humanity, and his search for meaning led him to apply his personal spiri-
tual awareness to existential theory.
CHAPTER THIRTY ONE Spirituality and Pastoral Counseling 669

䊏 May and Existentialism

May grew up in a sensitive middle-American family, where, unfortunately, intel-

lectual pursuits were not appreciated. In his own search for meaning, May traveled
to Greece and later studied theology at Union Theological Seminary in New York
City and psychotherapy with Adler in Vienna. In his 30s, May contracted tubercu-
losis. During this illness, he read Freud, Kierkegaard, and Tillich. May began to fo-
cus on humanity’s experience of existential crisis and anxiety, as well as the con-
trasting experiences of meaningfulness, hope, and joy (Engler, 1984; Vitz, 1977/
1994). May has contributed to our understanding of love and violence and has been
a critic of contemporary society.

Reflections of Spirituality in May’s Approach to Counseling

䊏 May pointed to our spiritual impotence in a technological age of narcissism and
postulated that our Western concept of love has moved inward, mutating into
forms of apathy or power.
䊏 The concept of meaning suggests that “the future lies with the man or woman
who can live as an individual, conscious within the solidarity of the human race.
He then uses the tension between individuality and solidarity as the source of his
ethical creativity” (May, 1972, p. 254).
䊏 “For every act of love and will—and in the long run they are both present in each
genuine act—we mold ourselves and our world simultaneously. This is what it
means to embrace the future” (May, 1969, p. 322).

䊏 Rogers and Client-Centered Theory

Rogers’ client-centered theory expands on aspects of existential philosophy, and

more specifically, draws its primary emphasis from phenomenological humanism.
Rogers grew up in an atmosphere of strict religious standards. Although his family
was close, his mother could be judgmental. Rogers studied agriculture at the Uni-
versity of Wisconsin and later began religious studies at Union Theological Semi-
nary in New York City. However, he could not ascribe to a single set of beliefs and
transferred to Columbia Teachers College where he studied philosophy and clini-
cal psychology (Corey, 2004a; Engler, 1984).
The etymology of phenomenology comes from the Greek, phainomenon, refer-
ring to a “phenomenon,” or “that which appears or shows itself.” Rogers followed
a constructivist viewpoint focusing on the client’s individual experience and her or
his subjective interpretation of that phenomenon. The attempt to truly understand
the other—to connect with clients on a spiritual, rather than corporeal level—lies at
the heart of this theory. Spirituality is evident in these broad assumptions of cli-
ent-centered therapy (Rogers, 1951, 1961).
670 Special Topics and Important Trends That Counselors Might Encounter PART FOUR

Assumptions of Client-Centered Therapy

䊏 Significant, trusting relationships lie at the heart of powerful therapy.
䊏 A trusting therapeutic relationship is established through congruence or genu-
ineness, unconditional positive regard, and accurate empathic understanding.
䊏 Counselors are urged to seek the inherent worth in clients.
䊏 Clients must be allowed the freedom to explore all frightening, undesirable as-
pects of their personhood within the therapeutic relationship without fear of
judgment.

When counselors and clients are able to connect with one another, a client’s de-
fenses are lowered, and she or he becomes open to the therapist’s response. Tech-
niques at this point include drawing attention to the client’s subjective reality
through active listening, reflection, summarization, clarification, and gentle con-
frontation. Ultimately, the client moves from a static point of fixity to a life experi-
ence of the present, process, change, and flow (Vitz, 1977/1994). Rogers’ theory
continues to be applicable today, stressing the importance of the counselor’s atti-
tude toward the worth of the client.

See Chapter 9 for more about Rogerian therapy.

䊏 Perls and Gestalt Therapy

As the originator of Gestalt therapy, Perls (1969) also built on the existential and
phenomenological approaches of philosophy and psychology. He was born to a
Jewish family in Berlin and had trouble with the authorities as a youth. Through
perseverance, he completed his medical degree and served as a medic in the Ger-
man army. He later worked with brain-damaged soldiers after the war. Gestalt is of
German origin, meaning “a unified whole.” Perls emphasized integration of the
person as a whole individual and strove for awareness as a therapeutic goal. His
theory is existential in that through awareness individuals can choose, change, and
become responsible for their actions. Gestalt therapy is phenomenological, in that
it considers an individual’s subjective reality (Meier et al., 1997).
Spirituality and Gestalt therapy come together most apparently in the link be-
tween Perls’ vision of the therapeutic relationship and the I/thou concept pro-
posed by Buber. In his book I and Thou, Buber (1923/1970) synthesized the spiritual
idea of self, human relationship, and divine relationship, stating, “The basic word
I-You can be spoken only with one’s whole being. The concentration and fusion
into a whole being can never be accomplished by me, can never be accomplished
without me. I require a You to become; becoming I, I say You” (p. 62).

Aspects of Spirituality in Gestalt Therapy

䊏 The I/thou relationship between the therapist and the client, or between one cli-
ent and another client, is of utmost importance.
CHAPTER THIRTY ONE Spirituality and Pastoral Counseling 671

䊏 The therapist must be wholly present for the client and open to both the client’s
subjective experience and the present therapeutic experience.
䊏 The goal of therapy is to help clients, through awareness, to become a gestalt or a
whole.
䊏 The therapist challenges the client to become aware of her or his layers of neuro-
sis so that unfinished business might be dealt with and attached anxiety might be
expressed through feelings (Meier et al., 1997).

Just as in Buber’s theological understanding of the I/thou relationship one cannot

exist without the other, Perls underscored the importance of the relationship, and
the challenges offered by the therapist are crucial—required, even—for the client’s
awareness and ultimately, wholeness.

See Chapter 9 for more information about Gestalt therapy.

BEHAVIORAL THEORIES AND SPIRITUALITY

One might easily question the role of spirituality and religion in behavioral psy-
chology. Behavioral psychology originally arose as the antithesis to previous psy-
chological theories and to the concepts of religion, soul, and human freedom. Wat-
son and Skinner were two pioneers in behavioral psychology, contributing to
classical and operant conditioning (Watson, 1925; Wood & Wood, 1993).

䊏 Watson and Behaviorism

Watson was born on a farm in South Carolina to a very religious mother and an al-
coholic father who was unfaithful to his wife and abandoned the family. Watson
applied the methods of observable science to the field of psychology. Rejecting the
concepts of consciousness and spirit, Watson relied on measurable actions and ob-
servable behaviors. His most famous study examined the conditioned fear re-
sponse of little Albert. Ironically, Watson later wrote the book Psychological Care of
the Infant and Child. He later left academia and incorporated his theory to become a
success in advertising (Watson, 1925; Wolpe, 1990; Wood & Wood, 1993). Watson
made these statements about behaviorism.

Polarity Between Spirituality and Behaviorism (Watson, 1925, p. 3)

䊏 “All schools of psychology except that of behaviorism claim that ‘consciousness’ is
the subject matter of psychology. Behaviorism, on the contrary, holds that the sub-
ject matter of human psychology is the behavior or activities of the human being.”
䊏 “Behaviorism claims that ‘consciousness’ is neither a definable nor a usable con-
cept; that it is merely another word for the ‘soul’ of more ancient times.”
䊏 [In contrast to behaviorism], “the old psychology is … dominated by a kind of
subtle religious philosophy.”
672 Special Topics and Important Trends That Counselors Might Encounter PART FOUR

䊏 Skinner and Behavioral Conditioning

Skinner was born in Susquehanna, Pennsylvania and enjoyed school. It is interest-

ing that he resented many of his college’s attempts to control his behavior, particu-
larly mandatory chapel attendance. In rebellion, Skinner was known for playing
practical jokes. As a behaviorist, he expanded on classical and operant condition-
ing and emphasized the role of reinforcement (Wood & Wood, 1993).
The role of spirituality in the behavioral approach is purposely less pronounced.
Whereas spirituality is understood as that which allows people to connect with one
another or with the divine apart from a corporeal level, behaviorism focuses pri-
marily on bodily interactions and casts doubt on free choice and self-determina-
tion.
Perhaps the most positive contribution of behaviorism to the field of psychology
was the concepts of behavior modification and positive reinforcement. As contem-
porary theorists move away from the radical concepts of classical behaviorism, the
emphasis moves toward individual learning theory and cognitive psychology. In
understanding how behavior is learned and unlearned, therapists can focus on em-
powering clients rather than controlling them.

䊏 Lazarus and Multimodal Therapy

Lazarus grew up in Johannesburg, South Africa, and later moved to the United
States to head the Behavior Therapy Institute. There has been a movement toward
cognitive behaviorism since Bandura’s social learning theory combined classical
and operant conditioning with observational learning, thus making a case for the
acceptance of cognition in the behavioral science.
The current view of human nature in behavior theory falls somewhere between
that of humanistic theorists and classical behaviorists, which broadens the context
of the theory and allows counselors to maintain a spiritual and humanistic frame-
work, at the same time applying behavioral learning theory and modification tech-
niques in the therapeutic setting.

Expansions of Behaviorism in Multimodal Therapy

䊏 Humans are viewed as both the producers and the products of their own envi-
ronments (Bandura, 1974, 1977, 1986; as cited in Corey, 1996, p. 285).
䊏 Cognitive techniques expanded traditional, determinist behavioral methods to
allow for greater follow-up with clients after the end of therapy (Lazarus, 1981).

Lazarus’ (1981) work in multimodal therapy and Wolpe’s (1990) work in behavior
therapy are prime examples of the beneficial techniques that can be drawn from be-
havioral studies and applied to the counseling setting. There has been much suc-
cess in the treatment of depression, anxiety, phobias, and behavior disorders
(Wolpe, 1990).
CHAPTER THIRTY ONE Spirituality and Pastoral Counseling 673

COGNITIVE AND COGNITIVE BEHAVIORAL THEORIES

AND SPIRITUALITY

Two of the main proponents of cognitive and cognitive behavioral therapy are
Glasser and Ellis. Although they might not have addressed spirituality directly,
their philosophies and assumptions of therapy reveal spiritual undertones.

䊏 Glasser and Choice Theory

In his training at the Veterans Administration Center in West Los Angeles and as a
consulting psychiatrist at the Ventura School for Girls, Glasser became frustrated
between his psychoanalytic education and what seemed to work best in therapy.
Glasser brought together many aspects of cognitive, behavioral, existential, per-
son-centered, and Gestalt theories and incorporated them in his theory of reality
therapy or choice theory. Although Glasser rarely made reference to the nature of
religion or spirituality, his theory parallels much of what has been said in humanis-
tic psychology (Meier et al., 1997).
Glasser maintained that individuals encounter problems when basic needs are
not fulfilled and irrational thoughts are manifested. These basic needs echo much
of the I/thou experience in that Glasser (1965) stressed our need for healthy human
relationships.

Features of Spirituality in Choice Therapy

䊏 An individual person must be involved with (i.e., care about and be cared for) by
at least one other person in life.
䊏 Only through relationships are the basic human needs fulfilled.
䊏 The goal of reality therapy is to help people fulfill the need to love and be loved
and to feel self-worth and a sense of being of worth to others.
䊏 People have the freedom of choice over thoughts, feelings, and actions and are
held responsible for the choices they make.

Like Rogers, Glasser stressed the relationship between therapist and client.
Corey (1996) summarized these basic beliefs, “which are that we are all responsible
for what we choose to do with our lives and that in a warm, accepting, non-puni-
tive therapeutic environment we are willing to learn more effective choices, or
more responsible ways to live our lives” (p. 258). Glasser’s reality therapy is very
appropriate for counseling when combined with an individual’s spiritual frame-
work. Other benefits of the theory include Glasser’s use of brief therapy and the
model’s applications to the school setting.

䊏 Ellis and REBT

Ellis often is referred to as the grandfather of cognitive-behavior therapy. After sev-

eral years of psychoanalytic training and therapy, he began to look for more effec-
674 Special Topics and Important Trends That Counselors Might Encounter PART FOUR

tive therapies. Similar to Glasser, he drew from many different theories including
Adler’s individual psychology, and incorporated what seemed to work in his the-
ory of rational-emotive behavior therapy. Many of his techniques were a result of
his struggle to overcome poor health and personal anxieties. Ellis believed that hu-
mans are capable of both rational and irrational beliefs. The belief about an experi-
ence is more important for the individual than the actual reality of the phenomena.
Ellis credited Greek philosophers for their impact on his theoretical orientation and
referred to Epictetus as saying, “Men are disturbed not by things, but by the view
which they take of them” (Ellis, 1973, p. 166).
Although Ellis did not concentrate on the role of spirituality, he did challenge
the irrational idea that others must approve of us, and support the rational idea of
self-acceptance and the acceptance of others. Ellis’s (1973) fundamental ideas about
therapy and human personality are listed next.

Evidence of Spirituality in REBT

䊏 People can come to enjoy their life in the present through challenging irrational
belief systems.
䊏 REBT helps individuals to foster positive, natural human tendencies toward in-
dividuality, freedom of choice, and enjoyment and to minimize defeating ten-
dencies to be comforting, suggestible, and unenjoying.
䊏 People can learn how to enhance the positive side their humanness and be at
peace with—not squelch or repress—the side that still requires development and
change.

CONCLUSION

What is the role of spirituality in our own therapeutic practices? The therapist
needs to explore her or his own spiritual belief system and develop a congruent
personal theory of counseling. The therapist then can enter into a genuine relation-
ship from a centered perspective. The therapist also must acknowledge the many
ways religious and spiritual beliefs are part of a larger multicultural context. In the
continuous process of spiritual development, the therapist must attend to the com-
mon threads echoed throughout philosophy, theology, and the human sciences.
The goal of incorporating spirituality in counseling is to facilitate the client’s spiri-
tual and psychological growth as we continue to grow ourselves (Eliason, 2000).

Chapter 31: Key Terms

䉴 Religion 䉴 Pastoral counseling
䉴 Spirituality 䉴 Competence
appendix Preparing for the National Counselor Exam:
What You Need to Know
A

As we stated in the preface, The Counselor’s Companion is a tool for those thinking
of taking a licensure or certification examination, and more specifically, the Na-
tional Counselor Examination (NCE). To help you practice for the exam, we have
compiled a 200-item test based on the eight content areas warranted by the
Council for Accreditation of Counseling and Related Educational Programs
(CACREP) and tested on the NCE. The questions all are drawn from information
presented in the chapters that comprise this book. Hence, the key concepts you
need to know to complete the sample exam successfully, as well as review for the
actual exam created by the National Board of Certified Counselors, are at your
fingertips.

CLASSIFICATION OF MULTIPLE-CHOICE ITEMS

Similar to most examinations using multiple-choice items, including the NCE,

the questions on the sample examination are written to address three cognition
levels:

1. Recall. Your best ally here is your memory, from which you will retrieve
information, facts, concepts, theories, or procedures to tackle these
items.

EXAMPLE OF A RECALL ITEM

The acronym CACREP stands for the ____.

a. Counseling Association for Cultural Representation and Equity in Practice.
b. Council for Accreditation of Counseling and Related Educational Programs.
c. Corporation of All Counseling and Related Education Programs.
d. Company for the Allocation to Counselors of Resources and Equitable Parity.

675
676 Preparing for the National Counselor Exam APPENDIX A

2. Application. If you are able to apply low-level problem skills, you need not
worry too much about these items, which call for interpretation and applica-
tion of data.

E X A M P L E O F A N A P P L I C AT I O N I T E M

A brief solutions-focused family therapist views resistance as:

a. The family’s conviction that their situation is the best available.
b. A result of social disorganization.
c. A sign that the suggestions of the therapist were not optimal ones.
d. A form of protection from threatening emotions.

3. Analysis. Once you combine your good judgment with your problem-solving
skills, doing well on these test items is easy as you evaluate data, resolve prob-
lems, and draw on the information presented in this text as a review.

E X A M P L E O F A N A N A LY S I S I T E M

John has been participating in a person-centered group for 4 months and continually engages
in confrontational behaviors with several other group members. He has not achieved any of
the original goals he has set for himself. John:
a. Has not been part of the group process long enough for change to begin to occur.
b. Is in the “insight and reorientation phase” of the group, and his behavior is appropriate.
c. Is not progressing through the stages of counseling appropriately.
d. None of the above.

TYPES OF ITEMS

The multiple-choice items in the sample NCE exam mirror the format commonly
used by most credentialing examinations in that you are asked to choose the single
best response for three forms of items.
APPENDIX A Preparing for the National Counselor Exam 677

䊏 Direct Question

EXAMPLE OF DIRECT QUESTION

The Stanford–Binet and the Wechsler Adult Intelligence Scale measure which of the following
constructs?
a. Cognition.
b. Occupation.
c. Personality.
d. Behavior.

䊏 Incomplete Statement

E X A M P L E O F I N C O M P L E T E S TAT E M E N T

According to Jean Piaget’s cognitive development theory, children alter their schemas or orga-
nized psychological structures through the processes of assimilation and ______________.
a. Organization.
b. Symbolic substitution.
c. Accommodation.
d. Equilibration.

䊏 Calculation

E X A M P L E O F C A L C U L AT I O N

Discovering a personality test on the Internet, a counselor decides to perform a reliability test
before using it with his clients. He discovers that the test has a reliability coefficient of .55. The
counselor knows that the reliability coefficient indicates that:
a. 45% of the people who are tested will score accurately.
b. 55% of the score is accurate and 45% is not.
c. 55% of the people tested will score accurately.
d. 45% of the score is accurate and 55% is not.
678 Preparing for the National Counselor Exam APPENDIX A

GIVE IT YOUR BEST SHOT

As we mentioned earlier, the items on this sample examination are drawn from the
eight core curriculum areas sanctioned by CACREP. You will be allotted 4 hours to
complete the 200-item examination when you sit for the NCE. For those who intend
to sit for a credentialing examination or a licensure examination, we recommend
that you set some time aside and give the sample exam your best shot. Find a quiet
and comfortable place where you will not be disturbed and have time for yourself
as you start to take the test. Answer all questions. On the actual NCE exam you will
be evaluated on only 160 of the 200 items, and you will not be penalized for guess-
ing, which means that for items for which you are uncertain, just mark your best
guess as the answer.
We have provided an answer key that you can use to check your responses
and see how well you have done on the test. Because this book is broken down
into chapters (see the Table of Contents) we have also provided a table of the
chapters as they relate to the corresponding question numbers. If you have trou-
ble with Question 1, for example, you can use Table A.2 at the end of the test to
find that this question relates to information in Chapters 7 and 8 (human growth
and development). Using Table A.2 will help you to easily locate the areas where
you might need to fine-tune your knowledge based on the items with which you
had difficulty. We hope that this simple tool will help foster your professional de-
velopment and wish you good luck!

TESTING AREAS AND CORRESPONDING CHAPTERS

Table A.1 provides a list of the chapters in which you will find information relating
to each testing area covered in the sample exam.

TABLE A.1
Testing Areas and Corresponding Chapters

Area of Testing Chapters

Human growth and development 7, 8

Social and cultural foundations 4, 11
Helping relationships 9, 10, 18, 26, 27
Group work 12, 13, 14
Career counseling 15 , 16
Appraisal 20 , 21
Research 22 , 23
Professional orientation 1, 2, 3, 5
APPENDIX A Preparing for the National Counselor Exam 679

SAMPLE CREDENTIALING EXAMINATION

Set some time aside and answer all questions. Time yourself as you start. When tak-
ing the NCE you usually will be allotted 4 hours for the completion of all 200 items.
An answer key is provided so that you will be able to evaluate your progress after
you finish. Guessing is permitted, so make sure you answer all the questions. Table
A.2, which provides the question numbers associated to their relevant chapters is
also available to you for revision purposes. Good luck.

1. A counselor explained to her pregnant client that some of the behaviors in

which she is currently involved are placing her unborn child at high risk for de-
velopmental disruptions known as teratogens. The counselor was able to make
such an assumption based on the fact that her pregnant client was:
a. Sleeping only 6 hours a day instead of 9 hours.
b. Working 8 hours a day without proper protection at a processing plant
that disposes of toxic waste.
c. Listening to too much loud music when alone.
d. Spending 10 hours a week working out at the gym.

2. During a supervision session a trainee counselor expressed his frustrations

about one of his client’s apparent resistance: “He tends to evade my every at-
tempt to get him to address issues regarding his family. He does not want to
disclose anything about his mom and dad or even his siblings. I am convinced
the source of his problems is rooted in the family, but he is so resistant to talk
about it. Moreover, it is so hard to get him to maintain eye contact with me, in
spite of my constant invitation for him to do so.” The trainee’s client is most
likely:
a. An Arab American.
b. A Latino American.
c. An African American.
d. A Native American.

3. A counselor trainee told her supervisor, “I am so inadequate.” After a discus-

sion about her “inadequacy,” the counselor trainee was able to restate the same
experience in the following terms: “I asked a client today whether or not our
therapy sessions are helping and he replied no. I wish I could help him solve
his problem with his family, but I do not how to do that.” The supervisor has
helped the trainee to be more:
a. Empathic and warm.
b. Confronting and challenging.
c. Concrete and specific.
d. Fluent and outspoken.
680 Preparing for the National Counselor Exam APPENDIX A

4. During a group therapy session, the leader keeps reminding the members of
the following principle: People have no power over others’ behaviors, but they
do have control over their own behavior, for which they are responsible. The
group is operating from the perspective of:
a. Psychoanalytic group therapy.
b. Reality group therapy.
c. Person-centered group therapy.
d. Rational Emotive Behavioral Therapy (REBT) group.

5. As he nears graduation from college, Stan is still very confused about his career
choices. He seeks the help of a guidance counselor who, after talking to him
and reviewing the results of a battery of personality tests that he took, told him
that he will be excellent as a teacher or in sales. The guidance counselor was
able to come to this conclusion because:
a. Stan is person-oriented as suggested by Anne Roe’s needs theory.
b. Stan is still in the anticipation stage as suggested by Tiedeman,
Miller-Tiedeman, and O’Hara’s individualistic theory.
c. She has made use of Gottfredson’s theory of circumscription and com-
promise.
d. She has utilized John Krumboltz’s social learning career theory.

6. Discovering a personality test on the Internet, a counselor decides to perform a

reliability test before using it with his clients. He discovers that the test has a re-
liability coefficient of .55. This indicates that:
a. 5% of the people who are tested will score accurately.
b. 55% of the score is accurate and 45% is not.
c. 55% of the people tested will score accurately.
d. 45% of the score is accurate and 55% is not.

7. A group of clients is being observed in a research study, and the researcher

notes improvement in the clients even though they are not receiving counsel-
ing. She hypothesizes that their improvement is a consequence of the attention
she has given them and explained it as:
a. The halo effect.
b. The side effect.
c. The placebo effect.
d. The Hawthorne effect.

8. To promote his practice, a counselor decides to start his own personal Web site
where he will advertise his services. Not being an expert in computer technol-
ogy, he asks one of his clients, who is a software programmer with a huge com-
APPENDIX A Preparing for the National Counselor Exam 681

puter company, to set up his Web site in exchange for free counseling. Such a
practice is known as___________ and is _____________.

a. Bartering; unethical.
b. Bargaining, ethical.
c. Reciprocity, highly recommended for clients with limited income.
d. Dual-relationship, unethical.

9. A researcher is interested in finding out the role of social interaction in predict-

ing well-being among residents of nursing homes. The research design that is
most appropriate to the researcher’s aims is:
a. Longitudinal study.
b. Pretest–posttest design.
c. Correlation.
d. Quasi-experimental design.

10. Having developed an achievement that yielded a high reliability coefficient, a

counselor started to use it with her clients. After receiving complaints from
several clients that the test was too long, she decided to shorten it. To measure
the impact that the shortening of the test will have on its reliability, the coun-
selor will most likely use:
a. The Spearman Brown formula.
b. The Kuder–Richardson coefficients of equivalence.
c. The Cronbach’s alpha.
d. The odd–even split-half method.

11. A counselor is working with a client who wants to conduct her career search
primarily through online sources. Aware of this, the counselor recommends
that the client access ____________, which is a widely used description of job ti-
tles.
a. The Strong Interest Inventory.
b. O*Net.
c. The Life Career Rainbow.
d. MBTI.

12. Groups often are co-led; that is, they have two facilitators. Coleading groups
places certain demands on leaders. Good coleaders will:
a. Have competing leadership styles to introduce diversity to the group.
b. Be close personal friends.
c. Discuss their relationship, perceptions, and experiences of each other.
d. Share similar theoretical approaches to group work.
682 Preparing for the National Counselor Exam APPENDIX A

13. Life scripts are intended to:

a. Allow clients to let go of harmful critical parent messages.
b. Give permission to clients to behave against the direction of their parent ego.
c. Allow clients to rewrite their programmed scripts into more productive
interactions.
d. Act as a contract between the client and the therapist about the nature of
the therapeutic relationship.

14. Culturally sensitive research in the field of career counseling should include
the following:
a. Attention to adequate sample size.
b. Longitudinal studies involving a variety of cultural groups.
c. Examinations of new and adjusted career models.
d. All of the above.

15. A counselor meets with a client for career counseling. Until this point in her ca-
reer, the client has focused primarily on “getting ahead” and increasing her
wealth. She willingly admits that she has shown little regard for the welfare of
others in her work endeavors and confesses that at times she even knowingly
engaged in behaviors that denigrated her coworkers because she was trying to
impress her boss. Evaluating the client in terms of Kohlberg’s theory of moral
development, the counselor would most appropriately classify the client in
which stage?
a. Postconventional morality stage.
b. Preoperational stage.
c. Preconventional morality stage.
d. Conventional morality stage.

16. Mores can be defined as:

a. The impact of culture on human development.
b. The moral rightness or wrongness of behavior.
c. A combination of learned thoughts, behaviors, and beliefs.
d. Overlapping cultural dimensions that have an impact on one another.

17. In a structural family therapy session, the father is talking about how he is al-
ways blamed for the family problems. The therapist would best:
a. Teach the family about why scapegoating occurs.
b. Exaggerate blaming the father for everything to illustrate the way in
which he is not responsible for all of the family’s problems.
c. Ask the father what it would look like if the family stopped blaming him
for problems.
d. Ally with the father and support him in expressing his feelings.
APPENDIX A Preparing for the National Counselor Exam 683

18. During a psychodramatic group session, Dan declares, “I am so short tem-

pered that I sometimes experience it as curse that has been cast on me. I wish I
could relate with my family and friends with more empathic understanding.”
Using the __________ technique, the leader encourages Dan to barter his ill
temper for some more active listening skills with the other members.
a. Magic shop.
b. Role reversal.
c. Mirror.
d. Sculpting.

19. In her sophomore year in college, Lori, 26 years old, has not yet selected a
major. She has been in different unsatisfying jobs and has decided to go to
college to be able to find a more fulfilling job in the future. For now, though,
she cannot identify a career she really wants to pursue or a major that will
help her prepare for her choice. After meeting the guidance counselor on
campus, she was given a copy of one of Holland’s inventories that will help
her identify her interests and skills. The inventory that Lori most probably
took home was the:
a. Career Assessment Inventory.
b. Self-Directed Search.
c. Position Classification Inventory.
d. O*Net Interest Profiler.

20. Coming out from a visit to his therapist, Andy told a friend that the therapist
made him take a test where he had to (a) describe what came to his mind
when he was asked to look at an inkblot, (b) complete several sentences with
real feelings, and (c) draw a person. The friend concluded that Andy had
been given:
a. An IQ test.
b. A projective personality test.
c. A standardized personality test.
d. The Myers–Briggs Type Indicator.

