Volume4 Number 1 Jou'lnafof Counseling Research andPractice A Publication of the Mississippi Counseling Association
Rebekah Reysen & Amanda Winburn Editors Journal of Counseling Research and Practice
Volume 4 Number 1 CO-EDITORS
Rebekah Reysen Amanda Winburn University of Mississippi
______EDITORIAL REVIEW BOARD
George R. Beals Lacy C. Overley Delta State University Arkansas State University
Gloria Dansby-Giles Julia Y. Porter Jackson State University Mississippi State University
Suzanne Degges-White Mariana Rangel Northern Illinois University University of Mississippi
Franc Hudspeth Hewitt Rogers Southern New Hampshire University University of Georgia
Daphne H. Ingene Tyler Rogers University of Virginia Richmont Graduate University
Cheryl Justice Daya Singh Sandhu Mississippi State University Lindsey Wilson College
Laith Mazahreh Donna S. Sheperis Mississippi State University Palo Alto University
Tony Michael Kevin B. Stoltz Tennessee Technological University University of North Alabama
JungSu Oh Eric Suddeath University of Georgia Mississippi State University
Jana Frankum Editorial Assistant
______Dylan Wren (Word Processing and Formatting) Katie Cayson, M.Ed. (Cover) University of Mississippi Journal of Counseling Research and Practice
Volume 4 Number 1
The Journal of Counseling Research and Practice (JCRP) is supported by the Mississippi Counseling Association (MCA) for the purpose of promoting professional growth and enhancing the skills of professional counselors. The primary goals of the journal are to: (a) enhance research and scholarly pursuits, (b) promote best practices among professional counselors, and (c) share creative and innovative strategies. The editors of the JCRP invite counselor educators, practitioners, and counseling education students to submit manuscripts that meet the following qualifications: 1. Research and Theory, 2. Innovative Practices/Current Issues, 3. Multicultural Issues, 4. Graduate Student Works.
Research and Theory Manuscripts in this area must describe original research on topics pertaining to counseling. This section will host a variety of topics that include both quantitative and qua litative inquiry. Innovative Practice/Current Issues Manuscripts in this area must provide thorough descriptions of techniques, strategies, skills, and activities that have been developed and/or implemented by counselors in practice. Multicultural Issues Manuscripts in this area must include research, innovative approaches, and cu rrent issues that address multicultural populations that include race, ethnicity, gender, sexual orientation, religion, and socio economic status. Graduate Student Works Manuscripts in this area must include written works that include original research that is conducted during graduate training.
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Title: A separate first page of the document should include the title, author(s) name, and institutional affiliation of all authors (if not affiliated with an institution, city and state should be listed). Abstract: Please include an abs tract describing the article in 50-100 words.
Submission Guidelines. All manuscripts must be submitted electronically to Dr. Amanda Winburn at [email protected] or Dr. Rebekah Reysen at [email protected] as an email attachment u sing Microsoft Word. The submitted work must be the original work of the authors that has not been previously published or currently under review for publication elsewhere. The Journal of Counseling Research and Practice retains copyright of any published manuscripts. Client/Research participants’ anonymity must be protected, and authors must avoid using any identifying information in describing participants. All manuscripts are initially reviewed by the editors with acceptable manuscripts sent to additional reviewers of the editorial board. Reviewer comments, suggestions, and recommendations will be sent to the authors. Authors and reviewers remain anonymous throughout the review process. ------>>>>>>>>Subscriptions to JCRP<<<<<<<<
All inquiries regarding the Journal of Counseling Research and Practice should be directed to the Co-Editors:
Rebekah Reysen, Ph.D., NCC, LPC, DCC [email protected] Assistant Director of Academic Support Programs Adjunct Assistant Professor Center for Student Success & First-Year Experience The University of Mississippi (662)915-1391
Or
Amanda Winburn, Ph.D., SB-RPT, NCC [email protected] Assistant Professor Department of Leadership & Counselor Education The University of Mississippi (662)915-8823
Journal of Counseling Research and Practice
Volume 4 Number 1
TABLE OF CONTENTS
Career Counseling Interviewing: ThemeMapping a Client’s Story 1
Counseling Theories Role Play as a Teaching Tool 21
Treating Emotional Distress through the use of Emotion and Cognitive-Based Therapies 35
Mental Health Literacy of OCD and OCPD in a Rural Area 52
Predictors of Supervisee Self-Disclosure Within the Supervisory Relationship 68
The Perceived Stressors and Coping Skills of Graduate Students: A Developmental and Validation Study 86
A Pilot Survey of the Integration of Technology into Counseling Practice 102
Cookie Friendships: School Counselors Use of Genograms as an Assessment Tool in the Digital Age 119
Acknowledgments 129 Career Construction Interviewing: The Journal of Counseling Research and Practice (JCRP) Volume 4, No. 1 ThemeMapping a Client’s Story (1-20) Kevin B. Stoltz University of North Alabama Susan R. Barclay University of Central Arkansas
Abstract Often, practitioners are reluctant to utilize client narratives due to a lack of training in detailed application concerning story construction and reconstruction and fear of moving into psychotherapy instead of career guidance or counselling(Lengelle & Meijers, 2012; Reid & West, 2011). In this article, wepresent a working process for organizing, mapping, and building viable co-constructions with clients.We offer theming strategies, schemes, and categories that practitioners can use during the career counselling process to help clients in gaining movement in their career trajectories.
Narrative approaches in career questions to collect narrative elements from counselling are gaining acceptance and the client. Based on career construction credibility within the profession (Brott, theory (CCT; Savickas, 2011), the 2001; Hartung, 2013; Lengelle, Meijers, & semi-structured interview is intended to Hughes, 2016; Maree, 2010a; Rehfuss, evoke aspects of the client’s career 2013; Savickas, 1998, 2011, 2013). With the adaptability, identity, interests, values, and increased interest in using narrative general life themes. This involves recording approaches, researchers have noted that the the narrative responses to each question in majority of practitioners are reluctant to the interview and, then, deconstructing this utilize client narratives because of a lack of data into themes. The remaining step is to training, detailed application concerning construct a career life story through a story construction and reconstruction, and cooperative process between the counsellor fear of moving into psychotherapy instead of and the client. See Savickas (2011) for career guidance or counselling (Lengelle & detailed procedures for conducting the Meijers, 2012; Reid & West, 2011). Many interview. researchers and practitioners (Vilhjalmsdottir & Tulinius, 2016; Maree, Current research (Maree, 2010b, 2010b, 2013; Savickas, 1998, 2011, 2012; 2013, Rehfuss, Del Corso, Glavin, & Taber & Briddick, 2011) have attempted to Wykes, 2011; Savickas, 1998; Taber & bridge this gap between theory and practice Briddick, 2011) indicates the interview by providing case studies and detailed sequence is helpful to career clients and applications of one specific narrative counsellors. Stoltz, Wolff, and McClelland approach: career construction interviewing. (2011) found the addition of the career construction interview (CCI) to traditional Career construction interviewing is career counselling methods resulted in an approach of narrative career counselling positive gains in career decision making for that uses a semi-structured sequence of rural African-American high school
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students. Barclay and Stoltz (2016) found psychotherapy narratives. In addition, we the CCI process useful in group career present common theme development counselling with academically undecided strategies from qualitative research methods. undergraduate students. These authors noted Following a brief explanation of the CCI gains on measures of career maturity and and existing co-construction strategies decision-making. Barclay and Wolff (2012) (Savickas, 2013; Taber, Hartung, Briddick, indicated that the CCI process was effective Briddick, & Rehfuss, 2011), we detail a in determining career personality themes. mapping scheme that allows the counsellor Additionally, Rehfuss, Cosio, and Del to assemble the narrative data into thematic Corso, (2011) found that counsellors categories created from the CCI questions. perceived the use of the interview helpful in From this map, the counsellor and client working with clients. Specifically, the organize a graphic co-construction of client participant counsellors highlighted client stories, which becomes a physical life-theme development and making representation intended to aid in the creation meaningful career decisions as most helpful. of a new client narrative.
Although the process and use of the To be clear, we view this process as CCI is well documented and described, the an integration of qualitative research narrative aspects of co-constructing strategies, narrative counselling, and career descriptions for career adaptability, life counselling. Reid and West (2011) discussed themes, and career identity remain the difficulties of limiting a narrative challenging to practitioners and students approach to career guidance. Career (Lengelle & Meijers, 2012; Reid & West, guidance is based on an empirical and 2011). Savickas (2011) claimed that logical approach and usually involves test counsellors need to develop “narrative scores comparing the individual to group competence” (p. 69). Vilhjalmsdottir and norms (Savickas, 2011). Career counselling Tulinius (2016) stressed the importance of incorporates many aspects of other forms of identifying fundamental concepts in the counselling (e.g., negative thinking, client’s stories to aid reflexivity. Moreover, emotion) and aids clients to think in our collective experience in training holistically about career (Peterson, doctoral and master’s students, we receive Sampson, Lenz, & Reardon, 2002; Hartung, consistent student feedback declaring 2013). In this article, we embrace the difficulty in arriving at productive and concepts expressed by Blustein and useful narrative themes and stories. The Spengler (1995), who posited that purpose of this article is to provide a guide counselling includes both career and for deconstruction using theming categories personal dimensions. These authors avoided from research with early recollections and the categorical nomenclature of career or autobiographical memories. Additionally, personal counselling by suggesting the term the process provides a strategy for domain (career, personal, relationship) to constructing themes to collaborate with represent the focus of the counselling. Many clients in re-authoring a new life story. We authors (Betz & Corning, 1993; Krumboltz, accomplish this by providing a brief review 1993, Zunker, 2008) provided further of the extensive literature on theming elaboration of the difficulty in narrative materials, ranging from conceptualizing career counselling as autobiographical memories to complete separate from other forms of counselling.
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However, the focus of career guidance is psychotherapy and counselling is a unique clearly different from career counselling, and specific method of understanding a and we are presenting this mapping client’s verbal and behavioural content technique for use in career counselling using (Braun & Clarke, 2006). Braun and Clarke the narrative CCI process. (2006) posited that theme analysis is a systematic approach for exploring and Much of the narrative career reporting patterns and relationships in data development literature focuses on client collected from clients. The process borrows identity, adaptability, and life themes. The methods from qualitative research and very nature of these constructs entails incorporates the processes of rich domains from other domains of counselling description, inductive and deductive (e.g., early life experiences, family reasoning, and specific epistemologies (e.g., relationships, developmental tasks, constructivist). Braun and Clarke discussed projective techniques). Thus, we posit, as the typical qualitative research processes of many before us, that career and other types exploring data, generating initial codes, of counselling are not mutually exclusive searching for themes, reviewing and naming and often co-occur, especially when using themes, and developing reports. Several client narratives. Although we promote this theming systems (Meier et al., 2008; Singer integration, we recognize that many career & Bonalume, 2008; Thorne & McLean, counsellors may not possess experience or 2001) represent attempts to detail and training in treating mental health issues. We explain the process of developing reliable do support and recognize ethical obligations themes across psychotherapy sessions for to make appropriate referrals for more research and therapeutic purposes. targeted treatment of mental health issues identified in this process (e.g., trauma, Using autobiographical memories clinical depression, anxiety disorders). (ABMs), Singer and Bonalume (2010) Although the narrative approach might described a system of reviewing client present challenges in limiting counselling to stories concerning past and recent life the career domain, in this article, we use a events. This review process entails dividing mapping process as a way of integrating the transcribed psychotherapy sessions into other domains (e.g., life themes, segmented topics within the session content. developmental tasks, stress coping) but After identifying each topic, the researchers focus particularly on the career application suggest identifying each narrative for aspects (e.g., career identity, career complexity (e.g., completeness of story, adaptability). causal links, timeline, context, and emotions). Researchers use the narratives Stranding, Theming, and Storying: that hold many of these story elements Mapping Narrative Elements (rated three or higher on a five point scale) for analysis. Reviewing counselling and psychotherapy content for themes is an Analysis begins with determining the historic, yet emerging, practice in the story as an ABM different from a non-ABM. helping professions (Bruhn, 1984; Clark, The ABM is a story that contains “direct 2013; Meier, Bolvin, & Meier, 2008; Singer personal experience” (Singer & Bonalume, & Bonalume, 2010). Exploring themes in 2010, p.174), not stories told by others to the
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client (a non-ABM). These personal previously. Also included were categories of experience stories are the narratives utilized tension, meaning, gaining insight versus for theming with the dimensions of lessons learned, and reporting of listener specificity, meaning, and affect. Specificity responses (positive, negative) to the represents the detail and integration of the narrative, and whether participants told the story, including time, self-in-context, and narrative to others prior to the study. Thorne unique occurrence (Singer & Bonalume, et al. found a modest, yet positive, 2010). Meaning signifies attempts to qualify relationship between the reporting of tension a person’s use of the memory to create in a narrative and the construction of purpose and significance (e.g., making meaning. This indicated that tension and personal sense from the event). Affect stressful events might promote meaning includes the emotional aspects of the event making and adaption, similar to Savickas’s from past to present. The system also (2002) conceptualization of mild, moderate, includes Thorne and McLean’s (2001) and severe disharmony in career identity scheme for scoring the types of narratives or match to career environments. Additionally, specific content (i.e., life threatening events, this meaning making process is synonymous recreation/exploration leisure events, with reflexivity noted in process research relationship events, achievement events, using narratives (Vilhjalmsdottir & Tulinius, guilt/shame, doing wrong vs. doing right 2016). events, drug, alcohol, tobacco use events, and events unclassifiable). Content is a Those narratives that were categorical assignment of the memory mortality-based had the highest amounts of events that include type of events as outlined meaning associated with the event. There by Thorne and McLean. Although used in was equal distribution of meaning between psychotherapy research, many of the the memory events that had been shared theming categories included in this model previously and those not shared previously, overlap with career domains, especially with indicating that meaning making can be the use of identifying thematic material either an individual or a shared experience. (e.g., preoccupation, emotion) in career Thorne et al. (2004) reasoned that when work (Maree, 2010b; Savickas, 1998, 2012; individuals experience positive life events, Vilhjalmsdottir & Tulinius, 2016). they need little social support, and these events do not necessarily lead to meaning Thorne, McLean, and Lawrence making transformative experiences. (2004) conducted a study concerning early However, the experience of negative events memories and reflecting. These authors used showed benefit from social support for the self-defining memory questionnaire managing the negative emotional (Singer & Saloney, 1993) to collect early experiences associated with these events. memory data from college students. Thorne This story telling can lead to significant et al. (2004) collected 504 memory meaning making as the person explores and narratives, and they coded each narrative narrates life insights. Furthermore, these using the theming system derived by Thorne researchers found story recipients (i.e., and McLean (2001, 2002). This system supporters hearing the story) who responded provided four narrative event categories with positive versus negative responses were (relationship, mortality, achievement, leisure helpful in assisting the narrator to make events) from the original eight outlined meaning of the events. This research
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highlights the significance of tension as a category that represents the common aspects theming category and draws attention to the of the second-order themes draws attention process of counsellors (as listeners) being to the overall descriptor for the third-order open to and promoting positive reflection category (e.g., not stating feelings might be concerning the story and ultimate meaning categorized into behaviours in relating, and for the clients’ lives. This process is feeling unrecognized or ignored might be certainly present and active in the career categorized into cognitive responses to domains as represented by Maree (2010b, social interactions). This is another step in 2013) and Savickas (2011). co-constructing the overall theme from the narratives. Meier et al. (2008) described a theme analysis procedure using a hierarchical After placing all the descriptive theming system consisting of four levels of themes into second-order and third order themes (descriptive themes, second-order categories, counsellors are able to develop a themes, third-order themes, and core core theme. The core theme represents the themes). Descriptive themes, the most basic, relationships between all the third-order represent the client’s concerns and specific categories. For example, a theme of lacking experiences. These include emotions, assertiveness might represent behaviours in thoughts, perceptions, needs and relating and cognitive responses to social lamentations, and other specifics and interactions. This hierarchical organization represent the basic elements or allows for the compilation of themes to deconstructed elements of a story. To arrive come directly from the client’s narrative at descriptive themes, the focus is on unique story. The core or life theme, then, informs feelings, perceptions, needs, wants and the counsellor about the organizing goals, thoughts, and experiences. In framework or dynamic structure of the organizing these, counsellors use a individual’s thinking, behaviour, and continuum from least to most (e.g., feeling emotionality. This is the focus of treatment relaxed to feeling anxious). The description in psychotherapy and counselling, and is reduced to these bi-polar dimensions and career counsellors can conceptualize this as accompany the object of the experience the pre-occupation noted by Savickas (e.g., anxious when talking with supervisor). (2011). Once identified, the counsellor uses The supervisor is the object in this example. the pre-occupation to help the client make meaning of the events and construct an Counsellors form second-order occupation that actualizes this meaning. themes by combining descriptive themes that are similar (e.g., events that describe The theming models presented offer common occurrences, such as not stating insights into how to deconstruct and needs, feeling ignored or unrecognized). co-construct client narratives. Attending to This represents preliminary co-construction the specificity and complexity of the as the counsellor notes commonalities across narrative can provide insights into the narratives. Compiling second-order themes client’s identity development (McAdams, into common blocks is the process of 1985; McAdams & McLean, 2013). developing third-order themes. Looking for Organizing narratives into specific themes relationships between second-order themes helps to identify tension and meaning and and grouping them under a generalized can indicate personal value systems. Finally,
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learning to use a hierarchical structure to In summary, the various theming organize client stories assists in defining systems reviewed above, although thorough primary difficulties or challenges for the and extensive, cannot address all aspects of client. Counsellors might conceptualize the client’s narrative. However, these these as the life themes or preoccupations as systems can broaden and deepen the analysis described by both Savickas (2011) and process of client narratives and assist Maree (2010b). counsellors, using the various categories, to help clients understand identity and use of One additional section of the early memory stories in forming plans and literature related closely to the CCI is the commitments concerning the career domain. use of early recollections as conceptualized by Adler (as cited in Ansbacher & Themes and the CCI Ansbacher, 1979). According to Adler, early recollections represent overall life themes In the career construction interview (lifestyle) and include degrees of activity, (CCI), many memories and current purposeful behaviours, and attitudes toward experiences, as cultivated by the interview social tasks. Understanding the assessment questions, aid the client in building and and translation of early memory stories in constructing a career story. Savickas (2011) psychotherapy is a long-standing tradition of explained that counsellors need to witness the Individual Psychology approach of the client’s stories and relate the personal Adler. meaning back to the client to address the original reason for seeking counselling. Manaster and Perryman (1973, 1974) Then, the counsellor must be able to draw developed a system for theming early relationships accentuating meaning for the recollection material to help practitioners client, expose themes for career and life develop lifestyle themes. They included design, and extend the story into the future. characters (e.g. mother father, siblings, This process includes drawing from past and pets), theme of the memory (e.g., death of a present stories (micro-narratives) to develop loved one, disagreement or conflict), a macro-narrative that portrays a career story sensory detail (e.g., visual, auditory), setting with greater coherence, continuity, and (e.g., home, school, outdoors), mode of complexity. According to Savickas (2011), interaction (e.g., active versus passive), specific categories for story construction perception of event (e.g., internal locus include “self, setting, script, and strategy” versus external locus of control), and affect (p. 68). Additionally, Vilhjalmsdottir and (e.g., happy, sad, scared). Review of these Tulinius (2016) provided guidance in categories helps practitioners assess a understanding story conflict, relationships, client’s lifestyle that includes life themes and motivations in the story. The theming and perceptions of the world. Counsellors schemes discussed earlier reflect several of can use these categories, although altered these categories. These categories become a and revised, in career construction framework for listening to the story and counselling to identify life themes organizing elements of the narrative. (preoccupations), career adaptability (problem solving strategies), and career Several components outlined in the identity (values and worldview). various theming approaches presented earlier represent categories offered by
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Savickas (2011). The client’s descriptions process of helping the client tell and re-story and traits of favoured characteristics in the life events. narrative represent self . Helping the client report actual memories, and not stories Strategy, from an Individual about the client, is an important aspect of Psychology (Ansbacher & Ansbacher, 1979) assessing the self. More important is the perspective, represents the total movement concept of self and personal identity that of the client. This movement is the client’s emerges from the story (McAdams, 1985, way of perceiving, being, and reacting to the McAdams & McLean, 2013). Listening for world. Savickas (2011) stated that the themes across stories helps counsellors strategy is the way the client enacts the develop a sense of the client’s identity. script within the context. From the story, the counsellor gleans the strategy or movement Setting is a category discussed by of the client. This movement represents the both Singer and Bonalume (2010) and way the client deals with the tasks, Manaster and Perryman (1973, 1974). relationships, or challenges presented in the Singer and Bonalume described assessing memory. for the self immersed in the context. Manaster and Perryman included context as These seemingly four simple the frame in which the story unfolds. Other categories (self, script, setting, and strategy) aspects help to build the elements of context outline elements in the client’s story. The (e.g., are there other people [Characters] in counsellor must listen, garner understanding the memory? Does the client describe from the story, and narrate this back to the aspects [e.g., smells, visual cues] of the client in a collaborative process helping the context in detail?). client gain skill in developing narrative chapters for future life events. This process Script is the most noted of the goes beyond basic counselling skills and categories. The script represents the client’s includes interpretation and realigning role and the sequence of events in the story. elements of the client’s story so the client Thorne and McLean (2001) offered the most can begin to conceptualize new chapters. complete list of categories for types of scripts (e.g., life threatening events, This theming process is the recreation/exploration events). Review of cornerstone of the CCI. The ability to these categories simply assists the develop useful themes that capture the practitioner in identifying the type of event client’s experiences, values, emotions, and and how the client perceives the event. The beliefs is crucial to success in using this script concept goes deeper into the narrative approach. To aid in this process, interaction and focuses on the happening we outline the CCI questions below and and processing of the client. Much of the life suggest theming processes derived from the themes emerge from listening to the telling literature presented above. of the events. Listening for the client’s emotional reactions (Manaster & Perryman, Career Construction Interview: 1973, 1974; Singer & Bonalume, 2010) and Questions and Themes meaning making responses (Singer & Bonalume) are important concepts in the Clearly, the CCI is a narrative approach that taps the domains of mental
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health and career functioning problems and moving through life (e.g., simultaneously. In this section, we present strategy and reflexivity). the CCI questions, along with theming concepts that are relevant from the What are the interests of the client? psychotherapy literature, to aid counsellors in mapping the client’s career This question (Tell me what self-construction. magazines you read, the television shows you watch, and the websites you visit Client Concern or Problem in Enacting regularly. What, in particular do you like the Self-Concept about each?) addresses major interests of the client. Also assessed is the tension between The first question (Tell me how I acting on the interests and the social might be helpful to you in constructing your opportunities and self-assessed abilities to career) of the CCI is an inquiry about how act on the interests. The theming categories the counsellor might be helpful to the client used here are very familiar to counsellors. in constructing his or her career. This The RIASEC codes from Holland (1992) question focuses on defining the problem or become a focus for theming. Furthermore, task offered by the client. Furthermore, this using the specific categories of values, question provides the counsellor with the self-concept, rewards, personal style, and client’s present context and, perhaps, self-expression taken from the Self-Directed emotional reactions to the problem or task. Search You and Your Career brochure Counsellors must return to the presenting (Holland, 1994) are helpful in understanding problem after assembling the microstories the client’s expressed interests. Additionally, into a macrostory. Theming for the problem using Prediger’s (1982) dimensions might include the client’s self, context, (people-things and ideas-data) is helpful in relationships, timeline, completeness, and understanding the client’s broad orientations tension. These categories help the counsellor to work. Finally, understanding the tension listen to and categorize aspects of the between actualizing the interests and client’s presenting problem so that, together, opportunities is important. Specifically, what they can reconstruct a narrative into a career restricts the client from pursuing interests? story with goals to address the problem. What is the client’s script? What are salient aspects of the client’s self-concept? With the next question (What is your favourite story? Tell me about the plot.), the The second question (Describe the counsellor inquires about the client’s current people you admired when you were a child. favourite story. From this question, the These might be real people or fictional counsellor is attempting to discover how the characters) addresses aspects of the client brings self and identity to the projects self-concept by asking about role models and settings housed in the person’s interests admired as a child. By asking about role (Savickas, 2011). The counsellor instructs models, the counsellor is hoping to the client to tell the favourite story and propagate narrative about the client’s listens for how the client develops a self-concept. Theming categories include personal interpretation of the tale. The values, morals, and ways of addressing life counsellor listens for the descriptions of how
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the characters move and negotiate the phrase or headline that captures the primary conflicts or climax of the story. These theme of each memory. The headline descriptors are the script used by the client presents a clear theme of the perspective or to negotiate life and conflict. Furthermore, worldview the client constructs concerning the main character in the story usually has a the story. These early life events hold many demeanour and specific values. These can of the theming categories presented in this often be associated with the client’s identity article. The theming of the memories is very and strategies for addressing perceived important to understanding what themes the difficulties. client evokes when facing life tasks, challenges, or adversity. What is the self-talk for facing life challenges? Counsellors consider use of theming for specificity, completeness, causal links, To answer this question (What is and emotions (Singer & Bonalume, 2010), your favourite motto or saying?), the type of event (Thorne & McLean, 2001), counsellor searches for advice the client uses tension and meaning making (Singer & to face life challenges. The counsellor Bonalume; Thorne & McLean), characters, requests a favourite motto or saying and theme, sensory detail, setting, mode of uses this content during re-storying. The interaction, perception of events, and affect motto might represent encouragement, hope, (Manaster & Perryman, 1974) when hearing and expectancy. The client uses the self-talk and interpreting these micro-narratives. The to cope with current and future challenges. memories are cumulative and contain Thus, enlisting the client’s self-guidance aspects of the self, setting, script, and becomes a powerful force for strategy described by Savickas (2011). The encouragement in the new story compilations of these stories provide a construction. holistic worldview. From the theming categories, the counsellor engages in What is the worldview? building a story that represents the client’s generalized view of life and the world. Often in early memories, clients Using specific story elements and the report stories of pain, discouragement, and theming of Meier et al. (2008) is helpful in disappointment, but other memories may building a cohesive and integrated view that present happiness and contentment. The the client can understand as an interpretive centrality of these stories represents the lens for life events. From this point, the pre-occupation or worldview in the client’s counsellor shares this constructed worldview life story. Asking about early memories and with the client and begins to build a new a headline is the next part of the interview narrative to address the client’s presenting sequence (Please give me three early problem or main concern for seeking recollections. These should be memories assistance. rather than stories others have told you. Who is in the memory? What is happening? If the Cartography of Client’s Stories: Building story were published in a local newspaper, the Map what would be the headline?). Counsellors elicit the memories by asking the client to We suggest organizing the story recount three early memories along with a elements from the CCI. First, recording all
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the CCI responses from the interview to the recursive processes outlined in sequence is important. Recording of the qualitative research. narratives should be as accurate as possible using the client’s actual words. Metaphors Reviewing the deconstructed and specific words or phrases are key elements and identifying relationships is the aspects of building a re-constructed story first step in reconstruction (see Figure 4 – with the client. Once all recording is ThemeMap Example). Identifying the complete, the counsellor begins by relationships with colour coding, arrows, or underlining, circling, or highlighting specific some scheme helps highlight emerging words or phrases identifying descriptive themes. Also, reviewing for narrative themes. Counsellors might do this with the aspects of identity, adaptability, values, and client or independent of the client and, then, interests supports in re-constructing a present to the client in later sessions. narrative with the client. Reviewing these Developing thematic links (e.g., underlining, narrative building materials aids in circling, highlighting) shows the reminding the client of the elements and can relationships among the themes in the lead to clarifications. Counsellors can various micronarratives and culminate into accomplish this by mapping the themes and the second and third order life themes that phrases onto the ThemeMapping scheme. represent various aspects of the client’s This scheme provides a visual aid for the general approaches to life tasks and client to see and review the narrative problems in career transitions. Finally, material, along with the counsellor, and taking the themes from the third order provides an organizing frame for the themes and creating core themes helps narrative material. Counsellors use this as a formulate the re-storying. direct reference when re-constructing the client’s new narrative. In the example (see Beginning with the first question, the Figure 4), the map highlights the repetitive counsellor reviews the responses and starts nature of themes (e.g., pressure, frustration). identifying descriptive words and phrases. In These are examples of what Meier et al. the example (see Figures 1, 2, & 3), we used (2008) called descriptive themes. The numbers, underlining, and symbols to show culmination of these descriptive themes the relationships of descriptive themes to the creates the second-order theme of emotional second and third order theming categories. reaction and a third order theme The counsellor repeats this process using the conceptualized as stress. For this example, categories proposed for each CCI question. client decision-making events seem to be The intent of this process is to organize the present in key examples given during the categories in hierarchal fashion similar to interview. The core theme might be labelled Meier et al. (2008). There might be cause as stress resulting from forced choice with some narratives to list or develop a new decision-making. Rather than identifying theme or use a category from another this as a negative trait, we suggest that the question. Once the counsellor reviews and experience of distress and pressure, derived identifies all the second and third level from the presentation of a forced choice categories for all the questions, the (e.g. ice cream flavours, known career deconstruction process is complete. Review choices without exploration) becomes a might help to refine and draw further themes signal to the client for enlisting his hero, or relationships from the categories, similar Iron Man, to use intellect, problem-solving
