1.

Human Growth and Development

1. Development
a. is defined as systematic changes and continuities in the individual that
occur between conception and death. These systematic changes occur
in three broad areas: physical development, cognitive development,
and psychosocial development.
2. Theories of how humans grow and develop fall into the following
broad categories:
a. learning including behavioral theories, social learning theories, and
information-processing theories
b. cognitive theories
c. psychoanalytic including the neo-Freudian and ego psychology theories
d. humanistic psychology and self theories
3. Human growth and development changes can be viewed as:
a. Qualitative: change in structure or organization (for example, sexual
development) or
Quantitative: change in number, degree or frequency (content changes,
for example, intellectual development).

b. Continuous: changes are sequential and cannot be separated easily (for

example, personality development) or
Discontinuous: certain changes in abilities or behaviors can be separated
from others which argue for stages of development (for example, language
development).

c. Mechanistic: this is the reduction of all behavior to common elements (for

example, instinctual, reflexive behavior)or
Organismic: because of new stages, there is change or discontinuity; it is
more than Stimulus-Response. The organism is involved including the use of
cognition. Examples would be moral or ethical development.

4. Self-concept
 Self-concept may be defined as your perception of your qualities,
attributes and traits.
 At birth, infants have no sense of self. In early months this quickly
changes.
 By 24 months, most infants show signs of self-recognition; they can
identify social categories they are in such as age and gender, "who is
like me and who is not like me"; they exhibit various temperaments.
 The pre-school child's self-concept is very concrete and physical. By 8
or so, they can describe inner qualities.
  By adolescence, self-concepts (self-descriptions) become more abstract
and psychological. Stabilization of self-concept attributes continues.
 Cultural and family factors influence the development of attributes and
some traits.

5. Developmental concepts
 Nature vs. nurture: Nature includes genetic and hereditary factors.
 Nurture includes learning and environmental factors.
 Genotype and Phenotype: Genotype is the genetic (inherited) makeup
of the individual.
 Phenotype: the way an individual's genotype is expressed through
physical and behavioral characteristics.
 Tabula rasa: John Locke's view that children begin as a 'blank slate'
 acquiring their characteristics through experience.
 Plasticity: for most individuals lifespan development is plastic
representing an easy and smooth transition from one stage to the next.
 Resiliency: the ability to adapt effectively despite the experience of
adverse circumstances. For example, some children, despite
experiencing potentially damaging conditions and circumstances,
seem to suffer few consequences.

6. Neurobiology
 Neuroscience is sometimes referred to as the missing link in the
mental health professions. Ivey, D'Andrea and Ivey (2012 - see
references) believe that "the mind is the product of the activity
occurring in the brain at the molecular, cellular, and anatomical levels,
which are in turn impacted by a person's interpersonal relationships,
cultural context, and societal experience.”
 Counselors, by using different theories, skills and interventions
promote the release of various neurotransmitters which promote
related brain changes.
 Neurotransmitters affect various cognitive, emotional, psychological
and behavioral reactions that people have to their life experiences.
 Neurotransmitters carry messages between neurons that stimulate
reactions in the brain. These chemical reactions stimulate different
parts of the brain leading to different cognitive, emotional,
psychological and behavioral outcomes.
Four principal neurotransmitters important to counselors:

a. Acetylcholine -- important for memory, optimal cognitive functioning,

emotional balance and control
b. Serotonin -- affects feelings, behaving, thinking; critical for emotional and
cognitive processes; vital to sleep and anxiety control
c. Dopamine -- important for emotional wellness, motivation, pleasurable
feelings
d. GABA (gamma amino butyric acid) -- helps reduce anxiety, promotes
relaxation and sleep
Different counseling and therapy skills help promote the production of each
of these four neurotransmitters.

7. Abraham Maslow (Humanistic Psychologist)

Maslow developed the 'hierarchy of needs.' People are always motivated to
higher-order needs:
 food/water to
 security/safety to
 belonging/love to
 self-esteem/prestige/status to
 Self-actualization.
We go from filling our needs from the physiological level to the social level
to the cognitive level.

8. Robert Havighurst
Havighurst identified stages of growth-each one requiring completion of the
last one for success and happiness.
Developmental tasks arise from physical maturation, influences from culture
and society, and desires and values of the person.
Developmental tasks are the skills, knowledge, behaviors, and attitudes that
an individual has to acquire through physical maturation,
social learning, and personal effort.

9. Behaviorism (John Watson, B.F. Skinner)

This is a learning approach. Behaviorists believe the environment
manipulates biological and psychological drives and needs resulting in
development.
Learning and behavior changes are the result of rewards and punishments. A
reward is a positive-reinforcing stimulus which maintains or increases a
behavior. When a behavior results in the termination of a positive-reinforcing
stimulus or the beginning of a negative stimulus we have punishment. Such
a behavior should weaken or drop out. We grow, develop, and learn through
the nature of experience the rewards and punishments we receive.

10. Law of effect

Edward Thorndike formulated this law which states that when a stimulus-
response connection is followed by a reward (reinforcement), that connection
is strengthened. In other words, a behavior's consequences determine the
probability of its being repeated.
11. Conditioning principles
Classical conditioning: food-salivation; bell-salivation.
Operant conditioning: pick up toys-get a hug or a cookie.
Reinforcement schedule: This schedule can be continuous or variable.
Behaviors established through variable or intermittent reinforcement are
tougher to extinguish.
Fixed ratio: reinforce after a fixed number of responses.
Variable ratio: reinforce, on the average, after every nth (e.g. 5th)
response.
Fixed interval: reinforce after a fixed period of time.
Variable interval: reinforce, on the average, after every nth (e.g. 3rd)
minute. Spontaneous recovery: after a rest period, the conditioned response
reappears when the conditioned stimulus is again presented.
Stimulus generalization: Once a response has been conditioned, stimuli
that are similar to the conditioned stimulus are also likely to elicit the
conditioned response.
We can shape behavior through successive approximations.

12. Psychoanalytic approach and psychosexual development (Freud)

There is an interaction between our internal needs/forces and the
environment.
Freud identified five stages of development:
a. oral (birth to 18 months)
b. anal (2 to 3 years)
c. phallic (3 to 5 years)
d. latency (6 to 12 years)
e. genital (12 to 19; others have said it never ends)

The phallic stage has the Oedipal (son attraction to mother) and Electra
(daughter attraction to father) complexes. These are conflictual times for the
child.
The libido is the basic energy or force of life. It consists of life instincts and
death instincts.
Fixation: incomplete or inhibited development at one of the stages.
Other psychoanalytic concepts include: castration anxiety, penis envy,
pleasure principle, and reality principle.
Erogenous zones are areas of bodily excitation such as the mouth, anus,
and no genitals.

13. Defense mechanisms

Defense mechanisms are unconscious protective processes that help us
control primitive emotions and anxiety.
They include:
 Repression: rejecting from conscious thought (denying or forgetting)
the impulse or idea that provokes anxiety.
 Projection: avoiding the conflict within oneself by ascribing the ideas
or motives to someone else.
 Reaction formation: expressing a motive or impulse in a way that is
directly opposite what was originally intended.
 Rationalization: providing a reason for a behavior and thereby
concealing the true motive or reason for the behavior.
 Displacement: substituting a different object or goal for the impulse
or motive that is being expressed.
 Introjection: identifying through fantasy the expression of some
impulse or motive.
 Regression: retreating to earlier or more primitive (childlike) forms of
behavior.
 Denial: refusing to see something that is a fact or true in reality.
 Sublimation: may be viewed as a positive defense mechanism
wherein anxiety or sexual tension or energy is channeled into socially
acceptable activities such as work.

14. Erik Erikson

Erikson identified eight stages wherein a psychosocial crisis or task is to be
mastered.

 The stages, corresponding ages and resulting ego virtue are:

 Trust vs. mistrust (birth to 12 years), Hope
 Infant develops trust if basic needs are met.
 Autonomy vs. shame and doubt (12 to 3), Will (a sense of self)
 Infant asserts self; develops independence if allowed.
 Initiative vs. guilt (3 to 6), Purpose (goal setting)
 Children meet challenges; assume responsibility; identify rights of
others.

Industry vs. inferiority (6 to 11), Competence

 Children master social and academic skills or feel inferior.
Identity vs. role confusion (adolescence), Fidelity (ability to
commit)
 Individuals establish social and vocational roles and identities or are
confused about adult roles.
Intimacy vs. isolation (early adulthood), Love
 Young adults seek intimate relationships or fear giving up
independence and becoming lonely and isolated.
Generativity vs. stagnation (middle adulthood), Care (investment in future)
 Middle-aged adults desire to produce something of value, and
contribute to society.
Integrity vs. despair (later adulthood), Wisdom
 Older adults view life as meaningful and positive or with regrets.
Erikson viewed life as in constant change; the social context is important in
the development of personality.

15. Jean Piaget

 Piaget studied cognitive development (intelligence).
 We inherit two tendencies—organization and adaptation.
 Organization is how we systematize and organize mental processes
and knowledge.
 Adaptation is the adjustment to the environment.

Two processes within adaptation are:

Assimilation: modifying the re they can be incorporated into the
individual's existing structure.
Accommodation: modifying the organization of the individual in response
to environmental events.
Schema another word for a mental structure that processes information,
perceptions, and experiences.

Piaget identified four stages of cognitive development:

a. Sensorimotor (birth to 2): the child differentiates self from objects; can
think of an object not actually present; seeks stimulation.
b. Preoperational (2 to 7): language development is occurring; child is
egocentric; has difficulty taking another's point of view; classifies objects by
one feature.
c. Concrete operational (7 to 11): begins logical operations; can order
objects (small to large; first to last); understands conservation.
d. Formal operational (11 to 15): moves toward abstract thinking; can test
hypotheses; logical problem solving can occur.

16. Lawrence Kohlberg

Kohlberg studied moral development; thinking and reasoning are involved.
He identified three levels relating to the relationship between self and
society:

a. Preconventional
 Stage 1: A punishment and obedience orientation exists.
 Stage 2: An instrumental and hedonistic orientation prevails (obtaining
rewards).
b. Conventional:
  Stage 3: Interpersonal acceptance orientation prevails; maintaining
good relations, approval of others.
 Stage 4: A law and order orientation exists; conformity to legitimate
authorities.
C. Postconventional:
 Stage 5: Social contracts and utilitarian orientation exists; most values
and rules are relative.
 Stage 6: A self-chosen principled orientation prevails; universal ethical
principles apply.

17. Daniel Levinson

 Levinson wrote: The Seasons of a Man's Life.
 He identified three major transitions/times occurring between four
major eras of life:
 a. early adult transition (17 to 22)
 b. mid-life transition (40 to 45)
 c. late adult transition (60 to 65).
In adulthood, the individual copes with three sets of developmental
tasks:
 a. build, modify, and enhance life structure
 b. form and modify single components of the life structure such as: life
dream, occupation, love-marriage, family relationships, mentor, and
forming mutual relationships
 c. tasks to become more individuated. d that the majority of the men
he studied experienced midlife Levinson believed crisis, a time of
questioning their life structure including their career. This occurred in
the transition period of age 40 to 45.

18. Ude Brofenbrenner

 Brofenbrenner took an ecological approach to the study of human
development, i.e., he believed it was important to look at all levels and
systems impacting a person.

 For example: A troubled adolescent is a part of several systems such
as family, school, peers, community, etc. We must be sensitive to the
influences of all of these systems.

19. Social-learning models - Albert Bandura developed a social

learning theory.
 These models see the importance of social environment and cognitive
factors.
  They go beyond behaviorism, i.e., the simple stimulus-response
paradigm because we can think about the connections between our
behaviors and the consequences.
 One of the central concepts of this cognitive-behavioral approach is
self-efficacy, the belief that we can perform some behavior or to Self-
efficacy can help explain how it is that people change.
 One's self-efficacy is facilitated through four mechanisms which are:
modeling after others' behavior, vicarious experience, i.e., watching
others perform the behavior, receiving verbal persuasion from others
that one can do a task, and lastly, paying attention to one's own
physiological states such as emotional arousal or anxiety involved in
doing the behavior.

20. William Perry

 Perry developed a scheme for intellectual development and ethical
development.
 He identified three general categories and nine positions:
 a. Dualism
 i. authorities know
 ii. there are true authorities and wrong authorities
 iii. good authorities may know but may not know
everything yet
 b. Relativism is Discovered
 i. there may not be right or wrong answers; uncertainty
may be OK
 ii. all knowledge may be relative
 iii. in an uncertain world, I'll have to make decisions
 c. Commitment in Relativism
 i. initial commitment
 ii. several commitments—and balancing them
 iii. commitments evolve, and they may be contradictory

21. Theories of how women develop

Theories of women's development are evolving. Many writers argue that
gender stereotyping, male-imposed standards, and the devaluation of
feminine qualities have made women second-class citizens. In the mid-70s,
Nancy Chodorow was one of the first to speak out against the masculine bias
found in psychoanalytic theory.

 In Toward a New Psychology of Women, Jean Baker Miller indicated that

a large part of women's lives has been spent helping others develop
emotionally, intellectually, and socially. This 'caretaking 'is a central
concept differentiating the development of women from men.
  Judith Jordain and others affiliated with the Stone Center, Wellesley
College, presented a developmental theory of women in 1991 which
was referred to as self-in-relation theory. The principal components of
this theory included:
a. people grow toward relationships throughout life
b. mature functioning is characterized by mutuality and deepening
connections
c.psychological growth is characterized by involvement in complex and
diversified relational networks
d. mutual empathy and empowerment are at the core of positive
relationships
e. growth-fostering relationships require engagements to be authentic
f. growth-fostering relationships stimulate growth and change in all people
g. goals of development are characterized by an increasing ability to name
and resist disconnections, sources of oppression, and obstacles to mutual
relationships
 This theory of development is now known as relational-cultural theory.

22. Other writers who addressed women's issues included:

a. Harriet Lerner in The Dance of Intimacy, believed women needed to re-
evaluate their intimate relationships which may not be working, and choose
a healthier balance between other-oriented and self-absorption. Competent
relationships allow for each person to be appreciated and enhanced, and the
woman should show strength, independence and assertiveness.
b. In The Mismeasure of Woman, Carol Tavris indicated that women are
judged and mismeasured by their fit into a male world. In fact, both genders
are more alike than different but they are perceived as different because of
the roles they have been assigned. Society also `pathologizes' women.
c. Carol Gilligan, In A Different Voice and other writings, believed that women
view relationships and experience of relationships differently than men do.
Their communication patterns are also different. Women use different criteria
than men in making moral judgments. Conse-quently, they score lower on
Kohlberg's Moral Dilemma Test. Men use the criteria of justice and rights,
women use human relationships and caring. There is overlap between men
and women on the instrument.

23. Gail Sheehy She wrote Passages: Predictable Crises of Adult Life
in 1976.

Passages are transitional periods between life stages and are different for
most
individuals. These passages also provide opportunities for growth--through
the crises we face in making constructive changes between life stages. Other
Sheehy books include: The Silent Passage: Menopause, New Passages,
Understanding Men's Passages, and Passages in Caregiving: Turning Chaos
into Confidence.

24. Spiritual development

 Some research indicates that over 90 percent of the U.S. population
has a belief in a divine power or force greater than oneself. Spirituality
is viewed more broadly than belief in a religion. In any case, spirituality
may directly influence clients in their view of self, relationships,
worldview, as well as nature and cause of perceived problems. For
many individuals, their spirituality is a key component in their
definition of being whole and of wellness. Counselors must be willing
and able to address and identify issues of spirituality important to the
client's situation. They may have to acquire knowledge and the
language to communicate effectively with clients who have a wide
variety of spirituality issues and beliefs. Essentially, this process may
require counselors to examine their own spirituality.

25. Intelligence
 Intelligence has been defined as 'adaptive thinking or action' (Piaget)
or ability to think abstractly. Charles Spearman believed there was
general intelligence (g) and special abilities (s). Louis Thurstone
identified several primary mental abilities. Intelligence is not fixed or
determined solely by genetics. One's environment, experiences, and
cultural factors influence intelligence. Intelligence testing may be
biased against those who have not had the opportunities to learn or
experience those things the test measures.

In emotional intelligence: why it can matter more than IQ, Daniel Goldman
proposed that one component of intelligence can operate out of human
emotions that is independent of the person's reasoning and thinking process.
This emotional intelligence is a learned, developmental process, beginning
and infancy, and proceeding to adulthood to varying Levels of development.
An emotionally, intelligent person is self motivated, empathetic, social
signals and nonverbal messages and develop strong interpersonal abilities.

26. Propinquity
This is the concept that implies Nearness or proximity. For example, in
selecting partner one is most likely to become involved with someone who
lives nearby works at the same location.
27. Midlife crisis
Stress may occur as an individual encounter as various transitional
period/stages. Although Levinson believes that most men experience my life
crisis, many writers do not. Both women and women makes a painful self
evaluation process, but not at a crisis level.

Abnormal Human Behavior

28. Definitions

Psychological dysfunction: a breakdown in cognitive, emotional, or

behavioral functioning. The dysfunction is unexpected in its cultural context
and associated with personal distress or substantial impairment in
functioning.

Psychopathology: the scientific study of psychological disorders.

Prevalence: how many (what percent) of the population has the disorder.

Incidence: how many new cases occur within a given time frame such as a
year.

Prognosis: the anticipated course of a disorder.

Etiology: what causes a disorder, i.e., why does it begin? Biological,

psychological and social dimensions are involved. Equifinality: there may be
multiple paths to a given outcome. For example, depression may be caused
by physical injury, loss of a loved one or substance abuse.

Comorbidity: means that an individual has two or more disorders at the

same time.

Adaptive Functioning: occurs when defense mechanisms are used •to

cope with stressors. Mechanisms leading to optimal adaptation include
anticipation, humor and sublimation.
At the other extreme, failure to regulate stress may lead to a break with
reality resulting in delusional projection or psychotic distortion.

29. Causal models

a. One-dimensional — this model assumes that a disorder is caused by one

factor such as a chemical imbalance. Research does not support this linear
model.
b. Multidimensional models — these models assume that a disorder is
caused by the interaction of several factors and dimensions. The context of
the individual is important and includes the biology and behavior of the
individual as well as cognitive, emotional, social, and cultural dimensions.
i. Biology includes genetic factors. Genetic factors appear to make some
contribution to all psychological disorders by influencing cognitions,
behaviors and emotions. The nervous system influences psychological
disorders primarily through biochemical neurotransmitters in the brain.
ii. Behavior and cognitive factors. How we acquire and process
information, store and retrieve it influences behavior. We also acquire and
learn behaviors through conditioning and social learning.
iii. Emotions have an important role in psychological disorders. The
emotion of fear, for example, has an important influence on our bodies and
influences our behavior. Emotion is viewed as temporary and short-lived.
Mood is a more persistent period of emotionality.
iv. Cultural, social and interpersonal behaviors influence our lives.
Gender influence on the incidence of some disorders. The amount and kind
of social relationships and contacts help predict reducing the incidence of
certain physical disorders perhaps by influencing the immune system.

30. Symptoms or traits may be

 Ego-dystonic: the individual perceives the symptoms or traits as
unacceptable and undesirable.
 Ego-syntonic: the individual perceives the symptoms or traits as
acceptable.

31. Clinical assessment is the process of determining the

psychological, biological, and social factors which may be associated
with a psychological disorder.
Diagnosis is the process of determining whether a presenting problem meets
the criteria for a psychological disorder as set forth in DSM-5.
32. Mental Status Exam
The mental health practitioner may use the clinical interview to examine the
mental status of an individual seeking services.

A formal mental status exam covers the following five areas:

a. appearance and behavior
b. thought processes
c. mood and affect
d. intellectual functioning
e. sensorium
The sensorium addresses the individual's orientation and awareness to
surroundings, time, place, and identity.

33. Behavioral assessment

This is the use of direct observation to assess formally an individual's
thoughts, feelings, and behavior in specific situations or contexts.
The clinical interview provides one avenue of behavioral assessment.
Sometimes targeted behaviors are identified and observed.

34. Psychological assessment

Psychological tests may measure cognitive functioning, emotional or

behaviors responses, or personality characteristics.
Examples are:
 Projective tests - e.g., Rorschach, Thematic Apperception Test,
Incomplete Sentences Blank
 Personality tests — e.g., Minnesota Multiphasic Personality Inventory
(MMPI), California Psychological Inventory Intelligence tests — e.g.,
Wechsler Adult Intelligence Scale — IV

35. Neuropsychological assessment

These instruments measure brain dysfunctions and measure such abilities as
language expression, attention and concentration, memory, motor skills, and
perceptual abilities.

Examples are: Luria-Nebraska Neuropsychological measures organic damage

and location of such injury. Bender Visual-Motor Gestalt Test often used with
children, and can measure brain dysfunction.
36. Treatment plan

This is a therapeutic road map to help individuals improve their mental

health and daily functioning. Minimally, the treatment plan helps an
individual resolve enough problems so they can function at a higher level,
and move to a less restrictive treatment environment.

37. Continuum of care

Many individuals in treatment move through a continuum of care. The most

restrictive environment is inpatient hospitalization followed by partial or day
hospital care, followed by group home or residential care. Less restrictive
possibilities include intensive outpatient programs, home health care, and
outpatient services.

38. Diagnostic and Statistical Manual of Mental Disorders (DSM-5)

The fifth edition of the DSM was published in 2013 by the American
Psychiatric Association. The international classification codes of the World
Health Organization from its International Statistical Classification of
Diseases and Related Health Problems(ICD) are also included in the DSM.
ICD-10 is now the current one.
Much of the following information about the DSM-5 and summaries of the
major disorder categories within the DSM-5 are taken from: DSM-5 Learning
Companion for Counselors (2014 -- see references).

39. Changes in the DSM-5 from DSM-IV-TR

a. Structural

Principal changes include the removal of the axial classification system. The
Global Assessment of Functioning (GAF) scale has been dropped. V Codes are
conditions not attributable to a mental disorder but are important to 1
intervention efforts.
The list of V codes is expanded to provide for the client's worldview,
psychosocial and contextual information. Relational problems, abuse,
occupational and acculturation issues may be included.
 Not Otherwise Specified (NOS) will not be an option for labeling
disorders.
  Two replacement options for NOS are Other specified disorder and
Unspecified disorder.
 There have been a number of changes and modifications to the
classification of disorders.

b. Philosophical
The focus for identifying disorders shifts from observation of symptoms and
behavior to identifiable pathophysiological origins — a more biological
orientation. - Problems of growth and development of the brain or central
nervous system impact behavior, learning and social interactions.
 One consequence of this biological approach is the potential to view
treatment as pharmacological with the need for more prescriptions and
drugs. A result may be a decrease in the belief in the need for
psychotherapeutic (counseling) approaches and holistic client care.
 A second philosophical change is the reliance on dimensional
assessments rather than categorical descriptions of disorders.
Although many dimensional assessments (scales) are still under
development, their focus will be on the frequency, duration and
severity of the client's experience with a disorder rather than on the
presence or absence of a particular symptom.

c. Selected diagnostic category changes

i. Mental retardation is now intellectual disability with level of disability
determined by new measures, not IQ.
ii. Communication disorders now include social communication disorder and
two categories are language disorder and speech disorder.
iii. Autism and Asperger's disorder have been replaced by one umbrella
diagnosis — autism spectrum disorder.
iv. Stuttering becomes childhood-onset fluency disorder.
v. Schizophrenia is viewed as a spectrum and the five subtypes are no longer
used. vi. Anxiety disorders now include the diagnostic categories of
agoraphobia and panic disorder.
vii. PTSD now includes four rather than three distinct diagnostic clusters.
viii. Neurocognitive disorders include dementia and delirium. Dementia is
conceptualized as a major neurocognitive disorder.

40. Differential diagnosis

 Information about differential diagnosis is presented for the disorders
in DSM-5. For example, disruptive mood dysregulation disorder is used
for children (6 to 18 years of age) who are experiencing severe,
recurrent outbursts of temper with an average frequency at least three
times per week for at least 12 months or more. If these criteria are not
met, a different diagnosis is in •order.
  Furthermore, if the child or adolescent experiences any manic or
hypomanic episodes, the diagnosis of disruptive mood dysregulation
disorder cannot be assigned.
 The following information summarizes the diagnostic categories
from the DSM-5 along Learning Companion for Counselors. with
some implications for treatment. The order of these summaries
comes from DSM-5
NOTE to READER: Perhaps 2 or 3 questions on the NCE or CPCE will come
from all of the following material on diagnostic categories. Remember, these
are not clinical exams.

41. Depressive disorders

Depressive disorders do not contain any disorders related to mania.

Bereavement has been excluded as part of a major depressive episode.
Physical causes for depression must always be considered. The most
common and effective treatment for depressive disorders include medication
and psychotherapy. The two most effective psychotherapeutic interventions
appear to be cognitive behavior therapy and interpersonal therapy.

Specific disorders include:

a. Disruptive mood dysregulation disorder

b. Major depressive disorder, single episode and recurrent episode
c. Persistent depressive disorder (dysthymia)
d. Premenstrual dysphoric disorder

42. Bipolar and related disorders

 Mania and hypomania criteria focus on changes in energy and activity.
Depression and anxiety are often viewed as comorbid with bipolar and
related disorders.

 Mood-stabilizing medication and psychotherapy are the typical

recommended treatments. Specifically, psychoeducation, family-
focused therapy, CBT, and interpersonal therapy have been shown to
be effective.

 Disorders include:
a. Bipolar I disorder
b. Bipolar II disorder
c. Cyclothymic disorder

43. Anxiety disorders

Fear and anxiety are part of anxiety disorders as well as a variety of
physiological symptoms such as heart palpitations, sweating, and shortness
of breath. Comorbidity with depressive disorders is common although anxiety
is often characterized by anxious anticipation and fear unlike depressive
disorder.

Anxiety disorders often have an early-age onset and suicide risk assessment
is important. Effective interventions include CBT, behavior therapy and
relaxation training.

Anxiety disorders include:

a. Separation anxiety disorder
b. Selective mutism
C. Specific phobia
d. Social anxiety disorder (social phobia)
e. Panic disorder
f. Agoraphobia

44. Obsessive-compulsive and related disorders

 Obsessive-compulsive disorders feature obsessive preoccupation and
engagement in repetitive behaviors. Previously classified in the anxiety
disorders category, the principal feature of these disorders is not
anxiety. Comorbidity with other diagnoses is not uncommon and these
include depressive and anxiety disorders, hypochondriasis, eating
disorder, and ADHD, to name a few.

 Treatment approaches for obsessive-compulsive disorders involve a

combination of psychopharmacologic treatment and psychotherapy.
CBT and a form of CBT namely, exposure and response prevention,
have also shown to be effective.

In this category, disorders include:

a. Obsessive-compulsive disorder
b. Body dysmorphic disorder
c. Hoarding disorder
d. Trichotillomania (hair-pulling) disorder
e. Excoriation (skin-picking) disorder

45. Trauma- and stressor-related disorders

Traumatic or stressful events may threaten an individual's physical, social,
emotional, cognitive or spiritual well-being. These events include sexual or
physical assault, combat, torture, disasters, severe car accidents, child abuse
and life-threatening illnesses. These events can occur once or be re-
occurring and overwhelm a person's coping ability.

A wide variety of psychopharmacological and psychotherapeutic approaches

may be indicated for disorders in this broad category. Variables such as age
of the person from child to adult, nature of and duration of traumatic event,
and the individual's coping skills and support, will help determine the
appropriate psychotherapeutic approach that could be implemented.

Trauma- and related-stressor disorders include:

a. Reactive adjustment disorder
b. Disinhibited social engagement disorder
C. Posttraumatic stress disorder
d. Acute stress disorder
e. Adjustment disorders

46. Gender dysphoria in children, adolescents, and adults

Gender dysphoria refers to conscious or unconscious feelings (especially in

children) that there is a mismatch between the gender they were born and
their desire for the gender they want to be identified as. Especially in
adolescents and adults this discomfort often leads to the desire for gender
reassignment through hormone replacement or surgery. Although not listed
as a disorder, being included in the DSM-5 will make such medical
intervention more likely than if it was not included in the DSM.
The overall treatment that counselors should consider in their therapeutic
approach is to support the client in coping with their feelings of incongruence
and helping them promote optimal functioning. Family therapy may be
helpful for children who are gender variant including increasing the
awareness of children and adolescents in how others react to them. In
addition to possible medical interventions, counseling can help with adult
clients' awareness, understanding and functioning. There are diagnostic
criteria for:
a. Gender dysphoria in children
b. Gender dysphoria in adolescents and adults
47. Substance-related and addictive disorders
Prevalence rates of substance use are very high in the U.S. with over 22
million individuals reporting use. Substance-related and addictive disorders
focus on ten classes of drugs. The concepts of abuse and dependence are no
longer included in the diagnosis. Severity of disorder can be specified as
mild, moderate or severe. A cluster of cognitive, behavioral and physiological
symptoms typify the disorder. Other criteria cover social, occupational and
interpersonal issues as well as risk-taking, tolerance and withdrawal.
Treatment may include medical interventions including use of medically-
controlled substitutes. Adaptive coping mechanisms and substituting positive
behaviors can be effective treatment options. Mindfulness training has been
found effective in some cases.

Some of the ten substance-related disorders are:

a. Alcohol-related disorders
b. Cannabis-related disorders
c. Hallucinogen-related disorders
d. Inhalant-related disorders
e. Opioid-related disorders
f. Sedative-, hypnotic-, or anxiolytic-related disorders
g. Stimulant-related disorders

Gambling disorder has similar neurochemical brain responses and risk-taking

behavior.

48. Disruptive, impulse-control, and conduct disorders

Some of the characteristics of these disorders include impulse-control;
conduct disorders are aggressive or self-destructive behaviors, destruction of
property, conflict with authority figures, and disregard for norms and
outbursts of anger not proportionate to the situation. All disorders listed here
include the common characteristic of problems with emotional or behavioral
regulation and these disorders typically appear first in childhood or
adolescence. There is high comorbidity with substance use disorders,
depressive disorders and anxiety disorders.

Parent/family interventions, including training and fostering positive time

between parent and child, may be the treatment of choice together with the
appropriate psychopharmacological interventions especially for pyromania
and kleptomania. CBT can help clients modify cognitive distortions and
develop problem-solving skills.
Disruptive, impulse-control, and conduct disorders include:
a. Oppositional defiant disorder
b. Intermittent explosive disorder
c. Conduct disorder
d. Pyromania
e. Kleptomania

49. Specific behavioral disruptions

Behavioral disruptions are classified into five distinct areas. They are
grouped together because each of them will be disruptive in the behavior of
the individual who has the disorder. Although similar in this regard, the
specific disorders differ widely. For many of these disorders, medical
interventions may be necessary including psychopharmacological treatment.
The disorders are also appropriately treated through psychotherapeutic
means although the approaches many vary depending upon the specific
disorder. A trusting relationship with a counselor is necessary and the
application of DBT may be helpful especially when other approaches have
failed. The eating disorders and the elimination disorders may lend
themselves to family counseling in addition to a range of medical and
behavioral interventions.

Some examples of disorders in each of the five groups include:

Feeding and eating disorders:

a. Pica
b. Rumination disorder
c. Anorexia nervosa
d. Bulimia nervosa
e. Binge-eating disorder

Elimination disorders:
a. Enuresis
b. Encopresis

Sleep-wake disorders
a. Insomnia disorder
b. Restless legs syndrome
Sexual dysfunctions
a. Erectile disorder
b. Female orgasmic disorder
c. Premature (early) ejaculation

Paraphilic disorders
a. Pedophilic disorder
b. Voyeuristic disorder
c. Fetishistic disorder

50. Neurodevelopmental and neurocognitive disorders

These disorders are similar in that they very probably have a biological basis.
It also means that counselors are not likely to be the ones to diagnose them.
A more formal background in medicine or neurobiology and neuropsychology
will be necessary although once formally diagnosed, counselors can certainly
provide treatment, usually in conjunction with other providers.
Neurodevelopmental disorders typically begin in childhood whereas
neurocognitive disorders may be more prevalent later in life, however, they
can be found in people of all ages. It is important for counselors to recognize
the signs and symptoms of a variety of neurodevelopmental and
neurocognitive disorders in order to make referrals for assessment and
appropriate clinical treatment. Following diagnosis, counselors can work with
such clients and their families in conjunction with any medical or
pharmacological treatment. Children and adolescents with
neurodevelopmental disorders may initially be in contact with counselors in
school and community mental health settings.

Some neurodevelopmental disorders include:

a. Intellectual disability
b. Language disorder
c. Autism spectrum disorder
d. Attention-deficit/hyperactivity disorder

Neurocognitive disorders include:

a. Delirium
b. Alzheimer's disease
c. Parkinson's disease

51. Schizophrenia spectrum and other psychotic disorders

 These disorders are characterized by one or more of the
following five symptom classes: delusions, hallucinations,
disorganized thinking, disorganized or abnormal motor behavior,
and negative symptoms. Some of these symptoms may be
temporary and found in individuals as a result of medication or
drug or alcohol use.
Many of the individuals who meet the criteria for psychotic
disorders have a lifelong struggle with psychotic
symptomatology.
If psychotic symptoms are identified in a client, counselors need
to refer to medical personnel for definitive diagnoses.

Following such diagnosis and likely medications, counselors can

provide psychosocial interventions to assist with coping and
occupational functioning. CBT, psychoeducation, and family
intervention and support may be appropriate. Counselors may
also find instruction and support useful to the client and family
regarding medication management.

