The Profession of Counseling: An IntroductionEbone T. Johnson, Ph.D.
REHB 510
Counseling versus Psychotherapy: Is there a difference?
Counseling
Psychotherapy
Distinction between 2 terms ambiguous
Some debate:
counseling is more popular in educational and human service settings
psychotherapy is more popular in medical settings (Sharf, 2012)
Some debate:
psychotherapy:
Has greater depth and intensity
Has longer duration
Addresses personality organization and reconstruction
Provides services to persons with more severe pathology
Counseling:
More reality based problems
More problems of living, decision making, personal growth (Tyler, 1958; Gelso & Fretz, 1992)
Brief History of Counseling and Specialty Areas of Practice
Counseling: The Early Years
Many attribute to Frank Parsons
father of the guidance movement
1st career counseling center in Boston in 1909
Book: Choosing a Vocation(1909)
Jesse Davis
Principal
Introduced vocational guidance into public education
Idea of Call to a vocation
Clifford Beers
Patient
Advocate for reform of mental health facilities
Book A Mind that Found Itself (1908)
19th century-1960s- Dominant influence of Psychoanalysis and its derivatives
Freud
Alder
Jung
Horney
Sullivan
Counseling: The Middle Years
Known as professionalization of the counseling practice
Continuance of psychoanalysis (Freud)
Emergence of behaviorism (Skinner, Bandura, Lazarus)
Emergence of humanistic view of counseling beyond vocation
Rogers: client-centered approach
Counseling and Psychotherapy published in 1942
50s-70s
Major strides towards the professionalization of counseling
Specialty areas of counseling practice emerged
Rehabilitation counseling, mental health counseling, etc.
Contemporary Years
Issue of professional identity and professional unification
Professional associations
American Counseling Association
Education and training
CORE and CACREP
Practitioner credentials
NCC, CRC, Licensure (varies by state)
New Approaches based on:
Social constructivism
Narrative therapy
SFBT
Mindfulness and Acceptance
Mindfulness based CBT
Mindfulness based stress reduction
Acceptance and commitment therapy
Dialectical behavior therapy
CACREP Accredits 10 Masters Level Program Categories
Addition counseling
Community counseling
College counseling
Career counseling
Gerontological counseling
Marital, couple, and family counseling
Clinical mental health counseling
Student affairs and college counseling
Student affairs practice in higher education
College counseling emphasis
Professional practice emphasis
School counseling
CORE/CACREP Affiliation: Clinical Rehabilitation Counseling
CORE/CACREP Merger
Clinical Rehabilitation Counseling
http://www.cacrep.org/wp-content/uploads/2015/05/2016-CACREP-Standards.pdf
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Role and Function of Professional Counselors
Theories of Counseling
Psychological
Sociocultural
Systemic
Do we work with…
Patients
Clients
Customers
Consumers?????
Counselor Role
assist clients in reaching their optimal level of psychosocial functioning through
resolving negative patterns
prevention
rehabilitation and
Improving quality of life (QoL) (Hershenson & Power, 1987; p. 16)
Counselor Role
apply mental health, psychological, or human development principles through cognitive, affective, behavioral, or systemic intervention strategies , that address wellness, personal growth, or career development, as well as pathology
Counselor Function: NBCC
5 major work behavior dimensions
Fundamental counseling practice
Counseling for career development
Counseling groups
Counseling families
Professional practices
7 Counselor Functions: CRCC
Counseling (individual, group, marriage, family)and psychotherapy
Guidance and consultation
Appraisal
Diagnostic and treatment planning for persons with psychological disorders or disabilities
Functional assessments and career counseling for persons adjusting to a disability
Referrals
Research
Additional Functions from CRCC
Advocacy
Case Management
Crisis Management
Outreach
Importance knowledge areas of rehabilitation counselors
Job placement, consultation, and assessment
Case management and community resources
Individual, group, and family counseling
Medical, functional, and psychosocial aspects of disability (Leahy, Chan, Sung, Kim, 2013)
Licensure
49 states with licensure laws
Licensed Professional Counselor
Others have specialty licenses
Marriage and family
Mental health
Rehabilitation counseling
No state portability
Counselor as a Therapeutic Person
Authentic
Genuine
practice what you preach
Model appropriate behavior
Honesty
Personality of therapist vs. Techniques used (Lambert, 2011)
Effective Counselors….