21. For his doctoral dissertation, John chose to compare men grieving their fathers’
deaths according to birth order. After some preliminary work with a popula-
tion of 60 men, the chair of his committee advised John to increase the sample
size. This will:
a. Increase the construct validity.
b. Reduce Type I and Type II errors.
c. Not impact Type I and Type II errors.
d. Produce a placebo effect.
684 Preparing for the National Counselor Exam APPENDIX A

22. Privileged communication can be most accurately defined as:

a. A legal concept that guards against required disclosure in legal proceed-
ings that breaks a promise of privacy.
b. An ethical term that safeguards clients from unauthorized disclosures of
information.
c. The constitutional right of people to decide when and where they will
share themselves with others.
d. The counselor’s right to disclose clients’ information in court proceed-
ings.

23. Which of the following properties are often not found in qualitative re-
search?
a. Use of naturalistic settings.
b. Researcher involvement in the process.
c. Laboratory settings.
d. A holistic approach.

24. Concurrent validity provides the most appropriate type of validation for a test
designed to:
a. Select high-level job applications.
b. Screen out untrainable industrial workers.
c. Diagnose a psychiatric condition.
d. Examine applications for admissions to graduate school.

25. When engaging in career counseling with an Asian American client, a coun-
selor may need to keep the following ideas in mind:
a. Asian Americans typically adopt a collectivist and interdependent
worldview that influences their career choice.
b. A career counseling approach that capitalizes on autonomy will be use-
ful.
c. Direct interventions may be most effective with Asian American clients.
d. Asian American clients probably will be very open to discussing their ca-
reer-related issues.

26. Group members’ ability to connect with one another through similar experi-
ences, behaviors, thoughts, and feelings is known as:
a. Universality.
b. Cohesion.
c. Group dynamics.
d. Processing.
APPENDIX A Preparing for the National Counselor Exam 685

27. A counselor who subscribes to logotherapy would likely make the following
statement to a client:
a. Tell me about your family dynamics—are you the first born, last born, or
middle child?
b. What meaning does this experience hold for you?
c. What is present for you now, in this moment?
d. What are you thinking as you tell me about that experience?

28. Culture can best be defined as:

a. Learned behaviors, thoughts, and beliefs that are promoted by and
shared among members of a particular society.
b. Racial and ethnic factors that influence development.
c. Ideas about the rightness or wrongness of behavior.
d. Social and political beliefs held by a dominant group.

29. In Freud’s personality theory, the id is guided by:

a. The reality principle.
b. Parental and social values.
c. The pleasure principle.
d. The imaginary audience.

30. During a class discussion on multiculturalism a student made the following re-
marks: “Immigrants who come to our country have chosen to do so freely.
They must, therefore, forgo their language and culture and learn our own in or-
der to get along with us. Since they decided to come here and we are hospitable
to them, it is normal that they espouse our values and not the other way
around.” The student’s remarks reveal him to be someone who is:
a. Culturally encapsulated.
b. Xenophobic.
c. Very altruistic.
d. Operating out of an emic viewpoint.

31. Invited to assess the problems of an organization, the consultant was able to
help his client discover that the organization has been working with obsolete
beliefs and visions, and was repeating patterns of behavior that were inconsis-
tent with the current environmental demands. The consultant will most likely
push for:
a. An organizational diagnosis.
b. A transfer of effect.
c. A paradigm shift.
d. A total quality management approach.
686 Preparing for the National Counselor Exam APPENDIX A

32. After his first group meeting, a counselor trainee told his supervisor, “I felt
very ill at ease during the group session. There were too many moments of si-
lence that seemed to last eternally. Members were just being nice to each other,
no one wanted to disclose as if they were afraid of each other. The resistance
was so thick that it could be sliced with a knife.” After reviewing the stages of
group with the trainee and helping him realize that the group is still at the
forming stage, the supervisor encouraged the trainee to work at promoting the
following therapeutic factors during the next group session:
a. Imparting information and altruism.
b. Imitative behavior and development of socializing skills.
c. Instillation of hope and universality.
d. Catharsis and interpersonal learning.

33. After completing Holland’s General Occupational Themes (GOT), a counselor

helped Andy summarize his interests using the three-letter RIASEC type code.
Andy was found to be the kind of person who is (a) persuasive, likes leadership
role, sees himself as stable, adventurous, bold, and self-confident; (b) con-
cerned about others, nurturer, introspective, responsible, likes social situa-
tions, verbally skilled; (c) artistic, creative and imaginative, sensitive, intro-
spective, and independent. Andy’s code therefore is:
a. ESA.
b. REA.
c. SEA.
d. IEA.

34. After testing a new IQ test, a researcher found out that it has a standard error of
measurement (SEM) of 3. A client took the test and scored 123 on the new IQ
test. If the client took the test over and over at a 68% confidence interval, the re-
searcher can predict that about 68% of the time:
a. The client will score between 100 and 126.
b. The client will score between 100 and 120.
c. The client will score between 120 and 126.
d. The client will score between 68 and 100.

35. A nondirectional hypothesis contends that:

a. There are no differences between groups.
b. There are differences between groups.
c. One research treatment will be more effective than another treatment.
d. Any differences that are found are due to chance.

36. A counselor spent a great deal of time in the gym growing up and considers
herself to be an expert on nutrition. She does not, however, hold any degree or
certifications in nutrition. When her overweight client discusses his weight is-
APPENDIX A Preparing for the National Counselor Exam 687

sues, the counselor immediately writes out a detailed nutrition plan for her cli-
ent. This is an example of:

a. Ethical behavior.
b. Practicing outside of one’s competency.
c. Beneficence.
d. A culturally insensitive intervention.

37. A brief solutions-focused family therapist views resistance as:

a. The family’s conviction that their situation is the best available.
b. A result of social disorganization.
c. A sign that the suggestions of the therapist were not optimal ones.
d. A form of protection from threatening emotions.

38. A mother was expressing her concerns about her 3-year-old son’s linguistic de-
velopment to a counselor, stating that he communicates mostly with two-word
sentences. Based on the information gathered from the mother, the counselor
concludes that:
a. The child was communicating within a holophrastic pattern.
b. The child was using telegraphic expressions to communicate.
c. The child is evolving normally in his linguistic development.
d. The child is able to underextend and overextend words of meaning.

39. Joe is a very devout Christian who has been diagnosed with lung cancer
caused by heavy smoking. Despite his illness, he has never quit using tobacco.
Speaking to his counselor, Joe expresses that his deep faith in God and inten-
sive prayer life will help him go through this illness and come out victorious.
When advised to quit smoking, he is very reluctant. The counselor can apply
__________ as a motivator for change with Joe by helping him become aware of
inconsistencies in his thoughts and behaviors.
a. Heider’s balance theory.
b. Congruity theory.
c. Attribution theory.
d. Dissonance theory.

40. As a clinician you are explaining to a client the reason you believe he has devel-
oped an addiction. You mention that throughout his life he has learned to med-
icate negative thoughts and feelings with the addiction, and that this reinforce-
ment has led to a repeated pattern of using the behavior. Which model of
addiction are you explaining?
a. Social learning model.
b. Disease model.
c. Genetic model.
d. Impulse control model.
688 Preparing for the National Counselor Exam APPENDIX A

41. A counselor decides to start a counseling group in his high school. While plan-
ning for the group, the counselor must decide which students should partici-
pate in the group. The counselor should remember which of the following
when selecting participants?
a. It is important to choose members whose needs and goals are compatible
with those of the group.
b. It is important to find members who will have enough self-esteem to en-
dure negative feedback.
c. It is important to select members with a narrow range of personality styles.
d. It is important to encourage diversity by having a broad range of de-
pressed and anxious clients.

42. All of the following are key components of Super’s theory of career develop-
ment except:
a. Life span.
b. Life space.
c. Self-concept.
d. Circumscription.

43. Achievement tools measure accomplishment related to a specific academic

area, whereas aptitude tests measure:
a. IQ.
b. The total academic needs of a child.
c. Potential of an individual.
d. Academic personality of a child.

44. A 13-year-old girl threatens to commit suicide, and her counselor fails to in-
form her parents. The counselor’s behavior can best be described as:
a. An example of informed consent.
b. An example of negligence.
c. An appropriate use of beneficence in the therapeutic relationship.
d. The desire to maintain the confidentiality of the therapy relationship.

45. A teacher was complaining to a school counselor that she was not being suc-
cessful with a number of students in her language class. After listening to the
narrative of the teacher, the counselor explained to the teacher that the core of
the problem is that those students with whom she was unsuccessful were in
fact skipping the fast mapping process. In other words, those students were:
a. Not able to build vocabularies very quickly by learning to connect new
words with their underlying concepts after only brief encounter.
b. Were too knowledgeable of their metacognitions.
c. Relying on word meanings to learn grammatical rules.
d. Discovering the meaning of words by observing how the words are used
in syntax.
APPENDIX A Preparing for the National Counselor Exam 689

46. The statistical test known as ANOVA is most frequently used:

a. To examine the differences between two or more means.
b. To determine the correlation between two factors.
c. To determine the predictive ability of one factor in relation to another.
d. To examine the differences between two or more means while also ac-
counting for confounding variables.

47. A form of assessment that relies primarily on direct observation is:

a. Cognitive assessment.
b. Behavioral assessment.
c. Occupational assessment.
d. Personality assessment.

48. Which of the following is not a division of the American Counseling Associa-
tion?
a. Association for Play.
b. Association for Counselor Education and Supervision.
c. American Mental Health Counselors Association.
d. National Career Development Association.

49. After being happily married for 25 years and having been a housewife whose
major career so far has been to take care of the home and the children, Suzan
suddenly found herself a widow after losing her husband to a massive heart at-
tack. From her primary responsibility of taking care of the home and the chil-
dren, Suzan is now forced to look for outside paid job. People like Suzan are re-
ferred to as _________ and would benefit more from _________ prior to career
counseling.
a. Downshifting; moving sideways.
b. Enriching the status quo; moving up.
c. Displaced homemakers; personal counseling.
d. Midlife career changers; dual-career considerations.

50. A client told to his therapist during an individual counseling session that he
would like to join a therapy group where he will be able to reexperience with
other members relationships that are similar to his own family relationships,
and develop greater insight into his defenses and resistances. The therapist is
more likely to orient her client toward a:
a. Psychodramatic therapy group.
b. Gestalt therapy group.
c. Psychoanalytic therapy group.
d. Rational emotive therapy group.
690 Preparing for the National Counselor Exam APPENDIX A

51. During a counseling session with his therapist, a client routinely replies to the
therapist with compliance. Operating from a transactional analysis approach,
the therapist might say that the client is responding from:
a. The free or natural child ego state.
b. The adult ego state.
c. The parent ego state.
d. The adapted child ego state.

52. Which of the following therapeutic techniques is most closely aligned with
Skinnerian behavioral therapy?
a. Extinction.
b. Free association.
c. Social modeling.
d. Thought interrupting.

53. The viewpoint that suggests that older Americans are less capable than their
younger counterparts is known as:
a. Ableism.
b. Ageism.
c. Sexism.
d. Bias.

54. A conjoint family therapist is primarily interested in how families:

a. Negotiate power.
b. Long for love and acceptance of each other.
c. Communicate with one another.
d. Prioritize their time so the family can spend time together.

55. Margie has been participating in a Gestalt group for several months. She re-
cently has been asked to head her preschooler’s parent–teacher organization,
but politely refused by stating that she currently has several other commit-
ments. Margie has demonstrated the ability to:
a. Translate her insights into action.
b. Define her boundaries with clarity.
c. Have awareness of what she is feeling, sensing, or thinking in the present.
d. Use self-support instead of looking to others for confirmation.

56. _________ is often considered the father of vocational guidance or career coun-
seling.
a. Frank Parsons.
b. Donald Super.
c. John Holland.
d. John Krumboltz.
APPENDIX A Preparing for the National Counselor Exam 691

57. An IQ score of 75 falls within the:

a. Genius range.
b. Below-average range.
c. Average range.
d. Above-average range.

58. A researcher believes that students who play golf are more likely to do very
well in mathematics. Dividing the students into three groups, one experimen-
tal group plays golf three times a week, another one plays once a week, and the
third group does not play at all. The statistic that the researcher will most likely
choose to analyze her results will be:
a. The t test.
b. The MANCOVA.
c. The ANOVA.
d. The chi-square.

59. In the case of Tarasoff v. Board of Regents of the University of California, the coun-
selor of record was cited primarily for:
a. Failure to accurately evaluate his client’s psychological state.
b. Failure to warn and protect a threatened person from potential harm.
c. Failure to properly document a threat against another person that was
disclosed by the client.
d. Failure to uphold the client’s right to confidentiality.

60. During a family therapy session, a counselor commented to the parents,

“Based on my observations of your children, I must say that you use an author-
itative style of parenting.” The counselor made this remark because:
a. He had noticed some maladaptive antisocial behaviors in the children.
b. The children were overly sensitive and angry.
c. The children were socially well-behaved and emphatic with one another.
d. The children were emotionally dry and uncaring toward one another.

61. Sandy complains to her therapist that after 23 years of working for a huge in-
surance company, she has never been promoted beyond the status of a sales
representative. She assumes that her boss does not care for the employees in
the sales department, and favors only young male recruits from the accounting
department. In helping Sandy discover what reasons could be driving her
boss’s decisions, the therapist is using ________________.
a. The law of reciprocity.
b. Attribution theory.
c. Newcomb’s A-B-X model of interpersonal attraction.
d. Symbolic interaction theory.
692 Preparing for the National Counselor Exam APPENDIX A

62. A counselor declares to his client, “My goal is to help you achieve a greater de-
gree of independence and integration, and not to solve your problem.” This
counselor is operating from a:
a. Person-centered theoretical perspective.
b. Psychoanalytic theoretical perspective.
c. Cognitive-behavior theoretical perspective.
d. Solution-focused theoretical perspective.

63. John has been participating in a person-centered group for 4 months and
continually engages in confrontational behaviors with several other group
members. He has not achieved any of the original goals he has set for him-
self. John:
a. Has not been part of the group process long enough for change to begin
to occur.
b. Is in the “insight and reorientation phase” of the group, and his behavior
is appropriate.
c. Is not progressing through the stages of counseling appropriately.
d. None of the above.

64. What is the main criticism of the current career theories and models as they are
applied within a multicultural context or with diverse clients?
a. There is currently only one model of multicultural career counseling.
b. Most career theories are not comprehensive enough.
c. Most career theories were developed years ago and are outdated.
d. Most career theories were tested with White undergraduate students and
therefore are not necessarily valid across cultural groups.

65. The _______ is a job-related personality measure that is based on Jung’s theory
of personality.
a. General Aptitude Test Battery.
b. Myers–Briggs Type Indicator.
c. MMPI.
d. Armed Services Vocational Aptitude Battery.

66. A researcher concludes that there is a significant difference or relation between

the treatment and control groups when in actuality there is none. This is known
as:
a. John Henry effect.
b. Confidence interval.
c. Type II error.
d. Type I error.
APPENDIX A Preparing for the National Counselor Exam 693

67. The acronym CACREP stands for the ____.

a. Counseling Association for Cultural Representation and Equity in Prac-
tice.
b. Council for Accreditation of Counseling and Related Educational Pro-
grams.
c. Corporation of All Counseling and Related Education Programs.
d. Company for the Allocation to Counselors of Resources and Equitable
Parity.

68. A 10th-grade student shared with her counselor: “I have some money saved so
that after graduating from high school, I can go to college and hopefully gradu-
ate with an MBA. Then I would like to open my own insurance company. I
know it is still a dream, but I will do everything in my power to fulfill it, even
though some people think I am crazy.” The student’s disclosure indicates her
psychological well-being and a healthy search for a sense of self, which
prompted the counselor to conclude that her attitude reflects both ________
and _________.
a. Identity achievement and identity foreclosure.
b. Identity moratorium and identity foreclosure.
c. Identity diffusion and identity achievement.
d. Identity achievement and identity moratorium.

69. ____________ is considered to be the primary figure in existential family

therapy.
a. Virginia Satir.
b. Viktor Frankl.
c. Salvador Minuchin.
d. Carl Whitaker.

70. Sue Lin has not been her normal self for a while. She hinted to one of her close
colleagues that she was having marital problems. The colleague advised her to
seek the help of a counselor and referred her to the best therapist in town. Even
though Sue Lin was very grateful to her colleague and accepted the referral,
she never went into therapy. The most probable reason for Sue Lin’s behavior
is:
a. The therapist is a White man.
b. Doing so will bring shame on her family.
c. Her religious values advocate against it.
d. She did not want to say no to her friend for fear of hurting her feelings.

71. A counselor is conducting a study about how engineers decided to make their
career choice. The counselor accounts for educational opportunity, socioeco-
nomic status, and mentoring received by professionals in the field. However,
694 Preparing for the National Counselor Exam APPENDIX A

the counselor failed to account for the impact of gender socialization on career
choice. In this case, gender socialization can be considered a:

a. Hawthorne effect.
b. John Henry effect.
c. Independent variable.
d. Confound.

72. Before using a standard score for a test, researchers first must transform raw
score data into z scores. If a researcher has a raw test score of 25, a raw mean
score of 10, and a raw score standard deviation of 3, what is the z score?
a. 15.
b. 5.
c. 12.
d. 20.

73. The principle function of item analysis is to:

a. Identify test items that may be faulty.
b. Determine the discrimination index for a test.
c. Shorten a test.
d. Calculate the validity of items on a test.

74. In psychodramatic therapy, the protagontist is encouraged to expand his or her

emotional response pattern by trying out different responses to a situation, re-
lationship, or other concern at the direction of the leader. This exercise takes
place during which phase?
a. The warm-up phase.
b. The action phase.
c. The discussion phase.
d. The sharing phase.

75. A client was asked to complete a personality test by his guidance counselor. He
was very resistant to the proposal and declared that he hated personality tests in
general because they might reveal something about him that he does not like. “It
is best for me to be ignorant about my shadows,” said the client. “Take this one,”
the counselor responded, “it is based on the premise that all personality prefer-
ences are equally valuable.” Satisfied with the counselor’s response, the client
took the ___________ and completed it with much trepidation.
a. Sixteen Personality Factor (16PF).
b. Vocational Preference Inventory.
c. Myers–Briggs Type Inventory (MBTI).
d. Minnesota Multiphasic Personality Inventory–2 (MMPI–2).
APPENDIX A Preparing for the National Counselor Exam 695

76. In experimental research, the control group receives __________ and the treat-
ment group receives ___________.
a. Treatment; a more intense treatment.
b. No treatment; no treatment.
c. Randomly assigned participants; nonrandomly assigned participants.
d. No treatment; treatment.

77. The founding association that eventually became the American Counseling
Association began in _______.
a. 1992.
b. 1983.
c. 1952.
d. 1947.

78. The use of assessment tools in career counseling was initiated through which
theoretical approach?
a. Needs theory.
b. Social learning theory.
c. Life-span, life-space theory.
d. Trait and factor theory.

79. A researcher created a 15-tem achievement instrument, and the reliability test
for the instrument yielded a coefficient of .80. Based on feedback from other
colleagues, she decided to lengthen the test with 10 more items, logically as-
suming that reliability coefficient would now:
a. Be approximately .89.
b. Remain unchanged.
c. Be at least 10 points higher or lower.
d. Be higher than .80.

80. Which of the following is one of the four stages of a typical Adlerian group?
a. Confrontation of group members.
b. Establishment of openness and sharing in the group.
c. Promotion of individual insight and self-awareness.
d. Action exercises.

81. The Life Career Rainbow is most closely associated with the work of:
a. Anne Roe.
b. John Holland.
c. Gottfredson.
d. Donald Super.
696 Preparing for the National Counselor Exam APPENDIX A

82. Which theorist is most associated with the bioecological model of human de-
velopment?
a. B. F. Skinner.
b. Uri Bronfenbrenner.
c. Carl Rogers.
d. Sigmund Freud.

83. A group whose goal is to teach new parenting skills to teenage mothers could
best be characterized as which type of group?
a. Counseling.
b. Task.
c. Psychoeducational.
d. Psychotherapeutic.

84. The American Counseling Association promotes multicultural competence

among all helpers. Adhering to multicultural competencies means that coun-
selors recognize their need to do all of the following except:
a. Be aware of personal values, beliefs, and worldviews.
b. Rely on mainstream understandings of or stereotypes about diverse groups.
c. Engage in research about diverse groups with whom they are working.
d. Create culturally sensitive interventions for diverse populations.

85. Meeting with his supervisor after attending a weekend seminar, a counselor
trainee made the following statement, which he says he had learned from the
seminar: “I have the capacity to ‘self-regulate’ in my environment for I am fully
aware of what is happening around me.” The supervisor deducts that he has
attended a seminar on _________ and is simply stating one of the basic princi-
ples of that therapy.
a. Reality therapy.
b. Neurolinguistic programming (NLP).
c. Thought field therapy (TFT).
d. Gestalt therapy.

86. Which of the following memory processes appears to show the least decline
with age?
a. Fluid intelligence.
b. Semantic memory.
c. Episodic memory.
d. Working memory.

87. Rajeev, a 17-year-old youth, is finding it hard to adapt to his newly found home
and shares his grief about having to leave his home in India to follow his family
APPENDIX A Preparing for the National Counselor Exam 697

to the United States. The counselor advises him that it will be best for him to let
go of his past, to make new American friends, go to see Hollywood movies,
and listen to rap and hip-hop music. In other words, it is in his best interest to
change so that he can “fit into” American society. The counselor is working
from an:
a. Autocratic perspective.
b. Autoplastic perspective.
c. Authoritarian perspective.
d. Alloplastic perspective.

88. Gestalt therapy promotes all of the following except:

a. Increasing awareness.
b. Dealing with unfinished experiences and feelings.
c. Examining childhood traumas.
d. Acknowledging and dealing with the most pressing needs first.

89. One of the members in a counseling group repeatedly criticizes another mem-
ber’s way of sharing. This is likely happening during which stage of the group?
a. Storming.
b. Performing.
c. Norming.
d. Adjourning.

90. More than other career theories, Gottfredson’s theory of career development
focuses on:
a. The role of childhood experiences in career choice.
b. The role of gender in career choice.
c. The role of personality factors in career choice.
d. The role of economic factors in career choice.

91. The Minnesota Multiphasic Personality Inventory and the NEO–Personality

Inventory–Revised both are:
a. Measures of personality.
b. Objective measures.
c. Tools that measure the Big Five.
d. Both a and b.

92. Which form of ethnography looks at the observations and reflections of a sin-
gle person?
a. Standard ethnography.
b. Autoethnography.
c. Online ethnography.
d. Protraiture.
698 Preparing for the National Counselor Exam APPENDIX A

93. Based on the ethical precept of _______________, a counselor has an obligation

to explain the purpose of using a paradoxical technique.
a. Nonmaleficence.
b. Justice.
c. Utilitarianism.
d. Fidelity.

94. State licensure typically requires which of the following?

a. A graduate degree that includes supervised practicum and internship ex-
periences.
b. Two to three postdegree years of supervised clinical experience.
c. Successful completion of an examination.
d. All of the above.

95. Levinson’s season’s of life theory focused on adult development. The main
thrust of development in later life, according to Levinson is:
a. Disengagement, or withdrawal from social activities.
b. Overcoming social and physical barriers to active involvement in later
life.
c. The search for intimacy during which the focus is on relationships with
significant others.
d. Reaching out and giving to the next generation.

96. The emic perspective to counseling is characterized by all of the following ex-
cept:
a. Universal definitions of health and wellness.
b. Application of therapeutic techniques similarly across cultures.
c. Counselors using their own cultural realities as a measure for under-
standing clients’ experiences.
d. Unique definitions of normal and abnormal or healthy and unhealthy be-
havior.

97. A client has been court mandated to enter drug and alcohol rehabilitation. Be-
sides being arrested for drunken driving more than once, the client also spends
all of her income on liquor, spends hours in a bar each evening, and has devel-
oped a high tolerance for alcohol. When confronted with these factors in ther-
apy, the client innocently says that she does not have a problem with drinking.
The client’s response can be characterized as:
a. Repression.
b. Sublimation.
c. Displacement.
d. Denial.
APPENDIX A Preparing for the National Counselor Exam 699

98. According to the Association for Specialists in Group Work, groups can be di-
vided into which of the following four areas?
a. Beginning, transition, working, and concluding.
b. Task, psychoeduational, counseling, and psychotherapeutic.
c. Interpersonal, intrapersonal, leadership, and conflict resolution.
d. None of the above.

99. When questioned about his views on individual development, a student re-
sponded, “I don’t believe that my individual development is dictated by my
inherent genetic make-up, but rather, it is my interactions with the environ-
ment that influence my development and even impact all of my behaviors.”
This student is purporting a(n) ________ viewpoint.
a. Ecologist.
b. Naturist.
c. Nurturist.
d. Biologist.

100. Bordin’s psychoanalytic model relates career choice to Freud’s psychosexual

stages and places importance on the role of ________ in adult work.
a. Id.
b. Superego.
c. Repressed drives.
d. Play.

101. Which discipline area has not played a key role in the development of qualita-
tive research?
a. Statistics.
b. Anthropology.
c. Education.
d. Sociology.

102. A sexual relationship between client and therapist is:

a. Ethical if the client initiates the relationship.
b. Ethical if both the client and the counselor consent to the relationship.
c. Never ethical.
d. Ethical if the counselor uses the relationship toward a therapeutic goal.

103. The career theory based on the idea of self-efficacy is tied to the work of:
a. Hoyt.
b. Krumboltz.
c. Super.
d. Bandura.
700 Preparing for the National Counselor Exam APPENDIX A

104. The Stanford–Binet and the Wechsler Adult Intelligence Scale measure which
of the following constructs?
a. Cognition.
b. Occupation.
c. Personality.
d. Behavior.

105. Carkuff developed a training model for helpers and added three concepts to
Rogers’s essential characteristics of counselors. Carkuff’s model is known as:
a. Microskills.
b. Human resources development model.
c. Relationship enhancement therapy.
d. Interpersonal process recall.

106. The classical theoretical formulation of group developmental stage theories

was formulated by:
a. Gerald Corey.
b. Irvin Yalom.
c. George Gazda.
d. Bruce Tuckman.

107. According to Jean Piaget’s cognitive development theory, children alter their
schemas or organized psychological structures through the processes of assim-
ilation and ______________.
a. Organization.
b. Symbolic substitution.
c. Accommodation.
d. Equilibration.

108. A counselor who advises her minority client to make adjustments in her tradi-
tions and worldview to find economic success can be said to be promoting the
following viewpoint:
a. Accommodation.
b. Ethnocentrism.
c. Autoplastic.
d. Cultural encapsulation.

109. In the nature versus nurture controversy, naturists subscribe to the belief that:
a. Human development is primarily determined by genetics, yet is influ-
enced by environmental interactions.
b. Human development is the primary result of environmental interactions,
yet influenced to some degree by genetic predisposition.
c. Human development is equally the result of both hereditary and envi-
ronmental forces.
d. Human development is the result of genetic predisposition and is not sig-
nificantly affected by environmental experiences.
APPENDIX A Preparing for the National Counselor Exam 701

110. When working with an African American client, a common mistake that a
non-Black counselor may make is:
a. Using a socioecological approach that accounts for environmental fac-
tors.
b. Assuming an active and directive stance.
c. Avoiding a medical model approach.
d. Ignoring the issue of race and maintaining a stance of color-blindness.

111. A therapy group that is led by a facilitator whose style can be characterized
largely as laissez faire would likely:
a. Invite members to begin on time during each session, but have minimal
interventions throughout the group.
b. Use directive interventions.
c. Model appropriate behavior to members.
d. Be very active at the beginning of the group experience and slowly taper
off her interventions as the process proceeded.