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skills, and decision-making confidence. This quantitative assessments, interview data) becomes part of the new story construction looking for confirmatory and for the client. non-confirmatory data, and self-monitoring Review of the example reveals through peer supervision to guard against additional descriptive codes (e.g., smart, personal biases when interpretation (Stoltz, intellect, visionary, influential, creativity). Bell, & Mazahreh, 2019). These descriptive codes might be combined into a desired personal style. This personal Conclusion style becomes the way of movement for the client to practice and enhance during career In this article, we reviewed various exploration. The core theme coalesces into theming strategies and schemes for studying an entrepreneurial artistic self-concept. client narratives from the psychotherapy and Again, this would be re-narrated into the counselling literature. We described these new story for the client. theming categories in the context and application of the CCI. By applying these From these highlighted relationships theming categories to the micro-stories (second and third order themes) in the derived from the CCI questions, counsellors narrative elements (descriptive themes), the can gain efficacy and skill for generating counsellor and the client begin to build new future career narratives with clients. narrative elements by identifying important Although intended for the idiographic strengths (adaptability), identity elements, application of career construction, and meaning demonstrating the core themes practitioners can use these theming used for story reconstruction. Building from categories to construct nomothetic research these narrative themes, the counsellor and designs to understand narrative content client develop new chapter outlines better within groups. Generating databases addressing the needs of the client. Savickas of narratives and theming categories may (2015) calls this a “unifying life portrait” (p. reveal patterns in data that presently go 65). This portrait includes goal statements unnoticed in idiographic applications. and conceptualized strengths that draw from the many theming elements presented in this In summary, our purpose in writing article. The client’s experiences, coping this article was to provide support and a strategies, and strengths converge into new strategy to counsellors who have trouble in narratives helping the client to gain developing post-session narratives that help confidence and self-understanding in facing the client cultivate meaning and hope, and the life challenges stated at the outset of the inventorying skills, abilities and session (see Table 1). self-knowledge. These elements are intended to help the client transition into Although this is a qualitative and developing future career stories. Finally, we narrative process, counselors can use believe that by using these theming specific processes to support credibility strategies, borrowed from mental health when co-constructing the interpretation with research, practitioners can make links that the client. This includes processes of demonstrate the inseparable nature of career checking in regularly with the client and mental health work. concerning interpretations, triangulating the narrative responses with other data (e.g.,
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Lengelle, R. & Meijers, F., & Hughes, D. Meier, A, Bolvin, M., & Meier, M. (2008). (2016). Creative writing for life Theme-analysis: Procedures and design: Reflexivity, metaphor, and application for psychotherapy change processes through narrative. research. Qualitative Research in Journal of Vocational Behavior, 97 , Psychology, 5, 289-310. 60-67. Peterson, G. W., Sampson, J. P., Lenz, J. G, Manaster, G. J., & Perryman, T. B. (1973). & Reardon, R. C. (2002). A Manaster-Perryman manifest content cognitive information processing early recollection scoring manual. In approach to career problem solving H. A. Olson (Ed.), Early and decision making. In D. Brown, recollections: Their use in diagnosis & Associates (Eds.). Career and psychotherapy. Springfield, IL: development and choice (4th ed.) Charles C. Thomas. (pp. 255-311). San Francisco, CA: Jossey-Bass. Manaster, G. J., & Perryman, T. B. (1974). Early recollections and occupational Prediger, D. J. (1982). Dimensions choice. Journal of Individual underlying Holland's hexagon: Psychology, 30 , 232-238. Missing link between interests and occupations? Journal of Vocational Maree, J. G. (2010a). Brief overview of the Behavior, 21 , 259-287. advancement of postmodern doi:10.1016/0001-8791(82)90036-7 approaches to career counseling. Journal of Psychology in Africa, 20, Rehfuss, M. C. (2013). The role of 361-368. narratives in career counseling: Career as story. In A. Di Fabio, J. G. Maree, J. G. (2010b). Career story Maree (Eds.), Psychology of career interviewing using the three counseling: New challenges for a anecdotes technique. Journal of new era. (pp. 61-68). Hauppauge, Psychology in Africa, 20, 369-380. NY: Nova Science Publishers.
Maree, J. G. (2013). Counselling for career Rehfuss, M. C., Cosio, S., & Del Corso, J. construction: Connecting life themes (2011). Counselors' perspectives on to construct life portraits: Turning using the career style interview with pain into hope . Rotterdam, clients. Career Development Netherlands: Sense Publishers. Quarterly, 59 , 208-218. doi:10.1002/j.2161-0045.2011.tb000 McAdams, D. P. (1985). Power, intimacy, 64.x and the life story. Homewood, IL: Dorsey Press. Rehfuss, M. C., Del Corso, J., Galvin, K., & Wykes, S. (2011). Impact of the McAdams, D. P., & McLean, K. C. (2013). career style interview on individuals Narrative identity. Current with career concerns. Journal of Directions in Psychological Science, Career Assessment, 19, 405-419. 22 , 233-238. doi:10.1177/1069072711409711
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Reid, H., & West, L. (2011). “Telling tales”: New London: CT: Department of Using narrative in career guidance. Psychology, Connecticut College. Journal of Vocational Behavior, 78, 174-183. Singer, J. A., & Bonalume, L. (2010). Autobiographical memory narratives Savickas, M. L. (1998). Career style in psychotherapy: A coding system assessment and counseling. In T. J. applied to the case of Cynthia. Sweeney (Ed.), Adlerian counseling: Pragmatic Case Studies in A practitioner’s approach (4th ed., Psychotherapy, 6(3), 134-188. pp. 329-359). Bristol, PA: Accelerated Development. Singer, J. A., & Saloney, P. (1993). The remembered self: Emotion and Savickas, M. L. (2002). Career construction: memory in personality. New York: A developmental theory of Free Press. vocational behavior. In D. Brown & Associates (Eds.), Career choice and Stoltz, K. B., Wolff, L. A., & McClelland, S. development (4th ed., pp. 149-205). S. (2011). Exploring lifestyle as a San Francisco, CA: Jossey-Bass. predictor of career adaptability using a predominantly African American Savickas, M. L. (2011). Career counseling. rural sample. Journal of Individual Washington, DC: American Psychology, 67 , 147-161. Psychological Association. Stoltz, K. B., Bell, S., & Mazahreh, L. G. Savickas, M. L. (2012). Life design: A (2019). Selecting and understanding paradigm for career intervention in career assessments. In K. B. Stoltz, the 21st century. Journal of & S. R. Barclay (Eds.). A Counseling & Development, 90, comprehensive guide to career 13-19. assessment (7th ed.). Stoltz, K. B., & Barclay, S. R. (Eds). Broken Arrow, Savickas, M. L. (2013). Career construction OK: National Career Development theory and practice. In R. W. Lent & Association. S. D. Brown (Eds.) Career development and counseling: Putting Taber, B. J., & Briddick, W. C. (2011). theory and research to work (2nd Adlerian-based career counseling in ed., pp. 147-183). Hoboken, NJ: an age of protean careers. Journal of John Wiley & Sons. Individual Psychology, 67 , 107-121.
Savickas, M. L. (2015). Life-design Taber, B. J., Hartung, P. J, Briddick, H., counseling manual. Retrieved from Briddick, W. C., & Rehfuss, M. C. www.vocopher.com (2011). Career style interview: A contextualized approach to career Singer, J. A., & Bonalume, L. (2008). The counseling. Career Development Coding System for Autobiographical Quarterly, 59 , 274-287. Memory Narratives in Psychotherapy. Unpublished article.
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Thorne, A., & McLean, K. C. (2001). enough: Reflecting on self-defining Manual for coding events in memories in late adolescence. self-defining memories. Unpublished Journal of Personality, 72, 513-541. article, University of Santa Cruz, doi: CA. 10.1111/j.0022-3506.2004.00271.x http://www.selfdefiningmemories.co m/Thorne___McLean_SDM_Scorin Vilhjálmsdóttir, G., & Tulinius, T. H. (2016). g_Manual.pdf The career construction interview and literary analysis. The Journal of Thorne, A., & McLean, K. C. (2002). Vocational Behavior, 97, 40-50. Gendered reminiscence practices and self-definition in late adolescence. Zunker, V. (2008). Career, work, and mental Sex Roles: A Journal of Research, health: Integrating career and 46, 267-277. personal counseling. Thousand Oaks, CA: Sage Publications. Thorne, A., McLean, K. C., & Lawrence, A. M. (2004). When remembering is not
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Table 1
Sample of Some of CCI Question the Coding Cue(s) Storied Theme(s) Reconstructed Narrative
6-ERs Context; perception Aesthetics (beautiful; shining sun); When confronted with limited options of events; helping others; forced choice (vanilla vs. you often feel pressure to decide and relationships; strawberry ice cream); lack of options in “move on” to the goal at hand. This strategies; tension; choice; paralyzed (cannot decide); stress is enhanced when people storied needs/values pressure; frustration; parents important in your life are requesting a conflict decision, similar to your headline, “under strong pressure, I cannot decide!” 1-Role Models Values; strategies; Intellectual; smart; brains; problem This is frustrating for you as you strive storied needs/values solving; leading; visionary; influence; to use your intellect and abilities to conflict; movement success solve problems, similar to Iron Man. You have a vision for your life that includes influence and success, and not being able to decide thwarts these characteristics. 3-Interests RIASEC; Entrepreneurial; global influence; You want to enact your vision by being people/things; film/video; fantasy/anime; possibilities; influential and making a meaningful ideas/data; personal problem-solving and saving/helping difference in people’s lives. This might style; rewards; people; non-traditional methods of include using your artistic and self-concept; influence technological abilities and interests to self-expression; create solutions for complex human tension problems. 4-Favorite Story Climax; context; Leadership; helping and protecting Similar to King Arthur, you want to relationships; employees (knights) and community approach these human problems by tension; values; (Camelot); humility, kindness, merciful; influencing a small group of peers to storied needs/values aggressive only when necessary; heroic work towards meaningful solutions. conflict and just You believe in humility, kindness, and collaboration, and understand sometimes you may have to be assertive to make progress toward your goals. 5-Motto Outlook; strategies; Flexibility; freedom; unrestricted; less You believe that life is full of storied needs/values pressure around decisions due to the possibilities and you tell yourself that conflict values of flexibility, freedom, and “Life is whatever you want it to be.” decreased restriction 1-Presenting Context; Distressed/frustrated; pressure to make a To engage in finding a solution you concern relationships; forced-choice decision (now vs. later); will look for those possibilities, tension; timeline; paralyzed (cannot decide); parents beyond those presented and engage the storied needs/values Knights of the round table (external conflict resources) and your Iron Man intellect to help you explore possibilities. Through reconstructing the narrative, the client and counselor began conceptualizing ways in which the client might form a career by exploring areas like film and anime for spreading important social messages to the world. Both understood that the client valued and needed flexibility and possibilities, both in life and in a career. When faced with limited choices, the client experiences both the pressure of making an immediate decision and the restriction of forced choices that do not include other possibilities. Such situations “freeze” the client; his cognition shuts down, and he is unable to make an immediate decision. Throughout the next few sessions together, the client and the counselor spent time utilizing tools and search functions on the O*Net Online website. Through that, and other resources, the client was able to identify career information concerning the visual arts. This led him to selecting an academic major in digital media.
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20 Counseling Theories Role Play as a The Journal of Counseling Research and Practice (JCRP) Volume 4, No. 1 Teaching Tool (21-34) Sarah Stewart-Spencer Capella University Rob Eubanks Capella University Jamison Law Walden University Dale V. Wyman Capella University Annette Pullen Mid-America Christian University Donna James Walden University
Abstract Transitioning from knowledge and understanding to practical application can be a challenging step for counseling students (Authors, 2016). Although the professional field accepts integration as a working model, the ability to effectively integrate theories is a more advanced skill. Research strongly advocates the importance of graduate students connecting with a specific counseling model or theory as a foundation into the profession (Halbur & Halbur, 2015). Beginning counselors may see this as overwhelming as they do not fully understand each theory well enough to integrate. Firsthand experience, such as seeing a theory in action, not only provides a sense of connection for new counselors to a theoretical orientation, but also facilitates proficiency within it (Sharf, 2012). Thus, a role-play demonstration can transition a new student or supervisor from understanding to practical application of theory. This article offers guidance on how to navigate a live demonstration of counseling theories and how to structure the demonstration while providing a brief overview of theory. The article will also explore reflections of both the counselor and the client in the given demonstration scenario and tips, considerations, and ideas for future teaching techniques will be provided.
Transitioning from knowledge and discussion and processing to enhance understanding to practical application can be growth. This can be especially important for a challenging step for counseling students assisting students in selecting a theoretical (Authors, 2016). Specific counseling skills, orientation or model. techniques or theoretical constructs are best conveyed when educators implement a While research on the relative equal variety of explanations to ensure each efficacy of counseling models is abundant method of learning is addressed (Levitt & (Duncan, Miller, Wampold, & Hubble, Jacques, 2005). A demonstration of 2010; Hunsley, John & Di Giulio, 2002; counseling skills is an effective strategy for Wampold, 2001), research more specific to visual learners. When the demonstration is the focus of training new counselors executed in vivo, it further stimulates strongly advocates the importance of
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graduate students connecting with a specific health counseling students. Three faculty counseling model. Halbur and Halbur (2015) instructors executed a variation of the state, “beginning counselors may be best famous “Three Approaches to served by developing a single theoretical Psychotherapy," often referred to as the orientation that works best for them and "Gloria Tapes" (Rogers, Perls, Ellis, & learning to be as effective as possible within Shostrom, 1965). The current demonstration that paradigm” (p.7). Although the varied from the original theories by opting professional field accepts integration as a to showcase Adlerian, Gestalt, and working model, the ability to smoothly Existential theory. Besides the obvious integrate approaches is a more advanced theoretical differences from the original skill in which beginning counselors may see "Gloria Tapes," this role-play demonstration as overwhelming to thoroughly understand also varied in structure. Instead of starting each theory well enough to integrate. with a new client session for each session, Beginning counselors can tackle this feat by this demonstration had each counselor step embracing one theory as a base or into the counseling role as one continuous theoretical home and later integrate other session (i.e., the same story line along with theories as their knowledge grows. Spruill what the client had shared). Each counselor and Benshoff (2000) echo similar opinions demonstrated his or her model for 15 to 20 suggesting that counseling students should minutes. Essentially, the session was paused mature into a single theoretical model to in order for the next "counselor" to initially form their practice. Firsthand demonstrate the new theory as if he or she experience in seeing a theory in action had been sitting with the client from the provides additional support to connecting beginning. with a theoretical orientation and developing proficiency within it (Sharf, 2012). Thus, a A doctoral intern volunteered to be role-play demonstration furthers these the client and role-play a real life issue from important principles of counselor education. her past. She was given instructions to exaggerate an aspect of her life while, at the This article offers guidance on how same time, carefully ensuring that whatever to effectively navigate a live demonstration she selected was not a topic that would not of counseling skills with applied theory and elicit a strong response. The intern was provides suggestions for how to structure the informed she would submit reflections demonstration while providing a brief regarding her experiences throughout the overview of theory. The article will also role-play without reference to her name or explore reflections of both the counselor and identity. The student was also informed each the client in the given demonstration counselor would document and reflect on scenario. Last, this article will present tips, the session without using her name or considerations and ideas for future teaching identifying information. The student techniques. understood and consented to continue with the role-play. Demonstration Structure While this group is not the first to At a clinical training event, several demonstrate counseling models in faculty members joined together to offer a succession with a single client for learning unique learning opportunity for mental purposes (Rogers, Perls, Ellis, & Shostrom
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1965; American Psychological Association, same client, proved to be a helpful 2012), they did harness a unique and experience for the students. Students were important learning opportunity through able to see how counseling approaches can spontaneous collaboration with colleagues. lead a client in very different directions, The demonstration hinged on the premise while still being effective. that this was a second session, making the assumption that each counselor previously Students were cautioned that such a conducted an intake interview and was short demonstration segment is not a fair familiar with the presenting problem. This representation of a theory, as they had allowed for each counselor to clearly already completed a counseling theories illustrate intervention strategies within the course prior to the clinical training given period of time. Each counselor experience. However, the addition of a live worked with the same presenting issue from client working on a “real” problem provided the client, which centered on an experience educational benefit. After the when she was 10-years-old. At this young demonstration, each counselor reviewed key age, she was left with the responsibility of points within the theory and highlighted taking her younger brother to the swimming areas of application to the case. Students pool. However, he left the pool area for the were allowed to query the intern about the playground without notifying her. This experience and also discussed different created a frightening situation for both the aspects of the theory. This type of training parents and the client, which has impacted experience is consistent with Adler’s idea of their relationship to this day. This will be learning as a social practice (Bluvshtein, explored further as the sessions unfold in the Belangee & Haugen, 2015) and students following sections. moving with “others who are pursuing the same aim” (Saran & Neisser, 2004, p. 4). It Interestingly, the three theories is important to note that the client did not selected represented the past (Adlerian read any of the authors’ work for this paper Theory), present (Perls’ Gestalt Theory), before constructing her own reflections of and future (Frankl’s Existential Theory) of a her experience. person’s functioning. These are crude categories as each of these three theories Individual Psychology: The Adlerian includes all the time dimensions of a Session person’s life; however, for purpose of the demonstration, this was the approach used. Adlerian theory is applicable to all Through the Adlerian role-play, the early phases of life, noting that transitions can childhood recollection brought the client to a cause developmental crises during which point of inner conflict. Once the early counseling is helpful. Adlerian theory is recollection shifted into a present state of foundational to many counseling conflict, the Adlerian counselor paused and theories/approaches/taxonomies. Horney’s allowed the Gestalt counselor to start. The neo-psychoanalytic approach, Erickson’s shift happened for the Existential counselor ego-analytic approach, Object Relations in order to help the client resolve the conflict theory, Rational Emotive Behavior Therapy, in the future. This segmentation of the Cognitive Behavior Therapy, Maslow’s’ counseling session, approximately 15 to 20 Hierarchy of Needs, Carl Rogers’ Theory, minutes per theory in succession with the Kellian and constructivist theories, and
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contemporary constructivist approaches are individual. The technique was adapted from just a sampling of Adler’s influence (Oberst Adlerian theory and the writing of Leman & Stewart, 2003). and Carlson (1989). Leman and Carlson's work references how childhood memories Some of the uniqueness of Adlerian hold secrets for how one approaches life as theory lies in the concepts of inferiority an adult, "pursuing goals and actualization" (inferiority complex and superiority (Lemberger, 2017, p. 131). Adler's postcard complex), private logic, early recollections, is a procedure that allows the client to access family constellation, and an early childhood memory. Typically, the “gemeinschaftsgefuhl” which roughly early memories recalled are significant to translated is “social interest” (Adler, 1929). the point where they impact how one Each person decides how they think, value processes the world as a child and are often and feel about themselves and fashions a carried over into adult life, resulting in a unique way of moving through life as all lifestyle (Oberst and Stewart, 2003). This behavior is purposeful. Further, Adlerians lifestyle is a way of navigating these believe that everyone is confronted with five childhood conclusions derived from the major life tasks: work, friendship, love, early childhood recollections. A lifestyle spirituality, & coping with self (Sweeney, brings private logic into focus, which the 2009). counselor can then explore to make sense of the early childhood recollection (Sperry, Though there are many ways of 2017). understanding this unique way of moving through life, a lifestyle analysis is one of the The postcard technique has proven to main ways of helping the counselor as well be very beneficial in helping clients as the client perceive their own form of understand how their private logic as a child misery, dysfunction and “stuckness” so that (derived from the early experience) may still they can move forward with a more be a guiding factor as they travel through satisfying way of progressing through life life as an adult. (Oberst & Stewart, 2003). There are several ways of analyzing a client’s lifestyle with Client Reflections: Adlerian Session early childhood recollections being a major pathway to insight. The Adlerian counselor began the role-play by asking about a conversation Adlerian Counselor Reflections previously held about a childhood memory and requested to explore that memory. The During the counseling memory was from an experience when I was demonstration, the client was taken through 10-years-old. I was left responsible for a simple early recollection using what the taking my younger brother to the swimming author (Wayman) created as being “Adler’s pool. Unbeknownst to me, he left the pool postcard.” This technique involves a vivid area and went to the playground, which retelling of the early recollection by the caused me to panic and my parents to do the client, recalling it as a movie and then same. This event changed and challenged narrowing down the most poignant scene the relationship with my parents ever since. from the “movie” to be placed on an imaginary postcard and mailed to an
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In the counseling session, the today and anxiousness from realizing the counselor’s exploration of this memory led same. to the most salient part of the session, an illustration of the postcard technique. The Gestalt Therapy Session Though challenging, the use of the postcard technique highlighted for me how deep my Gestalt is a phenomenological field shame was rooted despite former efforts to theory operating through dialog created in work through those feelings. It allowed me the present moment with hopes of achieving to see, feel, and express this reality today, so the primary goal of awareness. Diverse many years after the incident. I realized how forms of Gestalt have formed throughout this experience as a child has influenced various countries but the purist practice of many parts of my life. this theory remains focused on Perls, Hefferline and Goodman (1951) as basis for When I named the movie of my philosophical roots. childhood memory, I remember feeling sadness in the pit of my stomach. A movie Gestalt is infused with holistic about a 10-year-old child should not be principles and existential growth, which “Way to Screw it Up”, but this was the most deviate from a pathology driven stance fitting title. This childhood memory brought (Mann, 2010). Individuals cannot exist about many emotions and fear of failing without contact to the environment and their others, which drives my motivation to response. Therefore, the relationship succeed. When asked to describe what the between the counselor and client yields an promotional movie post would look like, I entity that grows into a working platform stated that it would depict a sad little girl referred to as the “I-Thou crying. A sense of failure came over me in contact/withdrawal process” (Yontef, 1993). that moment of sharing. I was asked who I The relationship evolves and lends itself to would want to see that movie poster. I inspection as a viable member of the replied, “My parents.” There was a part of therapeutic alliance. Mann (2010) further me that felt afraid to admit this because I describes the dialogue as what is created could not risk them finding out how I really between the client and counselor, but this felt and risk being vulnerable and failing "between" becomes observed as fertile soil them again. In that moment, I realized that I where interaction and awareness flourish. continue to experience feelings of shame This allows the client to identify restrictions and insecurity, which affect my thoughts and on their ability to authentically relate to their relationships to this day. I was asked to take field (i.e., their environment or situation), a step further and to imagine that I wrote a which stems from unfinished business postcard to my parents describing my manifested through introjects, retroflection reflection on this childhood experience. I and projection (Mann, 2010). This type of described it as simply saying, “Dear Mom exploration occurred in the role-play and Dad…Your words have power.” Saying demonstration when the client shared a these words brought about a shift in emotion desire to "measure up" to her parent's in me. The Adlerian counselor brought expectations through academic and about a sense of relief coupled with some professional achievement. By achieving, she anxiousness. Relief came from knowing ensured their happiness and escaped her own that this memory is still influencing my life fear of experiencing their disappointment or
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disapproval. These expectations have been Therapeutic sessions hinge on the swallowed (introjected) and manifest into present moment, the here-and-now, which her expectations of herself. At no point did explores the what and how of the client's the counselor refute her perspective or world. Perls (1947) recognized that, "there is experience, as the importance is not truth, no other reality than the present” (p. 208). but what is true to her. The here-and-now is one of the primary tools for the Gestalt therapist. Gestalt therapy aims to assist the client to attain greater awareness, and with Gestalt Counselor Reflections it, greater choice (Corey, 2017). According to Corey (2017), increased and enriched Throughout the demonstration, a awareness, by itself, is curative. With continued sense of immediacy was applied increased awareness, “clients have the to increase the here-and-now experience. capacity to face, accept, and integrate denied For example, the client shared, "I don't want parts as well as to fully experience their to let them down." To deepen the connection subjectivity” (Corey, 2017, p. 206). In with these emotions, the counselor asked her Gestalt therapy, an “experiment” is a to repeat this statement followed by silence therapeutic intervention and active technique (allowing reflection). The last example of that facilitates collaborative exploration of a here-and-now work was the counselor's client’s experience (Yontef & Schultz, disclosure of observation. When the feeling 2013). Experiments are spontaneously emerged into the now , the client created as the client explores thoughts, immediately pulled back from it. This was feelings, and perceptions that are present noted with a simple observation, "I feel like and become known through the therapeutic you pulled back just then." This faithfulness process (Corey, 2017). Gestalt experiments to the now relies on the connectedness can be useful tools to assist the client gain between the client and counselor. fuller awareness, experience internal conflicts, and resolve inconsistencies that During this counseling may prevent completion of unfinished demonstration, the empty chair did not place business (Conyne, 2015). The empty chair a person in the chair, but rather the parts of technique, originated by Jacob Moreno and self that were identified during the incorporated into Gestalt therapy by Perls, is exploration of the client's introject (i.e., the a therapeutic intervention that utilizes role angry self, and the exhausted/sad self). By reversal to bring into consciousness the separating these parts, greater understanding possibilities of what the “other” might be was gained of how they impact the whole thinking or feeling (Corey, 2017). and if unfinished business existed. This Traditionally, two chairs are used and the intervention gave voice to all aspects of her client plays all parts of the role-play in order experience. It's important to note that neither to experience all aspects of the situation, part of self should be labeled good or bad, as perception, or belief (Corey, 2017). each part exploration. Introjects may surface which can enable the client to experience the conflict more fully. The client moved into the first chair The conflict can be resolved by the client’s to explore the angry-self. This part felt angry acceptance and integration of both sides that she continued to live by the standard (Corey, 2017). and expectations of others; anger at the
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inability to live authentically. The client more personal responsibility. In fact, at the reported anger but displayed minimal visible end of this session, the client stated that she emotion. The counselor confronted this wants to bring the walls down to see "what disconnection between the anger and her the walls are really about." actual experience of anger. Staying present and intensifying the emotion attacked the Client Reflections: Gestalt Session resistance. Before moving into the next chair, the counselor respected the client's The Gestalt counselor continued with field by ensuring all points were explored by the memory work from the Adlerian session offering, "What else does she [the whole] but picked up on the theme of, "wanting to need to know?" measure up”. The approach felt different as the counselor kept me in present moment The client then moved into the part awareness while reflecting back on the of self that felt "exhaustion" from a memory. She pulled from my memory the continued persistence of introjection. This immense experience of sadness; sadness that part reported sadness, disappointment, and the true emotion was fear of talking badly fear of not living up to her parent's about my parents, though the memory was expectations. In order to stay in contact with decades old. My desire to work through this aspect of self, the counselor asked her to these deeper emotions in a way that would identify the area in her body where these respect my parents created a clear block for feelings live. Larger amounts of therapeutic me. I then felt stuck and paralyzed even silence were integrated into this exploration trying to “breath into the feelings of as the client struggled with experiencing sadness”, as the counselor requested. It these emotions by cutting herself off from demonstrated to me further unfinished this part. She explained that she feels business based on this childhood memory emotionless with this part of self, as if a and the years of striving to do enough, to "wall" had been constructed to where this hold it together and to do as I was told. part exists. Once the client brought a metaphor into the session, focus shifted to The counselor conducted further understanding this "wall" and the means of exploration and then asked me to speak to protection it yielded to the whole. She my “whole self”, imagining her sitting in a admitted that holding up these walls are chair across from me and to describe to that "tiring" and it is exhausting to experience self what I felt about the continued fear all of the time. It is essential to identify struggles. My mind drew a blank. I had no if this wall contributed to any retroflection, words to describe that moment. Though which can be a protective boundary from challenging, the use of the empty chair perceived rejection. technique highlighted for me how deeply I was hurt by the experience as a child and After exploring each part via how that hurt influences my choices. It also separate chairs, the client then moved back allowed me to express my authentic feelings into the chair representing the whole self out loud. It was upon the closing of this and reflected on how these parts interact in work that presented one of the most resonant relation to the whole self. This final moments in the Gestalt session. I remember exploration brought forth awareness about feeling strong affirmation when the her introject-related behavior and evoked
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counselor stated, “you just wanted to be that not all existential struggles or crises are validated for the work you were doing.” neurotic (diagnosable).