Have an identity
Respect and appreciate themselves
Are open to change
Make choices that are life oriented
Are authentic, sincere, and honest
Have a sense of humor
Make mistakes and are willing to admit hem
Live in the present
Appreciate the influence of culture
Have a sincere interest in the welfare of others
Possess effective interpersonal skills
Become deeply involved in their work and derive meaning from it
Are passionate
Are able to maintain healthy boundaries
Effective services by Rehabilitation Health Professionals
Establishing a therapeutic working relationship
Communicating in a facilitative and helpful way
Obtaining information in a comprehensive and thorough manner
Helping clients tell their stories and explain their problems and needs
Understanding and conceptualizing behavior and problems in a way to facilitate treatment and service planning
Facilitating follow-through, commitments, and compliance with treatment and service plans
Is Personal Therapy Needed or Required?
Self-exploration to increase self-awareness
Understanding of how personal issues impact work
healing the healer
Contributions of personal therapy (Orlinsky et al., 2005)
Models the helping relationship
Enhances interpersonal skills
Helps deal with stressors of clinical work
Values
Core beliefs that influence behavior
Can we be 100% objective?
Respect
Exposing values vs. imposing values
Value imposition: directly attempting to define a clients values attitudes, beliefs, and behaviors(p. 23)
See ACA Ethics Code (A.4.b)
Becoming an Effective Multicultural Counselor
actively in the process of becoming aware of his or her own assumptions about human behavior, values, biases, preconceived notions, personal limitations, and so forth.
actively attempts to understand the worldview of his or her culturally different client without negative judgments.
actively developing and practicing appropriate, relevant, and sensitive intervention strategies and skills in working with his or her culturally different clients.
Issues faced by Beginning Therapists
Dealing with your anxieties.
Being yourself and self-disclosure.
Avoiding perfectionism.
Being honest about your limitations.
Understanding silence.
Dealing with demands from clients.
Dealing with clients who lack commitment.
Issues faced by Beginning Therapists
Tolerating ambiguity.
Becoming aware of your own countertransference.
Deals with our issues, impacts counseling relationship
Developing a sense of humor.
Sharing responsibility with the client.
Declining to give advice.
Defining your role as a counselor
Issues faced by Beginning Therapists
Learning to use techniques appropriately.
Developing your own counseling style.
Maintaining your vitality as a person and as a professional.
Counseling Efficacy and Effectiveness
What do we mean by ?
Variable: trait
Effectiveness: how well treatment works
Efficacy: if the treatment works
Effect size: numeric indicator of how well a treatment works
Evidence based practice:
Moderator
Mediator
Evidence Based Practice
DePalma (2000)
Process that begins with knowing what clinical questions to ask
Finding and reviewing best practices and critically evaluating/appraising findings on the basis of validity and utility
Must be used by an experienced clinician who considers the clients values and needs
Ends with evaluating the effectiveness and using that data to improve process
Hierarchy levels of evidence
Holm (2000) and Nathan and Gorman (1998)
Level 1: strong evidence from at least 1 systematic review of multiple well designed RCTs
Level 2: strong evidence from at least 1 properly designed RCT of appropriate size
Level 3: evidence from well-designed trials without randomization, single group, pre-post, cohort, time series, or matched case controlled studies
Level 4: evidence from well-designed non-experimental studies from more than 1 center or research group
Level 5: evidence from opinions of respected authorities based on clinical evidence, descriptive studies, or reports of expert committees.