Schizophrenia disorders include:

a. Brief psychotic disorder
b. Schizophrenia
c. Schizoaffective disorder

52. Dissociative disorders

These disorders represent a disconnection between things
usually connected. These disconnections signify a disruption in the
normal integration of consciousness, identity, memory, body
representation, motor control and behavior. Dissociative disorders are
usually associated with trauma and can occur at any age. Certain
medical conditions, seizures, drug use, and brain injuries may result in
dissociative symptoms.
Comorbidity, especially with depressive, anxiety, and substance use
may be signals for the counselor to be alert to self-injurious and
suicidal behavior. A usual first level of treatment may be to establish a
safe and stable environment for the client. Working through traumatic
memories with approaches such as CBT, DBT, and hypnosis may be
adjuncts to possible psychotropic medication.

The five types of dissociation are:

- Depersonalization
- Derealization
- Amnesia
- identity confusion
- identity alteration
53. Somatic symptom and related disorders
These disorders are characterized by the presence of physical or
somatic complaints and the feelings, thoughts and behaviors that go
along with these complaints. Individuals report distress and
impairment because of these symptoms. Although many of their
complaints cannot be confirmed by examining physicians, to
the individual they are real. Because of stigmatization, the
concept of hypochondriasis is not used.
Also, there may be cultural factors which contribute to an individual's
experiencing of symptoms. Treatment begins with a physical exam to
determine the validity of the somatic complaint. Following any
psychiatric intervention including medication, counseling may take a
problem-solving approach. CBT, psychoeducation, including how stress
influences bodily sensations, and relaxation training may be helpful.

Disorders falling into this category include:

a. Somatic symptom disorder
b. Illness anxiety disorder
c. Conversion disorder

54. Personality disorders

These disorders are characterized by persistent maladaptive patterns

of behavior, affect, cognition and interpersonal functioning. These
patterns deviate from one's culture and usually begin before
adulthood. Furthermore, these traits have an impact on an individual's
life and ability to function in home, school or work. There is a tendency
to see these maladaptive patterns as persistent throughout life thus
making treatment difficult.
Ten distinct types of personality disorder are identified:
1. paranoid,
2. schizoid,
3. schizotypal,
4. antisocial,
5. borderline,
6. narcissistic,
7. avoidant,
8. histrionic,
9. obsessive-compulsive
10. dependent

These clients are often viewed as difficult and challenging to treat.

Some evidence seems to support that psychotherapy is more effective
than psychopharmacological approaches. It is not always easy to
 distinguish normal from pathological personality functioning;
personality is a very complex phenomenon.
55. Mental health services

These concepts are related to abnormal human behavior and mental

health services. Mental illness is a legal concept usually meaning
severe emotional or thought disturbances that negatively affect an
individual's health and safety.
Each state has civil commitment laws that describe how an
individual can be declared legally to have a mental illness and be
placed in a treatment facility.

Beginning in the 1980s, the process of deinstitutionalization,

which moved many people with severe mental illness out of
institutions, accelerated. An increase in homelessness and criminal
justice system contacts occurred because not enough community
mental health facilities and services were available.

Right to Treatment legislation has been passed assuring appropriate

treatment for patients in mental health facilities. There is also a
movement for patients to be able to refuse treatment legally. Although
this issue has not been finally settled, some court rulings have
supported this notion.

SOCIAL AND CULTURAL DIVERSITY

Demographics and Other Characteristics in the U.S.

1. Hispanics:
o Over 41 million, encompassing more than 20 nationalities, with
Mexican and Puerto Rican being the largest groups.
o By 2050, all minority groups combined will become larger than
the Non-Hispanic White population.
o Over 20 percent of the population over 4 years of age speaks a
language at home other than English.
o The median age of the U.S. population is over 37—the oldest
ever; non-Hispanic Whites are the oldest group.
o The aging of the baby boomers (born between 1946 and 1964)
continues to result in the graying of the U.S. About 10,000 baby
boomers reach 65 years of age every day. Over 14.5 percent of
the population is over 65.
o The baby busters (born between 1965 and 1976) are sometimes
referred to as 'Generation X.' They are characterized by seeking
stimulation, wanting the facts—the right answers, wanting
exciting, non-boring jobs, and keeping options open.
o Millennials (Echo Boomers, Internet Generation, Nexters,
Generation Y) follow Gen X individuals. They were raised to be
 self-confident, tech-aware, goal-oriented, civic-minded, and
multiculturally inclusive.
o More than 50 percent of marriages begin as cohabitations,
decreasing the marriage rate, increasing the age of first
marriage, and increasing the number of children born out of
wedlock. Over 40 percent of children are born to unmarried
women.
o Under 20 percent of households consist of a married couple and
their children; families are averaging about two children; 10
percent of grandparents live with a grandchild.
o Over 40 percent of first marriages end in separation or divorce.
Remarriages have declined in number as cohabitation has
become more accepted.
o 'Sandwich generation' parents are those who are caring for their
own children as well as their elderly parents.
o Females comprise about 51 percent of the population; for anyone
born now in the U.S., life expectancy is about 79 years of age.
o Women comprise about 47 percent of the labor force. They are
nearly twice as likely as men to work part-time, and nearly 50
percent work in public sector jobs.
2. Socialization Processes:
o Biological factors, including hormones, influence development.
Many social factors interact with biological and physical
characteristics during the individual's development. Some major
social factors are:
 Parents and parenting styles, such as authoritarian and
permissive.
 Peers and the modeling of peer behaviors, including play.
 Television, the most influential mass medium affecting
children's behavior.
o Most children achieve a sense of being male or female, or gender
identity, by the age of three. Each gender has a role, a set of
gender expectations prescribing how girls and boys should think,
act, and feel. These expectations are promoted by family, school,
religion, peers, culture, and society in general.
3. People are Products of Five Different Cultures:
o Universal: As human beings, we are biologically alike; we have
the same biological needs.
o Ecological: Humans are influenced by where they live, such as
northern versus temperate climates. Language is influenced by
the region we live in—also by what we eat, wear, and live in.
o National: This represents a country, often with one predominant
language. A central government establishes laws, policies, and
institutions. Each country has a worldview, and citizens socialize
each other accordingly through education and other means.
 o Region: This is a culture specific to a region within a nation. In
the U.S., this could be the South, Midwest, etc.
o Racio-ethnic: Race refers to assumed biological differences,
including physical features that are used by people to identify
majority and minority groups. One may be treated as inferior;
race-related cultures develop. Ethnic refers to practices,
language, and earnings of a group and style of living, which are
often regionally or culturally based.
4. Differences Within Ethnic Minority Groups:
o Most ethnic group minorities are characterized by large
differences between members of the group. These differences
are found across a range of variables, including values, attitudes,
behaviors, education, racial identity development, and
acculturation. Socioeconomic differences within an ethnic group
must also be recognized.
5. Culture and Social Class:
o Culture is the set of values and behaviors that are learned and
passed on within an identifiable community. It includes the
symbols and products of that community, including language,
music, food, and rituals.
o Social class relates to differential levels of material possessions
or economic advantage, including assets and money. Related to
social class are values, language, interpersonal relationship style,
worldview, different levels of opportunity, respect, and influence.
Counselors and clients are the products of their respective
cultures and social classes. In cross-cultural counseling, the
behaviors, thoughts, and values of clients must be viewed from
that culture's perspective.
6. Cultural Pluralism:
o Cultural pluralism refers to the broad categories of individuals
who may have special concerns and needs or seek respect,
representation, and development in society. These categories
include racial, ethnic, and religious classifications, women, the
elderly, single-parent families, divorced individuals, handicapped
persons, LGBTQ+ individuals, the poor, children, and young
adults.
7. Cultural Norms:
o These norms represent a group's basic interpretation of life.
Norms provide the values for living and lifestyle.
8. Prejudice:
o Prejudice is a preconceived judgment or opinion without just
grounds or sufficient knowledge. Prejudice may be positive or
negative. It is often an irrational attitude or behavior directed
against an individual or group. Many "isms" exist, such as racism,
classism, ageism, sexism, weightism, and ableism.
9. Racism:
 o Racism is the belief that some races are inherently superior to
others. It can be expressed on:
 An individual basis
 An institutional basis
 A cultural basis (all or most members of a society express
it)
o Disproportionality is the process of treating some school-age
children differently than others by referring them to special
education or disciplinary procedures. The result is that these
children may experience unneeded special services, less rigorous
curricula, lower expectations, and more disciplinary
consequences.
10. Ethnocentrism:
o Ethnocentrism is the belief that one's own group is the center of
everything; it sets the standard. This may cause
intergenerational conflict when younger members begin to adopt
attitudes and behaviors of other cultures around them.
11. White Privilege:
o This refers to the subtle advantages and entitlements that
European Americans (whites) experience, usually without their
awareness. Such individuals have been raised with the
perception that their lives are normative, average, and ideal, and
that the lives of other white people are the same. Benefits and
entitlements accrue to white men. White women and other white
individuals of special groups, such as sexual minorities and
people with disabilities, would experience privilege differentially.
12. Acculturation and Assimilation:
o Acculturation is the extent to which an individual from a racial or
ethnic minority adopts and incorporates the values, beliefs, and
customs of the dominant culture. Assimilation is the extent to
which an individual has changed so much that he or she is
absorbed into the dominant group, losing their original values
and behaviors.
13. Cultural Differences:
o Historically, scientific literature argued for differences between
minorities and whites. Pathology and deficiency were more
associated with minorities. Arthur Jensen and others suggested
genetic differences in intelligence. The Bell Curve by Hernstein
and Murray continued that line of thinking. Testing for differences
predictably found differences between cultural and racial groups,
often as a function of the assessment instruments. Environment
and class factors explain academic achievement differences.
14. Cultural Encapsulation:
o From Gilbert Wrenn, this term refers to:
 The substitution of model stereotypes for the real world.
  Disregarding cultural variations—believing in some
universal notion of truth.
 Use of a technique-oriented definition of the counseling
process. For example, a Gestalt therapist might only use
certain Gestalt techniques, no matter who the client is or
what the problem is.
15. Worldview:
o Worldview is how an individual perceives his or her relationship
to the world, including its institutions, other peoples, things, and
nature. Worldviews are comprised of our attitudes, values,
opinions, and concepts, and affect how we think, make decisions,
behave, and define events. Two views of the world are:
 Emic: The belief that you need to understand and help
groups from their perspectives—their culture—a specific
focus.
 Etic: The belief that you have a global view of humanity,
that is, we are more similar than different. The focus is on
the similarities instead of the differences.

16. Multicultural Counseling

This is counseling which addresses and comprises all components of
various cultural environments together with pertinent theories,
techniques, and practices of counseling. Cross-cultural counseling
takes place within the larger socio-political environment which cannot
be ignored. Counseling might involve network therapy. Such network
therapy may include intervention with immediate family members,
extended family, and important persons in the client's community,
including religious/spiritual leaders and other respected individuals.
Introductions may be important; someone from the culture (a
respected person, perhaps) could introduce the counselee to the
counselor.

To be effective with many cross-cultural clients, the counselor may

need to foster a relationship on a personal level through 'small talk'
and more personal sharing than may be true with white clients. With
Hispanics, the counselor must be sensitive to and aware
of familism, the client's strong identification with and attachment to
family. Ivey, A E., D'Andrea M. J., and Ivey, M. B. (2011) developed a
multicultural counseling theory and believe multicultural counseling
should make use of indigenous helping roles and strike a balance
between individual, family, and cultural issues.

Atkinson suggested that the traditional time-bound, space-bound,

cathartic psychotherapy may not be relevant to many cross-cultural
clients. The following roles of the counselor may be more relevant:
 advocate, change agent, consultant, adviser, facilitator of indigenous
support systems, and facilitator of indigenous healing methods.

17. Counselors have underlying assumptions (typical of white

middle-class counselors):

a. concern and respect for the uniqueness of clients

b. emphasis on the inherent worth and dignity of all regardless of
race, creed, etc.
c. high priority placed on helping others reach their self-
determined goals
d. valuing freedom and opportunity to explore one's
characteristics
e. future-oriented promise of a better life

White counselors often have a Eurocentric perspective and view of the

world. There is a need to ascertain the assumptions which cross-cultural
clients bring.

18. Characteristics of Counseling

The following characteristics may pertain to counseling:

a. Culture-bound values: counseling tends to be individual-centered

with verbal/emotional and behavioral expressiveness, with defined
communication patterns, openness, and intimacy.

b. Class-bound values: strict adherence to a time schedule (50

minutes, each week), ambiguous/unstructured approach to seeking
long-range goals or solutions.

c. Language variables: there is use of standard English and the

emphasis is on verbal communication. These values and use of
language could be sources of conflict between the counselor and
culturally different client.

19. Issues of Culture and Class in Cross-Cultural Counseling

Normative behavior: each culture has a set of norms pertaining to

almost every phase of existence.
 Structuring: defining the counseling situation may be necessary.
Client and counselor roles may need to be defined.

Transference and Countertransference: feelings and attitudes

toward each other's culture are likely to be present.

Language: verbal and nonverbal language may be highly specific to

cultures; there may be little, or no English spoken.

Personalism: clients from some cultures like to get to know the

counselor first as a person.

Diagnosis: there must be sensitivity to making judgments about

clients and their problems; what is "strange" to you may not be
strange to them. Use of tests may be contraindicated.

20. Responsibilities as Counselors

a. confront, become aware of biases, stereotypes, values, etc.

b. become aware of culturally different worldviews, values, biases, etc.

c. develop appropriate help-giving practices, intervention

strategies, etc. that take into account the historical, cultural, political,
and environmental experiences and influences of the culturally
different.

d. develop awareness for and competence in client/student

advocacy, systems advocacy, and social/political advocacy. The ACA
Advocacy Competencies can be found in Professional Orientation and
Ethical Practice.

Additional suggestions include the following from ACA Past President,

Cirecie West-Olatunji: develop an awareness of transnationalism,
access and use culture-centered interventions, understand the
intersectionality of multiple identities within the same individual, and
understand the diverse White identities.

Hanna and Cardona in a Journal of Counseling and Development article

believe counselors working cross-culturally should use a variety of
techniques to help the client achieve freedom from any ongoing
oppression they feel. Without achieving this freedom, they will
continue to experience pain and anger.
 21. Racial/Cultural Identity Development Model
This is a conceptual framework to help counselors understand the
attitudes and behaviors of culturally different clients. These have
implications for counseling.
1. Five stages of development of a minority individual:
a. Conformity: self-depreciation attitude and identification with
the majority.
b. Dissonance: current self-concept is challenged; there is a
conflict between appreciating and depreciating self.
c. Resistance and Immersion: the individual accepts/endorses
the minority views and rejects the majority resulting in self-
appreciating.
d. Introspection: the individual moves from the intensity of
feelings in the R&I stage and becomes concerned with the basis
of self-appreciating.
e. Integrative Awareness: the individual can own and
appreciate minority and dominant aspects of both cultures.
In writing of this process, Janet Helms speaks of ego statuses (not stages)
and suggests a dynamic evolution rather than static structures or types.
Some believe this process occurs for Whites as well as people of color.

22. White Identity Development Model

Whites may go through similar racial/cultural identity development
because they also experience societal forces including racist attitudes
and beliefs. The same stages are possible, culminating for some whites
in integrative awareness from which a nonracist identity emerges.

23. Counselor Training Issues

Counselors should develop competencies in cross-cultural counseling.
Courses should include a consciousness-raising component, an
affective component, a knowledge component, and a skills component.
Training programs should realize that we are feeling, thinking,
behaving, social, cultural, and political beings. This might be
termed systematic eclecticism. In addition to affective empathy,
counselors may develop cognitive empathy. This reflects the
 counselor's learning about the client's cultural background, daily life,
hopes, fears, and aspirations.

24. Cross-Cultural Family Counseling

Because of between and within-family differences in a culture, the
family counselor must learn about the counseling issues within the
particular family in its particular culture. Worldviews and values of
family members should be ascertained. Traditional cultural family
structure and extended family ties must be recognized. Family
members' interpersonal relationships must be identified. The cross-
cultural family counselor should identify the usual help-giving networks
and structures which already exist for the cross-cultural family.

25. Gender-Based Counseling

Counselors must be aware that men and women have been socialized
differently in this country. Stereotyping and such issues as societal
discrimination and different role expectations are based on gender.

1. Counseling Women: The application of long-standing theories

of development and personality to women may be inappropriate
because of their focus on men. Women's development,
interactions, and expressive patterns are different from men's.
Sexism is the belief that women should be treated differently
because of and not according to their abilities. Women are more
susceptible to some psychological problems (e.g., depression)
than men. Women are more apt to initiate counseling than men
and to be more emotionally expressive. Focus must include
attention on their unique attributes, history, and socialization
patterns. Developmental and physiological issues cannot be
ignored. Many women experience conflicts in the multiple roles
they are expected to fulfill including childbearing and child-
rearing, homemaking, and career. The feminist approach to
therapy directs awareness of counselors to the historical
oppression, marginalization, and cultural limitations to which
women have been subjected.

2. Counseling Men: Socialization patterns for men include

expectations that they be active, competitive, and generally,
emotionally unexpressive. Their lives are more clearly laid out for
them in terms of work and family responsibilities. The words and
behaviors men use are less revealing of their inner worlds. Men
are less apt to initiate counseling than women, and once there
tend to deal with their problems cognitively rather than
affectively. Denial of problems and feelings, or simple inability to
express them, may characterize the male in counseling. Men in
 counseling may be very goal-oriented. Group work for men may
be effective in allowing members to build a community, make
them aware that other men have similar problems, and provide a
comfort level to challenge each other around defenses and
denials.

26. Counseling Lesbian, Gay, Bisexual, and Transgendered

Persons: Counselors should be aware of the history of abuse and
discrimination that gay, lesbian, bisexual, and transgendered persons
have experienced and continue to face. The emotional and
psychological difficulties of 'coming out' to family, significant others,
and in school and the workplace are often overwhelming. Counselors
must educate themselves about different sexual orientations and be
able to assist their clients, not just in problem resolution and
adjustment, but in accommodating themselves to an often hostile
world. It is important for counselors to let clients know that they are
accepting and sensitive to clients with varying sexual orientations.

The last ten years have seen significant progress on behalf of the LGBT
population which include:

a. According to a 2011 UCLA Survey, 3.5 percent of Americans identify

as lesbian, gay, or bisexual.
b. As of 2013, 14 countries had legalized same-sex marriages.
c. As of 2013, the US Supreme Court ruled the US Congress-passed
Defense of Marriage Act was unconstitutional. State laws banning
same-sex marriages began to fall and as of 2014, no state law banning
same-sex marriage was legal, although a few states were still
appealing.

27. Social Influence Model of Counseling

Stanley Strong viewed counseling as an interpersonal influence process. The
counselee may view the counselor as having these characteristics:
a. Expert: Has formal training, experience, and special knowledge.
b. Attractive: The counselor is perceived as similar to the client; the client
has a desire to gain the counselor's approval.
c. Trustworthy: The counselor is perceived as wanting to help and is caring.

28. YAVIS and QUOID

Acronyms for certain kinds of desirable and undesirable clients:
 YAVIS: Young, Attractive, Verbal, Intelligent, Successful.
 QUOID: Quiet, Ugly, Old, Indigent, Dissimilar culturally.

29. Motivation
  Intrinsic motivation: Internal desire to be competent and to do
something for its own sake.
 Extrinsic motivation: Drive to do something influenced by external
rewards and punishments.
J. Rotter and others formulated the concept of internal-external control:
 Internal control: The belief that rewards and satisfaction are
contingent on their own actions and that people can shape their own
fate.
 External control: The belief that events occur independently of their
own actions and that the future is determined more by chance and
luck.
Attribution theory: The explanations (causal attributions) we offer for our
outcomes influence our future expectancies of success and our future
motivation to succeed.

30. Self-Fulfilling Prophecy

This is an expectation that individuals will act in a certain way. It is a
powerful attitude, especially significant in its ability to influence school
children's performance. Differential expectations by teachers of various
racial and ethnic minorities based on stereotypes are common. 'Bloomers'
are those expected to perform well.

31. Disability and Handicap

 Disability: The actual physical or mental limitation.
 Handicap: Exists if the disability impacts performance in one or more
of life's major roles because of some barrier, e.g., the need for a ramp
to access a place of employment.
Alternative conceptualizations of handicap:
 Physically challenged
 Mentally challenged
 Other-abled or differently-abled
 Handicapable

32. Individuals with Disabilities Education Improvement Act of 2004

(IDEA)
In 1997, IDEA replaced PL94-142 Education for All Handicapped
Children's Act. The provisions of IDEA 2004 include: a. Free, appropriate
public education must be assured to all children and youngsters between 3
and 21.
b. These individuals with handicaps will be placed in the least restrictive
environment.
c. Each person has an individualized education plan (IEP).
d. Children with qualifying disabilities attending private schools or those
institutionalized are also eligible for services.
Furthermore, the law provides for supplemental funds to communities for
services to eligible children from birth through age 2 if the state meets
requirements of the law. The law requires that children with disabilities
should be placed/educated with other children including those without
disabilities. Mainstreaming and inclusion can be inferred from the
language in the law.

33. Americans with Disabilities Act (ADA-1990)

The act prohibits employers of 15 or more workers from discriminating in
employment (or even applying for employment) against the disabled
(including substance abusers who are in rehabilitation, AA, etc.). The act also
prohibits discrimination in public and private transportation as well as access
to public buildings and facilities.
Officially, a disability substantially limits the individual in one or more major
life activities such as caring for one's self, performing manual tasks, walking,
seeing, hearing, speaking, learning, and working. Based on 2010 data, the
US Census Bureau estimates there are over 56 million Americans with
varying degrees of disability. The increasing older population is a prime
contributor to this estimate.

34. Older Adults

 Over 14 percent of the population is 65 and over. At age 65, the
individual has a life expectancy of about 20 years.
 The oldest old (85 and over) numbered about 6 million in 2012.
 Ageism includes negative attitudes and stereotypes which may
suggest that older people are incompetent, forgetful, and useless.
Characteristics of Older Adults
a. By age 60 to 70 most adults have a physical impairment such as a
chronic disease, sensory impairment, etc.
b. Some intellectual decline into the 70s is possible but not inevitable.
c. Most characteristic personality traits remain stable.
d. Estimates suggest 10 percent of older adults may have depression
and other mental illness.
e. Few older adults receive mental health services.
f. Typical issues older adults contend with include:
- Loss (death of friends and spouse)
- Retirement and increased leisure time
- Physical changes
- Changing family roles, including dealing with adult children
In Counseling Older Adults:
a. Help them build and maintain positive attitudes toward their worth
and dignity.
b. Educate society and advocate for a change in attitudes about
obsolescence.
c. Use a problem-solving approach; deal with specific and immediate
problems.
d. Use a structured life review process to integrate the past and
prepare for the future.
Older Workers:
a. Tend to have longer unemployment periods than younger ones.
b. Their intellectual functioning is not impaired.
c. There is a persistent and progressive decline on speeded tasks.
d. Their age is related positively to overall job satisfaction.
e. There is an increasing need for security and affiliation.

35. Family Abuse and Violence

Child abuse and neglect is sometimes referred to as child
maltreatment. Abuse and neglect can be physical or psychological.
Abuse occurs in all ethnic groups and cultures as well as at all
socioeconomic levels. Most at risk may be children from families under
stress, including single-parent families with few resources or social
support. Often the family believes in physical punishment. Hyperactive,
irritable, ill, premature, and defiant children are more apt to be abused
than others.
Although not definitively documented, most experts believe that there
is a greater tendency to abuse as an adult by someone who was
abused as a child. Child sexual abuse occurs most often between the
ages of 7 and 13 by a male known to the child. Spousal abuse and
abuse of family members who are elderly or have disabilities also occur
frequently. Treatment of violence in the family requires services to the
high-risk parent, the high-risk child, and other family members. The
social context of the family system must be considered. State laws
require reporting suspected or actual child abuse and elder abuse.

36. Teenage Suicide

Suicide is the third leading cause of death among 10 to 24-year-olds.
Although the rate has declined in recent years, about 4,500 adolescents kill
themselves each year. At greatest risk of suicide in this age range are
American Indian, Alaska Native, and gay and lesbian youth. Although more
girls attempt suicide, boys are more successful (about 80 percent of all
suicides).
Indicators to Look For:
 Depression and anger
 Someone talking about committing suicide
 Having a plan and the means to commit suicide
 Giving away valuable possessions
 Suffering loss or rejection
Comprehensive school programs include trained staff,
psychoeducational programming on coping skills, stress reduction, self-
esteem, the use of support groups, a crisis plan, and community
involvement.

37. Leon Festinger

The concept of cognitive dissonance is associated with Leon Festinger.
Cognitive dissonance is a source of motivation—we try to reduce dissonance.
For example, under pressure to make a career decision (e.g., choosing a
college major), the individual selects an occupation to reduce the stress.
However, to make that selection, the person may need to rationalize that he
or she will learn to like that occupation, that there will be jobs, etc.

38. Kübler-Ross

Kübler-Ross believed that dying persons experienced the following behaviors

and feelings:

a. Denial and isolation – "It's not really happening."

b. Anger – "Why me?"
c. Bargaining – "If I don't die, I will..."
d. Depression – Characterized by silence, suffering, and grief.
e. Acceptance – A sense of peace, it's okay.

In this process, individuals might skip or return to a previous stage before

moving on. Others believed that these stages did not adequately represent
the dying person's complex and often recurring feelings. Kübler-Ross also
indicated that caregivers' conscious or unconscious concerns could be an
issue for the dying person in their moving through these stages of grief. It
has been suggested that experiencing any loss can lead to this series of
emotions.

39. Masters and Johnson

Sexual interest and activity generally decline with age; however, men
and women may be sexually active into old age. Later sexual activity and
practices reflect earlier activity and practices. Physical and psychological
factors (including perceived attitudes of others) may influence sexual
activity.
The Masters and Johnson approach used male-female co-therapy teams to
work with marital partners together. They believed that a primary reason for
sexual dysfunction was that the participant was "critically watching and
evaluating" their own sexual performance. Masters and Johnson's therapy
tried to suspend this self-evaluation.
40. Nonverbal Communication
Counselors and clients use nonverbal communication. Counselors
interpret it intuitively. When a discrepancy exists between verbal and
nonverbal messages, the nonverbal one will be believed.
 Paralanguage: These are the other vocal cues individuals use to
communicate, including loudness of voice, pauses, silences,
hesitations, rate of speech, and inflections.
41. Conflict Resolution
One method of resolving conflict is through mediation:
a. Mediation may present new methods of solution, or
b. Mediation may present a solution that would not be acceptable unless it
was presented by a third party.

42. Assertiveness Training

Assertiveness training promotes:
a. The ability to express all manner of emotion,
b. The capacity to express one's rights without denying others' rights,
c. Differentiating between aggression and assertion.

43. Androgyny
Every individual has both male and female characteristics. Sandra Bem (Bem
Sex-Role Inventory) found that approximately 30 percent of children and
college samples are androgynous. Androgynous counseling helps clients
uncover both male and female characteristics.

44. Program Accountability

Accountability is justifying activities engaged in by counselors to those
served and to those who finance their work. Program accountability had its
origins in government bureaucracies. Accountability argues for performance
evaluation. For counseling program management and evaluation, see the
Professional Orientation and Ethical Practice section.

3. Helping Relationships (Theories)

III. HELPING RELATIONSHIPS

1. Helping relationships
Considerable research evidence suggests that the relationship in counseling
is the determining factor whether or not counseling is successful. Theories of
counseling provide the underlying philosophy and strategies for building and
maintaining this relationship.

Four key elements in building this relationship are:

a. Human relations core: empathy, respect and genuineness as
identified by Carl Rogers.
b. Social influence core: competence, power and intimacy.
Expertness, attractiveness, and trustworthiness were identified by
Stanley Strong in his social influence model.
c. Skills core: Allen Ivey identified microskills-communication skill
units such as attending, inquiry and reflection.
d. Theory core: These help the counselor understand self and
interpersonal relationships and skills. They also help to understand
the problems of clients and help to choose interventions that are likely to be
effective with the identified problems.
NOTE: Each major counseling theory is presented here briefly.
Additional information about these theories is presented in a table
on Pages 97-100.

