Main Counseling A Comprehensive Profession, Eighth Edition
Counseling A Comprehensive Profession, Eighth EditionSamuel T. Gladding
The most readable, practical, comprehensive overview of the roles and responsibilities of the professional counselor available--updated and improved to meet the needs of today's counselors. Long respected as the most comprehensive guide to the counseling profession available, Samuel Gladding's text continues to emphasize counseling as a profession and counseling as an identity, while focusing on the roles and responsibilities of the professional counselor. Designed to ensure students get a head start in preparing for the professional challenges they will face in their futures as effective counselors, the book includes the latest research from counseling journals and other professional resources to show clearly the challenges of the profession that lie ahead. The new edition of the text contains an even stronger emphasis on counseling as a profession and counseling as an identity, along with new or expanded sections on wellness, trauma, social justice, theories, process, multiculturalism, diversity, rehabilitation, motivational interviewing, bullying, microaggression, international counseling, addiction, abuse, and ethical and legal issues within the counseling profession. This text is even more equipped to help students prepare for professional challenges and a lifetime as an effective counselor than ever before. Among the text's new features are: Counselors are kept current on the emerging trends in the field through over 240 updated and new references. The text is now more approachable for courses taught on a semester basis through a format consolidation from 20 to 18 chapters. Important information on the history of counseling (previously presented as an opening chapter in the Seventh edition) now appears in Appendix A, providing additional reading for those interesting in expanding their knowledge. Students and professors get a strong look at many of the main tenets of the major approaches to counseling through new charts that appear within the two chapters on theories and in Appendix B. A more in-depth knowledge of supervision is provided in the expanded section. The flow of counseling as a complete entity is made clearer that combines the topics of working in a counseling relationship, and closing or terminating a counseling relationship. Learning through visual cues is enhanced through the inclusion of over 40 new graphs and tables inserted throughout the text without interrupting the narrative around them. How to work effectively with diverse and multicultural populations is supported through information that reflects the changes in demographics in the United States today. Infused throughout the book is material on working in a diverse and multicultural climate.
www.acetxt.com www.acetxt.com Eighth Edition Counseling A Comprehensive Profession Samuel T. Gladding Wake Forest University 330 Hudson Street, NY, NY 10013 www.acetxt.com Director, Teacher Education & the Helping Professions: Kevin M. Davis Portfolio Manager: Rebecca Fox-Geig Content Producer: Janelle Rogers Content Project Manager: Pamela D. Bennett Media Project Manager: Lauren Carlson Portfolio Management Assistant: Anne McAlpine Executive Field Marketing Manager: Krista Clark Executive Product Marketing Manager: Christopher Barry Procurement Specialist: Deidra Smith Cover Designer: Melissa Welch Cover Photo: Getty Images/Marion Owen, Design Pics Full-Service Project Management: Sadika Rehman, iEnergizer Aptara®, LTD Composition: iEnergizer Aptara®, LTD Printer/Binder: RR Donnelley/Crawfordsville Cover Printer: RR Donnelley/Crawfordsville Text Font: Times LT Pro 10/12 Copyright © 2018, 2013, 2009 by Pearson Education, Inc. or its affiliates. All Rights Reserved. Printed in the United States of America. This publication is protected by copyright, and permission should be obtained from the publisher prior to any prohibited reproduction, storage in a retrieval system, or transmission in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise. To obtain permission(s) to use material from this work, please visit http://www.pearsoned.com/permissions/. Acknowledgments of third party content appear on the page within text or on pages 512–513, which constitute an extension of this copyright. Unless otherwise indicated herein, any third-party trademarks that may appear in this work are the property of their respective owners and any references to third-party trademarks, logos or other trade dress are for demonstrative or descriptive purposes only. Such references are not intended to imply any sponsorship, endorsement, authorization, or promotion of Pearson’s products by the owners of such marks, or any relationship between the owner and Pearson Education, Inc. or its affiliates, authors, licensees or distributors. Library of Congress Cataloging-in-Publication Data Names: Gladding, Samuel T., author. Title: Counseling : a comprehensive profession / Samuel T. Gladding, Wake Forest University. Description: 8th edition. | Boston : Pearson Education,  | Includes bibliographical references and index. Identifiers: LCCN 2016042268| ISBN 9780134460604 | ISBN 013446060X Subjects: LCSH: Counseling. | Counseling psychology. Classification: LCC BF636.6 .G62 2018 | DDC 158.3--dc23 LC record available at https://lccn.loc. gov/2016042268 10 9 8 7 6 5 4 3 2 1 ISBN 10: 0-13-446060-X ISBN 13: 978-0-13-446060-4 www.acetxt.com To Dr. Thomas M. Elmore of Wake Forest University, who first taught me the art and science of being a counselor and who encouraged me to dream beyond the possible. www.acetxt.com PREFACE Counseling is a dynamic, ever-evolving, and exciting profession that deals with human potentials and problems in an intensive, personal, and caring way. It is a profession dedicated to growth, prevention, development, exploration, insight, empowerment, change, wellness, and remediation in an increasingly complex and chaotic world. In the past, counseling emphasized guidance by helping people make wise choices. Now guidance is but one part of this multidimensional profession. This text presents counseling in a broad manner covering its history, theories, activities, specialties, and trends. In addition, this text concentrates on the importance of the personhood of counselors and of the multicultural, ethical, and legal environments in which counselors operate. By focusing on the context and process of counseling, this text provides you with a better idea of what counselors do and how they do it. Materials in Counseling: A Comprehensive Profession, Eighth Edition, have been divided into four main sections. Part I, Professional Foundations of Counseling, contains chapters dealing with an overview of the important competencies of contemporary counselors. Specific chapters that will orient you to the counseling profession are: Chapter 1: Chapter 2: Chapter 3: Chapter 4: Personal and Professional Aspects of Counseling Ethical and Legal Aspects of Counseling Counseling in a Multicultural Society Counseling with Diverse Populations Part II, Counseling Processes and Theories, highlights the main processes, stages, and theories of the counseling profession. This section addresses the universal aspects of popular counseling approaches and zeros in on specific theories and ways of dealing with client concerns. The four chapters are: Chapter 5: Chapter 6: Chapter 7: Chapter 8: Building Counseling Relationships Working in and Closing a Counseling Relationship Psychoanalytic, Adlerian, and Humanistic Theories of Counseling Behavioral, Cognitive, Systemic, Brief, and Crisis Theories of Counseling Part III, Core Counseling Activities in Various Settings, emphasizes universal skills required in almost all counseling environments. Counselors use group counseling, consultation, supervision, research, testing, assessment, and diagnostic skills in various arenas. The chapters in this section include: Chapter 9: Chapter 10: Chapter 11: Chapter 12: Groups in Counseling Consultation and Supervision Evaluation and Research Testing, Assessment, and Diagnosis in Counseling Finally, Part IV, Counseling Specialties, contains six chapters that focus on specific populations with whom counselors work or professional practices in which they are engaged. The chapters are titled: Chapter 13: Career Counseling over the Life Span Chapter 14: Couple and Family Counseling iv www.acetxt.com Preface Chapter 15: Chapter 16: Chapter 17: Chapter 18: Professional School Counseling College Counseling and Student-Life Services Abuse, Addiction, Disability, and Counseling Clinical Mental Health and Private Practice Counseling A common theme woven throughout this text is that counseling is both a generic and s pecialized part of the helping field. Although it is a profession that has come of age, it is still growing. It is best represented in professional organizations such as the American Counseling Association (ACA) and its divisions. There are also numerous other helping professional groups—social workers, psychologists, psychiatric nurses, psychiatrists, marriage and family therapists, and pastoral counselors—that use and practice counseling procedures and theories on a daily basis. In essence, no one profession owns the helping process. However, being a counselor is distinct. This text is the result of a lifetime of effort on my part to understand the counseling profession as it was, as it is, and as it will be. My journey has included a wide variety of experiences— working with clients in all ages and stages of life in clinical settings and with students who are interested in learning more about the essence of how counseling works. Research, observation, dialogue, assimilation, and study have contributed to the growth of the content contained in these pages. NEW TO THIS EDITION Counseling is changing so rapidly that it is difficult to keep up. Four years makes a world of difference in the profession. So, updating and expanding a comprehensive text like this is a challenge. What is new? Plenty! • This edition of Counseling: A Comprehensive Profession has more than 240 updated and new references within its pages. Dozens of older references that are not as relevant anymore have been deleted. Many of the new additions are from the flagship journal of the profession: Journal of Counseling & Development. However, a number of other articles drawn from ACA divisional journals and related periodicals and texts are included. • The text has been consolidated from 20 to 18 chapters. This format is more amenable to courses offered on a semester basis. • The first chapter in the seventh edition of this text on the history of counseling has been moved to Appendix A. History is important and most chapters in this eighth edition contain a brief history of the topic being discussed. For those wishing more details, they are still available and the development of counseling in previous decades up to the present is traced. • Charts outlining the major theories of counseling have been added to the text and are available in Appendix B. These charts are excellent supplements to the two chapters on theories. They are also useful in reminding students (and professors) of many of the main tenets of these approaches to counseling. • Another change in this edition is an expanded section on supervision in counseling. It has been incorporated into the chapter on consultation. • The chapter on closing or terminating a counseling relationship has also been combined with the chapter on working in a counseling relationship. v www.acetxt.com vi Preface • More than 40 new graphs and tables have been inserted into the text, too. Many times those who study need visual cues as to what is being described linearly. The new visuals will meet this need while not affecting the narrative surrounding them. • Boldface terms in this text highlight important points that readers should remember. • Finally, this eighth edition is much more multicultural than ever before. Counseling is becoming more diverse in regard to the people who are seen. This edition reflects the changes in demographics that are a part of the United States. Infused throughout the text is material on working in a diverse and multicultural climate. ALSO AVAILABLE WITH MYCOUNSELINGLAB® This title is also available with MyCounselingLab, an online homework, tutorial, and assessment program designed to work with the text to engage students and improve results. Within its structured environment, students see key concepts demonstrated through video clips, practice what they learn, test their understanding, and receive feedback to guide their learning and ensure they master key learning outcomes. • Learning Outcomes and Standards measure student results. MyCounselingLab organizes all assignments around essential learning outcomes and national standards for counselors. • Video- and Case-Based Exercises develop decision-making skills. Video- and Case-based Exercises introduce students to a broader range of