Existentialism The goal of counseling from an existential or Logotherapy perspective is to Victor Frankl, the renowned help the client analyze and bring to developer of Logotherapy, an existential awareness internal meanings of events or method for psychotherapy, found through struggles and find a future meaning. This personal and professional experience that may result in hearing things that are difficult finding meaning in suffering could bring to hear, but that can aid them in moving about a newfound optimism and forward and developing. This requires intrapersonal strength (Frankl, 1984). Frankl having an awareness of meaning in life as it (1984) indicated that struggles could rob an can change from day-to-day and individual of their values and that if a person hour-to-hour. In order to find meaning, the could “struggle against (it) in a last effort to individual must be willing to answer the save his self-respect” he/she could lose the question “what is my purpose” as if he/she is feeling of being “an individual being with a being asked by it (life), thus being held mind, with inner freedom and personal responsible and accountable for their life’s value” (p. 60). Part of this effort was to find choices (Frankl, 1984). meaning in life’s challenges and suffering as it could bring about a chance of Another goal of counseling is achievement, and that life affords helping the client understand and be aware individuals suffering to learn from and to of their personal meaning of life’s finiteness, develop character, purpose and values. love, and suffering (Frankl, 1984). All three Furthermore, having a purpose to live for of these are explored in a similar fashion as can help an individual hope for something psychoanalysis. The counselor leads and better in the future, and to realize for oneself encourages the client to explore and become “…that it did not really matter what we aware of his or her own meanings and expected from life, but rather what life determine where the client feels their expected from us” (Frankl, 1984, p. 85). responsibility lies. Furthermore, helping a client come to a resolution of life’s Frankl (1984) indicated that difficulties (i.e. finding meaning in Logotherapy differs heavily from suffering) can help them free themselves psychoanalysis as it focuses more on the from neuroses (Frankl, 1984). future and the client’s individual meaning of the future rather than the past. Additionally, Therefore, in the case of a person’s meaning on the future can affect existentialism, the counselor takes the their present as they get caught in neurotic position as an expert on life’s meaning. loops. It focuses on a person’s ideals and However, he/she only knows life’s meaning values and how they affect their meaning in from his/her own perspective as one cannot experiences. Neuroses (i.e. disorders) can know the meaning of life for another. It is a result when a person experiences existential more philosophical stance on life and frustrations or crises. In other words, their counseling rather than a step-by-step process meaning and purpose in life comes into that one might find with Cognitive Therapy question. Furthermore, Frankl (1984) posits or another more structured treatment. In
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order to use an existential perspective, the (Frankl, 1984). The purpose of paradoxical counselor must work from the perspective intention is to encourage the client to look at and value system of the client, which ineffective behaviors and then to encourage requires an open-mindedness and acceptance new choices to move towards actualization of the client, their experiences, their (Frankl, 1984). For example, it could have interpretations of life, and their culture. been suggested to the client that she practice not being enough in the session and in her Existential Counselor Reflections personal life. The counselor would encourage her to quit trying with certain The clinical training experience aspects of her life. In order to do this, the afforded a great opportunity to demonstrate client and counselor would require a for training and educational purposes the stronger trusting relationship than had been differences between past, present, and established at the point of the recording. future-oriented counseling methodologies. Then, continued collaboration on the results Frankl’s existentialism was chosen as a of her efforts at not being enough might future-oriented approach as its purpose is to bring to light some of the underlying find current and future meaning in struggles, existential beliefs that keep her from and to develop the capacity to continue attaining a higher state of actualization. making future choices and realize that one has the continuous freedom to find meaning. Client Reflections: Existential Session
The client's situation provided a few The pace of the Existential session opportunistic subjects such as the meaning was the most immediate difference that I of her 10-year-old experience which sensed. The counselor took his time early in continued to influence her pursuit of the session and used good attending skills, minimizing discomfort through seeking for allowing me to feel a rapport that eased the excellence in academia, personal life, and transition. This conversational approach spirituality. She indicated that much of her evolved into a discussion about my efforts were to maximize a feeling of being perception of what it means to “do enough” “enough” while decreasing the existential and to “fully arrive”. While I was unable to anxieties of not being “enough.” At one immediately define these terms, the point in the experience she indicated that she counselor’s gentle nature and inviting was not entirely certain what it would feel approach allowed me to discover the internal like to be enough or how she might peace I would achieve in both doing enough recognize it. This one area is a great and fully arriving. Further along in the processing example that many of us (not just conversation, I was challenged to answer clients) experience. We seek for a higher how I would know that I had achieved plain of existence, yet are not certain how it internal peace. Not knowing this felt scary to might appear. Continued exploration might me. I felt my mind racing. Hearing the have brought more aspects of being counselor say, “What would it be like to be "enough" to her awareness. One existential at that place?” helped bring me to a vision of technique is using paradoxical intention. In letting my arms go. I felt a calmness come psychotherapy, paradoxical intention is the over me when I actually let my arms fall to deliberate practice of a neurotic habit or my side. Though challenging, exploring my thought in order to identify and remove it ideas of “doing enough” and “finally
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arriving” was beneficial. It allowed me to was aware of my emotional process and had express my thoughts and to understand how a desire to keep my emotions "in check”. they are influencing decisions I make. Again, the context prevented a deeper level of counseling from occurring but still Client’s Concluding Thoughts provided many opportunities for adequate illustration of the models. When I think of As a current Counselor Education the Existential session, I will recall the and Supervision (CES) doctoral student, I calmness I felt by the pace and tempo of the believe that counseling students would approach as well as the insight it provided. benefit from this demonstration by seeing While the future focus felt safer in front of the varied techniques employed by each an audience, it still provided relevant and approach. Additionally, the style of each significant insights. I strongly recall the counselor would provide an advantage for vision of letting my arms go and the students to see how each one brought about calmness come over me when I actually let a reaction or response from the client, my arms fall to my side. demonstrating effectiveness of each approach. For me, each theory brought about As a CES student, I find it different emotions, each one taking me a embarrassing to see the conflicted inner step further into progressing with this process of managing my life when I do well significant childhood memory. at appearing structured and disciplined. However, seeing this through the lens of Although the venue was difficult for each of the theories is helpful. I’m reassured doing deep work, the steps that were taken that life is messy and chaotic by nature and in these role-plays revealed the need for offering one’s self to the process of further personal work around this memory. counseling affords me the hope of resiliency The strength of the Gestalt approach was in and growth. the empty chair technique and the way the counselor had me speak to the two different Student Experiences and Reflections parts of myself. I also remember feeling a strong affirmation when the counselor The engagement of the audience of stated, “you just wanted to be validated for over 45 students was palpable during these the work you were doing.” Conversely, I demonstrations. During the conclusion of wanted to explore feeling stuck further; each demonstration, there was active however, I was aware of the audience participation in the form of questions, watching the "session" and I did not feel it student-to-student discussion, and note was a safe environment to go deeper. Since taking by many. At more than one debrief that time, reflecting back I suspect that I group discussion with 12+ students may have been protective so as to not participants shared the value gained from expose myself in the vulnerable position. viewing multiple approaches to the same client. Comments were made regarding how The strength of the Adlerian each counselor translated and utilized each approach was the use of the movie clip counseling model and technique according technique. I will remember the powerful to proper theoretical foundations, but each postcard strategy with the name of the with a unique twist according to the movie and note on it. Similar to Gestalt, I
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therapist's personally developed style of regulation that would not typically occur in counseling. a connected, trusting therapeutic relationship. This hindered the true nature of When asked of the value of this the client-counselor relationship. For activity, students stated that the example, during the Gestalt application, the demonstrations added value to their counselor would have likely shifted the development as counselors. It was agreed focus more to the client's protective factors; that the experience was worthwhile and addressing the emerging resistance between highlighted the value of developing a the client-counselor in the here-and-now. In personal style of counseling, developing Gestalt Therapy, resistance is seen as the proficiency with one or two counseling manifestation of energy to protect oneself models as a beginning counselor, and (Perls, 1947). It is valuable to explore this learning to value the clients experience and retreating on the continuum of contact and roll in therapy. withdrawal. Unfortunately, it was clear during the role-play that the volunteer client Considerations for Implementing experienced thoughts and feelings she Demonstration believed to be resolved and was not comfortable sharing this with the gallery of A crucial learning point emerged observers or her supervising instructors. The from this role-play and will serve as a Gestalt counselor identified this in the caution for future use with this method of role-play and chose to avoid the demonstration. A doctoral intern here-and-now in order to care for the volunteered to be the client for this role-play volunteer client. This maintained with permission to quit at any time. The use appropriate boundaries with the client while of a doctoral intern for this type of role-play simultaneously maintaining the boundary was thoughtfully discussed among the between the client and the audience. As an instructors/counselors regarding benefits and unintended result, this highlighted the pitfall possible concerns. The doctoral intern was of dual relationships, which contributed asked to use an authentic past experience; further to discussion with students. not an active personal situation where there was emotional sensitivity. The selected topic After the demonstration, the doctoral to explore needed to be worked through with intern was privately debriefed and allowed either deep self-reflection, supervision, to process her experience with each journaling or personal counseling. These counselor from the role-play. Since this instructions centered on the desire to avoid clinical event served as internship hours for an inadvertent emotional reaction for the counselor education and supervision, she intern. The decision to use a doctoral intern was able to evaluate the demonstration was agreed upon with the understanding that based on her training and how to convey the intern’s emotional well-being would take counseling skills. She received supervision precedence over the role-play exercise. from her faculty supervisor as well as her fieldwork site supervisor. She was Despite the hope to avoid emotional encouraged to continue reflecting on the reactivity, the role-play did elicit some role-play for personal growth and engage in emotional reaction that unintentionally self-evaluation, such as journaling, reflective triggered the client to exert emotional thoughts, expressive artwork or seeking
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personal therapy. The intern was also one continuous session at three different allowed the opportunity to reach out to each points (Rogers, Perls, Ellis, and Shostrom faculty member from the demonstration if 1965). At the end of the role-play, each she wanted to discuss aspects of the counselor explained a concise overview of demonstration or had follow-up ideas about their theory, along with theoretical pillars, how to improve future role-plays. assumptions, beliefs, and how it applied to the client. Students were allowed time to It is impossible to predict how discuss the theory and the role-play after deeply a student will engage in the role-play hearing the overview of each theory. activity when instructed to role-play a previous real life situation with While an educator instructs, it can be exaggeration. An ethical concern would be difficult for students to notice that the student chooses a real life situation that theoretical beliefs and assumptions are not has not been worked through and often as easily identified as techniques or experiences unresolved feelings and issues. interventions. However, it is the instructor Ultimately, it is the responsibility of the who clarifies that techniques and instructor to anticipate if the chosen interventions do not force the counselor into situation will indeed cause an unintentional a particular theory, thus reinforcing the idea emotional response. Therefore, a doctoral that a technique does not a counselor make. intern should not be selected for future For example, students may feel they are a role-play demonstrations. Instead, a fellow Gestalt therapist if they utilize the empty instructor should be used for a role-play chair technique. Thus, educators can exercise. Additionally, the instructor should encourage students to see the assumptions provide a fictional scenario for role-play and beliefs of the theory shining through the instead of the fellow instructor recalling a role-play. Counselors are purposeful and real life, personal experience. This will these purposes help define theoretical significantly decrease the probability of framework. negatively affecting the person participating in the role-play exercise. References
Conclusion Adler, A. (1929). The science of living. Garden City, NY: Anchor Books. Three counseling theories were Bluvshtein, M., Belangee, S., & Haugen D. selected to present how orientation to time (2015). Adler’s unlimited universe. impacts a therapeutic session. Adlerian The Journal of Individual Theory (1929) represented past, Perls' Psychology, 71 (2), 89-101. Gestalt Theory (1947) focused on the present, and Frankl’s (1984) Existential American Psychological Association, Theory (Logotherapy) regarded future. (Producer). (2012). Three Arranged from past to future, the approaches to psychotherapy with a demonstration smoothly transitioned female client: The next generation between each counselor that counseled the [DVD]. Available from same client. Differing from the “Three https://www.apa.org/pubs/videos/431 Approaches to Psychotherapy” model, this 0889 demonstration had each counselor step into
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Conyne, R. K. (2015). Gestalt group memories. Nashville, TN: Thomas therapy. In E. Neukrug (Ed.), The Nelson. Sage encyclopedia of theory in counseling and psychotherapy, Vol. 1 Lemberger, M.E. (2017). Adler as a (pp. 452-456). Thousand Oaks, CA: preceptor of humanistic Sage. psychotherapy. The Journal of Individual Psychology, 73 (2), Corey, G. (2017). Theory and practice of 124-138. counseling and psychotherapy (10th ed.). Boston, MA: Cengage Levitt, D. H., & Jacques, J. D. (2005). Learning. Promoting tolerance for ambiguity for counselor training programs. Duncan, B. L., Miller, S. D., Wampold, B. Journal of Humanistic Counseling, E., & Hubble, M. A. (Eds.). (2010). Education and Development, 44 (1), The heart & soul of change: 46-54. Delivering what works in therapy. Washington, DC: American Mann, D. (2010). Gestalt therapy: 100 key Psychological Association. points & techniques. New York, NY: Routledge. Frankl, V. E. (1984). Man’s search for meaning. Boston, MA: Beacon Neuman, W. L. (2006). Social research Press. methods: Quantitative and qualitative approaches (6th ed.). Halbur, D. A., & Halbur, K. V. (2015). Boston, MA: Allyn & Bacon. Developing your theoretical orientation in counseling and Oberst, U. E., & Stewart, A. E. (2003). psychotherapy. Boston, MA: Adlerian psychotherapy: An Pearson. advanced approach to Individual Psychology. New York, NY: Hunsley, J., & Di Giulio, G. (2002). Dodo Routledge. Bird, Phoenix, or Urban Legend? The Question of Psychotherapy Perls, F. (1947). Ego, hunger and Equivalence. The Scientific Review aggression. London, UK: George of Mental Health Practice: Objective Allen and Unwin Ltd. Investigations of Controversial and Perls, F., Hefferline, R., & Goodman, P. Unorthodox Claims in Clinical (1951). Gestalt therapy: Excitement Psychology, Psychiatry, and Social and growth in the human personality. Work, 1 (1), 11-22. London, UK: Souvenir Press. Kottler, J. A. (2010). On Becoming a Rogers, C. R., Perls, F. S., Ellis, A., Therapist (4th ed.). San Francisco, Shostrom, E. L., & Psychological. E. CA: Josey-Bass. F. F. (1965). Three approaches to Leman, K., & Carlson, J. (1989). Unlocking psychotherapy [I].Corona Del Mar, the secrets of your childhood CA: Psychological & Educational Films.
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Saran, R., & Neisser, B. (Eds.) (2004). Angeles, CA: Pacific Gestalt Enquiring minds: Socratic dialogue Institute. in education. Sterling, VA: Trentham Books.
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34 Treating Emotional Distress through the The Journal of Counseling Research and Practice (JCRP) Volume 4, No. 1 use of Emotion and Cognitive-Based (35-51) Therapies
Kimberly Mills Jake A. Johnson Masica Jordan Bowie State University
Abstract This article will present an integrated approach for treating emotional distress. The authors review the purposes of emotions and explore how they operate in individuals’ lives based on learned responses and inaccurate perceptions. Distinct categories of emotions are identified, including both maladaptive and adaptive forms. Basic ideologies and negative evaluations will also be reviewed to illustrate how these patterns develop and maintain disturbing conditions. The authors will examine the complimentary association between affective and cognitive material and how treating both in therapy can be beneficial. Emotion and cognitive-based interventions will be presented through the use of a case study.