2.
3.
Psychoanalytic (Sigmund Freud)
superego.
Freud identified a structure of personality, namely, the id, ego and
Unconscious motivation or energy is the id ruled by the pleasure
principle.
The ego is controlled by the reality principle; the superego is
internalized
ethics.
(See also Psychosexual Development in Section I, Page 28.)
Therapy techniques include: free association, interpretation of dreams and
other
client material.
Transference (projections onto therapist) must be worked through.
Countertransference consists of projections of the therapist onto
the patient.
Neo-Freudians
A number of psychoanalysts moved away from Freud's emphasis on the id as
the dominant psychological force and placed more emphasis on the ego,
including both psychodynamic and sociodynamic forces.
Karen Horney: Security is each person's major motivation and the person
becomes anxious when it is not achieved. Irrational ways to mend
disrupted human relationships may become neurotic needs.
Erich Fromm: The individual must join with others to develop self-fulfillment -
social character - otherwise she or he may become lonely and
nonproductive.
Society offers opportunities to experience mutual love and respect.
Harry Stack Sullivan: A social systems (interpersonal) approach can lead to
understanding human behavior. Behavior can best be understood in terms of
social interactions, not as mechanistic and linear.
Other neo-Freudians include Otto Rank, Wilheim Reich, and Theodore Reik.
Carl Jung and Alfred Adler can be found later in this section.
Object relations theory
Object relations theory is based on psychoanalytic concepts.
Object relations are interpersonal relationships as represented
intrapsychically.
Freud used the term object to mean a significant person or thing
that is the
object or target of one's feelings or drives.
Object relations are interpersonal relationships that shape an
individual's
current interactions with people, both in reality and in fantasy.
Four broad stages of development have been identified as important
in the first three years of life.
These are:
a. Fusion with mother: normal infantile autism (first 3 to 4
weeks of life)
b. Symbiosis: with mother (3rd to 8th month)
c. Separation/Individuation: (starts the 4th or 5th month)
d. Constancy of self and object: (by the 36th month)
Progressing through these stages provides the child a secure base for later
development. The child develops trust that his or her needs will be met.
Attachment, borderline and narcissistic disorders may occur when
normal
progression through these stages does not occur.
Margaret Mahler wrote Psychological Birth of the Human Infant.
Heinz Kohut and Otto Kernberg are other writers in this area.
Person-centered (client-centered, Rogerian)
Rogers reacted against the directive psychoanalytic approach which
put the
counselor in charge of giving advice, teaching and interpreting. His focus was
more on the person's phenomenological world reflecting and
clarifying their
verbal and nonverbal communication.
The process of becoming, moving clients to self-actualization, and
the relationship between client and counselor were critical
concepts. The focus of counseling went from past to present and
was on feelings. The counselor showed: unconditional positive
regard, genuineness (congruence), and empathic understanding.
These are the core or facilitative
conditions of effective counseling.
Rogers' principal books are: Counseling and Psychotherapy (1942), Client
Centered Therapy (1951), and On Becoming A Person (1961).
Gestalt (Frederick 'Fritz' Perls)
This approach is based on existential principles, has a here-and-now
focus, and
a holistic systems theory viewpoint.
Individuals experience needs. To the extent a need is in the forefront, it
represents the 'figure' and other needs are 'ground,' i.e., in the background.
As the need is met, it completes the 'gestalt' and a new need takes it place.
The goal for individuals in therapy is to become whole beings, to complete
'gestalts.'
Key concepts in the theory include personal responsibility, unfinished
business,
and awareness of the 'now.'
This is an experiential therapy, encouraging the taking of responsibility by
the client. The counselor uses confrontation and encourages the client to
stay with
feelings and to relive experiences and finish business.
Role playing, two-chair techniques, and dream work are used.
Interpretation is done by the client not by the counselor.
Perls wrote: Gestalt Therapy Verbatim and In And Out of the Garbage Can.
7.
Individual Psychology (Alfred Adler and Rudolph Dreikurs)
The belief in the uniqueness of each individual is influenced by
social factors.
Each person has a sense of inferiority and strives for superiority.
We choose a lifestyle, a unified life plan, which gives meaning to our
experiences which include habits, family, career, attitudes, etc.
Counseling goals are to help the client understand lifestyle and identify
appropriate social and community interests. Also, counseling strives to
explain clients to themselves and for them to overcome inferiority.
Techniques used are those leading to insight such as life histories,
homework
assignments and paradoxical intentions.
8.
Transactional analysis (Eric Berne)
The personality has three ego states: Parent, Adult, and Child.
A life script develops in childhood and influences a person's behavior. Many
transactions with others can be characterized as games with the intent to
avoid
intimacy.
Complementary transactions (Adult to Adult) lead to good communication.
Crossed transactions (Adult to Child & Child to Parent) lead to
barriers to
communication.
The goal of therapy is to teach the client the language and ideas of TA in
order to
recognize ego state functioning and analyze one's transactions.
Techniques include teaching concepts, helping diagnose, interpretation, and
use
of contracts and confrontation.
Berne wrote: Games People Play.
Thomas Harris wrote: I'm OK-You're OK.
Existential (Rollo May, Victor Frankl, Irvin Yalom)
Other existentialists include: Soren Kierkegaard, Paul Tillich, Martin
Heidegger,
and Jean Paul Satre.
Phenomenology is the basis of existential therapy.
Phenomenology is the study of our direct experiences taken at their face
value.
We have freedom of choice and are responsible for our fate.
We search for meaning and struggle with being alone, unconnected
from others. Anxiety and guilt are central concepts: anxiety is the
threat of non-being and guilt occurs because we fail to fulfill our
potential.
The goal of existential therapy is the understanding of one's being,
one's awareness of who one is and who one is becoming.
Awareness of freedom and choosing responsibility are other goals.
The authentic relationship is important in existential therapy.
Client-centered counseling techniques are appropriate.
Logotherapy is the name of Victor Frankl's counseling theory found
in his book
Man's Search for Meaning which followed his concentration camp experience.
The principles underlying his theory are individuals':
a. motivation to find meaning in their life journey,
b. freedom to choose what they do, think and how they react, and
c. with freedom of choice comes personal responsibility.
Cognitive and behavioral counseling
The leading proponents of cognitive and behavioral counseling include
Joseph Wolpe, Donald Meichenbaum, Aaron Beck, and Albert Bandura. Albert
Ellis and his Rational Emotive Behavior Therapy, and Arnold Lazarus with
Multimodal Therapy, are often included in this broad category but are
presented here
separately.
The stimulus-response and stimulus-organism-response paradigms are at the
basis of this theory.
The belief is that behavior is learned and, consequently, can be unlearned
and
relearned.
The goals of counseling are to identify antecedents of behavior and the
nature of
the reinforcements maintaining that behavior. The counselor helps create
learning conditions and may engage in direct intervention.
Goals of therapy are likely to be behaviorally stated.
Counseling techniques may include any of the following: operant and
classical conditioning, social modeling, problem-solving, direct training,
reinforcement,
and decision making.
Most counselors would establish a strong, personal relationship with the
client. Dialectical behavior therapy (DBT)
Marsha Linehan developed this therapeutic approach for the
treatment of borderline personality disorder. It is now used more
widely with a variety of disorders including traumatic brain injury,
eating disorders, as well as a range of mood disorders. DBT has
been used with adolescents as well as adults. A group component
usually complements individual work. Used with adolescents, family
members may be involved if available and willing.
A basic principle of DBT, in addition to the usual cognitive behavioral
techniques, is helping clients increase emotional and cognitive regulation by
learning the triggers that lead to their undesired behaviors. The dialectical
principle of recognizing two sides to situations, such as the need for
accepting change and recognizing the resistance to change, receives
attention.
DBT is viewed as a long-term therapeutic intervention in part
because it
requires the learning, practicing and acquiring of a number of skills by the
client.
The skills are conceptualized in the following four modules:
a.
Mindfulness - paying attention to the present moment nonjudgmentally, and
experiencing one's emotions and senses fully.
b. Distress tolerance - accepting and tolerating oneself and the current
situation, often painful and negative, in a non-evaluative way.
c. Interpersonal effectiveness - developing effective strategies for asking for
what one needs, saying no as appropriate, and coping with interpersonal
conflict.
d. Emotion regulation - identifying emotions and obstacles to changing them,
reducing vulnerability, and increasing positive emotions.
The DBT practitioner might also use such tools as diary cards (tracking
interfering behaviors), chain analysis (analyzing sequential events that lead
to
behaviors), and the dynamics of the milieu or culture of the client's group.
For effective use of dialectical behavior therapy, the counselor must obtain
training in order to teach the required skills and facilitate the application of
these skills on an individual and group basis with a variety of clients.
Rational emotive behavior therapy -- REBT (Albert Ellis)
REBT is based on the philosophy that it is not the events we experience that
influence us, but rather it is our interpretation of those events that is
important.
Individuals have the potential for rational thinking. In childhood, we learn
tiple gal irrational beliefs and re-indoctrinate ourselves on a continuing basis.
This leads to
inappropriate affect and behavior.
Belief system, self-talk and 'crooked thinking' are major concepts.
deod Therapy follows an A-B-C-D-E system as follows:
13.
A = external event (an activity or action)
B = belief in the form of a self-verbalization.
C = consequent affect-which may be rational or irrational.
D = disputing of the irrational belief which is causing the affect/behavior. ofer
E = effect (cognitive)-which is a change in the self-verbalization.
Emotive techniques in therapy include role-playing and imagery.
This theory teaches that self-talk is the source of emotional disturbance.
Multimodal therapy (Arnold Lazarus)
This is a comprehensive, holistic approach sometimes classified as eclectic. It
has strong behavioral ties.
This multimodal model addresses seven interactive yet discrete modalities
summarized in the acronym BASIC ID.
These seven modalities are:
B = Behaviors (acts, habits and reactions)
A = Affective responses (emotions and moods)
S = Sensations (five senses as touch, smell, sight, hearing and taste)
I = Images (how we see selves, memories, dreams)
C = Cognitions (insights, philosophies, ideas)
I = Interpersonal relationships (interactions with people)
D = Drugs which is to signify, more generally, biology including nutrition
Assessment covering all seven modalities is necessary to determine total
human
functioning.
Counseling techniques from a variety of theoretical perspectives are used.
These
include anxiety-management training, modeling, positive imagery, relaxation
training, assertiveness training, biofeedback, hypnosis, bibliotherapy, and
thought stopping.
Reality therapy (William Glasser)
Although it is based on Choice Theory, Glasser continues to refer to the
therapy
as Reality.
Individuals determine their own fate and are in charge of their lives.
Our perceptions control our behavior and we behave (appropriately or
inappropriately) to fill our needs. We have five genetically-based needs:
survival, love and belonging, power or achievement, freedom or
independence and fun.
Choice theory means we act to control the world around us and the real
world is important to the extent it helps us satisfy our needs. We may not
satisfy
our needs directly.
Taking responsibility is a key concept.
Characteristics of reality therapy include:
a. emphasize choice and responsibility
b. reject transference - by being yourself as the therapist
c. keep the therapy in the present - the past is not critical
d. avoid focusing on symptoms - focus on how to meet needs
e. challenge traditional views of mental illness - take a more solution-
focused approach
Robert Wubbolding has developed a system for helping counselors learn and
use
reality therapy. The acronym, WDEP, represents:
W - exploring clients' wants as these relate to perceived needs
D - encouraging clients to discuss actions and feelings
E- refers to self-evaluation by clients concerning their behaviors
P - following self-evaluation, planning in order to effect change
15. Feminist therapy
Feminist therapy origins can be traced back to the women's
movement in the
1960s but no specific individual is associated with its development and
nurturance.
Basic perspectives include gender as central to therapeutic practice,
awareness
and understanding of the role of sociocultural influences as they manifest
themselves in therapy, and the need to empower women and address
societal
changes.
The basic principles of feminine psychology which underlie feminist
therapy are (from Corey, 2012):
a. the personal is political - the problems of the client have societal and
political roots which often result in marginalization, oppression,
subordination and stereotyping
b. commitment to social change - therapy is not only for the individual but to
advance a transformation in society. Therapists must also
take action for social change
c. women's and girls' voices and ways of knowing are valued and their
experiences are honored - women's perspectives are
considered central rather than using the male experience as the
norm against which women often appear deviant
d. the counseling relationship is egalitarian - clients are experts on
themselves and their oppression is recognized; therapy is a
collaborative process
e. a focus on strengths and a reformulated definition of
psychological
distress - intrapsychic factors are only a part of the explanation for
the pain experienced; psychological distress is reframed as a
communication about unjust systems; symptoms can be reframed
as survival strategies
f. all types of oppression are recognized - all clients can be best
understood in the context of their sociocultural environments. In
addition to helping clients make changes in their lives, feminist
therapists work toward societal change
Therapeutic processes and techniques which may be used in feminist
therapy include: gender-role analysis and intervention, empowering
techniques, self- nurturance activities, power analysis and intervention,
bibliotherapy,
assertiveness training, reframing and re-labeling, groups, and social action.
Solution-focused brief therapy (SFBT)
Solution-focused brief therapy does not address the history or past
experience of a problem. Understanding the nature of the problem is not
necessary to generating solutions to a problem.
One focus of solution-focused brief therapy is to maintain a positive
orientation believing that the client can construct solutions. Stress
is placed on what is working for the client, the exceptions that exist
to the problem pattern.
Some principal therapeutic techniques and procedures include:
a. Exceptions question: what were the circumstances when the problem did
not exist; these circumstances represent news of difference.
b. Miracle question: If a miracle happened, how would you know and what
would be different?
c. Scaling questions: Using a scale from one to ten, identify changes
in the client's affect, anxiety, etc. Focus is on any positive change
and then duplicate or increase that change.
Brief therapy models are becoming more important with the need to meet
health
maintenance and employee assistance program needs for services. The
number of sessions may be limited to six or eight or fewer. Even in college
counseling
centers, limits to the number of counseling sessions are common.
Brief therapy dictates setting specific goals early in the counseling
relationship. The focus may be on resolving the immediate problem which
led to the counseling intervention and the development of coping skills to
assist counselees
manage current and future problems.
A related therapeutic approach is intermittent counseling. A client sees a
counselor on and off as problems arise sometimes over several years. Not all
client problems will be addressed adequately using brief therapy models. The
counselor and client must identify those circumstances when additional
sessions are necessary and do what is possible to meet the client's needs
appropriately. Using brief therapy procedures with certain client problems
may raise ethical questions of professional competence and abandonment.
Narrative therapy
As one of the strength-based therapies, narrative therapy's philosophical
basis is social constructionism. This post-modern approach believes that
independent, objective reality exists through subjective experiences, and the
client's perception of reality is valid. This reality is based on the language
and words clients use to represent their situation and circumstances in which
people live. Consequently, their realities are socially constructed.

Narrative therapy believes that clients' lives are stories in progress and these
stories can be told and explored from a variety of perspectives. Stories use
words and language to give meaning to experiences and help determine
feelings and attitudes. They are subjective and constructed by the individual
living within a context made up of family, culture, race, ethnicity, gender
orientation, etc.

In narrative therapy, the client tells the often 'problem-saturated' story and
the therapist encourages other perspectives and interpretations. The story
might
be 'deconstructed' and new meanings and variations may be substituted.
After
deconstruction, the focus is on helping the client rewrite the story.
Some specific therapeutic techniques and interventions may be:

a. Questions and clarifications - by the therapist to discover and

construct the story of the client's experience.

b. Externalization and deconstruction - with the focus that the person

is not the problem, the problem is the problem. Externalizing
the problem can help deconstruct it.

c. Re-authoring - helping the client find a more appropriate alternative story.

By finding strengths and exceptions, help the client write a
new story more consistent with what they want their life to be like.

d. Documenting the evidence through writing of letters. Therapists can

consolidate gains and advance therapy by writing letters to the client
between sessions. These have been found to be powerful adjuncts to the
sessions.

Integrative counseling
Integrative counseling goes beyond eclectic counseling which is the use of a
variety of techniques from a variety of theories that best meet the needs
of the client.

Integrative counseling implies the creation of a model by synthesizing

existing theories and practices, not the mere borrowing of useful techniques.
Integrative counseling begins with the counselor developing a personal
theory based on values, worldview, education and experience. From this
personal perspective, the counselor fleshes out this integrative counseling
theory to include the processes and techniques that fit from other theoretical
perspectives. The result is a highly individualistic theory owned by the
counselor, highly congruent, and yet flexible so that the counselor can
address particular client problems and use counseling experiences to further
develop this integrative theory.
19. Comparison of theories of psychotherapy
This section adds considerable additional information about the major
theories of counseling from Corey (2012). Reproduced here are the Basic
Philosophies and Key Concepts from two of his tables. Other tables in his
book identify Goals of Therapy, Therapeutic Relationship, Techniques of
Therapy as
well as other aspects of counseling theories.
Table 15.1 The Basic Philosophies and Table 15.2 Key Concepts

Theories of Psychotherapy
Psychoanalytic therapy
The Basic Philosophy
Human beings are basically determined by psychic energy and by early
experiences. Unconscious motives and conflicts are central in present
behavior. Early development is of critical importance because later
personality problems have their roots in repressed childhood conflicts.

Key Concepts
Normal personality development is based on successful resolution and
integration of psychosexual stages of development. Faulty personality
development is the result of inadequate resolution of some specific stage.
Anxiety is a result of repression of basic conflicts. Unconscious processes are
centrally related to current behavior.

Adlerian therapy
The Basic Philosophy
Humans are motivated by social interest, by striving toward goals, by
inferiority and superiority, and by dealing with the tasks of life. Emphasis is
on the individual's positive capacities to live in society cooperatively. People
have the capacity to interpret, influence, and create events. Each person at
an early age creates a unique style of life, which tends to remain relatively
constant throughout life.

Key Concepts
Key concepts include the unity of personality, the need to view people from
their subjective perspective, and the importance of life goals that give
direction to behavior. People are motivated by social interest and by finding
goals to give life meaning. Other key concepts are striving for significance
and superiority, developing a unique lifestyle, and understanding the family
constellation. Therapy is a matter of providing encouragement and assisting
clients in changing their cognitive perspective and behavior.

Existential therapy
The Basic Philosophy
Key Concepts
The central focus is on the nature of the human condition, which includes a
capacity for self-awareness, freedom of choice to decide one's fate,
responsibility, anxiety, the search for meaning, being alone and being in
relation with others, striving for authenticity, and facing living and dying.
Essentially an experiential approach to counseling rather than a firm
theoretical model, it stresses core human conditions. Interest is in the
present and on what one is becoming. The approach has a future orientation
and stresses self-awareness before action.

Person-centered therapy

The Basic Philosophy

Positive view of people; we have an inclination toward becoming
fully functioning. In the context of the therapeutic relationship, the
client experiences feelings that were previously denied to
awareness. The client moves toward increased awareness,
spontaneity, trust in self, and inner-directedness.

Key Concepts

The client has the potential to become aware of problems and the
means to resolve them. Faith is placed in the client's capacity for
self-direction. Mental health is a congruence of ideal self and real
self. Maladjustment is the result of a discrepancy between what one
wants to be and what one is. In therapy attention is given to the
present moment and on experiencing and expressing feelings.

Gestalt therapy
The Basic Philosophy

The person strives for wholeness and integration of thinking,

feeling, and behaving. Some key concepts include contact with self
and others, contact boundaries, and awareness. The view is
nondeterministic in that the person is viewed as having the capacity
to recognize how earlier influences are related to present
difficulties. As an experiential approach, it is grounded in the here
and now and emphasizes awareness, personal choice, and
responsibility.

Key Concepts

Emphasis is on the "what" and "how" of experiencing in the here

and now to help clients accept all aspects of themselves. Key
concepts include holism, figure-formation process, awareness,
unfinished business and avoidance, contact, and energy.
Behavior therapy
The Basic Philosophy

Behavior is the product of learning. We are both the product and the
producer of the environment. Traditional behavior therapy is based on
classical and operant principles. Contemporary behavior therapy has
branched out in many directions.

Key Concepts

Focus is on overt behavior, precision in specifying goals of treatment,

development of specific treatment plans, and objective evaluation of therapy
outcomes. Present behavior is given attention. Therapy is based on the
principles of learning theory. Normal behavior is learned through
reinforcement and imitation. Abnormal behavior is the result of faulty
learning.

Cognitive behavior therapy

The Basic Philosophy
Individuals tend to incorporate faulty thinking, which leads to emotional and
behavioral disturbances. Cognitions are the major determinants of how we
feel and act. Therapy is primarily oriented toward cognition and behavior,
and it stresses the role of thinking, deciding, questioning, doing, and
redeciding. This is a psychoeducational model, which emphasizes therapy as
a learning process, including acquiring and practicing new skills, learning
new ways of thinking, and acquiring more effective ways of coping with
problems.

Key Concepts

Although psychological problems may be rooted in childhood, they are

reinforced by present ways of thinking. A person's belief system is the
primary cause of disorders. Internal dialogue plays a central role in one's
behavior. Clients focus on examining faulty assumptions and misconceptions
and on replacing these with effective beliefs.

Reality therapy
The Basic Philosophy

Based on choice theory, this approach assumes that we need quality

relationships to be happy. Psychological problems are the result of our
resisting the control by others or of our attempt to control others. Choice
theory is an explanation of human nature and to best achieve satisfying
interpersonal relationships.
Key Concepts
The basic focus is on what clients are doing and how to get them to evaluate
whether their present actions are working for them. People are mainly
motivated to satisfy their needs, especially the need for significant
relationships. The approach rejects the medical model, the notion of
transference, the unconscious, and dwelling on one's past.
Feminist therapy
The Basic Philosophy
Feminists criticize many traditional theories to the degree that they are
based on gender-biased concepts, such as being androcentric, gender
centric, ethnocentric, heterosexist, and intrapsychic. The constructs of
feminist therapy include being gender-fair, flexible, interactionist, and life-
span oriented. Gender and power are at the heart of feminist therapy. This is
a systems approach that recognizes the cultural, social, and political factors
that contribute to an individual's problems.

Key Concepts
Core principles of feminist therapy are that the personal is political,
therapists have a commitment to social change, women's voices and ways of
knowing are valued and women's experiences are honored, the counseling
relationship is egalitarian, therapy focuses on strengths and a reformulated
definition of psychological distress, and all types of oppression are
recognized.

Postmodern approaches
The Basic Philosophy

Based on the premise that there are multiple realities and multiple truths,
postmodern therapies reject the idea that reality is external and can be
grasped. People create meaning in their lives through conversations with
others. The postmodern approaches avoid pathologizing clients, take a dim
view of diagnosis, avoid searching for underlying causes of problems, and
place a high value on discovering clients' strengths and resources. Rather
than talking about problems, the focus of therapy is on creating solutions in
the present and the future.

Key Concepts

Therapy tends to be brief and addresses the present and the future. The
person is not the problem; the problem is the problem. The emphasis is on
externalizing the problem and looking for exceptions to the problem. Therapy
consists of a collaborative dialogue in which the therapist and the client co-
create solutions. By identifying instances when the problem did not exist,
clients can create new meanings for themselves and fashion a new life story.
Family systems therapy
The Basic Philosophy

The family is viewed from an interactive and systemic perspective. Clients

are connected to a living system; a change in one part of the system will
result in a change in other parts. The family provides the context for
understanding how individuals function in relationship to others and how
they behave. Treatment deals with the family unit. An individual's
dysfunctional behavior grows out of the interactional unit of the family and
out of larger systems as well.

Key Concepts

Focus is on communication patterns within a family, both verbal and

nonverbal. Problems in relationships are likely to be passed on from
generation to generation. Key concepts vary depending on specific
orientation but include differentiation, triangles, power coalitions, family-of-
origin dynamics, functional versus dysfunctional interaction patterns, and
dealing with here-and- now interactions. The present is more important than
exploring past experiences.

20. Neurobiology and psychotherapy

The brain grows and differentiates not only because of genetics but
continues this process through its continuous interaction with the
environment. Consequently, the person's experiences with different
environmental conditions and events throughout life can promote re-
mapping of different regions of the brain. So, too, the experience of
psychotherapy can restructure neural
networks in the brain.
The triune model of the brain suggests three principal locations and
functions.
a. The Surviving brain is the stem and responds to danger and controls
automatic functions (flight-fight).
b. The Feeling brain (limbic system) is the emotion center, mediating feelings
and thoughts, and storing some memory.
c. The cortex comprises the Thinking brain including executive functions,
meaning-making and self-awareness.
Neuroplasticity is the brain's ability to produce new neurons and
reorganize itself as the individual experiences new situations and
experiences
(including psychotherapy). Various counseling theoretical approaches, skills
and interventions result in the formation of new neurons and connections.
The
production of neurotransmitters is promoted (see Section I, Page 25).
Research suggests that cognitive behavior therapy (CBT) promotes cognitive
restructuring useful in working with clients who have experienced trauma
such as PTSD. CBT promotes new connections within their memory network
leading to a reduction of symptoms. Eye-Movement Desensitization and
Reprocessing (EMDR) is believed to help clients access new, more adaptive
information.

Biofeedback (or neurofeedback) has been found useful for a number

of
client problems such as sleep disorders, anxiety attacks, phobias and
migraine
headaches. Biofeedback procedures attempt to "re-wire" neural networks.
Ivey, D'Andrea and Ivey (2011) argue that most counseling relationships
foster the development of new neurons and neural networks whether
counselors know that or not. They also write of cultural neuroscience and
how counselors help generate neurons and networks to assist diverse clients
to lead more
satisfying and empowered lives.
Other ways to increase production of positive neurotransmitters
besides talk therapy include involvement in integrative therapies
such as art, music, physical
movement and exercise, relaxation exercises, balanced nutrition, and yoga.
Medication can reduce or control symptoms but there are no biochemical
means to change faulty interaction patterns and behaviors that have led to a
disorder. In addition to the processes listed above, change will come with
new and repeated emotional, verbal and interpersonal processes of learning
that over time become ingrained into brain structures.
Current standards of the Council for Accreditation of Counseling and Related
Educational Programs (CACREP) require curricular experiences for all
counselors in training that promote an understanding of theories of learning
and personality development including current understanding of neurological
behavior. Separate courses in anatomy or neurobiology are not required.
CACREP defines neurological behavior as the relationship among brain
anatomy, function, and biochemistry, as well as learning and behavior.

21.

Mindfulness
The concept of mindfulness is appearing more frequently as an important
aspect in many counseling approaches especially cognitively-oriented
applications. There are two major aspects to mindfulness as applied to
counseling. One component is a focus and attention on one's current
experience including one's environment as well as internal sensations,
emotions and thoughts. The other important component of mindfulness is a
nonjudgmental, accepting attitude to whatever the client is experiencing
externally or internally. Mindfulness is viewed as a form of mental discipline
with a focus on the here and now rather than the past or the future. Most
individuals need instruction and practice in order to implement mindfulness
as defined here. Instruction may include deep breathing exercises, other
relaxation techniques, and meditation. Mindfulness-based cognitive therapy
assists the client in stopping the self- perpetuating mental habits of
ruminating on negative thoughts. Clients learn to pay attention to their
thoughts and body sensations in a nonjudgmental way learning to accept
them and let go of cycles and patterns of responding that are not useful. The
purpose is not to change these thoughts and body sensations as much as
change the relationship to them in a reframing sort of way. Application of
mindfulness counseling practices have been described with a variety of
troubled clients such as those with depression, generalized anxiety disorders,
Post Traumatic Stress Disorders as well as other clients experiencing anxiety
and stress. Most counselors might find mindfulness techniques useful with a
wide variety of clients and their issues no matter what counseling theory
and techniques are used.
Counseling skills and conditions influencing counseling
Empathic understanding: the ability to experience the client's
subjective world
including feelings and cognitions.
Congruence: also called genuineness, this characteristic implies that the
counselor is authentic and integrated in the counseling session. Congruence
can also mean an agreement between a client's behavior and
his or her values and beliefs.
Unconditional positive regard: also called acceptance, this characteristic
implies the counselor is caring without condition and is neither evaluative
nor judgmental.
Concreteness: this is the extent to which the client and the
counselor deal with
issues in specific terms rather than in vague generalities.
Immediacy: this is dealing with what is going on in the counseling process at
the
present time.
Interpretation: this is a therapeutic technique used to uncover and
suggest
meanings and relationships often underlying the apparent expression. Self-
disclosure: appropriate self-disclosure means that the counselor shares
personal affect and experiences relative to the client's issues.
Attending: this refers to several behaviors including listening,
engaging in eye
contact and being psychologically present.
Restatement: repeating what the client has stated with emphasis on
the cognitive
message.
Reflection: repeating what the client has stated with emphasis on
the affective or
feeling portion of the message.
Paraphrasing: restating the message of the client to show or to gain
understanding.
Summarizing: this is a process whereby the counselor or client
brings together
several ideas or feelings usually following a lengthy interchange.
Silence: silence may have many meanings such as quietly thinking,
boredom, hostility, waiting for the counselor to lead, preparing the next
thrust, or
emotional integration.
Confrontation: confrontation occurs when the counselor identifies and
presents discrepancies between a client's verbal and nonverbal behaviors

23. Structuring
or between the counselor's and client's perceptions.
Structuring refers to defining the nature, limits, and goals of the counseling
process. The roles of the client and counselor may be described.

24. Robert Carkhuff

Carkhuff developed 5-point scales to measure empathy, genuineness,
concreteness and respect.
Counselor responses may be viewed as additive, interchangeable or
subtractive.
The counselor's empathic response may be:
Level 1: Does not attend to or detracts significantly from the client's
affect.
Level 2: Subtracts noticeably from the client's affect.

Level 3: Interchangeable with the client's content and affect.

Level 4: Adds noticeably to the client's affect.
Level 5: Adds significantly to the client's affect and meanings.

For example:
Client: (obviously distressed and anxious) "We had an argument last night
and he got very angry. I was really afraid - then he stormed out and I haven't
seen him since."

Counselor Level 1 Response: "Where do you think he went?"

Counselor Level 2 Response: "You seem a little worried about all
this."
Counselor Level 3 Response: "You're very anxious about what
happened last
night and about his whereabouts."
Counselor Level 4 or 5 Response: "You're very anxious about what happened
but also afraid for your safety and wondering where this relationship is
going."
25.
Carl Jung
Jung believed in the collective unconscious.
The collective unconscious is determined by the evolutionary
development of
the human species and it contains brain patterns for the most intense
emotional responses that humans experience.
The operant for the collective unconscious is the archetype. An archetype is
a response pattern occurring universally in the human experience and is
characterized by an emotional charge to the existential issues of identity,
meaning, and purpose.

Examples of archetypes are: anima and animus (female and male

traits).
Goals of Jungian therapy include: transformation of self including gaining
knowledge of self; recognition and integration of self.
Therapy is viewed as a healing process.
Jung introduced concepts of introversion and extraversion.
The Myers-Briggs Type Indicator is based on Jung's theory. Alfred Adler
Two important concepts are birth order and family constellation.
Techniques of counseling: counselor is egalitarian with client-it's a
collaborative effort. Adler views neuroses as a failure in learning
which
results in distorted perceptions.
Stress is on client responsibility in counseling.
ford Counseling examines family constellations, dreams, early memories.
Asking 'The Question': "What would be different if you were well?" focuses
the
counseling process.
Birth order implications: Children in the same family have different
psychological environments because of the difference in birth order.
Oldest child: Gets much attention; tends to be dependable, hard-working,
achievement oriented. When another child (intruder) comes,
oldest may fear losing love.
Second child: Shares attention; sees self as if in a race to compete with
first child; often succeeds where older fails.
Middle child: Often feels left out; may see life as unfair; "poor me"
attitude; may develop problems.
Youngest child: Baby in family; pampered; special role to play;
influenced by all others; tends to go own way; often develops in
directions no one else thought of.
Only child: does not learn to share or cooperate; often deals with adults
well; wants center stage even as adult and if does not get it, may
have difficulties.
Childhood experiences influence our adult interactions and family dynamics.
Gordon Allport and Kurt Lewin

Allport acknowledged that individuals with their personalities exist

within systems. Behavior of an individual must be viewed as fitting
any system of interaction including culture, its situational context,
and field theory. Lewin, a field theorist, believed behavior is a
function of life space which is a function of the person and the
environment. He challenged the linear, mechanistic view of
behavior.

27. Aaron Beck

Developed a system of psychotherapy called cognitive therapy. Identified
automatic thoughts in client. These were similar to the preconscious. There is
an internal communication system. In depressed people, this internal
communication was negatively focused resulting in low self-esteem, self-
blame
and negative interpretations of experiences.
The person experiences a negative cognitive shift.
The cause of depression may be in any combination of biological, genetic,
stress
or personality factors. Follow-up studies suggest there is a greater stability of
results and fewer relapses with cognitive therapy than anti-depressant drugs.
Developed assessments including Beck Depression Inventory.

Joseph Wolpe
Wolpe developed a theory of reciprocal inhibition.
The underlying principle states that a person cannot be both anxious and
relaxed
at the same time.
Systematic desensitization (based on the theory of reciprocal
inhibition) is a
behavioral intervention of counterconditioning. The goal is to reduce
anxiety by associating negative stimuli with positive events. Specifically,
negative images are paired with muscle relaxation.

Donald Meichenbaum
Meichenbaum spoke of cognitive behavior modification-a shift from
self-
defeating thoughts to coping ones.
He introduced the concept of stress inoculation which is practicing
positive or
reinforcing self-statements.
Other behavioral techniques
Token economy: This is the use of tokens (points, ratings, etc.) as a
reinforcement in a behavioral treatment program. Shaping of behavior
can occur through the use of tokens. Privileges and goods can be
purchased with tokens.
Paradoxical intention: With this method, clients are urged to
'intend' that
which they fear or wish to change. It may work with a variety of
unwanted behaviors such as insomnia, smoking, arguing, etc.
Implosive therapy: This behaviorally based intervention induces anxiety
around the problem by presenting vivid images or cues (flooding). The
anxiety is
expected to diminish (extinguish) with repeated exposure and in the
absence of any threat.
Thought stopping: This behavioral intervention is designed to inhibit
recurring
thought by consciously stopping it whenever it occurs.

32. Johari Window

Known to Others - Known to Self
Not Known to Others - Not Known to Self

The window was named after Joe Luft and Harry Ingham. The client brings
material in this window to the counseling session; some is known and other
information is not.
Several principles of change may be identified:
a. A change in one quadrant affects all other quadrants.
b. It takes energy to hide, deny or be blind to behavior.
c. Threat increases awareness; mutual trust tends to increase awareness.
d. The smaller the first quadrant (upper left), the poorer the
communication.
e. There is universal curiosity about the unknown area but customs, social
training, and fears keep parts unknown.
f. The goal of counseling is to minimize the lower right quadrant and
maximize the upper left.

Consultation
Consultation is defined as a voluntary, problem-solving process, initiated or
terminated by the consultant or consultee, to help consultees develop
attitudes or skills so they can function more effectively with individuals,
groups or
organizations. Consultation is work related.

Consultation may be client, consultee, or system focused, and the

goal is not just to resolve the issues that cause human problems but
to increase competence
so future problems may be avoided. Thus, consultation has a
preventive
function as well.
You use many of the same skills as in counseling but the context, role and
function are different. Consultation is not counseling or therapy. Consultation
may be:
a. Content oriented: transfer of knowledge or information from
the consultant to the consultee.
b. Process oriented: looking at the process-may use communication
theory, attribution, change or motivation theory.

Examples of some models of consultation are:

Bergan: This is a behavioral model with four stages which are:
problem
identification, problem analysis, plan implementation, and
problem evaluation. Part of the focus of this consultation is on
problem behaviors and their antecedents and consequences.
Bergan's model emphasizes the verbal interaction in consultation. Bandura:
This is a social learning model.
There is a dynamic interplay of behaviors, cognitions, and the environment
and all three are assessed in problem identification. Many solutions revolve
around modeling, rehearsing, and
changing cognitions.
Schein: Identified the 'purchase model' which involves buying the
consultant expert's knowledge or service. His 'doctor-patient' model stresses
diagnosis
and problem identification. The process model involves the consultee with
the consultant in the diagnostic process and identification of interventions.
Caplan: This is a mental health consultation model. Consultation
occurs between two professionals and can be centered on the
client, the consultee and client, the program, or the consultee and
administration.
A nine-stage process of consultation is described by Splete. These
are: a. pre-
contract, b. contract and exploration of relationship, c. contracting,
d. problem identification, e. problem analysis, f. feedback and planning,
g. implementation of the plan, h. evaluation of the plan,

and i. conclusion and termination of relationship. Animal-assisted, adventure-

based counseling, and wilderness therapy
Animal-assisted counseling helps clients establish a relationship with an
animal that facilitates communication, builds self-confidence, and is non-
judgmental. These positive interactions can be used to better understand
oneself and generalize to others. Dogs and horses are used most commonly
although
many other animals have been found effective.
Individuals who are physically or mentally challenged, victims of trauma, and
socially shy persons may be especially good candidates for animal-assisted
counseling.
Adventure-based counseling is designed for children as well as
younger and older adults as an experiential set of outdoor activities.
These activities may range from camping to hiking to completing
'challenge' courses designed for individuals, pairs, or small groups.
Self-awareness, self-confidence, communication skills, trust, and camaraderie
are possible outcomes of adventure-based activities. Depending upon the
make-up
of the participants, diversity sensitivity and multicultural skills may
be
developed.
A more clinically-oriented program, Wilderness Therapy, is an
outdoor behavioral mental healthcare approach for troubled adolescents and
adults. The purposes of wilderness therapy are to identify and address
emotional, behavioral and psychological problems through an outdoor, often
unfamiliar
environment.

35. Cybercounseling
Cybercounseling is a broad term encompassing webcounseling, E-
counseling and telephone counseling. When conducted on the
internet, it may occur via e-mail messages, be chat-based, or video-
based. It may consist of information- giving, be assessment-focused,
psycho-educational in nature, or deal with
personal, therapeutic issues.
Anyone may benefit from cybercounseling including those who are shy,
physically-challenged, agoraphobics, or those who have no counseling
resources nearby. Some younger individuals who tend to be technologically
savvy may
prefer this medium for counseling.
Some issues surrounding cybercounseling include security of
communications, imposters (both counselor and client), records
maintenance, trust building/transparency, and contacts for clients in
case of crisis.