clients, and therefore a broader range of presenting problems, than they will encounter in their own pre-professional clinical experiences. Students watch videos of actual client-therapist sessions or high-quality role-play scenarios featuring expert counselors. They are then guided in their analysis of the videos through a series of short-answer questions. These exercises help students develop the techniques and decision-making skills they need to be effective counselors before they are in a critical situation with a real client. • Licensure Quizzes help students prepare for certification. Automatically graded, multiple-choice Licensure Quizzes help students prepare for their certification examinations, master foundational course content, and improve their performance in the course. • Video Library offers a wealth of observation opportunities. The Video Library provides more than 400 video clips of actual client-therapist sessions and high-quality role plays in a database organized by topic and searchable by keyword. The Video Library includes every video clip from the MyCounselingLab courses plus additional videos from Pearson’s extensive library of footage. Instructors can create additional assignments around the videos or use them for in-class activities. Students can expand their observation experiences to include other course areas and increase the amount of time they spend watching expert counselors in action. www.acetxt.com ACKNOWLEDGMENTS I am particularly indebted to input from my original mentors, Thomas M. Elmore and Wesley D. Hood, Wake Forest University, and W. Larry Osborne, University of North Carolina, Greensboro. Other significant colleagues who have contributed to my outlook and perception of counseling include C. W. Yonce, Peg Carroll, Allen Wilcoxon, Jim Cotton, Robin McInturff, Miriam Cosper, Charles Alexander, Chuck Kormanski, Rosie Morganett, Jane Myers, Diana Hulse, Ted Remley, Jerry Donigian, Donna Henderson, Debbie Newsome, Art Lerner, and Thomas Sweeney. Then, of course, there have been graduate students who have contributed significantly to this endeavor, especially Shirley Ratliff, Marianne Dreyspring, Hank Paine, Don Norman, Tom McClure, Paul Myers, Virginia Perry, Pamela Karr, Jim Weiss, and Tim Rambo. I am especially indebted to Wake Forest graduate assistants Sheryl Harper, Brandi Flannery, Elizabeth Cox, Joe Wilkerson, Jay Key, and Jayna Mumbauer for their hard work and contributions in helping me put together varied editions of this text. I am also grateful to the current reviewers for their comments and suggestions for improvement: Bret Hendricks, EdD, LPC-Supervisor, Texas Tech University; Kevin J. Kelley, Ph.D., Pennsylvania State University, Lehigh Valley Campus; Stacie Robertson, Southern Illinois University – Carbondale; and Charles Williams, University of Maryland Eastern Shore. Also appreciated is the valuable input of reviewers of the previous editions: Jesse A. Brinson, University of Nevada, Las Vegas; Sharon Jones, University of Georgia; Kristin A. Smiley, Oakland University; Brian L. Turner, University of West Florida; Lisa Costas, University of South Florida; Stuart Itzkowitz, Wayne State University; John Krumboltz, Stanford University; Sally Murphy, George Mason University; Julie Yang, Governors State University; Irene M. Ametrano, Eastern Michigan University; Jamie Carney, Auburn University; James S. DeLo, West Virginia University; Thomas DeStefano, Northern Arizona University; Michael Duffy, Texas A&M University; Thomas M. Elmore, Wake Forest University; Stephen Feit, Idaho State University; David L. Fenell, University of Colorado–Colorado Springs; Joshua M. Gold, University of South Carolina; Janice Holden, University of North Texas; Roger L. Hutchinson, Ball State University; Robert Levison, California Polytechnic State University–San Luis Obispo; Michael Forrest Maher, Sam Houston University; A. Scott McGowan, Long Island University; Karen N. Ripley, Georgia State University; Simeon Schlossberg, Western Maryland College; Holly A. Stadler, University of Missouri–Kansas City; Arthur Thomas, University of Kansas; JoAnna White, Georgia State University; Mark E. Young, University of Central Florida; and Scott Young, Mississippi State University. Their feedback and excellent ideas on how to improve this book were invaluable. I also owe a debt of gratitude to my past editors at Merrill, including Vicki Knight, Linda Sullivan, Meredith Fossel, and Kevin Davis. They have kept me on track, been extremely helpful, and made the writing and rewriting of this book a real joy. Finally, I am grateful to my parents, Russell and Gertrude Gladding, who gave me the opportunities and support to obtain a good education and who called my attention to the importance of serving people. Their influence continues to be a part of my life. Likewise, I am thankful to Claire, my wife, who has given me support over the years in writing and refining this text. She has been patient, understanding, encouraging, and humorous about this book, even in the midst of three pregnancies, three moves, and the launching of three children who are now young adults. She exemplifies what an ally in marriage should be. Her presence has brightened my days and made all the hard work a delight. Samuel T. Gladding vii www.acetxt.com ABOUT THE AUTHOR Samuel T. Gladding is a professor of counseling in the Department of Counseling at Wake Forest University in Winston-Salem, North Carolina. He has been a practicing counselor in public as well as private agencies since the early 1970s. His leadership in the field of counseling includes service as president of the following groups: the American Counseling Association (ACA), the American Association of State Counseling Boards (AASCB), the Association for Counselor Education and Supervision (ACES), the Association for Specialists in Group Work (ASGW), and Chi Sigma Iota (counseling academic and professional honor society international). Gladding is the former editor of the Journal for Specialists in Group Work and the author of more than seven dozen refereed professional publications. In 1999, he was cited as being in the top 1% of contributors to the Journal of Counseling & Development for the 15-year period 1978–1993. Some of Gladding’s other recent books are Clinical Mental Health Counseling in Community and Agency Settings (with Debbie Newsome) (5th ed., 2017); Group Work: A Counseling Specialty (7th ed., 2016); Family Therapy: History, Theory, and Practice (6th ed., 2015); Becoming a Counselor: The Light, the Bright, and the Serious (2nd ed., 2010); The Counseling Dictionary (3rd ed., 2011); and The Creative Arts in Counseling (5th ed., 2016). Prior to Wake Forest, Gladding’s previous academic appointments were at the University of Alabama at Birmingham (UAB) and Fairfield University (Connecticut). He received his degrees from Wake Forest, Yale, and the University of North Carolina—Greensboro. He is a National Certified Counselor (NCC), a Certified Clinical Mental Health Counselor (CCMHC), and a practicing Licensed Professional Counselor (North Carolina). Gladding is a Fellow in the American Counseling Association and a recipient of the Gilbert and Kathleen Wrenn Award for a Humanitarian and Caring Person, the Arthur A. Hitchcock Distinguished Professional Service Award, and the David K. Brooks Distinguished Mentor Award. Both the American Counseling Association and the Association for Creativity in Counseling have named national awards in his honor. Dr. Gladding is married to Claire Tillson Gladding and is the father of three sons. Outside of counseling, he enjoys walking, swimming, history, and humor. viii www.acetxt.com BRIEF CONTENTS PART I Professional Foundations of Counseling Chapter 1 Chapter 2 Chapter 3 Chapter 4 Personal and Professional Aspects of Counseling Ethical and Legal Aspects of Counseling 26 Counseling in a Multicultural Society 50 Counseling with Diverse Populations 71 PART II Counseling Processes and Theories Chapter 5 Chapter 6 Chapter 7 Chapter 8 1 2 91 Building Counseling Relationships 92 Working in and Closing a Counseling Relationship 115 Psychoanalytic, Adlerian, and Humanistic Theories of Counseling 146 Behavioral, Cognitive, Systemic, Brief, and Crisis Theories of Counseling 172 PART III Core Counseling Activities in Various Settings Chapter 9 Chapter 10 Chapter 11 Chapter 12 Groups in Counseling 202 Consultation and Supervision 222 Evaluation and Research 243 Testing, Assessment, and Diagnosis in Counseling PART IV Counseling Specialties Chapter 13 Chapter 14 Chapter 15 Chapter 16 Chapter 17 Chapter 18 EPILOGUE 201 264 287 Career Counseling over the Life Span 288 Couple and Family Counseling 314 Professional School Counseling 333 College Counseling and Student-Life Services 362 Abuse, Addiction, Disability, and Counseling 383 Clinical Mental Health and Private Practice Counseling 408 424 Appendix A HISTORY OF COUNSELING 427 Appendix B SUMMARY TABLES OF MAJOR COUNSELING THEORIES 451 Appendix C COUNSELING-RELATED ORGANIZATIONS 464 ix CONTENTS Part I Professional Foundations of Counseling 1 Chapter 1 PERSONAL AND PROFESSIONAL ASPECTS OF COUNSELING 2 Definition of Counseling 3 Guidance 3 • Psychotherapy 4 • Counseling The Personality and Background of the Counselor 6 4 Negative Motivators for Becoming a Counselor 6 • Personal Qualities of an Effective Counselor 7 • Maintaining Effectiveness as a Counselor 10 Professional Aspects of Counseling 12 Levels of Helping 12 • Professional Helping Specialties 12 • The Education of Professional Counselors 14 Credentialing of Counselors 15 Inspection 15 • Registration 15 • Certification 15 • Licensure 16 Attribution and the Systematic Framework of Counseling 17 Attributes 18 • Systems of Counseling 19 Engaging in Professional Counseling-Related Activities 22 Continuing Education 22 • Advocacy and Social Justice 23 • Portfolios 24 • Health Insurance Portability and Accountability Act (HIPAA) 24 Summary and Conclusion 25 Chapter 2 ETHICAL AND LEGAL ASPECTS OF COUNSELING 26 Definitions: Ethics, Morality, and Law 27 Ethics and Counseling 28 Professional Codes of Ethics and Standards 29 The Development of Codes of Ethics for Counselors 29 • Limitations of Ethical Codes 31 • Conflicts Within and Among Ethical Codes 31 Making Ethical Decisions 32 Other Guidelines for Acting Ethically 33 Educating Counselors in Ethical Decision Making 34 x Contents Ethics in Specific Counseling Situations 35 School Counseling and Ethics 36 • Computers, Counseling, and Ethics 36 • Couple and Family Counseling and Ethics 36 • Other Counseling Settings and Ethics 36 Multiple Relationships 37 Working With Counselors Who May Act Unethically 38 The Law and Counseling 39 Legal Recognition of Counseling 40 Legal Aspects of the Counseling Relationship 41 Civil and Criminal Liability 42 Legal Issues Involved When Counseling Minors 44 Client Rights and Records 44 Minimizing Legal Liability 46 The Counselor in Court 46 Ethics and the Law: Two Ways of Thinking 47 Summary and Conclusion 48 Chapter 3 COUNSELING IN A MULTICULTURAL SOCIETY 50 Counseling Across Culture and Ethnicity 51 Defining Culture and Multicultural Counseling 52 History of Multicultural Counseling 54 Difficulties in Multicultural Counseling 56 Issues in Multicultural Counseling 57 Counseling Considerations With Specific Cultural Groups 59 European Americans 60 • Blacks and African Americans 61 • Hispanics/Latinos/as 63 • Asian Americans 64 • Native American Indians 65 • Arab Americans 66 • International Counselling/Counseling 67 Summary and Conclusion 69 Chapter 4 COUNSELING WITH DIVERSE POPULATIONS 71 Counseling Aged Populations 72 Erikson’s Stages of Human Development 73 • Old Age 74 • Needs of the Aged 75 • Counseling the Aged 76 Gender-Based Counseling 78 Counseling Women 79 • Counseling Men 82 Counseling and Sexual Orientation 84 Counseling with Gays, Lesbians, Bisexuals, and Transgenders 85 xi xii Contents Counseling and Spirituality Summary and Conclusion 87 90 Part II Counseling Processes and Theories 91 Chapter 5 BUILDING COUNSELING RELATIONSHIPS 92 Factors that Influence the Counseling Process 93 Seriousness of the Presenting Problem 93 • Structure 94 • Initiative 97 • The Physical Setting 100 • Client Qualities 102 • Counselor Qualities 103 Types of Initial Interviews 104 Client- versus Counselor-Initiated Interviews 105 • Information-Oriented First Interview 105 • Relationship-Oriented First Interview 106 Conducting the Initial Interview 108 Empathy 109 • Verbal and Nonverbal Behavior 110 • Nonhelpful Interview Behavior 111 Exploration and the Identification of Goals 112 Summary and Conclusion 114 Chapter 6 WORKING IN AND CLOSING A COUNSELING RELATIONSHIP 115 Counselor Skills in the Working Stage of Counseling: Understanding and Action 117 Changing Perceptions 117 • Leading 119 • Multifocused Responding 119 • Accurate Empathy 119 • Self-Disclosure 122 • Immediacy 124 • Hope 124 • Humor 125 • Confrontation 125 • Contracting 126 • Rehearsal 128 Transference and Countertransference 129 Transference 