112. Using Betz and Hackett’s career theory for women, a counselor who is working
with a female client around career and vocational issues might do the follow-
ing:
a. Encourage the client to self-reflect on her interests.
b. Use an assessment tool to determine how well the client’s current job fits
with her personality.
c. Direct the client to observe female role models in the career area in which
she is interested but doubts the chances of her potential success.
d. Help the client understand if she prefers working with other individuals
or alone.

113. The best definition of reliability is:

a. Consistency.
b. Exactness of measurement.
c. Correlation coefficient.
d. Ability to measure what an instrument purports to measure.

114. After receiving several complaints from a group of parents about the results of
research conducted among 12th graders, a panel of investigators found out
that the researcher had unconsciously rated blond athletic males as more so-
cially skilled than others. This is an example of:
a. The halo effect.
b. The side effect.
c. The placebo effect.
d. John Henry effect.
702 Preparing for the National Counselor Exam APPENDIX A

115. HIPAA, enacted in 1996, requires health care providers to protect client health
care information. HIPAA stands for:
a. Health Insurance Privacy and Accountability Act.
b. Health Insurance Portability and Accountability Act.
c. Health Information Protection and Authorization Act.
d. Health Information Privacy and Authorization Act.

116. A career can be described as:

a. A conscious effort aimed primarily at producing benefits for oneself and
others.
b. The constellation of work and leisure experiences one has in a lifetime.
c. Relatively self-determined activities one has because of discretionary
time, money, and resources.
d. The understanding one has of his or her interests and skills.

117. When conducting an assessment, a counselor needs to engage in all of the fol-
lowing actions, apart from which exception?
a. Obtaining background information.
b. Considering systemic influences.
c. Observing the client in a natural setting when possible.
d. Prescribing medication based on the assessment.

118. Acculturation can be described as:

a. The degree to which an individual understands race as affecting work-
place opportunities.
b. The process by which minority groups overcome institutionalized rac-
ism.
c. The degree of identification an individual from an incoming cultural
group makes with a dominant culture.
d. The degree to which a dominant culture adjusts to incoming minority
groups.

119. For a cognitive-behavioral therapist, _________ is more important than

__________.
a. Assessment; evaluation.
b. Insight; action.
c. Change; understanding the genesis of a problem.
d. Thought stopping; exposure.

120. Which theorist is credited with discovering the concept of imprinting?

a. Bowlby.
b. Freud.
c. Piaget.
d. Lorenz.
APPENDIX A Preparing for the National Counselor Exam 703

121. A feminist therapist would be less likely to approach a family therapy session
from the perspective of the ____________ than a ____________ therapist.
a. Teacher; psychodynamic.
b. Model; conjoint.
c. Expert; strategic.
d. Negotiator; brief solution-focused.

122. McIntosh suggested that dominant groups carry an invisible knapsack that af-
fords them advantages over other minority groups. The idea of the invisible
knapsack is commonly used to refer to:
a. White privilege.
b. Racial identity development.
c. Discrimination.
d. Prejudice.

123. Random assignment has which of the following benefits to experimental re-
search?
a. It removes all of the influences from extraneous variables.
b. It decreases error by equating groups and diffusing the influence of ex-
traneous variables across groups.
c. It statistically controls for the effects of variables through analysis proce-
dures.
d. It makes sure that groups are gender diverse.

124. Rogers characterized the effective helper as having three essential qualities.
They are:
a. Openness, respect, concreteness.
b. Empathy, unconditional positive regard, congruency.
c. Congruency, intentionality, warmth.
d. Unconditional positive regard, communication competence, respect.

125. The assessment instrument known as the self-directed search was developed by:
a. Ginzberg.
b. Roe.
c. Crites.
d. Holland.

126. Each week during participation in an REBT group, a group member makes
statements such as “I should have spent more time on my school work,” and
“Only students who spend hours on studying can succeed.” To respond to the
client, the group leader would:
a. Help the group member dispute her irrational thoughts.
b. Give the member suggestions on how to become a better student.
c. Ask the member to act out her emotions to gain further insight.
d. Invite the member to work on repressed childhood memories.
704 Preparing for the National Counselor Exam APPENDIX A

127. The one-group posttest-only design is particularly vulnerable to which of the

following threats to internal validity?
a. History.
b. Diffusion of the treatment.
c. Testing.
d. Regression toward the mean.

128. The professionalization of counselors has included all of the following except:
a. State licensure.
b. National professional credentialing.
c. Accreditation of counselor education programs.
d. Third-party reimbursement.

129. The branch of ACA that deals with career development is known as the Na-
tional Career Development Association. It is formerly known as:
a. The American Career Association.
b. The National Vocational Guidance Association.
c. The Professional Association for Career and Guidance.
d. The American Vocational Association.

130. Which of the following least describes the normal distribution curve?
a. A majority of scores are either high or low.
b. The mean is in the middle at the highest elevation of the curve.
c. One standard deviation in either direction from the mean is an inflection
point.
d. The curve is asymptotic.

131. The theory of the BASIC ID is most closely associated with the work of which
theorist?
a. Bandura.
b. Beck.
c. Lazarus.
d. Adler.

132. During a group session of a psychoanalytic group, members report their feel-
ings or impressions as they arise. This process relates to which therapeutic
technique?
a. Interpretation.
b. Dream analysis.
c. Transference.
d. Free association.
APPENDIX A Preparing for the National Counselor Exam 705

133. Pavlov is best known for his theory of:

a. Classical conditioning.
b. Operant conditioning.
c. Higher order conditioning.
d. Reverse conditioning.

134. The experience known as loss of face is associated most with which cultural
group?
a. African Americans.
b. Asian Americans.
c. Native Americans.
d. Gay and lesbian Americans.

135. A counselor is helping her client to stop interpreting events and actions as if
they were directly related to the client, even when they are not. This counselor
can best be described as operating from which perspective?
a. Cognitive.
b. Cognitive-behavioral.
c. Rational emotive.
d. Existential.

136. The ________ consists of the words that are shared between individuals in a
group while the _______ is the relationship between the members.
a. Topics; cohesion.
b. Content; process.
c. Feedback; universality.
d. Conflict; structure.

137. In a session, a client tells the counselor that she is considering going back to
work because her family is struggling financially. Although being supportive
of the client’s desires, the counselor also would like to help the client form real-
istic expectations about how her going to work can have an impact on the fam-
ily. The counselor may suggest that the client consider which of the following?
a. The impact of dual working parents on child–parent relationships.
b. The adjustments that may have to occur in household duties.
c. The impact of dual working partners on time spent together.
d. All of the above.

138. The ______ method of estimating reliability involves only one test administra-
tion.
a. Test–retest.
b. Alternate forms.
c. Split-half.
d. Internal consistency.
706 Preparing for the National Counselor Exam APPENDIX A

139. The 1974 Family Education Rights and Privacy Act (FERPA) is most appropri-
ately defined as:
a. Federal legislation that governs educational records and dictates how all
written information on a student will be handled and disseminated for
the protection of the student and his or her family.
b. Federal legislation that allows school counselors to disclose information
on student and family records to any agency or school without requiring
written consent from the child or family.
c. Federal legislation that prohibits eligible students, those who reach the
age of 18 while in secondary schools, from having access to their records
without parent or guardian written consent.
d. Federal legislation that governs how counselors in agencies will handle
and disseminate client records.

140. A counselor is working with a client who was recently laid off of his job. The
counselor might expect the client to display which of the following reactions as
a result of the job loss?
a. Withdrawal.
b. Loss of positive self-image.
c. Confusion.
d. Both a and b.

141. A counselor who is conducting research on test anxiety decides to plot her data
and finds that most of the students scored in a below-average range of anxiety,
whereas only a few scored in an average or above-average range. The coun-
selor can best describe her data as:
a. Positively skewed.
b. Normally distributed.
c. Negatively skewed.
d. None of the above.

142. An addict has recently stopped using heroin and now has started using cocaine
for the first time. This is an example of:
a. A new addiction.
b. Switching addictions.
c. A passing phase.
d. A process addiction.

143. Jose is a member of a behavioral therapy group. He recently stated in a group

that he is very afraid of public speaking and becomes so anxious at the thought
of talking in front of large groups that his heart races, his palms get sweaty, and
he begins to tremble. Utilizing behavioral therapy, a group leader may suggest
that Jose:
a. Participate in assertion training so he is better able to deal with his fears.
b. Be given homework assignments that address his fears.
APPENDIX A Preparing for the National Counselor Exam 707

c. Rehearse a short presentation to himself when he is alone, then make sev-

eral short presentations to his group members, and finally give the same
presentation to his group members and 5 to 10 other family members and
friends who are invited to hear his presentation.
d. Focus on his ability to choose whether or not to be anxious when he is
asked to speak publicly.

144. The theorist Thorndike came to the conclusion that behavior is learned via trial
and error with the resulting behavior having a higher propensity to reoccur if
the consequence of that behavior is positively reinforcing. Thorndike’s propo-
sition is called:
a. Adverse stimuli.
b. Law of effect.
c. Law of exercise.
d. Positive reinforcement.

145. Racial and cultural identity development models examine the process through
which minority groups form their personal and cultural identities. The process
through which minorities progress, as described by the racial and cultural
identity development model includes all of the following except:
a. Conformity to the dominant culture.
b. Resistance to the dominant culture.
c. Overt negativity and prejudice against the dominant culture.
d. Acceptance of the minority culture to which one belongs.

146. The key premise of rational emotive behavioral therapy is that:

a. Interpretation is used to help group members gain insight into their be-
haviors.
b. All anyone can control is their own present life.
c. If people are successful at controlling their irrational thoughts, they will
feel happy.
d. Unconditional positive regard and genuineness of a therapist leads to
positive changes in the client.

147. Multicultural group work can be understood as:

a. Group work inclusive of need for an expansion of personal and group
consciousness of self in relation by providing intentional, competent, and
ethical helping behaviors that promote the mental health of group mem-
bers.
b. Group work inclusive of race and ethnicity.
c. Group work inclusive of race, ethnicity, sexual orientation, and gender.
d. Group work that focuses only on issues of diversity among members.
708 Preparing for the National Counselor Exam APPENDIX A

148. One of the most frequently used personality inventories in career counseling is
the Myers–Briggs, which counselors use to assess clients in four areas of per-
sonality. These personality types include all of the following except:
a. Investigative-Introversion.
b. Introversion-Extroversion.
c. Thinking-Feeling.
d. Sensing-Intuiting.

149. In statistics, p = .05 means:

a. There is a 5% chance that results are due to chance factors.
b. In 95% of the cases, the results are not due to chance factors.
c. Every 5 out of 100 scores is due to chance factors.
d. The test is not highly reliable.

150. The most important advantage of the Solomon Four-Group design with re-
spect to internal validity is that _________ is controlled.
a. Instrumentation.
b. Selection.
c. Resentful demoralization.
d. Testing.

151. When complex ethical dilemmas arise, counselors are best advised to:
a. Consult with friends who have dealt with similar ethical dilemmas.
b. Trust their “gut” response in deciding how to proceed.
c. Seek supervision with other professionals.
d. Ask the client how she or he wants to deal with the dilemma.

152. A counselor using Holland’s theory of career development would be interested

in knowing the personality traits of the client. All of the following are among
the six classifications of personality described by Holland except:
a. Realistic.
b. Artistic.
c. Social.
d. Extrovert.

153. A counselor is trying to decide on a test to measure depression. The manual for
the test reports that the instrument has a reliability coefficient of r = .5. Based on
what he knows about reliability coefficients, the counselor should:
a. Decide not to use the test.
b. Use the test with great assurance that the results will be reliable.
c. Use the test and then consult with colleagues about the results.
d. Contact the publisher of the instrument for further information.
APPENDIX A Preparing for the National Counselor Exam 709

154. Adler emphasized all of the following concepts in his approach to psychology,
except:
a. Family constellation.
b. Birth order.
c. Social interest.
d. Automatic thoughts.

155. Core competencies for multicultural group work include:

a. Group workers’ awareness of their personal values, beliefs, stereotypes,
and biases.
b. Group workers’ knowledge of diverse members’ values, life experiences,
and worldviews.
c. Group workers ability to lead diversity-sensitive interventions with
group members.
d. All of the above.

156. When asked about his career choice, an adolescent experiencing identity fore-
closure is most likely to say:
a. My Mom says I should be a pediatrician like her.
b. I don’t know, I haven’t thought about it.
c. I don’t know, I’m still considering what I might like as a career.
d. I’ve decided that I want to be an astronaut.

157. A client recently has complained to her counselor that she is involved in a
carpool for her children. Among the three families in the carpool, one family is
only driving once a week, whereas she and the third family drive three times
each. The counselor understands that the client is operating from:
a. Law of effect.
b. Law of exercise.
c. Attribution theory.
d. Law of reciprocity.

158. Longitudinal studies investigate:

a. Differences in the same subjects over time.
b. Trends in sample populations over time.
c. Differences in the same group of people at one point in time.
d. Both a and b.

159. Professional counselors are obligated to do all of the following except:

a. Attend to the welfare of clients and students.
b. Belong to professional organizations.
c. Recruit others to join their professional field.
d. Adhere to the standards of competency set by the professionals in the
field.
710 Preparing for the National Counselor Exam APPENDIX A

160. Tiedeman, Miller-Tiedeman, and O’Hara described two stages of career devel-
opment: anticipation and implementation. The anticipation stage is comprised
of four phases known as:
a. Exploration, crystallization, choice, and clarification.
b. Orientation to size and power, orientation to sex roles, orientation to so-
cial valuation, orientation to unique, internal self.
c. Dealing with change, developing career focus, exploring options, prepar-
ing for the job search.
d. Fantasy stage, tentative stage, realistic stage, and choice stage.

161. There are a number of different types of validity. Researchers should put the
least amount of confidence in which type of validity?
a. Concurrent validity.
b. Content validity.
c. Construct validity.
d. Face validity.

162. Archetypes can be described as primordial images that contain psychic energy
and assign meaning to experience. Which of the following theorists is the origi-
nator of this concept?
a. Freud.
b. Bandler.
c. Jung.
d. Beck.

163. According to Maslow’s needs hierarchy, there is one need that must be met be-
fore a person can move toward higher development. This need is:
a. Biological needs.
b. Self-actualization.
c. Love and belongingness.
d. Safety needs.

164. A counselor is interested in knowing the effect of a 12-week cognitive treat-

ment program on the self-concepts of girls with eating disorders. The coun-
selor has read several articles about the subject and is getting ready to begin her
research project. Prior to testing, she states the null hypothesis this way:
a. Cognitive therapy will be significantly more effective than no cognitive
therapy.
b. Girls with eating disorders who participate in a cognitive treatment
group will have significantly higher self-concepts than girls who do not
participate in the cognitive treatment program.
c. There will be no significant differences in the self-concepts of girls who
participate in the treatment program and girls who do not.
d. Girls with eating disorders who participate in a cognitive treatment
group will have significantly lower self-concepts than girls who do not
participate in the cognitive treatment program.
APPENDIX A Preparing for the National Counselor Exam 711

165. Balance theory purports that:

a. People will tend to agree on interests and ideas to increase the stability of
their relationships.
b. People tend to look for internal reasons for their motivations.
c. Relationships are strongest when people both give and take.
d. Behavior is influenced by socially imposed roles.

166. Egan’s problem management training model entails three stages, each of
which is characterized by three steps. The first stage is guided by the question,
“What’s going on?” A goal of this stage includes the following:
a. Helping clients tell their stories.
b. Creating goals for the client.
c. Assessing action strategies.
d. Helping clients find incentives for change.

167. When group leaders are not culturally sensitive, there may be a number of neg-
ative implications for group members. Which of the following is not a reper-
cussion of a leader’s lack of multicultural competence?
a. The group worker may unconsciously impose personal or theoretical
values, beliefs, and attitudes on members.
b. Group members holding a different worldview and value system may
not be empowered to live life more fully.
c. Group members will feel understood and appreciated for their cultural
heritages.
d. The group member(s) holding a different worldview and value system
may physically or psychologically leave the group or get little to nothing
from the group experience.

168. If a client is taking a test with forced choice responses, this means that the
client:
a. Will most likely be answering questions on a Likert scale.
b. Must answer all questions to give a valid and reliable score.
c. Will have the opportunity to write in personal responses to questions.
d. Will use free association techniques in responding to pictures or inkblots.

169. The emic perspective suggests that:

a. Cultural values, worldview, and contexts are important to understand-
ing behavior.
b. Action inputs must equal action outputs.
c. Behavior is universal and can be understood similarly across cultures.
d. People should adjust to the dominant culture rather than having the
dominant culture adjust to minority groups.
712 Preparing for the National Counselor Exam APPENDIX A

170. The life events such as marriage, a first job, a first child, and so on, that follow
age-graded patterns based on societal and cultural expectations are referred to
as:
a. The biological clock.
b. The social clock.
c. The family life cycle.
d. The social convoy.

171. The most widely used and researched personality measure is:
a. TAT.
b. Rorschach.
c. MMPI–2.
d. BASC–2.

172. Quasi-experimental designs are used when:

a. The researcher wants to control for extraneous variables with random as-
signment.
b. There are no manipulated independent variables.
c. It is not possible or ethical to use randomization.
d. The researcher wants to examine the correlations between an independ-
ent and dependent variable.

173. The ACA Code of Ethics as well as the ASCA Code of Ethics serve all of the fol-
lowing purposes except:
a. Protect counselors from issues of liability and malpractice.
b. Offer guidelines and standards with which counselors must be familiar
before beginning their practices.
c. Reflect changes in the practice of ethical conduct with which counselors
must remain current and to which counselors can turn in times of uncer-
tainty.
d. Provide the community with a sense of security essential to a profession.

174. Eight-year-old Julia has just transferred to a new school and has been identified
by several teachers as a student who may benefit from talking to the school
counselor. Julia reported to the counselor that a group of girls at her new school
tease her and tell her that she can’t play with them at recess. The counselor un-
derstands that the girls are engaging in which of the following?
a. Overt aggression.
b. Associative play.
c. Instrumental aggression.
d. Relational aggression.
APPENDIX A Preparing for the National Counselor Exam 713

175. Culture can be understood as including the following dimension(s):

a. Race.
b. Gender.
c. Religion.
d. All of the above.

176. A client shares with the counselor that her daughter has recently died in a car
accident. The counselor responds, “That must be a terrible loss for you. Surely,
your heart is breaking.” The counselor’s response is an example of:
a. Restating.
b. Summarization.
c. Interpreting.
d. Empathizing.

177. Which of Piaget’s cognitive development stages involves monumental ad-

vances in mental representations of objects and events, as well as animistic
thought?
a. Sensorimotor.
b. Concrete operational.
c. Preoperational.
d. Formal operational.

178. A school counselor decides to start a lunchtime counseling group for elemen-
tary-age students who are being bullied. Before she begins to meet with the stu-
dents, the counselor is obligated to:
a. Advertise the group in the school.
b. Obtain permission from the school principal.
c. Reserve an appropriate space for the group to take place.
d. Secure informed consent from the parents of group participants.

179. Active listening skills such as ______________, summarization, and restate-

ment are three Adlerian therapeutic techniques utilized in group therapy.
a. Integration.
b. Reflection.
c. Ulterior transactions.
d. Genuineness.

180. Projective measures such as the TAT and Rorschach use unstructured stimuli to
infer:
a. Attitudes.
b. Personality traits.
c. Feelings.
d. All of the above.
714 Preparing for the National Counselor Exam APPENDIX A

181. An independent variable is one that the researcher:

a. Manipulates.
b. Holds constant.
c. Correlates with other variables.
d. None of the above.

182. Irvin Yalom is a premier figure in describing therapeutic factors in group coun-
seling. These factors are elements that increase clients’ ability to change as a re-
sult of participation in group therapy. Which of the following are therapeutic
factors described by Yalom?
a. Forming, storming, norming, and performing.
b. Instillation of hope, universality, interpersonal learning, group cohesive-
ness.
c. Catharsis, venting, relief, sharing.
d. Insight, awareness, risk-taking, and cohesiveness.

183. A dependent variable can best be described as:

a. The variable that is held constant and that the researcher is interested in
measuring.
b. The treatment a researcher applies to an experimental group.
c. The variable that the researcher manipulates.
d. The variable that the researcher hypothesizes to be responsible for a treat-
ment effect.

184. The field of counseling is increasingly recognizing the place of supervision in

the careers of professional counselors. Which of the following is most true
about supervision?
a. Clinical supervision is most beneficial during graduate school training.
b. Clinical supervision is only called for during crisis moments or during
ethical dilemmas.
c. Clinical supervision is most effective when it is applied throughout the
expanse of a professional counselor’s career.
d. Clinical supervision is used only when trying to obtain counselor
licensure.

185. According to Freud’s psychosexual theory of human development, each child

passes through a series of psychosexual stages. These stages are:
a. Concrete, phallic, oral, anal, and genital.
b. Phallic, latency, oral, and anal.
c. Oral, anal, phallic, and latency.
d. Oral, anal, phallic, latency, and genital.
APPENDIX A Preparing for the National Counselor Exam 715

186. In group therapy, a counselor continues to shun a particular member because

he reminds her of her abusive father. The counselor’s behavior is an example
of:
a. Countertransference.
b. Transference.
c. Repression.
d. Denial.

187. Alpha level can best be described as which of the following?

a. A predetermined probability value.
b. Equal to p ≤ .05 or p ≤ .001 in behavioral sciences.
c. Both a and b.
d. None of the above.

188. The mother of an infant who displays the ambivalent-resistant pattern of at-
tachment is most likely to behave in which of the following ways when inter-
acting with her infant?
a. Abusive.
b. Permissive.
c. Overcontrolling.
d. Inconsistent.

189. A counselor who is operating from an ethnocentric viewpoint:

a. Tends to use his or her cultural standards to evaluate and understand cli-
ents’ issues.
b. Disregards his or her own cultural views and assumes the views of the
client.
c. Recommends that dominant cultures should accommodate to minority
groups.
d. None of the above.

190. A counselor practices in a rural area that has few mental health resources apart
from her own private practice. In trying to serve the needs of the community,
the counselor works 6 days a week and often works 10-hour days. Although
the counselor strongly desires to serve the people in her community, she is no-
ticing that lately she is fatigued, not listening empathically to her clients, and
her mind wanders while in session. This counselor may be said to be:
a. Negligent.
b. Suffering from burnout.
c. Extremely incompetent.
d. Acting in her own best self-interest.
716 Preparing for the National Counselor Exam APPENDIX A

191. During which of Erikson’s stages does an individual develop trust for others
through warm responses with from people in his or her environment?
a. Autonomy versus shame and guilt.
b. Initiative versus guilt.
c. Identity versus identity diffusion.
d. Basic trust versus distrust.

192. A counselor learns that his client has recently been involved in a high-profile
affair, and chooses to spread slanderous information about the client to other
professionals in the agency. This counselor could be accused of:
a. Nonmaleficence.
b. Defamation.
c. Fidelity.
d. Boundary violation.

193. A counselor is working with a client who is in his 70s. All of the following po-
tentially can be issues that a counselor will decide to explore first with the cli-
ent, except:
a. Spousal death.
b. Financial concerns.
c. Relocation to a health care institution.
d. Career change.

194. A counselor has just completed a 2-hour continuing education seminar on in-
fusing hypnotherapy into treatment of clients who suffer from trauma.
Ethically, the counselor can now advertise herself as:
a. A certified hypnotherapist.
b. A licensed hypnotherapist.
c. A professional hypnotherapist.
d. None of the above.

195. When alpha is changed from .01 to .05:

a. The probability of incurring a Type II error increases.
b. The probability of incurring a Type I error increases.
c. There is a lower chance that the results will occur only by chance.
d. The probability of failing to reject the null hypothesis increases.

196. A supervisor listens to a supervisee’s comments and watches counseling vid-

eotapes, and notices that the supervisee is not demonstrating many basic inter-
vention skills. Moreover, the supervisee seems insecure about the counseling
process. The supervision model that may best assist this supervisee is:
a. Developmental supervision.
b. Supervision from an REBT theoretical framework.
c. Supervision using microskills training.
d. An eclectic approach to supervision.
APPENDIX A Preparing for the National Counselor Exam 717

197. In his social-learning theory, Bandura proposed that learning occurs not only
by way of classical and operant conditioning but also as a result of a process
called ____________ or __________.
a. Observational learning; imitation.
b. Observational learning; attention.
c. Attention; vicarious reinforcement.
d. Retention; attention.

198. Social exchange theory postulates that:

a. People strive to make their thoughts and behaviors consistent with one
another.
b. People with similar interests are more likely to be attracted to one an-
other than people with dissimilar interests.
c. People unconsciously account for the costs and benefits in relationships
and value relationships with the greatest benefits.
d. People have a higher degree of commitment to activities that are immedi-
ately reinforced.

199. A researcher is interested in knowing the effect of assertiveness training on as-

sertiveness levels in a group of high school seniors who are looking for their
first jobs. In this example, the dependent variable is:
a. The training that students receive.
b. The group of students.
c. The students’ level of assertiveness.
d. The instrument the researcher uses to measure assertiveness.

200. A counselor’s caseload is full, so she provides referral numbers of other coun-
selors in the area to a person she cannot take on as a new client. This counselor
is adhering to:
a. Mandatory ethics.
b. Aspirational ethics.
c. Ethical principle of beneficence.
d. The ethical principle of justice.
718  Preparing for the National Counselor Exam Appendix A

   SAMPLE TEST ANSWER KEY

1. B 44. B 87. B 130. A
2. C 45. A 88. C 131. C
3. C 46. A 89. A 132. D
4. B 47. B 90. B 133. A
5. A 48. A 91. D 134. B
6. B 49. C 92. B 135. A
7. D 50. C 93. A 136. B
8. A 51. D 94. D 137. D
9. C 52. A 95. C 138. C
10. A 53. B 96. * 139. A
11. B 54. C 97. D 140. D
12. C 55. B 98. B 141. A
13. C 56. A 99. C 142. B
14. D 57. B 100. D 143. C
15. C 58. C 101. A 144. B
16. B 59. B 102. C 145. C
17. D 60. C 103. D 146. C
18. A 61. B 104. A 147. A
19. B 62. A 105. B 148. A
20. B 63. C 106. D 149. B
21. B 64. D 107. C 150. D
22. A 65. B 108. C 151. C
23. C 66. D 109. D 152. D
24. C 67. B 110. D 153. A
25. A 68. D 111. A 154. D
26. A 69. D 112. C 155. D
27. B 70. B 113. A 156. A
28. A 71. D 114. A 157. D
29. C 72. B 115. B 158. D
30. A 73. A 116. B 159. C
31. C 74. B 117. D 160. A
32. C 75. C 118. C 161. D
33. A 76. D 119. C 162. C
34. C 77. C 120. D 163. D
35. B 78. D 121. C 164. C
36. B 79. D 122. A 165. A
37. A 80. B 123. B 166. A
38. B 81. D 124. B 167. C
39. D 82. B 125. D 168. A
40. A 83. C 126. A 169. A
41. A 84. B 127. A 170. B
42. D 85. D 128. D 171. C
43. C 86. B 129. B 172. C
Appendix A Preparing for the National Counselor Exam  719

173. A 180. D 187. C 194. D

174. D 181. A 188. D 195. B
175. D 182. B 189. A 196. C
176. D 183. A 190. B 197. A
177. C 184. C 191. D 198. C
178. D 185. D 192. B 199. C
179. B 186. A 193. D 200. B *  Discard # 96

REVISING THE SAMPLE TEST QUESTIONS

If you missed any of the questions in the sample exam, you may want to review the
content area that corresponds to the question(s) missed.
Table A.2 provides a list of the question numbers that correspond to each of the
content areas. Additionally, the chapters in which you will find information relating
to each testing area are indicated.