Some Conventions for Defining Effect Sizes
PV=Proportion of variance in the DV explained by the linear model. [Minimum effect tests]
f2 = R2/(1-R2) [Traditional null hypothesis tests]
Moderators
Frazier, Tix, and Barron, 2004
Address when and for whom a variable most strongly predicts or causes an outcome variable
Chan, Tarvydas, Blalock, Strauser, and Atkins (2009)
An interaction whereby the effect of an IV (type of therapy) differs at different levels of another IV (race)
Mediators
Hoyt, Imel, and Chan (2008)
Provides info about the underlying mechanisms for change
For theory or model building-important to study mediator effect to better design interventions
Common Curative Factors
Client factors:
Goal directedness
Therapeutic Relationship
Empathy
Expectancy/Placebo/ Hope
Credibility
Techniques/Models
Questions
Feedback
Range of Client Characteristics (Unchangeable)
Therapeutic working alliance
What is the TWA?
Collaboration between client and counselor
Development of a bond and shared commitment to the goals and tasks of counseling
Bond: compatibility
Goals: targets for interventions
Tasks: behaviors/thoughts exchanged during therapy
Evidence shows it is the therapeutic relationship that make or break therapy (p. 306, Blow et al., 2007)
Efficacy of counseling interventions Wampold (2001)
Common Factors
Wampold (2001)
70% due to common factors
Underlie all psychotherapeutic approaches that affect outcome
Working alliance
Empathic listening
Goal setting
22% individual client differences
8% due to specific factors
Theoretical orientation/techniques
Dodo bird effect
Rosenweig (1936)
Common factors responsible for efficacy in psychotherapy
everybody has won, and all must have prizes (Caroll, 1865)
Luborsky, Singer, and Luborsky (1975)
Seminal review of outcome literature providing evidence for dodo bird effect
Alliance: Matching
Beutler and Consoli (1993) state the therapist is not the only contributor to a successful treatment outcome; and a match between counselor and client will strengthen the quality of the working alliance.
Demographics
Age match: 24.2% of client expressed a preference in counselors age, 65.2% of those wanting an older counselor
Disability status match : 90.5% of clients dont have a preference
Gender match: 70% of clients express a preference in gender, wanting to work with a female counselor
Race match: associated with increase treatment duration and decreased drop out among African Americans, not European Americans (Flaherty & Adams, 1998)
Expectancy match: Congruence in counselor-client expectances is positively associated to ratings of the working alliance (Al-Darmaki & Kivlighan, 1993 in Chan & Shaw, 1997).
Alternative Viewpoints on Matching
Norcross (1981) show there is a shift from the ideology that matching is essential for psychotherapeutic benefit.
Mahoney and Norcross (1993) state too similar a match does not allow for a different perspective or new learning experiences.
More on TWA
an active agent of the change process in its own right (Stevens et al., 2007).
occurs in phases, high/low pattern
Phase 1: a period of high hope from the client which is encouraged by the therapists supportive stance.
Phase 2: client realizes that all expectations will not be met and begins to question the treatment, leading to ambivalence and resistance.
Phase 3: in successful treatment, the client gains a more realistic understanding of the role of therapy and accepts change process, which occurs due to the therapist’s focus on working through and termination.
Navigating the therapeutic process, while working through conflicts with an empathic and responsive listener, is an essential part of change.
References
Chronister, J., Chou, C.C., ; Chan, F. (2009). The roles and functions of professional counselors. In I. Marini ; M.A. Stebnicki (Eds.). The professional counselors desk reference (pp. 15-25). New York, NY: Springer Publishing Company.
Corey, G. (2013). Theory and practice of counseling and psychotherapy (9th ed.). Belmont, CA: Brooks/Cole Cengage Learning.
Leahy, M.J., Rak, E., ; Zanskas, S.A. (2009). A brief history of counseling and specialty areas of practice. In I. Marini ; M.A. Stebnicki (Eds.). The professional counselors desk reference (pp. 3-13). New York, NY: Springer Publishing Company.
Sue, D.W. (2001). Multidimensional facets of cultural competence. The Counseling Psychologist, 29(6), 790-821.
Sue, D.W. ; Sue, D. (1990). Counseling the culturally different: Theory and practice. New York: Wiley.