129 • Countertransference 130 The Real Relationship 131 Closing a Counseling Relationship 132 Function of Closing a Counseling Relationship 132 Timing of Closing 133 Issues in Closing 134 Closing of Individual Sessions 134 • Closing of a Counseling Relationship 135 Resistance to Closing 136 Client Resistance 137 • Counselor Resistance 138 Contents Premature Closing 138 Counselor-Initiated Closing 140 Ending on a Positive Note 142 Issues Related to Closing: Follow-Up and Referral Follow-Up 142 • Referral and Recycling Summary and Conclusion 142 143 144 Chapter 7 PSYCHOANALYTIC, ADLERIAN, AND HUMANISTIC THEORIES OF COUNSELING 146 Theory 148 Importance of Theory 149 • Theory into Practice Psychoanalytic Theories 152 Psychoanalysis 152 Adlerian Theory 156 Adlerian Counseling 156 Humanistic Theories 160 Person-Centered Counseling 160 • Existential Counseling 164 • Gestalt Therapy 167 Summary and Conclusion 149 170 Chapter 8 BEHAVIORAL, COGNITIVE, SYSTEMIC, BRIEF, AND CRISIS THEORIES OF COUNSELING 172 Behavioral Counseling 173 Behavioral Therapy 173 Cognitive and Cognitive–Behavioral Counseling 177 Rational Emotive Behavioral Therapy (REBT) 178 • Reality Therapy (RT) 180 • Cognitive Therapy (CT) 183 Systems Theories 185 Bowen Systems Theory 185 • Structural Family Counseling 188 • Strategic (Brief) Counseling 190 Brief Counseling Approaches 192 Solution-Focused Counseling 192 • Narrative Counseling 194 Crisis and Trauma Counseling Approaches 196 Crisis Counseling 196 Summary and Conclusion 199 Part III Core Counseling Activities in Various Settings Chapter 9 GROUPS IN COUNSELING 202 A Brief History of Groups 203 Psychodrama 204 • T-Groups 204 • 201 xiii xiv Contents Encounter Groups 205 • Group Marathons 205 • Self-Help/Support Groups 205 Misperceptions and Realities about Groups 206 The Place of Groups in Counseling 206 Benefits and Drawbacks of Groups 208 Types of Groups 209 Psychoeducational Groups 209 • Counseling Groups 210 • Psychotherapy Groups 210 • Task/Work Groups 211 Theoretical Approaches in Conducting Groups 212 Stages in Groups 213 Issues in Groups 214 Selection and Preparation of Group Members 214 • Group Size and Duration 217 • Open-Ended versus Closed Groups 217 • Confidentiality 217 • Physical Structure 217 • Co-Leaders 218 • SelfDisclosure 218 • Feedback 218 • Follow-Up 219 Qualities of Effective Group Leaders 219 The Future of Group Work 220 Summary and Conclusion 221 Chapter 10 CONSULTATION AND SUPERVISION 222 Consultation 223 Consultation: Defining a Multifaceted Activity 223 Basic Aspects of Consultation 224 Consultation Versus Counseling 225 Four Conceptual Models 227 Levels of Consultation 228 Individual Consultation 228 • Group Consultation 229 • Organization/Community Consultation 230 Stages and Attitudes in Consultation 230 Specific Areas of Consultation 233 School Consultation 233 • Agency Consultation 236 Training in Consultation 237 Supervision 238 Summary and Conclusion 242 Chapter 11 EVALUATION AND RESEARCH 243 The Nature of Evaluation and Research 244 Evaluation 245 Incorrect Evaluation Methods 245 • Steps in Evaluation 245 • Selecting an Evaluation Model 246 Contents Counselors and Research 248 Research 249 Steps in the Research Process 249 • The Relevance of Research 250 • Choosing a Research Method 251 • Emphases of Research 252 • Major Research Methods 254 • Guidelines for Using Research 260 Statistics 261 Statistical Concepts 261 • Statistical Methods 262 Summary and Conclusion 263 Chapter 12 TESTING, ASSESSMENT, AND DIAGNOSIS IN COUNSELING 264 A Brief History of the Use of Tests in Counseling 265 Tests and Test Scores 267 Problems and Potential of Using Tests 268 Qualities of Good Tests 270 Validity 270 • Reliability 271 • Standardization and Norms 271 Classification of Tests 272 Intelligence/Aptitude 273 • Interest/Career 274 • Personality 276 • Achievement 278 Administration and Interpretation of Tests 279 Assessment 281 Diagnosis 283 Summary and Conclusion Part IV Counseling Specialties 285 287 Chapter 13 CAREER COUNSELING OVER THE LIFE SPAN 288 The Importance of Career Counseling 289 Career Counseling Associations and Credentials 290 The Scope of Career Counseling and Careers 291 Career Information 291 Career Development Theories and Counseling 294 Trait-and-Factor Theory 294 • Developmental Theories 296 • Social–Cognitive Career Theory 299 • Constructivist Career Theory 301 Career Counseling With Diverse Populations 302 Career Counseling with Children 303 • Career Counseling with Adolescents 304 • Career Counseling with College Students 306 • Career Counseling with Adults 307 • xv xvi Contents Career Counseling with Women and Ethnic Minorities Career Counseling with Gays, Lesbians, Bisexuals, and Transgenders 312 Summary and Conclusion 309 313 Chapter 14 COUPLE AND FAMILY COUNSELING 314 The Changing Forms of Family Life 315 The Beginnings of Couple and Family Counseling 316 Trends 316 • Couple and Family Therapy Pioneers and Contemporary Leaders 317 Associations, Education, and Research 318 Associations 318 • Education 319 • Research 319 Family Life and the Family Life Cycle 320 Couple/Family Counseling Versus Individual/Group Counseling 324 Overview of Couple and Family Counseling 325 Couple Counseling 325 • Family Counseling 325 The Process of Couple and Family Counseling 327 Presession Planning 327 • Initial Session(s) 328 • The Middle Phase of Couple and Family Counseling 329 • Termination/Closure 331 Summary and Conclusion 332 Chapter 15 PROFESSIONAL SCHOOL COUNSELING 333 The ASCA National Model 335 School Counselors at Various Levels 336 Elementary School Counseling 337 Emphases and Roles 337 • Activities 340 Middle School Counseling 346 Emphases and Roles 348 • Activities 348 Secondary School Counseling 351 Emphases and Roles 352 • Activities 353 21st-Century School Counseling 358 Summary and Conclusion 360 Chapter 16 COLLEGE COUNSELING AND STUDENT-LIFE SERVICES 362 The Beginning of Student-Life Services and College Counseling 364 The Theoretical Bases and Professional Preparation for Working with College Students 365 Theoretical Bases 365 • Professional Preparation 368 • Contents xvii College Counseling 368 Emphases and Roles 368 • Activities 369 Student-Life Professionals 374 Emphases and Roles 374 • Activities 376 Counseling and Student-Life Services with First-Year, Graduate Students, and Nontraditional Students 377 First-Year Students 377 • Graduate Students 378 • Older Students 378 • Part-Time Students 379 • First-Generation Students 379 • Minority Culture Students 379 • Student Athletes 381 Summary and Conclusion 382 Chapter 17 ABUSE, ADDICTION, DISABILITY, AND COUNSELING 383 The Cycle of Abuse 384 Interpersonal Abuse 384 Child Abuse 385 • Sibling Abuse 386 • Spouse and Partner Abuse 386 • Older Adult Abuse 388 • Preventing and Treating Interpersonal Abuse 388 Intrapersonal Abuse and Addiction 389 Physiological Abuse and Addiction 389 • The General Nature of Substance Abuse and Addiction 390 • Treating Substance Abuse and Addiction 391 • Treatment for Alcohol Abuse/Misuse and Addiction 392 • Treating Nicotine Abuse and Addiction 393 • Treating Drug Abuse and Addiction 394 Process Addictions 395 Compulsive Gambling 396 • Work Addiction (Workaholism) 396 • Internet Addiction 398 • Treating Internet Addiction 398 Treating Women and Minority Cultural Groups in Abuse and Addiction 398 Affiliation, Certification, and Education of Counselors Who Work in Abuse and Addiction 399 Counseling and Disability 400 The Nature of Disabilities 400 • Working with People Who Have Disabilities 401 • Clients with Specific Disabilities 402 Affiliation, Certification, and Education of Counselors Who Work with the Disabled 404 Counseling with the Disabled 404 • Counselors Who Work in Rehabilitation 405 Summary and Conclusion 406 xviii Contents Chapter 18 CLINICAL MENTAL HEALTH AND PRIVATE PRACTICE COUNSELING 408 The Development of Clinical Mental Health Counseling 409 Clinical Mental Health Counseling as a Specialty 410 Interests, Theories, and Functions 411 • Two General Clinical Disorders: Depression and Anxiety 419 • Trauma and Hopelessness 420 Employment of Clinical Mental Health Counselors 420 Private Practice as a Specialty 421 Difficulties in Setting Up a Private Practice 421 • Advantages in Setting Up a Private Practice 422 Summary and Conclusion EPILOGUE 423 424 Appendix A HISTORY OF COUNSELING 427 Appendix B SUMMARY TABLES OF MAJOR COUNSELING THEORIES 451 Appendix C COUNSELING-RELATED ORGANIZATIONS References 465 Credit 512 Name Index Subject Index 514 526 464 PART I Professional Foundations of Counseling Chapter 1 Personal and Professional Aspects of Counseling Chapter 2 Ethical and Legal Aspects of Counseling Chapter 3 Counseling in a Multicultural Society Chapter 4 Counseling with Diverse Populations 1 1 Personal and Professional Aspects of Counseling Chapter Overview From reading this chapter you will learn about: The consensus definition of counseling adopted by 29 diverse counseling associations ■■ The important personality factors and background qualities of counselors ■■ The professional aspects of being a counselor, including credentialing ■■ The attribution and systematic framework of counseling ■■ Engaging in professional counselor-related activities ■■ As you read consider: ■■ What has motivated you to enter the profession of counseling ■■ What qualities you need to cultivate in order to be successful as a counselor ■■ The many facets of credentialing and the differences in the types of credentials available RATOCA/Fotolia There is a quietness that comes in the awareness of presenting names and recalling places in the history of persons who come seeking help. Confusion and direction are a part of the process where in trying to sort out tracks that parallel into life a person’s past is traveled. Counseling is a complex riddle where the mind’s lines are joined with scrambling and precision to make sense out of nonsense, a tedious process like piecing fragments of a puzzle together until a picture is formed. Reprinted from “In the Midst of the Puzzles and Counseling Journey,” by S. T. Gladding, 1978, Personnel and Guidance Journal, 57, p. 148. © S. T. Gladding. 2 Chapter 1 • Personal and Professional Aspects of Counseling Counseling is a noble and altruistic profession. It emphasizes growth as well as remediation over the course of a life span in various areas of life: childhood, adolescence, adulthood, and older adulthood. Counselors specialize in helping individuals, couples, groups, families, and social systems that are experiencing situational, developmental, and long- or short-term problems. Counseling’s focus on development, prevention, wellness, and treatment makes it attractive to those seeking healthy life-stage transitions and productive lives. However, counseling has not always been an encompassing and comprehensive profession. It has evolved over the years from diverse disciplines “including but not limited to anthropology, education, ethics, history, law, medical sciences, philosophy, psychology, and sociology” (Smith, 2001, p. 570). (See Appendix A for a history of counseling.) Some people associate counseling with educational institutions or equate the word “guidance” with counseling because they are unaware of counseling’s evolution. As a consequence, outdated ideas linger in their minds in contrast to reality. They misunderstand the essence of the profession and those who work in it. Even among counselors themselves, those who fail to keep up in their professional development may become confused as to exactly what counseling is, where it has been, and how it is moving forward. As C. H. Patterson, a pioneer in counseling, once observed, some writers in counseling journals seem “ignorant of the history of the counseling profession . . . [and thus] go over the same ground covered in publications of the 1950s and 1960s” (Goodyear & Watkins, 1983, p. 594). DEFINITION OF COUNSELING There have always been “counselors”—people who listen to others and help them resolve difficulties—but the word “counselor” has been misused over the years by connecting it with descriptive adjectives to promote products. Thus, one hears of carpet counselors, color coordination counselors, pest control counselors, financial counselors, camp counselors, and so on. These counselors are mostly glorified salespersons, advice givers, and supervisors of children or services. They are to professional counseling what furniture doctors are to medicine. Counseling as a profession grew out of the progressive guidance movement of the early 1900s. Its emphasis was on prevention and purposefulness—on helping individuals of all ages and stages avoid making bad choices in life while finding meaning, direction, and fulfillment in what they did. Today professional counseling encompasses within its practice clinicians who still focus on the avoidance of problems and the promotion of growth, but the profession is much more than that. The focus is on wellness, development, mindfulness, meaningfulness, mattering, and growth, as well as the remediation of mental disorders, for individuals, groups, couples, and families across the life span. To understand what counseling is now, it is important first to understand how counseling is similar to and different from concepts such as guidance and psychotherapy. Guidance Guidance focuses on helping people make important choices that affect their lives, such as choosing a preferred lifestyle. Although the decision-making aspect of guidance has long played an important role in the counseling process, the concept itself, as a word in counseling, “has gone the way of ‘consumption’ in medicine” (Tyler, 1986, p. 153). It has more historical significance than present-day usage. Nevertheless, it sometimes distinguishes a way of helping that differs from the more encompassing word “counseling.” 