TABLE A.2
Questions Corresponding to Area of Testing

Area of Testing Question Numbers

Human growth and development 1, 15, 29, 38, 45, 52, 60, 68, 86, 95, 99, 107, 109, 120, 133, 144, 156, 163,
(Chapters 7, 8) 170, 174, 177, 185, 188, 191, 197
Social and cultural foundations 2, 14, 16, 28, 30, 39, 53, 70, 84, 87, 96, 108, 110, 118, 122, 134, 145, 157,
(Chapters 4, 11) 165, 169, 175, 189, 193, 198
Helping relationships 3, 13, 17, 27, 31, 37, 40, 51, 54, 62, 69, 72, 82, 85, 88, 97, 105, 119, 121,
(Chapters 9, 10, 18, 26, 27) 124, 131, 135, 142, 146, 154, 162, 166, 176, 186, 196
Group work 4, 12, 18, 26, 32, 41, 50, 55, 63, 74, 80, 83, 89, 98, 106, 111, 126, 132, 136,
(Chapters 12, 13, 14) 143, 147, 155, 167, 179, 182
Career Counseling 5, 11, 19, 25, 33, 42, 49, 56, 61, 64, 75, 81, 90, 100, 103, 112, 116, 125,
(Chapters 15, 16) 129, 137, 140, 148, 152, 160
Appraisal 6, 10, 20, 24, 34, 43, 47, 57, 65, 73, 79, 91, 104, 113, 117, 130, 138, 141,
(Chapters 20, 21) 149, 153, 161, 168, 171, 180
Research 7, 9, 21, 23, 35, 46, 58, 66, 71, 76, 78, 92, 101, 114, 123, 127, 150, 158,
(Chapters 22, 23) 164, 172, 181, 183, 187, 195, 199
Professional orientation 8, 22, 36, 44, 48, 59, 67, 77, 93, 94, 102, 115, 128, 139, 151, 159, 173, 178,
(Chapters 1, 2, 3, 5) 184, 190, 192, 194, 200
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WHAT IS PENELOPE?

Penelope is a multiversion case management software solution for social and

human service organizations. It is a comprehensive and user-friendly Web-based
program that integrates client information, scheduling, and a full range of service
delivery tracking, including treatment planning and progress monitoring, billing,
outcome evaluation, reporting, and more. The version of the software known as
Penelope Light comes in a variety of “flavors,” so that users can pick and choose
which software package works best for them. The various package offerings of
Penelope are specifically designed for solo practitioners and small clinical settings.
For information about the software packages that Athena offers, please visit their
Web site at http://www.athenasoftware.net/penelope_light-get- started.html.
Directions on how to access your subscription to the student version of Penelope
are included at the end of this appendix.

721
722 An Introduction to Penelope Software APPENDIX B

FIGURE B.1 Penelope uses a client-centric model of service delivery. Case files are composed of one or
more individuals that may receive services together or independently.

INDIVIDUALS AND CASES

Files can be created for individuals who interact in some manner with you or your
organization. Individuals represent anyone who has participated in education or
community-building programs, workers at other agencies, clinical clients (case
members), including group members, and so on. Cases can be created for clients re-
ceiving clinical services, and it is in these case files that confidential clinical infor-
mation is stored, workers are assigned to deliver service within a program, and ac-
tivities are scheduled and documented.
APPENDIX B An Introduction to Penelope Software 723

FIGURE B.2 In this image, you see the multifaceted options for keeping track of information about
each individual client. A wealth of information can be recorded at the individual, case, program, and ac-
tivity levels of the case file. Penelope also contains an outcomes evaluation survey tool that allows agen-
cies to build outcomes tools into the system and monitor outcomes throughout or following service for
each client.
724 An Introduction to Penelope Software APPENDIX B

GETTING TO KNOW THE CASE FILE

Cases are usually comprised of an individual or family members that may receive
services together. However, different combinations of case members may partici-
pate in different services. For example, mom, dad and their two children may be
participating in family therapy with Worker A. Mom also may be coming in for in-
dividual therapy with Worker B. The children may be coming in for art therapy on
their own with Worker C, and dad may be coming in for group therapy with
Worker D. Programs may be closed without closing the case. This allows the
agency to have a complete and coherent record of what is happening with the case,
and relevant information can be stored at the appropriate levels (individual, case,
program, activity). Workers then have access to case information on a
need-to-know basis.

Highlights of the Case File

䊏 Custom document creation tool that allows an agency to build forms within the
case file, such as intake and closing documents, forms, or logs used in specific
programs.
䊏 Custom treatment planning, assessment, and progress monitoring tools.
䊏 Multimedia case file with attachments.
䊏 Appointment notes tool that is free form or template based and can be locked.
䊏 Billable and nonbillable services, including service codes that are tracked using a
simple shopping cart model.
䊏 Case history and a wealth of other reports.

THE CASE WORKER

Penelope has different types of login accounts based on a worker’s role at an

agency. The case worker account provides access to the worker’s case files, ap-
pointments, messages and tasks, search functions, and some links, all of which are
easily accessible from the home page. The intake account has all the functions of the
case worker account plus the ability to create a case file, assign clients to a program
and worker, and access the schedule of the whole agency.

LOGGING INTO PENELOPE

Every case worker has access to a personalized home page in Athena. After logging
in, each screen in Penelope has a title that appears at the top left, and, on the top
APPENDIX B An Introduction to Penelope Software 725

FIGURE B.3 A screen shot of the case worker home page.

right, the name of the worker, along with the date appear. In addition, the case
worker can always access the home page by clicking the Home icon at the top left of
all Athena screens.
Every home page also displays the currently assigned clients and programs. To ac-
cess the service file, click the Program Provided ID (PP ID; see column with numbers
such as 1007, 5675, 1018, etc.). To access information on the program participant, click
the name of the program member you want to see.
726 An Introduction to Penelope Software APPENDIX B

WHAT ARE SOME OF THE USEFUL TOOLS ON MY HOME PAGE?

You can always get to your home page by clicking the home icon.

You can access the color-coded master agency schedule by clicking the Schedule
icon.

You can book a case appointment or find a case by clicking the Book Appt icon.

A wealth of help resources can be accessed by clicking the Help icon.

You can print any page you are on by clicking the Print icon. (Note: All reports may
be printed from within the report, without using this Print button.)
APPENDIX B An Introduction to Penelope Software 727

Additionally, there are tools that will help with the following functions:

䊏 You can navigate back to the last screen visited by clicking the Back button, and
you can refresh the information on the page by clicking the Reload button.
䊏 You can access the Case Information page by clicking any of the case links in the
case applet.
䊏 You can access the Individual Profile page of the primary client by clicking their
name.
䊏 You can refer to the Reference Page, which contains links to Web sites, documents,
and other information.
䊏 You can access your own worker information—to change your availability or
password, for example—by clicking the My Profile link.
䊏 You can access each of your Appts. for the Day by clicking its link.
䊏 You can access your Appts. for the Week by clicking the Weekly View button.
䊏 You can access the schedule of the entire agency by clicking the Today’s Agency
Appts. link (intake account required).
䊏 You can leave messages for yourself or other workers by using the Tasks feature
displayed underneath the case applet.
䊏 You can view or create news items by clicking the News icon.
䊏 You can check the status of each case by looking at the CTC check box, which in-
dicates Call to Confirm the activity.

WHAT ARE SOME OTHER COOL FEATURES OF PENELOPE?

In addition to the basic features described as useful tools in the Penelope software,
there are many other features that make Penelope the online resource of choice for
counselors and agencies. Some of these features include the following:

䊏 Secure/encrypted Web-based application.

䊏 Centralized or individualized scheduling—including group appointments.
䊏 Internal messaging, tasks, and alerts.
䊏 Wait-list, community-based service, and brief service tracking (e.g., crisis calls,
referrals, seminar presentations, outreach contacts, etc.).
䊏 Indirect activity tracking (meetings, nonclinical appointments, etc.).
䊏 Extensive reports and data export capabilities.
䊏 Extensive billing and accounts receivable features enable sliding scale self-pay
and copay, EAP, and Medicaid billing.
䊏 User-customizable.
728 An Introduction to Penelope Software APPENDIX B

FIGURE B.4 This image shows some of the various options for adding individuals and creating case
files.

SAMPLE PROCESS: HOW DO I ADD AN INDIVIDUAL?

You can add individuals either one at a time—through the Add Individual link on
the home page—or more than one at a time—through the Intake Wizard (which
adds them as case members in their newly created case).

SAMPLE PROCESS: HOW DO I BOOK AN APPOINTMENT?

Another great tool in the Penelope software is its ability to let you keep your ap-
pointment calendar online. When you have finished with each session, just log in
and update your appointment book to keep track of your schedule.
APPENDIX B An Introduction to Penelope Software 729

FIGURE B.5 This screen shot indicates how to use the appointment calendar that is part of the soft-
ware.
730 An Introduction to Penelope Software APPENDIX B

CONCLUSION

This short description has provided just a glimpse of what this powerful software
program is all about. There are a lot of other things to discover and tons of other
mechanisms available to you as you explore the student version of Penelope. We
encourage you to explore, use it to its full potential, and enjoy!

For more information, visit Athena Software at:

http://www.AthenaSoftware.net

To access your Counselor’s Companion subscription to the student version

of Penelope for just $7.95, please visit www.AthenaSoftware.net/Counselors_
Companion.html
appendix Hints, Helps, and FAQs About Working
in a Managed Care Environment
C
The managed care revolution has brought dramatic transformations in the provi-
sion and financing of mental health treatments in the private sector. With the ad-
vent of managed mental health care (MMHC), “the familiar fee-for-service system
is being replaced by a system in which costs are controlled by placing limits on the
amount and type of services, by monitoring services intensively, and by changing
the nature of services” (Foos, Ottens, & Hill, 1991, p. 332). These changes have re-
quired mental health counselors to develop new knowledge and skills to establish
and maintain economically viable practices. As managers in businesses and indus-
tries became aware of the fast escalation of their employees’ mental health care ben-
efits over the costs of other medical benefits, they realized that such benefits
needed to be restrained. Consequently, any method that is developed to bring con-
tainment to the costs of employees’ mental health benefits inevitably affects all
mental health providers, as well as professional counselors.

THE BOURGEONING OF HEALTH MAINTENANCE

ORGANIZATIONS

To control costs, insurance companies, corporate businesses, and the health care
providers are appealing more and more to health maintenance organizations
(HMOs) and other managed care systems. The methods that are utilized to ensure
cost control and clinical effectiveness can include the following:
䊏 Submitting every proposed treatment plan for peer review.
䊏 Ensuring early detection and treatment of mental health issues.
䊏 Ensuring that treatment modality matches presenting problem.
䊏 Giving preauthorization for hospital admission.
䊏 Paying close attention to case management.

THE STRUCTURE OF MANAGED MENTAL HEALTH CARE

As corporations, insurance companies, and business organizations placed caps on

the financing and delivery of mental health services, new models of managed care
have emerged. According to Foos et al. (1991), the four most common models are:

731
732 The Managed Care Revolution APPENDIX C

1. Employee assistance programs (EAPs). These began as programs to treat alcohol-

ism in the workforce, and they have now evolved and are utilized by busi-
nesses “to provide services such as wellness in the workplace, stress reduction,
smoking cessation seminars, alcohol and drug interventions, and referral” (p.
333).
2. Utilization and concurrent review (UR). This requires practitioners to justify and
submit in writing a comprehensive treatment plan that is then analyzed by a
utilization reviewer for appropriateness.
3. Preferred provider organizations (PPOs). These are “a network of providers that
collectively offer comprehensive services or specialty care” (MacCluskie &
Ingersoll, 2001, p. 252), under certain guidelines such as submission to UR and
acceptance of reduced fees from insurance companies or businesses.
4. Staff model HMOs. Subscribers covered under this model are eligible for reim-
bursed services only if the services are obtained from a provider employed by
the mental health HMO.

ADVANTAGES OF MANAGED MENTAL HEALTH CARE

The managed care revolution brought along in its trail a plethora of advantages
and disadvantages for clients, counselors, and the counseling profession as a whole
(Lawless, Ginter, & Kelly, 1999). Listed next are some of these advantages and dis-
advantages.

Advantages of MMHC
䊏 The spiraling costs of health care services are kept under control.
䊏 Clients have better access to mental health care.
䊏 Referrals for some practitioners are on the rise.
䊏 Quality control and standards of practice become the norm.

Disadvantages of MMHC
䊏 There is a reduction in some types of usually available services.
䊏 Pharmacological interventions are overused.
䊏 The duration for treating some disorders is inadequate.
䊏 Outpatient services are overly relied on.

IMPACT OF MANAGED MENTAL HEALTH CARE

ON COUNSELING

Johnson and Combs (2001) reported that there is a good cluster of evidence from
the counseling literature that indicates “that brief, time-limited therapies which
APPENDIX C The Managed Care Revolution 733

emphasize primarily cognitive-behavioral or brief therapies appear, in and of

themselves, effective in treating some disorders” (p. 88). They further postulated
that the importance given by managed care companies to these interventions has
contributed to the rise in popularity of these approaches. The following are some of
the implications that the advent of MMHC has for counselors and the counseling
field.

Implications for Counselors

䊏 Counseling is taking a more holistic orientation, embracing interventions that
produce positive change in the health of clients and is moving counselors to offer
premium and highly effective prevention programs.
䊏 The use of medical services by employees is reducing the benefit of counseling,
based on the fact that a great percentage of physical symptoms have emotional
rather than organic causes, which are sometimes resolved through brief counsel-
ing (Cummings, 1977).
䊏 Effectiveness of treatment offered on outpatient basis as opposed to inpatient ba-
sis is becoming the treatment of choice, attracting employers and third-party
payers who are finding it hard to absorb the spiraling costs of residential treat-
ment.
䊏 Due to parameters set on time and caps placed on costs for counseling services,
counselors will need to develop proficiency in brief or time-limited therapies,
rapid formulation of treatment plans, and familiarity with counseling interven-
tions that focus on crisis interventions and active problem solving (Austad,
DeStafano, & Kisch, 1988).
䊏 Individual practice in counseling is greatly reduced, clearing the way for group
practice to become the standard, at the same time transforming the field of coun-
seling into a competitive market.

SURVIVING THE MANAGED CARE ENVIRONMENT

Based on the recommendations of Lawless et al. (1999), MacCluskie and Ingersoll

(2001) proposed the following skills that counselors need to master to effectively
work in a managed care environment.

Counselors’ Skills
䊏 Business know-how and aptitude.
䊏 Ability to utilize the Diagnostic and Statistical Manual of Mental Disorders (4th ed.
[DSM–IV]; American Psychiatric Association, 2000) effectively.
䊏 Ability to design and write effective treatment plans.
734 The Managed Care Revolution APPENDIX C

䊏 Ability to keep records and manage billing.

䊏 Ability to function with brief and solution-focused therapy.
䊏 Ability to develop research skills.
䊏 Ability to provide clear treatment philosophy to both clients and managed care
organizations.
䊏 Ability to work as a team with other service providers and utilization review-
ers.
䊏 Ability to develop awareness of standards of practice for various clinical prob-
lems.
䊏 Ability to master managed care jargon.

MAKING IT WORK PROFITABLY: HINTS FOR COUNSELORS

Anderson (2000) offered some practical suggestions on how to deal constructively

with managed care organizations. A former mental health counselor and managed
care case manager, Anderson provided some hints on how mental health counsel-
ors can:

䊏 Develop working relationships with case managers.

䊏 Do treatment planning.
䊏 Submit claim forms.
䊏 Resolve disputes.

How Can Counselors Develop Working Relationships

With Case Managers?
䊏 Mental health counselors need to provide the case manager with clear and spe-
cific clinical information about the clients’ treatment that include current symp-
toms, past interventions, success or failure of these interventions, and goals and
objectives for treatment.
䊏 Mental health counselors need to adhere to the managed care company’s guide-
lines as a network provider.
䊏 Mental health counselors need to avoid taking the managed care process person-
ally and see case managers’ questions not as a concern about their clinical exper-
tise, but rather as a genuine attempt to secure accurate information about how
clients can be helped.
䊏 Mental health counselors need to develop a familiarity with managed care pro-
cedures, and consult with the case manager whenever there is a doubt about the
procedures.
䊏 Mental health counselors need to get to know their clients’ benefits, the amount
used, the amount that remains, as well as the referral procedures, the criteria for
medical necessity, and the emergency procedures.
APPENDIX C The Managed Care Revolution 735

䊏 Mental health counselors need to treat the case manager as they wish to be
treated themselves, which involves not delaying to return phone calls and to re-
spond to the case manager’s requests.
䊏 Mental health counselors need to use the case manager as a resource for guid-
ance when needed.

What Are Skills Counselors Need to Do Treatment Planning?

䊏 Mental health counselors need to develop clear individualized treatment plans
for the clients.
䊏 Mental health counselors need to be well informed and conscientious in their
clinical duties, which involve being able to state clearly the symptoms of the cli-
ents, and articulate specific plans and outcomes that make clinical sense.
䊏 Mental health counselors need to provide to the case manager a good treat-
ment plan that includes the following elements: a clear statement of the client’s
problem, specific goals with measurable criteria and time frames for comple-
tion of the goals, and a clear statement of the means to be used to achieve these
goals.
䊏 Mental health counselors need to communicate progress of clients to case man-
agers when performing clinical reviews of treatment plans, so that continued
sessions can be certified when benefits are available.

How Do Counselors Go About Submitting Claim Forms?

䊏 Mental health counselors need to accurately use service codes on claim forms
that reflect exactly what counseling services have been certified to avoid denial
of claim by the case manager.
䊏 Mental health counselors need to clarify with the case manager what services
have been certified when clinical review is being done by phone.
䊏 Mental health counselors need to keep copies of certification forms that outline
exactly what has been certified.
䊏 Mental health counselors need to advise the case manager of any deviation from
what has been certified so that adjustment could be made to the certification
form to reflect what exactly took place.
䊏 Mental health counselors need to know that certifications are often time limited
and that claims for the services provided prior to the beginning date and past the
ending date will be rejected.
䊏 Mental health counselors need to be aware that reimbursement for services is in
accordance with the rate negotiated in the original contract with the managed
care provider, and that the contract will need to be renegotiated if the rate should
be changed.
䊏 Mental health counselors need to know that case managers can help when prob-
lems with claims arise.
736 The Managed Care Revolution APPENDIX C

What Can Counselors Do for Resolving Disputes?

䊏 In cases where clients’ benefits are not covered by an individual insurance plan,
counselors and case managers can team up to devise strategies that will help cli-
ents make the best use of their existing benefits, or identify other sources of fund-
ing.
䊏 In cases where benefits have been exhausted it is imperative that counselors
work together with the case manager right at the beginning of treatment to grasp
the scope and amount of benefits available to clients.
䊏 In cases where disagreements arise over medical necessity, mental health coun-
selors can do the following to bring about a resolution: Provide clear therapeutic
reasons for the medical necessity, explain the rationale and intended outcomes
behind the request, provide clear information that matches the specific criteria
used by the case manager to determine medical necessity, be knowledgeable of
pragmatic references that support the treatment request, keep the relationship
with the case manager nonadversarial, and initiate the appeal process in the last
resort.

FREQUENTLY ASKED QUESTIONS ABOUT MANAGED CARE

This section of frequently asked questions is based on the series of

bulletins offered by Walsh and Dasenbrook on the American Coun-
seling Association’s Web site at:
䉴 http://www.counseling.org/Counseling/PrivatePracticePointers.aspx

䊏 1. How Easy Is It to Become a Managed Care Provider?

Because of the bureaucracy and paperwork involved in managed care, becoming a

provider can be very difficult, but not impossible.

䊏 2. Are Mental Health Counselors Accepted as Third-Party Payers?

Some 40 national and regional managed care and insurance companies accept li-
censed mental health professionals as third-party payers. Although this figure var-
ies from state to state, 80% of the top insurance companies like Blue Cross/Blue
Shield will pay third-party reimbursement in most states.
APPENDIX C The Managed Care Revolution 737

䊏 3. What Does One Do if One Is Not on the Client’s Panel

or if a Panel Is Closed in One’s Area?

Not a problem! There is always the option of entering through the “back door” and
attempting to become an ad hoc provider, which means you are accepted for one
client. You will then be included in the system and will be given provider status
with a provider number.

䊏 4. What Are the Steps That Need to Be Followed if One Chooses

to Use the Back Door System?

1. The client writes a clear, polite letter to the employer requesting that the man-
aged care company consider paying you as his or her chosen mental health cli-
nician. The letter must speak about your credentials and experience as a thera-
pist, and indicate that you meet all the necessary requirements of your state for
licensed professional counselors. The letter goes to the benefits manager of the
company and a copy is sent to the managed care company provider relations
director.
2. A second letter is sent to the managed care company by you, the licensed men-
tal health professional, requesting to be considered for reimbursement for ser-
vice delivery. A copy of the letter that includes your credentials and explains
the benefits of the mental health professional services for the employee and the
company in general is also sent to the client’s employer.
3. Secure a letter from the state counselors association of which you are a member
to be sent to the managed care company on your behalf. The letter will advo-
cate your case for accepting licensed mental health counselors into a mental
health option package.

䊏 5. Should Counselors Be HIPAA Compliant?

The Health Insurance Portability and Accountability Act of 1996 (HIPPA) regula-
tions are in force, and any professional counselor considered as a covered entity is
legally obliged to comply.

䊏 6. What Is Meant by “Covered Entity?”

Any provider that uses electronic forms to transmit information is a “covered en-
tity.” It is advisable that counselors become HIPAA compliant on account of credi-
bility of professionalism vis-à-vis their clients. Moreover, whether you are a cov-
ered entity or not, or elect not to comply, the HIPAA still impacts release of
information, record keeping, and confidentiality.
738 The Managed Care Revolution APPENDIX C

KEY TERMS FOR MANAGED CARE PROVIDERS

Counselors working in a managed care environment need to develop a familiarity

with terms and language commonly used in that setting.

Capitation: A form of payment in which a fixed amount of money is paid in

advance to a provider for the delivery of health care services on a per-patient,
per-unit-of-time basis.

Case management: A process that uses clinical protocols as a guide to assign

the least expensive appropriate treatment for special populations who are ex-
pected to generate large expenditures, such as people with severe persistent
mental illness and children with severe emotional disturbances.

Case manager: A nurse, doctor, or social worker who works with patients,
providers, and insurers to coordinate all services deemed necessary to pro-
vide the patient with a plan of medically necessary and appropriate health
care.

Case rate: A previously agreed-on fee paid to a provider for the entire course
of treatment for one case.

Cost-containment case management: A model that allows case managers to

develop treatment plans that take into account the client’s social and medical
needs. This may include authorizing services beyond the coverage of the
plan, particularly if such treatment proves less costly.

Employee assistance programs (EAPs): Worksite-based programs designed

to assist in the identification and resolution of productivity problems associ-
ated with employees impaired by personal concerns including, but not lim-
ited to health, marital, family, financial, alcohol, drug, legal, emotional, stress,
or other personal concerns that may adversely affect employee job perfor-
mance.

Gatekeeper: Under some health insurance arrangements a primary care pro-

vider serves as the patient’s agent, and arranges for and coordinates appro-
priate medical services, laboratory studies, hospitalizations, and other neces-
sary and appropriate referrals.

Health maintenance organization (HMO): A type of health care plan usually

associated with specific geographical areas where members pay a flat
monthly rate in return for health care services delivered by a group of mental
health and medical professionals.
APPENDIX C The Managed Care Revolution 739

HMO group practice: An HMO that contracts with a single multispecialty

medical group partnership to provide services to its members on preagreed
per-capita rate, which the group distributes among its physicians.

HMO staff: A type of closed-panel HMO in which medical professionals are

employed by the HMO to provide care to members in the HMO’s own facili-
ties.

Indemnity health insurance: Through this type of plan, the patient or the
provider receives reimbursement for services as expenses are incurred.

Independent practice associations (IPAs): Groups of independent medical

practitioners who band together for the purpose of contracting their services
to HMOs, preferred provider organizations (PPOs), and insurance compa-
nies, to provide services to both HMO and non-HMO plan participants on an
agreed, prepaid, capitated rate.

Management services organization: An organization whose task is to pro-

vide business-related services, such as marketing and data collection, to indi-
vidual groups of providers.

Medical staff organization: A group of physicians who have teamed together

to contract with others for provision of services.

Mixed model: A prepaid system that combines features of more than one
HMO model, without one particular model dominating another.

Network: An HMO model that contracts with two or more independent

group practices to provide services to HMO members, and may involve large
single and multispecialty groups.

Open-ended or open panel HMO: An HMO that allows its members to uti-
lize health care services from providers outside their own network of provid-
ers without referral authorization.

Preferred provider organization (PPO): A health care delivery system that

contracts with providers of medical care to provide services at discounted
fees to members. Members may seek care from nonparticipating providers
but generally are financially penalized for doing so by the loss of the discount
and subjection to copayments and deductibles.

Third-party administrators (TPAs): Individuals or firms that an employer

hires to handle claims processing, reimburse providers, and deal with all
other health-insurance-related matters.
740 The Managed Care Revolution APPENDIX C

Utilization management: The process of evaluating the necessity, appropri-

ateness, and efficiency of health care services against established guidelines
and criteria.