36. Trauma and disaster counseling

The need for mental health crisis counseling is growing as a result of various
natural disasters as well as human-caused wars, tragedies, violence, and
terrorism. The skills needed for counseling individuals impacted by these
incidents are unique and training is required. CACREP Standards require the
"infusion of emergency preparedness language" throughout the training
curriculum as well as crisis intervention and suicide prevention models. The
Red Cross continually trains qualified mental health counselors for specific
roles dealing
with crises and tragedies.
Possible consequences for counselors working with clients impacted
by trauma
115. and violence include compassion fatigue, secondary traumatic
stress and
vicarious trauma. Counselors may deny they have been impacted, however,
they may show some of these reactions: lack of energy, prefer isolation, be
irritable, have sleeping problems, self-medicate and cease self-care
activities.
Compassion fatigue may be evidenced by counselors who work with difficult
client issues and it may result in loss of empathy and interest in the client's
concerns. It may occur even when working with clients who have not
experienced trauma.
Secondary traumatic stress may result because of the exposure to graphic
material presented by traumatized clients. The counselor may begin
experiencing some of the same symptoms as the client.
Although some writers equate vicarious trauma to secondary traumatic
stress, others believe vicarious trauma includes a change in the counselor's
worldview, sense of self and beliefs.
37.
Neurolinguistic programming
38.
Richard Bandler and John Grinder are the original proponents.
NLP is a communications theory using the five sensory channels. It
can be
used to establish and maintain rapport and pace the client's verbal cues.
NLP examines the structure of language and how it is used to
represent reality. Eye Movement Desensitization and Reprocessing
(EMDR)
EMDR is a counseling technique used to facilitate the client's
accessing of memories of painful and traumatic experiences and
reprocessing these experiences through eye movements similar to
those found in REM sleep

116.
cycles. EMDR has generated considerable positive research.
Alcohol and substance abuse counseling
Over 23 million Americans suffer from substance abuse addiction and for 18
million of these the abuse is alcohol related. Nearly 50 percent of adults
have been exposed to alcohol dependence in the family either in a blood
relative or partner/spouse.
Teenage drinking is associated with suicide, early sexual activity,
date rape,
and automobile accidents.
Substance abuse is often viewed as the number one problem in the
U.S.
Estimates of use are difficult to determine because of unknown recreational
use (especially marijuana), addiction to prescription drugs, and simultaneous
use of alcohol and drugs (polysubstance abuse). In addition to themselves,
substance abusers adversely affect as many as four other people including
family, friends,
and co-workers.
Beginning in 2012, two states (Colorado and Washington) approved the
recreational use of marijuana. As of 2014, additional states had
passed similar legislation. Many states allow for the legal use of
marijuana for medical purposes.
Personality traits often found in alcoholics and drug users include: low self-
concept, anxiety, underachievement, feeling of social isolation, sexual
dysfunctions, dependence, fear of failure and suicidal impulses.
Questionnaires such as SASSI (Substance Abuse Subtle Screening
Inventory)
are useful in assessing signs of addiction.

117. Alcoholism is viewed by many as a disease in itself, not a

symptom, thus
requiring treatment of the disease before effective counseling can begin.
Twelve Step programs have been found effective for many with alcohol or
drug problems. Individual, group and family counseling are valuable
components of treatment. Residential programs, often using behavior
modification and social learning theory, may be effective. Treatment of
the physical addiction is also necessary.
40. Kinesics and Proxemics
41.
Kinesics refers to nonlinguistic communication which occurs through body
movements such as gestures and facial expressions.
Proxemics refers to the spatial features of the environment such as
positioning
of furniture, seating arrangements, etc. How we arrange space will have an
impact
on behavior.
Each of us has a personal space.
Theories and multicultural issues (Corey, 2012)
Person-Centered: The theory encourages open dialogue and
breaking down of
cultural barriers. There is respect for others' values and
differences.
Some clients want more structure than this theory provides and the
core
values may not be congruent with the client's culture. The
counselor's lack of direction may not fit the client's expectation
for help with answers from a knowledgeable professional.
Existential: This approach may be the most useful in helping clients
find
118.
meaning and harmony in their lives as well as empowerment in
an oppressive society. It assists clients to examine the options for
change within their cultural reality.
This approach may not be effective with multicultural clients who
see
themselves as having little personal choice and freedom. Clients
may see this therapy as promoting values which conflict with
collectivism and respect for tradition. Some may want answers
and solutions with more focus on surviving in the world.
Psychoanalytical: The focus on family dynamics may appeal to
multicultural clients. The therapist's formality may appeal to the
client's
expectation of professional distance.
Because this theory often requires long-term restructuring of
personality, it may not be appropriate for many clients or
counseling settings. Many multicultural clients want short-term,
solution-oriented counseling.
Gestalt: The variety of techniques allows the counselor to choose
those that fit
the client. Different approaches allow for many different ways
of
working with clients who may have difficulty expressing feelings.
The focus on nonverbals may be easier for some clients.
Many Gestalt techniques with their high stress on feelings, may be
difficult or inappropriate for multicultural clients, at least
initially.
Behavior: A collaborative relationship between the counselor and
multicultural

119.
client aims for agreed-upon goals which suit the client's unique situation.
The focus is on learning practical skills and self-management
strategies.
Counselors must help clients incorporate their new behaviors into their
cultural context, and be willing to address the consequences these new
behaviors may lead to.
Cognitive-Behavior: The psychoeducational focus of this theory
works well with multicultural clients in that it gets them to examine
their cultural conflicts and teach new behaviors. The emphasis is on thinking
rather than on expressing feelings. Clients may self
value the active and directive approach of the therapist.
The therapist must understand and respect the client's world before
appropriate ways of solving problems can be determined.
Solutions presented may not be consistent with cultural beliefs.
Because the counselor has 'solutions,' clients may become
dependent on the counselor.
Reality: Using this theoretical approach, the counselor explores how
satisfying
the client's current situation is for themselves and others. Thus, it
may work well in multicultural settings helping clients find a balance
between their own ethnic identity and integrating some of the values and
practices of the dominant society.
Cultural and environmental factors, as well as social and political
realities must be recognized by the counselor. Clients may be

120.
more interested in changing their environment and circumstances
than their own life.
Feminist: Therapy approaches are very compatible with multicultural clients.
Issues of oppression and privilege are common to both and the use of power
in relationships is often a concern for multicultural clients. In addition to
individual empowerment, social change is
often a core issue.

This model may be biased toward values of White, middle-class

women which may not fit many women of other cultures. The
feminist therapist must be aware of the consequences of some
client actions and behaviors including the potential isolation from
extended family as life changes are made and new roles assumed.
Adlerian: Focus on 'person-in-environment' is helpful working with
clients from diverse cultures. The therapy's emphasis on
collectivism, importance of the family, social interest and belonging
is consistent with the values of many cultures.

121.
A detailed focus on the client's family background may conflict with
cultural concerns in disclosing family matters. The counselor's
interest in a joint, egalitarian process may be uncomfortable
with clients who see the therapist as authority.
Postmodern approaches: Stories told in counseling can fit into the
social
world of clients. Therapists don't make assumptions about
people and their background. They take an active role in challenging
injustices leading to oppression of the client.
Therapists' interests in having their clients talk about exceptions to their
problems may lead to resistance. Clients may view therapists as
experts and not see themselves as experts on their problem.
Family systems: Therapy's focus on family and community may fit in
well with the views of many clients about extended family.
Networking
is a part of the process and fits the values of having others in their
support system.
Some value assumptions of family therapy may not be congruent
with the clients of some cultures. For example, individuation, self-
actualization, and self-determination may be foreign concepts
to some members of some cultures. Admitting family problems may be
shameful.

122.

FAMILY COUNSELING

42. Paradigm shift

For counselors trained in individual one-on-one psychotherapy, moving into
family counseling requires a paradigm shift in thinking. Rather than an
individual perspective, problem definition and problem resolution is viewed
from
a systems perspective.

43. Reciprocal determinism

In a social system such as a family, every member can influence and
be
influenced by every other member in a continuous process.
Linear causality suggests that one event causes another in a unidirectional
fashion such as found in a stimulus-response situation. Simple,
straightforward language (content) may explain what is occurring.
Circular causality suggests that there are forces moving in many directions at
the same time so the influences and results impact each other resulting in a
complex array of outcomes. The explanation of what is occurring in this
situation focuses on the process.

44. Differences between individual counseling and family counseling

theories. Locus of pathology
Family counseling views the locus of pathology not within the individual but
within the social context of the individual, ordinarily the family.
Focus of treatment interventions
The focus of treatment of the family counselor is on the family rather
than the individual even though a particular individual may be the

123.
identified client or patient.
Unit of treatment
Because the locus of pathology is the family, the unit of treatment
in
family counseling is the family not the individual.
Duration of treatment
Individual psychotherapy is often focused, at least in part, on problems of
a long standing nature and consequently, long term counseling is
indicated.
Family counseling, in general, attempts to provide brief counseling to
resolve current family problems. Thus the duration of family counseling
45. Life cycle of a family
may be shorter than individual therapy.
Family theorists express caution when reducing family development into
discrete,
identifiable and common stages or cycles. Within the contexts of class and
culture, there are many variations, and the cycles and stages of
family development within a particular class or culture are dynamic.
For many families of various classes and cultures, the cycles may look like
this:
a. Leaving home (single young adults): accepting emotional and financial
responsibility
b. Joining of families through marriage or cohabitation: commitment
to
new system
c. Families with young children: accepting new members into system
d. Families with adolescents: increasing flexibility of family boundaries with

124.
adolescents and aging grandparents
e. Launching children: accepting a multitude of exits from and entries into
the family system
f. Families in later life: accepting the shifting of generational roles

46. Family and ethnicity

47. Family is defined differently in different cultures and ethnic
groups.
Family membership may differ (some more extended than others). Child
rearing practices may differ. The mother may be home or there may be
grandparent or extended family involvement. The nature and severity of the
use of punishment varies among cultures and classes.
Time of adolescence or adulthood (as well as transitional rituals) may be
more clearly defined in some cultures and classes than others.

Alternative families
The number of alternative families is growing and the rate of growth of these
alternative family styles in the United States may be greatest among those
with
Eurocentric backgrounds.

Some of the more common alternative families are:

a. Single-parent families which comprise about one-fourth of all families
with children.

b. Remarried families, (because of the high divorce rate and subsequent

remarriages) result in complex relationships within stepfamilies.

c. Gay and lesbian families, which may or may not have children, are not
immune from complex multigenerational family dynamics, and need to sort
through the roles and rules which will arise.

General systems theory

Ludwig von Bertalanffy (biologist) proposed systems theory. This is not the
reductionistic view where structure was important. In this view, the
organization and the interrelations of the parts are important. This is not
linear thinking
(A causes B) but circular (A may cause B, but B also causes A, which
may
affect B, etc.).

49. Psychodynamic theory of family counseling Nathan Ackerman is

principal proponent. Theory came out of psychoanalytic
background. In a new marriage, the couple brings psychological
heritage and resemblances from families of origin. They may bring
introjects (imprints or memories) from parents or others. The family
unit seeks homeostasis and an individual family member's
symptomatic or
pathological behavior disturbs the homeostasis.

Ackerman believed in an interactive style of therapy, moving into the

family's
living space, stirring things up and acting as a catalyst for change.
James Framo, also psychodynamic in orientation, believed the social context
of a person's life helped shape behavior. Conflict stemming from one's family
of origin continued to be acted out in current relationships in one's family.
Framo believed that human beings in childhood are object seeking, i.e.,
hoping to establish satisfying object relationships, especially with parents. If
the child is rejected, this frustration is retained as an
introject which will appear later.
51. Although Framo begins therapy with the entire family, he often
concludes therapy
by doing conjoint (couple) therapy followed by couples group
therapy and
then family of origin (intergenerational) conferences.

Experiential family counseling

Carl Whitaker does family counseling from an experiential
perspective. Less reliant on theory, he becomes highly involved in
the therapeutic process.
He actively joins the family paying close attention to what he himself was
experiencing in the therapy. He would then use that awareness to press for
changes in the family.
The process of therapy is most important and the encounter in
therapy is designed to challenge the old ways of thinking and
behaving, on the way to new
growth.
Whitaker uses symbolism to help explain many experiences, and these
symbols are often outside of awareness or consciousness.

50. Humanistic family counseling

Virginia Satir represents a humanistic model of family counseling. Human
beings as well as families have the resources within themselves to flourish,
grow and develop. Self-concept of the individual is important. Poor
communication (discrepancies) within the family is often blocking members
from healthy functioning so Satir would serve as a teacher and
trainer. Under stress, Satir believed that family members would
adopt one of five different styles of communication: placater,
blamer, super- reasonable, irrelevant, and congruent communicator.
The last one is a healthy style.

Satir's counseling approach has also been characterized as one of process

orientation thus her therapeutic style is also an experiential one. She
believed in interacting closely with the family and stressed the need for
intimacy in family relationships.

Family systems theory

Murray Bowen is the architect of the systems theory of family counseling and
presented the most well developed family counseling theory. Based on
general systems theory, Bowen emphasized the family as an emotional unit
in the formation of dysfunctional behavior in a family member. Because he
believed that family history including more than one generation of the family
was central to therapy, his approach has often been labeled
transgenerational.

Eight theoretical concepts were identified by Bowen:

Differentiation of self: the degree to which individuals can
distinguish between their intellectual (thinking) processes and their
feeling processes.
If there is fusion between these two processes, individuals are likely to
experience involuntary emotional reactions and become dysfunctional.
Triangles: Individuals have a need for closeness and individuation. To the
extent two individuals (e.g. husband and wife) are fused, they may bring in a
third person (e.g. child) to resolve such two-person stress. The basic building
block of a family's emotional system is the triangle. The greater the fusion in
the family, the greater the triangulating that will Occur.

Nuclear family emotional system: Marital partners chose mates with

equal
levels of differentiation. Thus two undifferentiated partners will probably
become highly fused and produce a family with similar characteristics. Such
a nuclear family emotional system will be unstable. Family projection
process: the fused, unstable marital partners will focus on one of the children
(typically the most infantile) and this is called the
family projection process.

Emotional cutoff: children involved in the projection process may try to

escape the fusion by moving away geographically, or isolating themselves
psychologically. This emotional cutoff is only a deception. Multigenerational
transmission process: the poorly differentiated child of poorly differentiated
parents will select a similarly poorly differentiated child to marry. This
process could repeat itself through several generations with the 'weak links'
always marrying weaker links, etc. Sibling position: roles tended to be
associated with birth order. If two individuals of the same birth order or
different birth order marry, these individuals could complement each other or
compete with each other. Societal regression: Bowen extended his thinking
to society's emotional functioning, and in his pessimistic view, society is
regressing because it does not differentiate between emotional and
intellectual decision making.
Bowen's therapy begins with a comprehensive assessment process. He
develops a

genogram for the last three generations. This is a visual picture of the
shin family tree. In therapy, Bowen's tendency is to work only with the
marital
couple even if children have been identified (IP -- identified patient) as
having the family problem. His goal is to maximize each partner's self-
differentiation.

His style as a therapist is to remain neutral and detriangulated unlike the

experiential and humanistic family therapists.
Structural family therapy
Salvador Minuchin is the primary proponent of structural family therapy. Each
family has an organization or structure characterized by the evolved rules
which are the transactional patterns between members. These rules dictate
how, when, and with whom, family members interact. Rules may be generic
(for all family members) or idiosyncratic (individualized). The family is
composed of subsystems which are necessary to carry out family functions.
These subsystems have boundaries and rules for membership.
Examples of subsystems are: spousal, parental, and sibling.
Boundaries between subsystems may be permeable or diffuse. If boundaries
are too diffuse, this may lead to enmeshment. Rigid boundaries lead to
disengagement.
Either extreme is likely to create problems within the family.
Other concepts defined in structural family therapy are alignments (the way
family members join together or oppose each other), power (who has
authority and who has responsibility), and coalitions (alliances between
specific family members).

Minuchin uses a map diagramming the current family structure in identifying

where dysfunction may be present. This structural map shows boundaries,
alliances, coalitions, conflicts, etc.
In therapy, structuralists challenge the transaction patterns in the family and
hope to change, reorganize, or restructure the family. One goal might be
clearer boundaries. The parental subsystem must be clearly defined with
executive power and responsibility.

Minuchin joins the family in therapy as an active member. He may mimic

(mimesis) some aspect of the family's manner, style, etc., and encourages
enactments of some dysfunctional interactions. Through reframing, he labels
what occurs into a more positive or constructive perspective.

54. Strategic family therapy

The Mental Health Institute (MRI) focused on family communication patterns
in its research in helping families with problems. Metacommunication
qualifies or puts conditions on the communication which occurs on the
surface or content level. It is called the second level of communication.

Several communication techniques were identified which have proven useful.

Therapeutic double bind: a paradoxical technique wherein the client is asked
to continue some undesirable behavior or symptom when he or she expected
to be told to stop it. The client is caught in a bind and must give up the
symptom or acknowledge control over it.

Prescribing the symptom: the paradox here is to refuse to continue the

behavior and abandoning it or acknowledging control over it.
Relabeling: similar to reframing wherein the meaning of a situation is
changed so that the situation is perceived differently.
The strategic family therapy approach advocates are Jay Haley and Cloe
Madanes. Power and control characterize relationships in families, and
symptoms are attempts at controlling a relationship.
Strategic therapy techniques are often direct suggestions or assignments.
Assignment of paradoxical tasks often occurs.

55. Milan systemic family therapy

This therapeutic approach came out of Milan, Italy and was led by Mara
Selvini-
Palazzoli. The family is viewed as a system with connections between family
members with a goal of keeping the system in balance. The family is viewed
as playing a 'game' to maintain the system.
Systemic family therapists bring hypotheses to the therapy sessions to be
checked out. Usually a team of therapists are also observing, and they may
provide the suggestions and directives to be relayed to the family before it
leaves. Circular questioning is the process of asking several family members
the same question about the same relationships. This reveals family
members' connections and the differences in meaning they ascribe to an
event. Rituals of the family are often used therapeutically; established family
patterns might be changed suggesting new ways of doing things, which may
alter beliefs and attitudes. By revealing family 'games' and through new
information, Milan therapists hope to change family rules and
relationships.

56. Behavioral/cognitive approaches

Behavioral techniques have been used effectively for behavioral marital
therapy,
l behavioral parent-skills training, functional family therapy, and conjoint sex
therapy.

Cognitive behavior therapy, with its focus on thoughts and actions, has
received
increasing emphasis.

Robert Liberman introduced operant conditioning and social learning

principles to the solution of family problems.

Richard Stuart called his approach operant interpersonal therapy. His social
exchange model argues for the influence of ongoing behavioral exchanges
on their long-term outcomes in relationships. Marital skills training and
behavioral contracting were other features of Stuart's approach.

Behavioral parent-skills training focuses on child management. Techniques

such as time out and designing contingency contracts may be used.
In functional family therapy, all behavior is viewed as adaptive, always
serving a function. Therapy helps individuals learn new skills through
education.

Conjoint sex therapy, as practiced by Masters and Johnson, assumes that any
sexual inadequacy exists in a system the two partners represent.
Consequently, conjoint therapy is necessary. A very high success rate is
reported by Masters and Johnson.

57. Social constructionist

Some postmodern approaches to family therapy are gaining acceptance.
These approaches challenge the traditional systems way of thinking about
family dynamics and relationships. For example, there may be no objective
'functional' family dynamics in reality that apply to all families. Individuals of
various cultures, genders, races, sexual orientations, etc. determine their
own level of healthy family functioning.
Social constructionists do not believe there is a common reality we share. We
use language to share our experiences and perceptions and use language to
communicate with others and construct a common reality.

One therapeutic approach adopting a social constructionist philosophy is that

of Steve deShazer who focuses on solutions rather than problems. Solution-
focused therapy pays little attention to the history of the problem or
underlying causes. The therapist and clients have 'discussions' about
solutions they want to construct together.
The language (words) that are used give meaning to the therapist-family
discussions and 'stories' they bring. Since word and language meanings vary
for different people and from different perspectives, one task is to get
agreement on the 'reality' under discussion.
One assumption is that clients already know what they need to do to solve
the problem but need help in constructing a new way to use that knowledge.
deShazer viewed clients as facing locked doors with no keys and through the
counseling process, he would help provide them "skeleton keys" -
interventions
that they could use to unlock many doors.

A counseling approach developed from deShazer's model was the solution-

oriented therapy of William O'Hanlon. Again, the language used by clients
and therapists is important because meanings and perceptions are
embedded within.
In solution-oriented therapy, the counselor collaborates with clients,
acknowledges them and suggests that the possibilities for solution and
change already exist within them. Some of the focus in therapy is on what is
working well (rather than what is not) and, increasingly doing something
different.
58. Narrative family therapy
Another postmodern therapeutic approach involves the use of narratives,
which are stories family members bring to therapy. These narratives may be
negative and limiting perceptions of themselves and their lives.
Deconstruction is the process of examining a narrative, determining
underlying assumptions, and suggesting that there may be other
meanings that may be attached to the story. This provides the
family an opportunity to reauthor the story and the process
empowers them. The family therapist may assist in building a
scaffold for a new story and assist in the co-authoring.

59. Psychoeducational family therapy

Psychoeducation may be a therapeutic technique or adjunct to any
number of family therapy approaches. The goal of psychoeducation
is to assist a family with their daily functioning in general, and in
dealing with specific issues the family
may be experiencing such as with an individual with medical problems.
In addition, families who have a member with mental health problems may
need
assistance with medication regimens and life coping skills. Stress and time
management, and self-care issues may be present.
Psychoeducation may also be valuable in such areas as marriage
preparation,
marital enrichment, and stepfamily blending.

60. Comparison of Family Therapy Theories

Table 18.1 A Comparison of Theoretical Viewpoints in Family
Therapy
From GOLDENBERG/GOLDENBERG.
61. Feminist issues and gender-sensitive family therapy
Feminist and gender-sensitive issues are important in family therapy. There
must be recognition of the social, cultural and political factors which
influence the treatment of men and women. Roles for men and women within
a society, within a culture, and within families are well established. In many
cultures, patriarchal models dominate with attendant power differentials
between genders. And, therapists are influenced by the same social and
cultural factors and role stereotypes as anyone else.

Feminist and gender-sensitive family therapy challenges traditional

viewpoints of gender roles and the family therapist must be
sensitive to how these roles are being played out in the family in
therapy. There should be an identification of strengths and needs of
both men and women. Family members must be empowered and
enabled to move beyond traditional sex roles and be given choices
such as changing established sex roles and the expectations of
those Genogram roles.

62. Genogram
The genogram is a pictorial representation of the relationships
within a
family typically extending through three generations. Developed with the
help of family members, the genogram may identify emotional,
communication,
and behavior patterns within a family. Other items of information such as
religion, occupations, and ethnic origin may be added.

63.
Play therapy
In play therapy, children are encouraged to express feelings, act out dreams
and ambitions, and direct their own life. Play helps the child master
anxieties, relieve tensions, cope with life's problems, and expend physical
energy. Play therapy also allows the child to relieve frustrations and helps the
therapist analyze the child's conflicts. Children often feel less threatened and
more at ease in showing their feelings through play.

Providing them with a variety of media including toys, art supplies and
equipment gives them an opportunity to make decisions and the therapist an
opportunity to
observe how children deal with conflict (approach-approach).
Virginia Axeline wrote Play Therapy and Dibs: In Search of Self.
She believes the leader or therapist attends, recognizes feelings, helps the
child
express them, and helps the child implement new behaviors.

64. Definitions (from, Goldenberg & Goldenberg, 2012))

Alignments -- Clusters of alliances between family members within the
overall family group; affiliations and splits from one another, temporary or
permanent, occur in pursuit of homeostasis.

Boundary - An abstract delineation between parts of a system or between

systems, typically defined by implicit or explicit rules regarding who may
participate and in what manner.

Closed system - A self-contained system with impermeable boundaries,

operating without interactions outside the system, resistant to change and
thus prone to increasing disorder.

Coalitions - Covert alliances of affiliations, temporary or long term, between

certain family members against others in the family.

Conjoint - Involving two or more family members seen together in a therapy

session.
Cybernetics - The study of methods of feedback control within a system,
especially the flow of information through feedback loops.
Enmeshment - A family organization in which boundaries between members
are blurred and members are overconcerned and overinvolved in each
other's lives, limiting individual autonomy.

Family sculpting - A physical arrangement of the members of a

family in space, with the placement of each person determined by an
individual family member acting as "director"; the resulting tableau
represents that person's symbolic view of family relationships.

Feminist family therapy - A form of collaborative, egalitarian, nonsexist

intervention, applicable to both men and women, addressing family gender
roles, patriarchal attitudes, and social and economic inequalities in male-
female relationships.

Genogram - A schematic diagram of a family's relationship system, in the

form of a genetic tree and usually including at least three generations, used
in particular by Bowen and his followers to trace recurring behavior patterns
within the family.

Homeostasis - A dynamic state of balance or equilibrium in a system, or a

tendency toward achieving and maintaining such a state in an effort to
ensure a stable environment.
Identified patient (IP) - The family member with the presenting symptom;
thus, the person who initially seeks treatment or for whom treatment is
sought. Joining - the therapeutic tactic of entering a family system by
engaging its separate members and subsystems, gaining access in order to
explore and ultimately to help modify dysfunctional aspects of that system.

Multiple family therapy - A form of therapy in which members of several

problems. families meet together as a group to work on individual as well as
family

Nuclear family - A family composed of a husband, wife, and their offspring,

living together as a family unit.

Open system - A system with more or less permeable boundaries that

permits outside influences. interaction between the system's component
parts or subsystems and

Permeability - The ease or flexibility with which members can cross

subsystem boundaries within the family.
Strategic approach - A therapeutic approach in which the therapist
develops a specific plan or strategy and designs interventions aimed at
solving the presenting problem.

Structural model - A therapeutic approach directed at changing or

realigning the family organization or structure in order to alter dysfunctional
transactions and clarify subsystem boundaries.

System - A set of interacting units or component parts that together make

up a whole arrangement or organization.

Triangulation – A process in which each parent demands that a child ally

with him or her against the other parent during parental conflict.

Maslow’s Hierarchy of Needs

1. Physiological Needs
2. Safety and Security
3. Love and Belonging
4. Esteem
5. Self-Actualization

IV. GROUP WORK

1. Definition of a group
A straightforward definition of any group is: two or more individuals
interacting
together to achieve some goal.
The more classic definition of group counseling comes from George Gazda
and states: Group work refers to the dynamic interaction between collections
of individuals for prevention or remediation of difficulties or for the
enhancement of personal growth/enrichment through the interaction of
those who meet together for a commonly agreed-on purpose.

2. Advantages of group counseling

Some advantages of group counseling include:
a. people learn in a social context
b. experience social support
c. source of new behaviors
d. learn some counseling skills
e. peer confrontation
f. able to play a variety of roles
g. group norms develop
h. any biases of the counselor may be addressed more readily
 i. more nearly replicates the participants' everyday world
k. spreads out the counselor(s) further in schools and agencies
i. the counseling is less costly per individual
J. safe place to practice new skills

3. Goals of group counseling

Some goals of group counseling include:

a. learn to trust self

b. self-knowledge
c. recognize the commonality among members
d. find alternative ways of resolving conflicts
e. increase self-direction
f. learn more effective social skills
g. become more sensitive to others' needs
h. learn how to confront appropriately
i. clarify expectations, goals, and values
j. make specific plans for changing certain behaviors and to commit to
these plans

4. Types of groups
Differences between groups revolve around their goals. The types of groups
include:
Guidance
 The purpose of these groups is to provide information.
 Discussions are focused on how this information is relevant to
members of the group.
 Guidance groups are often found in school settings
Counseling:
 The purpose of these groups is growth, development, removing blocks
and barriers, and prevention. Group members have problems they are
trying to address in a group format.
Psychotherapy
 The purpose of these groups is remediation, treatment, and personality
reconstruction. Such groups may run longer than others and are found
in mental health agencies, clinics, and hospitals. Therapists in private
practice also conduct such groups.
Psychoeducation
 These groups focus on acquiring information and skill- building and can
be preventive, growth-oriented or remedial. Psychoeducation groups
are found in a variety of social service agencies, mental health
settings, and universities.
Structured
 These groups are focused on a central theme.
 Examples of structured groups are:
  Learning job seeking skills, anger management, dealing with
'drinking and driving' issues, and loss/grief.
Self-help
 These are support systems to help with psychological stress. These
groups are focused on issues such as weight control, survivors of
incest, parents who have lost a child, etc.
 These groups are usually not professionally led.
T-Group (training group):
 The focus of these groups is to examine and improve interpersonal
skills. How one functions within a group
 (e.g., at a work site) is examined.
Task/Work groups:
 Such groups include committees, planning groups, and study groups
formed to accomplish specific goals. Teams of individuals operating
interdependently and sharing one or more goals found in work settings
is another example.

5. Group dynamics; content and process

Group dynamics refers to the development and interaction of the forces
inherent between and among members of a group. Forces relating to the
roles members play, the goals of the group, and the norms the members
adopt will influence how the group behaves. Group behavior may range from
positive and socially acceptable to negative and destructive.
Group members and the leader may focus on the content which is the
subject under discussion or the focus may be on the process which is how
the interaction or discussion is occurring.

Focus on the process results in examining the meaning of an experience with

its attendant feelings which leads to affective learning and the development
of trust in the group. In conducting counseling and therapy groups, the
leader must be skilled in processing and is able to model this skill for
group members.
In addition to content and process issues, each group session can be
characterized as having a warm-up, action, and closure sections. In
successful groups, there is usually a balance between content and
process in all three sections which allows for the best experience for
group members.

6. Group cohesion
 A cohesive group means that members find the group
attractive, and it provides them a feeling of belonging and inclusion.
Cohesion is not automatic but occurs when group members take risks
including self- disclosure, drop defenses, and make commitments to
each other. The unifying force of a cohesive group leads to an effective
 working group. Some similarities between group members encourages
the formation of cohesion, and attacks on a cohesive group result in
greater cohesion.
 Group members are likely to identify with members who are perceived
as attractive or who have power. Modeling the behaviors of such
members is likely, however, such behavioral changes are more apt to
persevere if the behaviors are internalized because of a change in
motivation.

7. Roles of group members

 Group members may assume a number of different roles which
may impact the dynamics of a group. Some common roles are:
a. Facilitative/building role which may help group members feel a
part of the group and contribute to the positive and constructive functioning
of the group.
b. Maintenance role contributes to the bonding of the group by
encouraging the social and emotional bonding of the group members.
c. Blocking role often attempts to hinder group formation and
accomplishment of goals through negative and diverting behaviors.
8. Styles of leadership
Leader styles have been described as autocratic, democratic or
laissez faire. In laissez faire members are free to do as they choose.
Each style has its advantages.
- The autocratic style is best for quick decision- making but may
generate resentment.
 The democratic style doesn't always generate the most production.
 If the group is committed to a common goal, the laissez faire
approach often yields the best results.

9. Group counselor's core skills

Corey in Theory and Practice of Group Counseling (2011) lists the following
core for skills of competent group leaders:
a. Active Listening
b. Restating
c. Clarifying
d. Summarizing RE
e. Questioning
f. Interpreting
g. Confronting
h. Reflecting Feelings
i. Supporting
j. Empathizing
k. Facilitating
1. Initiating
m. Setting Goals
n. Evaluating
 o. Giving Feedback
p. Suggesting
q. Protecting
r. Disclosing Oneself
s. Modeling
t. Terminating

10. Group leader's general knowledge and responsibilities

Leaders of groups should:

a. Know theories of group counseling
b. Understand the principles of group dynamics
c. Know ethical issues involved in group work
d. Linking: look for themes (common issues) and connect them.
This facilitates members working on each other's problems.
e. Blocking: stop unproductive behaviors such as scapegoating, storytelling
and gossiping.
11. Universality
 Mutuality (universality) is the feeling that one is not alone or unique,
and that others have similar problems or have been in similar
situations.
12. Intellectualization
 This is the process of keeping material or content in the group on a
cognitive level.
13. Scapegoating
 This is a process whereby several members of a group gang up on an
individual member and ‘dump' on him or her.
14. Dealing with resistance
Resistance is individual or group behavior that impedes group
progress.
 These behaviors might include arriving late, appearing unable to set
goals, silence, talking too much, preoccupation with side issues, fear,
etc.
 Resistive behaviors may psychologically protect the group member.
Discussing resistive behaviors with the group
 before they begin may help prevent them.
  Counselors can address resistive behaviors and model for others how
to deal with them.
 Confrontation is a powerful technique.
15. Issues regarding co-leaders
 With co-leaders the group members benefit from the experiences and
insights of two leaders
 Co-leaders can recreate roles and serve as models so more linking is
possible.
 Co-leaders should give each other feedback.
 It is helpful if the co-leaders are male and female.
 Different reactions and feedback from the leaders may enhance group
energy
 and discussion.
 Co-leaders should have a good working relationship and should not
have conflicting theoretical orientations.
 They should not have a power struggle which may fragment the group.
h. Co-leaders should process the 'co-leading' experience regularly.
 Co-leading is a good way to start out 'new' group leaders, that is,
pairing an inexperienced counselor with one who has group
experience.

16. Group formation issues

a. Homogeneous vs. heterogeneous.
 Groups that are homogeneous are composed of similar kinds of
members.
 If the members are too heterogeneous, the group members may not be
able to relate to each other and their problems. However,
heterogeneity is more like the real world and stimulates interactions.
b. Open vs. closed group.
 In an open group you replace members who leave; new
members provide new ideas, stimulation, and resources.
 In a closed group where you do not admit new members,
building and maintaining trust and cohesion is facilitated.
c. Group size.
 For an adult group with no co-leader, the optimum size is 8.
 With children who are five or six years of age, three or four members
may be ideal. For older children, counseling groups may be larger.
d. Duration.
 The number of weeks a group will run should be set in advance
and group members should be advised of the duration.