3 4 Part I • Professional Foundations of Counseling One distinction between guidance and counseling is that guidance focuses on helping individuals choose what they value most, whereas counseling helps them make changes. Much of the early work in guidance occurred in schools and career centers where an adult would help a student make decisions, such as deciding on a course of study or a vocation. That relationship was between unequals and was beneficial in helping the less experienced person find direction in life. Similarly, children have long received “guidance” from parents, religious leaders, and coaches. In the process they have gained an understanding of themselves and their world. This type of guidance will never become passé. No matter what the age or stage of life, a person often needs help in making choices. But guidance is only one part of the overall services provided by professional counseling. Psychotherapy Traditionally, psychotherapy (or therapy) has focused on serious problems associated with intrapsychic disorders (such as delusions or hallucinations), internal conflicts, and personality issues (such as dependency or inadequacy in working with others). It has dealt with the establishment or “recovery of adequacy” (Casey, 1996, p. 175). As such, psychotherapy, especially analytically based therapy, has emphasized (a) the past more than the present, (b) insight more than change, (c) the detachment of the therapist, and (d) the therapist’s role as an expert. In addition, psychotherapy has historically involved a long-term relationship (20 to 40 sessions over a period of 6 months to 2 years) that concentrated on reconstructive change as opposed to a more short-term relationship (8 to 12 sessions spread over a period of less than 6 months). Psychotherapy has also been more of a process associated with inpatient settings—some of which are residential, such as mental hospitals—as opposed to outpatient settings—some of which are nonresidential, such as community agencies. However, in more modern times, the distinction between psychotherapy and counseling has blurred, and professionals who provide clinical services often determine whether clients receive counseling or psychotherapy. Some counseling theories, such as psychoanalysis, are commonly referred to as therapies as well and can be used in multiple settings. Therefore, the similarities in the counseling and psychotherapy processes often overlap. Counseling The term counseling eluded definition for years. However, in 2010, a consensus definition of counseling was agreed upon by 29 counseling associations including the American Counseling Association (ACA) and all but two of its then 19 divisions, along with the American Association of State Counseling Boards (AASCB), the Council for the Accreditation of Counseling and Related Educational Programs (CACREP), the National Board for Certified Counselors (NBCC), the Council of Rehabilitation Education (CORE), the Commission of Rehabilitation Counselor Certification (CRCC), and Chi Sigma Iota (counseling honor society international). It was achieved through a process called 20/20 where these groups met over a 3-year period in person and through Internet exchanges to create a broad, concise, and inclusive description of the process. According to the 20/20: A Vision for the Future of Counseling consortium, counseling is defined as follows: Counseling is a professional relationship that empowers diverse individuals, families, and groups to accomplish mental health, wellness, education, and career goals. (www.counseling.org/20-20/index.aspx) Chapter 1 • Personal and Professional Aspects of Counseling This definition contains a number of implicit and explicit points that are important for counselors as well as consumers to realize. • Counseling deals with wellness, personal growth, career, education, and empowerment concerns. In other words, counselors work in areas that involve a plethora of issues including those that are personal and those that are interpersonal. These areas include concerns related to finding meaning, adjustment, and fulfillment in mental and physical health, and the achievement of goals in such settings as work and school. Counselors are concerned with social justice and advocate for the oppressed and powerless as a part of the process. • Counseling is conducted with persons individually, in groups, and in families. Clients seen by counselors live and work in a wide variety of settings and in all strata of society. Their problems may require short-term or long-term interventions that focus on just one person or with multiple individuals who are related or not related to one another. • Counseling is diverse and multicultural. Counselors see clients with varied cultural backgrounds and at different ages and stages of life. Those from minority and majority cultures are helped in a variety of ways depending on their needs, which may include addressing larger societal issues, such as discrimination or prejudice. • Counseling is a dynamic process. Counselors not only focus on their clients’ goals, but they also help clients accomplish them. This dynamic process comes through using a range of theories and methods. Thus, counseling involves making choices as well as changes. Counseling is lively and engaging. In most cases, “counseling is a rehearsal for action” (Casey, 1996, p. 176) either internally with thoughts and feelings or externally with behavior. In addition to defining counseling in general, the ACA has defined a professionalcounseling specialty, which is an area (within counseling) that is “narrowly focused, requiring advanced knowledge in the field” of counseling (www.counseling.org). Among the specialties within counseling are those dealing with educational settings such as schools or colleges and those pertaining to situations in life such as marriage, mental health, rehabilitation, aging, assessment, addiction, and careers. According to the ACA, becoming a specialist is founded on the premise that “all professional counselors must first meet the requirements for the general practice of professional counseling” (www.counseling.org). PERSONAL REFLECTION What special talents do you have? How did they develop from your overall definition of yourself as a person? How do you see your personal circumstances paralleling the general definition of counseling and counseling specialties? Individuals aspire to become counselors for many reasons. For the most part, “it attracts caring, warm, friendly and sensitive people” (Myrick, 1997, p. 4). However, some motivators, like the people involved, are healthier than others, just as some counselor education programs, theories, and systems of counseling are stronger than others. It is important that persons who wish to be counselors examine themselves before committing their lives to the profession. Whether they choose counseling as a career or not, people can be helped by studying counseling. By doing so they may gain insight into their thoughts, feelings, and actions; learn how to relate better to others; and understand how the counseling process works. They may also further develop their moral reasoning, critical thinking, and empathetic abilities. 5 6 Part I • Professional Foundations of Counseling The effectiveness of a counselor and of counseling depends on numerous variables, including • the personality and background of the counselor; • the formal education of the counselor; and • the ability of the counselor to engage in professional counseling-related activities, such as continuing education, supervision, advocacy, and the building of a portfolio. Counselors and the counseling process have a dynamic effect on others. If counseling is not beneficial, it is most likely harmful (Carkhuff, 1969; Ellis, 1984; Mays & Franks, 1980). Thus, personal and professional factors that influence the counseling profession must be examined. THE PERSONALITY AND BACKGROUND OF THE COUNSELOR A counselor’s personality is at times a crucial ingredient in counseling. Counselors should possess personal qualities of maturity, empathy, and warmth. They should be humane in spirit and not easily upset or frustrated. Unfortunately, such is not always the case, and some people aspire to be in the profession of counseling for the wrong reasons. Negative Motivators for Becoming a Counselor Not everyone who wants to be a counselor or applies to a counselor education program should enter the field. The reason has to do with the motivation behind the pursuit of the profession and the incongruent personality match between the would-be counselor and the demands of counseling. A number of students “attracted to professional counseling … appear to have serious personality and adjustment problems” such as narcissism or unresolved developmental issues (Witmer & Young, 1996, p. 142). Most are screened out or decide to pursue other careers before they finish a counselor preparation program. However, before matriculating into graduate counseling programs, candidates should explore their reasons for doing so. According to Guy (1987), dysfunctional motivators for becoming a counselor include the following: • Emotional distress—individuals who have unresolved personal traumas • Vicarious coping—persons who live their lives through others rather than have meaningful lives of their own • Loneliness and isolation—individuals who do not have friends and seek them through counseling experiences • A desire for power—people who feel frightened and impotent in their lives and seek to control others • A need for love—individuals who are narcissistic and grandiose and believe that all problems are resolved through the expression of love and tenderness • Vicarious rebellion—persons who have unresolved anger and act out their thoughts and feelings through their clients’ defiant behaviors Fortunately, most people who eventually become counselors and remain in the profession have healthy reasons for pursuing the profession, and a number even consider it to be a “calling” (Foster, 1996). Counselors and counselors-in-training should always assess themselves in regard to who they are and what they are doing. Such questions may include those that examine their development histories, their best and worst qualities, and personal/professional goals and objectives (Faiver, Eisengart, & Colonna, 2004). Chapter 1 • Personal and Professional Aspects of Counseling CASE EXAMPLE Roberta’s Rotation Roberta had been a business student pursuing an MBA. However, she found dealing with facts and figures boring. So she quit. “What now?” she wondered. After a few months of floundering, she went to see a career specialist. In examining her interests, she found she liked working with people. “That’s it!” she said excitedly. “I’ll become a counselor! That way I can ‘assist’ all those overwrought and overeducated business types who are bored to death with their jobs. And all I’ll have to do is listen and, of course, give them advice. Sweet!” Would you want Roberta in your counseling program? Why? What else do you think she should consider? Personal Qualities of an Effective Counselor Among the functional and positive factors that motivate individuals to pursue careers in counseling and make them well suited for the profession are the following qualities as delineated by Foster (1996) and Guy (1987). Although this list is not exhaustive, it highlights aspects of one’s personal life that make a person best suited to function as a counselor. (You can evaluate how you rate yourself on these qualities by taking the “Effective Counselor Self Examination” on the next page.) • • • • • • • • • • Curiosity and inquisitiveness—a natural interest in people Ability to listen—the ability to find listening stimulating Comfort with conversation—enjoyment of verbal exchanges Empathy and understanding—the ability to put oneself in another’s place, even if that person is totally different from you Emotional insightfulness—comfort dealing with a wide range of feelings, from anger to joy Introspection—the ability to see or feel from within Capacity for self-denial—the ability to set aside personal needs to listen and take care of others’ needs first Tolerance of intimacy—the ability to sustain