Utilization review (UR): A formal process for reviewing the appropriateness

and quality of health care services delivered to clients before, during, or after
the delivery of the services.
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 Index

A pendent on the degree to which a person is emotion-

ally dependent on others. 380
A–B–C model of personality: In REBT, this model sug-
Addiction, 568
gests that A (the activating event) does not cause C
assessment, 574–579
(the emotional consequence). Instead, B, which is the
models, 572–574
person’s belief about A, largely causes C, the emo- process, 569–572
tional reaction. 176 treatment, 579–585
Aber, J. L., 588 Adjourning: The termination stage in a counseling group
Ableism: A pervasive system of discrimination and exclu- when members may feel a sense of loss and a need to
sion that oppresses people who have mental, emo- make sense of what has happened in the group. 289,
tional, and physical disabilities. 63, 65–66, 241–242 295
Abrami, P. C., 440, 441, 445, 448, 449, 450, 451, 452 Adkins, W. R., 204, 205
Abrego, P., 333 Adler, A., 161, 162, 163, 249, 633, 646
Abstinence model: Individuals can only be considered Adler, P. A., 518
healthy and recovering if they are not using any of Adler, P., 518
the substance to which they are addicted. 583 Adult ego state: The ego state in transactional analysis
Academic development: Strategies and activities imple- that acts much like a computer, taking in and regulat-
mented to support and maximize student learning ing information from the parent, the child, and the
and help students understand the significance of edu- environment. This ego state is the logical and realistic
cation to their future economic success and their qual- part of a person and makes the best possible decision
ity of life. 364–365 in a given situation. 165, 252
Accommodation: In Piaget’s theory of cognitive develop- Adultism: Prejudice and accompanying systematic dis-
ment, the process of altering current ways of thinking crimination against young people. 63, 65
or creating new ways of thinking to understand new Advocacy, 13–14
knowledge. In structural family therapy, the process Affectional orientation: The type of person with whom a
through which the therapist adapts to enter the fam- given individual is predisposed to bond emotionally
ily system, and the process that the family undergoes and share personal affection. 55, 62, 65
to make changes. 147, 398 Affectional prejudice: Subsumes homophobia as it incor-
Accreditation, 8 porates negative attitudes and biases based on
Acculturation: Suggests that minority groups adapt to the affectional orientation, including homosexuality, bi-
culture, values, and norms of the dominant group sexuality, or heterosexuality. 65
rather than the dominant group adjusting to the pres- Affective assessment tools: Tools measuring affective
ence of the minority group. 59 variables by asking for ideas, preferences,
Achievement tests: Measures of the effects of learning self-descriptors, and opinions. 328
from specific, controlled experiences such as aca- Afferent neurons: Sensory neurons that carry signals to-
demic courses or programs of instruction. 468, 470 ward the central nervous system. 608
Achinstein, B., 98 Ageism: Systematic and stereotypic prejudice against peo-
Ackerman, J., 389 ple simply because they are old. 63, 65, 239
Ackerman, N. W., 390, 391 Ainsworth, M. D. S., 116
Active mastery: In the microskills approach, the ability to Airasian, P., 496
produce specific and intentional results from the cho- Alderian approach, 249–251
sen counseling skill. 81–82 Alderman, N., 621, 622
Adaptability: In Bowenian family therapy, the degree to Alexander, K., 42, 43
which a person is able to manage life stress is de- Alexander, M. D., 42, 43

785
786 INDEX

Alloplastic perspective: Suggests that people focus pri- Apply: Stage in the FERA inquiry learning model that in-
marily on working to adjust society to better fit their volves monitoring the implementation of new learn-
needs and preferences. 59–60 ing as it is used in the practice of counseling and su-
Allstetter-Neufeldt, S., 90, 96 pervision. 100, 103, 106, 108
Alonso, A., 109 Aptitude tests: Measure informal learning from a variety
Alpha level: The predetermined probability value se- of uncontrolled experiences and are said to measure
lected by the researcher to make a decision about the innate potential, as well as predict future academic
null hypothesis. 489–490 performance. 470
American Association of Pastoral Counselors, 660 Arab American Institute, 236
American Counseling Association, 3, 20, 73, 659 Arbitrary interferences: The conclusions that people
American Psychiatric Association, 212, 243, 408, 569, 571, make about situations without due cause. 173
572 Arbona, C., 341, 345, 349, 357
American School Counselor Association, 11, 12, 361 Archer, J., 645
American Society for Addiction Medicine, 578 Archetypes: Described in Jungian psychology, these are a
American-Arab Anti-Discrimination Committee, 238 priori structures in the psyche that form the building
Americans with Disabilities Act: The act passed by Con- blocks of psychological reality; they are primordial
gress to end discrimination against people with dis- images that contain psychic energy and assign mean-
abilities in the employment sector. 241, 316, 335 ing to experience. 160, 667
Amundson, N., 316 Arciniega, G. M., 641
Amygdala: Part of the limbic system that is responsible Arredondo, P., 54, 203
largely for emotional control, and especially fear and Arrestment: In psychoanalytic theory, the inability to
aggression. 611 move to a higher level of development because of in-
Analysis of covariance(ANCOVA): Used to test for statis-
adequate gratification. 140–141
tically significant differences in same means of three
ASCA Ethical Guidelines on Educational Records, 43–44
or more groups; however, by combining the ANOVA
ASCA National Model: A model that integrates the three
with a correlation, it also statistically removes the ef-
widely accepted and respected approaches to pro-
fects of identified covariates or confounding variables
gram development—comprehensive, developmental,
that potentially can influence the dependent variable.
and results-based approaches—that were created to
444, 493, 500
assist school districts in designing school counseling
Anderson, B. S., 36, 37, 41
programs that support the academic success of every
Anderson, C. E., 94
Anderson, S., 382 student. 367–368
Anderson, T., 395 ASCA National Standards: National standards for the
Andres-Hyman, R., 614 school counseling profession that define what stu-
Androcentrism: The practice, conscious or otherwise, of dents should know and be able to do in academic, ca-
placing male human beings or the masculine point of reer, personal, and social realms as a result of partici-
view at the center of one’s view of the world and its pating in a comprehensive, developmental K–12
culture and history. 61 school counseling program. 364
Androgynous: A person who has both feminine and mas- Aspirational ethics: The highest standards of conduct to
culine qualities and who may assume female and which counselors aim to meet ethical standards.
male roles. 61 21–22
Angrosino, M. V., 518 Assertion training: Training that increases individuals’
Animism: Attributing live characteristics to inanimate ob- behavioral repertoire so they are better able to choose
jects. 118 whether or not to behave assertively in a given situa-
Anonymity: A facet of protecting participants from risk of tion. 169, 259
harm in which participants are ensured that their Assessment: The process of collecting and integrating
identities or any identifying information will not be data from interviews, case studies, observations, and
revealed or used in the study. 435 psychometric tools for the purposes of informing clin-
Ansbacher, H. L., 164, 646 ical decisions. 460–463
Anthony, E. J., 248 behavioral, 475–477
Anti-Semitism: The systematic discrimination against, ha- cognitive, 463–467
tred of, denigration of, or oppression of Judaism, educational, 468–472
Jews, and the cultural, religious, and intellectual heri- employment interest, 480–482
tage of Jewish people. 63, 65 neuropsychological, 478–480
Apostoleris, N. H., 601 personality, 472–475
 INDEX 787

Assimilation: In Piaget’s theory of cognitive develop- Baldwin, B. A., 556

ment, the process of using preexisting knowledge to Bales, R. F., 288
make sense of new experiences. Also refers to adapta- Balzer, W. K., 483
tions that are made by the minority group to the Bambino, D., 98
norms, values, and culture of the dominant group as Bandler, R., 393–394
well as structural adaptations made by the dominant Bandura, A., 170, 172
group to include portions of the culture, values, and Barlow, S. H., 257, 324, 672
norms of the minority group. 59 Basal ganglia: Part of the forebrain related to emotional
Association for Advanced Training, 221 control, eye movement, turning cognition into action,
Association for Clinical Pastoral Education, 663 and motor control. 610–612
Association for Specialists in Group Work, 12, 275 Basch, M. F., 598
Associations, 11–12 Basic mastery: In the Microskills counseling approach, the
Atkinson, B., 224, 611, 614, 616, 617, 622 ability to demonstrate chosen counseling skills dur-
Atkinson, D. R., 68, 69 ing the counseling interview. 80, 82
Attachment: The bond between a child and the primary Basic psychological needs: In self-determination theory,
caregiver. 151 the inner resources with important survival value
Attrition: A threat to internal validity that occurs when that are held to be universal and include the needs for
participants drop out of the study in different num- relatedness, competence, and autonomy. 595–599
bers and for different reasons, which in turn affects Baucom, D. H., 379
the sample size and the composition of the treatment Baumeister, R., 595
and control groups. 495, 509 Baumrind, D., 121
Audience: In psychodramatic group therapy, the remain- Beach, A., 94
ing group members who witness an enactment and Beck, A. T., 173, 378, 409
hopefully experience a release of feelings and in- Beck, J. S., 94
creased insight into their own struggles while observ- Becker, B., 593
ing a performance. 126, 255 Becker, D., 94
Austin, B. D., 6, 8 Bednar, R. L., 288, 290
Austin, L., 264, 272 Behavioral approach, 257–260
Austin, N. L., 350 Behavioral assessment: A process of systematically gath-
Automatic thoughts: Deep-seated personal beliefs that are ering observations of a set of target behaviors, exam-
triggered by the environment and typically result in ining the relations between these observations and
maladaptive feelings and behaviors. 174, 631 possible causes of the behavior, and applying the in-
Autonomy: The ethical precept that counselors respect cli- formation to treatment planning and progress moni-
ents’ right to be self-governed. 25–26, 166, 557, 562, toring. 475–477, 574
596, 598, 600–601 Behavioral consultation: A relationship whereby services
Autoplastic perspective: Suggests that people focus on consistent with a behavioral orientation are provided
adapting to the regulations of the dominant social either indirectly to a client or a system (through the
structure and setting. 59–60 mediation of important others in the client’s environ-
Auxiliary ego: In psychodramatic group therapy, the ment or of those charged with the system’s well-be-
group members selected by the protagonist to repre- ing) or directly by training consultees to enhance
sent inanimate objects, pets, or persons who are dead, their skills with clients or systems. 539–542
alive, real, or imagined. 255–256 Belsky, J., 588, 589, 591
Aversive conditioning: An undesirable stimulus is pre- Bemak, F., 6, 8
sented after a target behavior to decrease the proba- Bemmels, B., 217
bility that such behavior will happen again. 145 Beneficence: The ethical precept that counselors should
Axlerad, S., 315 attempt to perform some good for their clients (as op-
Axon: Extends from the cell body and carries output sig- posed to merely avoiding harm). 24–25
nals to other neurons. 608–609 Ben-Porath, Y. S., 474
Berenson, B., 199
Berg, I. K., 394, 395
Bergan, J. R., 531, 541, 542
B Berger, P. L., 513
Baker, J., 47, 80 Berk, L. E., 126, 140, 141, 142, 148, 150
Baker, S. B., 544, 659 Berkowitz, S., 258
Balbernie, R., 608, 609 Bernal, M. E., 68
788 INDEX

Bernard, J. M., 74, 77, 78, 83, 87, 88, 93, 94, 95, 100, 106 Bridges, J., 388, 389
Berne, E., 165, 167, 251, 253, 254, 665 Brief, A. P., 62
Bernstein, J., 164 Briggs, K., 330
Berry, J. W., 58, 341 Brigman, G., 540
Bertalanffy, L. V., 529 Broadband tools: Tools that simultaneously measure a
Betz, N. E., 324, 342, 347, 348 wide range of characteristics, behaviors, and symp-
Bias: A preference, tendency, or inclination toward partic- toms that can be used to diagnose one or several dis-
ular ideas, values, people, or groups. 64–65, 158, 306, orders. 409
388, 455 Bronfenbrenner, U., 588, 589, 595
Biglan, A., 397 Brown, D., 317, 318, 323
Bingham, R. P., 341, 354, 355 Brown, G. K., 409
Birth order: A child’s chronological or psychological birth Brown, L. L., 95, 106
position that influences the child’s behavior and Brown, M. T., 252, 341, 342, 349, 350, 357
eventual perception of his or her world. 162, 164, 237, Brown, S. D., 343
249, 381 Browning, D. S., 663
Blaming: In conjoint family therapy, a communication Bruner, J. S., 593
style in which a person declares himself or herself to Bryant, R. A., 397, 564
be in control and more powerful than others. 392 Buber, M., 662, 670
Bloch, S., 280 Buhrmester, D., 130
Block, C. B., 230 Bullis, R. K., 36, 664
Block, P., 230, 531 Bureau of Labor Statistics, 10, 362
Blocking: A specific type of protection that is used to stop Burlingame, G. M., 275, 280, 288
a group member from storytelling, rambling, or oth- Burnout: Occurs when professional counselors do not
erwise talking in a manner that runs counter to the take care of their physical, emotional, spiritual, and
purposes of the group. 294 existential needs and continually encounter high lev-
Blumenfeld, H., 609, 610, 611, 612, 613 els of stress. 16–17
Blustein, D. L., 320 Burr, V., 383
Bochner, A. P., 521 Butcher, J. N., 409, 473, 474
Bogdan, R. C., 513 Butman, R. E., 664, 665
Bogdevic, S. R., 518 Byars, A. M., 347, 348
Bonanno, G. A., 565
Borders, L. D., 82, 87, 95, 106, 641
Bordin, E. S., 101, 321
Borgatta, E. F., 288
C
Borgen, F. H., 481 Cade, B., 394
Boscolo, L., 401 Call, K. T., 213
Boszormenyi-Nagy, I., 389, 390 Callahan, J., 555, 556, 557
Botwinick, J., 130 Callanan, P., 46
Boulding, K. E., 279 Campbell, C. A., 364, 365, 366, 372, 374
Boulian, P. V., 484 Campbell, D., 330, 401
Boundaries: The physical and psychological limits that Campbell, J. M., 87, 96
frame a professional counseling relationship. 29, 268, Canalization: Situations in which the environment has lit-
399, 544 tle impact on inherited characteristics. 113
Bowen, M., 380, 381, 382 Capitation: A form of payment in which a fixed amount
Bowen, R., 126 of money is paid in advance to a provider for the de-
Bowers, J., 364 livery of health care services on a per-patient,
Bowlby, J., 150, 151, 588, 589, 595 per-unit-of-time basis. 738
Bowman, S. L., 346 Caplan, G., 529, 530, 531, 536, 538
Boyce, W. T., 593 Cappas, N. M., 614
Bozarth, J. D., 266 Capps, D., 663, 666
Bradley, A., 335 Capuzzi, D., 300
Bradley, L. J., 88, 94 Career: The totality of work and leisure one does in a life-
Brammer, L. M., 197, 199, 201, 552 time. 317
Brammer, L., 333 Career counseling, 315–317
Braverman, L., 396, 397, 398, 566 assessment tools, 328–332
 INDEX 789

multicultural issues, 341–357 Central nervous system (CNS): Responsible for control of
process, 325 all major systems of the body; contains the brain and
special issues, 332–336 the spinal cord. 420, 608
technological competencies, 336–338 Centration: A narrow topical focus. 121, 148
theory, 317–325 Cephalocaudal: The sequence of growth that occurs first
Career development: Strategies and activities imple- in the head and progresses downward. 114, 115, 127
mented to help students acquire attitudes, knowl- Cerebellum: Part of the hindbrain that receives sensory
edge, and skills to successfully transition from grade inputs from the brain and spinal cord that are used to
level to grade level, from school to postsecondary ed- coordinate movement, and also to support higher
ucation, and ultimately to the world of work. 317 cognition through connections with the cortex. 612,
Career maturity: In Super’s life-span, life-space career 613
theory, the ability to perform the developmental tasks Cerebral cortex: The outermost part of the brain that is
of life stages. 344 comprised of the frontal, temporal, occipital, and pa-
Career self-efficacy expectations: Beliefs about one’s own rietal lobes. 610
ability to perform occupationally relevant behaviors Certification, 10–11
successfully; these expectations determine one’s ac- Charmaz, K., 523
tions, effort, and persistence in regard to career be- Cheatham, H. E., 342
Child ego state: An ego state described in transactional
haviors. 347
Carkhuff, R., 199, 210 analysis that consists of the adapted child and the
Carlsen, M. B., 593 free child (or natural child). The adapted child con-
Carlson, J., 195, 545, 546 forms to the rules and wishes of the parent ego state
Carmichael, K. D., 237, 238 and is basically compliant. The free child is spontane-
Carroll, J. B., 464 ous, fun, creative, and curious, caring for its needs
Carta-Falsa, J., 94 without regard for others. 165
Carter, B., 133, 387 Chi-square statistic: Statistical test that provides a mea-
Carter, R. T., 345 sure of goodness of fit or independence. It allows re-
Casas, J. M., 53, 347 searchers to infer if two nominal variables are inde-
Case management: A process that uses clinical protocols pendent of one another or are related. 445
as guides to assign the least expensive appropriate Cholmsky, P., 440
Chou, E. L., 348, 350
treatment for special populations who are expected to
Cicchetti, D., 588, 591, 592, 593, 595
generate large expenditures, such as people with se-
Cicerone, K. D., 616, 621
vere persistent mental illness and children with se-
Cingulate gyrus: Part of the limbic system that is involved
vere emotional disturbances. 738
with attention, response selection, error detection,
Case manager: A nurse, doctor, or social worker who
and emotional behavior. 611
works with patients, providers, and insurers to coor- Circular interviewing: In constructivist family therapy, a
dinate all services deemed necessary to provide the technique in which family members are questioned
patient with a plan of medically necessary and appro- about how others in the family connect to a problem-
priate health care. 738 atic issue to illuminate a variety of perspectives and
Case rate: A previously agreed on fee paid to a provider highlight the systemic nature of problems. 384
for the entire course of treatment for one case. 738 Circumscription: In Gottfredson’s career counseling the-
Casile, W. J., 97 ory, the process by which individuals gradually re-
Categorical independent variables: In a nonexperimental strict the occupations they consider acceptable, based
design, participants are classified into discrete groups on their developing self-concept. 322, 346
(e.g., gender, race, marital status, religious affiliation, Cisgender: Describes people who possess a gender iden-
level of education). 507, 508 tity or perform a gender role society considers appro-
Causal-comparative study: Designs that use categorical priate for one’s sex. 61
independent variables. 508 Civil law: Includes everything that does not fall under the
Caust, B., 387 category of criminal law and is exemplified by law-
Cecchin, G., 401, 402 suits resulting in sanctions (generally monetary
Ceci, S. J., 588 awards). 36
Cell body: Contains the nucleus of the neuron and makes Clark, C., 660
up gray matter in the brain such as the cerebral cor- Clark, L. E., 310, 311
tex. 609 Clark, M., 375
Center for Credentialing and Education, 73, 88 Classical conditioning, 143
790 INDEX

Clifford, J., 520 Compromise: In Gottfredson’s career counseling theory,

Clifton, D., 94 the process by which individuals choose among
Cline, R. J., 292 available, but imperfect occupational alternatives by
Cliques: Small groups of five to seven members who tend compromising some needs for others. 322
to resemble one another in family background, inter- Conditioned response (CR): The response that is elicited
ests, and social status. 130 in the presence of the conditioned stimulus. 143
Cognitive assessment tools: Measure cognitive variables, Conditioned stimulus (CS): Stimulus that is paired with
such as aptitude or skill tests, which typically pose the unconditional stimulus with the goal of evoking
questions that have correct or incorrect answers. 465 the same response as the unconditional stimulus. 143
Cognitive assessment: The gathering of information Confidence interval (CI): The range of scores that repre-
about an individual’s overall cognitive ability and sents some percentage of confidence of including a
functioning. 463 person’s true score. 448
Cognitive–behavioral approaches, 167 Confidentiality: An ethical standard that safeguards cli-
behaviorism, 167–169 ents from unauthorized disclosures of information
cognitive therapy, 172–175 given in a counseling relationship. 28, 46
multimodal therapy, 182–184 in schools, 47–48
neo-behaviorism, 169–172 Conformity prescription: Seeks to make clients fit the
rational emotive therapy, 176–179 therapy by trying to enhance in them a positive ap-
reality therapy, 179–181 preciation for the therapeutic relationship. 205
Cognitive development: Involves changes of inherent in- Confound: Variable not considered in the study (extrane-
tellectual and linguistic abilities through stimulating ous variables) that influences the outcome of the
interactions with the surrounding environment. 146 study and consequently does not allow for valid in-
Cognitive maps: Mental representations of large-scale terpretation of the results. 492
spaces. 148 Congruence: In Holland’s career theory, the match be-
Cohen, R. J., 439, 483 tween personal interest and work environment. 199
Cohen, R. R., 62 Congruent: In conjoint family therapy, the pattern of com-
Colapinto, J., 398 munication reflects the reality of the self and the other
Collateral informants: Individuals who are close to a situ- in that moment. Looks, feelings, tone of voice, and
ation of addiction (e.g., partner, family, employer, etc.) body language are all reflecting the same message.
and who are most likely to know about the addiction. 392
575 Congruity, 215–216
Collective unconscious: The unconscious memories and Connell, J. P., 596, 597
common images, such as mother, earth, or death Connolly, J., 129
shared by all of humanity that are inherited from the Conoley, C. W., 540, 547
ancestral past. 160 Conoley, J. C., 540, 547
Collins, B. G., 554, 565 Conscious: The smallest piece of the mind that contains
Collins, T. M., 554, 565 the thoughts and feelings of which a person is aware.
Combs, A., 199, 200, 732 157
Comer, R. J., 406, 423, 424, 426 Conservation: The ability to recognize that an object’s
Coming out: Individuals have accepted and announced physical properties remain constant despite alteration
their homosexuality. 243 to the object’s appearance. 124
Commission on Rehabilitation Counselor Certification, 15 Consistency: In Holland’s career theory, the similarity be-
Compensatory rivalry: A threat to internal validity that tween an individual’s top few interests. 214, 217
occurs when the effects of the treatment are negated Consonance: Exists when two cognitions are aligned or
because one group sees the other group as competi- consistent with one another. 214
tors and consequently works harder than usual. 496 Construct validation: A determination of how well test
Competence: A combination of clinical expertise, high lev- scores are indicative of the characteristics of the con-
els of self-awareness, and interpersonal effectiveness. struct being measured. 451
40–41 Construct: An abstraction or concept inferred from the ob-
Comprehensive school counseling program: Counseling servation of regularly occurring patterns of behavior.
program that is intended to deliver counseling to all 451
students; it has an organizational structure that in- Consultation: A process in which a human service profes-
cludes standards and competencies, as well as a man- sional assists a consultee with a work-related (or
agement and delivery system. 367, 369 caretaking-related) problem with a client system,
 INDEX 791

with the goal of helping both the consultee and the Costa, S. R., 98
client system in some specified way. 40–41, 528 Cost-containment case management: A model that allows
behavioral, 539–542 case managers to develop treatment plans that take
Block’s model, 532 into account the client’s social and medical needs.
historical evolution, 529–532 This may include authorizing services beyond the
mental health, 536–539 coverage of the plan, particularly if such treatment
organizational, 542–545 proves less costly. 738
orientation, 535–536 Cottone, R. R., 587
school-based, 545–547 Council for Accredation of Counseling and Related Edu-
theories, 533–534 cational Programs, 9, 15, 221, 659, 675
Conte, C., 566 Council on Rehabilitation Education, 9
Content validity: The test items on an instrument are rep- Counseling history, 3
resentative of the attribute being measured. 450 Counseling theory: A framework for observing and un-
Content-oriented consultation: Implies that the consultee derstanding human behavior that also allows for
lacks understanding and awareness and, therefore, making predictions about the concerns, actions, per-
needs the consultant to provide expertise to success- ceptions, emotions, and motivations of human be-
fully solve the problems. 543 ings. 195
Continuous development: Development that occurs Countertransference: Projections counselors cast on their
gradually over the life span in a fashion that may be
clients. 15, 30
thought of as cumulative or quantitative in nature.
Cournoyer, B. R., 558, 559
138 Covariates: Confounding variables that can potentially in-
Continuous independent variable: In nonexperimental
fluence the dependent variable. 444
designs, participants are placed or fall along some
Cowan, M., 204
continuum such as age, IQ, self-esteem, persistence,
Coward, R. L., 94
or goal orientation. 507
Coyne, J., 397
Control group: In an experimental design, the group that
Cozolino, L. J., 607, 613, 615, 616, 617, 622
receives no treatment or the groups that are assigned
Crace, R. K., 331
to different levels of the treatment. 499
Crawford, R. L., 41
Conventional morality: The second level of Kohlberg’s
Criminal law: Involves crimes punishable by fine, impris-
moral development stages in which ethical decision
onment, or death and is prosecuted by the govern-
making is based on societal expectations and necessi-
ment. 36
ties for the purpose of maintaining societal normality.
Crisis: The perception or experiencing of an event or situ-
148
ation as an intolerable difficulty that exceeds the re-
Convergence: The phenomenon of overlapping cultural
sources and coping mechanisms of the person; unless
dimensions affecting experience and identity. 55
the person gains relief, the crisis has the potential to
Cook, D. A., 62, 345
Coombs, R. H., 572, 577 cause severe affective, cognitive, and behavioral mal-
Coping skills development, 203–205 functioning. 551–559
Corbin, J., 524 Crisis intervention, 559
Corey, C., 82 six-step model, 559–562
Corey, G., 157, 158, 162, 164, 167, 170, 172, 173, 174, 176, trends, 564–566
177, 181, 185, 186, 188, 189, 190, 202, 248, 251, 257, 259, triage assessment, 562–564
271, 272, 387, 396, 664, 669, 676, 673 Cristofalo, V. J., 130
Corey, M. S., 282, 290 Criterion-referenced test: Test that is used to determine if
Cormier, S., 197, 201 an individual demonstrates a predetermined stan-
Cornell, S., 62 dard of performance. 432
Correlational study: Designs that use continuous inde- Criterion-related validity: A high association or correla-
pendent variables. 508 tion between the test score and some other measure
Correlations: Used to indicate the strength of the relation of interest. 452
between two variables and to determine the extent to Critical friend: A trusted person who asks provocative
which the behavior of one variable can predict that of questions, provides data to be examined through an-
another variable. 444 other lens, and offers critiques of a person’s work as a
Corsiglia, V., 396 friend. A critical friend takes the time to fully under-
Corsini, R. J., 251 stand the context of the work presented and the out-
Costa, P. T., Jr., 473, 474, 475 comes that the person or group is working toward.
792 INDEX