 The time length of a session with adults may be up to two

hours. For outpatient groups, 90 minutes may be appropriate while
inpatient groups may meet for a shorter time. For children, length of
 session should be shorter depending upon their age and may be only
20-30 minutes for five
17. Screening
Selection of appropriate members for a group requires advance preparation
including screening.
Screening is usually conducted through an interview (typically with
the group leader) during which time the goals and purpose of the group
are explained to the prospective member.
Characteristics of the potential member and motivation should be
ascertained. Some individuals, such as those who function below the level
of other group members and those who are disruptive or dominating, will
retard the group process.
Screening should include a review of the group norms (rules),
confidentiality issues and appropriateness of that particular group
focus to the prospective member. The screening should also be an
opportunity for the individual to determine whether the group is the right one
to join.
18. Ethical guidelines for group counseling
 Informed consent: tell the client before counseling about the rights
and expectations. Get this 'informed' consent before counseling
begins.
 Confidentiality: difficult to assure in group counseling. The leader
must impress the need for confidentiality on all group members. There
are exceptions to confidentiality such as danger to self or others, court
actions, or when signed waivers have been obtained.
 Research: group members are asked for permission before
participating in research.
 Group counselor training: counselors have acquired skills and
competencies through education and experience.
 Group members' rights include: freedom from undue pressure,
participation is voluntary (if it is), freedom of exit, and the right to the
use of the group's resources.
19. Norms
 Norms are a group's rules of behavior which provide parameters to
members about acceptable behaviors.
 There are formal and informal rules, spoken and unspoken ones.
 The rules may be different from the norms outside, in the 'real world.
 For example, sharing and expressing feelings is okay; self-disclosure is
okay.
There may be pressure on members to conform to the norms.
Consequences for not doing so may be established.
20. Stages of a group
Some writers have identified five stages of a group.
 One writer (B. Tuckman) called them: forming, storming,
norming, performing, and mourning (adjourning).
  Yalom identified four stages: orientation, conflict, cohesion, and
termination.
 Corey identified six stages of a group although the middle four
stages are commonly acknowledged as core. His stages are:
Stage 1: Formation - Pregroup Activities
Issues: planning, leader preparation, recruiting, and screening and selecting
group members.
Leader: identifies goals and purposes of the group and announces the group.
Potential group members are screened and selected. Practical, operational
details are identified and addressed.

Stage 2: Orientation and Exploration

Issues: orientation and structuring of group process, inclusion, identity, and
establishing cohesion and trust.
Leader: models, helps identify goals and structures. The leader states
expectations and ground rules for the and models interpersonal honesty and
spontaneity. Helps group members share thoughts and feelings and teaches
interpersonal skills. The leader should be psychologically present and
genuine.

Stage 3: Transition - Dealing with Resistance

Issues: anxiety, conflict, resistance, intellectualization; questioning;
challenging leader.
Leader: creates a supportive, trusting climate; addresses anxiety and
resistance; provides a role model. Identifies behaviors both positive and
negative to the group process. Keeps group goals in focus. The leader
supports but also challenges group members.

Stage 4: Working - Cohesion and Productivity

Issues: cohesion, effective working group, using resources within the group.
The group is now productive with less dependence on the leader. Self-
exploration increases. More focus on here-and-now.
Group members help each other through the issues.
Leader: provides reinforcement; links themes; supports risks; models
appropriate behavior; encourages translating insight into action.
Stage 5: Consolidation and Termination
This is the final stage of the group process and will determine how effective
the group experience was for the members.
Issues: feelings about termination including sadness and anxiety; unfinished
business; feedback; preparing for the outside world; decisions about what
courses of action to take.
Leader: deals with feelings; reinforces changes; helps members make plans
and contracts. Assists members to understand and integrate what happened
in the group. Confidentiality continues. Just because the group ends, doesn't
mean the members can start talking/gossiping.

Stage 6: Postgroup Activities - Evaluation and Follow-up

Issues: evaluation of outcomes; follow-up referral for other services.
Leader: processes the group experience with others(including supervisor) if
possible; evaluates the process and outcomes; conducts follow-up sessions
with the group members to reinforce learnings, provides support, and helps
evaluate outcomes.
21. Irvin Yalom
Yalom postulated 11 curative factors which existed in successful group
work:
 Altruism
 Universality
 Interpersonal learning
 Imparting information
 Developing socialization techniques
 Imitative behavior
 Group cohesiveness
 Catharsis
 Corrective Recapitulation of the primary family group
 Installation of Hope
 Existential factors Such as One is alone and responsible
If these represent, participant growth and development would occur

22. Group Leader functions

 Yalom Suggested leadership functions were present in group
counseling no matter what the theoretical orientation of the counselor.
 These leader functions were:
o Emotional stimulation:Encouraging the expression of feelings,
values, and beliefs, deep emotional concerns.
 Leader uses: Confrontation, challenge, self disclosure, the
leader, models behaviors
 Caring: Characterized by warmth, acceptance, genuineness, and
concern
o Leader is honest, an open leader promotes growth of trust in the
group.
 Meaning attribution: the leader provides cognitive
understanding of the events in the group; experiences are named and
feelings are put into words
o Leader: interprets, clarifies and explains.
 Executive leadership function: the leader structures, suggests
limits and norms, and provides direction.
o Leader: is active in terms of pacing, blocking, stopping.
 o Emphasis is on 'managing' the group as a social system.
Effective leaders used:
a. moderate amounts of emotional stimulation
b. moderate amounts of executive direction
c. frequent use of caring functions
d. consistent use of meaning attribution

A poor style of group leadership meant:

a. very low or very high emotional stimulation
b. very low or very high executive behavior
c. low use of caring function
d. low use of meaning attribution

Zander Ponzo's studies found some support for Yalom's factors and
he found:
some different ones which were present in successful groups.
These are: openness, participation, risk-taking, conflict-confrontation, and
caring support.

23. Michael Waldo

Waldo suggested different levels of leadership functions were
needed depending on the needs of the group (diagnostic category) and the
clinical setting such as inpatient vs. outpatient, and time limits, stated goals
and objectives of the group.
For example: For a psychiatric inpatient group:
a. the executive function of group counseling might be stressed;
b. emotional stimulation might be de-emphasized or closely
moderated;
c. meaning attribution might be carefully geared to the kind and level of
information this population can understand;
d. the caring function might depend whether the population is schizophrenic,
borderline or sociopathic.
24. Jacob Moreno
 Moreno began the 'Theater of Spontaneity' in Vienna in 1921.
 Psychodrama emphasizes enacting conflicts or crisis situations
in the present.
 The focus is on the here and now. The goal is to reorganize individuals'
perceptions. It allows for catharsis, insight, and reality testing.
Psychodrama has a:
 director/producer (usually the group leader),
protagonist who is a group member (either a volunteer or selected),
auxiliary ego (may be several, also called actors) representing people or
objects, and an audience.
The psychodrama occurs on a stage which may be an actual stage or
part of the room.
Three parts of the psychodrama are
1. warm-up (preaction)
2. Action
3. Integration.
Moreno was the first to use the term 'group psychotherapy' in the
literature in the 1920's.
He founded the American Society of Group Psychotherapy and Psychodrama
in 1941.

25. Family counseling and couples counseling

 Family counseling is a special application of group counseling. The
parents and children will be seen together and often alone as well.
Much of the emphasis in family counseling is identification of
the family problems, defining personal and family goals, and
teaching family members new behaviors and interaction
patterns.

 Group couples counseling often focuses on educating couples to

improve communication between themselves and their children,
resolve conflicts, and learn parenting skills. A number of parent
education training programs have been developed.
26. Primary, secondary, tertiary prevention groups
 Primary groups: the emphasis is on preventing problems and
developing
healthy behaviors. (These may be called guidance or
psychoeducational
groups.)
For example: educational programs on drugs, alcohol or AIDS.
Secondary groups: there are preventative and remedial elements in these
groups. The focus may be on reducing the length or severity of a
problem. (These may be called counseling groups.)
For example: dealing with grief, adjusting to a death, problem solving.
Tertiary groups: the focus of these groups is to return members to healthy,
full functioning. (These may be called counseling or therapy groups.)
This may involve personality change or rehabilitation.
For example: counseling individuals with post-traumatic stress disorder.
27. Group counseling and multicultural issues
In counseling groups with multicultural clients, special issues may be
present.
Cross-cultural clients may not understand how counseling works.
 Extent of group members' acculturation may be a significant factor in
their understanding of and willingness to participate.
  Some cultures discourage sharing of personal problems or
family concerns with others; this may be defying traditional
family customs. In the group it may appear to be resistance.
 Also, silence is valued in some cultures. Participants in a diverse
counseling group may be insensitive or lack understanding of
cultural differences among members.
 The use of some techniques such as confrontation may have a different
impact cross-culturally.
 Leaders of multicultural groups should be trained in group counseling
and multicultural issues.
 They must be aware of how their own cultural background influences
their perceptions and actions. Systemic and historical factors pertinent
to group members must be recognized.
 Clients in a multicultural group may gain much from feedback from
other group members. Watching others learn new behaviors and
modeling may be effective. Learning new ways of dealing with cultural
prescriptions and family reactions can be beneficial to cross-cultural
clients.
Typical goals of multicultural groups may be:
 from a cultural perspective, understand the circumstances that brought
the person to the group
 provide learning for the individual in the group process
 help the group member understand how new behaviors and skills fit
within the context of their culture
28. Research on groups can be outcome or process oriented
 Outcome research shows evidence of effectiveness of group work; data
supports group counseling.
 Process research: this has shown a higher level of quality of
research-more laboratory studies.
 Research demonstrates that perceptions, expectations and beliefs of
group members can be changed.
The continuing question about researching the effectiveness of any
counseling is: Who has been helped with which method or technique,
applied by what
kind of helper, under what conditions? This applies to group as well as
individual counseling.
29. Counseling theory applied to group work
(from Corey, 2011 and Gladding, 2011).
This list contains a number of major and historical theoretical approaches for
conducting group counseling. Newer trends and approaches to group
counseling should not be ignored. These include family groups, brief and
narrative therapy groups, and the groups working from a feminist
therapy perspective.

a. Person-centered Group
  Goal: encourage openness; explore full range of feelings; increasing
self- understanding; develop openness, honesty and spontaneity.
 Techniques: active listening and reflection; support and 'being there'
and altering self-concepts; few structured techniques.
 Content: feelings, personal meanings, attitudes, sense of trust in the
group.
 Focus: insight and affect oriented.
 Leader: group member centered and process oriented; leader creates
climate, conveys acceptance, facilitates and links.
 Multicultural: person-centered therapy respects cultural
values; encourages active listening; group members may not like 'lack
of direction'; they may want more structure, and a more directive
problem-solving approach.
b. Gestalt Group
 Goal: awareness, experience in the moment, personality change.
 Techniques: focus on the here and now; experiential; use of exercises
including confrontation, empty chair, guided fantasy; catharsis.
 Content: clients have responsibility for moment-to-moment
experiencing and awareness; deal with unfinished business.
 Focus: action/insight and affect oriented.
 Leader: group member centered and process oriented; leader brings
structure to group; serves as catalyst for change; encourages working
through unfinished business.
 Multicultural: different techniques can be adapted to different
clients; focus may be on nonverbals and what they mean; many
clients are less apt to respond with intense feelings and be less willing
to participate in some techniques.
c. Transactional Analysis Group
 Goal: awareness; making new decisions; become free of scripts and
games; altering course of life.
 Techniques: interacting with others; making contracts; use script-
analysis checklist; teaching/learning; role-playing.
 Content: life script; three dynamic ego states-parent, adult and child;
games people play.
 Focus: a combination of insight/action and rational/affect oriented.
 Leader: leader is teacher and diagnostician; group is leader-centered
with equal process and outcome orientation.
 Multicultural: clients like the structure of the TA group; the
contracts they design can account for cultural values.
d. Cognitive Behavior Group
 Goal: eliminate problem behaviors and teach self-management skills.
 Techniques: examine the learning process and find ways of
changing/learning behaviors, cognitions and emotions; use of
reinforcement, contracts, modeling.
  Content: target behavior, environmental circumstances maintaining
the behavior, and environmental changes and intervention strategies
that can change the behavior.
 Focus:action and rational oriented.
 Leader: leader-centered and action oriented (teacher, expert); teaches
coping skills and methods of modifying behavior.
 Multicultural: behavioral groups de-emphasize focus on feelings;
they are often short-term and structured and work toward specific
goals, clients learn new coping strategies, clients may learn new
behaviors they will have to integrate with family and cultural values as
well as with historical/systemic factors.
E. Rational Emotive Behavior Group
 Goal: constructive changes in client's thinking and behavior leading to
a
greater acceptance of self; move past self-defeating behaviors.

 Techniques: learning A-B-C theory; practicing disputing; exercising

self-discipline; role-playing; homework assignments.

 Content: irrational beliefs and values and consequent problem

behaviors.

 Focus: action/insight and rational oriented.

 Leader: leader centered and both process and outcome oriented;

confronts illogical thinking and serves as a model for others.

Multicultural:
counselor would be viewed as a teacher versus a therapist and teaches
clients pert role and leader directiveness.
Rational-emotive approach may be too directive/forceful for some clients and
the highly active role of the group leader could create dependence; what the
leader views as irrational behavior may not be.

f. Reality Group
 Goal: improve the quality of life by achieving increasing control over
one's life; taking responsibility.
 Techniques: confront and encourage honest self-examination;
evaluate behavior; formulate a plan for change (contract); commit to
such a plan and follow through.
  Content: member's awareness and present behavior; wants and
needs; responsibility.
 Focus: rational and action oriented.
 Leader: leader centered and outcome oriented; assist members make
choices, formulate and implement a plan.
 Multicultural: group work takes on a teaching/learning
approach often resulting with contracts by group members; contracts
can be consistent with their own identity and cultural values;
 no strong emphasis on feelings;
 group members may feel leaders do not understand the strong
influence of discrimination and other socio-historical factors;
 The cultural emphasis may be to work for the community's good and
not just for the individual.
G. Adlerian Group
 Goal: explore basic life assumptions; understand lifestyles; recognize
strengths and accept responsibility; increase self-esteem; develop
social interest.
 Techniques: psychoeducational; analysis and assessment; explore
 family constellation; cognitive restructuring.
 Content: cognitive, behavioral and affective sides of human nature;
early history; lifestyles; belief systems.
 Leader: leader centered; challenges beliefs and goals; models;
encourages members to action.
 Multicultural: members can view culture from their own unique
perspective and background. They can create their own meaning from
their own personal experiences. Members may be reluctant to share
family background details in the group.
30. Adlerian influences
Adlerian theory maintains a belief in the strong belief in the strong
social nature of people. Adler’s approach is also known as individual
psychology but the focus is not on the individual but the individual in the
group.
This approach has a holistic view of the person with more emphasis on
interpersonal and intrapersonal factors. The role of the family is critical in
Adlerian counseling. The meaning clients give to their position in the family,
sibling relationships and birth order are important. The individual’s
orientation to life and its themes called lifestyle are also addressed. Adler’s
psychological concepts have been successfully implemented into family
counseling centers and family education programs and materials.
Rudolf Dreikurs transplanted Adler’s ideas to the US and expanded the use of
Adlerian concepts to the group process.
The Adlerian group approach has been transformed into successful
psychoeducation models for parent education and for use in schools. One of
those is the STEP - Systematic Training for Effective Parenting program
developed by Don Dinkmeyer.
31. Association for Specialists in Group Work (ASGW)
 This is one of the divisions of ACA. ASGW has best practice guidelines
for statement group workers which serves as its code of ethics.

V. CAREER DEVELOPMENT

1. Theories of career development

Although many theories have been presented to explain how career
development occurs; five theories are most influential today. These are the
theories of Donald Super, John Holland, Linda Gottfredson, John Krumboltz
and Mark Savickas.
Other theories have historical value and newer ones are introduced regularly.
Some of the theories presented in the section on Human Growth and
Development also have implications for career development such as that of
Erikson and Levinson.

2. Classification of career theories: Actuarial and Developmental

Actuarial: theorists from this perspective focused on some 'structure' of the
individual such as needs, traits, interests, etc., and designed a theory of how
career development occurs from that basis.b
Examples of actuarial theories are: trait-factor and needs-based
theories.
Developmental: theorists from this perspective viewed career
development as occurring over time, usually through stages.
This process of career development could include various
'structures' such as self-concept and need.

3. Donald Super (developmental approach to careers)

Super preferred a broad self-description and labeled himself a differential-
developmental-social-phenomenological psychologist. Evolving over time, his
theory has been characterized as life-span, life-space.

Early Super
 His early conception of career development (1950's and 1960's)
included vocational development stages and vocational
development tasks.
The vocational development stages are:
 Growth (birth to 14-15). Development of capacity, interests and self-
concept.
 Exploratory (15-24). Tentative choices made.
 Establishment (25-44). Trial (in work situations) and stabilize.
 Maintenance (45-64). Continual adjustment process.
 Decline (65+). Preretirement, work output issues and retirement. He
later changed decline to disengagement.
According to Super, self-concept was implemented in choice of career.
He identified the concept of career maturity and later renamed it career
adaptability to make it less age-related.
Super also identified five vocational development tasks. These are:

a. Crystallization (ages 14-18)-formulating a general vocational

199150 goal through awareness.
b. Specification (18-21)-moving from a tentative to a specific
vocational choice.
c. Implementation (21-24)-completing training and entering
employment.
d. Stabilization (24-35)-confirming a preferred choice by performing the
job.
e. Consolidation (35+)-becoming established in a career;
advancing; achieving status.

The ages of Super's stages and tasks no longer apply because some
people have gaps in their employment (careers) and recycle. This model
was initially focused primarily on white, middle-class, College-educated
males.
Super recognized that we can repeat or recycle through these
developmental tasks.

Later Super
By the 1970's, Super viewed career development as more holistic,
that is, involving more of the individual than just the job or career. He
presented the concept of life-career rainbow which included the life span
with its major stages and life space which consists of the roles we play.
The nine major roles we play in life are:
1. Child
2. Student
3. Citizen
4. Spouse
5. Homemaker
6. Parent
7. Worker
8. Leisurite
9. pensioner
Roles are played out in four theaters which are: home, community, school,
and workplace.
  Super developed the Archway Model as a graphic
representation of the many determinants that comprise one's
self-concept.
 One pillar of the archway represents the factors and variables
within the individual that influence career development such
as needs, aptitudes, interests and achievements.
 The other pillar includes external factors such as family,
community, and labor market.
 At the top of the arch between the two pillars is the Self of the
individual.
Super is responsible for the Career Pattern Study which examined the
vocational behavior of 9th graders all the way into their 30s. Those
adolescents who were career mature and achieving in high school tended to
be more career mature and successful as young adults.

4. John Holland (a typology)

Although much of Holland's theory is actuarial or structural in
approach, he goes to considerable lengths to explain how types develop.
Furthermore, types provide the energy and motivation to do certain things,
learn certain skills, associate with particular people, and avoid other skills as
well as people.
To Holland, career choice is an expression of personality. We choose a career
based on the stereotypes we hold about different jobs or careers.
Holland identified six modal personal orientations (personality
types) which developed based on genetic factors, environment, and
parental influences.
Holland's six styles or types are: RIASEC
 Realistic: aggressive; prefers explicit tasks requiring physical
manipulation; has poor interpersonal skills.
 Examples: mechanic, technician.

 Investigative: intellectual; prefers systematic, creative investigation

activities; has poor persuasive and social skills
 Examples: chemist, computer programmer.

 Artistic: imaginative; prefers self-expression via physical, verbal or

other materials; dislikes systematic and ordered activities.
 Examples: artist, editor.

- Social: social; prefers activities that inform, develop, or enlighten

others; dislikes activities involving tools or machines.
 Examples: teacher, counselor.

- Enterprising: extroverted; prefers leadership and persuasive roles; dislikes

abstract, cautious activities.
- Examples: manager, sales personnel.

- Conventional: practical; prefers ordered, structured activities; dislikes

ambiguous and unsystematized tasks.
- Examples: file clerk, cost accountant.

Every person has all six types in varying amounts.

Occupational environments may be categorized into the same six types

because environments are defined by the people (types) in that
environment.

One of the values of Holland's theory is that there are many methods for
determining an individual's type. He developed the Vocational
Preference Inventory and the Self-Directed Search.
Other instruments, such as the Strong Interest Inventory and the
Career Assessment Inventory, have adopted Holland's typology.
Focused questions in an interview can usually determine the individual's
Holland type as well.
Most occupations in the United States have been assigned a Holland type
and can basil be found in the Dictionary of Holland Occupational Codes.

Holland used the hexagon to explain some important concepts

about his theory:

The types must be arrayed around the hexagon in the order indicated. The
theory is sometimes referred to as the RIASEC theory.
 Consistency: adjacent pairs of types are more psychologically alike
than non adjacent pairs of types.
 Differentiation: an individual's profile of six types has
significant highs and lows (differentiated) or the profile of six types
tends to be flat (undifferentiated).
 Congruence: the individual's type and the environment type are the
same.
  Vocational identity: high identity individuals are those who have a
clear and stable picture of their interests and goals.
Holland's theory is very popular; many others have incorporated this theory
into their own work.

5. Linda Gottfredson (developmental)

 This newer (1980's) career development theory is called
'Circumscription and Compromise' and focuses on the
vocational development processes experienced by children.
Vocational self-concept is central and influences occupational selection.
 Individuals circumscribe (narrow down occupations) and
compromise (opt out of unavailable or inappropriate occupations) as
they develop.
 Individual development progresses through the following four
stages:
a. Orientation to size and power (age 3-5)
Children have neither; they are concrete thinkers and begin to understand
what it means to be an adult. Even as young as age 3 they can name
occupations they would like to do.
b. Orientation to sex roles (6-8)
Children learn that adults have different roles, and occupations are sex-
typed. Even today, most occupations are performed primarily by one sex or
the other.
c. Orientation to social valuation (9-13)
There is greater awareness of values held by peers, family and community;
occupations vary greatly in social value - desirability.
d. Orientation to internal unique self (14+)
In occupational selection as a teenager or adult, internal factors such as
aspirations, values, and interests are critical. Young children (ages 6-8, and
even younger according to some research) tend to choose occupations
which fit their gender. Preadolescents tend to choose occupations
which have social values consistent with their perceived social
class. They may also rule out occupations which are inappropriate
because of a 20ono mismatch in ability, intelligence level or cultural
factors. In the teenage years and later, self-awareness of personal
characteristics helps determine which occupation is selected.
Individuals develop a cognitive map of occupations based on sex-type, social
value (prestige), and field of work (interest area). A zone of acceptable
alternatives is identified and occupations within this range are consistent
with the individual's self-concept.

6. John Krumboltz (learning theory of career counseling -- LTCC)

Krumboltz used Bandura's social learning theory to identify the principal
concepts for this theory of career development and career counseling.
Reinforcement theory, cognitive information processing, and
classical behaviorism are important concepts.

Career development and career decision making involve the following:

a. genetic endowments and special abilities
This includes inherited qualities which may set limits on career opportunities.
b. environmental conditions and events
Events and circumstances influence skill development, activities, and career
preferences. Natural resources,
economic conditions, and legislation may be involved.
c. instrumental and associative learning experiences
This is learning through reactions to consequences, results of actions, and
through reactions to others. Reinforcement and non- reinforcement of
behaviors and skills are important. Associative learning experiences come
from associations learned through observations and written materials. They
influence an individual's perceptions.
d. task approach skills (problem-solving skills, work habits, etc.)
Skills acquired such as problem-solving, work habits, mental sets, and
emotional and cognitive responses.
Learning experiences over the lifetime influence career choice. An
individual's generalizations and beliefs may be problematic and may need to
be challenged by the career counselor. New beliefs and courses of action
may need to be learned and substituted. The Career Beliefs Inventory of
Krumboltz may be used to identify clients' mental barriers preventing them
from taking action.
Unplanned and chance events will influence an individuals' career
development, and such occurrences should be expected and taken
advantage of. Krumboltz refers to these events as 'planned happenstance.'

7. Ginzberg, Ginsburg, Axelrad, and Herma

These developmentalists first presented their theory in 1951 and
believed
occupational choice progressed through three periods:
a. fantasy (birth to 11). Play becomes work oriented.
b. tentative (11-17). Four stages in this period are: interest, capacity,
value, and transition.
c. realistic (17+). Three stages in this period are: exploration,
crystallization, and specification.
The Ginzberg group based their early theoretical formulation on a small
group of middle-class males who supposedly had freedom of choice in
occupation.
Decision making was important and was influenced by adolescent
adjustment patterns. Later, Ginzberg agreed that occupational decision
making was a lifelong process. Their theory stimulated further research.
Super, for example, found many concepts in the Ginzberg et al. theory useful
in the formulation of his own career development theory which he presented
a few years later.

8. Ann Roe (needs approach)

 Roe believed that genetic factors, environmental experiences, and
parent-child relations influenced the needs structure each child
developed. Parental influences and early childhood experiences were
viewed as major determiners. Later, occupational selection would be a
function of those needs. Roe believed that careers were chosen to
meet needs through either person oriented or non-person oriented
occupations. This part of the theory was not well supported by
research.
Roe developed a field-by-level classification of occupations.
She identified Six levels:
1. Professional and managerial (highest level)
2. Professional and managerial (regular)
3. Semi-professional and managerial
4. Skilled
5. Semi-skilled
6. Unskilled

Eight fields:
1. Service
2. Business contact
3. Managerial
4. General cultural
5. Arts and entertainment
6. Technology
7. Outdoor
8. Science
The last three contained the non-person oriented occupations.
Robert Hoppock was also a needs-based career theorist. He identified a
number of hypotheses which addressed the role of needs in choosing,
changing and being satisfied with a career.

9. Tiedeman and Miller-Tiedeman's decision-making model

Tiedeman (with O'Hara) believed that career development occurred as part
of cognitive development as one resolved ego-relevant crises. For them,
career development paralleled the eight psychosocial stages identified by
Erikson.
Tiedeman saw life decisions and career decisions as integrally related.
Career
decision making is a continuous process consisting of two phases,
anticipation or preoccupation, and implementation or adjustment.
Anticipation or Preoccupation includes the following phases:
 Exploration
 Crystallization
 Choice
 Clarification
The phases of Implementation or Adjustment are:
 Induction
 Reformation
 Integration

Later, Tiedeman (with Miller-Tiedeman) emphasized the importance of the

individual in the decision making process.
The personal reality (I-power) of the individual was at the center of this
potential for self-improvement and subsequent self-development.
Through a continuous process of differentiating one's ego development,
processing developmental tasks, and resolving psychosocial crises, career
development takes place.

10. Cognitive information processing and career development

Reardon, Lenz, Sampson & Peterson (2008) presented a theory of career
development based on cognitive information processing (CIP).
A procedure for solving career problems was developed based on a series of
assumptions which emphasize cognitions, information, and problem solving.

This sequential procedure, summarized as CASVE, involves the following

processing skills:
a. Communication: identifying the career-related needs of the client.
b. Analysis: identifying the problem components and placing them in a
conceptual framework.
c. Synthesis: formulating courses of action or alternatives.
d. Valuing: judging each action as to its potential for success or failure and
impact on others. This is a prioritizing process.
e. Execution: developing plans and implementation strategies.
11. Social cognitive theory and self-efficacy
Many concepts are based on Bandura's social learning theory. A cornerstone
of that theory is self-efficacy which postulates that an individual's
expectations will influence whether a behavior will be initiated, how much
effort will be expended, and how persistent the individual will be in the face
of barriers. In short, self-efficacy theory is an individual's belief that he or she
can perform some task or be successful in some endeavor.
In the career domain, these beliefs will influence choice, performance and
persistence. Nancy Betz and Gail Hackett, and others, believe these concepts
explain gender differences in career choice.
Society empowers males, through expectations, to pursue a wider range of
occupations than females and this may help explain why more men pursue
math and science majors and careers.

Personal agency reflects an individual's ability and power to achieve

objectives. Self-efficacy can be strengthened through learning experiences
such as:
a. personal performance accomplishments
b. vicarious learning
c. social persuasion
d. physiological states and reactions

The career counselor can structure these learning approaches to increase a

client's self-efficacy.
12. Constructivism and contextualism
The constructivist approach suggests that individuals construct their own!!
reality or truth through their own way of organizing information. This
becomes a very subjective phenomenon and focuses on how individuals
extract meaning from their present situation.
Contextualism implies that career development is a constant interplay of
forces within the individual, within the environment, and the interaction
between the two. One cannot separate (remove) individuals from their
environments (context) and the individuals' perceptions and information
organizing processes create their reality.

The goal for the career counselor is to encourage the client to make meaning
of his or her situation. Because context is so important, unraveling
(dissecting) events into very small pieces may be counterproductive and
reduce the possibility for constructing personal meaning. The focus of
attention is actions which are cognitively and socially based. These actions
are viewed from three perspectives: the behavior which occurs, the internal
state (affect), and their social meaning.

13. Mark Savickas

Savickas is a proponent of a postmodern career counseling approach based
on career construction theory. The career counselor is not viewed as the
expert with infallible scores from inventories but rather as an active agent in
assisting career clients to make sense of their life and work in order to be
successful and satisfied.
Recently, Savickas presented the concept of life design as a paradigm for
career intervention. In this paradigm, individuals construct careers through
identifying and presenting small stories in response to a few questions.
These stories are deconstructed with the help of the counselor and then
reconstructed. Using these small stories, the counselor coconstructs with the
client a life portrait or identity narrative and assists the individual to
construct this career story into a new episode.

This life design paradigm focuses on contextual possibilities,

nonlinear progress, dynamic processes, multiple perspectives, and personal
patterns which represent the world of work today. It takes into account the
changing nature of the workplace including the need for workers to be
flexible, continuously employable, and have the ability to be temporary,
contingent, casual, freelance, and self-employed.

14. LH.B. Gelatt

Gelatt focuses on the decision-making process and outlines a fairly
traditional
five step process:
1. Recognize a need to make a decision
2. Collect data and look at courses of action
3. Besides looking at courses of action, examine potential outcomes and
their probability
4. Attend to your value system
5. Evaluate and make a decision (choose), and the decision can be
investigatory or permanent.

His later model of career decision making is called 'Positive

Uncertainty' and is viewed as a whole-brained approach. Rational
and intuitive components must be considered in decision making.

15. Trait and Factor (career counseling approach)

This approach is sometimes called an actuarial or matching approach.
The trait-factor approach was developed by Frank Parsons (Father
of Guidance).
Parsons wrote Choosing a Vocation which was published in 1909 the year
after he died.
Trait-factor means you:
a. study the individual (trait)
b. survey occupations (factors)
c. match the person with an occupation (using true reasoning)
This approach stimulated the development of assessment techniques (tests
and
inventories) and occupational information gathering.

E. G. Williamson (1930's) refined the 'trait-factor' approach. To him, the

career counseling approach involved six steps:
1. Analysis
2. Synthesis
3. Diagnosis
4. Prognosis
5. Counseling
6. Follow-up.
16. Sociological or situational models of career development
There are sociological reasons why individuals choose the work that they do.
People choose what they know about, i.e., occupations family members may
expose them to. Ethnic group membership and cultural factors influence
individuals toward and away from certain jobs and careers. Other factors
which may influence occupational choice include risk behavior, work identity
and career mobility.
Situationally, the environment and its opportunities influence the work an
individual does. Local labor market conditions, educational/training and
employment opportunities, as well as the mix of employers will impact what
is available and often determines an individual's 'career development.'

17. John Crites

Crites developed a comprehensive model of career counseling. 22
The counselor makes three diagnoses of the career problem. a.
differential-what are the problems?
b. dynamic-why have the problems occurred?
c. decisional-how are the problems being dealt with? After
diagnosis, Crites advocated:
client-centered and developmental counseling to begin with, later followed
by the use of psychodynamic techniques such as interpretation, finally
followed by trait-factor and behavioral approaches.

Crites is associated with the study of vocational maturity. He viewed

it as a continuous developmental process moving through a series of stages
and tasks. He developed the Career Maturity Inventory.

18. Decision models

In applying a decision-making model to career development, several factors
which might affect decision making are:
a. risk taking style
b. investment (by chooser, such as time, money, deferred gratification)
c. personal values
d. self-efficacy (belief that the individual can perform the behavior necessary

19. Career theory limitations

Many career theories had their origins in the 1950s and 1960s with data from
small samples usually comprised of young, white, middle-class males. Many
samples were college-educated. Non-whites and women were often
excluded.
Consequently, early career theories had limited generalizability to
women,
non-whites, and other ages. Over the years, other issues such as
workplace
trends, women in the labor market, an increasing multicultural population,
single family homes, and dual-earner families argue for modifications in
career theories.
Most good career theories are still evolving.

20. Undecided and indecisiveness

Undecided implies the individual needs more information and then
can or make a decision. It is a state of being.
Indecisiveness is an ongoing trait of the individual which implies
that even with more information, the individual has problems making a
decision.
This is true beyond the career domain.
Different counseling approaches are indicated based on whether the
individual is undecided versus indecisive. With an indecisive client, personal
counseling may be necessary before career counseling is helpful.

21. Career development

Career development is a lifelong process in which we develop values,
skills, interests, and knowledge of the world of work. In this process, we also
make decisions and implement these decisions through education and work.

22. Career-related definitions

Job: one person in one position doing a set of tasks.
Occupation: a definable work activity found in many locations (e.g.
counseling,
welding).
Career: a series of jobs and occupations one does (narrow).
Career: the education, training, work experience, and related professional
activities associated with one's occupation (middle).
Career: all of the work and other life roles one engages in (broad - from
Super). Lifestyle: refers to the person's orientation and preference in regard
to career,
family, leisure, place of residence, work climate, and overall style of life.