emotional closeness Comfort with power—the acceptance of power with a certain degree of detachment Ability to laugh—the capability of seeing the bittersweet quality of life events and the humor in them In addition to personal qualities associated with entering the counseling profession, a number of personal characteristics are associated with being an effective counselor over time (Welfel & Patterson, 2005). They include stability, harmony, constancy, and purposefulness. Overall, the potency of counseling is related to counselors’ personal togetherness (Carkhuff & Berenson, 1967; Gladding, 2009; Kottler, 2010). The personhood or personality of counselors is as important, if not more crucial in bringing about client change, than their mastery of knowledge, skills, or techniques (McAuliffe & Lovell, 2006; Rogers, 1961). Education cannot change a person’s basic characteristics. Effective counselors are growing as persons and are helping others do the same both personally and globally. In other words, effective counselors are sensitive to themselves and others. They monitor their own biases, listen, ask for clarification, and explore racial and cultural differences in an open and positive way (Ford, Harris, & Schuerger, 1993). In addition, effective 7 8 Part I • Professional Foundations of Counseling counselors practice what Wicks and Buck (2014) call “alonetime”—an intentional practice of devoting periods in their lives to silence and solitude and reflectivity. These are times when they improve self-awareness, renew self-care, and practice gratitude. They need to be planned and do not have to be long but can be as simple as taking a walk, waiting in line, or preparing for sleep. Effective Counselor Self Examination Answer the following questions as you see yourself in regard to the peer group with whom you most identify. What do the results tell you about yourself? not like me 1 somewhat like me 2 like me 3 a quality I aspire to 4 Intellectually Curious Capacity for Self Denial Self-Aware Sense of Humor Able to Listen Empathic Emotionally Insightful Introspective Comfortable with Conversation Comfortable with Power Tolerant of Intimacy Related to this sensitive and growth-enhancing quality of effective counselors is their appropriate use of themselves as instruments in the counseling process (Brammer & MacDonald, 2003; Combs, 1982). Effective counselors are able to be spontaneous, creative, and empathetic (Gladding, 2016a). “There is a certain art to the choice and timing of counseling interventions” (Wilcox-Matthew, Ottens, & Minor, 1997, p. 288). Effective counselors choose and time their moves intuitively and according to what research has verified works best. It is helpful if counselors’ lives have been tempered by multiple life experiences that have enabled them to realize some of what their clients are going through and therefore to be both aware and appropriate. Chapter 1 • Personal and Professional Aspects of Counseling The ability to work from a perspective of resolved emotional experience that has sensitized a person to self and others in a helpful way is what Rollo May characterizes as being a wounded healer (May, Remen, Young, & Berland, 1985). It is a paradoxical phenomenon. Individuals who have been hurt and have been able to transcend their pain and gain insight into themselves and the world can be helpful to others who struggle to overcome emotional problems (Miller, Wagner, Britton, & Gridley, 1998). They have been where their clients are now. Thus, “counselors who have experienced painful life events and have adjusted positively can usually connect and be authentic with clients in distress” (Foster, 1996, p. 21). Effective counselors are also people who have successfully integrated scientific knowledge and skills into their lives. They have achieved a balance of interpersonal and technical competence (Cormier, Nurius, & Osborn, 2017). Qualities of effective counselors over time other than those already mentioned include the following: • Intellectual competence—the desire and ability to learn as well as think fast and creatively • Energy—the ability to be active in sessions and sustain that activity even when one sees a number of clients in a row • Flexibility—the ability to adapt what one does to meet clients’ needs • Support—the capacity to encourage clients in making their own decisions while helping to engender hope • Goodwill—the desire to work on behalf of clients in a constructive way that ethically promotes independence • Self-awareness—a knowledge of self, including attitudes, values, and feelings and the ability to recognize how and what factors affect oneself (Hansen, 2009). According to Holland (1997), specific personality types are attracted to and work best in certain vocational environments. The environment in which counselors work well is primarily social and problem oriented. It calls for skill in interpersonal relationships and creativity. The act of creativity requires courage (Cohen, 2000; May, 1975) and involves a selling of new ideas and ways of working that promote intrapersonal as well as interpersonal relations. The more aligned counselors’ personalities are to their environments, the more effective and satisfied they will be. PERSONAL REFLECTION Take the O’Net Inventory Profiler (www.onetcenter.org/IP.html?p=3). Compare your highest interest scores with those found in different occupations, including counseling. What does this information reveal to you about how well you might fit into the environment of a helping profession? How does your score relate to the Wiggins and Weslander study that follows? What are the drawbacks to making a career decision based on a single inventory? In an enlightening and classic study, Wiggins and Weslander (1979) found empirical support for Holland’s hypothesis. They studied the personality traits and rated the job performance of 320 counselors in four states. In general, those counselors who were rated “highly effective” scored highest on the social (social, service oriented) and artistic (creative, imaginative) scales of John Holland’s Vocational Preference Inventory. Counselors who were rated “ineffective” generally scored highest on the realistic (concrete, technical) and conventional (organized, practical) scales. Other factors, such as gender, age, and level of education, were not found to be statistically significant in predicting effectiveness. The result of this research and other studies like it 9 10 Part I • Professional Foundations of Counseling affirms that the personality of counselors is related to their effectiveness in the profession. Nevertheless, the relationship of persons and environments is complex: Individuals with many different personality types manage to find places within the broad field of counseling and make significant contributions to the profession. CASE EXAMPLE Pass the Pain, Please Patricia grew up in a comfortable environment. She went to private schools, was extensively tutored, toasted by her parents’ associates, and was on the path to succeeding her father as CEO of a large corporation when she realized she wanted to work with people in a therapeutic way. She applied to a number of counseling programs and was accepted. However, she decided that before she entered a program she would take a year to work with poor people in a developing country so she could “suffer” some and become more empathetic. What do you think of her idea? Do you think her plan would help her? Maintaining Effectiveness as a Counselor Counselors gain confidence through experience, successes, and earning respect from others for what they do (Moss, Gibson, & Dollarhide, 2014). Nevertheless, persons who become counselors experience the same difficulties as everyone else and are challenged to deal with these situations effectively. Among the personal events counselors must deal with are aging, illness, death, marriage, getting a mortgage, parenting, job changes, divorce, loneliness, success, and a host of other common, developmental, and unexpected problems and occurrences that fill the lives of ordinary people. Some of these life events, such as marrying for the first time late in life or experiencing the death of a child, are considered developmentally “off time,” or out of sequence and even tragic (Skovholt & McCarthy, 1988). Other events consist of unintended but fortuitous chance encounters, such as meeting a person with whom one develops a lifelong friendship (Bandura, 1982; Krumboltz & Levin, 2004). Both traumatic and fortunate experiences are problematic because of the stress they naturally create. A critical issue is how counselors handle these life events. As Roehlke (1988) points out, Carl Jung’s idea of synchronicity, “which he [Jung] defined as two simultaneous events that occur coincidentally [and that] result in a meaningful connection,” is perhaps the most productive way for counselors to perceive and deal with unexpected life experiences (p. 133). Besides finding meaning in potentially problematic areas, other strategies counselors use for coping with crisis situations include remaining objective, accepting and confronting situations, asserting their own wishes, participating in a wellness lifestyle, and grieving (Shallcross, 2011b; Witmer & Young, 1996). Counselors who have healthy personal lives and learn from both their mistakes and their successes are more likely than others to grow personally and therapeutically and be able to concentrate fully and sensitively on clients’ problems. Therefore, counselors, and those who wish to enter the profession, need to adapt to losses as well as gains in life and remain relatively free from destructive triangling patterns with persons, especially parents, in their families of origin (McGoldrick, Gerson, & Petry, 2008). Such a stance enables them to foster and maintain intimate yet autonomous relationships in the present as desired (Gaushell & Lawson, 1994). Chapter 1 • Personal and Professional Aspects of Counseling Other ways effective counselors maintain their health and well-being include taking preventive measures to avoid problematic behaviors, such as compassion fatigue and burnout (Grosch & Olsen, 1994; Merriman, 2015; Morkides, 2009). Compassion fatigue is indifference and apathy to those who are suffering, as a result of frequent or overexposure to people in need. It is characterized as an inability to react sympathetically or empathetically to a crisis or need situation. Burnout consists of three components: emotional and physical exhaustion, cynicism, and decreased perceived efficacy (Lambert & Lawson, 2013). Those who have burnout describe it as a state of being emotionally or physically drained to the point that one cannot perform functions meaningfully. Burnout may exist simultaneously with compassion fatigue. There are a number of reasons why professional counselors become burned out, some of which overlap with compassion fatigue (Sang Min, Seong Ho, Kissinger, & Ogle, 2010). One of the main reasons involved in both is too much work and not enough downtime, hobbies, distractions, or other activities outside of counseling. When such a state of living occurs, counselors may not just lose concern, compassion, and feeling for others but they may also develop a negative self-concept and a negative job attitude. They often feel physically exhausted and emotionally spent as well. Burnout and compassion fatigue are the most common negative personal consequences of working as a counselor. It is estimated that approximately 39% of school and clinical mental health counselors experience a high to moderate amount of symptoms associated with these maladies during their careers (Emerson & Markos, 1996). To avoid compassion fatigue and burnout, counselors need to modify environmental as well as individual and interpersonal factors associated with these conditions (Wilkerson & Bellini, 2006). For example, counselors need to step out of their professional roles and develop interests outside counseling. They must avoid taking their work home, either mentally or physically. They also must take responsibility for rejuvenating their professional selves through such small but significant steps as refurbishing their offices every few years; purging, condensing, and creating new files; evaluating new materials; and contributing to the counseling profession through writing or presenting material with which they are comfortable (McCormick, 1998). Furthermore, they must invest time in becoming individuated by developing their personalities and sense of self outside of work, through reflective practices connected with their cognitive and affective functioning (Rosin, 2015). Other ways in which counselors can avoid or treat compassion fatigue and burnout include the following: • • • • • • • • • • • Associate with healthy individuals Work with committed colleagues and organizations that have a sense of mission Be reasonably committed to a theory of counseling Use stress-reduction exercises Modify environmental stressors Engage in self-assessment (i.e., identify stressors and relaxers) Periodically examine and clarify counseling roles, expectations, and beliefs (i.e., work smarter, not necessarily longer) Obtain personal therapy Set aside free and private time (i.e., balance one’s lifestyle) Maintain an attitude of detached concern when working with clients Retain an attitude of hope In summing up previous research about the personalities, qualities, and interests of counselors, Auvenshine and Noffsinger (1984) concluded, “Effective counselors must be emotionally mature, stable, and objective. They must have self-awareness and be secure in that awareness, incorporating their own strengths and weaknesses realistically” (p. 151). 