The presenting issue for many that are useful in addressing distressing individuals who enter therapy is the emotional and psychological experiences. occurrence of emotional pain. Whether these persons are addressing problems related to From an evolutionary perspective, divorce, grief, or unresolved trauma, they emotions have primarily served adaptive are all hurting in some way. It is the purposes (Leahy, 2015). Individuals are experience that individuals “do not feel directed in appraising whether a situation is good” that leads them to seek therapeutic positive or negative, advantageous or support (Chhatwal & Lane, 2016). Various unfavorable, and morally correct or authors have used different terminology to unethical (Zhu & Thagard, 2002). As such, define the existence of emotional pain. Most “emotions are forces inside us that are trying recently, Meerwijk and Weiss (2011) used to tell us something about our state of the concept of psychological pain to define well-being with relationship to the outside “a lasting, unsustainable, and unpleasant world” (Quebodeaux, 2015, p. 4). feeling resulting from negative appraisal of Consequently, emotions also serve to an inability or deficiency of the self” (p. prepare individuals to take action (Gross, 410). Psychological distress has been 2002). Different reactions may occur as defined as “a state of emotional suffering individuals decipher what affect the emotion associated with stressors and demands that will have on them. For instance, threatening are difficult to cope with in daily life matters may cause individuals to elude (Arvidsdotter, Marklund, Kylen, Taft, & certain situations, whereas non-intimidating Ekman, 2015, p. 687). Life’s hardships can material may be more approachable (Brosch, all lead to difficult experiences that are Pourtois, & Sander, 2010). uniquely defined. The essence of this article will be to identify treatment interventions
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On the surface, it may appear that change. In his review of psychotherapy dealing with emotions should be easily models, Brown (2010) noted that the current attainable. For instance, common cliché’s trend among counselors involves integrating surrounding the issue encourage individuals therapeutic approaches. As offered by Leahy to “get over it”, “quit having a pity party”, (2007), “several approaches may arrive at and “stop feeling sorry for yourself”. Well, the same endpoint-improvement for the for clients who may have tried everything patient, but they may reach their destination else, this may be easier said than done. through different means” (p. 356). Whereas Research has indicated that emotions are counselors were initially more dedicated to much more involved than they may appear. treating clients based on one primary As noted by Hoffman (2013), “we not only theoretical orientation, many are now feel an emotion, such as fear, anger, sadness, demonstrating an appreciation for alternative or happiness, as a response to a stimulus, but conceptualizations. According to Prochaska we also feel emotions about emotions” (p. and Norcross (2010), “psychotherapy 94). Verbal expressions about how emotions integration is motivated by a desire to look have impacted the lives of clients may beyond the confines of single-school include such explorations about why the approaches to see what can be learned and emotion is lasting so long, whether the how clients can benefit from other emotion is appropriate to the situation, and approaches” (p. 455). what can be done to heal the emotional experience (Leahy, Tirch, & Napolitano, Cognitive therapy is one system that 2011). Often times, clients may buy into has evolved to include the consideration of myths such as emotions being other theoretical models. More specifically, uncontrollable, unhealthy, and un-ending many cognitive therapists value the role that (Van Dijk, 2012). Because clients’ emotion plays in contributing to the presenting problems are often referenced in well-being of individuals (Leahy, 2007; terms of their emotional experience (e.g., I Power, 2009). In this integrated approach, feel sad), a significant point of therapeutic practitioners explore how both emotions and intervention will be to address this affective cognitions create and maintain the component. presenting condition. A framework offered by some researchers is that the emotional Integrating Emotion and Cognitive-Based impact is experienced preceding the Therapies cognitive content. In this view, it may be important for the therapist to access the Among the factors influencing the affective information first. For instance, effectiveness of therapy is the use of the Whelton (2004) suggested that “emotional practitioner’s theoretical orientation to guide engagement and arousal facilitates effective the therapeutic process (Gladding, 2009). therapy but lasting personal change also Therapists first become aware of clients’ requires cognitive reflection and the presenting issues during the assessment construction of new meaning” (p. 67). phase of therapy. Because all client issues are unique it is important to consider how to Other theorists suggest that thoughts frame treatment in a way that is meaningful initiate clients’ experiences. According to for clients, accurately addresses their Brosch (2013), “emotional responses are problem areas, and will create beneficial elicited as the organism evaluates the
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relevance of environmental changes for its experiences offer one point of intervention well-being” (p. 370). Notwithstanding which because, “while there is no magic potion to component commences the event, the point cure all that creates suffering in our of intervention for an emotion and lives…one thing has proven extraordinarily cognitive-based integrated approach is to helpful in moving people beyond those concur that there exists a reciprocal places-their emotions” (Quebodeaux, 2015, relationship between both components. As p. 2). offered by Burum and Goldfried (2007), “emotion is a basic component of human From the perspective of experience inexorably interwoven with Emotion-Focused Therapy (EFT) people can thought and action” (p. 407). This “fusion” use their emotions in order to increase is further supported by Spradlin (2003) who greater self-understanding (Greenberg, contends that emotions and thoughts share a 2011). Upon encountering an event, significant connection (p. 12). individuals’ emotional systems automatically assess whether a situation will In this current article, the authors impact them in a good or bad way. support the use of an Consequently, this evaluation leads to a emotion/cognitive-based model to help physiological sense about what occurred. clients deal with distressing life experiences. This affective component is further What will follow is a framework for processed by a linguistic element that working with clients in therapy who are provides a narrative understanding about the experiencing emotional distress. The authors event. Collaboratively, these mechanisms will be guided by the work of are all formed into schemes (e.g. an anger Emotion-Focused Therapy, Emotional scheme) that inform how individuals may Schema Therapy, and Cognitive Therapy. respond to a situation. In Leahy’s (2015) The outline will include: a rationale, Emotional Schema model, emotions also therapeutic goals, a case presentation, and an serve an evaluative purpose. In this way, the integrated treatment plan. thoughts that people develop about their emotions can lead to distress. After Rationale for Addressing Emotional experiencing an emotion individuals then Responses interpret the meaning, thus forming an emotional schema. For instance, people may The precipitating experience that assume that their pain will be unbearable, often pushes clients to seek treatment is uncontrollable or ongoing (Leahy, Tirch, & when they realize they are experiencing Napolitano, 2011). In both models, the disturbing emotions. “Old emotional clutter emotional response may be maintained by directly affects our ability to regulate the persisting evaluation. As clients become emotions, experience joy, and have a skilled at uncovering affective content, they fulfilling life” (Altman, 2016, p. 2). Clients will develop the capacity to manage or may notice a pattern in which they are alleviate emotional disturbances. consistently sad, anxious or even angry. Perhaps the emotions intensify or linger Identifying Emotions without any alleviation. There may also be times in which the emotions flee and later Emotions have been defined as “a return. Targeting these emotional complex chain of loosely connected events
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that begins with a stimulus and includes interconnected, any disturbance in one area feelings, psychological changes, impulses to will impact other areas. Mckay, Davis, and action and specific, goal-directed behavior Fanning (2007) describe a feedback loop in (Plutchik, 2001, p. 345). Various authors which individuals experience distressing have differentiated between the unique thoughts related to significant life events, categories of emotions (Leahy, 2015; which in turn leads to painful feelings. The Braniecka, Trzebinska, Dowgiert, & point of intervention in Cognitive Therapy is Wytykowska, 2014; Hoffman, 2013). to intervene in the processing of thoughts According to Leahy (2015), there are four (Wilding, 2012). main distinctions including primary adaptive emotions, maladaptive primary emotions, Affective and behavioral responses secondary primary emotions, and are triggered by the way people interpret instrumental emotions. Primary adaptive their situation (Curwen, Palmer, & Ruddell, emotions refer to those immediate responses 2000). According to Beck (1976), it is the to a situation that prompts some type of meaning and importance individuals attach action. Maladaptive primary emotions to significant life events that impacts their reflect those reactions that were once used experiences. What maintains emotional for adaptive purposes. Individuals rely on episodes (e.g. anxiety, sadness) is the these responses in present day as an internal self-talk and automatic thoughts that automatic support when they encounter individuals continually review in their minds familiar stimuli. Secondary primary (McKay, Davis, & Fanning, 2007). Clients’ emotions are reactions that are elicited to abilities to perceive information from a more protect against the original emotion or used logical viewpoint will improve their overall to respond to a primary emotion. responses and reactions. Instrumental emotions are reactions that are developed in an effort to manipulate others. Identifying Cognitions Emotions typically arise from situations that individuals deem as significant in some way. Throughout life experiences, Thus, occurrences that are appraised in a individuals develop their own perceptions positive light will reveal more promising about themselves, others and society in emotions. Negative evaluations lead to more general. These core beliefs guide the way in distressing affective states (Frijda, 1988). which people interpret their understanding Clients who are willing to experience and of a given situation (Beck, 1995). process their emotions can further uncover Evaluations may include clients’ thoughts the associated meaning they assign to about how worthy, loved, and competent significant situations. they are (McKay, Davis, & Fanning, 2007). It is the persisting “ongoing dialogue” or Rationale for Addressing Cognitions “internal chatter” that influences how deeply embedded these cognitions are (McMullin, During distressing events, 2000, p. 65). These thoughts are problematic individuals may experience reactions in because individuals’ interpretations are quite various areas of functioning, including their unrealistic (Beck, 1976). There is “a lack of thoughts, emotions, behaviors, and accurate correspondence between perception physiology (Curwen, Palmer, & Ruddell, and actual events-or by misperception of the 2000). Because these systems are world” (Dobson, 2012, p.11). Based on
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Beck’s work of cognitive distortions, various engage in negative coping behaviors authors have highlighted the major negative (Strosahl & Robinson, 2008). thinking patterns: Catastrophizing involves In their review of emotion-based predicting the worst possible outcome; therapies, previous authors suggested that dichotomous thinking occurs when the primary task of therapists is to assist individuals evaluate events in a rigid way; clients with appropriately assessing selective abstraction includes fixating on the emotions (Ehrenreich, Fairholme, Buzzella, negatives in a given situation; and Ellard, & Barlow, 2007). By exploring the overgeneralization occurs when individuals structure and function of emotions, clients pessimistically predict that all situations will learn about what emotions are, what turn out the same way (Curwen, Palmer, & purposes they serve and how to best Ruddell, 2000; Dobson, 2012). determine whether they are having an emotional experience. These same authors Developing Collaborative Goals propose that, by investigating the context of emotion, clients become aware of how Utilizing an integrated approach situational factors, early socialization, and involves helping clients to explore how culture impact their emotional experiences. unproductive emotions and cognitions are Emotional hardships are often accompanied maintained in their lives. Regarding by a desire to understand the experience. For emotions, the EFT perspective stipulates that instance, people may describe the therapists and clients must become aware of occurrence of “crying for no reason”. When emotion schemes that are currently in use. addressing issues of emotional pain, it These constructs are activated automatically becomes important for clients to find a way when individuals encounter familiar to make sense of their emotions (Greenberg, situations that correspond to pre-coded 2004). concepts (Greenberg, 2011). Thus, individuals who have a history of Cognitive processing offers a abandonment (i.e., abandonment scheme) mechanism for clients to develop an may relive these experiences in their current understanding of why they feel the way that relationships. EFT can be beneficial for they do. Thus, a major goal of cognitive clients seeking treatment for distress by therapy becomes teaching clients “how their considering the impact that past and current thoughts function to trigger and maintain experiences or memories play in dysfunctional emotions and reactions to maintaining their emotions. Using situations” (Shean, 2003, p. 196). The Emotional Schema Therapy further assists interaction between problematic thought therapists and clients with exploring the patterns and distressing emotions can often impact of emotions in functioning. In be seen in how individuals respond to the facilitating the sessions, therapists help situation. In the case of emotions, clients become aware of their guiding individuals may utilize their learned principles ( schemas) about emotions. In this emotional responses (schemes ) and their way, clients uncover their interpretations of basic ideologies ( schemas) to develop their emotions and the strategies they use to reactions. According the Gross (2001), control them (Leahy, 2015). Thus, “emotions call forth a coordinated set of individuals who are not able to effectively behavioral, experiential, and physiological manage their emotions may be likely to response tendencies that together influence
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how we respond to perceived challenges and would include establishing a collaborative opportunities” (p. 281). In regards to relationship in which clients would feel cognitive appraisals, it is the clients’ comfortable to explore underlying thoughts evaluations that impact the reaction in such and emotions related to current distress. The a way that “consequences are likely to be therapist would provide a supportive negative” (Dobson, 2012, p. 24). environment in which the clients’ feelings are empathically understood and validated Power and Dalgleish (2008) (Timulak, 2014). Additionally, therapists developed a model that considers the role of would help support clients in considering both emotion and cognition. As indicated by healthy, new perspectives and ways of these authors, when presented with a thinking that would assist them in creating situation, different levels of processing positive outcomes while eliminating occurs. Individuals first encounter sensory negative coping responses. The case study information which initiates the primary and outline that follow provides a experience of emotions. Further processing demonstration of how therapists can work may include automatic arousal of emotion with clients dealing with distressing based on associations of previous experience experiences from an and learning. As all of this information is emotion/cognitive-based perspective. integrated persons also begin to develop Sample interventions will be provided using narratives and generalizations about the case of Evelyn. themselves and the world. Although dealing with difficult emotions can be a painful Case Presentation undertaking, avoiding negative experiences can prove detrimental as well. For instance, Evelyn is a 34-year old female who if distressing emotions persist, “or are so first entered therapy to deal with intense that they overwhelm, or evoke past “relationship issues”. For the past two years loss or trauma they can become the client has been in a courtship with her dysfunctional” (Greenberg, 2004, p. 4). In current boyfriend. Recently, the boyfriend the same vein, engaging in a continual has been talking about the topic of pattern of negative thinking can impact engagement and starting a family. These individuals’ overall well-being (Greenberg, conversations have led Evelyn to feel 2008). According to Dobson (2012), healthy ambivalent, as she never imagined the adjustment occurs when “the individual relationship evolving any further. Evelyn accurately appraises his or her environment fears that her boyfriend may be “too good” and is therefore able to cope with the for her. Evelyn admits that although she demands of the environment” (p.11). deeply cares for her boyfriend, she does not think she is “in love” with him. The client An Integrated Emotion and entered therapy to sort out her feelings about Cognitive-Based Treatment Approach whether she should accept the pending marriage proposal. She would also like to A treatment approach that utilizes an seek support for the significant life emotion/cognitive-based perspective can be challenges she endured throughout her beneficial for clients in helping them to deal childhood and young adult years. with distressing emotions (Power, 2009). An integrated approach in working with clients
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The client was raised by her maternal does not measure up. She judges herself as grandparents after her parents gave up their being “contemptable” and wishes she could parental rights when she was two years of erase the memories of her former life. The age. Evelyn’s parents maintained some client reports a history of seeking out contact with her until she was approximately superficial unions that have no real future. five years of age, but then opted for the These relationships were “drama-filled” “party lifestyle”. To date, the client has had with episodes of arguing and playing mind minimal contact with them. Although an games. Although these patterns exist in only child, Evelyn was raised in a home Evelyn’s current relationship, her boyfriend with her cousin who is two years older. At is tolerant and remains willing to work the age of six, Evelyn’s cousin was re-united through their issues. Evelyn contends, “he with her biological mother and the family accepts me unconditionally, with all of my re-located out of state. When Evelyn was 17, baggage”. The client fears that she will her grandmother passed away. Two months never have any “true connections” and later, her grandfather had a stroke and was wonders if she is “good enough to love”. placed into a nursing home until he died one year later. Providing a Rationale
Evelyn describes experiencing “utter In addressing the importance of loneliness” throughout her life. During her working with emotions, therapists may college years, the client began a life of begin by discussing the usefulness of “partying”. Evelyn describes this as a “wild” emotions in preparing individuals to take time in her life where she needed guidance. action (Van Dijk, 2012). With further During these years the client experimented explanation, clients will learn that although with alcohol and drugs, engaged in emotional responses can serve protective promiscuous sex, and failed her classes. As purposes, they can also be used in ways that a result, Evelyn lost several significant are not productive (Quebodeaux, 2015). friendships with “really good people” who Thus, when individuals use emotions cared about her. Now as an adult, Evelyn has maladaptively their coping responses too made great efforts to have a better life and may be unbeneficial. In Evelyn’s case, her make more appropriate choices. The client is experience of anger may serve as a currently a customer service representative protective factor in her efforts to keep her in a bank but considers plans of returning to relationships at a comfortable distance. To school for human resource management. She acknowledge the importance of working engages in a healthy-eating and with cognitions, therapists may provide substance-free lifestyle. education about how patterns of thinking can persist if they are not restructured The client struggles with feeling (McMullin, 2000). Furthermore, these “undeserving” of happiness as a result of her cognitions may impact feeling and behavior past experiences. Evelyn reports holding a (Beck, 1995). Based on her early life lot of “sadness, anger, and shame” in her experiences, Evelyn has held certain beliefs heart. She often engages in people-watching about herself and her social world that now and determines that other couples have remain active in her adult life. Some of perfect relationships. Evelyn compares Evelyn’s guiding principles include the idea herself to other women and feels that she that she is not good enough to love and that
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she is underserving of happiness. As she Emotion Log (see Greenberg, 2004; Leahy, learns that, “appraisal of reality can be 2015) can help clients develop an flawed by unrealistic patterns of thought” understanding about how they are feeling, (Beck, 1976, p. 234), she can adopt healthier why certain events and thoughts impact their perspectives. reactions, and whether their emotions are serving adaptive purposes. As a framework for identifying a rationale, it may be useful to implement the First, clients can complete an use of a Cost-Benefit Analysis (see Leahy, exercise in which they are tasked with 2003). In utilizing this tool, Evelyn can list Identifying Moods (Greenberger & Padesky, the possible advantages and disadvantages 1995). As they recall specific situations that for maintaining current thinking patterns and led to a significant emotional response they emotional patterns versus adopting new also become skilled at labeling common ones. For instance, to explore her thought of mood states (e.g., sadness, anger). By not being “good enough to love”, a possible completing this activity, clients learn the advantage of thinking this way may be connection among their experiences while avoiding rejection, yet a possible identifying associated factors that may disadvantage may be missing out on caring contribute to their current feeling. For relationships. To work with her emotion of instance, as clients explore who and what “shame”, a possible advantage of feeling was associated with the reaction they can this way would be that she holds herself to connect cause and effect events. In Evelyn’s high standards. Yet, a possible disadvantage case, she may determine that she becomes is that she does not learn the therapeutic sad when she sees happy families. This forces of self-forgiveness. As clients weigh reminds her of the childhood she wishes she the pros and cons of maintaining their would have experienced. current affective and thinking reactions, they can determine if new ways of being might The Emotion Log (Greenberg, 2002) be more plausible. can be further utilized to help clients explore the frequencies in which they are Assessment experiencing specific feelings. For further assessment of emotional content, clients will During the assessment phase, the learn to uncover maladaptive emotions and focus of intervention will be to help clients associated beliefs (Greenberg, 2004; Leahy, become aware of how they are experiencing 2015). Additionally, they will be able to emotion-based and cognitive information. connect unpleasant emotions with As a preliminary assessment of emotions, distressing thoughts (Curwen, Palmer, & clients can be instructed on how to identify Ruddell, 2000). Helping the client to survey their affective states. Various exercises can which emotions are serving adaptive be used to help clients increase purposes and which ones are unproductive is self-awareness by identifying what makes a primary goal. For instance, Evelyn them feel a certain way and how certain cues describes feeling “sadness” and “loneliness” in the environment impact healthy or which may be associated with her history of unhealthy reactions (Sarzotti, 2018). Two significant abandonments. The “shame” and exercises, Identifying Moods (see “anger” she feels however, may be used to Greenberger & Padesky, 1995) and The
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create distance in her current relationships as Treatment Planning and Intervention a way to avoid real intimacy. The aim for clients during the During the assessment of cognitive treatment planning phase will be to help content, clients will explore how their them deal with emotional and cognitive automatic thoughts and core beliefs are content in a more productive manner. In maintaining their condition. Clients will addressing emotion-based issues, possible learn to pay attention to the messages they goals may include helping clients to process are hearing during a distressing event unresolved past issues as well as to identify (McKay, Davis, & Fanning, 2007). current triggers (Jongsma, Peterson, & Additionally, they will learn how the rules McInnis, 2003). In unearthing this material they live by are influencing their responses clients will eventually learn to increase (Beck, 1995). The Thought Record (see acceptance of all emotions; regulate their Greenberger & Padesky, 1995) and emotions; and replace emotional control Laddering Technique (see McKay, Davis, & with re-engagement in life’s positive Fanning, 2007) are useful interventions that experiences (Gross, 2002; Leahy, 2015; can assist clients with uncovering thought Strosahl & Robinson, 2008). processes associated with particular occurrences. Clients first develop Whether self-imposed or caused by realizations about what they are thinking and others, all individuals experience some then are further able to analyze what these emotional wounds from the past which can perceptions mean to them. greatly impact their present level of functioning (Altman, 2016). When Therapists can instruct clients in the individuals connect with certain triggers use of a Thought Record (Greenberger & through “remembering, thinking, and Padesky, 1995) as a tool to record feelings ruminating” (Spradlin, 2003, p. 67) they and automatic thoughts that accompany an may be more inclined to have emotional upsetting situation. For instance, when experiences. As indicated by Knaus (2008), Evelyn has been inclined to people-watch emotions are often associated with people, other couples, her associated thought may events, images, or memories. In order to have been, “I’ll never have any true begin dealing with emotional content clients connections”. The associated emotions may will need to connect with underlying have been sadness or loneliness. To go a bit feelings and challenge themselves to deeper, therapists can encourage clients to purposefully resolve significant experiences. explore underlying fears or concerns that Imaging Techniques (see Ellis, 2001) can may be attached to these basic ideals. The primarily be used to help clients freely Laddering Technique (McKay, Davis, & express how events have instinctively Fanning, 2007) can be used to help clients impacted them. The Empty Chair Technique uncover their basic core beliefs. Evelyn can (see Leahy, 2003) can then be utilized as an be instructed to question the deeper meaning opportunity for clients to tackle their of each of her views. In doing so, she exposed feelings. determines the essence of not having “true connections” as a possible fear of “not being By implementing the use Imaging loveable”. Techniques (Ellis, 2001), clients have the opportunity to uncover previous content and
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current triggers. Through journal writing, reworked, and resolved” (Greenberg, clients are able to identify and express their Warwar, & Malcolm, 2008, p. 186). most painful emotions. Ellis (2001) further suggests that these clients reframe It will also be important for clients to adversities to view them in a healthier maintain awareness about particular fashion. For Evelyn, it may be useful to catalysts that prompt emotional states and in write about the anger, sadness, and turn learn to effectively welcome and loneliness she experienced by being manage their feelings. For instance, clients abandoned initially by her parents and then may be made aware that certain persons, later losing her grandparents. By reframing social pressures, or activities proceed their these experiences, Evelyn may discover that distressing experiences (Sobell & Sobell, her grandparents rescued her from her initial 2011). In order to properly handle these abandonment. Additionally, friends and a events, clients can benefit from honoring supportive boyfriend eventually offered love their reactions and reflecting on their during her time of loss. In this way, Evelyn responses from a compassionate viewpoint. is able to process these feelings while determining that she is worthy of love. Clients can be guided to explore how various situational factors may act as As clients continue to connect with elicitors in provoking affective states. They difficult emotions, they may feel trapped by can be taught to appreciate their emotions the memories of others hurting them in the and process them in adaptive ways. A useful past, and may feel helpless to reverse the starting point is for clients to complete effect. Further processing of emotional Identification of Triggers (see Riggenbach, content can be achieved through use of the 2013). In doing so, clients are made aware Empty Chair Technique (Leahy, 2003). of their responses to precipitating stimuli. Therapists can first instruct clients to As clients allow their emotional experiences identify significant others who have caused in, they increase their capacity to own their them some type of harm. Clients are then emotions and are empowered to change guided in holding an imaginary conversation them by focusing on their needs (Greenberg, with their violators. As clients engage in this Warwar, & Malcolm, 2008). Though exchange, they are able to honor their Self-Validation (see VanDijk, 2012) and emotions, while identifying unmet needs Self-Compassion (see Neff, 2003), clients (Diamond, Rochman, & Amir, 2010.). In the can learn to increase their understanding of case of Evelyn, therapy may involve intuitive human reactions. With this new visualizing a previous relationship in which awareness, they can refocus from she felt that her partner did not respect her. self-blaming to optimizing their ability to In this exercise, Evelyn would share with the promote self-care and meet their needs individual how the painful experience (Beaumont & Hollins Martin, 2015). affected her. The purpose of this technique is to engage Evelyn in dominating and By utilizing Identification of defeating the credibility of the partner who Triggers (Riggenbach, 2013) clients can demoralized her at an earlier time. The more reflect on situations, time periods, and insight that Evelyn develops allows her related themes that seem to be present when interpretations to be “re-examined, the problematic emotions occur. In this way, clients are able to be preventative in warding
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off more negative emotions. For Evelyn, this distress. Such skills include: engaging in may mean being aware of times where she enjoyable activities; connecting to tends to people-watch. Because emotional experiences that bring about opposite experiences will continue to come and go, it emotions; and participating in self-soothing is essential that clients learn to increase rituals. Further treatment for emotional acceptance of them. One way in which distress also entails teaching clients how to clients can embrace their emotions is deal with their emotions. Individuals can through the process of Self-Validation . As learn to avoid certain triggers, provoking clients learn to acknowledge, allow, and events, and people that prompt strong understand their feelings they are emotions. Additionally, they can learn to consequently able to suspend their alter how they are perceiving the experience judgments of them (Van Dijk, 2012). (Hofmann, 2013). Emotional regulation Through learning Self-Compassion (Neff, skills should also be developed for clients to 2003) clients can increase kindness towards access in times of turmoil. In a recent themselves, eliminate judgments, normalize publication, Linehan (2015) stated that their experiences as a part of being human, clients can alter their emotional experiences and respond to their thoughts and feelings by learning to review the facts of the (Neff, 2003). situation, utilize problem-solving skills, and engage in opposite actions. As offered in her Therapists can offer clients further earlier work, Linehan (1993) also support by teaching them to tolerate and encouraged clients to increase positive regulate their emotions. Various authors emotion by engaging in interpersonal have incorporated Linehan’s distress actions and by remembering positive tolerance and emotion regulation skills into experiences. their frameworks for teaching clients how to deal with affective content (Van Dijk, 2012; An ultimate goal for teaching clients Spradlin, 2003). In utilizing these to deal with emotional content is to help interventions, clients learn to cope with and them to re-engage with life. “By aligning address emotional material that arises. Final with purpose, everything in life becomes a emotion-based techniques focus on helping little shinier, more alive, more exciting, and clients to achieve more productive more meaningful” (Altman, 2016, p. 215). outcomes. “Therapeutic interventions not For clients dealing with difficult emotional only aim to alter people’s awareness of experiences, it may be useful to complete a emotions, but also to change their emotional Values Assessment . As Leahy (2003) experience (Burum & Goldfried, 2007, suggests, it is in reviewing values that p.410). Both Crisis Survival Strategies (see individuals can connect their emotional Spradlin, 2003) and Values Assessment experiences (e.g., sadness) with unfulfilled activities can be used to help clients cope needs (e.g., intimacy). As clients get in with emotional content and plan for touch with their values, they can connect pursuing ideals that support emotional with a sense of motivation and meaning in fulfillment. life (Strosahl & Robinson, 2008). For Evelyn, an exploration of her values may Spradlin (2003) identified several lead to new discoveries about how she can Crisis Survival Strategies in which clients take chances in relationships and regain trust are taught to develop resiliency in times of and security in others.