The friend is an advocate for the success of that work. relativism, 55–56
98 universality, 55
Critical period: Brief stage of development during which Cummings, N. A., 733
a developing child is predisposed to learn a specific
ability or function because of heightened susceptibil-
ity to particular environmental stimuli. 113
Crnic, K., 589 D
Cronbach’s alpha: A method of establishing internal con- Dahir, C. A., 364, 365, 366, 372, 373, 374
sistency for test items that are not scored dichoto- Dahlstrom, W. G., 409, 473
mously, such as questionnaires. 448 Dandeneau, C. J., 83
Cross, W. E., 67 Danger: Distress may be so severe that a person becomes
Cross-cultural career counseling: The study of how racial a danger to himself or herself (suicide) or to others
and ethnic minority groups adjust to White majority (homicide). 406
work environments. 342 Daniels, J., 55
Crouch, E. C., 280 Daniels, T., 80
Crystallized intelligence: Acquired skills and knowledge Dasen, P. J., 58
such as verbal abilities and general information that Dattilio, F. M., 379
increase over time. 464 Davidson, L., 614
Cultural constructs, 60–63 Davis, J. H., 522
biases, 64 Davis, T., 15, 49, 50
discrimination, 64–66 Davison, R., 97
privilege, 66–67 Dawis, R. V., 331, 484
Cultural context: The totality of the context in which peo- Day, J., 391
ple live, “including ethnographic, demographic, sta- Day, S. X., 343
tus and affiliation variables.” 222 de Perez, K. A. M., 518
Cultural encapsulation: Counselors’ reliance on a narrow deCharms, R., 596
model of helping that fails to account for cultural val- Deci, E. L., 593, 594, 595, 596, 600, 601, 605
ues, beliefs, and variables and interprets health and Deferred imitation: An infant’s ability to imitate an
wellness the same across cultures. 57 adult’s sounds or behaviors after a delay of several
Cultural heterosexism: The stigmatization, repudiation, hours or days. 116
subjugation, or defamation of sexual minorities Deiter, P. J., 564
within societal institutions. 65 DeJong, P., 395
Cultural identity: Involves taking account of cultural dif- DeLucia-Waack, J. L., 276, 282, 299, 300
ferences that may overlay other components and in- Delworth, U., 76, 77, 94
fluence individual career development and voca- Deming, W. E., 530
tional behavior. These differences typically surface in Dendrites: Branches that extend from the cell body and
attitudes and discriminatory practices in the current receive signals from other neurons. 609
job market and world of work. 354 Denzin, N. K., 514
Cultural identity development, 67–69 Dependent variable: Variable that is considered the con-
R/CID model, 68 sequence of the independent variable to the extent
Cultural values: The worth, importance, or usefulness of that it is predicted by the independent variable. 491
something to a person that is aligned with the per- Descriptive statistics: Statistical inquiry that uses obser-
son’s cultural background. Cultural values contain a vations to describe or make summary statements
historical component in that they are passed from one about data. 436
generation to another and are highly esteemed by the DeShazer, S., 394
individual as well as the community from which the DeStafano, L., 733
individual comes. 309 DeTrude, J. C., 6
Culture: A combination of learned behaviors, thoughts, Deurzen-Smith, E., van, 271
and beliefs as well as the results of learned behaviors, Developmental Counseling and Therapy: an integrative
thoughts, and beliefs whose components and ele- theory that was developed within a counseling,
ments are shared and transmitted by the members of wellness, developmental, and co-constructive frame-
a particular society. 55 work and that brings all types of developmental the-
Culture-sensitive counseling, 54–55 ory into the counseling interview. 624
convergence, 55–56 consciousness models, 628–632
encapsulation, 57–58 historical context, 625–626
 INDEX 793

philosophy, 626–628 Discrimination: Unfair and unequal treatment that sys-

systemic cognitive therapy, 634–641 tematically prevents certain groups from being af-
wellness, 632–634 forded opportunities that are provided to other
Developmental crisis: Occurs when events in the normal groups. 79, 64
flow of human growth are disrupted by a dramatic Dishabituation: An infant’s restored interest in a known
shift that precipitates a change in the way people stimulus. 117
function. 552 Disney, M. J., 95
Developmental psychopathology: A combination of eco- Disorder: Abnormal psychological symptoms that tend to
logical and transactional theories that studies the con- occur together, present to a marked degree, and last
tributions of the person and the environment to both for a significant amount of time. 634
adaptive and maladaptive developmental outcomes. Displaced homemakers: Persons who find themselves
591 leaving their responsibilities of taking care of the
Deviance: Thoughts, emotions, or behaviors that are dif- home and perhaps children to find paid work. 334
ferent for what is expected of that time and place. 406 Dissonance: Occurs when there is inconsistency between
Diagnosing: The process of matching an individual’s ob- two thoughts. 214–215
served and reported abnormal psychological symp- Dissymmetry: In Newcomb’s model of attraction, the
toms to a cluster of symptoms known as a syndrome state that exists when either A or B have contradic-
or a disorder. 408 tory attitudes toward X; when dissymmetry exists, A
Diagnosis: Statement made when psychological symp- and B change intensity of their attitudes toward X or
toms are consistent with a known mental health dis- their attraction toward one another until symmetry is
order or syndrome. 408 reestablished. 216
Diamond, G. M., 94 Distress: Deviant thoughts, emotions, or behaviors that
Dickerson, V. C., 384 cause disruption and upset to the person experienc-
Dickson, W., 565 ing them, and, at times, to others in contact with the
DiClemente, C. C., 580 individual experiencing distressing symptoms. 406
Dies, R. R., 293 Diversity, see Multicultural realities
Dietz, J., 62 Doan, R., 94
Differentiation: In Bowenian family therapy, the process Donigian, J., 299, 300
of becoming an individual self who is not defined by Dougherty, M. A., 531, 536, 538, 539, 540, 542, 547
family roles or expectations; the outcome of this pro- Draguns, J. G., 221
cess is emotional and intellectual clarity and low lev- Draper, R., 401
els of anxiety. In Holland’s career theory, the differ- Drawing out: In group counseling, a technique the leader
ence between the highest and lowest interest. 381 uses to invite group members who find it difficult to
Diffusion: A threat to internal validity that occurs when share or who only share at a superficial level to par-
the treatment or control group becomes aware of the ticipate at a level of involvement of the member’s
experimental treatment and because of the awareness own choosing. 294
does not respond as they normally would on the de- Dreikurs, R., 249
pendent variable. 496 Drummond, R., 410
Dinkmeyer, D. C., 531, 545, 546 Dryden, W., 261, 380
Direct observation: Systematic observation of a person in Dual diagnosis: Individuals who have some form of ad-
a naturalistic setting in which the observer simulta- diction, typically a chemical addiction, and an addi-
neously considers the person’s behavior and its envi- tional Axis I diagnosis. 581
ronmental context. 476 Dual relationships: Any significantly different relation-
Directional hypothesis: Specific statement about which ship a counselor has with a client outside of his or her
group will exhibit more or less of a treatment effect. counselor-client relationship. 29, 45–46
487 clients’ emotional health, 46
Director: The psychodramatic group leader who encour- Duffy, M., 37, 45
ages intense emotional participation by a protagonist, Duhl, B., 392
helps delineate what occurs after the psychodramatic Duncan, B., 396, 398
enactment, and helps the protagonist gain insight and Dunn, H. L., 644
emotional resolution through group feedback. 255 Dunning, C., 565
Disability, see Ableism Duties, 49–50
Discontinuous development: Development occurs in dis- Duty to warn: Refers to the responsibility of a counselor
tinct stages throughout the life span. 138 or therapist to breach confidentiality if a client or
794 INDEX

other identifiable person is in clear or imminent dan- Empathy: Ability of the counselor both to enter the world
ger. 49 of the client without being influenced by his or her
Dye, H. A., 87 own personal values or beliefs and to communicate
Dysfunction: Distress is so significant that it causes im- understanding genuinely and effectively. 186
pairment in important daily activities (e.g., work or Empirical dictates: Interventions clinically proven to alter
school) or relationships. 406 problematic behavior or thoughts that are used dur-
ing therapy. 378
Employee assistance programs (EAPs): Worksite-based
programs designed to assist in the identification and
E
resolution of productivity problems associated with
Echterling, L. G., 558, 565 employees impaired by personal concerns including,
Eclecticism: Borrowing from a variety of approaches de- but not limited to health, marital, family, financial, al-
pending on the presenting problem; the client’s most cohol, drug, legal, emotional, stress, or other personal
important needs at a moment and time; how much concerns that may adversely affect employee job per-
time is available to initiate change; what objectives formance. 732
and goals have been agreed on; the preferences, Empty chair technique: In Gestalt therapy, a technique
styles, and mood of the helper; and the philosophy of
designed to help members work through unfinished
the organization. 196
business. A member sits directly across from and
Eco, U., 519
speaks to an empty chair that he or she envisions
Ecological-transactional counseling, 587–593, see also
holding the person with whom he or she is in conflict.
Self-determination theory
Bowlby, 589 268
Bronfenbrenner, 589–590 England, G., 484, 551
Vygotsky, 588–589 Engler, B., 667, 668, 669
Educational assessment: Methods for obtaining informa- Enns, C. Z., 387, 388
tion relating to a student’s overall academic progress Epicurus, 22
and informal and formal learning. 468 Epstein, N. B., 379
Edwards, A., 344 Eriksen, K. P., 91
Effective counselors, 7–8 Erikson, E., 132, 142, 143, 665
Efferent neurons: Motor neurons that carry signals away Etaugh, C., 388, 389
from the central nervous system. 608 Ethical codes: The written form of ethical conduct that is
Egan, G., 99, 204, 207, 208 intended to improve professionals’ ability to success-
Eghrari, H., 601 fully and competently respond to clients’ needs.
Ego state: In transactional analysis, a system of feelings 34–35
accompanied by a related set of behavior patterns. Ethical theory, 22
165 Epicureanism, 22–23
Ego syntonic: Psychological symptoms that cause individ- Kantianism, 23
uals little distress. 428 Situationalism, 23–24
Ego: Component of personality that relies on the reality Utilitarianism, 23
principle to weigh the desires of the id against the de- Ethics: The standards governing the conduct of members
mands of the superego and the external world. 140 of the counseling profession. 14–15, 19, 21
Egocentrism: A self-centered view of the world in which ACA, 20–21
everything is perceived in relation to oneself. 120 and cultural diversity, 20
Ehlers, A., 564 codes, 19–20
Eichhorn, K., 520 concerns, 28–31
Eisenberg, N., 126 Ethics and decision making, 24, 26–27
Eisler, R., 551 autonomy, 25
Elbert, S., 398 beneficence, 24–25
Eliason, G., 658, 661, 662, 663, 664, 674 fidelity, 25
Elkind, D., 128 justice, 25–26
Ellis, A., 78, 176, 177, 261, 262, 378, 627, 673, 674 nonmaleficence, 24
Ellis, C., 521 Ethnocentrism: The tendency to use one’s own cultural
Emic perspective: Suggests that cultural values, standards as the standards by which to evaluate other
worldviews, and contexts all affect definitions of nor- groups and to rank these standards higher than all
mal and deviant behavior. 56 others. 58
 INDEX 795

Ethnography: A specialized form of field work that grew Falendar, C., 90

out of cultural anthropology and that should be con- Falicov, C. J., 55
ducted with as few presuppositions and as few pre- Fall, K. A., 182, 183
determined goals as possible. 520 Falvey, J. E., 95, 96
Etic perspective: Suggests that many aspects of human Family constellation: Variables such as personality, devel-
behavior are universal and counselors, therefore, can opmental issues, family attitudes and values, and
apply therapeutic techniques similarly across cultures structural factors that influence a child’s interaction
and contexts. 56 with and perception of the family compilation, and
Eurocentric perspectives, 53 the ways in which a child views himself or herself
Evaluation: The objective appraisal of the supervisee’s outside of the family. 162
performance based on clearly defined criteria that are Family Education Rights and Privacy Act (FERPA): Fed-
realistic and attainable. 106 eral legislation that governs education records and
Everett, C. A., 400, 401 dictates how all written information on a student will
Existential crisis: Occurs when individuals become aware be handled and disseminated for the protection of the
that an important intrapersonal aspect of their lives student and his or her family. 42–43
may never be fulfilled, which, in turn, has an impact Family map: A visual representation of three generations
on self-purpose and self-worth. 552 of the “star” or identified client’s family that records
Existential-humanistic approaches, 184, 270–272 adjectives to describe each person’s personality or re-
gestalt, 187–189 lationship to the larger family as well as general de-
logotherapy, 190–192 mographic information. 393
person-centered, 185–187 Family therapy
Exner, J. E., Jr., 472 behavioral, 378–380
Explore: Stage in the FERA inquiry learning model that Bowenian, 380–382
involves encouraging the counselor to frame ques- constructivist, 383–384
tions, develop hypotheses, and predict consequences experiential, 385–386
of action that might be taken; issues and processes feminist, 387–389
that are emerging in the counseling or supervisory re- psychodynamic, 389–391
lationships are also investigated. 100 Satir growth model, 391–394
External motivation: Initiatives that are characterized by a solution-focused, 394–396
sense of pressure, coercion, and control. 597 strategic, 396–398
External validity: Generalizability of the results or the ex- structural, 398–400
tent to which results are replicable and can be gener- systemic, 400–402
alized to other groups and contexts beyond the exper- Family time inventory: Family members track their activ-
imental setting. 496 ities throughout the day to facilitate the scheduling of
Externalization: A technique in constructivist family ther- family time for at least 1 hour per day. 393
apy in which problems are conceptualized as separate Fast mapping: The ability to build vocabularies very
from the family to free members from the belief that quickly by learning to connect new words with
they are problematic. 384 their underlying concepts after only brief encounter.
Extinction: Withholding reinforcement from a formerly 121
reinforced behavior. 145 Faust, N., 531
Feedback: A group member or leader’s shared observa-
tions and reactions to another member’s expressed
feelings, thoughts, or behaviors. 292
F Feller, R., 334, 336
Fabes, R. A., 126 Fetterman, D., 514
Face validity: An informal assessment made by the per- Fick, A. C., 589
son taking the test that the instrument measures what Fidelity: The ethical precept stipulating that counselors
it appears to measure. 450 act faithfully and honestly with their clients. 25
Facilitator: A leader who participates genuinely in the Finch, M. A., 213
group process as a member of the group without us- Fine motor skills: Physical abilities that require the use of
ing gimmicks or planned procedures. 266 small muscles. 115
Factor analysis: Statistical test used to analyze the effects Fisch, R., 401
of more than one independent variable as well as the Fischer, L., 42
interaction effects of the independent variables on a Fishman, H. C., 400
dependent variable. 451 Fitzgerald, L. F., 342
796 INDEX

Fixation: In psychoanalytic theory, the inability to move to Frontal lobe: The front-most and largest area of the cortex
a higher level of development because of excessive that contains the motor cortex and sensory cortex. 610
gratification. 140 Fry, R. K., 621
Fixed battery: An instrument consisting of a number of Frye, N., 667
standardized subtests administered in a determined Fuhriman, A. J., 275, 280
fashion. 478 Fuqua, D., 532, 545
Fleming, A., 299, 300 Furman, W., 130
Flexible battery: An instrument that consists of specific
tests tailored to the examinee’s apparent presenting
problem. 485
Flores, L. Y., 343 G
Fluid intelligence: Abilities such as reasoning and con- Gage, L., 645
cept formation that are related to mental operations Gagne, M., 600
and processes that decline over time. 464 Gale, A. U., 6, 8
Focus: Stage in the FERA inquiry learning model that in- Games: In transactional analysis, an ongoing series of
volves engaging the counselor and determining what complementary ulterior transactions progressing to a
is known and what is not known about both content well-defined, predictable outcome. 253
and process. The supervisor must listen for and deter- Garmezy, N., 588, 592
mine what is explicit and what is implied in the coun- Gatekeeper: Under some health insurance arrangements a
seling or supervision relationship. 105 primary care provider serves as the patient’s agent,
Focusing: Paying attention to a problem as a whole within arranges for and coordinates appropriate medical ser-
one’s body, as these bodily shifts and responses to vices, laboratory studies, hospitalizations, and other
problems or solutions often go unrecognized. 211 necessary and appropriate referrals. 738
Folstein, M. F., 478 Gatson, S. N., 520
Folstein, S. E., 478 Gay, L. R., 496
Fong, 87 Gazda, G. M., 275
Foos, J. A., 731 Geertz, C., 519
Forced choice response: On an assessment instrument, Gelman, R., 125
the responder is forced to choose from the options Gelso, C., 536
given, such as never, sometimes, and always. 477 Gender role stereotypes: Socially determined models that
Forebrain: Comprised of the limbic system, the thalamus, contain the cultural beliefs about what the gender
the hypothalamus, and the basal ganglia, the roles should be. 61
forebrain lies below the cortex and contains commu- Gender roles: Behaviors, attitudes, values, emotions, be-
nication, motor control, memory, and emotional pro- liefs, and attire that a particular cultural group con-
cessing centers of the brain. 610 siders appropriate for males and females on the basis
Forester-Miller, H., 15 of their biological sex. 61
Formal norms: Group norms that are communicated and Gender: A system of sexual classification based on the so-
agreed on. 290 cial construction of the categories “men and boys”
Forming: In group therapy, the initial stage during which and “women and girls” and usually refers to a per-
members are getting to know each other, the group son’s masculinity or femininity. 61
leader, and the group boundaries. 289 General intelligence (g): A construct used in the field of
Forsyth, D. R., 214, 216, 276 psychology that measures what is common to the
Fouad, N. A., 341, 342, 343, 354 scores of all cognitive intelligence tests. 464
Foulkes, S. H., 248 Genetic determination theory, 151
Framo, J. L., 133, 385, 386, 389, 390, 391 Genotype: The underlying genetic makeup of an organ-
Francis, M. K., 130 ism. 113
Frank, E., 397, 690 Genuineness: The congruence or “realness” of an individ-
Frankl, V. E., 190, 668 ual counselor or group leader that increases the likeli-
Franklin, K. K., 230, 522 hood of growth and change in clients. 185
Frederickson, J., 391 Gerler, E. R., 47
Freedman, Z. R., 600 Gerrity, D. A., 276, 282
Freeman, M., 392, 394 Gershenfeld, M. K., 281
Freire, P., 66 Gestalt: A complete pattern or configuration. 267–270
Fretz, B., 536 Geuss, R., 519
Freud, S., 247, 665, 666 Gevarter, W. B., 609, 612, 614, 616, 622
 INDEX 797

Giacino, J. T., 616 Group norms: Informal and formal beliefs about group
Gibson, R. L., 47 behavior such as language, attendance, confidential-
Gill, S., 94, 100 ity, degree of self-disclosure, punctuality, content
Ginter, E. J., 275, 732 shared, and processes expected to occur. 290
Ginzberg, E., 319 Group process: Nature of the relationship between inter-
Giordano, J., 226 acting individuals. 279
Gladding, S. T., 19, 156, 157, 158, 166, 252, 254, 255, 382, Group work: A broad professional practice involving the
386, 389, 391, 393, 394, 399, 400, 401 application of knowledge and skill in group facilita-
Glaser approach, 523 tion to assist people in reaching mutual goals, which
Glaser, B. G., 513, 523 may be intrapersonal, interpersonal, or work related.
Glasser, W., 179, 180, 181, 263, 673 247–272
Gleitman, L. R., 121 fundamentals, 276–278
Glisky, E. L., 619, 620, 621 history, 275–276
Glisky, M. L., 619, 620, 621 multicultural, 300
Go around: A procedure during which group members pregroup planning, 287–296
are asked to either spontaneously or sequentially dis- Grow, V. M., 600
cuss what they learned, what they wish they had ac- Guba, E. G., 514
complished but did not, and how they will take their Guerney, B., 208, 398
new knowledge and use it in the future. 296 Guth, L. J., 83
Goals 2000, 363, 364 Guthrie, I. K., 126
Goenjian, A., 558 Gysbers, N. C., 316, 325, 367
Goh, M., 285, 286
Goldberg, A., 129
Goldner, V., 387, 389
Goldstein, A. P., 205
H
Goodman, P., 188, 267 Habituation: An infant’s waning interest in a stimulus
Goodyear, R. K., 78, 79, 83, 87, 88, 93, 95, 100, 106 that is repeatedly presented. 117
Gordon, R., 440 Hackett, G., 324, 343, 347, 348
Gordon, T., 265 Hackney, H. L., 78, 197, 201
Gottesman, I. I., 113 Haddad, N. K., 601
Gottfredson, L. S., 322, 323 Hadden, S. B., 275
Graham, J. R., 409, 473, 474 Hafdahl, A. R., 130
Graun, K., 531 Haley, J., 396, 397
Gray-Little, B., 130 Haley, T., 384
Green, M., 149, 150 Halgin, R. P., 82
Greenberg, K. R., 47 Hall, C. S., 160
Grieger, T. A., 551 Hall, D. L., 540, 542, 543
Grinder, J., 393 Hammer, A. I., 481
Grolnick, W. S., 600, 601 Hankin, S., 262
Gross motor skills: Physical abilities that require the use Hanley, C., 658
of large muscles. 120 Hann, D. M., 589
Gross, D. R., 300 Hanna, F. J., 6, 8, 542
Groth-Marnat, G., 408 Hansen, J. C., 259, 330, 481, 531
Group cohesiveness: The attractiveness of a group to Hardin, E. E., 345, 353, 356
the members that can be developed between indi- Hardy, E., 94
vidual group members, between the member and Hare, I., 50
the group, and between the members and the Hare, P., 288
group leader. 280 Hare-Mustin, R. T., 384, 388, 400
Group content: The words that are spoken between indi- Harlow, H. F., 595
viduals in a group. 279 Harmon, L. W., 481
Group dynamics: The way in which the members interact Harper, F. D., 225, 226, 228, 230, 231, 234
with each other and mutually influence one another’s Harrington, T., 330
perceptions and behavior. 278–281 Harris-Bowlsbey, J., 316
Group leadership, 281–284 Harrison, T. C., 540, 546
cultural considerations, 284–287 Hart, G., 87, 88
798 INDEX

Harter, S., 129 Herma, J., 315

Hartmann, D., 62 Herr, E. L., 361
Hartung, P. J., 341, 351, 354, 356 Hess, A. K., 109
Haskell, M. R., 256 Hill, C. E., 99
Haskins-Herkenham, D., 50 Hill, G. W., 98
Hatch, T., 364 Hill, L. K., 731
Hathaway, S. R., 443, 473 Hill, M. R., 524
Hattie, J. A., 647 Himes, B. S., 531
Haughey, J., 290 Hindbrain: Found at the base of the brain between the
Hawkins, P., 94 cortex and the spinal cord, the hindbrain is the path-
Hawthorne effect: Participants behave differently simply way between the brain and the rest of the body. 610,
because they know they are being studied. 497 612
Haynes, R., 82, 89 Hippocampus: Part of the limbic system that is responsi-
Health and wellness, 15, 17, 57, 579, 643, 644 ble for memory function, through involvement in the
burnout, 16–17 creation of new memories and recall of old memories.
countertransference, 15, 30–31 611
networking, 17 Hirsch, S. I., 391
specialties, 4–5 History: Threat to internal validity that refers to any event
Health Insurance Portability and Accountability Act that is not part of the experimental treatment but oc-
(HIPAA): Federal legislation that emerged to address curs during the study and influences responses on the
the substandard level of care in place with regard to dependent variable. 495
sharing and releasing of client health and mental HMO group practice: An HMO that contracts with a sin-
health information. 44 gle multispecialty medical group partnership to pro-
Health maintenance organization (HMO): A type of vide services to its members on a preagreed per-ca-
health care plan usually associated with specific geo- pita rate, which the group distributes among its
graphical areas where members pay a flat monthly physicians. 739
rate in return for health care services delivered by a HMO staff: A type of closed-panel HMO in which
group of mental health and medical professionals. medical professionals are employed by the HMO
738 to provide care to members in the HMO’s own fa-
Heath, S. B., 521, 522 cilities. 739
Hefferline, R. F., 188, 267 Hobbs, N., 265
Heider, F., 214 Hodder, I., 524
Heider’s balance theory, 215–216 Hoff, L. A., 561
Heiman, M., 133 Holder, J. M., 182, 183
Held, B. S., 384 Holland, J. L., 318, 319
Helms, J. E., 62, 68, 344, 350 Hollander, M., 258, 259
Helping: A broad term that encompasses all the activities Holloway, E. L., 75, 94, 99
counselors use to assist others whether they have a Holophrastic: The expression of a complete thought as a
professional relationship or not. 195 single word. 117
diversity, 203 Homan, M. S., 530
effective helping, 199–202 Homophobia: The expression of irrational fears about
skills, 202–207 people who exhibit signs of accepting or using behav-
social–psychological approaches, 211–217 iors related to same-sex forms of sexual desire and
theories, 195–198 orientation. 65
training, 207–211 Horne, A. M., 256, 275
Henderson, D., 47 Howard-Hamilton, M. F., 55
Henderson, P., 367 Howatt, W. A., 577
Hendricks, C. B., 94 Howieson, D. B., 610
Hendricks, C. G., 561 Hoyt, M. F., 383, 384
Hendricks, J. E., 561 Huck, S. M., 213
Henly, G. A., 331 Hughes, T., 565
Henry, W. E., 133 Human development: The phenomenon of continuity and
Heppner, M. J., 487 change in the biopsychological characteristics of hu-
Heppner, P. P., 316, 487 man beings both as individuals and as groups. The
Herlihy, B., 21, 49, 664 phenomenon extends over the life course across suc-
 INDEX 799

cessive generations and through historical time, both Independent practice associations (IPAs): Groups of in-
past and present. 137–140 dependent medical practitioners who band together
Human growth and development for the purpose of contracting their services to HMOs,
adolescence, 125–128 preferred provider organizations (PPOs), and insur-
adulthood, 128–131 ance companies to provide services to both HMO and
approaches, 139–142 non-HMO plan participants on an agreed, prepaid
behavioral theories, 143–145 capitated rate. 739
cognitive theories, 146–150 Independent variable: Variable that is hypothesized to be
continuity and discontinuity, 138–139 responsible for the effect and also is called the treat-
death and bereavement, 131–133 ment or experimental variable. 491
developmental domains, 139 Individual values: The worth, importance, or usefulness
early childhood, 117–121 of something to an individual. 309
ethological theories, 150–151 Individuals with Disabilities Education Act, 760
humanistic theories, 152 Individuation: The movement of the personality toward
infancy, 112–117 its fullest creative potential. 160
learning theories, 146 Inferential statistics: Statistical inquiry that uses observa-
maturational theories, 151 tions of a sample population to make predictions and
middle childhood, 121–125 generalizations about the wider population. 436
nature vs. nurture, 137–138 Informal norms: Group norms that influence individuals
prenatal development, 111–112
without the individuals necessarily being able to
psychodynamic theories, 139–142
communicate the existence of the norms. 290
Hypothalamus: Part of the forebrain located beneath the
Informed consent: Disclosure to clients of what to expect
thalamus that is important for control of autonomic
from the counseling process. In research investiga-
nervous system responses and acts as the link be-
tions, participants must be made fully aware of the
tween the neural and endocrine systems. 611
scope of expectations surrounding their participation
in and the procedures of the study, and then freely
give their consent to participate. 28, 36–37
Ingersoll, R. E., 732, 733
I Inhelder, B., 128
Ibrahim, F. A., 53, 69 Instillation of hope: Members have a sense of hope that
Id: Structure of personality that is present at birth and they can receive help and learn how to better deal
may be considered the primitive, unconscious seg- with their problems. 289
ment of personality that motivates individuals to seek Instrumentation: Data collection devices must be reliable
immediate gratification of inherent desires (sexual, and must be consistent across measuring occasions to
physical, emotional) without regard for potential con- avoid internal threats to validity. 495
sequences. 140 Intention: Choosing the best potential response from
Identity, 4, 33 among the many possible options. 80
and social work, 5 Interest inventories: Inventories that identify an individ-
legal issues, 34 ual’s self-reported interests according to categories or
Idol, L., 38 scales, career fields, and specific job titles. 329
Ilardi, S. S., 613 Internal motivation: Refers to initiatives that are charac-
Imaginary audience: A form of egocentrism that describes terized by a sense of autonomy and choice. 597
adolescents’ impressions that they are the center of Internal validity: The results of the experiment are attrib-
everyone’s attention and judgment. 128 utable to the manipulated independent variable and
Imber, M., 42, 47 cannot be explained by other factors. 495
Imitation of treatments: see Diffusion. Internalization: An aspect of socialization in which exter-
Immanuel Kant, 23 nal values, norms, and regulations are taken in by the
Imprinting: A learning process driven by innate propensi- active, organismic self, and are experienced by that
ties to establish social bonds in the form of permanent self as either endorsed and congruent or as alien and
attachments with the first living, moving organisms a incongruent. 597
young animal or human notices and shadows. 150 Interpersonal process recall (IPR), 82–83
Indemnity health insurance: Through this type of plan, Intersex: A person who was born with genitalia or sec-
the patient or the provider receives reimbursement ondary sexual characteristics of indeterminate sex, or
for services as expenses are incurred. 739 with features combined from both sexes. A more ar-
800 INDEX

chaic and less preferred term for people who are Juntunen, C. L., 224
intersex is hermaphrodite. 61 Justice: The ethical precept that specifies counselors act
Intersubjectivity: The process through which two indi- fairly toward all potential, current, and past clients.
viduals with differing views modify such views to 25
come to a mutual understanding. 150
Interval scales: A form of measurement that also is rank
ordered on a scale that contains equal intervals be-
tween numbers on the scale. However, there is no ab- K
solute zero point indicating that no mathematical cal- Kaemmer, B., 409, 473
culations can be done with the data set. 437 Kaftarian, S., 514
Irrelevant: In conjoint family therapy, a communication Kagan, N., 82, 83, 210
style in which distracting the self and others by re- Kahn, W. J., 539
sponding in a way that is not related to the context of Kallick, B., 98
the situation or to what is being felt, or to what has Kalodner, C. R., 276, 378, 379, 380
been previously said. 392 Kane, R. A., 213
Isaacson, L. E., 317, 318, 323 Karren, R. J., 292
Isabella, R. A., 589 Kasser, V. M., 601
Ivey, A. E., 6, 625, 627 Kaul, T. J., 288, 290
Ivey, D., 346 Keala, D. K., 382
Ivey, M. B., 6, 8, 625, 637 Keith, D., 385, 386
Kell, B. L., 25, 30
Kelley, H. H., 217
Kelly, E. W., Jr., 662
J Kelly, K. R., 732
Jackson, B., 67, 531 Kemp, S., 480
Jackson, D. N., 68, 330 Kenyon, B. L., 134
Jackson, J. S., 62 Kerr, M. E., 381
Jackson, M. L., 285, 287 Kerwin, C., 68
Jacobs, E. E., 284 Keyes, C. L., 645
Jacobs, J. L., 666 King, C. A., 551
James, R. K., 556, 557, 558, 559, 560, 562, 563, 565 King, L., 646
James, W., 662 Kinicki, A. J., 484
Jaschik, S., 237 Kirk, U., 480
Jennings, L., 6, 202 Kisch, J., 733
Jensen, M. A., 289 Kiselica, M. S., 29
Job satisfaction: The pleasure that relates to one’s occupa- Kitchener, K. S., 24, 26
tional experience. 483 Kivlighan, D. M., Jr., 280, 281, 289
Jobes, D. A., 551 Kjos, D., 195
John Henry effect: see Compensatory rivalry. Kleckner, T., 397
Johnson, J. E., 280, 732 Kleespies, P. M., 551, 559
Johnson, M. J., 342, 349, 357 Kline, W. B., 284
Johnson, R. L., 140, 142 Klos, D., 344
Johnson, S. M., 484, 662 Knapp, L., 330
Johnson, S. W., 94 Knapp, R. R., 330
Johnston, J. A., 316 Knight, G. P., 68
John Stuart Mill, 23 Knudson-Martin, C., 380, 382
Joiner, T. E., Jr., 551 Kolski, T. D., 551
Joining: In structural family therapy, the process through Konrad Lorenz, 150
which the therapist enters the family system to diag- Koper, R. J., 213
nose the source of dysfunction, understand the way Korkman, M., 480
the family perceives reality, and form therapeutic Kottler, J. A., 195, 196
goals. 398 Kratochwill, T. R., 531, 541
Jones, E., 231, 402 Kreidler, M. C., 551
Joseph Fletcher, 23 Krumboltz, J. D., 323, 325, 379
Jung, C. G., 31, 159, 667 Krushinski, M. F., 33
 INDEX 801