11 12 Part I • Professional Foundations of Counseling PERSONAL REFLECTION What do you do that invigorates or refreshes you or that you enjoy? What other activities or hobbies would you like to include in your life? What keeps you from doing so? How might you get around any real or potential barriers? PROFESSIONAL ASPECTS OF COUNSELING Levels of Helping There are three levels of helping relationships: nonprofessional, paraprofessional, and professional (Table 1.1). To practice at a certain level requires that helpers acquire the skills necessary for the task. The first level of helping involves nonprofessional helpers. These helpers may be friends, colleagues, untrained volunteers, or supervisors who try to assist those in need in whatever ways they can. Nonprofessional helpers possess varying degrees of wisdom and skill. No specific educational requirements are involved, and the level of helping varies greatly among people in this group. A second and higher level of helping encompasses what is known as generalist human services workers. These individuals are usually human services workers who have received some formal training in human relations skills but work as part of a team rather than as individuals. People on this level often work as mental health technicians, child care workers, probation personnel, and youth counselors. When properly trained and supervised, generalist human services workers such as residence hall assistants can have a major impact on facilitating positive relationships that promote mental health throughout a social environment (Waldo, 1989). Finally, there are professional helpers. These persons are educated to provide assistance on both a preventive and a remedial level. People in this group include counselors, psychologists, psychiatrists, social workers, psychiatric nurses, and marriage and family therapists. Workers on this level have a specialized advanced degree and have had supervised internships to help them prepare to deal with a plethora of situations. In regard to the education of helpers on the last two levels, Robinson and Kinnier (1988) found that self-instructional and traditional classroom training were equally effective at teaching skills. However, it is the practice of helping skills that is most important. Professional Helping Specialties Each helping profession has its own educational and practice requirements. Counselors need to know the educational backgrounds of other professions in order to use their services, communicate with them in an informed manner, and collaborate with them on matters of mutual concern. TABLE 1.1 Three Levels of Helping Category Individuals Involved Helping Skills Nonprofessionals Friends, untrained volunteers Vary greatly, no formal training in helping skills Generalist human service workers Probation personnel, mental health technicians, etc. Have basic skills, often work as part of a team Professional helpers Counselors, psychologists, social workers, etc. Advanced skilled training; both preventive and remedial Chapter 1 • Personal and Professional Aspects of Counseling TABLE 1.2 Three Helping Professions Related to Counseling Profession Degree Emphases Psychiatry MD Major psychological disorders; biopsychological focus; may prescribe medications; clients called patients Psychology PhD, EdD, PsyD Clinical, counseling, and school specialties; counseling psychology Shares a long history with counselor education but is distinct Social Work BA, MSW, DSW, PhD Negotiates social systems and advocates for change; provides social services Three helping professions with which counselors frequently interact are psychiatrists, psychologists, and social workers (Table 1.2). Psychiatrists earn a medical degree (MD) and complete a residency in psychiatry. They are specialists in working with people who have major psychological disorders. They are schooled in the biomedical model, “which focuses on the physical processes thought to underlay mental and emotional disorders” (MacCluskie & Ingersoll, 2001, p. 8). Frequently, they prescribe medications and then evaluate the results, especially in agencies such as mental health clinics. Generally, psychiatrists take almost an exclusively biopsychological approach in treatment, and as a group they are not as heavily engaged in counseling activities as many other helping professionals. They must pass both national and state examinations to practice. Their clients are called patients. Psychologists earn one of the following advanced degrees in psychology: a doctor of philosophy (PhD), a doctor of education (EdD), or a doctor of psychology (PsyD). Their coursework and internships may be concentrated in clinical, counseling, or school-related areas. All states license psychologists, but the requirements for licensure differ from state to state. Most clinically oriented psychologists are listed in the National Register of Health Service Providers, which has uniform standards for inclusion. Graduates of counseling psychology programs follow a curriculum that includes courses in scientific and professional ethics and standards, research design and methodology, statistics and psychological measurement, biological bases of behavior, cognitive–affective bases of behavior, social bases of behavior, individual behavior, and courses in specialty areas. Counseling psychology and counselor education share many common roots, concerns, and significant persons in their histories but they differ too (Elmore, 1984; Evans & Gladding, 2010). While once close as disciplines, they differ now to the point that professionals who earn degrees in these distinct areas are no longer considered equals. Social workers usually earn a master’s of social work degree (MSW), although some universities award a bachelor’s degree in social work. There is also advanced training at the doctoral level. Regardless of their educational background, social workers on all levels have completed internships in social agency settings. Social workers vary in regard to how they function. Some administer government programs for the underprivileged and disenfranchised. Others engage in counseling activities. “Social work differentiates itself from counseling, psychology, and psychiatry in that its mission includes mandates to negotiate social systems and advocate for change, to understand clients’ habitats (physical and social settings within cultural contexts) and niches (statuses and roles in community) and to provide social services” (MacCluskie & Ingersoll, 2001, p. 13). The National Association of Social Workers (NASW) offers credentials for members who demonstrate advanced clinical and educational competencies. 13 14 Part I • Professional Foundations of Counseling The Education of Professional Counselors Few, if any, people have the ability to work effectively as counselors without formal education in human development and counseling (Kurpius, 1986b). The level of education needed is directly related to the intensity, expertise, and emphasis of work in which one engages. Professional counselors obtain either a master’s or a doctorate in counseling from a counselor education program and complete internships in specialty areas such as school counseling; rehabilitation counseling; mental health counseling; career counseling; gerontological counseling; addiction counseling; or marriage, couple, and family counseling. They are usually certified by the National Board of Certified Counselors (NBCC) (the primary national agency that certifies counselors) as a National Certified Counselor (NCC) (the entry level of national credentialing). Often they are credentialed on a specialist level, such as school, mental health, or addiction. In addition, they are licensed to practice by individual states. An accredited counselor education program is one recognized at either the master’s or doctoral level. The accrediting body for counselor education programs is the Council for Accreditation of Counseling and Related Educational Programs (CACREP). This independent body evolved from the efforts of the Association for Counselor Education and Supervision (ACES) and the American Counseling Association (ACA) to establish standards and guidelines for counseling independent of the National Council for Accreditation of Teacher Education (NCATE), which is the primary accreditation agency for teacher education programs. On the master’s level, CACREP accredits programs in career counseling; clinical mental health counseling; school counseling; marital, couple, and family counseling/therapy; college counseling and student affairs (Bobby, 2013). Graduates from accredited master’s programs have an advantage over graduates from nonaccredited programs in (a) obtaining admittance to accredited counselor education doctoral programs, (b) meeting the educational requirements for counselor licensure and certification, and (c) obtaining employment as a counselor (Urofsky, 2013). Although accreditation standards are periodically changing, the following broad standards must be met in an accredited counselor education master’s degree program (CACREP, 2016): • The entry-level program must be a minimum of 2 full academic years in length, with a minimum of 48 semester hours required of all students. The entry-level program in mental health counseling must be 60 semester hours long, and the entry-level program in marriage, couple, and family counseling must also be 60 semester hours. • Curricular experiences and demonstrated knowledge and skill competence is required of all students in each of eight common core areas of counseling: (a) human growth and development, (b) social and cultural foundations, (c) helping relationships, (d) groups, (e) lifestyles and career development, (f) appraisal, (g) research and evaluation, and (h) professional orientation. • Clinical experiences are required under the direction of supervisors with specific qualifications. The student must complete 100 clock hours of a supervised practicum with 1 hour per week of individual supervision and 1.5 hours per week of group supervision with other students in similar practice. • The program must require that each student complete 600 clock hours of a supervised internship, which is to begin only after successful completion of the student’s practicum. • Three full-time faculty members must be assigned to the academic unit in counselor education. CACREP accredits programs on the doctoral level too in counselor education and supervision (EdD and PhD). In 2016 there were 68 doctoral programs in counselor education accredited Chapter 1 • Personal and Professional Aspects of Counseling 15 by CACREP. Standards at this level assume that an individual has completed an entry-level master’s degree in counseling. Doctoral-level programs require more in-depth research, supervised field experiences, and specialization. A growing number of graduate schools are applying for CACREP accreditation because of the benefits and recognition such accreditation brings to them and to their students. Overall, counselor education programs have become deeper in course offerings and broader developmentally as a result of accreditation standards and procedures. CREDENTIALING OF COUNSELORS With the recognition of counseling as a separate professional entity, professional issues have arisen that must be addressed in a positive way. One of the most important of these is credentialing. Obtaining proper credentials to practice as a counselor is important to individual counselors and to the counseling profession as a whole. “Credentialed counselors possess enhanced visibility and credibility” (Clawson & Wildermuth, 1992, p. 1). There are basically four types of professional credentials, two of which, certification and licensure, have considerable prestige. In the past, most credentials were awarded by states, but now certification is also the function of a professional organization, the National Board for Certified Counselors (NBCC). Before deciding on what credentials to pursue, counselors need to know which are legally required for their practice and will enhance their credibility and development. Credentialing procedures have four levels: inspection, registration, certification, and licensure as explained as follows and summarized in Table 1.3. Inspection In the inspection process “a state agency periodically