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that she will never have any true From a cognitive perspective, agreed connections, the therapist can help her upon goals may include the following: challenge “never” as well as discuss the fact helping clients to increase their abilities to that as a couple, she and her boyfriend have identify when they are experiencing been able to successfully overcome previous dysfunctional thoughts and inaccurate disagreements. perceptions; helping clients to explore more productive ways of thinking, and helping As clients begin to identify some of clients to form a new belief system (Beck, these basic thoughts it will be as crucially 1976; Curwen, Palmer, & Ruddell, 2000 & important to uncover where these ideas stem Beck, 1995). Because thoughts offer from. One useful technique is for clients to information regarding individuals’ complete a Historical Evidence Log perceptions about themselves, it will be (Riggenbach, 2013). Clients are able to important to address both ideas and explore and connect specific environmental underlying beliefs in therapy (Wilding, and family influences or events that have 2012). An area of exploration for clients will contributed to their different emotional be to consider the legitimacy of their way of states. As individuals connect these thinking. By first Examining the Evidence emotions to specific situations they can be (see Leahy, 2003), clients can become challenged further to explore: in what ways familiar with their typical ways of viewing these experiences impact how they view themselves in relation to the world. They are themselves, others, the world and their challenged to weigh whether their ideas are future (Wilding, 2012). In the case of logical and to further consider if they should Evelyn, she may connect feeling contempt abandon or adopt new ways of thinking. The with her history of promiscuous behaviors. Historical Evidence Log (see Riggenbach, Additionally, she may decide that she chose 2013) can be used to help uncover the partners who did not respect her. With origins of these thought processes. If clients further analysis, Evelyn’s underlying belief no longer find their appraisals beneficial, may be that sex equals love, men cannot be they can be assisted in using Visualization trusted, and important people will abandon techniques (see McKay, Davis, & Fanning, her. 2007) to “promote changes in attitudes, behavior, or physiological reactions” As core beliefs are revealed clients (Joseph, 2004, p. 13) by creating healthy will need to begin challenging these rigid narratives and self-talk. viewpoints. The Visualization exercise allows clients to revisit painful memories of Treatment planning involves the past from a compassionate viewpoint challenging clients to explore the logic of (McKay, Davis, & Fanning, 2007). By using their underlying beliefs by Examining the optimistic coping thoughts and healthy, Evidence (Leahy, 2003). Clients should logical perspectives, clients learn to speak to assess whether they are being too critical, if their former selves. Evelyn’s desire to erase others view them in the same way, and if memories of her former life suggests that their belief holds true all of the time (Burns, she may be avoiding coping with her 1989). After a fight with her boyfriend, negative experiences. In using the Evelyn may think.. “he’s going to leave me” visualization technique, Evelyn can validate or “I’ll always be alone”. If Evelyn believes her feelings and provide normalization that
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being overwhelmed by multiple stressors increasing positive emotions and utilizing can be a lot for anyone to bear without the coping strategies. For clients like Evelyn, proper social supports and coping skills. She struggling with distressing emotions does can also remind herself of the strength and not have to be a persistent condition. By perseverance that she possesses as addressing emotional and cognitive material evidenced by her current accomplishments. in treatment, clients can learn to address emotional pain, confront negative thinking A final goal in the cognitive model is patterns, create new belief systems and be for clients to continue pursuing healthy well on their way to developing a healthier, belief systems. In part, this transformation more functional world. can be achieved by intentionally adopting new language. Walker (2013) suggests that References clients develop communications based on positive associations (i.e., peace, resilience, Altman, D. (2016). Clearing emotional optimism) versus negative responses (i.e., clutter . Novato, California: New worry, self-doubt, pessimism). To further World Library. promote a healthy outlook, clients will also benefit from the instillment of hope. If Arvidsdotter, T., Marklund, B., Kylen, S., clients believe that things will turn out well Taft, C., & Ekman, I. (2015). and that they have the resourcefulness to Understanding persons with pursue their goals, they are likely to stay psychological distress in primary motivated to reach for imagined aspirations health care. Scandinavian Journal of (Snyder, Ilardi, Cheavens, Michael, Caring Science, 30, 687-694. Yamhure, & Sympson, 2000). Hence, instead of Evelyn believing that she will Beaumont, E., & Hollins Martin, C. J. never have true connections, she can (2015). A narrative review exploring willfully claim that there is love out there for the effectiveness of her and take measures to pursue meaningful compassion-focused therapy. connections. Counselling Psychology Review, 30, 21-32. An integrated emotion and cognitive-based treatment approach offers Beck, A. T. (1976). Cognitive therapy and clients the opportunity to address significant the emotional disorders . New York, areas of functioning. Clients who are dealing NY: Penguin Books. with difficult life experiences are often challenged by strong, persistent emotions as Beck, J. (1995). Cognitive therapy: Basics well as negative, ruminating thoughts and and beyond. New York, NY: The beliefs. Counselors who utilize Guilford Press. emotion/cognitive-based interventions can guide clients to develop deeper Braniecka, A., Trzebinska, E., Dowgiert, A., self-awareness about how affective content & Wytykowska, A. (2014). Mixed and thought processes impact their emotions and coping: The benefits of responses and evaluations. As clients learn secondary emotions. Plos One, 9, to express emotions and resolve painful 1-13. experiences, they can create a path to
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Brosh, T. (2013). Comment on the role of Dobson, K. S. (2012). Cognitive therapy. appraisal processes in the Washington, DC: American construction of emotion. Emotion Psychological Association. Review, 5, 369-373. Ehrenreich, J. T., Fairholme, C. P., Buzzella, Brosh, T., Pourtois, G., & Sander, D. (2010). B. A., Ellard, K. K., & Barlow, D. H. The perception and categorization of (2007). The role of emotion in emotional stimuli: A review. psychological therapy. Clinical Cognition and Emotion, 24, 377-400. Psychology Science and Practice, 14, 422-428. Brown, J. (2010). Psychotherapy integration: Systems theory and Ellis, A. (2001). Feeling better, getting self-psychology. Journal of Marital better, staying better: Profound and Family Therapy, 36, 472-485. self-help therapy for your emotions. Atascardero, CA: Impact Publishers. Burns, D. D. (1989). The feeling good handbook. New York, NY: Penguin Frijda, N. H. (1988). The laws of emotion. Books. American Psychologist, 43, 349-358.
Burum, A., Goldfried, M. (2007). The Gladding, S. T. (2009). Counseling, a centrality of emotion to comprehensive profession (7th ed.). psychological change. Clinical New York, NY: Merrill Publishing. Psychology Science and Practice, 14, 407-413. Greenberg, L. S. (2002). Emotion-focused therapy: Coaching clients to work Chhatwal, J., & Lane, R. (2016). A through their feelings. Washington, cognitive-developmental model of DC: American Psychological emotional awareness and its Association. application to the practice of psychotherapy. Psychodynamic Greenberg, L. S. (2004). Emotion-focused Psychiatry, 44, 305-326. therapy. Clinical Psychology and Psychotherapy, 11, 3-16. Curwen, B., Palmer, S., & Ruddell, P. (2000). Brief cognitive behavior Greenberg, L. S. (2008). Emotion and therapy. Thousand Oaks, CA: Sage cognition in psychotherapy: The Publications. transforming power of affect. Canadian Psychology, 49, 49-59. Diamond, G. M., Rochman, D., & Amir, O. (2010). Arousing primary vulnerable Greenberg, L. S. (2011). Emotion-focused emotions in the context of therapy. Washington, DC: American unresolved anger: Speaking about Psychological Association. versus speaking to. Journal of Counseling Psychology, 57, 402-420. Greenberg, L. S., Warwar, S. H., & Malcolm, W. M. (2008). Differential effects of emotion-focused therapy
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51 Mental Health Literacy of OCD and OCPD The Journal of Counseling Research and Practice (JCRP) Volume 4, No. 1 in a Rural Area (52-67) Patricia McIntosh Northwestern University Lauren Paulson Allegheny College
Abstract This study examined the mental health literacy of Obsessive Compulsive Disorder (OCD) and Obsessive Compulsive Personality Disorder (OCPD) among the rural public. 89 volunteer participants (ages 19-86) completed this study using vignette methodology and a questionnaire. Results supported the hypothesis that mental health literacy would be low, specifically for OCPD. In addition, the majority of participants viewed the disorders similarly. The findings suggest that the current understanding of OCD may not reflect the disorders true diagnostic criteria and that participants viewed both disorders similarly in regards to treatment and stigma. Implications and further recommendations are discussed.
Mental health literacy, first coined by Blythe, 2012; Jorm, 2012), recognition and Jorm, Korten, Jacomb, Christensen, the ability to name mental health disorders is Rodgers, and Pollitt (1997), is defined as the generally low (Jorm, 2000; Jorm, “knowledge and beliefs specifically about Christensen, & Griffiths, 2006; Jorm, et al., mental disorders which aid their recognition, 2006; Jorm, et al., 1997). management, or prevention” (p. 182). For mental health literacy to be high, one must Recognition of mental health be able to identify particular disorders and disorders is important in order for patients to know how and when to seek mental health communicate with their physician or resources (Jorm, et. al., 1997). Knowing this clinician in a manner that facilitates information will allow one to evaluate when detection and ideally early intervention and to whom they should go to for help, (Jorm, 2000). It is critical for the general which could lead to proper symptom public to be literate in all aspects of mental management. Mental health literacy is health in order to encourage proper crucial for the recognition and early help-seeking behaviors. Lack of knowledge intervention of mental health disorders. The can make it difficult for someone to receive lifetime prevalence of any mental health treatment for a number of reasons. People disorder is 46.4%, meaning that close to half may put off treatment because they do not of the American population will be know the available options, they have diagnosed with a disorder in their lifetime negative views about treatment, or have a (Kessler, Berglund, Demler, Jin, fear of being stigmatized (Jorm, 2000). Merikangas, & Walters, 2005). It is likely These obstacles might be compounded in that almost every person has had or will rural areas where there are higher rates of have contact with someone with a mental illiteracy, access to mental health services is disorder. However, with the exception of limited, and fear of stigma may be depression and schizophrenia (Furnham & heightened (Wagenfield, 2003). In fact, the Committee on Rural Health, developed by
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the American Psychological Association, explains symptoms that directly reflect was created in recognition of the unique mental health disorders (Jorm, 2000). It is concerns and behavioral health needs of important for the rural public to be literate in rural communities and residents. There are symptomatology to ensure their ability to a large number of rural residents who lack properly explain to their general practitioner health insurance or are unable to afford what they are experiencing. services (Gale & Lambert, 2006). This stressor can be a barrier to treatment and Jorm et al. (1997) analyzed the may put a person at greater risk for mental mental health literacy of depression and health concerns (Gale & Deprez, 2003) or schizophrenia in a nationally representative delay help-seeking (Gale & Lambert, 2006; sample of over 2000 participants using Schank, Helbok, Haldeman, & Gallardo, vignette methodology. The majority of 2010). Additional stressors that those living participants were able to recognize a mental in rural areas experience are poor road disorder, but few were able to correctly label conditions, bad weather, lack of the disorder in each vignette. In a later transportation, and long travel distances to study, 75.6% of participants in Alberta were receive mental health services (Barbopoulos able to correctly label depression in a case & Clark, 2003; Gale & Deprez, 2003; vignette (Wang et al., 2007), compared to Sawyer, Gale, & Lambert, 2006; Smith, the 67.6% in the aforementioned study. This 2003). This can inhibit opportunities for may indicate improvement in mental health adequate mental health care in rural areas literacy over time. In another study compared to urban counterparts. examining the mental health literacy of anxiety disorders, 64% of the participants Mental Health Literacy were able to recognize OCD, with lower recognition rates for panic disorder, general With the importance of mental health anxiety disorder, and separation anxiety literacy being clear, it is worth noting that disorder (Furnham & Lousley, 2013) recognition of some mental disorders is not high among the general public (Jorm et al., Rural residents also lack awareness 2006) or among rural residents (Gale & of mental health problems and treatment Lambert, 2006). The rate of mental options (Sawyer et al., 2006). Specifically, disorders in rural areas is comparable to Kermode, Bowen, Arole, Joag, and Jorm urban areas; however, suicide rates (Mohatt, (2009) conducted a vignette survey with Adams, Bradley, & Morris, 2006), alcohol participants in rural India, assessing the abuse and chronic illness (Wagenfeld, 2003) participants’ mental health literacy of have been found to be higher in rural areas. depression and psychosis. The majority of To add to this risk, mental health care in participants recognized that the individuals rural areas is lacking, and most cases are in the vignettes were experiencing a mental treated by local primary care physicians health problem but lacked the knowledge (Campbell, Kearns, & Patchin, 2006; and awareness surrounding treatment and Harowski, Turner, LeVine, Schank, & how to respond (Kermode et al., 2009). Leichter, 2006; Wagenfeld, 2003). Rural Therefore, the authors concluded that there residents have been found to express mental was a need to improve mental health literacy health concerns somatically (Keefe, Hastrup, in this rural area (Kermode et al., 2009). & Thomas, 2005) and detection of mental disorders can be higher when the patient
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Rural areas are known to have scarce 2014). However, recent work has indicated resources, high rates of poverty, less access that the portrayal of OCD in a television to employment, and limited insurance series has the potential to reduce both the coverage (Gale & Lambert, 2006; self and other-stigma associated with mental Wagenfeld, 2003); therefore, it is important disorders and may improve attitudes toward to assess the mental health literacy in those help-seeking behaviors (Hoffner & Cohen, areas to address possible barriers to 2015; Hoffner, & Cohen, 2017). help-seeking behaviors. Low mental health literacy is related to a lack of help-seeking Stigma is a barrier to seeking behaviors (Munro, Freeman, & Law, 2004) treatment in all communities. However, as a and participants in rural Australia were result of the small town culture of a rural significantly less likely to seek mental health area, residents might experience shame, treatment than those in a metropolitan area embarrassment, and social stigma when they (Caldwell, Jorm, & Dear, 2004). In seek mental health treatment (Sawyer, Gale, addition, because of the often tight-knit & Lambert, 2006; Smith, 2003; Starr, communities found in rural areas, people Campbell, & Herrick, 2002). In addition, it often turn to family and friends for support has been suggested that rural areas and (Weigel & Baker, 2002). Most published geographical locations are considered research on mental health literacy in rural distinct cultures and culture influences areas has been conducted outside of the mental health literacy (Furnham, Raja, & United States; therefore, it is important to Khan, 2008; Furnham & Wong, 2007) and explore if these findings can be replicated in treatment decisions (Gale & Lambert, 2006). a rural area in the United States. However, not all rural and geographical locations are the same and it is imperative to Further, if people do not have access not overgeneralize from one area to the next to proper information regarding mental (Sawyer et al., 2006). health, they might turn to the media or Internet. The link between media exposure Obsessive Compulsive Disorder and and negative attitudes towards mental Obsessive Compulsive Personality disorders has been well established Disorder (Granello & Pauley, 2000). People with According to the American mental health disorders are usually Psychiatric Association’s (APA) Diagnostic represented in a negative and often and Statistical Manual (DSM-5; 2013) inaccurate manner which can contribute to Obsessive Compulsive Disorder (OCD) is stigmatization (Stout, Villegas, & Jennings, defined by symptoms of recurrent 2004). Specifically, the general public is obsessions and/or compulsions that are time commonly exposed to terminology such as consuming or cause significant distress in “OCD” or “Obsessive Compulsive” through one’s social, occupational, or other area of mainstream media (Furnham & Wincelaus, life functions. OCD is found to have a 2012). The media’s representation of lifetime prevalence between 2-3.5% Obsessive Compulsive Disorder (OCD) has (DSM-5; 2013) and approximately 2-3 been found to conflict with the true million people in the United States currently diagnostic criteria, often portraying OCD as have the disorder (Ruscio, Stein, Chiu, & humorous (Hoffner & Cohen, 2017) or as a Kessler, 2010). result of a personality trait (Fennell & Boyd,
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The cause of OCD is unknown; morality, and inability to delegate tasks however, possible risk factors include (APA, 2013). People with personality genetics, environment risk factors, and disorders are more likely to have abnormal brain structure and functioning impairments in various life domains (National Institute of Mental Health, 2016). including relationships, work, and OCD often goes unrecognized or untreated, unemployment (Morrison, 2014), often meet despite the availability of efficacious the criteria for another personality disorder, treatment (Coles, Heimberg, & Weiss, and have high levels of comorbidity (APA, 2013), with estimates of 57.3% of 2013). OCPD is found to be one of the most individuals not receiving treatment (Kohn, common personality disorders with a Saxena, Levav, & Saraceno, 2004). A study prevalence rate around 2.5-7.9% and is evaluating the stigma surrounding OCD found in twice as many men as women found that the median length people delayed (APA, 2013). Similar to OCD, there is no seeking treatment after onset was 47 known specific cause, but scholars have months, with 53.8% being aware of the fact established various etiological factors that they had a problem (Belloch, Del Valle, may contribute to this personality disorder. Morillo, Carrió, & Cabedo, 2009). The Genetics may play a role, as well as cultural most common reason for delayed treatment and environmental factors, including being was the fear associated with the stigma raised by overprotective and controlling surrounding the mental disorder (Belloch, et parents (Diedrich & Voderholzer, 2015). al, 2009). OCPD has not been studied to the Those with OCD who seek treatment extent that OCD has been in regard to are likely to be treated with medication, stigma; however, research indicates that psychotherapy, or both. Cognitive those with personality disorders experience behavioral therapy, a form of psychotherapy, more stigma than those with severe mental has been found to be as effective as disorders (Catthoor, Feenstra, Hutsebaut, medication in some patients (National Schrijvers, & Sabbe, 2015). Another factor Institute of Mental Health, 2016). However, related to stigma that might be a barrier to OCD is chronic and is thought to be one of help-seeking is the misconception that the most debilitating mental disorders personality disorders are not treatable (Rachman, 1997). (Sheehan, Nieweglowski, & Corrigan, 2016). Finally, some promising treatments The personality disorder, Obsessive for this disorder include psychotherapy, Compulsive Personality Disorder (OCPD) is medication, and relaxation techniques “a pervasive pattern of preoccupation with (Barber, Morse, Krakauer, Chittams, & orderliness, perfectionism, and mental and Crits-Christoph, 1997; Diaferia, Bianchi, interpersonal control, at the expense of Bianchi, Cavedini, Erzegovesi, & Bellodi, flexibility, openness, and efficiency, 1997). beginning by early adulthood and present in a variety of contexts” (APA, 2013, p. 678). Knowledge and Beliefs of OCD and OCPD also is indicated by four (or more) of OCPD the following, inflexibility, stinginess, perfectionism, over attention to detail, OCD has been found to be comorbid excessive devotion to work, inability to with OCD (Mancebo, Eisen, Grant, & discard worn or useless items, hyper Rasmussen, 2005) and some genetic models
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find links between OCD and OCPD and confusion between OCD and OCPD, OCPD other personality features (Bartz & is often portrayed in the media as OCD Hollander, 2006). However, the relationship (Furnham, Abajian, & McClelland, 2011). between OCD and OCPD has been subject Therefore, the mental health literacy of the of debate. One core difference between the two disorders needs to be evaluated to bring disorders is that OCD traits are ego-dystonic awareness to each disorder and to minimize and OCPD traits are ego-syntonic (Taylor, the stereotypes that can lead to popular Asmundson, & Jang, 2011). This means that misunderstandings. Few studies have the obsessions and compulsions may be investigated the awareness and knowledge conflicting with the goals of someone with of OCD and OCPD in the general OCD. In contrast, in OCPD, behavior tends population and no studies were found to be aligned with one’s goals and often investigating the mental health literacy of provides satisfaction (Taylor et al., 2011). OCD or OCPD in a rural area. Therefore, due to the nature of the personality disorders, it may be useful for Current Study family members, friends, and co-workers to The purpose of this study was to recognize the symptoms of OCPD. evaluate the awareness and knowledge of Coles and Coleman (2010) assessed OCD and OCPD in a public sample of rural the knowledge of and beliefs about OCD in US citizens using a vignette methodology. a sample of US undergraduates and found The information from this study adds to the that 90.9% of participants indicated that the limited knowledge in published research in behaviors in the OCD vignette to be the US. More research in this area can lead problematic; however, only one third were to heightened awareness of mental health able to correctly identify the disorder. In literacy and guide programs to implement in another study, researchers found very low rural areas. As noted previously, rural rates of recognition of OCPD compared to communities have been identified as being a OCD, depression, and schizophrenia distinct culture with unique concerns. We (Koutoufa & Furnham, 2014). This can proposed the following research questions: become problematic to individuals who need Do participants believe that the behaviors in treatment. Furnham, Abajian, and each vignette are a cause for concern? Do McClelland (2011) conducted a study in the participants believe that the behaviors in UK to determine the mental health literacy each vignette reflect a mental disorder? Are of several personality disorders. The results participants able to recognize and correctly indicated that only 41% were able to label the mental health disorder portrayed in identify OCPD as a personality disorder each vignette? If not, how do they describe (compared to 86% correctly identifying what is happening in each vignette? Do the Borderline Personality Disorder) and only participants recommend the person in the 25% could label the disorder correctly vignette seek help and to whom do the (Furnham, et al, 2011). In a more recent participants recommend that the person in study on the personality disorders, each vignette seek help? Do the participants participants generally were able to indicate a recommend that the person in each vignette mental disorder was present, but failed to avoid talking about their symptoms with correctly label the disorder (Furnham & other people? Wincesluas, 2012). To exacerbate the
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Even though previous research on gender neutral naming to avoid a gender the general populations’ knowledge and effect and both were maintained at 180-185 awareness of OCD and OCPD has varied, words. The vignettes were reviewed again we expected that recognition and and approved by the two mental health identification of mental disorders in the professionals and piloted by 5 undergraduate general population of rural residents would psychology students. The questionnaire was be low. We hypothesized that participants compiled from two previous studies looking would label the behavior in each vignette as at mental health literacy (Coles et al., 2013; a cause for concern and that participants Furnham & Lousley, 2013) and consisted of would incorrectly label the OCPD vignette seven questions that were meant to assess as OCD. each participant's mental health literacy.
Method Procedure
Participants The Institutional Review Board at the college where the study took place Eighty nine participants (70% approved the study protocol. One female) were recruited from a rural area in researcher contacted local businesses, the Northeast region of the United States. organizations, and the school system in a Participants were asked demographic small rural area (approximate population questions regarding gender, age, years living 5,860) and a single contact person from each in a rural area, and whether they have facility was chosen to handle the recruiting. experience with mental health treatment or Participants were asked to take the study in disorders, either with themselves, loved a large conference room in the community ones, or at work. The age of participants setting. Participants were able to have ranged from 19-86, with a mean age of 59 adequate space to ensure privacy and only a (SD=13.19) years old. The mean years limited amount of people were in the room participants have been living in a rural area at one time. After giving informed consent, was 43 years with 46% reporting previous the two vignettes were administered in a mental health experiences. counterbalanced manner to each participant. After reading the first vignette, each Materials participant was presented with the This study used vignette questionnaire. When they completed the first methodology, a common method for questionnaire, they were given the next examining mental health literacy (Farrer, vignette, followed by the questionnaire. Leach, Griffiths, Christensen, & Jorm, 2008; Demographic questions were asked after the Jorm et al., 2006) along with a two questionnaires were complete. questionnaire. The OCD vignette was Confidentiality was maintained by giving adapted from a previous study (Pirutinsky, each participant a unique identification Rosmarin, & Pargament, 2011) and the number and the completed questionnaires OCPD vignette was adapted from a teaching were returned in a sealed folder. The study book (Morrison, 2014). Each vignette was took 5-10 minutes to complete and once reviewed by two doctoral-level licensed completed the participants were debriefed. mental health practitioners and educators. There was no compensation for Each vignette was modified to include participating in this study.