23. Portfolio and encore careers

Portfolio career: Refers to the fact that many workers are engaged in more
than one line of work at the same time. These jobs may or may not require
similar skills.
Encore career: For a number of reasons, many retired individuals by choice
or necessity are returning to work. Typically, they do not go back to their pre-
retirement employer and thus do a "work encore" in some other kind of
employment.

24. Compensatory versus spillover theory of leisure son of yo

Leisure includes periods of time in which an individual engages in activities
or pursuits chosen freely such as relaxation, hobbies, sports, travel, and
other
We do outdoor or indoor activities.
Do you compensate (in terms of using skills, abilities, interests) for what you
cannot do on the job-so you do very different things off the job?
Does what you do on the job 'spillover' into your leisure-so you do the same
kinds of activities, using the same skills?

25. Career guidance and career counseling

Career guidance: assists individuals in understanding and acting upon self-
knowledge and knowledge of opportunities in work, education, and leisure,
and to develop decision-making skills.
Career counseling: the emphasis is on career development of an individual
with special attention to values and attitudes, in a dynamic environment with
a focus on self-understanding, career information, and career planning and
decision making.

26. Personal versus career counseling

Most professionals believe that career counseling is personal counseling.
Clients are holistic with problems and concerns that are multifaceted and
overlap in several domains of life including home, work, and family.
27. Career counseling process
a. Establish a relationship
As with all counseling, career counseling is built upon a relationship between
a career counselor and a client. In addition to helpful personality
characteristics of the counselor, certain conditions experienced by the client
in career counseling will facilitate sharing of issues with the career
counselor.
b. Problem identification
As a result of this sharing, the career counselor and client should develop a
better understanding of the issues or problems confronting the client.
Without this information, career counseling will lack direction and focus.
c. Assessment
Assessment is a continuous process and occurs from the moment the career
counselor meets the client. Assessment might include the use of
standardized and nonstandardized instruments. Some level of assessment
continues until termination.
d. Provide information
This step of the career counseling process relies on the career counselor as
an expert to provide pertinent information. The focus here is in informing the
client of possibilities, opportunities, and resources helpful in addressing her
or his specific career problem. Often, much of this information can be
gathered by the client with appropriate direction, rather than given to the
client.
e. Decision making
In the career counseling process, decision making usually follows.
With the help of the career counselor, the client has identified the problem,
participated in the assessment process, and has gathered and been given
information. Decision making is next.

f. Implementation and follow-up

The career decision made in the previous step in the career counseling
process is implemented. This will be highly idiosyncratic depending upon
the individual, her or his circumstances, and the educational, employment,
or other opportunities found in the environment. Follow-up with the client
should occur as agreed upon.

28. Career counseling and individual differences

Career counselors must be sensitive to the unique characteristics
presented by each client. They must fight the natural tendency to
stereotype a client because he or she comes from this ethnic group, has that
disability, etc.
Diversity includes such dimensions as gender, socioeconomic status, age,
and spirituality, as well as ethnicity, disability, and sexual orientation. Career
counselors must be committed to self-reflection, and aware of the personal,
social and occupational oppression that many individuals have experienced.

This section identifies some major categories of individual differences and

outlines some issues and characteristics about which counselors should be
sensitive.
a. Adults in career transition
i. identify issues; values and needs may be changing
ii. Skills may be obsolete; retraining considered
iii. physical capacities may be changing
iv. family structure; empty nest issues
v. leisure, lifestyle, pre-retirement issues
vi. may lack information resources and job-seeking skills
b. Cultural diversity
i. the career counselor must be sensitive to the various contexts (individual,
family, culture) of the client

ii. perceptions of power, work, time, and counseling will vary across cultures

iii. the career counselor must be sensitive to and respect the extent to which
a client comes from a collectivistic versus individualistic cultural framework

iv. career counseling effectiveness is enhanced as the counselor uses

procedures/techniques and defines counseling goals consistent with cultural
values and experiences

v. since much of what defines a culture is learned, level of acculturation

signifies
the extent to which an individual has learned and adopted the beliefs and
world-view of another culture

vi. to understand a cross-cultural client, the career counselor must be aware

of the historical and socio-political environment that has influenced that
culture

vii. discrimination and stereotyping characterize what many individuals of

cultural groups experience in the labor market
viii. individuals from minority groups are characterized as possessing less
vocational information than majority group members

ix. counselors must encourage and support the consideration and entry of
individuals in occupations nontraditional to that cultural group

c. People with disabilities

i. most disabilities are not perceptible

ii. functional limitations and the person's adjustment to them need to be

determined

iii. self-concept and social/interpersonal skills should be assessed

iv. independent living/coping skills may be an issue

v. counselor advocacy role with potential employers may

be necessary

vi. state vocational rehabilitation services offer specialized assessment

and placement

vii. counselors must know the "Americans with Disabilities Act" provisions
and job accommodation possibilities

d. Gays, lesbians, bisexuals and transgendered

i. for many gays, lesbians, bisexuals, and transgendered, a major conflict is

whether to 'come out' and the potential repercussions on the job

ii. discrimination by some employers (especially for certain jobs such as

caretakers and teachers) is still very strong

iii. many employers do not recognize same-sex partners for benefit purposes
iv. there is no federal law addressing employment discrimination based on
sexual orientation or gender identity

29. Manifested versus expressed interest

Knowing a person's interests can help predict future occupational selection

and
satisfaction with an occupation.

 Expressed interests are those spoken or reported.

 Manifested interests are determined by examining what a person is
studying (college major), previous jobs held, and what activities the
person likes.
 Tested interests are those measured via inventories or tests.

30. Testing/assessment in career counseling

When using tests and inventories in career counseling, the
counselor must be sensitive to the instrument's appropriateness for
that client's cultural and linguistic context. Is that test or inventory
functionally equivalent within that client's culture as for the culture
for which the instrument was originally designed?

Tests/inventories often used in career counseling are:

Aptitude:
 O*Net Ability Profiler (formerly, General Aptitude Test Battery, GATB)
 Armed Services Vocational Aptitude Battery (ASVAB)
 Differential Aptitude Tests (DAT)
Each of these measures several aptitudes and many are the same on each
instrument such as verbal reasoning, mathematical reasoning and spatial
perception.

Achievement:
 Iowa Tests of Basic Skills (ITBS)
 Scholastic Assessment Test (SAT)
 American College Test (ACT)
 Graduate Record Examination (GRE)
Interest:
 Strong Interest Inventory (SII)
 Self Directed Search (SDS)
 Kuder Career Search Planning System
 O*Net Interest Profiler
 COPSystem 3C (measure interests, abilities, & values)
 Campbell Interest and Skill Survey

Personality:
 Myers-Briggs Type Indicator

Values:
 O*Net Work Importance Profiler
 Super's Work Value Inventory - Revised
 Minnesota Importance Questionnaire
31. World-of-Work Map
The World-of-Work Map is a method of organizing families of occupations and
was developed by ACT. It incorporates the Holland codes by creating a
circle of occupations organized by the primary tasks of working with aid
People, Data, Things and Ideas.
ACT identified 26 career areas (families of occupations), and using their
career exploration materials, over 500 specific occupations can be identified
as well as hundreds of college majors.

32. Computer-Assisted Career Guidance Systems

Computer guidance systems are designed to complement or supplement
career
counselors and not to replace them. Research, in general, is finding
computer
guidance systems helpful.
The top-of-the-line systems are:
SIGI 3: System of Interactive Guidance and Information (www.valparint.com)
DISCOVER (www.act.org)
These two systems have extensive assessment components measuring
interests, values and skills. They do college major matching, provide
guidance activities and occupational information.
The following systems have limited assessment components, but, in general,
have very good information files covering occupations and colleges. Some
also have military occupations, financial aid, apprenticeship files, etc.

CHOICES (bridges.com)
Focus II (www.focuscareer2.com)
Many states have designed their own Career Information System (CIS) which
includes assessment, occupational search activities, occupational
information and educational information.
Other software is available for resume writing, interviewing skills, and job
matching.

33. Computer (Internet) Resources

The use of the Internet in career development activities is critical. Clients
should be encouraged to use all technology including social media sites
rather than be overcautious and not use such sites. Social media can be used
to present the client's qualifications, interests, goals, and activities which
enhance their employability. Tech media can also be used to explore job
openings, research prospective employers, provide information to potential
employers, do job interviews and network with those who might be helpful
about career possibilities.
Social media sites which may be the most useful for career related
purposes are LinkedIn, Twitter and Facebook. It is reasonable to
assume that employers will check social media sites in their search for
potential job candidates or to round out their picture of individuals who have
been identified as potential candidates.
Starting in high school and continuing in college, individuals should be
concerned and develop an “online” brand. This is the online image or
reputation which will be of interest to employers. Such things as academic
experiences, volunteer activities, awards, ideas, and travel can all help
develop a personal brand.

Besides social media sites, other potentially useful sites include educational
resources (training programs, colleges, universities, etc.) financial aid,
military opportunities, and job listings. Sending resumes via the Internet is
common. Self-assessment possibilities also exist online.
One source of information about online interviews is SparkHire
(www.SparkHire.com). Candidates may submit responses or a video of their
performance to questions submitted by the employer. Or the video interview
may be conducted directly with both candidate and employer present -
online. An excellent information source about employers and organizations is
Glassdoor (www.glassdoor.com)
Other internet sites in a variety of related areas are:
America's Career InfoNet (www.acinet.org)
America's Job Bank (www.jobbankinfo.org)
Monster (www.monster.com)
US Department of Education (www.ed.gov)
Career information for under-represented groups: Imdiversity
(www.imdiversity.com)
Military Careers (todaysmilitary.com)
34. O*NET (online.onetcenter.org)
O*NET (Occupational Information Network) is a free comprehensive database
of worker attributes and job characteristics. Its three major components are:
Find Occupations, Skills Search, and Crosswalk. It replaces the Dictionary of
Occupational Titles.
A number of assessment and career exploration tools have been developed.
These
a. Ability Profiler
b. Interest Profiler
c. O*Net Computerized Interest Profile
d. Work Importance Profiler
e. Work Importance Locator

35. Dictionary of Occupational Titles (DOT)

Although the O*Net system has replaced the DOT, it is still available. About
12,000 different jobs are defined. There are a total of over 20,000
different titles
of jobs in this U.S. Department of Labor document.
The DOT contains occupational descriptions including duties, tasks, and tools
used.
Each occupation has a nine digit code number. The first three digits
identify the general category, division, and group of occupations.
The middle three digits represent data-people-things. The lower the
number (zero is lowest) the greater the involvement of that job with data,
people,
or things.

36. Occupational Outlook Handbook (OOH) (www.bls.gov/oco/)

This is a national document published by the U.S. Department of Labor. It is
current (published every two years) and contains job trend data, to
employment projections for the next ten years, jobs of the future,
occupational
information, salary data, etc.
It is the document most used by career counselors as determined by a
national survey.

37. Hidden job market

It is estimated that approximately 80% of jobs are not advertised or
generally known. These jobs are most apt to be identified through
networking.
Most employers now list position vacancies on their websites. Failure to
examine these employer websites will decrease valuable job-hunting
information.

38. Outplacement Counseling

This is career counseling provided to workers of an organization who are to
be terminated.Outplacement counseling might include assessment, career
counseling, job seeking skills development, and job placement assistance.

39. Retirement Counseling

Individuals who retire may transition to a number of new and different roles.
Some of these individuals may find that their circumstances do not allow
them to continue retirement and may be forced to return to employment of
some kind.
Retirement counseling assists individuals in their transitions including the
examination of their circumstances, options, fears and possibilities which will
prevail following employment. This might include addressing family, home,
leisure, employment, social, medical, financial and legal concerns.

40. Career Education

Originally career education was a strategy of infusing career development
concepts into existing kindergarten through high school curricula. Ken Hoyt,
a long-term leader in the career development field, was closely associated
with this concept.

Goals of career education were:

a. Career Awareness (elementary level)
b. Career Exploration (middle or junior high level)
c. Career Orientation (high school level)
d. Career Preparation (high school level)
Career education promotes career awareness and development concepts
with school children via classroom activities, guest speakers, field trips,
internships 500s and part-time employment for older students.ni

41. Displaced homemaker and dislocated worker

A displaced homemaker has traditionally been a woman who is a former
homemaker whose children may be in school or gone. She is looking for
employment and may be divorced or widowed.
Issues for her may include lack of information about the labor market, poor
job-seeking skills, no support system, and shaky self-concept.
Dislocated worker is anyone who becomes unemployed because of obsolete
or smodylim) gn no longer needed skills, downsizing, rightsizing, company
relocation, shutdown, or high unemployment.

42. Dual-career (job) or dual-earner couples

Many individuals work but do not have careers in the traditional sense.
However, they have 'jobs' and are wage-earners.
Potential conflicts for dual-career or dual-earner couples are:

a. home and children chores are not equitable (asymmetry of roles)

b. whose job takes precedence if a career move is offered
c. time for leisure
d. the woman may make more money than the man

Identity tension line: This refers to the comfort area each sex has based on
sex
role socialization. Going beyond (doing opposite sex chores) may create
tension.
Most current research indicates that when the woman becomes the second
earner, she typically maintains the majority of her original household and
children chores in addition to her new job. 3

43. Family and gender issues

A variety of family issues influence the workplace:
a. Families are forming later and fewer children are the norm.
b. Single heads-of-household are common and, in part, reflective of the
high divorce rate.
c. The "traditional" family of father working and mother staying home to
care for children is no longer the norm.
d. The acceptance of cohabitation before/instead of marriage has delayed
or precluded marriage.

Gender issues
a. The number of women in the labor market is nearing 75 percent of all
working-age women. Many of these women work part-time.
b. Women make up about 47% of the workforce. More men than women
lost their jobs in the recent recession.
c. Women earn between 70% and 80% of what men earn with greater
wage equality among younger workers. However, more women than
men work in part-time jobs which pay less.
 d. Women are earning more undergraduate and master's degrees than
men and nearly as many degrees as men in law and medicine.
e. Women still assume primary responsibility for children as well as taking
care of sick and elderly parents.
f. 'Glass ceiling' refers to the set of restraints, typically imposed by men,
which impact women's (or any other group's) ability to move up the
career ladder within an organization.
In career counseling, family and gender issues must be addressed.
Research evidence suggests that family patterns and relationships are
carried into the workplace.
Family of origin issues are sometimes expressed in occupational choice
and workplace behavior.
An occupational family tree or genogram may be used in career
counseling.
Career couples counseling may be appropriate at times.

The Family and Medical Leave Act (FMLA) covers employers with 50 or
more
workers. This federal law provides up to a total of 12 weeks of unpaid leave
during any 12 month period. It may be taken by a new parent or to care for
an immediate family member who is ill.
44. Other workforce trends
Issues with economy:
 Even with the official national unemployment rate (those seeking work)
between 5 and 6 percent, millions of additional workers are
unemployed because they have become 'discouraged,' and are no
longer seeking employment.
 One consequence of the uncertain employment situation is the
increase in worker stress. The demand for employee assistance
services by workers has increased many fold over the past few years.

Occupational changes:

The fastest growing occupational clusters during the next ten years will
be health care/personal assistance, and professional and related
occupations. The occupations with the most job openings will be registered
nurses, personal care aides, and retail salespersons.
The slowest growing occupational clusters will be lumber workers,
locomotive firers, and postal service clerks.
Within government, federal employment will decrease during the next -gnol
adi tanlaga si ten years but state and local government employment will
banalog volqm
increase.
Unemployment:
Unemployment is experienced differentially depending on
cultural/ethnic group. From lowest to highest unemployment, the current
order is as follows: white male, white female, Hispanic male, Hispanic
female, black female and black male.

Relationship of education to income:

There is a strong positive relationship between levels of education by and
income including lifetime earnings. There is a strong negative relationship
between level of education and unemployment.

Outsourcing:
The cost of labor is cheaper in other countries (especially developing
countries) so many US companies find it economically rewarding to shift
some or all of their operations out of the US. This includes goods- producing
companies as well as those that provide information and technical services.

45. Issues for long-term unemployed

Following a recession, the number of long-term unemployed rises. As the
recession goes on, many of the short-term unemployed become long-term.
The two most likely reasons are:
a. With increasing length of unemployment, discouragement occurs and
less effort may be put into a job search.
b. There is evidence that employers may discriminate against the long-
term unemployed. One study found that employers preferred shorter-
term unemployed with less skill than longer-term unemployed who had
more skill.
46. Workforce Innovation and Opportunity Act
This federal law was passed in 2014. It consolidates programs for
employment
and training, adult education as well as programs under the 1973
Rehabilitation Act. It replaces the Workforce Investment Act of 1998.

47. National Career Development Association - National Employment

Counseling Association
These are divisions within the American Counseling Association which relate
to
career development and employment issues.
VI. ASSESSMENT
1. Measurement:
a. general process of determining the dimensions of an attribute or trait.
Assessment: processes and procedures for collecting information about
human behavior.
b. Assessment tools include tests and inventories, rating scales,
observation, interview data and other techniques.
Appraisal: appraisal implies going beyond measurement to making
judgments about human attributes and behaviors and is used
interchangeably with evaluation.
Interpretation: making a statement about the meaning or usefulness of
measurement data according to the professional counselor's knowledge and
judgment.

2. Measures of central tendency

A distribution of scores (measurements on a number of individuals) can be
examined using the following measures:
Mean: the arithmetic average symbolized by X or M
Median: the middle score in a distribution of scores
Mode: the most frequent score in a distribution of scores

All three of these fall in the same place (are identical) when the distribution
of scores is symmetrical, i.e., normally distributed (not skewed).
(NOTE: You do not need to know any formulas for the National Counselor
Exam or CPCE. Furthermore, you do not need to make any calculations and
are not allowed to use a calculator.)
3. Skew
The relationships between mean, median and mode are indicated
above for skewed distributions. The mode is the top of the curve
(most frequent score) and median is the middle score. The mean is pulled
in the direction of the extreme scores represented by the tail of a skewed
distribution.

4. Measures of variability
Range: this is the highest score minus the lowest score. Some researchers
talk of inclusive range which is the high score minus the low score and
adding one (1).
 For example: Ten individuals' ages are: 24, 26, 26, 27, 28, 29, 31, 32,
39, 47. 47-24 = 23 + 1 = 24 This range is inclusive; everyone is
included.

Standard deviation: this value describes the variability within a

distribution of scores. We use the symbol SD to signify the standard deviation
of a sample. When we talk about the population's variability, we use the
symbol σ (sigma).

Standard deviation is essentially the mean of all the deviations

from the mean. It is an excellent measure of the dispersion of scores.

Variance: this is simply the square of the standard deviation, i.e., SD2.
The variance does not describe the dispersion of scores as well as the
standard deviation. However, we will see it again in the next section when
we talk about analysis of variance.

5. Normal curve (bell-shaped curve)

The normal curve essentially distributes the scores (individuals) into six
equal
parts-three above the mean and three below the mean.
Counselors should be familiar with the distribution of scores within the
normal
curve:
 34% and 34% = 68% and comprises one standard deviation and
 13.5% and 13.5% = 95% and comprises two standard deviations and
 2% and 2% = 99% and comprises three standard deviations.
6. Percentile and stanine
Percentile is a value below which a specified percentage of cases fall.
For example: 75%. This score is higher than 74% of the scores; 25% of the
scores are higher than this score.
Stanine, from standard nine, converts a distribution of scores into nine parts
(1 to 9) with five in the middle and a standard deviation of about 2.

7. Standardized scores
A standardized score scale is like a 'common language' that we can use to
compare several different test scores for the same individual.
 For example: A person has a raw score of 60 on a vocabulary test and
a raw score of 45 on an arithmetic test. Which performance is better?
We cannot tell. Direct comparisons are not possible. After we convert
both scores to a standardized scale, we can realistically compare them.

Standardized scores occur by converting raw score distributions. These

derived
scores provide for constant normative or relative meaning allowing for
comparisons between individuals.
Specifically, standardized scores express the person's distance from
the mean in terms of the standard deviation of that standard score
distribution.
Standardized scores are continuous and have equality of units.
The two most commonly used standardized scores are:
a. z-score
The mean is 0; the standard deviation is 1.0. (See normal curve
figure.) The range for the standard deviation is -3.0 to 3.0.

The z in z-score should remind you of zero which is the mean of this
distribution.

b. T score
The mean of this standardized score scale is 50 and the standard deviation is
10. By (T)transforming this standard score, negative scores are eliminated
unlike the z-score. (See normal curve figure.)
The T should remind you of ten which is the standard deviation unit of this
distribution.
8. Correlation coefficient
The Pearson Product-Moment Correlation Coefficient (r) is frequently used.
A correlation coefficient ranges from -1.00 (a perfect negative
correlation) to 1.00 (a perfect positive correlation).

This is a statistical index which shows the relationship between two sets
of
numbers. When a very strong correlation exists, if you know one score of an
individual you can predict (to a large degree) the other score of that person.

A correlation between two variables is called bivariate; between

three or more variables, it is called multivariate.
The correlation coefficient tells you nothing about cause and effect,
only the degree of relationship.

9. Reliability
Reliability is the consistency of a test or measure; the degree to which the
test can be expected to provide similar results for the same subjects on
repeated administrations.

Reliability can be viewed as the extent to which a measure is free

from error.
If the instrument has little error, it is reliable. A correlation coefficient is used
to
determine reliability. If the reliability coefficient is high, about .70 or higher,
test scores have little error and the instrument is said to be reliable.

Reliability is a necessary psychometric property of tests and

measures.

10. Types of reliability

a. Stability: this is test-retest reliability obtained using the same
instrument on both occasions - same group tested twice.
The results of the two administrations are correlated.
The length of time and intervening experiences may influence stability and
reliability. Two weeks is a good time between test administrations.

b. Equivalence: alternate forms of the same test are administered to

the same group and the correlation between them is calculated.
How comparable the forms of the tests are will influence this reliability.
Intervening events and experiences may also influence reliability.
c. Internal consistency: In this split-half method, the test is divided into
two halves. The correlation between these two halves is calculated.
Because you reduce the length of the test (one-half versus one-half) you
necessarily reduce its measured reliability. Consequently, you may apply
the Spearman-Brown formula (sometimes called 'prophecy' formula) to
see how reliable the test would be had you not split it in two.

d. Internal consistency may also be determined by measuring interitem

consistency. The more homogeneous the items, the more reliable the
test.

Kuder-Richardson formulas (there are two) are used if the test contains
dichotomous items (such as true-false, yes-no). If the instrument contains
non dichotomous items (such as multiple choice, essay), Cronbach alpha
coefficient is applied

11. True and error variance

Tests measure "true" and "error" variance. You want to measure true
variance, the actual psychological trait or characteristic that the test is
measuring.

For example: Two tests are administered. Each one measures true variance
(T1 and T2) and error variance (E1 and E2).
If the correlation between two tests or two forms of the same test is, for
example,
.90, then the amount of true variance measured in common is the
correlation
booty squared (.902 = 81%).

Coefficient of Determination is the degree of common variance. It is the

index (81%) that results from squaring the correlation (.90).

Coefficient of Nondetermination is the unique variance, not common. For

the
above example, it would be 19% and represents the error variance.

12.Standard error of measurement

The standard error of measurement (SEM) is another measure of reliability
and useful in interpreting the test scores of an individual. The SEM may also
be
referred to as Confidence Band or Confidence Limits.

The standard error of measurement helps determine the range within which
an
an individual's test score probably falls.
 For example: A person scores a 92 on a test. The test's SEM = 5.0.
 Chances are about 2 in 3 (67%) that the person's score falls between
87 and 97. (Refer to the normal curve: 34% and 34% of the cases fall
within one standard deviation, positive and negative, for a total of
68%).
For the same test with the same SEM of 5.0, you can say that 95% of the
time the person's score would fall within the range of 82 and 102. Every test
has its own unique value of SEM which is calculated in advance and may be
reported on the test's score profile.
13. Validity
Validity is the degree to which a test measures what it purports to
measure for the specific purpose for which it is used. In other words,
validity is situation specific – depending on the purpose and population.
An instrument may be valid for some purposes and not others.
14. Types of validity
a. Face: the instrument looks valid.
For example: A math test has math items. This 'validity' could be important
from the test-taker's perspective.
b. Content: the instrument contains items drawn from the domain of
items which could be included.

 For example: Two professors of Psychology 101, devise a final exam

which covers the important content that they both teach.

c. Predictive: the predictions made by the test are confirmed by

later behavior (criterion).

 For example: The scores on the Graduate Record Exam predict later
grade point average.

d. Concurrent: the results of the test are compared with other tests' results
or behaviors (criteria) at or about the same time.
 For example: Scores of an art aptitude test may be compared to grades
already assigned to students in an art class.

e. Construct: a test has construct validity to the extent it measures some

hypothetical construct such as anxiety, creativity, etc.

Usually several tests or instruments are used to measure different

components of the construct or of the hypothesized relationships between
that construct and other constructs.

Convergent validation occurs when there is high correlation between the

construct under investigation and others.

Discriminant validation occurs when there is no significant correlation

between the construct under investigation and others.

The construct validation process is best when multiple traits are being
measured using a variety of methods.

15. Tests may be reliable but not valid.

Valid tests are reliable unless of course there is a change in the
underlying trait
or characteristic which might occur through maturation, training or
development.

16. Tests may be:

Power based: no time limits or very generous ones (such as the NCE and
CPCE). Speed based: timed, and the emphasis is placed on speed and
accuracy. Examples are measures of intelligence, ability and aptitude.

17. Assessment
Assessment may be:
Norm referenced: comparing individuals to others who have taken the
test
before. Norms may be national, state or local.
In norm-referenced testing, how you compare with others is more important
than what you know.

Criterion referenced: comparing an individual's performance to

some predetermined criterion which has been established as important.
The National Counselor Exam's cut-off score is an example. For the CPCE,
university programs are allowed to determine the criterion (cut-off score).
Criterion referenced is sometimes called domain referenced.

Ipsatively interpreted: comparing the results on the test within the

Individuals.
 For example, looking at an individual's highs and lows on an aptitude
battery which measures several aptitudes. There is no comparison with
others.

 Another example of ipsative is when an individual's score on a second

test is compared to the score on the first test.

A maximal performance test may generate a person's best

performance
on an aptitude or achievement test and a typical performance may occur on
an interest or personality test.

18. Purposes/rationale for using tests

 a. help the counselor decide if the client's needs are within the range of
his or her services.
b. help the client gain self-understanding.
c. help the counselor gain a better understanding of the client.
d. assist the counselor in determining which counseling methods,
approaches or techniques will be suitable.
e. assist the counselee to predict future performance in education,
training or work.
f. help counselees make decisions about their educational or work
futures.
g. help identify interests not previously known
h. help evaluate the outcomes of counseling.

19. Circumstances under which testing may be useful:

a. placement—in education or work settings
b. admissions such as undergraduate, graduate or professional schools
c. diagnosis
d. counseling
e. educational planning
f. evaluation
g. licensure and certification
h. self-understanding
20. Regression toward the mean
 Statistical regression means that if one earns a very low score (at 15%
or lower) or very high score (at 85% or higher) on a pretest, the
individual will probably earn a score closer to the mean on the
posttest.
 This is because of the error occurring due to chance, personal and
environmental
 factors. These factors can reliably be expected to be different on the
posttest.
21. Standardized vs. non standardized assessment
 Standardized: the instruments are administered in a formal,
structured
procedure and the scoring is specified.
 Nonstandardized: there are no formal or routine instructions for
administration or for scoring. Some examples may be checklists or
rating scales.
22. Tests and inventories
Tests and inventories are typically mentioned on the NCE and CPCE in the
context of an application-type exam question. Perhaps only two or three of
these will be mentioned on the exam. Examples of tests in several areas are
listed here and details about any test or inventory will not be the focus on
the exam.
 a. Intelligence is the ability to think in abstract terms; to learn. Some
also believe it is the ability to adapt to the environment and adjust to
it. It is also called general ability or cognitive ability.
 Intelligence Tests
 Stanford-Binet Intelligence Scales
 Wechsler Adult Intelligence Scale (WAIS-IV)
 Wechsler Intelligence Scale for Children (WISC-IV)
 Cognitive Abilities Testo
Specialized Ability Tests
 Kaufman Assessment Battery for Children - II
 System of Multicultural Pluralistic Assessment (SOMPA). It measures
medical, social systems and pluralistic factors. So roll
 ACT (American College Test Program)
 SAT Reasoning Test
 Miller Analogies Test (MAT)
 Graduate Record Exam (GRE)
b. Achievement: measures the effects of learning or a set of experiences.

These tests may be used diagnostically. Many states have their own K-12
achievement tests. A national measure of academic performance is National
Assessment of Educational Progress (NAEP).
Other tests available include:
 California Achievement Tests
 Iowa Tests of Basic Skills
 Stanford Achievement Test
Specialized Achievement Tests
 General Education Development (GED)
 College Board's Advanced Placement Program
 College-Level Examination Program (CLEP)

c. Aptitude: also called ability tests, these measure the effects of general
learning and are used to predict future performance. Each of those
listed here measures several abilities or aptitudes.
Differential Aptitude Tests (DAT)
O*Net Ability Profiler (formerly, General Aptitude Test Battery, GATB)
Armed Services Vocational Aptitude Battery (ASVAB)
Career Ability Placement Survey (CAPS)

d. Personality: is the dynamic product of genetic factors, environmental

experiences, and learning to include traits and characteristics.
Projectives (These tests present a relatively unstructured task or stimulus.
The person projects thought processes, needs, anxieties, etc.)
 Rorschach
 Thematic Apperception Test (TAT)
 Rotter Incomplete Sentences Blank
 Draw-A-Person Test

Inventories
 Minnesota Multiphasic Personality Inventory
 California Psychological Inventory (CPI)
 NEO Personality Inventory - Revised
 Beck Depression Inventory
 Myers-Briggs Type Indicator
Specialized
 Tennessee Self Concept Scale
 Bender Visual-Motor Gestalt Test

Interests: preferences, likes and dislikes of an individual and more broadly

includes values. Interests are often not stable in the teen years.
 Strong Interest Inventory
 Self-Directed Search
 Career Assessment Inventory
 Campbell Interests and Skills Survey
 O*Net Interest Profiler
23. Semantic differential
 This scale asks respondents to report where they are on a dichotomous
range
between two affective polar opposites. For example: "Think about the value
of this Study Guide.
Very Good ______________________________________________Very Bad
Responses can be codified and added to those of others. The adjective pairs
selected can usually be classified as having an evaluative, potency, and
activity ZTOS underlying structure thus providing for a second level of
analysis.

24. Intrusive and unobtrusive measurement

Intrusive (or reactive) measurement means the participant knows he or
she is
being watched or questioned and this knowledge may affect his or her
performance. Examples are questionnaires, interviews or observation.
Unobtrusive (or nonreactive) measurement means data is collected
without the awareness of the individual, or without changing the natural
course of events. Examples are reviewing existing records or unobtrusive
observation.
25. Observation as appraisal technique

With this technique, you observe samples from a stream of behavior. In

observation, you may use schedules, coding systems, and record forms.

26. Case/historical study; rating scales; interview

Case or historical study: This may be an analytical and/or diagnostic
investigation of a person or group.
Rating scales: these may be used to report the degree to which an attribute
or characteristic is present.

27. Sociometry
Sociometry can be used to identify isolates, rejectees or stars (popular
individuals).
You can measure the structure and organization of social groups which could
be a
classroom of fourth graders who have been together for a few months, or a
work
unit.
It requires revealing personal feelings about others.
Sociogram: a figure or map showing the interrelationships or structure of
the
group.

28. Social desirability

This is the tendency for test takers to respond in ways they perceive to be
socially desirable.

29. Using and interpreting test scores

a. You need training in test theory and background information about the
tests
you use.
You must study the test's technical manual.
b. Prepare for the test interpretation. Understand the scores, profiles, and
implications of the results before you counsel the individual.
c. Describe the test to the person in nontechnical terms and explain what
was being measured.
d. Describe the nature of the scores you are reporting. Explain percentiles,
stanines or any other technical terms.
e. Organize the data so it makes the most sense to the client.
Show profiles, charts and comparative data if appropriate.
Consider and explain interrelationships between scores and between
tests if more than one was used.
f. Provide an interpretation to the client and ask for reactions and feelings.
Help the client integrate the test results with existing information.
g. Remind the client that test scores are additional data for them to consider
and are not infallible. Test data may be useful in decision making or obtaining
some objective.
h. Go slowly. You may have used similar words in test interpretations
hundreds of times. It may be the first time the client is hearing these words.
30. Grade and age equivalent scores
In school settings, scores on an achievement test are often reported as grade
equivalent scores. If a student correctly completes the number of items on a
test
that the average sixth grader completes, that student has a grade equivalent
score
of 6.
Age equivalent scores work in a similar manner. An individual's score is
compared to the average score of others at the same age. For example, if a
7.6 year old student earned a score equivalent to 8.0 year old students that
would be his or her age equivalent score.
31. Percentile ranks
An individual's score can be compared to a group (norm group)
already examined. The individual's percentile rank indicates what
percentage of
individuals in that group have scores above or below this individual. A
percentile wh rank of 35 means that this individual's score is higher than 34
percent of the individuals in the norm group. On the other hand, 65% of the
individuals in that norm group have scores higher than this individual.
32. Computer-based assessment
Much academic as well as professional testing is now done on computers.
Some of the advantages and disadvantages include the following:
Advantages:
a. standardizes administration and scoring
b. feedback and results may be available immediately
c. assuming computers are available, costs will be reduced
d. profiles of results and reports can be generated
Disadvantages:
a. not all assessments are available on computer
b. testing by computer may be a scary proposition for some test takers
c. if not available, computer equipment is expensive to purchase
d. personal contact with a test administrator or proctor may not be available
33. Ethical issues in testing
 a. Tests may be biased against non-whites, females, and those of other
cultures. Many tests were originally developed and normed on white
middle-class males.
b. Counselors must be trained and competent to select and administer
tests and to interpret test results and information.
c. Test results should be released only to competent professionals and
with the consent of the test taker.
d. Tests may be used to label and stereotype; they may invade privacy.
e. Confidentiality of test results may be an issue especially with
computerization.
f. Computerized testing (on-line) may raise issues of validity. Is the test
the same on the computer as it is on paper?
g. If a test is given, its results should be interpreted. Many say the test
results belong to the client.
h. Review the measurement and evaluation section of the ethical
standards periodically.
34. Assessment resources
The Mental Measurements Yearbook which comes from the Buros
Institute, contains critical reviews of tests and it lists published references of
tests.
The nineteenth edition was published in 2014.
Tests in Print VIII (2011) has information on approximately 3,000 testing
instruments.
A Counselor's Guide to Career Assessment Instruments (6th ed.) was edited
by Chris Wood and Danica G. Hays (2013), and is published by the National
Career Development Association.
35. Association for Assessment and Research
The Association for Assessment and Research is one of the 20 divisions of
the American Counseling Association.