examines the activities of a profession’s practitioners to ascertain whether they are practicing the profession in a fashion consistent with the public safety, health, and welfare” (Swanson, 1983b, p. 28). Many state agencies that employ counselors, such as mental health centers, are subject to having their personnel and programs TABLE 1.3 Four Types of Professional Mental Health Credentials Type Activity Involved Reason Inspection Process whereby a state agency periodically ex- Ascertains whether professionals are pracamines the activities of a profession’s practitio- ticing the profession in a fashion consistent ners with the public safety, health, and welfare Registration Process whereby practitioners voluntarily submit A way to gain legal recognition for a information to the state concerning the nature of profession from a state their practice Certification Process by which an agency or association grants Broader than a state license, not subject to recognition to an individual for having met cer- state politics, provides referrals, recognizes tain predetermined professional qualifications counseling specialties Licensure Statutory process by which an agency of govern- Protects the public from nonqualified menment, usually a state, grants permission to a per- tal health practitioners; recognizes a professon meeting predetermined qualifications to sion and its practices engage in a given occupation and/or use a particular title to perform specified functions 16 Part I • Professional Foundations of Counseling regularly inspected. Such an inspection may include a review of case notes on treatment during a specific period, a review of agency procedures, and personal interviews. Registration Registration requires practitioners to submit information to the state concerning the nature of their practice. Usually a professional organization, such as a state division of the ACA, assumes the responsibility for setting standards necessary to qualify as a registrant and maintains a list of names of those who voluntarily meet those standards. This method is employed as a way to gain legal recognition for counselors who use the title “registered professional counselor.” Certification Certification is a professional, statutory, or nonstatutory process “by which an agency or association grants recognition to an individual for having met certain predetermined professional qualifications. Stated succinctly, certification … is a ‘limited license,’ that is, the protection of title only” (Fretz & Mills, 1980, p. 7). In this case, a state or national board or department issues a certificate to an individual in a specialty. Certification basically implies that the person meets the minimum skills necessary to engage in that profession and has no known character defects that would interfere with such a practice. Often states require candidates for certification to pass a competency test and submit letters of reference before a certificate is issued. School counselors were among the first counselors to be certified. NBCC is the main national organization that certifies counselors. Certification specialties are available from NBCC in school counseling, mental health counseling, addiction counseling, and supervision. Counselors who wish to become a National Certified Counselor (NCC) must have a minimum of 48 semester or 72 quarter hours of graduate study in counseling or a related field, including a master’s degree in counseling from a regionally accredited institution of higher education. They must include courses in their program of study that cover the eight core areas of counseling: (a) human growth and development, (b) group work, (c) research and program evaluation, (d) counseling theories/helping relationships, (e) professional orientation, (f) career and lifestyle development, (g) ethics and social/cultural foundations, and (h) appraisal. They must also have a minimum of two academic terms of supervised field experience in a counseling setting. In addition, they must pass the National Counselor Examination (NCE). In the case of individuals graduating from a non-CACREP program, 2 years of postmaster’s field experience with 3,000 client contact hours and 100 hours of weekly face-to-face supervision with an NCC or equivalent is also required. Counselors should obtain both NBCC certification and state licensure for four reasons (Clawson & Wildermuth, 1992). First, national certification is broader than state licensure and based on a larger population. Second, licensure is more susceptible than national certification to state politics. Third, national certification more readily provides referral sources and networking across state lines. Finally, most state counseling licenses do not recognize specialty areas, whereas national certification does. Licensure Fretz and Mills (1980) define licensure as “the statutory process by which an agency of government, usually a state, grants permission to a person meeting predetermined qualifications to engage Chapter 1 • Personal and Professional Aspects of Counseling in a given occupation and/or use a particular title and to perform specified functions” (p. 7). Licensure differs in purpose from certification but requires similar procedures in terms of education and testing for competence. Once licensure requirements are established, individuals cannot practice a profession legally without obtaining a license (Wheeler & Bertram, 2015). Licensure is almost exclusively a state-governed process, and those states that have licensure have established boards to oversee the issuing of licenses. “A licensee who commits an offense that violates the legal or ethical codes adopted by the board to regulate practice is subject to the board’s disciplinary authority. Disciplined providers of mental health services who do not face revocation or suspension of a license are generally permitted to continue to practice with one or more of the following requirements: • • • • • participating in corrective education, obtaining therapy, agreeing to be monitored, limiting the scope of their practice, and/or having their practice supervised by specified colleagues. (Cobia & Pipes, 2002, p. 140) In general, the licensing of professional helpers is always under scrutiny from the public, other professions, and state legislatures. The licensing of counselors gained momentum in the 1970s and 1980s, just as the licensing of psychologists did in the 1960s and 1970s. By 2010, all 50 states, plus Puerto Rico, Guam and the District of Columbia legally regulated the practice of counseling. To coordinate efforts at uniformity and growth in counselor licensure, the American Association of State Counseling Boards (AASCB) was formed in 1986 (Dingman, 1990). It holds annual conferences where counselor licensure board members meet to discuss and resolve mutual problems and concerns. CASE EXAMPLE Alice and the Alphabet When she moved to a new state, Alice set about making sure she was licensed. She worked hard, and in time the state licensure board granted her a license. Alice was thrilled but when she showed her new business cards to her friend Luke, his response was: “Why do you want to put the alphabet after your name? Who cares about letters like ‘LPC’?” Alice was taken aback initially but then she thought: “I want to do it because it indicates my professional status. I have earned it and the credential is important not only to me but to my clients.” What do you think of Luke’s reaction? How about Alice’s answer? ATTRIBUTION AND THE SYSTEMATIC FRAMEWORK OF COUNSELING Attribution and the systematic framework of counseling makes a difference in what counselors do and how effectively they do it. Attribution is what the counselor attributes the cause of a client’s problem to (e.g., an external circumstance or an internal personality flaw). A system is a 17 18 Part I • Professional Foundations of Counseling unified and organized set of ideas, principles, and behaviors. Systems associated with counseling are concerned with how the counselor approaches clients and are interrelated to attributes and theories. Two systems, one based on developmental issues and one based on the diagnosis of disorders, will be examined here because it is from these two perspectives (and the places in between) that counselors work. Attributes Both counselors and clients enter a relationship with some assumptions about what may have caused a problem. Often these personal perceptions are far apart. However, “diagnostic decisions, symptom recognition, and predictions concerning treatment response and outcome can be [and often are] influenced by counselors’ explanations for the cause [or causes] of clients’ presenting problems” (Kernes & McWhirter, 2001, p. 304). For example, if clients are seen as being responsible for their problems, such as bad decision making, they may be held directly responsible for their actions, whereas if the cause of a problem is viewed as beyond their control, such as the trauma of an unexpected death, they may be treated sympathetically. Regardless, attribution has a lot to do with how counselors work and what they do or require of clients. There are four main attribution models that counselors use on either a conscious or unconscious basis (Kernes & McWhirter, 2001). They are explained as follows and summarized in Table 1.4: Medical Model—“In this model, clients are not held responsible for either the cause of their problem or its solution” (p. 305). Counselors who adopt this model act basically as experts and provide the necessary services for change. Although clients are not blamed, they may become dependent. Moral Model—This model is best typified by the self-help movement and is basically the opposite of the medical model. “Clients are seen as responsible for both causing and solving their problems” (p. 305). Counselors are viewed primarily as coaches or motivators. The drawback to this model is that those who may be victims of circumstances may be held responsible for their own victimization. Compensatory Model—In the compensatory model, clients are held “responsible only for solving their problems but not for causing them” (p. 304). Essentially, clients are viewed TABLE 1.4 Four Main Attribution Models of Counselors Model Counselor Acts as Client Is Seen as Medical Expert Clients not blamed or held responsible for their problems; downside is clients may become dependent on counselor Moral Coach, motivator Clients held responsible for causing and solving their problems Compensatory Teacher Clients seen as only responsible for solving but not causing their problems; partner with counselor for solutions Enlightenment Authority figure Clients held responsible for causing their problems but not solving them Chapter 1 • Personal and Professional Aspects of Counseling as “suffering from the failure of their social environments to meet their needs” (p. 304). Therefore, counselors and clients form a partnership to overcome problems with the counselor taking a subordinate role and acting as a teacher who provides education, skills, and opportunities for clients. The drawback to this model is that clients may “feel undue pressure at having to continually solve problems they did not create.” Enlightenment Model—This model holds “clients responsible for causing their problems but not for solving them” (p. 304). Clients are seen as “guilty individuals whose lives are out of control” (p. 304). They need enlightenment into the nature of their problems and ways of resolving these problems that the counselor can provide. Whereas clients may feel relief in such an approach, the disadvantage in this model is that they may become dependent on the counselor who acts in the role of an authority figure, or they may structure their lives around external sources of authority after they have completed counseling. PERSONAL REFLECTION Think of difficulties you have had in your life. Which of the attribution models just discussed do you think you would feel most comfortable with had you gone to a counselor for help with most of these problems? Systems of Counseling Effective counselors adhere to certain systems of counseling as well as theories of counseling. Indeed, the strength of counseling ultimately depends on a continuation of that process. That counseling is not governed by one dominant system approach is hardly surprising considering its historical development. Counseling started like a person who mounted a horse and rode off in all directions; that is, the person had no focus or planned direction (Ungersma, 1961). It has only been in recent history that counseling has been more focused and united. As far back as the late 1940s, professionals noticed the lack of a system for counseling. Robert Mathewson (1949) observed that counseling was in “a search for a system … to win free from inadequate frames borrowed from traditional philosophy and education, from psychology, from political formulations underlying democratic government, from the concepts of physical science, etc.” (p. 73). Until the late 1940s, counseling used a variety of systems. Because the profession was without an organizational base, different factions defined what they did according to the system that suited them best. Competition among points of view, especially those connected with theories, was often spirited. For example, E. G. Williamson and Carl Rogers debated the merits of their approaches (counselor-focused versus client-focused) with passion. Some counselors recognized the need for a unifying systematic approach to their discipline, but the unplanned growth of the profession proved an obstacle. However, by the 1990s several systems of counseling had emerged, the two most dominant being the developmental/wellness approach and the medical/ pathological approach. The developmental/wellness perspective to counseling is based on stages various personality theorists have outlined that people go through THE DEVELOPMENTAL/WELLNESS APPROACH. 