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Results Mental Health Literacy: Management and Prevention Analysis and Coding of Data Table 2 presents the frequency of To address the research questions of responses to the open-ended format question the study, answers for each question were to who the individual in each vignette coded depending on the question (for should go to for help. Participants example, “yes” or “no” or on a Likert-type recommended psychologist/counselor the scale). The questions: “How would you most for each vignette. name and describe what is happening to the person in this vignette” and “Who should In regards to if the participants they go to for help?” were answered in an recommended counseling or medication for open-ended format. The qualitative data each vignette, the highest percentage of was analyzed independently by the two participants (62%) recommended counseling researchers using the guidelines outlined for in the OCPD vignette and 53% responded conducting a thematic analysis by Braun and that both counseling and medication would Clarke (2006). The researchers then be beneficial in the OCD vignette. To compared notes and discussed the answer the question whether the person in differences in coding until agreement was each vignette should seek professional help, found. participants rated each vignette on a seven-point Likert-type scale of 1 (not at all) Mental Health Literacy: Knowledge and to 7 (highly recommend) that the person Recognition seek professional help. Using a paired-samples t -test, a statistically The majority of participants significant difference in mean scores was responded that the behaviors in both the found between the OCD vignette (M=6.01, OCD and OCPD vignette were a cause for SD=1.37) and the OCPD vignette (M=4.05, concern (98% and 71% for OCD and OCPD, SD=1.76), t (86) =-10.25, p =0.001 respectively). However, the majority agreed (two-tailed). Meaning that the participants that the OCD vignette portrayed an actual recommended that the individual in the mental disorder (80%) and the OCPD OCD vignette seek professional help more vignette did not (31%). In addition, 63 % of than the individual in OCPD vignette. The the participants “correctly” labeled the OCD mean difference was 1.97 with a 95% vignette as OCD and 0% “correctly” labeled confidence interval [2.35, 1.58]. The the OCPD vignette as OCPD. Cohen’s d (1.24) indicated a large effect Table 1 demonstrates the results of a size. thematic analysis of the variety of responses Finally, participants were asked given by the participants when they were whether the person in each vignette should asked to describe what was happening in avoid talking about their symptoms with both the OCD and OCPD vignettes. For other people on a seven-point Likert-type both the vignettes, OCD was the most scale of 1 (not at all) to 7 (highly common response. recommend). This question was meant to evaluate stigma by asking if the participant thought the person in the vignette should avoid talking about their symptoms with
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other people. The assumption was that if it vignette reflected a mental disorder. This was recommended that the individual avoid might indicate that there is support that talking about symptoms, this would be individuals with certain personality because of the stigma associated with mental disorders, like OCPD, have been successful disorders (Coles et al., 2013). A in life, especially in the workplace. Hence, paired-samples t -test revealed a statistically participants might view OCPD as more of a significant difference in mean scores for the trait (perfectionism) versus a mental OCD vignette (M=2.67, SD=2.01) compared disorder (Koutoufa & Furnham, 2014). to the OCPD vignette (M=2.29, SD=1.70), t (86) =-2.59, p =0.01 (two-tailed). Even though the majority of the Participants recommended that the participants agreed that the behaviors in both individual in the OCD vignette discuss their vignettes demonstrated a cause for concern, symptoms with someone else more than the none were able to correctly label OCPD. person in the OCPD vignette. The mean These findings are in line with previous difference was 0.38 with a 95% confidence research (Furnham et al., 2011; Furnham & interval [0.67, 0.08]. The Cohen’s d (.02) Lousley, 2013; Koutoufa & Furnham, 2014). indicated a small effect size. For the OCPD vignette, 38.2% of participants responded that the behavior Discussion represented OCD. These findings support the fact that people are not knowledgeable The purpose of this study was to of the distinctions between OCD and OCPD assess the mental health literacy of OCD and despite high recognition of OCD (63%). OCPD in a rural area. To our knowledge Another important finding is that none of the this is the first study to examine the mental participants were able to label the disorder health literacy of OCD and OCPD in the of OCPD. This suggests that there is a general public in a rural area in the United misunderstanding of the diagnostic criteria States. We expected that recognition of for OCD, as well as a lack of mental health OCD and especially OCPD would be low literacy of OCPD. This might indicate that and that participants would find the people find the personality traits seen in behaviors in each vignette to be a cause for individuals with OCPD to be the same as concern. We also predicted that participants OCD. would incorrectly label the OCPD vignette as OCD. Furthermore, results indicate that OCD was the most common response given Results suggest that the majority of for both vignettes and, similar to previous participants found the behaviors in both research (Koutoufa & Furnham, 2014), the vignettes to be a cause for concern (98% and next common label for OCPD was 71% for OCD and OCPD, respectively). “perfectionist”. This demonstrates that This is promising as both vignettes participants understand one of the primary presented behaviors that were maladaptive symptoms of OCPD, but do not know the for the individual in one or more areas of specific label or may not see the behaviors their life. However, both vignettes as representing a mental disorder. One represented a mental disorder. Although explanation is that the general public may 80% of the participants identified a mental use the same terminology when someone is disorder in the OCD vignette, only 31% of the participants indicated that the OCPD
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“obsessive” whether it is perfectionist physician than their urban counterparts tendencies or compulsive hand washing. (Gale & Lambert, 2006). This finding highlights the importance of mental health The finding that participants would literacy for all people. recommend that the person in the OCD vignette seek professional help more than Finally, the last question was meant the individual in OCPD vignette is not to evaluate stigma. The assumption was that surprising, considering that participants if it was recommended that the individual were able to correctly identify OCD in the avoid talking about symptoms, this would be OCD vignette. This demonstrates higher due to the stigma associated with mental levels of recognition for treatment of OCD. disorders (Coles et al., 2013). Generally, the In regards to whom the person should seek participants recommended that the help, the findings suggest that people view individual in the OCD vignette discuss their outcomes of both disorders similarly. For symptoms with someone else more than the example, 40 (51%) of the participants person in the OCPD vignette. However, the recommended seeing a responses clustered around lower levels of psychologist/counselor in the OCPD stigma for both vignettes. This suggests vignette and 38 (46%) for the OCD vignette. higher knowledge or acceptance in areas of This finding indicates that OCD and OCPD management and stigma, another promising should be treated in the same manner. finding. Similar to previous findings (Wang, et al., 2007), participants may not actually know Limitations and Future Research what is the best treatment for each disorder. This study examined the MHL of a In addition, the findings might not represent sample of the population from one rural poor mental health literacy, as area; therefore, these findings might not be psychotherapy is a form of treatment for generalizable to all rural areas. Although both disorders. However, evidenced-based significant results were found, as well as a practices for OCD includes medication clear indication that mental health literacy (Fineberg, Brown, Reghunandanan, & was not high among the sample in regard to Pampaloni, 2012) and the findings of the OCPD, this study did have some limitations current study are in line with previous and needs replicated. One is the mean age of research that the general public holds the participants was 59 years old. The most negative views or lacks knowledge of the common age among participants was 62 effectiveness of medications for certain years old, which is generalizable to the mental disorders (Jorm, et al., 1997). population of this small area of the United Another finding that 16 (21%) of the States. Previous research indicates mixed participants did not recommend professional findings regarding mental health literacy and help in the OCPD vignette indicates that age (Coles et al., 2013; Fischer & Goldney, participants did not indicate that treatment 2003; Furnham et al., 2011; Koutoufa & was not necessary for a mental disorder. Furnham, 2014). In addition, there is a trend One promising finding of the study that is where younger populations are moving out supported by previous research is that of rural areas to urban areas (Campbell, people living in rural areas may to turn Kearns, & Patchin, 2006; Wagenfeld, 2003) toward informal networks (friends and family, clergy) or their primary care
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and this could have an influence on the currently seen in mental health literacy findings from this sample. research. There is very little research regarding the mental health literacy of OCD Another limitation is that the study and OCPD, especially in a rural area in the did not investigate why participants found US. This information can lead to the the behaviors to reflect a mental disorder implementation of programs within schools, and why they labeled the disorders as they community groups, and PCP’s to bring did. In addition, participants could be asked correct information to the public and aid in directly questions about stigma. A possible the recognition and early treatment of solution to this would be to administer a mental health disorders. In addition, OCD follow up questionnaire or interview causes distress to family members (Vikas, participants to explain why they chose to Avasthi, & Sharan, 2011); therefore, mental answer in the manner that they did. health literacy programs might be useful for Another avenue for further study would be family members or work colleagues. In to ask participants if they would actually addition, mental health literacy programs suggest to a person with symptoms that they may promote understanding and should seek professional treatment (Coles et help-seeking behaviors for a personality al., 2013). disorder, such as OCPD. Research suggests that educational programs informing Another way to further this study residents of the effectiveness of treatment would be to ask participants about income, would be useful (Fox, Blank, Rovnyack, & socioeconomic status, levels of education, Barnett, 2001) and national mental literacy and where they receive their information initiatives in Austria have demonstrated regarding mental health. Knowing this promise (Jorm, Christensen, & Griffiths, information could lead to a better 2006). understanding as to what factors play a role in the mental health literacy of the rural A final suggestion would be to public. Finally, the results surrounding who address how mental disorders are the individual in each vignette should go to represented, or misrepresented, in popular for treatment could be clarified in future culture and everyday language. Comments research as it is not clear if the participants such as, “that is so OCD of me” may add to understood the roles of a counselor, the confusion and perpetuation of myths psychologist, psychiatrist, and primary care held by the general public. Therefore, specialist in the treatment of OCD and educational programs that present accurate OCPD. information and replace myths about mental disorders are warranted. If individuals are Implications and Conclusions made aware of the fact that they are This study revealed that the mental confusing the two disorders, they may take a health literacy of OCPD among the sample closer look at the way other mental disorders of the rural public is limited and that the are represented as well. By bringing participants viewed both disorders similarly awareness to this issue it may be possible to in regard to labeling and treatment. This lack positively change the trajectory of those of understanding and knowledge can have a living and struggling with mental disorders detrimental influence on help-seeking and their family, friends, and coworkers. behaviors. These findings fill a gap
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Table 1. Ranking and Label of Name of What is Happening to the Person in Each Vignette
OCD Vignette N OCPD Vignette N OCD 54 OCD 30 Anxiety (Worried/fear) 13 Perfectionist 19 No answer 13 No answer 12 Cautious/concerned/sensitive 4 Personality 4 Paranoid 3 Neat (control) freak 4 Mentally unstable 2 Anxiety 3 Perfectionist 1 Careful (diligent/methodical) 3 Religious (need prayer) 1 Crazy (unstable/troubled) 3 Workaholic/strong work ethic 2 Asperger’s/autism 2 Controlling 2 Other 4
Table 2. Responses to Who the Person in Each Vignette Should Go To For Professional Help?
OCD (n=82) OCPD (n=77) Psychologist/Counselor 38 (46%) 40 (52%) Psychiatrist 12 (15%) 2 (3%) Psychiatrist and Psychologist 16 (20%) 7 (9%) General Practitioner 9 (11%) 9 (11%) Parents/Family 0 (0%) 2 (3%) Friends 2 (3%) 1 (1%) N/A 5 (6%) 16 (21%)
Note: Total ns vary due to missing data
67 Predictors of Supervisee Self-Disclosure The Journal of Counseling Research and Practice (JCRP) Volume 4, No. 1 within the Supervisory Relationship (68-85) Chelsey Hess-Holden The University of Southern Mississippi
Abstract The present study investigates how the supervisory working alliance, supervisor’s style, and the supervisee’s level of self-efficacy are able to predict the supervisee’s level of self-disclosure to the supervisor. Forty-two supervisees completed the Working Alliance Inventory – Trainee (Bahrick, 1990), Trainee Disclosure Scale (Walker, Ladany, & Pate-Carolan, 2007), Supervisory Style Inventory (Friedlander & Ward, 1984), and Counseling Activity Self-Efficacy Scales (Lent, Hill, & Hoffman, 2003). The supervisee’s level of self-disclosure was statistically significantly predicted by the supervisory working alliance, supervisor’s style, and the supervisee’s counseling self-efficacy. Counseling self-efficacy was found to be a statistically significant predictor of supervisee self-disclosure.
Predictors of Supervisee Disclosure supervisee chooses to disclose this The supervisory relationship plays a information, low levels of self-disclosure in vital role in the training and accountability supervision has great potential to interfere of mental health professionals (Armoutliev, with supervisor efficiency, supervisee 2013; Bernard & Goodyear, 2014; Guest & learning, and client outcomes (Farber, 2006; Dooley, 1999; Knox, 2015; Ladany, Mori, & Knox, 2015; Krieder, 2014; Ladany et al., Mehr, 2013). This process is vital to the 1996; Sweeney & Creaner, 2014). success of both counselors-in-training who are moving from classroom training into The supervisor and the supervisee clinical experiences in practicum and must both accept the responsibility to create internship settings, as well as recent open and honest dialogue that will facilitate graduates as they transition into full-time clinician growth and client success professional practice and pursue licensure. (Sweeney & Creaner, 2014); however, much The level of self-disclosure of the supervisee of this burden falls to the supervisor is an important and influential component of (Bernard & Goodyear, 2014). More research the success of the supervisory process within is needed to continue investigating how the counseling professions (Farber, 2006; supervisors may be able to facilitate the Ladany, Hill, Corbett, & Nutt, 1996; Ladany disclosure process for the highest quality of et al., 2013; Knox, 2015). Self-disclosure in service offered to clients and the efficacious supervision is defined as “supervisors or training of clinicians (Gibson, 2012). To supervisees revealing information about date, clinical supervisory literature has themselves, or revealing their reactions or indicated that the supervisory working responses to others as they arise in alliance, supervisor’s style of supervision, supervision” (Knox, 2015, p. 152). Because and the supervisee’s level of counselor supervisors are generally privy to their self-efficacy may be factors influential of supervisee’s inner experiences only if the supervisee self-disclosure to the supervisor
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(Ladany et al., 1996; Ladany et al., 2013; information not disclosed in supervision Mehr, Ladany, & Caskie, 2010; Sweeney & pertained to negative reactions to the Creaner, 2014; Yourman & Farber, 1996). supervisor, personal issues unrelated to Although there has been research into each supervision, mistakes in clinical work, of the three constructs, they have not yet concerns of negative evaluation, and general been explored together. The purpose of this observations about clients. Yourman and research is to explore whether these three Farber (1996) also found that supervisees constructs together can predict the level of admitted to the routine exclusion of supervisee disclosure. information about what they perceive to be clinical error when disclosing to their Supervisee Self-Disclosure supervisors. Some trainees reported that their nondisclosures were related to the Limits to supervisee self-disclosure process of what was happening in have been documented as a common supervision or in their clinical work rather occurrence in supervision (Farber, 2006; than the content (Hess et al., 2008; Jakob, Ladany et al., 1996; Ladany et al., 2013; Week, Höfling, Richtberg, & Bohus, 2014; Hess, 2008; Mehr et al., 2010). Reichelt et Reichelt et al., 2009). Mehr et al. (2010) al. (2009) found that 74% of their trainee found that undisclosed information was sample reported specific information that more about supervision itself than about they chose not to disclose to their clinical concerns, with the most common supervisors. Mehr et al. (2010) found that self-disclosures withheld related to negative 84.3% of trainees reporting on a single perceptions of the supervisor and supervision session stated that they chose supervision, as well as the supervisee’s not to disclose certain information to their concerns in his or her personal life. supervisor. Ladany et al. (1996) concluded Additionally, 14% of supervisees in the that over 97% of supervisees reported study reported nondisclosures surrounding having information they choose not to concerns about professional inadequacy disclose to their supervisors. Hess et al. (Mehr et al., 2010). (2008) found within their sample of doctoral trainees that all withheld information from Reasons for not disclosing. their supervisors. Because consistently high Although individual factors may vary, numbers of supervisees have been found not several common themes have emerged from to disclose information to their supervisors, research investigating the reasoning and it is important to understand what justification used by supervisees limiting information is not being disclosed, what self-disclosure to their supervisors. Ladany methods of limiting self-disclosure are most et al. (1996) found the most common commonly used, and what purpose this reasons for nondisclosure were perceived limited self-disclosure may be serving for irrelevance of the information, information the supervisee. being too personal to reveal, negative feelings about the information, poor alliance Information not disclosed . Several with supervisor, deferring to the supervisor, general categories of information and wanting to be perceived positively by supervisees do not self-disclose to the supervisor. Reichelt et al. (2009) found supervisors have been identified. Ladany et that supervisees reported nondisclosures for al. (1996) found that the most common many reasons including fear of hurting the
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supervisor, fear of criticism, and feeling of negative repercussions (Hess et al., 2008; professionally insecure. Hess et al. (2008) Ladany et al., 1996; Reichelt et al., 2009; found that a prominent reason for Yourman & Faber, 1996), the relationship nondisclosure was fear of negative dynamics that may contribute to this evaluation. This finding was consistent with supervisory insecurity should be previous research from Walsh et al. (2002), acknowledged. which found that 57% of counseling trainee participants reported their level of worry Supervision dynamics. Supervision over having made a mistake or of being represents a power differential that can judged for their actions played an present difficulties for both the supervisor to instrumental role in their readiness to be successful and for the supervisee to disclose to their supervisors. Mehr et al. receive appropriate training (Bernard & (2010) found that the most common reasons Goodyear, 2014; Reichelt et al., 2009; for nondisclosure to one’s supervisor Yourman & Farber, 1996). Supervisees are included impression management (defined particularly exposed for potential as “concerns about being perceived in a vulnerability in their training because of negative manner” [p. 109]), deferring to the being asked to honestly disclose their supervisor, and perceiving that there would clinical work and their personal issues be negative consequences if information impacting this work to their supervisor. At were to be self-disclosed. the same time, the trainee is being evaluated for competence and efficiency, which adds Methods of not disclosing . The another level of stress that supervisors must majority of the time, supervisees do not consider as systemically influential of intentionally change or misrepresent the supervisee self-disclosure levels (Alonso & information reported to their supervisor; Rutan, 1988; Holloway, 1995; Ladany & previous research has suggested that the Friedlander, 1995). Supervisees generally most common way that supervisees avoid are considerably less experienced in clinical self-disclosure is through passivity (Ladany practice than their supervisors are. et al., 1996; Yourman & Faber, 1996). That Accordingly, trainees may not always know is, rather than volunteering disclosure, the what issues are appropriate to bring up in student may simply choose not to bring up discussion with their supervisor and which information the supervisor did not directly ones they are responsible to take care of address. This passivity indicates the without their supervisor’s guidance. It can tendency for supervisees to use be difficult for supervisees to determine the nondisclosure as an impression management information and concerns that are most technique rather than to intentionally influential and salient to the supervision deceive their supervisors (Ladany et al., process (Ladany & Friendlander, 1995; 1996). Because of this passivity, it is Mehr et al., 2010). Although self-disclosure imperative for supervisors to be intentional is often part of a counseling relationship and about attending to their supervisees and the supervisory relationship (Gibson, 2012), being willing to ask questions about things it is the role of the supervisor to teach left unsaid (Hess et al., 2008). Considering trainees about self-disclosure and model that much information appears to be appropriate levels of self-disclosure (Knight, passively withheld because of impression 2012, 2014). Clinical supervision is a vital management, evaluative concerns, and fear part of how clinicians learn what it looks
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like to appropriately engage in therapeutic intentionally develop this bond may create a use of self in their work with clients and supervisory environment that discourages how to create a safe, collaborative supervisee disclosure (Gunn & Pistole, environment in which clients can grow 2012). Notably, a stronger alliance and (Armoutliev, 2013; Bernard & Goodyear, emotional bond is related to lower levels of 2014; Knox, 2015). ambiguity and conflict experienced by the trainee (Ladany & Friedlander, 1995). Along Supervisory Working Alliance with role ambiguity, supervisee feelings of powerlessness and lack of control within the The supervisory working alliance is supervisory relationship may contribute to the collaborative relationship between the less self-disclosure. Supervisors who are supervisor willing to have a discussion with their and supervisee that helps to establish mutual supervisees about supervisee feelings of understanding of the goals of the control of the supervision process may supervisory process, the tasks and role of facilitate the supervisory working alliance, each party, and the emotional bond between empower the trainee to voice his or her the supervisor and supervisee (Bordin, concerns, and encourage trainee 1983). The supervisory working alliance has self-disclosure within the supervisory been found to be directly influential of the relationship (Gnilka et al., 2012). supervisee’s level of disclosure (Bernard & Goodyear, 2014; Ladany et al., 2013; Mehr, Supervisor Style Ladany, & Caskie, 2015). Walsh et al. (2002) found the quality of the bond created Supervisory style is the method and manner between the supervisor and the supervisee in which a supervisor approaches the was the most salient factor influencing the supervisory relationship, how training is supervisee’s willingness to disclose sensitive facilitated, and how the supervisor interacts information to their supervisors. Ladany and with his or her supervisee (Friedlander & Friedlander (1995) suggested that the Ward, 1984; Holloway & Wolleat, 1981). working alliance could be just as important Supervisor style is an aspect of supervision within the supervisory relationship as it is that may be important when considering the within the therapeutic relationship. More therapeutic alliance and supervisee’s level of recently, several studies from Siembor disclosure (Armoutliev, 2013; Ladany et al., (2012), Gunn and Pistole (2012), Hutman 2013). In a study investigating what (2015), and Mehr et al. (2015) each found constitutes effective supervision, Ladany et that a stronger supervisory working alliance al. (2013) found that effective supervisors was related to higher willingness of the utilized a supervisory style with a balance of supervisee to self-disclose within the attractive interactions, task-oriented supervisory relationship. structure, and feedback to the supervisor that was both interpersonally warm and Supervisors should facilitate a bond challenging. This balance was recognized as that contributes to their supervisees being encouraging and empowering for comfortable with the necessity of discussing supervisees at all developmental levels and personal issues as they pertain to the facilitative of higher levels of self-disclosure supervisee’s clinical work (Gnilka, Chang, by supervisees. Interpersonal approaches to & Dew, 2012). Supervisors who do not supervision that encourage trainees to
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process their experiences as both a therapist their style of supervision to best suit what and a supervisee may help to facilitate more they perceive would best match their complete disclosure from the supervisee supervisee’s training needs (Holloway & (Friedlander, 2012, 2015; Hutman, 2015). Wolleat, 1981). Additionally, the task-oriented style of supervision has been found to be predictive Counselor Self-Efficacy of levels of supervisee self-efficacy (Fernando & Hulse-Killacky, 2005), which – Self-efficacy is an effective way to as discussed later – may hold implications monitor the advancement of novice for supervisee disclosure. Ladany, Marotta, clinicians and is relevant to both clinical and Muse-Burke (2001) found that work and to the supervisory relationship generally, supervisees prefer for their (Kozina et al., 2010). According to Mehr, supervisors to demonstrate moderate levels Ladany, & Caskie (2015), little research is of all three supervisory styles, thus engaging available to provide information about the in a flexible balance of style throughout the relationship between counseling supervisory process. self-efficacy and supervisee self-disclosure. Mehr and associates (2015) did not find a Supervisors who utilize a supervision direct significant relationship between style that allows for well-timed supervisor counseling self-efficacy and level of self-disclosure may facilitate greater self-disclosure in supervision; however, they supervisee disclosure. Alonso and Rutan did find that supervisees who showed higher (1988) suggested that the extent to which counseling self-efficacy experienced less supervisors choose to expose their own anxiety associated with their supervisory work, including strengths and weaknesses, is relationship. Their results indicate that the extent to which their supervisees will supervisors may be able to use the open up within supervision. Higher levels of supervision hour to facilitate activities that meaningful, appropriate supervisor will promote the growth of supervisee self-disclosure have been found to be related self-efficacy in order to help decrease to a more efficacious supervisory style supervisee anxiety, indirectly fostering the (Ladany, Walker, & Melincoff, 2001; supervisee self-disclosure (Mehr et al., Ladany & Walker, 2003). Supervisors who 2015). are able to self-disclose about their own supervision experiences can reasonably Also, training is a significant factor expect for this disclosure to foster the in the growth of counselor self-efficacy. supervisory working alliance and thus help Kozina et al. (2010) suggested that an supervisees to be more comfortable with increase in counseling self-efficacy can disclosure (Krieder, 2014; Ladany & occur quickly while in training. Their Walker, 2003). Supervisor self-disclosure research found that the counseling and supervisor style are most likely to have self-efficacy of master’s-level trainees an indirect impact on supervision outcomes increased significantly over an eight-week through their contribution to the supervisory measurement period while in a supervisory working alliance and supervisee relationship. Therefore, measuring and self-disclosure (Knox et al., 2008; Knox et processing the levels of counselor al., 2011). Supervisors may be able to self-efficacy of their supervisees may be an enhance supervision outcomes by adapting effective means for supervisors to facilitate
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the growth of their trainees, which in turn supervisory working alliance, and the may have implications for supervisee supervisor’s style of supervision predict the self-disclosure (Kozina et al., 2010; Motley, supervisee’s level of self-disclosure in the Reese, & Campos, 2014). With little supervisory relationship? Additionally, this empirical evidence informing this study seeks to answer a second question: relationship, more research is needed to how well does supervisee counseling better understand how self-efficacy may self-efficacy predict the supervisee’s level of influence level of self-disclosure for self-disclosure? supervisees (Mehr et al., 2015). Method Current Study Participants Supervision is a complex process with many influential variables, and supervisee Forty-two students and graduates self-disclosure is important to the currently in a supervisory relationship supervisory process for supervisee clinical completed the study questionnaire. Although training (Armoutliev, 2013; Ladany et al., 46 total participants responded, four did not 2013; Knox, 2015). It is up to the provide complete data and were not included supervisor to create a supervisory in the analysis. Of the 42 included environment that is conducive to supervisee participants, 19 (45%) were trained or being self-disclosure (Bernard & Goodyear, 2014; trained in a Clinical Mental Health Reichelt et al., 2009; Skjerve et al., 2009; Counseling Master’s Program, 2 (4.5%) in a Sweeney & Creaner, 2014). The supervisory Marriage, Couple, and Family Counseling working alliance and supervisor style are Master’s Program, 7 (17%) in a Marriage noted as influential components of and Family Therapy Master’s Program, 7 supervisee self-disclosure (Gnilka et al., (17%) in a Counselor Education and 2012; Gunn & Pistole, 2012; Hutman, 2015; Supervision Doctoral Program, and 5 (12%) Krieder, 2014; Ladany et al., 2013; Mehr et in a Marriage and Family Therapy Doctoral al., 2015); however, more research is needed Program. Two (4.5%) were trained in other to understand the relationship between the types of clinical programs. Nine (22%) of counselor self-efficacy of the supervisee and participants identified as male, and 32 (76%) levels of self-disclosure in supervision identified as female. The ages of participants (Mehr et al., 2015). To date, no research has ranged from 23 to 53, with the median age at investigated these three factors in unison as 28 and the average age at 30.5. Twenty-eight potentially systemic influences of supervisee (67%) participants identified as Caucasian, self-disclosure levels. The present study is a eight (19%) as African American, and six further investigation of the level of (14%) as Other. The median amount of time self-disclosure of supervisees in their spent in the supervisory relationship supervision relationship and how this level reported upon in the study was 12 months, of self-disclosure may be predicted by the with the average amount of time being 14 supervisory working alliance, the months. Fourteen (33%) reported on their supervisor’s style, and the supervisee’s level current supervisor, and 28 (67%) reported on of counseling self-efficacy. The research a previous supervisor. question guiding this study is: how well do the supervisee’s counseling self-efficacy, the
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Procedure this supervisor, what supervision sessions were like, how open they were with this This research was completed as part supervisor, how well their supervisor’s style of a doctoral research project in an advanced fit their needs, how close they felt to this supervision course at a university in the supervisor, and how well they felt equipped southeastern region of the United States. to work with clients after being supervised. Participants were recruited from The Participants were then asked to answer the Counsel for Accreditation of Counseling & questions according to their beliefs about Related Educational Programs (CACREP) and behaviors in this supervisory accredited and The Commission on relationship. Participants anonymously Accreditation for Marriage and Family completed the entire questionnaire online. Therapy Education (COAMFTE) accredited Master’s and Doctoral programs primarily in Instruments the southeastern region of the United States. One region of the country was selected in Demographic questions were used to order to streamline and expedite the research obtain information about the participants’ project. Program directors or department age, gender, ethnic background, length of chairs at 30 universities within the states of supervision with supervisor reported on in Alabama, Mississippi, Florida, and Georgia this questionnaire, when this supervisory were sent emails asking them to forward relationship ended, participants’ total invitations to participate in an online amount of supervision and total amount of questionnaire to their students enrolled in therapy experience, total number of the accredited clinical programs at their supervisors the participants have worked university. Invitations were sent out on the under, and what type of training program American Counseling Association’s participants attended or were attending. COUNSGRAD Listserv for graduate students. Invitations were also posted on the Working Alliance Inventory – American Association for Family Therapy’s Trainee Version (WAI-T). The WAI-T research forum discussion board and (Bahrick, 1990) is a 36-item self-report Member Research Projects Directory. instrument designed to assess the supervisee’s perspective of three factors of Participants were asked to think the working alliance within the supervisory about their most influential supervisory relationship, including goals, tasks, and relationship, or if they had only been in one bond. Each of these three factors represent a supervisory relationship, to report upon that subscale of 12 items. Participants rank their supervisory relationship. The most answers on a 7-point Likert scale (1 = Never influential relationship was specified in an to 7 = Always ). Scores are calculated by effort to provide information about a adding the totals of all three subscales supervisory relationship that held together, each ranging from 12 to 84, with significance to the supervisee. Participants higher scales indicating a more satisfactory were asked to complete all questions within working alliance. Bahrick (1990) reported the study according to their experiences with alpha coefficients for each scale as .92 for this supervisor and to keep in mind several the goals subscale, .93 for the tasks subscale, aspects of supervision, including: positive and .91 for the bond subscale. and negative thoughts and feelings toward