Kuder, F., 330, 681 Leong, F. T. L., 341, 342, 343, 345, 347, 348, 349, 350, 351,
Kuhl, J., 595 356, 357
Kuhn, D., 128 Leung, S. A., 346, 347
Kurpius, D. J., 529, 530, 531, 532, 535, 543, 545 Leventis, M., 658
Kurtosis: The extent to which a frequency distribution of Levers, L. L., 7
scores is bunched around the center or spread toward Levine, B., 622, 623
the endpoints. 440 Levinson, D. J., 132, 698
Kvale, S., 518 Lewin, K., 275, 281, 282
Lewis, J., 55
Lewis, M., 55
Lezak, M. D., 610, 611, 612, 613
L Liability: The legal responsibility one person has to an-
La Guardia, J. G., 605 other as a result of committing a negligent act. 34
Laatsch, L., 619 Libow, J., 387, 388
Ladany, N., 88, 96, 99 Licensure, 9–10
Lafreniere, P. J., 150 Liddle, H. A., 94
Lallas, J. E., 362 Lieberman, M. A., 247, 282, 290
Lambers, E., 94 Liese, B. S., 94
Lancy, D. F., 513 Life fact chronology: A detailed history of the family, in-
Landauer, T. K., 621 cluding the history of the parents’ romantic relation-
Lane, G., 402 ship, their respective family histories, any previous
Lang, F. R., 133 unions and divorces or deaths, a history of extended
Larson, D. D., 203, 204, 205, 206, 207, 209, 210, 211, 643 family members living with the family, or others who
Lasky, G. B., 284 contribute financially or in other ways and figure
Latent content: In psychoanalytic theory, the unconscious prominently. 393
meaning hidden behind the manifest meaning. 158 Life scripts: Plans for life developed in early childhood
Latham, G. P., 292 that are reinforced by parents. 253
Latner, J., 188 Lilienfeld, S. O., 559
Law of effect: Behavior has a higher propensity to be re- Lincoln, Y. S., 514
peated if the consequence of that behavior is posi- Lindemann, E., 551
tively reinforcing. 144 Lindle, S., 530
Law of exercise: A behavior will occur more frequently if Lindzey, G., 160
connections between the behavior and reinforcer or Linking: An intervention used by group leaders to con-
consequence are routinely practiced; conversely, fail- nect the concerns or behaviors of one member with
ure to support connections between the behavior and those of one or more other members. 294
reinforcer through practice will result in weaker asso- Lippitt, R., 281
ciations and a decreased likelihood of reoccurrence. Listening: Receiving what someone wishes to convey and
144 saying it back to the person exactly as it was meant.
Law of reciprocity: Suggests that resource outputs must 211
be balanced by inputs. 213 Litchy, M., 279
Law: The rule of conduct established by society and en- Littrell, J. M., 94
forced by that society’s government. 36 Liverpool, P., 254
Lawe, C. F., 256 Locke, D. C., 627
Lawless, L. L., 732, 733 Locke, E. A., 292
Lawrence-Lightfoot, S., 522 Loftquist, L. H., 331
Lazarus, A. A., 183, 672 Loganbill, C., 94
Lazarus, B. N., 126 Lohr, J. M., 559
Lazarus, R. S., 126 Long, J. K., 94
Leary, M. R., 595 Longitudinal study: Research design in which data are
Lebovici, S., 589 collected more than once over a period of time. 508
LeCompte, M., 520 Lonner, W. J., 221
Leddick, G. R., 82 Lorenz, J. A., 94, 150
Lee-Borden, N., 94 Loring, D. W., 610
Lent, R. W., 343, 347, 348, 349 Lovell, K., 378, 380
Leone, D. R., 601 Lowry, C., 522
802 INDEX

Luckmann, T., 513 Mazur, C. S., 664

Lunneborg, P. W., 343, 344 Mazur, J. E., 146
Luria, A. R., 616 McAuliffe, G. J., 91
Luthar, S. S., 593 McCarroll, J. E., 551
Lynch, J. H., 596 McCaulley, M. H., 481, 482
Lynch, M. F., 588, 591, 592, 595 McCrae, R. R., 473, 474, 475
McDavis, R. J., 54
McDermott, J. F., 382
McFadden, J., 225, 226, 228, 230, 231
M McFarlane, A. C., 558, 559, 564
MacCluskie, K. C., 732, 733 McGinn, L., 389
Maccoby, E. E., 123 McGoldrick, M., 133, 226, 231, 232, 233, 234, 236
Macdonald, G., 197, 199, 201 McGrew, 467
MacKenzie, K. R., 280 McHugh, P. R., 478
Madanes, C., 396, 397 McIntosh, P., 67, 223
Maddox, G. L., 133 McKee, J. E., 484, 558
Maestas, M. V., 59 McKinley, J. C., 443, 473
Main, M., 119 McNally, R. J., 564
Malpractice, 41 McNeill, B. W., 76
Management services organization: An organization McWhinney, M., 50
whose task is to provide business-related services, McWilliams, N., 412
such as marketing and data collection to individual Mean: A measure of central tendency that is represented
groups of providers. 739 by the arithmetic average of a set of test scores from
Manaster, G. G., 251 normally distributed interval or ratio data. 437
Mandatory ethics: The level of functioning counselors Measurement, see Psychometrics
must exhibit to fulfill the minimum ethical obliga- Median: The measure of central tendency that represents
tions. 21 the midway point in the distribution of data arranged
Manifest content: In psychoanalytic therapy, refers to the in either ascending or descending order. 437
obvious narrative of the dream. 158 Medical staff organization: A group of physicians who
Manipulation check: Process of examining the impact of have teamed together to contract with others for pro-
the treatment to determine whether the outcome was vision of services. 739
expected or whether the outcome had unintended ef- Medulla oblongata: Part of the hindbrain located at the
fects. 494 base of the brain near the spinal cord, which is the
Manly, T., 620 control center for essential bodily functions such as
Marcia, J. E., 129 breathing, blood pressure, heart rate, the gag reflex,
Marcus, D. K., 278, 520 and swallowing. 612
Marek, L. I., 94 Meier, P. D., 666, 667, 668, 670, 671, 673
Markland, D., 600, 602 Meier, S., 531
Martin, D. G., 342 Melnick, J., 290
Martin, E., 610 Mendoza, D. W., 538
Martin, F., 401, 402 Mental health consultation: A process of interaction be-
Martin, J. A., 123 tween two professional persons—the consultant, who
Martin, P., 375 is a specialist, and the consultee, who invokes the
Martin, S. D., 610 consultant’s help in regard to a current work problem
Maslow, A. H., 152, 198 with which he or she is having some difficulty and
Maslow’s hierarchy of needs, 152 which he or she has decided is within the other’s area
Mateer, C. A., 621 of specialized competence. 536
Mather, N., 467 Mento, A. J., 292
Matthews, D. A., 660 Merkur, D., 666
Maturation: A threat to internal validity that occurs over Merriam, S. B., 521
time during which there is a chance that participants Metacognition: The process of monitoring one’s own pro-
themselves undergo changes during the life of the cess of thinking and memory. 121
study. 495 Meyer, T., 98
May, K., 388 Meyers, J., 547
May, R., 270, 271, 669 Microcounseling supervision model (MSM), 80–82
 INDEX 803

Midbrain: A small section of the brain between the Mullis, F., 540
forebrain and the hindbrain whose primary function Multicultural career counseling: The study of career
is sensorimotor integration. 612 counseling in many cultures. 69–71
Miles, M. B., 282 Multicultural career development, 341–342
Miller, A., 598 models, 351–356
Miller, G., 659, 660, 661 theoretical approaches, 342–349
Miller, R. B., 382 variables, 349–351
Miller, W. R., 576, 602 Multicultural group work: The expansion of personal and
Minirth, F. B., 666 group consciousness of self–in–relation by providing
Minuchin, P., 384, 398, 399 intentional, competent, and ethical helping behaviors
Minuchin, S., 398, 399, 400 that promote the mental health of group members.
Mitchell, D., 94 300
Mitchell, M. H., 47 assessment, 305–311
Mitroff, I. I., 566 competencies, 301–303, 311–313
Mixed model: A prepaid system that combines features of history, 299–301
more than one HMO model, without one particular theory, 303–305
model dominating another. 739 Multicultural group worker competency: A framework
Mode: The measure of central tendency that represents used by group workers to anchor group goals, expec-
the most frequently occurring score. 437 tations, and processes that support and promote cul-
Modeling: A group leader or members exhibits behaviors turally relevant and sensitive group work. 301
and social skills that other group member can observe Multicultural influences, 53–54
and then apply to their own lives. 259 Multicultural realities, 220
Moderated management: Models of addiction treatment African Americans, 228–231
that see the goal of recovery as moderation rather Arab Americans, 236–238
than complete abstinence from the behavior or sub- Asian Americans, 231–234
stance. 583 children, 224–225
Moleski, S. M., 29 elderly persons, 239–241
Moller, A. C., 605 gay, lesbian, or bi- populations, 243–244
Molnar, A., 394, 395 Latin Americans, 234–236
Montalvo, B., 399 Native Americans, 225–228
Montgomery, M. L., 94 relationship differences, 221–223
Montgomery, R. W., 559 Murray, H. A., 472, 473
Moore, E. J., 367 Myelin sheath: The insulated covering around axons that
Moore, H., 565, 566 increases the speed at which signals travel. 609
Moral development theory, 148–149 Myer, R. A., 556, 557, 558, 560, 561, 562, 565, 566, 580
Moreno, J. L., 256 Myers-Briggs Type Inventory, 330–331
Mores: Convictions about the moral rightness or wrong- Myers, I. B., 481, 482
ness of behavior. 53 Myers, J. E., 6, 8, 15, 330, 633, 645, 646, 647, 648, 649, 650,
Morgan, C. D., 472, 473 653
Morgan, D. L., 310, 522 Myers, P., 625, 632, 647, 650
Morran, D. K., 279, 283, 292, 294, 296 Mytton, J., 378, 379
Morris, J. R., 285
Mortality: see Attrition.
Morton, G., 68, 69
Motherese: Child-directed speech. 117
N
Motivational interviewing: An interview method in the N.C. v. Bedford Central School District, 769
addictions field that is founded on a high-quality Nachmann, B., 321
clinical interview, incorporates many basic counseling Nance, D. W., 87
skills (e.g., active listening, reflection of feeling and Napier, A., 386
content, paraphrasing, etc.), and has a focus on an ad- Napier, R. W., 281
dict’s motivation to engage in the change process. 576 Narrative reenactment: In constructivist family therapy, a
Motor skills, 139 technique in which clients tell the story of their lives
Moulton, P., 82 and create new ones for a desired future; couples act
Moustakas, C., 519 out scenes written by their partners to share perspec-
Mowday, R. T., 484 tives and create new outcomes. 384
804 INDEX

Narrowband tools: Tools that measure a specific set of Nonmaleficence: The ethical precept stating counselors
characteristics of only one disorder or syndrome. 409 should do no harm. 24
National Board for Certified Counselors, 10, 316, 664 Non-person-oriented career: The individual satisfies
Naveh, D., 288 needs primarily by acting on things or ideas inde-
Negative reinforcement: The application of a desirable pendently. 320
stimulus to decrease a behavior. 168 Norcross, J. C., 82, 157, 158, 580
Negatively skewed data: Data contain few low scores and Norming: The stage in group work when the members
mostly are comprised of high scores. In this distribu- develop ingroup feeling and cohesiveness, new stan-
tion, the tail of the curve goes out to the left. 440 dards evolve, and new roles are adopted. 289
Negligence: Any conduct that does not meet the mini- Norm-referenced test: Test that has been given in a stan-
mum requirements for acceptable professional behav- dardized manner to a specific sample (group) of indi-
ior. 37 viduals, called the norm group. 432
Network: An HMO model that contracts with two or Nugent, F., 73
more independent group practices to provide services Null hypothesis: States that in the population, there is no
to HMO members, and may involve large single and change, no effect, no difference, and no relation due
multispecialty groups. 739 to the effect of the treatment or condition. 488
Neufeldt, S. A., 96, 97 Nykodym, N., 254
Neugarten, B. L., 133 Nylund, D., 396
Neukrug, E. S., 73, 203, 535 Nystul, M. S., 159, 162
Neural pathway: The pattern formed when a series of
neurons fire or release electrical impulses in the form
of neurotransmitters, that ultimately forms a perma-
nent circuit. 609 O
Neuropsychological assessment: Used to draw inferences O’Hanlon, B., 394
about brain functioning based on behaviors exhibited O’Hanlon, W., 385, 395, 396
by the person under structured conditions. 478 O’Hara, R. P., 321, 710
Neuroscience, 607 Object permanence: The understanding that an object
and psychotherapy, 607 continues to exist even when it is out of sight. 116
nervous system, 607–609 Object relations theory: A means of explaining how peo-
neural change, 613–618 ple relate to others based on early attachment experi-
processing deficits, 618–623 ences with a caregiver. 389
the brain, 609–613 Objective measures: Tools that evaluate personality
Neurotransmitters: Chemicals released by terminal but- through the use of forced choice responses to ques-
tons at the end of one neuron and received at receptor tions. 472
sites on the dendrites of other neurons. 609 Occipital lobe: Part of the cortex located at the back of the
Newcomb, T. M., 214, 216 head that is responsible for visual processing. 610
Newcomb’s A–B–X model of interpersonal attraction, 216 Occupational segregation: In Roe’s career theory, the ten-
Newlon, B. J., 641 dency for members of particular groups to be
Ng, M., 351 overrepresented in some occupations and
Nichols, M. P., 378, 379, 380, 389, 390 underrepresented in others. 344
Nichols, W. C., 400, 401 Office of Public Policy and Legislation, 770
Niemic, C. P., 601 Ohlsen, M. M., 256
Niles, S. G., 316, 559 Okech, J. E. A., 284
Nitza, A. G., 279 Okun, B. F., 201
Nixon, S. J., 565 Omer, H., 384
Nominal scales: The simplest form of measurement that One-downmanship: The relationship between the consul-
assigns numbers to classify data into one or more cat- tant and the consultee as one of equals or peers. 538
egories (e.g., one type of nominal measurement is One-way analysis of variance (ANOVA): Statistically
gender, and numbers can be assigned to the catego- equal to the t test, this statistical test can be used to
ries of male and female.) to make observations about test for true differences in two or more sample means
the frequency with which data fall into each category. on the same variable. 444
437 Open-ended or open panel HMO: An HMO that allows
Nondirectional hypothesis: Statement that there is simply its members to utilize health care services from pro-
a relation between variables or that groups differ on viders outside their own network of providers with-
the variable of interest. 487 out referral authorization. 739
 INDEX 805

Operant conditioning: Learning that relies on conse- Palmer, P. J., 40

quences that follow behavior. 144 Panel study: A study in which the same individuals are
Oppression: The unjust or cruel exercise of authority or tested at successive points in time over the period of
power that functions to crush or burden by abuse of the study. 509
power, privilege, or authority; oppression may also be Panksepp, J., 617
an act of physical or psychological violence that hin- Paradigm: A set of rules and regulations (written or un-
ders a person from being entirely human or alive. 66 written) that does two things: (a) It establishes or de-
Ordinal scales: Like the nominal scales, data are classified fines boundaries; and (b) it tells you how to behave
into categories, and they are also rank ordered. The inside the boundaries to be successful. 6
distance between the rankings, however, is not known Paradoxical intention: A technique used to aid group
and rankings are not necessarily equidistant. 437 members to exaggerate or magnify the behaviors that
Organizational commitment: The degree to which one are causing concern for the purpose of bringing
identifies with a particular organization. 484 awareness to the underlying feelings related to dis-
Organizational consultation: The process in which a pro- tressing behaviors. 269
fessional, functioning either internally or externally to Parallel process: The dynamic that occurs in the cli-
an organization, provides assistance of a technical, di- ent-therapist relationship that is played out in the
agnostic/perspective, or facilitative nature to an indi- supervisee-supervisor relationship. 78
vidual or group from the organization to enhance the Parent ego state: In transactional analysis, this ego state
organization’s ability to deal with change and main- consists of the critical parent and the nurturing par-
tain or enhance its effectiveness in some designated ent. The critical parent acts to protect and is filled
way. 542 with values, shoulds, and ought tos. The nurturing
Organizational culture: The socially transmitted behavior parent acts as a nurturer and caregiver. 165
patterns characteristic of a particular organization or Parham, T. A., 53, 350
company. 483–484 Parietal lobe: Part of the cortex found at the top of the
Organizational diagnosis: The process through which head between the frontal lobe and the occipital lobe
both the consultants and the consultees seek to grasp that contains motor and sensory processing areas. 610
the dynamic, problematic, organizational situations. Parker, W. M., 311
543 Parsons, F., 317–318
Organizational structure: A strategic configuration of or- Parsons, R. D., 195, 198, 200, 539, 547
ganizational functions, jobs, and policies in a pattern Parten, M., 122
that best serves organizational goals. 483 Participant observation: Individuals make it clear to the
Osborne, S. S., 529, 530 community that they are researchers, but then try to
Osgood, C., 214, 216 partake, as much as possible and as much as allowed,
Osipow, S. H., 345 in the daily and ordinary activities within that com-
Osofsky, J. D., 589 munity. 519
Ottens, A. J., 562, 731 Pastoral counseling: A process in which a pastoral coun-
Outcome expectations: Personal beliefs about the results selor utilizes insights and principles derived from the
of performance that are viewed as operating inde- disciplines of theology and the behavioral sciences in
pendently from efficacy expectations and dependent working with individuals, couples, families, groups,
on actual performance. 348 and social systems toward the achievement of whole-
Outcome goals: In behavioral family therapy, the desired ness and health. 659–660
changes that are clearly defined as the goals of ther- cognitive behavioral therapy, 673–674
apy. 378 ethics, 663–665
Overgeneralization: The tendency to apply conclusions or ideology, 660–663
beliefs about a specific instance to other, nonrelated theories, 665–672
instances. 173 Pate, R. H., Jr., 49
Overt aggression: Common in boys, and involves physi- Paton, D., 565
cally aggressive acts. 123 Patrick, B. C., 601
Overton, W. F., 594 Patterson, C. H., 94
Patton, M. Q., 514
Pearce, J. K., 226
Pearlman, L. A., 564
P Pedersen, P. B., 52, 60, 221, 222, 306
Pack-Brown, S. P., 299, 300, 310, 311 Pedhazur, E. J., 496
Padilla, A. M., 349 Peeks, B., 397
806 INDEX

Peele, S., 574 Point estimate: One statistic in the range of possible statis-
Peirce, C. S., 515 tics within the confidence interval that estimates the
Pelletier, L. G., 601 population parameter. 490
Percentiles: Describe the percentage of people whose Polarized thinking: The tendency to view events as either
score falls at or below a particular raw score. 440 completely negative or positive or thinking that is
Performing: Period of group work when the members dualistic and characterized by either-or traits. 174
have reconciled many of their differences and have Polite, C., 344, 522
developed enough trust and cohesion to examine Pons: Part of the hindbrain involved in posture, muscle
themselves and their relationship to the group. 289 movements, and coordination. 612
Peripheral nervous system (PNS): Comprised of nerves Ponterotto, J. G., 53, 68
extending from the spinal cord to the rest of the body Poortinga, Y. H., 58
(e.g., organs and muscles). 608 Pope, M., 96, 285
Perls, F. S., 30, 187, 188, 267, 670 Pope-Davis, D. B., 96
Perry, B. A., 379 Porter, L. W., 484
Personal and social development: Strategies and activi- Portraiture, 522
ties implemented to provide personal and social Positive reinforcement: Provision of a valued stimulus
growth experiences to facilitate students’ progress following a desired behavior. 144
through school and the transition to adulthood. 366 Positively skewed data: Data contain few high scores
Personal fable: Adolescents’ inflated opinion of them- and mostly are comprised of low scores. In this
selves and their importance. 128 distribution, the tail of the curve goes out to the
Personal responsibility: The concept that people have no right. 440
Postconventional morality: The third level of Kohlberg’s
power over others’ behaviors, but they do have con-
moral development theory in which moral conclu-
trol over their own behavior, for which they are re-
sions are internalized and individuals make moral
sponsible. 180
choices based on their evaluation of alternate moral
Personality assessment: A method that counselors use to
codes and ultimate subscription to a personal moral
measure a variety of components of personality in-
code. 149
cluding: traits, states, identity, cognitive and behav-
Prata, G., 401
ioral styles, and other individual characteristics. 472
Pratt, M. L., 275, 520
Personalization: Interpreting events and reactions as re-
Precision Matching: 640
lated to themselves even if there is no evidence of the Preconventional morality: The first level of Kohlberg’s
connection. 174 moral development theory in which moral judgments
Person-centered approach, 264–267 reflect considerations for personal needs, but place
Person-oriented career: The individual satisfies needs pri- little emphasis on societal needs. 148
marily through interactions with people. 320 Preferred provider organization: A health care delivery
Peterson, S. E., 566 system that contracts with providers of medical care
Pew, W. L., 249 to provide services at discounted fees to members.
Pfefferbaum, B., 565 Members may seek care from nonparticipating pro-
Phenotype: A organism’s manifest physical and psycho- viders but generally are financially penalized for do-
logical characteristics, which are determined by both ing so by the loss of the discount and subjection to
genetic makeup and environmental factors. 113 copayments and deductibles. 739
Physical development: Involves growth of a physical na- Prejudice: Generalizations or stereotypical beliefs about a
ture, including muscular strength and fine and gross group of individuals that are not grounded in empiri-
motor skills development. 139 cal evidence. 64
Physiological dependence: Occurs when individuals ex- Presbury, J. H., 558
perience tolerance and withdrawal in relation to a Presbycusis: Hearing loss that usually affects a person’s
substance. 572 ability to detect higher frequencies. 131
Piagetian theory of cognitive development, 146–148 Presbyopia: A major change in vision that results in di-
Piel, J. A., 149, 150 minished color discrimination, night vision, and vi-
Placating: In conjoint family therapy, a communication sual acuity of marked decline between ages 70 and
style in which a person denies the self to agree with 80. 131
someone else. 392 Pretending: A strategic family therapy technique that
Plant, R. W., 600, 601 entails performing the problematic behavior or
Plasticity: The ability of neurons and neural networks to symptom in the session and practicing coping
change. 613 skills. 397
 INDEX 807

Pretest sensitization: A threat to internal validity that oc- ples, through cognitive, affective, behavioral, or sys-
curs when participants’ performance on a test is im- temic interventions, strategies that address wellness,
proved because of having taken a pretest. 497 personal growth, or career development, as well as
Principle of awareness: In Gestalt therapy, clients gain in- pathology. 3
sight when they become aware of and take responsi- Professionalism, 8, 33, 35
bility for their sensations, thoughts, and behaviors in Professional school counseling, 361–375
the here and now. 188 ASCA model, 367–371
Principle of figure-ground: In Gestalt therapy, clients ad- ASCA standards, 364–367
dress their most pressing needs first and as these are Progression: The process whereby individuals experience
resolved, previously less evident needs emerge to be an ever-increasing feeling of being out of control, in-
dealt with. 188 creased consequences, and obsessive thinking related
Principle of holism: In Gestalt therapy, clients experience to their behavior. 570
a sense of completeness when they tie up problematic Projective identifications: In psychodynamic family ther-
situations—“loose ends”—from the past that cause apy, the ways in which parents project unwanted as-
anxiety and prevent integration. 188 pects of their personalities onto their children, who in
Principle of polarities: In Gestalt therapy, clients acknowl- turn accept that identity and unconsciously agree to
edge the opposite or hidden aspects of a problematic act out in such a way as to uphold those expectations.
situation to promote resolution of conflicts. 188 390
Principles, see Ethics Projective measures: Allow for inferences about an in-
Privacy: The constitutional right of people to decide the dividual’s personality through responses to ambig-
time, place, manner, and extent of personal disclo- uous or unstructured stimuli and are often used
sures. 47–48 for educational, forensic, and therapeutic assess-
Privilege: The state of being preferred or favored in soci- ment. 472
ety combined with a set of conditions that systemati- Protagonist: In psychodramatic group therapy, the group
cally empower select groups based on specific vari- member who has chosen to enact a life situation or re-
ables such as race and gender, while systematically lationship in an effort to experience a cathartic release
not empowering others. 66 of emotions, gain insight, and learn new and produc-
Privileged communication: A legal concept that guards tive ways of managing future situations or relation-
against compulsory disclosure in legal proceedings ships. 255
that breaks a promise of privacy. 47, 48–49 Protecting: A technique that is intended to protect a group
Probability: The likelihood that an occurrence will take member from too much self-disclosure and subse-
place given all other chance factors. 441 quent feelings of regret, as well as pressure from oth-
Probert, B. S., 645 ers in the group to reveal more than they may be
Process addiction: An addiction that does not require a comfortable with. 292
substance to be ingested, but often presents similar Protective factors: Those factors that can serve to
problems as a substance-related addiction (e.g., shop- buffer the individual from the influence of risk fac-
ping, sex, workaholism, etc.). 706 tors, such as the presence of a caring and nurtur-
Processing: An activity in which individuals and ing adult. 590
groups regularly examine and reflect on their be- Protinsky, H. O., 94
havior to extract meaning, integrate the resulting Prouty, A. M., 94
knowledge, and thereby improve functioning and Proximodistal: The sequence of growth that occurs from
outcome. 279 the midline of the body outward. 115
Process-oriented consultation: A set of activities on the Pryzwansky, W. B., 529
part of the consultant that help the client (consultee) Psychoanalytic approaches, 247–249
to perceive, understand, and act on the process events Psychodramatic approach, 254–257
that occur in the client’s (consultee’s) environment. Psychodynamic approaches, 156
543 analytic psychology, 159–161
Prochaska, J. O., 157, 158, 580 individual psychology, 161–164
Professional counseling paradigm: Approach to the help- psychoanalysis, 156–158
ing relationship that pays particular attention to the transactional analysis, 164–167
interface between clients and their cultural and sys- Psychoeducational tests: Take information from both cog-
temic connections, with strong emphasis on interper- nitive and achievement measures to provide an over-
sonal relationships. 6 all picture of a student’s abilities related to academic
Professional counseling: The application of mental success and to measure academic achievement re-
health, psychological, or human development princi- lated to reading, math, and writing achievement. 471
808 INDEX