VII. Research and Program evaluation

1. Research and evidence-based inquiry

 Research is the systematic process of collecting and analyzing
data for some purpose such as investigating a problem or answering a
question.
 Evidence-based inquiry is the search for knowledge using
empirical data which has been gathered systematically.

2. Research may be quantitative or qualitative in nature

Quantitative Qualitative

Assumes social facts have a Assumes multiple realities socially

single objective reality constructed by individuals and groups

Tends to study samples or Tends to study individual units person,

populations family, community in naturalistic setting

Researchers try not to influence Researchers may be primary instrument

collection of data (instruments) for collecting data (through observation)

Statistical methods comparing Researchers' impressions, judgments

and contrasting groups occurs and feelings may be used

Researchers examine for causes Goal is to describe the nature of things

and relationships

Both kinds of research are valued. One is chosen over the other because
it
better fits the assumptions of the researcher and the nature of the problem
under
investigation. Some professional journals prefer to publish one kind of
research
over the other.

3. Research may be:

 Inductive: this research begins at the real world, practical level. It
tends to be IV descriptive, correlational, or historical and leads to the
building of theory.

 Deductive: this research springs from theory which is already

established. This research tries to determine what the relationships are
between elements of the theory and may be experimental in nature.

4. Types of research -- Quantitative

a. Non-experimental designs:
i. Survey: this may occur through questionnaires, interviews, etc. and is
used to measure attitudes, perceptions, etc. (For example: Public Opinion
Poll).
Often the response rate of survey research is low, below 50 percent.
Unless you know that the characteristics of the non- respondents are similar
to the characteristics of the respondents, you must be cautious in
generalizing.

ii. Descriptive: this research simply describes an existing state of events.

Numbers may be used to characterize groups or individuals.

iii. Comparative: this research method investigates whether there are

differences between two or more groups. There is no manipulation of
conditions experienced by each group.

iv. Correlational: this research method uses the correlation coefficient to

determine the degree of relationship between two or more variables or
phenomena.
For example: Income level and attitude toward counseling.

v. Ex Post Facto:
 Also called causal-comparative, this research design studies possible
causal relationships among variables ex post facto (after the fact).
You do not manipulate any variables; the focus is on what has already
happened (after the fact). You may generate 'several' reasons (causes) for
the relationships you discover.

For example: Two employment agencies conduct job clubs. In one agency,
the job clubs are member-initiated and run whereas in the other,
employment counselors provide instruction and guidance. In examining the
job placement rates of members for the past year, you find that the
members of the professionally led groups had a higher placement rate.

Typical statistics used in ex post facto research are the t-test and analysis of
variance.

b. Experimental designs:
i. True experiment: This research is characterized by the use of
experimental and control groups with random assignment to each.
 Experimental designs are used to determine cause-and-effect
relationships.
For example: Sixty college freshmen are enrolled in an English class.
Thirty are randomly assigned to a one-hour per week writing lab, the others
comprise a control group. End-of-semester essay examination
results are analyzed to see if the lab was associated with better writing skills.

For experiments, there are design variations such as:

 treatment and control group with posttest only
 treatment and control group with pretest and posttest,
 two different treatment groups with control group and posttest, and
many other combinations.

ii. Quasi-experiment: This research is similar to experimental research

except that randomization of subjects to treatment and control groups is not
possible. It may be that no control or comparison group is available.

Results from such research will not be as unequivocal as results from a true
experimental study.

For example: An elementary school has two classrooms of fourth graders.

Each classroom of fourth graders is taught arithmetic by a different method
for the school year. In May, arithmetic achievement is compared for the two
classrooms using scores on a national exam.

There was no random assignment of students to the two classrooms

and the 'arithmetic teaching methods' were not randomly assigned to the
two classes.

5. Types of research -- Qualitative

Qualitative research emphasizes gathering data about naturally occurring
phenomena (individuals and groups' living experiences) and events. Data
collection may be in terms of words rather than numbers.
There are two principal qualitative research designs:
a. Interactive:
i. Case study in which the case may be a program, activity, or a set of
individuals who are bounded in time and place.
ii. Ethnography which is a description and interpretation of a cultural or
social group or system. Data is typically collected through observation and
interviewing. The issue of observer bias is important.

b. Noninteractive:
This is analytical research conducted primarily through document analysis.
Examples might be historical analysis (collecting and analyzing documents
describing former events), biographical analysis (written or oral) and legal
analysis which focuses on law and court decisions.

6. Mixed-method research designs

These designs combine quantitative and qualitative methods in the same
research effort. The researcher retains the flexibility to use both types of
designs. Typically, the designs are used sequentially. For example,
quantitative may be gathered first and then qualitative methods are used to
further explain or elaborate on the findings, using perhaps, surveys,
interviews, or focus groups.

7. Research Designs and Types

 Single-Subject Design: Studies the effects of a program or treatment
on an individual or group treated as an individual, usually after a
baseline has been established.
 Action Research: Conducted in an attempt to improve services or a
program. This research is often viewed as having an evaluative
function.
 Pilot Study: A small-scale research effort often used to determine the
feasibility of a larger scale effort, with an emphasis on refining
procedures and instrumentation.
 Longitudinal Research: Involves collecting data from the same group
of individuals over a period of time. This is also called a panel study.
For example, this author studied the career development of school
children beginning when they were in second grade and re-interviewed
them every two years until they were high school seniors.
 Cross-Sectional Research: Involves collecting data from different
groups at the same time and examining these differences. For
example, one approach to studying career development is to collect
data from each grade of students, from second to twelfth grade, at the
same time.
Research Outcomes May Be Measured in Two Ways:

a. Within-Subjects: Examining what changes occur within the

members of a group.

b. Between Subjects: Examining what changes occur between two or

more groups.

8. Meta-analysis
 This is research comparing findings across studies, i.e., the results of
many studies are examined simultaneously, and one or more research
questions are answered. For example, a number of studies have
examined what works in various counseling situations. Examining
several of these studies simultaneously can help determine which
counseling techniques work for which kinds of clients, with what kinds
of problems, under what conditions.

9. Internal Validity

Experiments are internally valid to the extent that extraneous variables

have been controlled. In other words, the treatment variable is the only
one producing the observed changes, making the experiment
internally valid. What are the threats (confounding variables) to
internal validity? The most likely ones are:

a. Selection of Subjects —
Differences in the results between two groups may not be due to the
treatment variable experienced by one group because the composition
of the two groups is different to begin with (probably not randomly
selected).

b. Instrumentation —
Differences in results between two or more groups may be due to
instruments that are unreliable or because the instruments are
changed during the study.
Or perhaps the observers Recording data became fatigued or bored
and they record behaviors differentially every time.

c. Maturation:
Changes in behavior may be due to natural maturation or other
factors, rather than the treatment itself. This is particularly
important if research data is gathered over a long period of time.
d. Mortality or Attrition,
losing subjects during the study, could lead to different
results than if everyone stayed.
Subjects
with the most or least amount of important characteristics
o the study may drop out, resulting in different outcomes t
han if everyone had stayed. Subjects might be the ones dr
opping out (think of
normal curve extremes).

e. Experimenter Bias:
The responses of the subjects may be influenced by the
researcher. This may occur by treating some subjects differently,
 reinforcing different behaviors, as well as the presence of many
other variables which deliberately or unintentionally influence
subjects.
f. History:
These may be the extraneous incidents (e.g., national or local tragedies
or other occurrences) which influence subjects in a research project. The
se events might interact
with the independent variable so the results which occur may be due to
a combination of the event and the variable under study.

g. Statistical Regression:
Sometimes subjects are recruited due to extreme high or low scores
on the dependent variable being measured (e.g., self-esteem or
social skills). Due to statistical regression, future measures would
expect these individuals to score closer to the mean score without
any intervention

10. External Validity

An experiment is externally valid to the extent that the results may be
generalized to people and situations beyond the study. There are several
threats to the external validity of experiments, some of which are also
threats to internal validity.

a. Selection of Subjects: If subjects are not randomly selected, the results

may only apply to the subjects in the study. Furthermore, the results can only
be generalized to people with similar characteristics. For example, can we
generalize results from research with college students to other adults?

b. Ecological Validity: The research has ecological validity if the results can
be generalized from one setting or circumstance to another. Sometimes, the
circumstances, conditions, or physical surroundings of the research are so
unique that the results cannot be generalized beyond that study.

c. Subject Reactions (Reactivity): If any of the following are present, the

results may not generalize beyond the study:

i. Hawthorne Effect: Refers to the influence on performance that

occurs when subjects receive attention or know they are participating
in research.
ii. Demand Characteristics: These are all the cues, information,
knowledge,
Even rumors the subject has heard about the experiment are likely to i
nfluence his or her performance.
iii. Experimenter Bias
 These are the changes in the subject's behavior brought about by the r
esearcher's expectations, behaviors, or attitudes. It may also be called
 the Rosenthal effect. He conducted research into this phenomenon and
called it the Pygmalion effect, which refers to the self-fulfilling expectat
ion of doing well because it is expected.
iv. Placebo
 Broadly, the placebo refers to any experimental treatment except for t
he critical item being studied (new drug, parenting skills training, reacti
on to violence in films, etc). Even so, control subjects may be influence
d by the placebo and react in unintended ways.
d. Novelty and Disruption Effect
 The measured effect of the treatment on the subjects may be due to its
novelty or the disruption it causes. Being selected for a research projec
t may be exciting and energizing; as it continues, it may begin to disru
pt routine and one's typical schedule. When novelty and disruption wea
r off or stabilize, there may be no long-term effects of the treatment.
11. Level of Measurement
 The level of measurement in your data determines the statistic you can
use.

The four levels of measurement are:

a. Nominal:
 The numbers represent the variable's qualities or categories.
 For example: Male and female.
 With nominal data, you would ordinarily use a nonparametric statistic s
uch as chi-square.
b. Ordinal:
 The numbers represent differences in some magnitude of the variable.
 You can order the data from top to bottom, from high to low.
 For example: Scores on a Psychology 101 final exam can be ranked fro
m highest to lowest.
c. Interval:
 The intervals between the numbers on a scale contain the same amou
nt of the variable throughout the scale.
 These intervals provide a constant unit of measurement.
 For example: On a standardized test, the distance (interval) between 11 and
12 is the same as the distance between 24 and 25. Other examples are Fahr
enheit or centigrade temperature scales.
d. Ratio:
 The numbers are on a scale which has a true zero. In addition, the num
bers can be
 compared by ratios.
 For example: Someone who weighs 200 pounds is twice as heavy as so
meone who weighs 100 pounds.
 In counseling and psychology, we cannot say someone is twice as intro
verted as someone else.

12.Sampling
How well sampling is conducted will determine how validly we can generalize
from a sample to a population.
Sampling involves the selection of a part of the population.

There are several types of sampling. They are:

a. Random Sampling:
 All the individuals in the population have an equal and independent ch
ance of being selected.
b. Stratified Sampling:
 This refers to selecting in such a way that all major subgroups in the po
pulation will be represented. These subgroups may be based on ethnici
ty, gender, etc.
c. Proportional Stratified Sampling:
 This refers to randomly selecting the same proportion of individuals for
the sample
 as they represent proportionally in the major subgroups in the population.
 For example, if one-half of a population is Hispanic and one-half is whit
e, you would randomly select your sample to be one-half Hispanic and
one-half white.
d. Cluster Sampling:
 In this sampling, the unit is not an individual but naturally occurring gro
ups of
individuals such as classrooms, city blocks, etc. Clusters are randomly
selected for study.
e. Purposeful Sampling:
 In some studies, there may be no interest in generalizing findings, so p
urposeful
sampling may be carried out. Possibilities include comprehensive samp
ling where
every case or event is selected, or there is extreme-case or typical-
case selection.

f. Other Samples:
 f. Other samples: Other non-random or nonprobability samples may be
samples of convenience or volunteer samples. These samples cannot
be counted on to yield a normal distribution of scores. However, they
could yield very useful and important data.

13. Sample size

Sample size influences statistical hypothesis testing. Tables for determining

appropriate sample size are available. A general rule is that 5 to 10 percent
of the population is adequate.

The suggested minimum sample sizes for different kinds of research are:
Correlational: 30

Ex post facto and experimental: 15

Survey: 100

A table of random numbers lists computer generated random numbers used

to assign to individuals. Selecting from the table assures randomness.

14. Statistical Analysis:

 Statistical analysis may be:
o a. Descriptive: Sometimes called summary, these techniques a
re used to
describe the data collected for a research sample or population,
and include
means, standard deviations, frequency counts, and percentages.
o b. Inferential: Used to make inferences from the sample to the
population.
The goal is to determine the probability of some event occurring
c. Parametric:
used when sample is normally drawn from a population and the
data is normally distributed. You have para (two-
sided) data that yields a bell-shaped curve. Also, you assume tha
t the variance of the sample you are studying is homogeneous (si
milar) to the variance of the population from which your sample i
s drawn.

The scores would give you a normal curve – more or less.

Examples of parametric statistics are: t-test and analysis of varia
nce.

b. Non-Parametric:
 Non-parametric
used when you cannot make any assumption about the shape of the cu
rve or
variance of the population scores (that is, they may not be normally dis
tributed and
variances may not be homogeneous).
 For example, you want to make a statement about a school's academic
performance but you only collected scores from the "gifted and talente
d" students. You will not have a normal distribution of academic scores
for the school.

 Examples of nonparametric statistics are: Chi-square, Mann-Whitney U

Test, and Wilcoxon Signed-Ranks Test.
15. Variables:
c. Independent Variable:
 This is the variable you manipulate or change to see if a change occurs
in the dependent variable. Sometimes you categorize the independent
variable. For example,
you categorize a group of individuals by gender, male and female. Or,
you categorize high school students as freshmen, sophomores, juniors,
and seniors.

The independent variable precedes or is antecedent to the dependent

variable.

Dependent variable: this is the variable you are measuring or trying to

change. The value of this variable depends upon the value of the
independent variable you selected.

For example: The effect of three kinds of therapeutic techniques

(independent variables) on anxiety (dependent variable).

The independent variable is sometimes called: stimulus variable,

predictor variable or experimental variable.

The dependent variable is sometimes called: response variable,

outcome variable or criterion variable.

16. Research questions and hypotheses

Some investigators ask research questions to be answered.

Ex: Is there a relationship between disciplinary practices and

leadership style for men in the military?

For example: Is there a significant difference in the mean number of

client contacts between public and private counseling agencies?

Some investigators formulate hypotheses (often in the null form) to

test. The null hypothesis states there is no difference between the
variables or groups measured.

At .05, you are willing to accept the possibility of rejecting the null hypothesi
s in error five times out of one hundred times (if you performed the experime
nt 100 times). (There is more explanation of this concept as we work through
an example.)
The following example will be used to explain concepts in the next seven ite
ms. For example:
Assume you are the director of a large counseling agency which employs 24 t
herapists, twelve of whom are men and twelve are women. You are curious a
bout the self-esteem level of clients who complete therapy and wonder if the
re is a relationship between gender of therapist and client self-esteem. For si
x months, you randomly assigned clients to all counselors. As these clients te
rminated, their self-esteem was measured using a standardized test. After all
the clients who began therapy during that six month period of time were ter
minated, you began your statistical analysis.
Your null hypothesis is: There is no significant difference in mean self-esteem
scores of terminated clients who had been counseled by female or male ther
apists. You set a significance level at .05.
19. Type I Error (Alpha)
Type I or alpha error are the names we use in referring to the rejection of the
null hypothesis (which states that there is no difference) when it is correct. In
short, you make an error. Remember: at a significance level of .05, you will re
ject the null hypothesis five times out of 100 when in fact there is not a real d
ifference.

 You can change the probability of Type I error by changing your signific
ance level.
 For example, in our example of female and male therapists (Item 16), c
ommitting a Type I error would mean that you would say there is a sign
ificant difference in the self-esteem level of clients when in fact the diff
erence is not significant.
Type II Error (Beta)
 Type II error refers to the failure to reject the null hypothesis when ther
e is, in fact, a difference.
 For example, in our example of female and male therapists (Item 16), c
ommitting a Type II error would mean that you would say there is not a
significant difference in self-esteem of clients but in fact, there is a diff
erence. You would accept (retain) the null hypothesis (in error).
 As the significance level goes down (e.g., .05 to .01), Type I error decre
ases but Type II error increases, i.e., the failure to reject the null hypoth
esis when you should.
 As one type of error goes up, the other goes down and vice versa.
Remember:
 Alpha (Type I) error: Reject (null hypothesis) when you shouldn't.
 Beta (Type II) error: Retain (null hypothesis) when you shouldn't.
T-test
 The t-test is used to determine whether the mean scores of two groups
are significantly different from each other. It can only be used when the
re are two groups (two mean scores). You would compare your obtaine
 d value of t (from the calculation using the formula) with the value of t
presented in a Table oft Values to make that determination. Computer
data analysis programs now provide this information automatically.

(NOTE: For the NCE and CPCE, you do not need to know the formulas
for t-test, analysis of variance or multivariate analysis of variance.)
In our example of female and male therapists (Item 18), we would
apply the t-test to determine whether mean self-esteem scores of
clients are significantly different.
It should be noted that even though statistical significance may be
reached, especially with large groups, there may be no practical
significance to the difference. DISPLAY: t-test Dependent variable:
Client self-esteem Independent variable: Gender of therapist: Male and
Female

22. Analysis of variance (One Way)

There are three basic kinds of analysis of variance. These are:

One-way
Factorial
Multivariate

Let's assume that in our Item 18 example, you as the agency director,
notice that you have therapists trained at three levels. These levels
are:
a. master's degree -- licensed professional counselor (LPC)
b. master's degree -- licensed social worker (LSW)
c. Ph.D. degree -- psychologist (Ph.D.)
You are attempting to determine self-esteem differences in clients
following counseling and are curious as to whether level of training of
therapist might lead to different levels of self-esteem.

Since you now have three groups (the levels of training) the t-test is
no longer appropriate.

You would use the one-way analysis of variance — when you

have only one variable (level of training) at three or more
levels.

Completing the calculation for the analysis of variance yields an F

value and this value must be compared to the values listed in an F
Distribution Table to determine whether significant differences are
present. Computer data analysis programs now provide this
information automatically.

DISPLAY:
 One-Way Analysis of Variance One Dependent Variable: Client self-
esteem
One Independent Variable (Factor) (At 3 or more levels):
Therapist training: Master's — LPC
Master's — LSW
Doctorate — Ph.D.

23. Analysis of variance (Factorial)

1. You would use the factorial analysis of variance (ANOVA) to
simultaneously determine whether mean scores on two or more
variables (factors) differ significantly from each other and
whether the factors interact significantly with each other.
2. In our example in Item 18, we are comparing self-esteem scores
of clients who have been counseled by female and male
counselors. Let's assume we want to compare self-esteem scores
with a second counselor variable as well, kind of training. Our
two independent variables then are (1) gender (two
kinds -- female and male) and (2) kind of training. Let's stay with
the same three kinds of training we used in Item 22.

The one dependent variable is the measure of self-esteem. This

is a 2 X 3 ANOVA design. By completing this calculation, one
could deter-mine if there are any significant differences in client
self-esteem based on therapist gender, or kind of therapist
training, or whether there is a significant interaction between
gender and training.
This is called a factorial analysis of variance because the effects
of two or more factors (independent variables) are being
measured.

3. DISPLAY: Factorial Analysis of Variance

1. One Dependent Variable: Client self-esteem
2. Two or more Independent Variables (Factors):
1. 1. Gender of Therapist: (2 kinds): Male and Female
2. Therapist Training: (3 levels): Master's — LPC
Master' s — LSW
Doctorate — Ph.D.

24. Analysis of variance (Multivariate) (MANOVA)

When your analysis involves more than one dependent variable, you
cannot use Factorial ANOVA. The appropriate statistic is multivariate
analysis of variance (MANOVA). If you were measuring something else
about the clients in addition to self-esteem, that would be more than
one dependent variable. In our continuing example (See Item 23 --
ANOVA), we had two independent variables -- gender and kind of
training. Our single dependent variable was a measure of self-esteem.
Let's assume that we also want to measure the locus of
control (internal vs. external orientation) of clients when they conclude
therapy. We have each client complete a locus of control scale in
addition to the self-esteem inventory.
DISPLAY: Multivariate Analysis of Variance Two Dependent Variables:
Client Self-esteem and Locus of Control Two or more Independent
Variables (Factors): Gender of Therapist: (2 kinds): Male and Female
Therapist Training: (3 levels): Master's — LPC Master's — LSW
Doctorate — Ph.D.
Whenever you have two or more dependent variables, you cannot use
ANOVA. You must use multivariate analysis of variance (MANOVA).

25. Analysis of covariance (ANCOVA) Analysis of covariance is used

similarly to analysis of variance except that the influence of one or
more independent variables on the dependent variable is controlled.
This means that initial group differences are adjusted statistically on
one or more variables that are related to the dependent variable.
For example: In our continuing example (Item 18 and onward), we are
looking at the impact of therapists' gender on clients' self-esteem. Let's
assume that we do not have random assignment of clients to
therapists. In fact, let's assume those most female clients are assigned
to female counselors and most male clients are seen by male
counselors. On the pretest of self-esteem, we find that women clients
score an average of five points higher than male clients. In ANCOVA,
we make use of such information which is obviously related to our
dependent measure, self-esteem. If we were measuring the impact of
therapist gender on clients' self-esteem, women therapists would have
started out five points higher on client self-esteem. So we statistically
adjust client self-esteem scores (for example, add points to the males
pretest scores and subtract points from the female pretest scores)
before making the comparison.
In this case, the covariate is the systematic difference in self-esteem
scores on the pretest (women clients score an average of five points
higher than men clients). Consequently, we conduct an analysis of
covariance — adjust the scores. Then we do the analysis of variance.
26. Post hoc or multiple comparisons tests If your analysis of variance
yields a significant F value, you still will not know which particular pair
of mean scores is significantly different from each other. You must
apply one of the post hoc (after the fact) tests to determine whether
different particular group means or combinations of group means are
significantly different. The most commonly used post hoc or multiple
comparison tests are: Scheffe's (most conservative) Tukey's HSD
(Honestly Significant Difference) Newman-Keuls Duncan's new multiple
range test Your computer data analysis program will conduct these
automatically.
28. Nonparametric tests When you cannot assume that your
distribution of scores is normally distributed (resembles a normal
curve) or that the variance of your sample is similar to the variance of
the population (homogeneity) you must use nonparametric statistics.

Some examples are: Mann-Whitney U test: when you collect data from
two samples that are independent from each other and the scores are
not normally distributed.

Wilcoxen signed-rank test: when you have scores for two samples and
these scores are correlated (that is, you matched them or got two
scores for each individual — repeated measures). However, the scores
do not approximate a normal distribution.

Kruskal-Wallis test: when you have more than two mean scores on a
single variable. This is a nonparametric one-way analysis of variance.

29. Chi-square
1. Chi-square is another nonparametric test and is used when you
have nominal data (groups or categories). This statistic is used to
determine whether two distributions differ significantly. For
example, you might be curious whether more boys than girls
wear jeans to
high school. The null hypothesis would be: There are no significant
differences in the number of boys and girls who wear jeans to high
school. You would use the
Observed frequency of jean-wearing with the Expected frequency.
Boys
Girls
Yes
No
This is called a contingency table. Is the wearing of jeans contingent on
the gender of the student? 29. Solomon four-group design This design
examines the effect of any pretest used on the experimental
treatment.
For example: Assume your subjects take a pretest measuring their
commitment to establishing career goals. This pretest could sensitize
them to 'the need' for career goals and interact with whatever
'treatment' (e.g., completion of aptitude and interest inventories) was
planned. The design:
Group Pretest Treatment Posttest A Yes Yes Yes B Yes No Yes C No Yes
Yes D No No Yes
This design allows you to determine whether the pretest by itself made
a difference (Group B), whether the treatment by itself made a
difference (Group C), whether a combination of pretest and treatment
made a difference (Group A), or whether nothing made a difference
(Group D).

30. Multiple regression This is the use of the correlation coefficient to

determine the strength of the relationship of predictor (independent)
variables on a criterion (dependent) variable. Multiple regression adds
together the predictive power of several independent variables
(predictors). For example: Predictor variables such as high school GPA,
class rank, and ACT scores may be used to predict the criterion
(outcome) variable, which could be end-of-college freshman year GPA.

31. Scatterplot (scattergram) This is a graphic representation of the

relationship between two variables for a group of individuals. Each 1 on
the graph is an individual who receives a score on the X test (e.g.,
anxiety) and a score on the Y test (e.g., hostility). The following
statement might represent the data: As individuals get more anxious
about the counselor exam, their hostility increases (positive
relationship).

32. Factor analysis

This is a statistical method using the correlation coefficient to
determine whether a set of variables can be reduced to a smaller
number of factors. For example: A factor analysis of all the items on a
long inventory with 15 scales may uncover only four or five factors
independent of each other underlying the scales. Thus many of the
constructs of the 15 scales overlap with each other.

33. Likert scale This is a widely used technique for measuring attitudes
or opinions. It allows for several response choices, e.g., a five (or seven
or nine) point scale.

34. Definitions

a. Biserial correlation -- an appropriate correlation coefficient to use

when one variable yields continuous data and the other yields data
that is dichotomous.

b. Cross-sectional -- studying or measuring characteristics of several

groups at the same time, versus Longitudinal -- studying or measuring
characteristics of a group over a period of time.

c. Degrees of freedom -- the number of observations that are free to

vary.
d. Double-blind technique -- this occurs when neither the researcher
nor the subject knows who is getting the active substance or the
placebo.
e. Halo effect -- this is the tendency for the observer (researcher or
data collector) to form an early impression of the person being
observed and then letting this impression influence observations or
ratings of that individual. Halo effect may be positive or negative.

f. Heteroscedasticity -- one end of a distribution of scores has more

variability than the other end resulting in a fan-like appearance.

g. Homoscedasticity -- there is an equal distribution of scores

throughout the range of scores, i.e., around a line of best fit. h. Inter-
rater reliability -- in qualitative research, the reliability calculated by
correlating the responses of several raters.

i. Observer bias -- this is the tendency of researchers to see, hear and

remember what they want to.

j. Pilot study -- this is a preliminary trial or test of the research

techniques and measures.

k. Placebo -- originally meant an inert drug (typically, a sugar pill); now

it also means a control treatment that gives subjects the same amount
and kind of attention as experimental group subjects get (this reduces
Hawthorne and Rosenthal effects). 1. Rank-order correlation (Spearman
rho) -- used when the values of the variables are reported in rank form
rather than continuous.

35. Counseling program evaluation The emphasis on accountability in

the human services field accelerated in the 1970s and continues today.
The push for accountability comes primarily from funders including
Health Maintenance Organizations, insurance companies, government
funding sources at all levels, and others. This accountability in human
services reflects what the business world adopted many years ago as
the `bottom line.' There is an acute need to demonstrate the efficacy
of counseling in general and the effectiveness of specific theories,
techniques, and approaches in particular. The emphasis on short-term
therapy, often between six and twelve sessions, argues for research
and evaluation to determine what works well for what kinds of
problems with what clients under what circumstances. Counseling
program evaluation requires that goals and measurable objectives be
specified in advance. Without those, evaluation data has little
relevance. The effectiveness of counseling techniques and processes
often occurs on an individual client basis. Evaluation is the systematic
collection of evidence of the worth of a program, process, or technique.
Two kinds of evaluation are:

a. Formative evaluation: This is ongoing, process evaluation to

measure the effectiveness of a technique or part of a program.
Formative evaluation tries to determine how well a new technique,
process or treatment works.

b. Summative evaluation: This is summary or product evaluation

designed to measure the effectiveness of a program, usually
conducted at the end of a cycle such as a school year, fiscal year, etc.

36.
Summative evaluation is conducted to see how well agency or
program
goals have been met. Usually a product (document) is generated so
this
is 'product' evaluation versus 'process' evaluation (formative).
Ethical issues in research

Confidentiality: no one should have access to the data except for the
researcher
and research assistants if any. Release of research data to others is
only
ethical with the consent of the subject.

Deception: deception may be justifiable if no risk to subjects is

involved. Such
research should be followed by debriefing of the subjects.

Informed consent: subjects should be informed of the research they

will be
participating in and give their consent.

Significance of research results should outweigh the potential benefits

denied
the control group.

Research must be approved by a 'human subjects committee' or

Institutional
Review Board when conducted within institutions or agencies when
federal funding is involved.
37. Writing research
Most counseling and psychological journals require that the writing
style
presented by the Publication Manual of the American Psychological
Association be used.
Sexist language is to be avoided.

Never submit a professional research manuscript to more than one

journal for
publication consideration at a time.

VIII. PROFESSIONAL ORIENTATION AND ETHICAL PRACTICE

1. Counseling defined
The American Counseling Association (ACA) has defined counseling
as:
The application of mental health, psychological or human
development
principles, through cognitive, affective, behavioral or systemic
interventions, strategies that address wellness, personal growth, or
career
development, as well as pathology.
In 2010 the ACA sponsored task force, 20/20: A Vision for the
Future
of Counseling, achieved consensus on the following definition of
counseling:
Counseling is a professional relationship that empowers
diverse
individuals, families, and groups to accomplish mental health,
wellness, education, and career goals.

2. Historical review
1879--First psychological laboratory established-Wilhelm Wundt
1890--Sigmund Freud used psychoanalysis in treating mental illness
1898--Jesse Davis began working as a counselor in a Detroit high
school
1908--Clifford Beers exposed conditions in mental health institutions
by writing,
A Mind That Found Itself
1908--Frank Parsons directed the Vocation Bureau in Boston
1909--Parson's book, Choosing A Vocation, was published;
established
the trait-factor guidance approach
1913--National Vocational Guidance Association founded - first
professional counseling association
1917--Smith-Hughes Act grants federal funds for vocational education
and
guidance
1927--Strong-Vocational Interest Blank published
1939--E.G. Williamson published How To Counsel Students which
modified
Parson's trait-factor approach
1942--Carl Rogers published Counseling and Psychotherapy
1945+ during the post WWII years, counseling services to veterans in
the VA
were greatly expanded
1951--The American Personnel and Guidance Association was
founded
1954--The Office of Vocational Rehabilitation was created
1958--The National Defense Education Act was passed
This provided money for training of school counselors
1960's--Several new theoretical counseling approaches were
developed such as
behavioral, reality, gestalt, and rational emotive
1962--Gilbert Wrenn published The Counselor in A Changing World
emphasizing counseling as a profession focused on developmental
needs
1976--State of Virginia passed the first general practice
counselor licensure
law
1981--Council for the Accreditation of Counseling and Related
Educational
Programs (CACREP) was established
1980's--Counseling credentialing (licensure and certification)
mushroomed
1983--APGA changed its name to American Association for Counseling
and
Development (AACD); became ACA in 1992
1990's--Counseling expands services and specialty areas increase
1990's and onward--more federal legislation recognizes counseling
as a distinct
profession
2000's--there are more than 55,000 nationally certified counselors and
more than
110,000 licensed counselors
2010--California passed counselor licensure legislation. Now all 50
states, the
District of Columbia, and Puerto Rico have licensure
2011--2020 ongoing issues are professional identity, licensure
portability, and
role of CACREP in setting standards
Upheaval in the profession
A significant professional issue at this time includes the roles,
values, and
influence being exerted by the national counselor accreditation
agency,
CACREP (Council for the Accreditation of Counseling and Related
Educational
Programs). Because the profession of counseling (e.g., American
Counseling
Association) is seeking to be more unified and recognized within and
outside the
profession, it is focusing on CACREP as a unifying force. As a
result, outside
constituencies including academic institutions, licensure
authorities, and hiring bodies are moving to include or require
CACREP program graduation
as a requirement for admission or eligibility.
For the many thousands of professional counselors who did not
graduate from or are enrolled in a non-CACREP program, this is a
dilemma. For
example, some states are moving toward licensing only CACREP
graduates as
professional counselors. Beginning in 2022, the National Board for
Certified
Counselors (NBCC) will only certify CACREP graduates. The US
Department of
Defense TRICARE program will require Certified Clinical Mental Health
Counselors for independent practice. Such counselors are certified
through
NBCC.
There will be pressure on academic institutions that have counselor
education
programs to see that these programs are CACREP-approved in order to
make
their graduates more viable in the counseling profession. Some entities
(such as school districts hiring counselors) are willing to consider non-
CACREP graduates
although they may prefer CACREP graduates.
Because master's degree programs in counseling psychology are not
eligible for accreditation by the American Psychological Association or
CACREP, some non- CACREP graduate education programs have
formed a coalition with these psychology programs to form a new
accrediting body. The mission of the Master's in Psychology and
 Counseling Accreditation Council (MPCAC) is "to accredit academic
programs in psychology and counseling, which promote training in the
scientific practice of professional psychology and counseling at the
master's level." Some counselors and educators in the counseling and
psychology
professions view this accreditation as an alternative to CACREP.