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Trainee Disclosure Scale (TDS). inventory test-retest reliability at .92 The TDS (Walker, Ladany, & Pate-Carolan, (Friedlander and Ward, 1984). 2007) is a 13-item self-report questionnaire designed to measure the level of supervisee Counseling Activity Self-Efficacy willingness to disclose to their supervisor. Scales (CASES). The CASES (Lent, Hill, & This instrument was created based on Hoffman, 2003) is a 36 item self-report Ladany et al.’s (1996) qualitative study questionnaire designed to assess clinically where supervisees indicated topics or issues relevant facets of counseling self-efficacy. that were often not disclosed within The CASES contains three domains, supervision. Thirteen general categories including (1) executing basic helping skills were created through this study, and with [15 items], (2) organizing and managing a this data, the TDS was created. Participants counseling session [10 items], and (3) are asked how likely they would be to handling difficult clinical situations and discuss an issue (e.g., clinical mistakes, client-presenting issues [16 items]. These personal issues, countertransference) with items are rated on a Likert-type scale their supervisor and directed to rate their ranging from 0 (no confidence at all) to 10 answer on a Likert-type scale ranging from (complete confidence), with participants 1 (not at all likely) to 5 (very likely). Scores rating their own efficacy to complete certain on all questions are added together with total tasks or manage certain situations. Higher scores ranging from 13 to 65; higher scores scores reflect higher counseling are indicative of higher willingness to self-efficacy. The CASES shows a total disclose in supervision. Internal consistency scale alpha coefficient of .97, with internal for this scale has been reported at .89 reliability ratings ranging from .79 to .94 (Walker et al., 2007), .85 (Mehr et al., 2010), (Lent et al., 2003). and .80 (Ladany, et al., 2013). Statistical Analysis Supervisory Style Inventory (SSI). The SSI (Friedlander & Ward, 1984) is a 33 A multiple regression was used to item self-report scale used for supervisors to determine how well the combination of the rate their own supervisory style or for supervisory working alliance, the supervisees to rate what they believe is the supervisor’s style of supervision, and the best reflection of their supervisor’s style. supervisee’s counseling self-efficacy was The SSI subscales include Attractiveness able to predict the supervisee’s level of (seven items with scores ranging from 0 to self-disclosure. Linear regression analysis 49), Interpersonally Sensitive (eight items was used to determine how each with scores ranging from 0 to 56), and independent variable – supervisory working Task-Oriented (10 items with scores ranging alliance, supervisor style of supervision, from 0 to 70). Higher scores reflect stronger supervisee counseling self-efficacy – was identification with the style; items are rated able to independently predict the on a Likert-type scale ranging from 1 (Not supervisee’s level of self-disclosure. The very) to 7 (Very). Internal consistency alpha level for this study was set at .05. estimates for the subscales ranged from .84 to .93; test-retest reliability of the SSI subscales range from .78 to .94, with a total
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Results statistically significant; working alliance was the only predictor variable that was The participants’ descriptive found to be a statistically significant statistics for each of the instruments are predictor of trainee level of self-disclosure. shown in Table 1. To answer the question of how well the supervisee’s counseling To answer the question of how well self-efficacy, the supervisory working the supervisee’s level of counseling alliance, and the supervisor’s style of self-efficacy predicts the level of supervision predict the supervisee’s level of self-disclosure to the supervisor, a simple self-disclosure in the supervisory linear regression was used. Again, one relationship, a multiple linear regression participant was determined to be highly analysis was used. In the initial assumptions influential in the data set according to check, the Interpersonally Sensitive subscale Cook’s distance (Cook & Weisberg, 1982) of supervisor’s style showed concerns of and was excluded from analysis. All other multicollinearity (VIF = 6.17). Due to this assumptions were met for the data set. This violation, which may have been influenced model was found to be statistically by the small sample size, this subscale of significant, F (1, 39) = 17.05, p < .001, supervisor’s style was excluded from the explaining 30.4% of the variance in the data multiple regression analysis. Therefore, only set (see Table 3). This is a medium effect working alliance total score, counselor size according to Cohen (1988). Counseling self-efficacy total score, and the two self-efficacy contributed .121 to the model supervisor styles of Attractiveness and and was found to be statistically significant Task-Oriented were included. One (p < .001). participant was determined to be highly influential in the data set according to Discussion Cook’s distance (Cook & Weisberg, 1982) and was excluded from the data set, leaving The purpose of this study was to 41 participants. investigate how the level of self-disclosure in supervisory relationships may be All other assumptions (i.e., linearity, predicted by the supervisee’s perception of normality, etc.) were met for the data set. the supervisory working alliance, the The model was found to be statistically supervisor’s style, and the supervisee’s level significant, F (2, 38) = 7.716, p < .001, of counseling self-efficacy. Additionally, explaining 45.5% of the variance in the data this study was designed to provide set (see Table 3). This is a large effect size additional information about whether the according to Cohen (1988). In terms of supervisee’s counseling self-efficacy would unique contribution, working alliance be able to predict the supervisee’s level of contributed .128 to the model and was found self-disclosure. Results of these analysis to be statistically significant (p = .043). revealed several statistically significant Counseling self-efficacy contributed .032, associations that hold important implications the Attractiveness subscale of supervisor’s for clinical supervisors and counselor style contributed .257, and the educators. Task-Oriented subscale of supervisor’s style contributed -.062 to the model. However, none of these unique contributions were
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Multiple Regression Discussion finding adds a significant contribution to an area of supervision research that has little A multiple regression analysis found empirical validation; previous research has that working alliance, counselor not been able to confirm or deny a self-efficacy, and the Attractiveness and relationship between self-efficacy and Task-Oriented subscales of supervisor’s self-disclosure (Mehr et al., 2015). This style were able to statistically significantly finding suggests a more direct relationship predict level of supervisee self-disclosure between these two constructs than what has and showed a large effect size. This model been previously documented. Mehr et al. accounted for over 45% of the variance in (2015) found that counseling self-efficacy supervisee’s level of self-disclosure. The may indirectly influence self-disclosure significant influence of working alliance on through helping to moderate the anxiety of level of supervisee self-disclosure has been the supervisee. However, the current results well documented in previous studies. indicate that increased levels of counseling Working alliance has been found to be self-efficacy is predictive of higher levels of influential of what level of comfort and self-disclosure to one’s supervisor. freedom the supervisee felt to disclose Therefore, supervisees who feel more information to their supervisor (Webb, 1998) confident and secure in their counseling and willingness to share sensitive abilities and counseling identity may feel information with the supervisor (Walsh et more comfortable disclosing difficult topics al., 2002; Hutman, 2015). A strong working such as clinical errors or ethical dilemmas alliance also serves to minimize the negative with their supervisors. Additionally, it may effects of power differentials (Gnilka et al., be less threatening for a supervisee with 2012), insecure attachment styles of higher self-efficacy to bring up personal supervisees (Gunn & Pistole, 2012), and concerns related to supervision, including minimize role conflict and role ambiguity in personal reactions to clients and the supervision (Ladany & Friedlander, 1995). supervisor and concerns about performance Synonymous with previous research, this and evaluation. model suggests that supervisees who perceive they have a strong and emotionally Finally, in conjunction with working safe collaborative relationship with their alliance and self-efficacy, the supervisee’s supervisors will be more likely to share perception of the supervisor’s style does observations about the client, clinical play a role in supervisee’s level of mistakes, evaluation concerns, ethical self-disclosure. Within this model, higher dilemmas, and personal reactions related to levels of supervisor’s perceived the counseling process with their supervisor. Attractiveness were found to predict higher levels of supervisee self-disclosure. However, working alliance is not the Additionally, when supervisor’s style was only factor influencing self-disclosure. In rated higher in Task-Oriented style, conjunction with working alliance, the self-disclosure level was predicted to supervisee’s level of self-efficacy pertaining decrease. Unfortunately, the Interpersonally to his or her ability to execute tasks, handle Sensitive subscale was not included in the clinical issues, and manage sessions with analysis; this subscale has been found to be clients was found to be a significant a statistically significant contributor to predictor of level of self-disclosure. This supervisee’s level of satisfaction in the
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supervisory relationship (Fernando & (Mehr et al., 2010). Results of this model Hulse-Kilacky, 2005) and may have been a indicate that skill-building and significant contributor to level of confidence-building should be intentionally self-disclosure. considered by the supervisor as methods to increase level of self-disclosure. Also, Overall, the current model suggests supervisors should consider how their that a more highly rated supervisory responses to supervisee self-disclosures may working alliance, supervisors perceived to build or lessen supervisee self-efficacy, and be higher in levels of Attractiveness style thus systemically influence how supervisees and lower in levels of Task-Oriented style, will disclose in future situations. This and higher supervisee self-efficacy work finding holds additional implications for together to create a supervisory environment upholding the core professional values of the that encourages greater levels of supervisee counseling profession, including self-disclosure to the supervisor. Results multicultural competence. Supervisors indicate that supervisors should intentionally should consider that self-efficacy levels may work to build supervisee’s self-efficacy influence supervisee’s ability to embrace a surrounding their counseling and session clinical approach that honors diversity and management skills in a supervisory supports the worth and dignity of all people environment that provides support, (American Counseling Association, 2015). collaboration, emotional safety, and warmth Counselor-in-training self-efficacy has been in order to maximize supervisee willingness found to have a positive relationship with to disclose information important to the multicultural counseling effectiveness supervision process. The current model (Barden & Greene, 2015). In addition to supports the idea that supervisors have the creating a more open and honest supervisory challenging and important task of relationship, attention paid to growing the considering how multiple factors – working supervisee’s counseling self-efficacy may alliance, supervisor’s style, and supervisee also serve to grow multicultural awareness self-efficacy – interact with one another to and competence and thus uphold this help create a balanced environment that foundational value of the counseling supervisees will perceive as a safe and profession. appropriate place in which to disclose information related to their clinical Limitations and Delimitations experiences. Several limitations and delimitations Simple Regression Discussion to this study should be considered. First, the multicollinearity issue present in the first Counseling self-efficacy was found multiple regression prohibited this research to be a statistically significant predictor of from including the Interpersonally Sensitive level of supervisee self-disclosure in a supervisor’s style in the analysis. Second, simple linear regression and explained 30% this study includes a small sample that was of the variance in the data set. This drawn largely from the Southeastern region individual variable analysis was included to of the United States – therefore, it is provide needed information about this area appropriate to use caution when generalizing of supervisee self-disclosure that has these findings to the larger population of received very little empirical attention clinical trainees. Third, participants also
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were asked to report upon the supervisory Summary relationship that was most influential for them, and other supervisory relationships Self-disclosure of the supervisee is could have been quite different experiences. not a new topic; however, there is still much Fourth, this research included only the to learn about its influence on the self-report of the supervisee and did not supervisory relationship and clinical include the supervisor’s perspective or practice. This research study was able to experiences, creating the possibility that contribute another piece to the puzzle of supervisee biases and judgements about understanding how self-disclosure is their supervisor clouded the accuracy of the influenced by other factors within the information provided. Additionally, supervisory relationship. Results of this participants represented a wide range of study indicate that the supervisory working lengths of experience as a clinician, which alliance, the supervisor’s style, and the may have had an influenced the length of supervisee’s level of counseling self-efficacy time since being engaged in the supervisory were able to predict the supervisee’s level of relationship and the accuracy of the self-disclosure. Specifically, a statistically information reported. significant regression model suggests that a more highly rated supervisory working Future Research alliance, supervisors perceived to be higher in levels of Attractiveness style and lower in Future researchers interested in levels of Task-Oriented style, and higher supervisee self-disclosure may consider supervisee self-efficacy work together to including a larger sample of supervisees and create a supervisory environment that also targeting a specific level of training encourages greater levels of supervisee (e.g., post-Master’s professionals working self-disclosure to the supervisor. toward licensure). Additionally, research Additionally, a statistically significant studies that include both the supervisee and simple regression found that counseling the supervisor’s perspective of self-efficacy was a significant predictor of nondisclosure within the relationship would level of supervisee self-disclosure, which is provide additional insight into the factors a new contribution to the literature on influential of self-disclosure. Given that supervisee self-disclosure. These results counseling self-efficacy was found to be an indicate that supervisors should continue to influential predictor of level of recognize the influence of the supervisory self-disclosure, a longitudinal investigation working alliance and their supervisory style of the relationship between self-efficacy and on their supervisee’s willingness to disclose self-disclosure from students’ first clinical information within supervision and should practicum until attaining licensure may also take into account the role that provide a helpful developmental lens encouraging and building supervisee through which supervisors can better self-efficacy can have on facilitating a conceptualize supervisee self-disclosure. supervisory environment that encourages Supervisors and counselor educators will be self-disclosure. able to better meet the needs of supervisees and their clients as supervisee self-disclosure and nondisclosure is better conceptualized and understood.
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Bernard, J. M., & Goodyear, R. K. (2014). Friedlander, M. L., & Ward, L. G. (1984). Fundamentals of clinical supervision Development and validation of the (5th Ed.). Boston; Pearson Education Supervisory Styles Inventory. Inc. Journal of Counseling Psychology, 31 , 541-557. Bordin, E. S. (1983). A working alliance based model of supervision. The Gibson, M. (2012). Opening up: Therapist self-disclosure in theory, research,
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Research, 18 , 543-559. doi: disclose to their supervisors. Journal 10.1080/10503300801982781 of Counseling Psychology, 43 (1), 10-24. Knox, S., Edwards, L. M., Hess, S. A., & Hill, C. E. (2011). Supervisor Ladany, N., Marotta, S., & Muse-Burke, J. self-disclosure: Supervisee’s L. (2001). Counselor experience experiences and perspectives. related to complexity of case Psychotherapy, 48 , 336-341. doi: conceptualization and supervision 10.1037a0022067 preference. Counselor Education and Supervision, 40, 203-219. Kozina, K., Grabovaria, N., de Stefano, J., & Drapeau, M. (2010). Measuring Ladany, N., Mori, Y., & Mehr, K. (2013). changes in counselor self-efficacy: Effective and ineffective supervision. Further validation and implications The Counseling Psychologist, 41, for training and supervision. The 28-47. doi: Clinical Supervisor, 29 , 117-127. http://dx.doi.org/10.1177/001100001 doi: 10.1080/07325223.2010.517483 2442648
Krieder, H. D. (2014). Administrative and Ladany, N., Walker, J. A., & Melincoff, D. clinical supervision: The impact of S. (2001). Supervisory style: Its dual roles on supervisee disclosure in relation to the supervisory working counseling supervision. The Clinical alliance and supervisor Supervisor, 33, 256-268. doi: self-disclosure. Counselor Education 10.1080/07325223.2014.992292 and Supervision, 40 , 263-275. doi: 10.1002/j.1556-6978.2001.tb01259x Ladany, N., & Friedlander, M. L. (1995). The relationship between the Lent, R. W., Hill, C. E., & Hoffman, M. A. supervisory working alliance and (2003). Development and validation trainees’ experience of role conflict of the Counselor Activity and role ambiguity. Counselor Self-Efficacy Scales. Journal of Education and Supervision, 34, Counseling Psychology, 50(1), 220-231. doi: 97-108. 10.1002/j.1556-6978.1995.tb00244.x Mehr, K. E., Ladany, N., & Caskie, G. I. L. Ladany, N., & Walker, J. A. (2003). (2010). Trainee nondisclosure in Supervisor self-disclosure: Balancing supervision: What are they not the uncontrollable narcissist with the telling you? Counselling and indomitable altruist. Journal of Psychotherapy Research, 10 (2), Clinical Psychology, 59 , 611-621. 103-113. doi: doi: 10.1002/jclp.10164 10.1080/14733141003712301
Ladany, N., Hill, C. E., Corbett, M. M., & Mehr, K. E., Ladany, N., & Caskie, G. I. L. Nutt, E. A. (1996). Nature, extent, (2015). Factors influencing trainee and importance of what willingness to disclose in psychotherapy trainees do not
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supervision. Training and Education supervision while in training. British in Professional Psychology, 9 , 44-51. Journal of Guidance and Counselling, 42, 211-224. Motley, V., Reese, M. K., & Campos, P. (2014). Evaluating corrective Walker, J. A., Ladany, N., & Pate-Carolan, feedback self-efficacy changes L. M. (2007). Gender-related events among counselor educators and site in psychotherapy supervision: supervisors. Counselor Education Female trainee perspectives. and Supervision, 53 , 34-46. doi: Counselling and Psychotherapy 10.1002/j.1556-6978.2014.00047.x Research, 7 , 12-18.
Siembor, M. J. (2012). The relationship of Walsh, B. B., Gillespie, C. K., Greer, J. M., role conflict to supervisee & Eanes, B. E. (2002). Influence of nondisclosure: Is it mediated by the dyadic mutuality on counselor supervisory working alliance? trainee willingness to self-disclose (unpublished doctoral dissertation). clinical mistakes to supervisors. The University at Albany, State Clinical Supervisor, 21 , 83-98. University of New York, Albany, NY Webb, A. S. (1998). How honest do Skjerve, J., Nielsen, G. H., Jacobsen, C. H., counsellors dare to be in the Gullestad, S. E., Hansen, B. R., supervisory relationship? An Reichelt, S., . . . Torgersen, A. M. exploratory study. British Journal of (2009). Nondisclosure in Guidance & Counselling, 26, psychotherapy group supervision: 509-524. The supervisor perspective. Nordic Psychology, 61 (4), 28-48. Yourman, D. B., & Farber, B. A. (1996). doi:10.1027/1901-2276.61.4.28 Nondisclosure and distortion in psychotherapy supervision. Sweeney, J., & Creaner, M. (2014). What’s Psychotherapy, 33 , 567-575. not being said? Recollections of nondisclosures in clinical
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Table 1
Descriptive Statistics
Variable M SD Min. Max.
Counseling Activity Self-Efficacy Scale 329.5 33.64 265 401
Supervisor’s Style
Attractiveness subscale 41.52 8.46 13 49
Interpersonally Sensitive subscale 47.33 10.39 12 56
Task-Oriented subscale 52.86 7.82 30 65
Trainee Disclosure Scale 52.86 7.82 30 65
Working Alliance Inventory - Trainee 189.21 26.96 98 226 Notes. N = 42. M = mean. SD = standard deviation. Min = minimum reported score. Max = maximum reported score. Totals of all subscales shown for Counseling Activity Self-Efficacy Scale and Working Alliance Inventory -Trainee.
Table 2
Correlations
CASES ATT IS TO TDS WAIT
CASES 1
ATT .201 1
IS .268 .882** 1
TO .334* .615** .719** 1
TDS .330* .602** .579** .370* 1
WAIT .293 .801** .789** .605** .642** 1 Notes. N= 42; CASES = Counseling Activity Self-Efficacy Scale. ATT = Attractiveness subscale of Supervisor’s Style Inventory. IS = Interpersonally Sensitive scale of Supervisor’s Style Inventory. TO = Task-Oriented subscale of Supervisor’s Style Inventory. TDS = Trainee Disclosure Scale. WAIT = Working Alliance Inventory -Trainee version. * = correlation is significant at the .05 level (2-tailed). ** = correlation is significant at the .01 level (2-tailed).
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Table 3
Beta Coefficients and Regression Analyses
Standardized β Multiple Regression Coefficients Analysis
Variable β p R R2 F Sig.
Multiple Linear Regression .647 .455 7.716 .000
Counseling Activity Self-Efficacy Scale .032 .288
Working Alliance Inventory .128 .043
SSI - Attractiveness .257 .195
SSI - Task-Oriented -.062 .521
Simple Linear Regression .552 .304 17.05 .000
Counseling Activity Self-Efficacy Scale .121 .000 Note . N = 41
85 The Perceived Stressors and Coping Skills The Journal of Counseling Research and Practice (JCRP) Volume 4, No. 1 of Graduate Students: A Development and (86-101) Validation Study
Alyse M.Anekstein Lehman College at City University of New York Pamela C. Wells Georgia Southern University Richard E. Cleveland Georgia Southern University Nicole R. Hill Shippensburg University Alexandria Kerwin The University of Mississippi Holly H. Wagner Southeast Missouri State University
Abstract This article outlines the development and validation of two instruments evaluating common stressors and coping skills as perceived by graduate counseling students. The review of the literature illustrated a need for the development of measures to provide empirical support in regard to the stressors and coping skills of graduate students in counseling programs. Exploratory factor analyses were applied to the two respective scales to evaluate the constructs. Recommendations and limitations are offered to further the development of psychometric properties within the scales.
Many, if not most, people will demand for change” (p. 132). Seyle and his experience stress on frequent basis. Stress lifelong work on stress, as chronicled in can take various forms for people including Szabo, Tache, and Somogyi (2012), was a physical and emotional symptoms. leader in the medical field. He also However, there is not a singular definition of identified and studied the differences stress, according to the American Institute of between eustress and distress as well as the Stress. The American Institute of Stress specific and non-specific effects of stress. maintains that a singular definition is not feasible due to the different ways people When stress is helpful and internalize stress. An incident that one motivating, it is known as eustress , and person may find stressful may not be when stress is overwhelming and stressful for another, and vice versa (The debilitating, it is known as distress . Stress is American Institute of Stress, n. d.). often viewed in a negative way, when it can actually be helpful and motivating for many Stress, as noted by the American people in different ways. Often, when stress Institute of Stress, is subjective. Seyle intensifies for a person, they become more (1936) attempted to define stress as, “the increasingly productive. However, there is non-specific response of the body to any also a stress “tipping point” of sorts. The
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stress “tipping point” is different for each Gladding, 2014), and the CACREP person, and the amount of time, as well as standards (2016) encourage the the combination of stressors, all are implementation of wellness and self-care at important factors to consider (Seyle, 1974). all levels of counselor training and With stress, comes the need for preparation. While all graduate education coping. Folkman (2010) described coping can be viewed as stressful (Lovitts, 2001; skills as cognitive and behavioral strategies Lovitts & Nelson, 2000), doctoral students one uses to deal with the demands of in particular are at significant risk of not stressors. Further, coping strategies can be completing their degree program; doctoral categorized as either problem solving, which attrition rates of all doctoral students across is aimed at minimizing the stressor, or disciplines is approximately 50% (Lovitts, emotion focused, aimed at decreasing one’s 2001; Lovitts & Nelson, 2000). Application distress related to the stressor (Folkman, to, and enrollment in master degree 2010; Folkman, Lazarus, Dunkel-Schetter, programs across all disciplines is at an DeLongis, & Gmen, 1986; Taylor, 1998). all-time high (Allum & Okahana, 2015), and yet there are many students who may not The determination to engage in complete their program of study (Allum & problem solving or emotional strategies Okahana, 2015; Lovitts, 2000; Lovitts & seem to be influenced by both personality Nelson, 2001). Certainly, stress plays a role type of the individual as well as the kind of in the success or lack thereof for graduate stressful incident (Folkman, 2010; Taylor, students and their completion or attrition 1998). Additionally, these coping strategies (Cooke, et al., 1995), as well as the use of are further examined as an active strategy or coping strategies. an avoidant strategy. Active strategies are typically seen as more helpful for stress Graduate students also appear to mitigation, while avoidant strategies have more responsibilities than increase psychological risk (Folkman, undergraduate students, which may also 2010). increase their levels of stress (Grady, La Touche, Oslawski-Lopez, Powers, & Graduate Students and Stress Simacek, 2014). Graduate students are often juggling work responsibilities, class Graduate students face a significant demands, and family and personal life tasks amount of stress, both inside and outside of (Grady et al., 2014; Hughes & Kleist, 2005). the classroom (Cooke, Sims, & Peyrefitte, Graduate students may also struggle with 1995; DiPerro, 2010; Hyun, Quinn, Madon, role strain and role confusion, as well as & Lustig, 2007; Oswalt & Riddock, 2007). “lack(ing) access to institutional power” Graduate students in counselor education (Grady et al., 2014, p. 6). Research done by programs are no different, with students Crothers (1991) acknowledges graduate identifying multiple stressors, including students as being in a transition period of expectations of faculty, financial stressors, sorts not fully in the realm of a professional, family and relational stressors, as well as and often not only in the role of student. feelings of competition with other students This “transitional status” is also mired in (Hughes & Kleist, 2005; Smith, Maroney, financial and resource limitations for Abel, Abel, & Nelson, 2006). Counseling is graduate students (Crothers, 1991). Hyun, a wellness profession (Kaplan, Tarvydas, & Quinn, Madon, and Lustig (2006) further
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examined graduate student mental health as Another study examined the impact well as the likelihood they would seek of a stress management course for counselor counseling services. Stress related issues education students. Students enrolled in the were reported by almost half of the course examined stress in three domains respondents in this study. The two most “psychological, physiological, and prevalent stressors graduate students socioenvironmental” (Abel, Abel, & Smith, reported were depressive symptoms and 2012, p. 66). The course proved successful financial stressors. for the students, and certainly seems to address the emergent counselors concerns of Graduate students in the helping thinking creatively about addressing professions may be at particular risk for wellness in counselor training programs burnout as mental health professionals have (Burck et al., 2014). higher levels of burnout than do those employed in other sectors (Felton, Coates, & Knowing the detrimental impact of Christopher, 2013). It is imperative for impaired counselors (Lawson, 2007), it is counseling students to be aware of potential important for counselor educators to stressors and available coping strategies understand the implications of choosing to because self-care is an ethical mandate in ignore wellness, self-care, and effective order to protect clients (ACA Code of coping strategies. While many counselors Ethics, 2014). Graduate students in that responded to the Lawson’s (2007) counselor education programs are not surveys were deemed to have a higher level immune to the stressors of other graduate of wellness, a number of counselors whose students. In fact, there may be additional wellness level was lower were “at a higher stressors for counselor education graduate risk of impairment” (p. 31). By focusing on students (Hughes & Kleist, 2005; Felton et the importance of wellness, self-care, and al., 2013; Smith et al., 2006). effective coping strategies during graduate education, counselors in training may Furthermore, Burck, Bruneau, Baker, develop lifelong strategies to combat the & Ellison (2014) examined the perceptions burnout and compassion fatigue Lawson of wellness with counselor education identified. graduate students through focus groups, and three distinct themes emerged: wellness is Although stress, wellness, coping important and unique for each individual; strategies, and self-care among clients, students becoming increasingly aware of practitioners and the general population are wellness; and emerging counselors areas of focus in the counseling literature recommendations for counselor education (Folkman, 2010; Folkman, Lazarus, programs. Participants, in providing Dunkel-Schetter, DeLongis, & Gmen, 1986; recommendations for counselor education Lawson, 2007), it is important for a wellness programs, encouraged counselor educators profession to encourage additional dialogue to examine the effectiveness of their current and encouragement in this area, particularly wellness foci, as well as urging counselor regarding counselors-in-training. The education programs to think creatively about researchers chose to develop their own how to deliver wellness information to instruments, due to a lack of previously students (Burck et al., 2014). existing measures unique to counseling students and due to the focus of the
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instruments available (Hyun et al., 2006) valid instruments in the profession of being insufficient to help answer the counseling to answer the research questions research questions. Specifically, the specifically focusing on graduate students in available instruments primarily focused on counseling programs. Although instruments utilization of mental health care, rather than existed in the literature that explored various the infusion of coping strategies by graduate aspects of the study, no comprehensive students. With the increasing instruments measuring the identified acknowledgement of the importance of constructs were found. Therefore, the wellness, stress mitigation/management, researchers modified two instruments coping strategies, and self-care, this study developed for a related pilot study (n = 87) aimed to address counselor education during doctoral level coursework at a graduate students’ stressors and coping northwestern university. The Graduate skills by examining the following three Student Stressor Scale (GSSS) and the research questions: (1) What are the Graduate Student Coping Survey (GSCS) psychometric properties of the Graduate were developed by several of the authors to Student Stressor Scale (GSSS)? (2) What are examine the stressors and coping skills of the psychometric properties of the Graduate doctoral students in CACREP accredited Student Coping Survey (GSCS)? (3) What programs (Authors, 2012). Graduate student are the perceived stressors and perceived participants were provided three instruments coping strategies of graduate students? to complete in the web-based tool Survey Monkey. The instruments included a Method demographic questionnaire, the GSSS, and the GSCS. Participants and Sampling Plan The Graduate Student Stressor Scale Participants were sampled from (GSSS) was developed to explore the masters-level and doctoral-level students perceived stressors of graduate students in enrolled in counseling programs in the counseling programs. The GSSS consisted United States. The researchers utilized of 22 statements that identified perceived purposeful sampling for the subject stressors based on current literature and population of graduate students in addressing each of the following constructs: counseling programs. Department chairs and time management, role conflict and strain, faculty designees were identified for each social evaluation, heavy workload and university in the United States housing a balancing program demands, intellectual graduate level counseling program. In mastery, integrating to the department, and addition, counselor educators known to the peer faculty interaction. Responses were researchers were identified as a secondary provided using a 5 point Likert-type scale contact person for corresponding ranging from strongly agree to strongly universities. disagree corresponding to each statement (e.g. I sacrifice sleep to complete school Instrumentation work).