Psychological dependence: Refers to individuals who re- R

main dependent on a substance or behavior for rea-
Race: An inbreeding, geographically isolated population
sons other than physiological ones. 572
that differs in distinguishable physical traits from
Psychological emergency: Sudden event characterized
other members of the species. 62
by the presence of immediate danger and potential
Racial and cultural identity development: The processes
permanent psychological or physical damage.
used by individuals of minority groups and op-
555
pressed peoples to understand their own identity in
Psychological heterosexism: The individual internaliza-
light of their culture, the culture of dominant groups,
tion of worldviews underlying cultural heterosexism
and the convergence of the two cultures. 68
resulting in prejudice against people who are not het-
Racial salience: The degree to which an individual per-
erosexual. 65
ceives race as a factor affecting workplace options.
Psychological paradigm: Approach to the helping rela-
350
tionship that emphasizes the etiology of
Racism: The belief that racial or ethnic groups other than
psychopathology as intrinsic to the individual. 6
one’s own are psychologically, intellectually, or physi-
Psychometrics: Any form of mental testing or the branch
cally inferior. 64
of counseling and psychology that deals with testing.
Random assignment: Individuals are assigned to either
435
the experimental group or the control group, or some
descriptive, 436–441
level of the treatment on the basis of chance. 492
inferential, 441–445
Range: Provides a quick assessment of the variability in
reliability, 445–449
the data by describing the uppermost and lowermost
statistics, 435–436
scores among the data. 438
test construction, 453–456
Raphael, B., 551
validity, 449–453
Rapin, L. S., 276
Psychopathology, 406–412
Raskin, N. J., 265
aging, 431–432
Raskin, P., 387
anxiety, 412–415
Ratcliff, D. E., 666
assessment, 407–411
Rational-emotive behavior, 260–262
childhood, 428–430
Ratio scales: Have all the properties of the interval scale
cognitive functions, 424–426, 431
of measurement and also have an absolute or true
diagnostic system, 411–412
zero point. 437
eating disorders, 418–419
Ray, W. A., 402
gender identity, 421–424
Reaction range: The range of possible phenotypes for a
mood, 415–417
particular genotype across all environmental influ-
personality, 426–428
ences. 113
substance use, 419–421
Reality therapy approach, 262–264
Pugh, S. D., 62
Reciprocal determinism: An individual’s behavior is both
Punishment: Applies an aversive stimulus to diminish the
influenced by and is influencing an individual’s per-
likelihood of occurrence of a behavior. 168
sonal factors and the environment. 171
Pynoos, R. S., 558
Record keeping, 42
Redding, S. G., 351
Reeve, J., 595, 601
Referral question: A statement given by the client or
Q other parties close to the client about the area of con-
Qualitative Research: An approach to research that, at its cern that guides counselors in making informed deci-
core, can be described as an empirical inquiry into sions to ensure proper treatment. 411, 461
meaning. 512 Reflect: Stage in the FERA inquiry learning model that
meaning, 514–515 uses dialogue to promote shared or mutual under-
products, 520–524 standing and insight into the counseling and super-
role in counseling, 524–525 vising experiences. New learning and the removal of
roots, 513–514 blind spots help both the counselor and the supervi-
techniques, 517–519 sor gain different perspectives on the work and the
QUOID client: Acronym for “quiet, ugly, old, indigent, relationships. 100
dissimilar” that refers to the type of client a counselor Reflecting team: In constructivist family therapy, a tech-
is least likely to want to work with. 245 nique in which a team of clinicians observe fam-
 INDEX 809

ily–counselor interactions and provide a diagnosis of Ricoeur, P., 667

family problems. 384 Ridley, C. R., 64
Reformity prescription: Seeks to make the therapy fit the Rigazio-DiGilio, S. A., 625, 627, 634, 637
client through structured learning therapy so that it Risk factors: Those that have the potential to interrupt the
can be more consistent with the client’s styles. 205 individual’s normal developmental pathway or tra-
Reframing: The counselor presents a different perspec- jectory, such as exposure to violence. 590
tive, usually a positive interpretation, of what the cli- Risk of harm: Participants will incur no physical or psy-
ent has presented. 384 chological harm as a result of taking part in the study.
Regression toward the mean: Occurs when participants 435
scoring on the extremes on the pretest tend to move Rita, E. S., 94
toward the middle or mean on the posttest. 496 Ritchie, M. H., 8, 49, 50
Rehabilitation counseling: The maintenance of, or the Riva, M. T., 276, 284, 290
improvement in, the physical, mental, and emotional Rivers, D. A., 57, 64, 197
states of a person, of any age, suffering from the ef- Robbins, S. B., 609, 615
fects of congenital mishap, crippling disease, injury, Robertson, I. H., 619, 620, 623
accident, or surgical intervention. 242 Robinson, D. T., 285
Reification: Treating concepts or abstractions as if they Robinson, S. E., 529, 530
were real, concrete things. 120 Robinson, T. L., 55, 235
Reinforcement: A behavior that is immediately followed Rocha-Singh, I. A., 347
by a positive event or experience; the likelihood of Rodin, G. C., 600
that behavior recurring is increased. 144 Roe, A., 315, 320, 321, 343, 344
Reiser, M., 126 Rogers, C. R., 101, 199, 208, 264, 266, 598, 669
Reitan, R. M., 479 Rohde, R. I., 290
Relational aggression: More common in girls and in- Roid, G. H., 465
volves the act of damaging social relationships and Rollnick, S., 576, 600, 602
status. 123 Ronen, T., 94
Reliability: Provides an indication of the consistency of Rønnestad, M. H., 6, 94
test scores over repeated test administrations. 445 Rorschach, H., 472
Religion: The belief system and ritual practices of a sect Rose, S. D., 258, 259, 260
or denomination of individuals that binds them to- Rosenbaum, M., 94
gether in worship, practice, and community. 63 Rosman, B., 398
Remley, T., Jr., 21 Rounds, J. B., 331, 343
Repeated measures ANOVA: Used to analyze a single Rovine, M., 589
factor (independent variable) and a single dependent Rowntree, D., 436, 444
variable when the sample is the same for each treat- Roysircar-Sodowsy, G., 59
ment condition. Rudd, M. D., 551
Research design, 487–490 Rudolph, L. B., 47
experimental research, 491–495 Russell, R., 412
experimental validity, 495–497 Russell-Chapin, L. A., 74, 75, 76, 80, 81, 82
nonexperimental, 507–510 Ruud, W., 254
quasi-experimental, 507–510 Ryan, R. M., 593, 594, 595, 596, 597, 600, 601, 605, 645
Resentful demoralization: Occurs when the responses of Ryckoff, I. M., 391
the participants do not reflect their natural behaviors. Ryff, C. D., 645
496
Resilience: Refers to positive or adaptive developmental
outcomes, despite the presence of risk factors or ad-
versity. 593
S
Reticular formation: Part of the hindbrain that regulates Sacks, O., 521
consciousness, which is a combination of alertness, Salter, A. C., 551
attention, and awareness and also is involved with Samuel, D., 412
posture, smoothness of muscle movements, and Sanchez, H. G., 551
maintenance of muscle tone. 612 Santrock, J. W., 118, 195
Reynolds, C. R., 477 Satir, V., 392, 393
Richardson, M. A., 227 Sattler, J. M., 408, 461
Richeport-Haley, M., 398 Savickas, M. L., 342
810 INDEX

Scaffolding: The altering degree of assistance that chil- Separation anxiety: Extreme stress experienced by infants
dren receive from the skilled adults to suit their level or young children when they are separated from their
of competence on which further development hinges. mother. 151
589 Serafica, F. C., 348, 357
Scarr, S., 113 Seriation: In Piagetian cognitive theory, the arrangement
Schein, E. H., 535, 543, 544 of items on a quantitative dimension that occurs in
Scheiner, M. J., 605 the concrete operational phase. 148
Schemas: New ways of thinking that change with age, ex- Sex: The system of sexual classification based on biologi-
perience, and exposure to new environmental circum- cal and physical differences, such as primary and sec-
stances; ways of processing information for specific ondary sexual characteristics, which create the cate-
activities. 147 gories male and female. 60
Schmidt, A. E., 562 Sexism: The belief that women and men are inherently
Schmidt, J. J., 239, 241, 243 and qualitatively different, with men being presumed
Schneider, J. P., 571 superior to women. 65
Schön, B., 90 Sexton, T., 97
School counseling initiative, 371–374 Sexual misconduct, 29–30
School counselors, 38–40 Shalev, A. Y., 565
Schulte, A. C., 529 Shallice, T., 614, 622
Schulte, E. H., 529, 530 Shank, G. D., 514, 517, 519
Schutz, A., 513 Shaping: Reinforcing behaviors that increasingly resem-
Schwallie-Giddis, P., 364 ble the desired behavior until the desired behavior is
Schwartz, B., 150 attained. 145
Schwartz, R. C., 378, 379, 380, 389, 390 Sharf, R. S., 321, 324
Schwitzer, A. M., 203 Shatz, M., 125
Secondary victimization: Also known as vicarious Shaver, P., 130
trauma, this can occur when bearing witness to the Sheldon, K. M., 594, 646
results of extreme or unexpected harm or violence to Sherman, N. E., 81
another person. 16 Shirk, S., 412
Seely, M. F., 551 Shohet, R., 94
Segal, J., 390, 391 Sibling position: In Bowenian family therapy, personality
Segal, S. J., 321 characteristics that are consistent with birth order and
Segall, M. H., 58 used to describe sibling position; failure to display
Seidman, I. E., 518 the expected personality characteristics of birth order
Selection: Inherent differences between groups at the out- is attributable to family projections and triangula-
set of the study; is more likely to happen with intact tions. 381
groups. 496 Silove, D., 555, 565
Self-determination theory, 593–597 Simon, J., 465
and helping professions, 598–604 Sink, C. A., 47
motivation, 597–598 Situational crisis: Emerges with the advent of unexpected
Self-efficacy: The individuals’ judgments of their capabili- events that lie outside the realm of normal function-
ties to organize and execute courses of action required ing; individuals neither anticipate nor have a way of
to attain designated types of performances. 171 controlling situational crises. 552
Self-report: Information gathering that relies on the cli- Skinner, B. F., 167, 168, 169, 257
ent’s input about behaviors of interest. 476 Skovholt, T. M., 6, 57, 64, 94, 104, 197, 202
Seligman, L., 156, 157, 195, 200, 202, 329, 331, 641 Skowron, E. A., 380, 381, 382
Seligman, M. E., 199 Skynner, R., 389, 391
Seltzer, W. J., 610, 611 Slaikeu, K. A., 565
Selvini Palazzoli, M., 401 Slawski, C., 212, 213, 214
Semantic bootstrapping: A process of relying on word Smart, D. W., 241, 242
meanings to learn grammatical rules. 121 Smart, J. F., 241, 242
Senescence: Genetically influenced declines in the perfor- Smedley, A., 62
mance of organs and systems. 130 Smedley, B. D., 62
Sensitive periods: In humans, the periods that are opti- Smith, E. J., 259
mal but not exclusive for certain aspects of develop- Smith, P. C., 484
ment. 113 Smith, P. L., 343, 348
 INDEX 811

Social clock: Refers to life events such as marriage, a first Steele, R. P., 292
job, a first child, and so on, that follow age-graded Steer, R. A., 409
patterns based on societal and cultural expectations. Steers, R. M., 484
133 Steffy, B. E., 530
Social convoy: The changes that occur in our social net- Steinberg, L., 558
works as people age. 133 Stephens, A. M., 95
Social interest: The need of human persons to experience Sternberg, R. J., 133
a sense of belonging and emphasizes the overall con- Stimulus–response model, 143–144
cern for humanity that individuals possess. 146 Stockton, R., 278, 279, 283, 290, 292, 293, 294
Social learning theory, 146 Stoltenberg, C. D., 76, 77, 94, 109
Sociocultural context: A precise set of cultural, physical, Stone, C., 38, 39, 40, 45, 46, 47, 372, 373, 374, 375
socioeconomic, and historical circumstances that have Stone, G., 397
an impact on variations in human development. 137 Storming: The stage of group work characterized by inev-
Sociocultural theory of development, 149–150 itable conflict, mild disagreements, and resistance
Socioemotional development: Involves changes in the that can have positive or negative implications. 289
ability to initiate and maintain interactions with oth- Strauss, A. L., 513, 523, 524
ers, changes in personality, and emotional regulation. Strong, E. K., 330
139 Structure: Encompasses many different techniques and
Sociological paradigm: Approach to the helping relation- interventions that have as their primary goal the de-
ship that focuses on systems. 6 velopment and maintenance of a healthy therapeutic
Soenens, B., 600 group.
Sohlberg, M. M., 621, 623 Structured learning therapy model, 205–206
Solomon, J., 119 Strunk, O., Jr., 662
Solovey, A., 396, 398 Stuhlmiller, C., 565
Sonstegard, M. A., 250 Substance abuse: A pattern of use that is chronic and ex-
Sorenson, G. P., 42 cessive, resulting in damage to relationships, work at-
Spark, G. M., 390 tendance or productivity, and health status. 419
Speirs, K., 636 Substance addiction: An addiction that requires the in-
Sperry, L., 33, 195, 198 gestion of a mood-altering substance (e.g., alcohol,
Spirituality: That which allows humans to transcend the drugs, etc.). 570
corporeal body and to connect on many levels with Substance dependence: Pattern of use where life activities
that which is other. 659–660, see also Pastoral Coun- are organized around the opportunity to consume a
seling drug, and where psychological and physical tolerance
Splitting: In psychodynamic family therapy, individuals (the need for more of the drug to get the same high)
perceive people as either good or bad if their early ex- develops and withdrawal symptoms can result. 419
periences are unresolved. 389 Sue, D. W., 54, 68, 69, 80, 222, 235, 284, 286, 341, 350, 354
Spontaneous recovery: The premise on which moderated Sue, S., 57, 68, 96, 222, 223, 235, 284, 286, 350, 354
management is built; refers to the assumption that Super reasonable: In conjoint family therapy, a communi-
many individuals learn to manage their bad habit or cation style in which feelings are not acknowledged
addiction without any type of professional interven- within the self or in others. 392
tion. 583 Super, D. E., 319–320
Spradley, J. P., 518, 520 Superego: Structure of personality that serves as an indi-
Sprinthall, R. C., 437, 440, 443, 445, 449 vidual’s conscience, represents a moral code handed
Spritz, B., 589 down from parent to child, and guides behavior to re-
Stachowiak, J., 392 flect rules that closely resemble societal norms or ex-
Stage: In psychodramatic groups, the formal stage area or pectations. 140
large open room in which the enactment takes place. Supervision: A distinctive, structured approach in which
255 an often more experienced professional counselor re-
Stake, R. E., 34, 521 sponds to a counselor trainee or supervisee’s needs
Standard deviation (SD): The most commonly used mea- with attention to the supervisee’s differing develop-
sure of test score spread that indicates how far indi- mental and competency levels. 73–75, 87–109
vidual scores are from the mean. 438 and professionalism, 73
Standard error of measurement: An estimate of how ac- collaborative model, 91–92, 97–98
curate the observed scores are at approximating the credentialing, 88
true score. 448 ethical and legal considerations, 94–96
812 INDEX

evaluation, 106–109 t test: A statistic that is used to determine whether or not

FERA learning model, 100–102, 105–106, 107–108 there are true differences in two sample means for the
multicultural impact, 96–97 same dependent variable. 444
novice supervisors, 92–94, 97, 99
self-developed skills, 90
theories, 93–94
therapeutic working alliance, 101–104 T
training, 89 Tang, M., 343
Supervision models, 75–84 Tannenbaum, P., 214
developmental, 75–77 Taschman, H., 392
discrimination, 79–80 Tata, S. P., 349
integrated model, 80–82 Tatar, M., 650
theory-specific, 77–78 Taylor, D. G., 589, 658
videotaping, 82–83 Technical competencies, 7
Suzuki, L., 346 Technical eclecticism: The idea that treatment can and
Swaney, K., 343 should consist of techniques from a variety of theoret-
Sweeney, T. J., 6, 14, 625, 632, 633, 646, 647, 648, 649, 650, ical perspectives without the therapist necessarily
653 adopting a theoretical basis for those techniques. 184
Swerdlik, M. E., 439, 483 Teed, C., 292
Switching addictions: Refers to the phenomenon often Teglasi, H., 473
seen when individuals stop or reduce one addiction Telegraphic: Expression of thought in two-word sen-
and trade it for another. 584 tences. 117
Symbolic substitution: The utilization of a word or other Temperament: A child’s typical way of behaving and re-
symbol in the place of a specific action. 147 sponding to the environment. 118
Symmetry: In Newcomb’s model of attraction, the state of Temporal lobes: Areas of the cortex located on the right
balance among A, B, and X (two individuals and an and left sides of the cortex, in the area around the ear,
object). 216 and are important for language processing. 610
Synapse: The area between neurons, in which information Teratogens: Environmental agents capable of causing de-
is passed from the terminal buttons at the end of one velopmental abnormalities in utero. 114
neuron’s axon to the dendrites of another neuron. 609 Terner, J., 249
Syndrome: Abnormal psychological symptoms that tend Tests of linear regression: see Correlation.
to occur together, present to a marked degree, and Thalamus: Part of the forebrain that is a relay center in the
last for a significant amount of time. 408 brain, facilitating connections between the cortex and
Syntactic bootstrapping: The process of discovering the limbic system. 611
meaning of words by observing how the words are The ordeal: A strategic family therapy technique that en-
used in syntax. 121 tails changing the family structure in a way that is
Systematic desensitization: The gradual exposure to an beneficial by prescribing a difficult activity that is
more severe than the problematic behavior. The tech-
aversive stimulus that eventually allows a person to
nique is useful in creating negative consequences for
overcome a specific fear. 259
problem behavior and in reinforcing appropriate
Systemic Cognitive Developmental Counseling: a thera-
boundaries and authority roles. 397
peutic approach that adapts Developmental Coun-
Thematic communication: frequently observed styles of
seling and Therapy constructs for work with families
communication that are used within a particular
and wider networks by examining the internal mean- ethnocultural community. 308
ing making of individuals, families, and institutional Theory: A set of principles that helps to explain a group of
systems and the factors that influence exchanges facts or a phenomenon and is used to make predic-
across these systems. 634 tions. 195
evaluation, 640–641 Therapeutic contracts: Contractual forms completed by
fundamentals, 635–636 group members who indicate what it is they wish to
questioning strategies, 636–639 accomplish as a result of participating in the group.
Systemic crisis: Occurs when an identifiable event ripples Goals must be concretely defined so that group mem-
out into large segments of the population and the en- bers can take responsibility for working toward them.
vironment and has a psychological impact not only 253
on the immediate victims, but on people throughout Therapeutic factor: An element of group therapy that
the world. 552 contributes to improvement in a patient’s condition
 INDEX 813

and is a function of the actions of the group therapist, Treatment group: In an experimental design, the group
the group members, and the patient himself or her- that receives the treatment. 491
self. 280 Treatment integrity: Refers to the extent to which the
Therapeutic working alliance: A supervisee-centered, treatment is the same for all groups across all con-
collaborative relationship driven by the clinical and texts. 493
developmental needs of the supervisee, in which the Trend study: Type of study in which the researcher takes a
process of identifying and addressing the new sample of persons from the population of inter-
supervisee’s needs as they arise must be the mutual est each year. All samples are asked the same ques-
responsibility of both professionals. 101 tions or administered the same treatment. 509
Third-party administrators (TPAs): Individuals or firms Tresini, M., 130
that an employer hires to handle claims processing, Triangulation: In Bowenian family therapy, a basic, stable
reimburse providers, and deal with all other relationship system that can be healthy or unhealthy;
health-insurance-related matters. 739 unhealthy triangles form when family members
Thomas, R. M., 149, 151 lower stress by projecting the anxiety between two
Thomas, V., 94 people onto a third person or thing. 381
Thompson, B., 490 Trimble, J. E., 221
Thompson, C. L., 47 Trochim, W., 435, 444
Tiedeman, D. V., 321, 680, 710 Truax, C., 199
Tobin, V. J., 600 Tucker, P., 484, 565
Tolerance: Either needing more of a substance to achieve Tuckman, B. W., 288, 289, 295
intoxication or the desired effect, or a significant de- Tuson, K. M., 601
crease in the effect of the substance when the same Type I error: Occurs when a researcher finds a significant
amount is used. 571 difference or relation when there is none. 489
Tolin, D. F., 559 Type II error: Occurs when the researcher fails to reject a
Tootle, A., 611, 612, 613 false null when a significant difference exists. 489
Torts: Civil wrongs recognized by law as grounds for a
lawsuit. 37
Toth, P. L., 278, 290, 292, 293
Toth, S. L., 588, 591 U
Training, 8–9 Unconditional positive regard: The nonjudgmental, car-
Transactional analysis approach, 251–254 ing, and accepting attitude of the therapist toward the
Transactional model: An approach to helping that ac- client. 186
knowledges that people are active creators of their so- Unconditioned response (UR): The natural response an
cial environments and are in turn influenced by them. organism makes to the unconditioned response. 143
206 Unconditioned stimulus (US): Stimulus that evokes an
Transfer of effect: What is learned in one situation should unconditioned response. 143
be transferred and used in future similar situations. Unconscious: The largest part of the mind that contains
538 thoughts and feelings of which a person is unaware
Transference: Projections clients cast on their counselors. or has repressed. 157
30 Unintentional racism: Occurs when White people ignore
Transforming School Counseling: An initiative funded the reality of privilege and potentially can take part in
by the Dewitt Wallace-Reader’s Digest Fund to create oppressing people of color. 67
a new vision for school counseling that emphasizes United States Census, 780
leadership, advocacy, use of data, and a commitment United States Employment Service, 330, 780
to support high levels of achievement for all students. Universality: Group members come to understand that
371 others have similar problems and they are not alone
Transgender: A person whose gender identity does not in their dilemma. 289
match her or his assigned gender (gender assignment Ursano, R. J., 551, 565
is usually based on biological or physical sex). 61 Utilization management: The process of evaluating the
Trauma: Occurs when an individual experiences or per- necessity, appropriateness, and efficiency of health
ceives an enormous sense of helplessness and physi- care services against established guidelines and crite-
cal threat that leads to the interruption of normal de- ria. 740
velopment. 558 Utilization review: A formal process for reviewing the ap-
Traupman, J. C., 661 propriateness and quality of health care services de-
814 INDEX

livered to clients before, during, or after the delivery Weiner-Davis, M., 385, 394, 395
of the services. 740 Weinrach, S. G., 319
Weinstock, L. M., 379, 380
Weiss, D., 331, 484
Weiss, R. L., 379
V Welfel, E. R., 26, 30
Validity: Evidence that a psychological test measures the Wellness: A way of life oriented toward optimal health
attribute or ability it purports to measure in the test and well-being, in which body, mind, and spirit are
manual. 449 integrated by the individual to live life more fully
Valliant, G. E., 132 within the human and natural community. Ideally, it
Values, 7 is the optimum state of health and well-being that
van der Kolk, B. S., 558, 559, 564 each individual is capable of achieving. 643–645
Van Hesteren, F., 6, 8 assessment tools, 648–650
Van Maanen, J., 519 counseling, 650–656
Vandereycken, W., 600 models, 645–648
Vandiver, B. J., 346 Wessler, R. L., 262
Vansteenkiste, M., 600 West, C., 62
Variance: Describes the spread of a distribution of scores Wewers, S., 589
by indicating how much variation there is in a set of Wheel of influence: A visual representation of all the in-
scores from the mean. 438 fluential people in the client’s life. 393
Vaslow, J. B., 62 Whisman, M. A., 379, 380
Vernon, A., 47 Whitaker, C., 385, 386
Vicarious reinforcement: Learning that occurs as a result Whitaker, D. S., 247, 290, 386
of watching someone model a particular behavior. White privilege: An invisible knapsack of special provi-
146 sions and unearned assets that put certain cultures at
Violanti, J. M., 565 an advantage over others. 223
Vitz, P. C., 666, 667, 669, 670 White, J. L., 53, 540
Volker, C., 130 White, R. K., 281
Voluntary participation: Participants are not coerced, White, V. E., 6
forced, or deceived into participation. 435 Whittingham, M. H., 294
Vontress, C. E., 284, 287 Whittington-Clark, L. E., 310, 311
Vygotsky, L. S., 588, 589 Whyte, W. F., 519
Wichern, F. B., 666
Widiger, T., 412
Wilk, J., 394
W Wilkenson, G. S., 468, 469
Wachtel, M., 284 Williams, C. L., 474, 600
Waddington, C. H., 113 Williams, G. C., 594, 600, 601
Walker, L. E., 551 Williams, R. C., 562
Wallace, W. A., 540, 542, 543 Wilson, C., 619, 623
Walz, G., 334, 336 Wilson, G. T., 257, 258
Wandersman, A., 514 Wilson, J. P., 551
Wanlass, J., 280 Withdrawal: Physiological symptoms associated with a
Ward, C. M., 354, 355 physical withdrawal (differs by substance), or the
Ward, D. E., 279 substance is used to relieve or avoid the withdrawal
Ward, S., 620 symptoms. 571
Warner, R. W., 259 Witmer, J. M., 633, 646, 647, 649
Watkins, C. E., Jr., 99 Wolf, A., 248
Watson, J. B., 671 Wolfson, D., 479
Watzlawick, P., 401, 402 Wolpe, J., 671, 672
Weakland, J. H., 401 Wood, E. R. G., 671, 672
Webb, L., 540 Wood, S. E., 671, 672
Weber, A. L., 140, 142 Woodcock, R. W., 467, 471
Wechsler, D., 466, 467, 468, 479 Woods, P. J., 78
Wegner, K. W., 362 Woollams, S., 252
 INDEX 815

Work Importance Locator, 331 Z

Work Importance Profiler, 331
World Health Oganization, 408, 644 Z score: Represents the number of standard deviations
Worldview: A counselor’s or client’s presuppositions and above or below the mean. 442
assumptions about the makeup of her or his world. Zeran, F. N., 362
299 Zimbardo, P. G., 140, 142
Wrenn, C. G., 57, 58 Zimmerman, J. L., 384
Wykes, T., 618 Zimpher, D. G., 6
Wynne, L., 391 Zinker, J., 267
Zone of proximal development: The dynamic and inter-
active process between what a child is capable of do-
ing by himself or herself and what a child can do with
Y the assistance of a parent, teacher, or mentor. 149
Zuckerman, M., 62
Yalom, I. D., 254, 279, 280, 282, 293
Zunin, L. M., 263
YAVIS client: Acronym for “young, attractive, verbal, in-
Zunker, V. G., 319, 320, 324, 332
telligent and successful,” the type of client a coun-
Zweerink, A., 521
selor is most interested in working with. 223
Zytowski, D. G., 330
Yehuda, R., 558
Young, M. E., 196, 198
Youngson, H. A., 621