19 20 Part I • Professional Foundations of Counseling as a normal part of human growth. Counseling from this perspective is premised on whether a problem a client is having is part of a developmental task of life or not. For example, establishing an identity is a developmental task in life with which individuals in early adulthood may struggle. However, it is not a task for those in their 70s who have already carved out an identity. Thus, behaviors that are appropriate at one stage of life are not as healthy or relevant at another stage of life, although if unresolved, they may well be present. Allen Ivey (1990) was not the first to suggest that counseling systems be based on a developmental perspective, but his integration of developmental growth with counseling strategies stands out as one of the most unique expressions of this approach. Basically, Ivey suggests applying Piagetian concepts of cognitive levels (i.e., sensorimotor, concrete, formal, and postformal) to clinical interviews with adults and children. Therefore, if clients do not initially recognize their feelings, counselors will work from a sensorimotor level to bring out emotions. In a similar way, clients who are interested in planning strategies for change will be helped using a formal pattern of thought. Developmental counseling and therapy (DCT) “specifically addresses the sequence and process of development as it occurs in the natural language of the interview” (Ivey & Ivey, 1990, p. 299). Wellness goes even further than development in emphasizing the positive nature and health of human beings (Granello, 2013). “Counselors have historically been in the business of helping their clients identify their strengths and build on their strengths” (Rak & Patterson, 1996, p. 368). In this perspective, individuals are seen as having the resources to solve their own problems in a practical, immediate way. “Problems are not evidence of an underlying pathology” (Mostert, Johnson, & Mostert, 1997, p. 21). Indeed, as Goodman (2015) points out, wellness and difficulties are connected to a community. Thus, individuals including at-risk children may show resilience if they receive support from the society in which they are a part. Resilience in this case refers to personal qualities and skills—either dynamic or trait—that allow the individual to make a healthy, successful, or adaptive response to a disruptive or adversarial life event (Lee et al., 2013; Rak & Patterson, 1996). Undeniably, as Zautra, Hall, and Murray (2010) argue, resilience, wellness, and disorders are integrative constructs. How people and their communities achieve and sustain health and well-being in the face of adversity is complex because it is a developmental process and like wellness, it exists on a continuum (Granello, 2013). An example of a counseling approach based on the wellness model is solution-focused theory. In this approach, the emphasis is on health and strength. The approach helps clients tap into their inner resources and find solutions to situations that already exist in their lives, some of which are universal in nature. Stress inoculation training (SIT) (Meichenbaum, 1993), a proactive, psychoeducational intervention that can be used in schools and with adults, is an example of a present and future wellness emphasis approach (Israelashvili, 1998). In this model, individuals are helped to understand their problematic situations, acquire skills for coping with them, and apply this knowledge to present and even future events through the use of imagery or simulated rehearsal. A cornerstone of the developmental/wellness approach is its stress on prevention and education (Kleist & White, 1997). Counselors and clients function best when they are informed about the mental, physical, and social spheres of human life as represented in the wellness wheel developed by Myers and Sweeney (2005). Through gaining knowledge of the multiple nature of wellness, counselors and clients recognize how they can focus on avoiding or minimizing disruptive forces that are either internal or external in nature. THE MEDICAL/PATHOLOGICAL MODEL. In contrast to the developmental/wellness view of counseling is the medical/pathological model of human nature represented by those who base Chapter 1 • Personal and Professional Aspects of Counseling treatment plans in accordance with the Diagnostic and Statistical Manual of Mental Disorders (DSM) (American Psychiatric Association, 2013). The DSM is compatible with the International Classification of Diseases manual (ICD), published by the World Health Organization, in codifying psychiatric disorders. The fifth edition of the DSM contains different clinical diagnoses with much more information about each than the 106 diagnoses in the initial edition of this manual published in 1952. The chapters in the fifth edition of the DSM are organized in a developmental life span fashion. Neurodevelopmental Disorders, which often are diagnosed in infancy and early childhood, are explained first. Then, in a progressive fashion, the manual focuses on diagnostic areas more commonly having an onset in adulthood, such as Sleep-Wake Disorders. Within each diagnostic category, individual disorders are similarly arranged. This chapter ordering makes an attempt to closely situate diagnostic areas that seem to be related to one another, such as creating a specific category for Bipolar and Related Disorders and placing it immediately after Schizophrenia Spectrum and Other Psychotic Disorders. DSM-5 Organizational Structure Neurodevelopmental Disorders Schizophrenia Spectrum and Other Psychotic Disorders Bipolar and Related Disorders Depressive Disorders Anxiety Disorders Obsessive-Compulsive and Related Disorders Trauma- and Stressor-Related Disorders Dissociative Disorders Somatic Symptom Disorders Feeding and Eating Disorders Elimination Disorders Sleep-Wake Disorders Sexual Dysfunctions Gender Dysphoria Disruptive, Impulse Control, and Conduct Disorders Substance Use and Addictive Disorders Neurocognitive Disorders Personality Disorders Paraphilias Other Disorders Overall, the DSM is an extremely interesting but controversial medical/pathology model. It is atheoretical and frames mental disorders as dispositional, that is, something that is within the individual and part of his or her psychological makeup. Social problems such as racism, discrimination, patriarchy, homophobia, and poverty may “become lost in the DSM’s focus on disorders being rooted in the individual” (Kress, Eriksen, Rayle, & Ford, 2005, p. 98). Furthermore, the DSM does not deal substantially with anything but individual diagnoses, many of which are severe. Therefore, this classification system is of limited value to group workers, 21 22 Part I • Professional Foundations of Counseling marriage and family counselors, and counseling professionals who are not working with highly disturbed populations or who work from a humanistic orientation. For instance, the DSM eliminated the term “bereavement” (formerly used to describe a grief reaction associated with the loss of a loved one). Instead, grief for more than two months following the loss of a loved one is classified now as a major depression (Fox & Jones, 2013). There is considerable difference in how a bereaved person and a major depressed individual are seen, let alone treated. However, on the plus side, the DSM-5 is logically and developmentally organized and is sophisticated in its use of neurobiological research. Counselors should not be naive about the limitations of the DSM or alternatives. However, they should master DSM terminology regardless of their setting, specialty, or even agreement with the classification system for the following reasons (Geroski, Rodgers, & Breen, 1997; Kress et al., 2005; Seligman, 2004, 1999): 1. The DSM system is universally used in other helping professions and forms the basis for a common dialogue between counselors and other mental health specialists. 2. The DSM system helps counselors recognize patterns of mental distress in clients who need to be referred to other mental health professionals or treated in a certain way. 3. By learning the DSM system, counselors establish accountability, credibility, uniform record keeping, informed treatment plans, research, and quality assurance. PERSONAL REFLECTION How exciting is diagnosing clients through the DSM to you? Did you expect that you would have to diagnose when you decided to become a counselor? What appeals to you most in regard to the two models just presented (medical vs. wellness)? More specifically, which do you like best and why? ENGAGING IN PROFESSIONAL COUNSELING-RELATED ACTIVITIES Becoming a counselor is a lifelong process. It continues well past the formal education of obtaining a master’s or doctoral degree and includes participation in professional counseling-related activities. Granello (2010a) found that counselors with more years in the counseling profession had higher levels of cognitive complexity (the ability to absorb, integrate, and make use of multiple perspectives). Earning highest degrees in the counseling profession also contributed to the prediction equation. However, becoming more cognitively complex with all the benefits it brings, such as the ability to tolerate ambiguity, listen carefully, suspend judgments, look for evidence, and adjust opinions when new information becomes available, is not automatic. Counselors must work at it! Ways they help themselves in this journey are by obtaining continuing education units (CEUs) to stay up-to-date on theories and practice, getting needed supervision to ensure excellence in treatment (covered in Chapter 10), advocating for both their clients and the profession of counseling, and creating portfolios. In addition, they must learn about and stay up-to-date on government regulations, for example the Health Insurance Portability and Accountability Act (HIPAA). Continuing Education There is a need for continuing education for all counselors, especially after graduation from a counseling program. The reason is that new ideas in the treatment and practice of clients are Chapter 1 • Personal and Professional Aspects of Counseling always evolving and must be evaluated, incorporated, and, if necessary, mastered. Counselors who stop reading professional publications or stop attending in-service workshops and conventions quickly become dated in the delivery of skills. Therefore, counselors must obtain a certain number of CEUs annually to stay abreast of the latest and best methods of working. CEUs are offered by approved professional counseling organizations on the local, state, regional, and national levels. It is possible to earn CEUs through correspondence courses as well as attending workshops. CEUs are even offered free for reading some ACA counseling journals and ACA’s monthly magazine, Counseling Today. Counselors who are licensed or certified have to earn a certain number of CEUs to retain their credentials. Engaging in such continuous efforts is sometimes expensive in terms of time and money, but the cost of not keeping up professionally (i.e., becoming incompetent or outdated) is much higher. Advocacy and Social Justice In addition to other characteristics and qualities connected with themselves and the counseling process, effective counselors engage in advocacy and social justice work. “Advocacy can be defined simply as promoting an idea or a cause through public relations. It involves networking and education” (Tysl, 1997, p. 16). Social justice refers to the idea of creating a society or institution that is based on the principles of equality, that values human rights, and that recognizes the dignity of every human being. Counselors need to support and actively espouse client concerns and the profession of counseling on multiple levels. By doing so, they correct injustices and improve conditions for individuals, groups, and society (Goodman, 2009; Osborne et al., 1998). This process can be achieved in a number of ways, such as making presentations to clubs and civic groups, writing articles for newspapers, contacting le