4. Other current and continuing trends and issues

a. Disaster mental health

A number of events, circumstances and natural phenomena are
leading to
an increased focus of the profession on disaster, trauma and crisis
counseling. Natural disasters, wars and conflicts, terrorism and
other traumatic events require particular mental health diagnostic
skills
and treatment interventions.
Beginning with the 2010 national convention of the ACA, a new
category
of programs titled Disaster Mental Health appeared. The recent
revision of
the Council for Accreditation of Counseling and Related Educational
Programs (CACREP) includes counselor training standards for
disaster, trauma and crisis counseling.

b. Definition and scope of practice

Counseling continues to define areas of interest and competence such
as violence/trauma/crises, multiculturalism, spirituality, wellness, and
technology. Because of the diversity of what counselors do, a
'collective
identity' is difficult to establish.
Scope of counseling practice is dynamic as changing state laws and
other professions exert influence on the profession.

c. Portability
The American Association of State Counseling Boards (AASCB) is
taking an active role in implementing a process of easing the
transition
of licensed counselors moving from one state to another. Some of the
issues involved include states have different educational
requirements,
titles of licensed professional counselors differ, different licensure
exams
are used, and scope of practice is different.
You can access AASCB at: www.aascb.org.
d. Social justice counseling
Building on the advances of multicultural counseling, the principle of
social justice is expanding. Social justice counseling addresses
issues of unequal power, unearned privilege and oppression, and
seeks a greater balance of power and resources in society. To better
empower clients, advocacy competencies for counselors have
been identified by ACA and implemented in counselor training
programs. These competencies
are identified in the next item (5).

e. Mind-body connections and implications

There is a need for counselors to understand the relationships
between body functions, nutrition, medications/drugs, and
mental states and behavior. Much behavior may be rooted in
biological and brain functions which cannot be overlooked to ensure
proper diagnoses and counseling approaches. This trend is manifested
through coursework in
counselor training programs as well as workshops and seminars for
professionals in the field.

f. Distance and technology in providing counseling

The use of distance counseling and various media is increasing. A
variety
of social media may be used as an adjunct to building and maintaining
a
counseling relationship. There is great potential to benefit or harm
consumers. Distance counseling and technology guidelines have
been
published by ACA in their Code of Ethics.

5. ACA Advocacy Competencies

In order to provide a more socially just community and system in
which their
clients live, counselors feel the need to advocate for their
clients, not only in
the counseling office but in the communities from which they
come. This
is true for their school clients as well as clients in the
community.
At the direction of ACA, a task force developed a set of
counselor advocacy
competencies that applied to individual clients and
students, to the
community and systems, and to the general public in
social and political
 arenas. The advocacy competencies, as endorsed and adopted
by ACA in 2003, follow.

ACA Advocacy Competencies

From: Toporek, R. L., Lewis, J. A., & Crethar, H. C. (2009). Promoting
systemic change through the ACA Advocacy Competencies. (Special
Section: Advocacy Competence) (American Counseling Association)
(Report). Journal of Counseling & Development, 87, 262-268.
Client/Student Empowerment
* An advocacy orientation involves not only systems change
interventions but also the implementation of empowerment strategies
in direct counseling.
*Advocacy-oriented counselors recognize the impact of social, political,
economic, and cultural factors on human development.
They also help their clients and students understand their own lives in
context. This lays the groundwork for self-advocacy.
Empowerment Counselor Competencies
In direct interventions, the counselor is able to:
1. Identify strengths and resources of clients and students.
2. Identify the social, political, economic, and cultural factors that
affect the client/student.
3. Recognize the signs indicating that an individual's behaviors and
concerns reflect responses to systemic or internalized oppression.
4. At an appropriate development level, help the individual identify the
external barriers that affect his or her development.
5. Train students and clients in self-advocacy skills.
6. Help students and clients develop self-advocacy action plans.
7. Assist students and clients in carrying out action plans.
Client/Student Advocacy
* When counselors become aware of external factors that act as
barriers to an individual's development, they may choose to respond
through advocacy.
* The client/student advocate role is especially significant when
individuals or vulnerable groups lack access to needed services.
Client/Student Advocacy Counselor Competencies
In environmental interventions on behalf of clients and students, the
counselor is able to:
8. Negotiate relevant services and education systems on behalf of
clients and students.
9. Help clients and students gain access to needed resources.
10. Identify barriers to the well-being of individuals and vulnerable
groups.
11. Develop an initial plan of action for confronting these barriers.
12. Identify potential allies for confronting the barriers.
13. Carry out the plan of action.
Community Collaboration
* Their ongoing work with people gives counselors a unique awareness
of recurring themes. Counselors are often among the first to become
aware of specific difficulties in the environment.
*Advocacy-oriented counselors often choose to respond to such
challenges by alerting existing organizations that are already working
for change and that might have an interest in the issue at hand. * In
these situations, the counselor's primary role is as an ally. Counselors
can also be helpful to organizations by making available to them our
particular skills: interpersonal relations, communications, training, and
research.
Community Collaboration Counselor Competencies
14. Identify environmental factors that impinge upon students' and
clients' development.
15. Alert community or school groups with common concerns related
to the issue.
16. Develop alliances with groups working for change.
17. Use effective listening skills to gain understanding of the group's
goals.
18. Identify the strengths and resources that the group members bring
to the process of systemic change.
19. Communicate recognition of and respect for these strengths and
resources.
20. Identify and offer the skills that the counselor can bring to the
collaboration.
21. Assess the effect of counselor's interaction with the community.
Systems Advocacy
* When counselors identify systemic factors that act as barriers to their
students' or clients' development, they often wish that they could
change the environment and prevent some of the problems that they
see every day.
Regardless of the specific target of change, the processes for altering
the status quo have common qualities. Change is a process that
requires vision, persistence, leadership, collaboration, systems
analysis, and strong data. In many situations, a counselor is the right
person to take leadership.
Systems Advocacy Counselor Competencies
In exerting systems-change leadership at the school or community
level, the advocacy-oriented counselor
is able to:
22. Identify environmental factors impinging on students' or clients'
development.
23. Provide and interpret data to show the urgency for change.
24. In collaboration with other stakeholders, develop a vision to guide
change.
25. Analyze the sources of political power and social influence within
the system.
26. Develop a step-by-step plan for implementing the change
process.
27. Develop a plan for dealing with probable responses to change.
28. Recognize and deal with resistance.
29. Assess the effect of counselor's advocacy efforts on the system
and constituents.
Public Information
* Across settings, specialties, and theoretical perspectives,
professional counselors share knowledge of human development
and expertise in communication.
* These qualities make it possible for advocacy-oriented counselors to
awaken the general public to macrosystemic issues regarding human
dignity.
Public Information Counselor Competencies
In informing the public about the role of environmental factors in
human development, the advocacy- oriented counselor is able to:
30. Recognize the impact of oppression and other barriers to healthy
development.
31. Identify environmental factors that are protective of healthy
development.
32. Prepare written and multimedia materials that provide clear
explanations of the role of specific environmental factors in human
development.fexil
33. Communicate information in ways that are ethical and appropriate
for the target population. 34. Disseminate information through a
variety of media.
35. Identify and collaborate with other professionals who are involved
in disseminating public information.
36. Assess the influence of public information efforts undertaken by
the counselor.
Social/Political Advocacy
* Counselors regularly act as change agents in the systems that affect
their own students and clients most directly. This experience often
leads toward the recognition that some of the concerns they have
addressed affected people in a much larger arena.
*When this happens, counselors use their skills to carry out
social/political advocacy.
7.
6.
Social/Political Advocacy Counselor Competencies
In influencing public policy in a large, public arena, the advocacy-
oriented counselor is able to:
37. Distinguish those problems that can best be resolved through
social/political action.
38. Identify the appropriate mechanisms and avenues for addressing
these problems.
39. Seek out and join with potential allies.
40. Support existing alliances for change.
41. With allies, prepare convincing data and rationales for change.
42. With allies, lobby legislators and other policy makers.
43. Maintain open dialogue with communities and clients to ensure
that the social/political advocacy is consistent with the initial goals.
Note. The ACA (American Counseling Association) Advocacy
Competencies were endorsed by the ACA Governing Council, March 20-
22, 2003.
Reprinted with permission.
Profession
A profession is a vocational activity with an underlying body of
theoretical
and research knowledge, and a publicly professed, self-
imposed set of
behavioral guidelines.
Counseling is a profession arising out of the many influences of the
past 140
Accreditation
years.
Accreditation is a process through which public recognition is
granted to a college or university or specialized program of
study which meets certain
established qualifications or standards.
Accreditation applies to programs of study, not to individuals.
Council for Accreditation of Counseling and Related
Educational Programs
(CACREP)
a. The Council was founded in 1981. This is the body that accredits
counselor training programs at the master's and doctoral
levels. It
establishes standards for professional competence and prepares
future
practitioners. CACREP encourages continual review and development
of
academic and professional practice programs. Most state licensure
boards accept CACREP standards and requirements for licensure.
b. CORE (Council on Rehabilitation Education) is an official
affiliate
of CACREP. Standards for Clinical Rehabilitation Counseling have
been adopted. Some CORE programs may also be eligible for
accreditation of their clinical mental health programs.
c. The CACREP standards are under revision for publication in
2016.
The current standards identify six master's level programs:
addictions; career; clinical mental health; marriage, couple
and
family; school; and student affairs and college. The one
doctoral
program accredited by CACREP is counselor education and
supervision.
d. There are about 700 accredited programs in the US and many
institutions have two or more. Additionally, about 60 accredited
doctoral
programs exist.

9. Other accrediting bodies

a. American Psychological Association (APA) accredits clinical,
counseling,
school, and combined areas psychology programs - all at the doctoral
level.
Nearly 400 separate programs are accredited.
b. American Association for Marriage and Family Therapy (AAMFT)
accredits
marriage and family therapy training programs at the master's,
doctoral,
and postdoctoral levels. About 120 AAMFT programs have been
accredited.

10. Certification
Certification is a voluntary process through which recognition is
granted to
an individual who has met certain predetermined
qualifications. Certification is a title control process.
For example: For the designation National Certified Counselor, the
word
controlled is 'Certified.' Others cannot use that word without threat of
lawsuit by whoever does the certification.
National Counselor Certification is mobile; it goes with you
wherever you
move.

11. National Board for Certified Counselors, Inc. (NBCC)

a. This Board provides for generic counselor certification (National
Certified Counselor-NCC). General requirements include a master's
degree in
counseling, coursework in eight content areas, pre-degree field
experiences (practica, internships), 3,000 hours of post-degree
supervised (100 hours) work experience over a two-year time period,
and successful completion of the National Counselor Exam (NCE).
There are over 55,000
active certificants.
b. Following receipt of the NCC, specialty counselor certification is
also
possible in these areas with an exam required:
i. National Certified School Counselor (NCSC).
ii. Certified Clinical Mental Health Counselor (CCMHC).
iii. Master Addictions Counselor (MAC).

c. NBCC requires continuing education units to remain certified -

100 clock
hours for each five years of certification.
d. Graduate students in counseling near the end of their programs
can apply for
and take the NCE. If they are in a CACREP program, they can become
certified upon graduation without post-degree work experience.
Graduate
students in a non-CACREP program become Board Eligible at
graduation
and must complete post degree work experience (3,000 hours).
e. Beginning in 2022, only CACREP graduates will be eligible for
national
certification by NBCC. Existing national certified counselors who are
non-CACREP graduates, will be able to continue their certification
status.
f. Other certifying bodies include:
Commission on Rehabilitation Counselor Certification
States certify school counselors, drug and alcohol counselors, and
other
counseling related groups

12. Licensure
Licensure refers to the passing of a law at the state level to control
the practice
and/or title of an occupation (e.g. counseling). In this process, a state
gives
permission to an individual to practice counseling (as defined in
that state's
law) and to use a title such as Licensed Professional Counselor or
something
similar. There is no licensure at the national level.
General requirements around the country for licensure are a
master's degree
in counseling, coursework in the eight content areas, pre-degree field
experiences,
post-degree supervised counseling work experience, and successful
completion of
an exam.
There are variations in requirements from state to state. For
example, some
require a 48-hour master's degree and others 60. Most states require
between
2,000 and 4,000 hours of post-degree work experience. Most states
use the
National Counselor Examination for licensure, some use the National
Clinical
Mental Health Counseling Examination, and some states allow either
exam. Some
states have two levels of licensure and use a different exam for each
level. The vast majority of states have 'title and practice-control'
laws which mean no one practices counseling unless he or she has a
license. A few states have 'title-control' laws which mean anyone
can practice counseling but cannot use the title (e.g., Licensed
Professional Counselor) legally unless they are licensed. Licensure is
state-bound. It does not move with you although you can go through
the licensure process in another state. You can be licensed in several
states simultaneously. Most states require continuing education hours
for
licensure renewal.
All 50 states, the District of Columbia and Puerto Rico have licensure of
counselors. Portability of the licensure credential between
states is difficult
without going through the licensure process again in the 'new' state.
(See also
Item 4 in this section.)
Some threats to licensure for counselors include:
a. As state licensure laws are revised, the scope of practice for
counselors may be redefined more narrowly, and
b. Proposed changes to some states' laws have suggested that
counselors
not to be allowed to use psychological tests.

13. Reciprocity
This is a process whereby one credentialing agency (e.g., state)
accepts the
credential of another agency as equivalent to its own.
For example: One state licensure board accepts the license of
another
state as equivalent. Some states call this process endorsement
instead of
reciprocity.

14. Confidentiality and privileged communication

Confidentiality is an ethical concept. It springs from the privacy
expected in a
counseling relationship and is respected by the counselor.
Privileged communication is a legal concept. It is granted to
counselors when a
state law has been passed, such as a licensure law.
This legal right to privileged counselor-client communication is similar
to the
privilege exercised by those in medical, legal, and psychology
professions. It
means that in a court of law, the counselor does not have to
reveal what was
said in counseling.
There are several circumstances under which privileged
communication is
waived and confidentiality is broken. These include:
i. Client is a danger to self or others
ii. Child abuse or neglect is alleged
iii. Client requests that counseling records be released
iv. A lawsuit is filed against you
v. The material is used in supervisory sessions
vi. Involuntary hospitalization is being considered
vii. A court orders the release of information
15. Duty to warn (Tarasoff Case)
The Tarasoff family sued the Board of Regents of the University of
California
after Tatiana Tarasoff was murdered by Prosenjit Poddar, a client of a
university
psychologist. In session, Poddar had threatened to kill Tarasoff.
The California court ruled in this 1976 case that failure to warn an
intended
victim was professionally irresponsible. Under such
circumstances, you must
break confidentiality (and waive the privilege if you have it) and warn
the
intended victim(s). Clearly, the ability of the counselor to adequately
and
appropriately determine the client's intentions is critical.
Court cases in other states have generally reaffirmed and expanded
this landmark
legal decision.

16. Duty to protect

In cases of suicidal clients, there is an obligation to protect the
client. Formal
operating procedures and referral options should be identified in
advance. Following are some signs in assessing the seriousness
of suicide risk:
a. direct verbal warnings and previous attempts,
b. definite plan established and the means available (gun, pills, etc.),
c. depression and sense of hopelessness,
d. giving possessions away,
e. history of alcohol or drug abuse.
The duty to protect also applies to others such as children, and in
most states,
the elderly and others with physical or mental disabilities.

17. Physician-assisted suicide

As of 2015, five states allow physician-assisted suicide: Oregon,
Vermont,
Washington, Montana, and New Mexico (one county only). In general,
the
individual must have a terminal illness. Physicians are allowed to
prescribe
medications to hasten death and cannot be prosecuted for doing so.

18. Statement of disclosure and informed consent

A statement of disclosure or informed consent is an ethical necessity
and may be
required by law in some states. This document may identify
counseling
procedures, techniques, counselor credentials, and grievance
procedures and
is given to the potential client before the counseling relationship
begins. The
disclosure can alert the client in advance under what circumstances
you as a
counselor, will break confidentiality depending upon disclosures made
by the
client. Informed consent includes the process for releasing client
information.

19. Professional liability

Counselors can be held liable, sued, and taken to court for
causing harm through mental distress, defamation, sexual
harassment or conduct, negligence,
misrepresentation of professional service, and battery.
Malpractice is the failure to provide professional services, or to
provide those services at a level below that which would be
expected of a professional in similar circumstances. In order for a
malpractice claim to succeed in a court of law, all four of the
following conditions must be met:

a. a professional relationship was established,

b. there was a breach of duty -- the therapist was negligent or
services did not meet community standards,
c. the client suffered physical or psychological injury,
d. the injury was caused by the breach of duty.
20. Professional liability insurance
21.
22.
This insurance is highly recommended. Several insurance providers are
available.
The American Counseling Association sponsors a professional
liability
insurance program for members through the Healthcare
Providers Service
Organization (HPSO).
Different rates are available for counselors employed, counselors self-
employed,
and graduate students.
Family Educational Rights and Privacy Act of 1974 (FERPA)
This federal law is also referred to as the Buckley Amendment.
The intent of the act was to protect the privacy of individuals.
It allows parents of students under 18 years of age and students
themselves, if
they are at least eighteen years old, access to information in their
educational (not counseling) records.
Title IX of the educational amendments
This 1972 legislation bans sex discrimination in schools (K-12
and colleges) in
academics and athletics. The focus of this law has been mostly on
providing
women equal opportunities as men in sports. The same sports do not
need to be
available, but women must be provided the same proportional
participation
23.
24.
opportunities (same number of athletes, not number or kinds of
teams).
Third party payment
This is reimbursement from an insurance company (third party) to
a private
practice counselor who provides services to a client insured by that
company, usually through the client's employer.
Payment to master's level counselors, even if they are licensed, is not
automatic.
Much depends on their state's counselor licensure law. Marital therapy
is often not reimbursed. Some private practice counselors will only
see clients who can pay them directly and the client may or may not
file for insurance reimbursement. In some states, insurance laws have
been changed so licensed counselors
must be reimbursed by insurance companies for the treatment of
certain mental
illnesses.
Managed health care
Managed health care refers to requirements promoted by
insurance companies to reduce health care costs. It includes
strict compliance with
policies regarding diagnosis, treatment plan, record-keeping, etc.
Many mental health professionals including counselors, social
workers, and psychologists, who choose to practice privately, apply
for provider list status which are managed by Health Maintenance
Organizations (HMOs) or
Preferred Provider Organizations (PPOs). Without such provider status,
many potential clients cannot be referred to them.
25. Affordable Care Act -- 2010
The purpose of the Affordable Care Act is to increase the
quality and
26.
affordability of health insurance, lower the uninsured rate by
expanding public
and private insurance coverage, and lower the costs of healthcare
for both
individuals and the government. A number of tools were designed
to accomplish
this including mandates, subsidies, and insurance exchanges-meant to
increase
coverage and affordability. Insurance companies must cover all
applicants within
new minimum standards and offer the same rates regardless of pre-
existing
conditions.
In general, mental health care services are to be treated the
same as regular
health care. This extends the requirement of the Mental Health Parity
and
Addiction Equity Act which was passed in 2008. In other words, if
health care
plans cover mental health and addictive disorder services, they must
do so under
the same terms and conditions as apply to substantially all other
general medical
services covered.
Health care plans cannot discriminate against counselors
providing services
which are authorized under their state's license or
certification. Health care
or plans must cover a package of benefits including mental health and
substance use
disorder services, including behavioral health treatment.
Health Insurance Portability and Accountability Act (HIPPA)
This national law establishes standards for protecting the
privacy of patient
information in the health industry including psychotherapy records
which
include medication, treatment, diagnostic and clinical test information.
It regulates the transmission of client records and insurance claim
information including that sent through electronic means. Clients must
sign a document stating they have
27.
been informed of HIPPA rules.
Mental health clients must sign a release before their
information may be shared with others. HIPPA allows them to inspect
their records and request changes. Strictly general, summary
counseling notes, not at all medical in
nature, are not subject to HIPPA and require a separate release of
information
for disclosure. For more information, visit:
www.hhs.gov/ocr/privacy/hippa/understanding/summary.
Mental health parity, TRICARE, and the VA
The federal law titled Paul Wellstone and Pete Domenici Mental
Health Parity and Addiction Equity Act is now in effect. Private
sector health plans covering 50 or more employees and state and
local government plans (not self- insured) must now provide the
same level of coverage to individuals with mental health and
addiction issues as to individuals with medical and surgical
issues. The law does not speak to providers of those mental health or
addiction services.
TRICARE allows active and retired military service members and
their
families to get services from TRICARE Certified Mental Health
Counselors without first seeing a physician, or getting a referral from
a physician. Other licensed professional counselors can continue to
practice under the supervision of
a TRICARE-authorized physician.
The Veteran's Administration has approved the hiring of
licensed
professional mental health counselors. If they have one or more
years of
mental health counseling experience, they are authorized to practice
29.
28.
independently within the various VA institutions and its components.
Employee assistance counseling
Counselors who work in Employee Assistance Programs (EAPs)
identify, counsel and/or refer out troubled workers. Sometimes the EAP
is located
within the company and other times the company has a contract
with an outside EAP provider.
Counseling program planning and development
The planning of a counseling program begins with
conceptualization of the
program and then proceeds to development, implementation
and evaluation.
Critical steps in program planning include:
a. Conceptualize the system
Examine and understand the broader system in which the counseling
program will be located.
b. Establish philosophy and assess needs
The general philosophy or mission of the counseling program must
be
established.
An assessment of needs is a critical data gathering effort.
c. Develop goals and objectives of the counseling program
Goals are broad statements of the general intentions of the program.
Objectives are specific, behavioral, and measurable and based on
the
goals of the program.
Goals and objectives are developed based, in part, on the needs
assessment
data collected.
d. Process information
Throughout the planning of the counseling program, a feedback loop
of information should be in place to assure program development is
proceeding appropriately, all steps are covered, etc.
e. Conduct a pilot study
If possible, a small scale pilot should be conducted in order to
determine
if development is on target, and any major problems may be
uncovered
before full-scale implementation.
f. Develop a plan
The plan is a roadmap guiding the development to assure the
goals
and objectives will be met. Personnel, facilities, resources, and money
are
part of the plan.
g. Implementation
Depending on how extensive the counseling program is to be, a plan
and
schedule for implementation, hiring, training and related issues
must be
developed.
h. Operate the counseling program
The doors open and clients make use of the services. Fine tuning of
procedures and services occurs.
i. Evaluate the program
This is the process of determining whether the goals and
objectives
established for the counseling program have been met.
31.
j. Modify the counseling program
Depending on the data gathered in the evaluation process, the
program
will be modified, or perhaps, eliminated.
30.
Needs assessment
A need is a discrepancy between what is and what is desired. A
needs
assessment measures these discrepancies. The actual form of the
needs
assessment may vary although a written questionnaire is often used.
For
efficiency and cost purposes, a needs assessment may be
conducted
electronically. However, needs assessments may also be
conducted through
interviews and focus groups.
To insure validity of the needs assessed, random sampling is critical
in order to
get a representative response and accurate picture of the needs. The
needs
assessment process should be structured so the data gathered can be
compiled,
analyzed and interpreted.
Counseling program management
Managing a counseling program requires the knowledge and skills
that other
management positions require. Management requires some or all
of the
following skills and activities:
a. Strategic planning - assessing the nature of the counseling
program
and what it might look like in the future.
b. Program design and development - in addition to goals and
objectives, performance objectives and standards must be designed
or adapted from other similar counseling programs.
32.
Code of ethics
c. Budgeting - forecasting and resource allocation skills are
necessary.
Managing the budget is essential.
d. Personnel management - hiring and training staff and
professional
employees including attention to affirmative action issues.
e. Supervision - occurs at two levels. There must be program
supervision as well as supervision of personnel around job
performance and counseling skills.
f. Evaluation - necessary to determine whether the counseling
program
is meeting its goals and objectives and whether staff are
meeting performance standards.
g. Marketing and public relations - successful program
management
includes developing and disseminating information about the
counseling program, advocacy, fund raising efforts, etc.
A code of ethics is a profession's statement of standards as to
what is right or
wrong regarding professional behavior.
A code of ethics comes from the distilled wisdom of its members,
cultural values
and mores, and legal judgments and opinions.
The ACA Code of Ethics can be found at the back of this Study
Guide.
The reader is encouraged to study the code. A number of ethical issues
or
dilemmas, which may be presented in vignette form, will appear on
the
NCE and CPCE.
The NBCC Code of Ethics is available from NBCC (see page 4). Since
there is
34.
33.
much overlap between the two codes, studying the ACA code is
sufficient.
Principles underlying ethical decision making
Faced with the same ethical dilemma, different counselors might
use different principles to guide them. The following principles
have been identified as those which typically underlie an ethical
decision made by counselors:
a. beneficence, working for the good of the individual and society
b. nonmaleficence, not doing or inflicting harm
c. autonomy, respecting freedom of choice and self-determination
d. justice, treating individuals equitably, fairly
e. fidelity, honoring commitments and keeping promises
f. veracity, being truthful with individuals
A number of ethical decision making models have been proposed. A
common
thread includes the steps found in a problem-solving process.
Obtaining
consultation during this process is an important additional step.
Legal and ethical issues and dilemmas
State laws for counselor licensure usually incorporate many
standards of
practice from the ACA Code of Ethics. In fact, many states now
require that
licensed counselors follow the ACA Code of Ethics.
A number of ethical and legal issues are presented here. They are
separated for
ease in conceptualization and study.
a. Professional Standards of Practice
i. Know what these standards are and apply them as well as you
can. Read your state statute and the ACA Code of Ethics.
ii. Use some form of diagnostic system so you can assess the
needs of clients and apply your services reasonably
tailored to the needs of the clients.
iii. Apply services which have a theoretical basis so you can
justify the methods and techniques you use.
iv. Your training and/or experience level must be consistent
with the diagnostic system and theoretical methods and
techniques you use.
v. Counselors must know and practice within their
boundaries of competence based on such things as
education, training, and supervised experience.
vi. Be careful not to misrepresent your training or credentials.
vii. Be prepared to terminate the relationship if your services
are no longer helpful.
b. Ethical Standards of Practice
i. Subscribe to a professional code of ethics and operate
accordingly.
ii. Know what is ethical in terms of professional practice in your
field.
iii. Obtaining informed consent will prevent troubles later.
iv. Let clients know in advance what you will do (such as break
confidentiality) to different client disclosures.
v. For minors, you may need to get a guardian's consent before

a counseling relationship can begin.

vi. Let clients know if you are recording, receiving
supervision, or are in a training program.
vii. Sexual contact is not ethical. A hug or touch used
appropriately may enhance therapy. Sexual attraction
toward clients should be recognized, not acted upon, and
may be a good reason to obtain consultation.
Sexual relationships between counselor educators and their
students or supervisees are unethical.
Sexual contact is unethical if it occurs less than five
years after therapy ends (ACA Code of Ethics). Some
state laws may mandate a different time period.
viii. The ACA Code of Ethics indicates that counselors
may be
'justified' in telling a partner that a client is HIV
Positive, has AIDS, or other life-threatening disease, if the
client does not do so. No state law requires disclosure to a
client's partner. Be sure to seek consultation.
ix. Ethical practice requires confidentiality which is the basis of
trust. You must recognize the limitations to
confidentiality which include:
⚫ serious and foreseeable harm to the client or others
⚫ discussion with other counseling professionals who
may be helpful
⚫ discussion with superiors or instructor if the
counselor is a student
⚫ client requests counseling records be released
⚫ a lawsuit is filed against you
⚫ when a court orders it
⚫ clerical personnel in the counseling office
⚫ managed care providers and insurance Bus
companies
x. Managing and maintaining boundaries and professional
relationships may carry risks. There could be a power
differential that could be exploitative.
Sometimes such relationships cannot be avoided. This
may occur most frequently in small communities.
Examples are:
The 17-year old daughter of your office secretary
wants counseling and you are the only therapist for
many miles
• One of your clients joins the community fraternal
organization to which you belong
Engaging in more than one role may be beneficial for the
client and not unethical.
Examples are:
• You are invited to an important event in the client's
life such as a wedding or funeral
• You attend a community event that is highly
valued to the client such as a cultural festival or
Gay Pride activity
xi. Counselors will be committed to increasing their
knowledge,
awareness, and sensitivity in order to work effectively
with diverse client groups. Without adequate preparation,
counseling such individuals may be unethical.
Some cultures may have customs and traditions which
may require particular counselor sensitivity.
For example:
• Giving a gift to the counselor is highly valued and
refusing the gift may be very culturally insensitive
• Confidentiality may be perceived differently
within a collectivistic culture than in many other
cultures
xii. Practicing distance counseling demands informed
consent about the relationship, technology, and social
media issues.
For example:
• googling a client is an invasion of privacy
⚫ the counselor may need to establish a personal
as well as a professional Facebook account
⚫ following a client on social media outlets without
permission is unethical
c. Legal Standards of Practice
i. There is considerable overlap of legal and ethical practices in
counseling. As licensure laws were formulated and passed
by states, many ethical principles of the counseling
profession were built into the law. There are some
behaviors and practices that only the law addresses.
ii. The law requires the reporting of abuse or suspected abuse of
children who are under 18
of years
In age. many states,
reporting of abuse is also required when elderly or those
with disabilities are involved.
iii. Sexual contact between clients and counselors is illegal in
most states.
iv. The laws in some states allow counselors to put 'holds' on
clients for medical observation and assessment.
v. Legally, parents of minors have a right to know about
matters pertaining to their children. Ethically, it might be
helpful to the counseling relationship if the parents agree to
the need for confidentiality. Under some circumstances,
minors can enter counseling without parental consent.
vi. 'Privileged communication' is a legal right offered to
counselors in most states, usually through licensure
35.
statutes.
vii. Assigning diagnostic codes (or certain codes) to clients
simply for insurance reimbursement purposes may
constitute insurance fraud and is both unethical and illegal.
Ethical issues in group counseling
Some ethical issues which apply to group counseling include:
a. Informed consent: providing information (about rights and
expectations) to prospective group members prior to the start of
the group.
b. Confidentiality: group members have an ethical obligation to
maintain confidentiality. However, confidentiality cannot be
assured when there are multiple clients, and group members
must be informed of that.
Exceptions to confidentiality should be identified. Privileged
communication (a legal concept) is ordinarily not applicable.
c. Social relationships: group members are discouraged from
forming
social relationships and discussing group issues in cliques or
subgroups outside the group session. Discussion of this possibility
should occur in the group and agreement should be reached as to
how to deal with it.
d. Diverse groups: group leaders may need to discuss their values
and their cultural assumptions. They need to respect cultural
differences and world views of group members and model these
behaviors for group members. Group members need to respect
other members' diversity.
36.
Ethical issues in family counseling
Some ethical issues which apply to family counseling include:
a. Counselor responsibility and values: who is the client -- the
family
or each member of the family? Does the counselor align with the
abused spouse? Or the neglected child? What if one spouse wants
to divorce and the other wants to preserve the marriage?
b. Confidentiality and secrets: family members should discuss
the
limits of confidentiality. Will material brought up in individual
sessions remain confidential or will 'such secrets' be brought into
the family session? Child abuse and incest must be reported.
c. Custody and other legal implications: diagnostic labels on
family
members could be used in court later. What will be the counselor's
s
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role or how will the counselor's information be used in child
custody hearings? Who is the client?
d. What is the counselor's perception of the role of women in
families?
Does the counselor espouse
traditional gender roles?
37. Chi Sigma Iota
e. Role values and expectations: There are many issues in
counseling
when the families are different culturally. What are the family
roles and dynamics in that culture?
This is the Counseling Academic and Professional Honor
Society
38.
International which began in 1985 at Ohio University. The purpose of
Chi
Sigma Iota is to promote scholarship, research, professionalism, and
excellence in
counseling. Members are students, educators and counseling
practitioners.
About 100,000 individuals have been initiated into CSI in chapters in
the US and
abroad. An important function of Chi Sigma Iota is the development
of leaders
in the field of counseling.
American Counseling Association
ACA consists of 20 divisions. Many divisions and ACA have agreed
that
counselors may be members of a division and not be required to join
ACA. As of
2015, the 20 chartered divisions in ACA are:
Association for Child and Adolescent Counseling American College
Counseling Association
Association for Counselor Education and Supervision National Career
Development Association
The Association for Humanistic Counseling
American School Counselor Association
American Rehabilitation Counseling Association
Association for Assessment and Research in Counseling
National Employment Counseling Association
Association for Multicultural Counseling and Development
Association for Spiritual, Ethical and Religious Values in Counseling
Association for Specialists in Group Work
International Association of Addictions and Offender Counselors
American Mental Health Counselors Association
Association for Adult Development and Aging
International Association of Marriage and Family Counselors
Association for Counselors and Educators in Government
Association for Lesbian, Gay, Bisexual and Transgender Issues in
Counseling
Association for Creativity in Counseling
Counselors for Social Justice
ACA has over 50 chartered branches in the U.S. and in many
international
territories and regions with a total membership of over 55,000.