In reviewing the existing literature The Graduate Student Coping regarding stressors and coping skills, the Survey (GSCS) was similarly developed to researchers attempted to find reliable and explore the perceived coping strategies of
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graduate students in counseling programs. Data Analysis The GSCS consisted of 38 statements identifying perceived coping strategies The confidential data collected was based on current literature and addressing downloaded from SurveyMonkey.com to the each of the following constructs: principal investigator’s computer. Statistical interpersonal coping, intrapersonal coping, Package for the Social Sciences (SPSS) balancing strategies, and time management. version 23.0 was used for data analysis. Again responses were provided on a 5 point Preliminary analyses incorporated Likert-type scale ranging from strongly descriptive statistics reviewing items’ mean, agree to strongly disagree that corresponded median, mode, standard deviation, skewness to each statement (e.g. I usually use humor and kurtosis. Secondary analyses utilized to cope). In addition, three open-ended exploratory factor analysis (EFA). Where questions were included at the end of the item skewness or kurtosis approached GSCS. Two questions explored other established thresholds for factor analyses potential coping strategies not identified in (Fabrigar & Wegener, 2012), histograms the 38 statements and the third question was were visually inspected. Additionally, included to inform researchers of concerns inter-item correlations were reviewed. This or comments regarding survey construction. review suggested the aggregate dataset was appropriate for exploratory factor analyses Data Collection (Field, 2013).
After obtaining IRB approval, Cronbach’s Alpha were computed distribution of the survey was conducted for each individual scale. Both scales using Survey Monkey. Department chairs demonstrated adequate reliability with and faculty designees for each university in Cronbach Alpha values of .838 for the GSSS the United States identified in the sampling and .872 for the GSCS. All items were plan were contacted by email. Additionally, retained as no substantial increase in counselor educators known to the reliability resulted from deletion of any researchers were contacted by email as a items. Finally, individual scale composite secondary contact person. The email scores were computed and reviewed contained a cover letter describing the study yielding a significant medium correlation of and asking recipients to forward the .514 suggesting concurrent validity. information to their graduate students and respond to the researchers indicating Factor structures for both whether or not they had forwarded the instruments were assessed using exploratory information. The cover letter further factor analysis (Principal Axis Factoring). informed participants the survey would take Direct Oblimin rotation was applied with approximately 15 minutes to complete and Delta set at 0. Standard criteria were utilized contained a link to Survey Monkey, reviewing eigenvalues, scree plots, and directing participants to the informed cumulative variance accounted for (Pett, consent and questionnaires. Lackey, & Sullivan, 2003). Next, the extracted solutions were reviewed in terms of parsimony and alignment with the literature.
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Results program at the time of survey completion. Program region was more distributed with Participants and Setting participants enrolled in the South (45.2%), West (20.2%), Midwest (18%), and Table 1 represents descriptive Northeast (16.5%). statistics of the sampling. An initial sample of 298 participants ( N = 298) was collected Further exploration of Master’s-level and the removal of cases with missing data students (n = 250) was conducted reviewing yielded a subsequent sample size of 272 program specialty, phase in the program, participants ( N = 272). The reported age of years engaged in Master’s studies, funding the participants’ ( N = 272) ranged from 21 received, and number of hours worked to 61 with a median age of 26 and a mode of outside of program requirements per week. 23. The majority participants identified as Participants reported pursing specialty areas White (82.4%) Heterosexual (91.5%) female of Clinical Mental Health/Community (84.6%). In terms of gender, remaining (47.6%), School Counseling (29.2%), participants identified as male (14.3%) and Marriage, Couple & Family (13.6%), other (1.1%) comprised of “Male identified, Student Affairs (3.6%), and Other (5.6%). gender non-conforming”, “Non-binary trans The majority specialties participants listed person”, and “Female to male transgender”. as “other” reflected dual-track programs Regarding affectional orientation, remaining (e.g., clinical mental health and school). The participants identifying as Gay, Bisexual, majority of participants reported completing Queer, Lesbian, and Pansexual. coursework (57.6%) in the first year of their Disaggregation of participants’ Ethnic Master’s program (55.6%). Identity is presented in Table 1. Participants’ relationship status was more distributed with Reviewing “Amount funding 37.1% identifying as single, 31.6% received to complete Master’s degree”, the identifying as married, 19.1% identifying as two largest groups of participants reported partnered, and remaining participants receiving “None” (36.4%) and “100%” identifying as Engaged, Divorced, (29.2%). Similarly, no majority emerged in Separated, Widowed, and Other. response to “Hours worked outside Master’s program per week”. Approximately 39.6% Nearly half (48.2%) the sampling of participants reported working more than reported being enrolled in a Clinical Mental 20 hours per week and 25.2% reported Health/Community specialty, with working 15-20 hours per week. remaining participants enrolled in School Interestingly, the next largest concentration Counseling (28.3%), Marriage, Family & (13.6%) of participants reported hours Couple (13.0%), and Other (10.7%). The worked outside of the Master’s program as majority participants (80.9%) reported “None”. Similar review was then focused on having earned a Bachelor’s Degree while participants identifying themselves as only 17.6% reported already possessing a Doctoral-level students. masters degree and less than 1% reporting other (e.g., Doctor of Education, Advanced A majority Doctoral-level Certificate). The majority of respondents participants (54.5%) reported pursuing were currently enrolled in a Master’s-level Clinical Mental Health/Community program (91.9%) CACREP-accredited (75.7%) specialty while 18.2% reported pursuing
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School Counseling and 27.3% reported explaining 41.833% of the cumulative “Other”. All participants choosing “Other” variance. After the initial extraction and responded with “Counselor Education” as rotation, items failing to adequately load their specialty or counselor education along (i.e., < .40) on any of the four factors were with a secondary specialty. No single dropped from the solution. While item #15 category majority emerged for participants’ (I am learning the skills I need to become a response to Phase in Program. The two counselor, counselor educator, or largest distributions represented students supervisor.) successfully loaded onto factor completing coursework (36.4%) and three, the loading was just over the students who having passed comprehensive threshold. Additionally the authors exams were working on completing their determined the item focus to be outside the dissertation (31.8%). Remaining participants scope of the other three items. Thus item were preparing for comprehensive exams #15 was dropped from further analysis. (18.2%) or having proposed their dissertation were collecting data (13.6%). PAF (with Direct Oblimin rotation) of this subsequent GSSS yielded a 15-item Similar to Masters-level students, no four-factor solution still demonstrating majority emerged with 40.9% of participants healthy KMO (.787) and significant reporting receiving 100% funding, 27.3% of Bartlett’s. Cumulative variance accounted participants reporting receiving 75-99% for by the revised four-factor solution funding, 18.2% reporting “None”, 9.1% increased to 46.090% with factor 1 reporting 50-74%, and 4.5% reporting explaining 22.960%, factor 2 10.634%, receiving 25-29% funding. factor 3 7.713% and factor 4 4.783%. Table 2 presents the pattern matrix for the GSSS Also mirroring Masters-level students, the four-factor extracted solution. two largest distributions in response to hours worked outside program per week were Graduate Student Coping Survey (GSCS) more than 20 hours (40.9%) and 15-20 hours (36.4%). Remaining responses indicated Similar appropriateness of factor 9.1% of participants worked 5-10 hours per analysis was found for the GSCS with a week, another 9.1% of participants listed significant Bartlett’s Test of Sphericity ( p < “None”, and 4.5% of participants worked .000) and a KMO value of .827. Review of 10-15 hours. eigenvalues and scree plot suggested an eleven-factor solution explaining 45.546% Factor Structure of the cumulative variance. After the initial extraction and rotation, items failing to Graduate Student Stressor Scale (GSSS) adequately load (i.e., < .40) on any of the eleven factors were dropped from the Consideration of the appropriateness solution. Additionally, single-item factors of factor analysis for the GSSS was explaining low amounts of variance were encouraging as Bartlett’s Test of Sphericity reviewed within the context of the literature was found significant (p < .000) and the to see if their continued inclusion was Kaiser-Meyer-Olkin (KMO) value was .811. warranted. Review of the GSSS eigenvalues and scree plot suggested a five-factor solution
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In finalizing the GSCS item #29 (“I The Graduate Student Stressor Scale (GSSS) am able to openly communicate my needs at and the Graduate Student Coping Survey home”) emerged as a single-item factor (GSCS) were created to address a lack of demonstrating a high loading (i.e., .859). tools available to measure the constructs we This was surprising considering the item did wanted to explore. This was determined not fall away with similar home-focused after an extensive literature review items (e.g., item #25 “My family supports addressing stressors and coping skills of my decision to be pursuing a graduate graduate students in counseling. After degree”), nor did it align with items creating individual instrument items based addressing social support/communication. In on a review of the literature, exploratory concert with factor analysis factor analyses were applied to the two recommendations (Pett, Lackey, & Sullivan, respective scales. 2003) item #29 (and the single-item factor it represented) was dropped from further The Graduate Student Stressor Scale analyses. (GSSS)
PAF (with Direct Oblimin rotation) Exploratory factor analyses of the revised GSCS yielded a 17-item conducted on the Graduate Student Stressor four-factor solution demonstrating healthy Scale (GSSS) yielded a four-factor solution KMO (.801) and significant Bartlett’s. accounting for approximately 46.090% of Cumulative variance accounted for by the the variance. Reviewing the literature, the revised four-factor solution was 43.90% researchers identified each of the four with factor 1 explaining 24.936%, factor 2 factors in pursuit of both parsimony and 8.729%, factor 3 5.840%, and factor 4 alignment with previous research. The four 4.395%. Table 3 presents the pattern matrix factors (and variance explained by each) for the GSCS four-factor extracted solution. were: Overwhelmed (22.960%), Professional Confidence (10.634%), Faculty Discussion Support (7.713%), and Acceptance from Family/Friends (4.783%). While it may be reasonable to presume most masters and doctoral Factor 1 (Overwhelmed) consisted of counseling programs address self-care in five items demonstrating moderate to one form or another (especially in healthy loadings and all focusing on consideration of CACREP curricular relatively common aspects of stress standards addressing such), counselor experienced in graduate school (i.e., not education graduate students are by no means enough time, neglecting outside obligations, immune to the effects of stressors commonly sacrificing sleep, taking on too much, and experienced within graduate studies fantasizing about quitting). Factor 2 (Thompson, Frick, & Trice-Black, 2011; (Professional Confidence) was comprised of Wolf, Thompson, Thompson, & five items, all demonstrating moderate to Smith-Adcock, 2014). This study undertook healthy loadings. More than just the development and validation of two self-confidence, items appeared to center instruments exploring commonly around how participants’ were perceived experienced stressors and coping strategies within the discipline as professionals (i.e., for counselor education graduate students. professional contributions, professional
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knowledge, conferences, professional explained by each) were: Intentional About identity, and transitioning roles). Factor 3 Self-Care (24.936%), Sense of Self (Faculty Support) was comprised of three (8.729%), Social Support (5.840%), and items demonstrating healthy loadings and Media for Coping (4.395%). addressing student-faculty interaction. Interestingly, all three items focused on Factor 1 (Intentional About more relational aspects of faculty (i.e., Self-Care) consisted of six items feeling supported, taking time to connect, demonstrating healthy loadings and all and freedom to be transparent) rather than centered on recognized forms of self-care official, programmatic support. Factor 4 practice (i.e., dedicating weekly time for (Acceptance from Family/Friends) self-care, “making” time for care of needs, contained two items both focusing on taking time to cope, having freedom to take friends/family members expressing negative personal time, weekends free from email, attitude towards participants’ graduate and strategies for maintaining balance). studies (i.e., pressuring to focus efforts Similarly, items forming Factor 2 (Sense of elsewhere, and difficulty accepting time Self) referenced various forms of internal dedicated to studies). reflection. Factor 3 (Social Support) consisted of items focused on the Overall, the researchers found the importance of friends and social emergent four factors of the GSSS aligned interaction/activities as a means for coping with the literature regarding stressors with stress. Finally, factor 4 (Media for commonly experienced by graduate Coping) was comprised of three items students. Of note is that in this investigation, describing different ways of participants’ responses demonstrated the expression/communication through media. importance of how professional identity as perceived is a significant stressor. This The finalized GSCS appeared finding may speak to the relative importance aligned with what literature exists placed upon practitioner professional addressing graduate students coping. identity within most counselor education Interestingly, the dimension Sense of Self programs (e.g., comportment, theoretical accounted for the second highest amount of orientation, etc.). However, the researchers variance in this sample, passing both Social recognize that more definitive statements are Support and Media for Coping. While a beyond the scope of the current study. majority of self-care/coping strategies seem to focus on forces external to the individual, The Graduate Student Coping Survey this finding suggests the important role of (GSCS) introspection as a means for graduate students managing stress. Exploratory factor analysis of the Graduate Student Coping Survey (GSCS) Limitations & Recommendations yielded a four-factor solution accounting for approximately 43.900% of the variance. While the findings from this study Similar to the GSSS, the researchers were encouraging, they are not without identified each of the four GSCS factors in limitations. This section summarizes alignment with themes emergent from the limitations of the study, specifically sample literature. The five factors (and variance size, sample demographics, and the potential
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influences on the study and/or outcomes. Additionally, such future Possible suggestions for addressing these investigations would benefit from concerns and recommendations for future confirmatory factor analyses (CFA) of the research are provided. instruments. While the use of principal axis factoring (PAF) in the current study was This study’s sample size of N = 272 aligned with best practices for instrument was within commonly accepted parameters construction, the authors acknowledge the for factor analyses (Field, 2013), however somewhat small variances accounted for in attention should be given to the both instruments (i.e., 46.090% for the subject-to-item ratios for both instruments. GSSS and 43.900% for the GSCS). Use of The GSSS initially consisted of 22 items and CFA would further validate the instruments’ the GSCS 38 items. Considering the study’s factor structures on a different sampling. sample size, this yielded subject-to-items ratios of approximately 12:1 and 7:1 Conclusion respectively. Professional preferences regarding adequate sample size for factor Recognizing stressors experienced analysis vary with some calling attention for by graduate students and utilizing coping not only large sample sizes such as greater strategies for effectively addressing them than 100 cases but high subject-to-item continues to emerge as a pertinent concern ratios as well (Beavers, Lounsbury, within counselor education (Mayorga, Richards, Huck, Skolits, & Esquivel, 2013). Devries, & Wardle, 2015). This study Future studies confirming both instruments outlined the development and validation of would benefit from independent two instruments, the Graduate Student investigations with higher subject-to-item Stressor Scale (GSSS) and the Graduate ratios potentially addressing this concern. Student Coping Survey (GSCS). The authors hope that both instruments may be employed While the sample size is considered as exploratory tools for continued research acceptable for the purposes of this study, into graduate students’ perceived stress and future investigations may be beneficial to coping. Additionally, the created instruments provide a more robust and diversified offer counselor education programs an sample. An overwhelming majority of the evaluative tool to effectively assess and respondents were white, heterosexual, address students’ self-care and wellness. females that were pursuing a master’s degree in clinical mental health counseling. References Respondents of different racial, ethnic, sexual orientation, gender, and professional Abel, H., Abel, A., & Smith, R. L. (2012). orientation may produce different results. The effects of a stress management For example, the stressors and coping skills course on counselors-in-training. of master’s degree students’ in clinical Counselor Education & Supervision, mental health counseling may be different 51 , 64-78. from doctoral students’ in counselor education and supervision focusing on Allum, J., & Okahana, H. (2015). Graduate professional school counseling. enrollment and degrees: 2004-2014 . Washington, DC: Council of Graduate Schools.
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American Counseling Association (2014). DiPerro, M. (2010). Healthcare education: ACA Code of Ethics, Alexandria, Making a difference in the lives of VA graduate students. Journal of Quality and Participation, 33, 15-17. The American Institute of Stress. (n. d.). America's number one health Fabrigar, L. R., & Wegener, D. T. (2012). problem. Retrieved November 1, Exploratory factor analysis. New 2015, from The American Stress York, NY: Oxford University Press. Institute Website: http:// www.stress.org/ americas-1-hea Fabrigar, L. R., Wegener, D. T., MacCallum, lth-problem/ R. C., & Strahan, E. J. (1999). Evaluating the use of exploratory Beavers, A. S., Lounsbury, J. W., Richards, factor analysis in psychological J. K., Huck, S. W., Skolits, G. J., & research. Psychological Methods, 4 , Esquivel, S. L. (2013). Practical 272-299. considerations for using exploratory factor analysis in educational Felton, T., Coates, L., & Christopher, J. research. Practical Assessment, (2013). Impact of mindfulness Research & Evaluation, 18 (6), 1-13. training on counseling students' perceptions of stress. Mindfulness . Burck, A., Bruneau, L., Baker, L., & Ellison, November 1, 2015. L. (2014). Emerging counselors' http:// dx.doi.org/10.1007/ s12671-01 perception of wellness: Implications 3-0240-8 for counselor development. Counseling Outcome Research and Field, A. (2013). Discovering statistics using Evaluation, 5(1), 39-51. SPSS (3rd ed.). Thousand Oaks, CA: Sage. Cooke, D., Sims, R., & Peyrefitte, J. (1995). The relationship between graduate Folkman, S. (2010). Stress, coping, and student attitudes and attrition. hope. Psycho-Oncology, 19 , Journal of Psychology, 129 , 910-908. 677-688. Folkman, S., Lazarus, R.S., Council for Accreditation of Counseling and Dunkel-Schetter, C., DeLongis, A., Related Educational Programs & Gmen, R.J. (1986). Dynamics of a [CACREP] (2016). 2016 standards stressful encounter: Cognitive for accreditation . Alexandria, VA: appraisal, coping, and encounter Author. outcomes. Journal of Personality and Social Psychology, 50, Crothers, C. (1991). The internal structure of 992-1003. sociology departments: The role of graduate students and other groups. Grady, R., La Touche, R., Oslawski-Lopez, Teaching Sociology, 19 (3), 333-343. J., Powers, A., & Simacek, K. (2014). Betwixt and between: The social position and stress experiences
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of graduate students. Teaching Lovitts, B. (2001). Leaving the ivory tower. Sociology, 2 (1), 5-16. Lanham, MD: Rowman & Littlefield. Hughes, F. & Kleist, D. (2005). First semester experiences of counselor Lovitts, B. E., & Nelson, C. (2000, education doctoral students. November-December). The hidden Counselor Education & Supervision, crisis in graduate education: Attrition 45 , 97-108. from PhD programs. Academe, 86 (6), 44-50. Hyun, J., Quinn, B., Madon, T., & Lustig, S. (2007). Mental health need, Mayorga, M. G., Devries, S. R., & Wardle, awareness, and use of counseling E. A. (2015). The practice of services among international self-care among counseling students. graduate students. Journal of Journal on Educational Psychology, American College Health, 56 , 8 (3), 21-28. 109-118. Oswalt, S., & Riddock, C. (2007). What to Hyun, J. K. & Quinn, B. C. & Madon, T. & do about being overwhelmed: Lustig, S. (2006). Graduate Student Graduate student stress and Mental Health: Needs Assessment university services. College Student and Utilization of Counseling Affairs Journal, 27, 24-44. Services. Journal of College Student Development, 47 (3), 247-266. Pett, M. A., Lackey, N. R., & Sullivan, J. J. (2003). Making sense of factor Kaplan, D., Tarvydas, V., & Gladding, S. analysis: The use of factor analysis (2014). 20/20: A vision for the future for instrument development in health of counseling: The new consensus care research. Thousand Oaks, CA: definition of counseling. Journal of Sage. Counseling & Development, 92(3), 366-372. Seyle, H. (1936). A syndrome produced by diverse nocuous agents. Nature, 138, Lawson, G. (2007). Counselor wellness and 132. impairment: A national survey. Journal of Humanistic Counseling, Seyle, H. (1974). Stress without distress. Education and Development, 46 , Philadelphia, PA: J.B. Lippencott 20-34. Co.
Longfield, A., Romas, J., & Irwin, J. (2006). Smith, R., Maroney, K., Abel, A., Abel, H., The self-worth, physical and social & Nelson, K. (2006). Doctoral activities of graduate students. programs: Changing high rates of College Student Journal, 40, attrition. Journal of Humanistic 282-292. Counseling, Education, and Development, 45, 17-32.
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Szabo, S., Tache, Y., & Somogyi, A. (2012). Thompson, E. H., Frick, M. H., & The legacy of Hans Seyle and the Trice-Black, S. (2011). origins of stress research: A Counselor-in-training perceptions of retrospective 75 years after his supervision practices related to landmark brief "Letter" to the Editor self-care and burnout. Professional of Nature. Stress, 15(5), 472-478. Counselor , 1 (3), 152-162.
Taylor, S. (1998). MacArthur SES & health Wolf, C. P., Thompson, I. A., Thompson, E. network . Retrieved November 1, S., & Smith-Adcock, S. (2014). 2015, from MacArthur SES & Refresh your mind, rejuvenate your Health Network Website: body, renew your spirit: A pilot http:// www/ macses.ucsf.edu/research wellness program for counselor /psychosocial/ coping.php education. Journal of Individual Psychology, 70 (1), 57-75.
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Table 1 Descriptive Statistics n % Gender Female 230 84.6 Male 39 14.3 Other 3 1.1
Affectional Orientation Heterosexual 249 91.5 Gay 8 2.9 Bisexual 7 2.6 Queer 4 1.5 Lesbian 3 1.1 Other 1 .4
Relationship Status Single 101 37.1 Married 86 31.6 Partnered 52 19.1 Engaged 14 5.1 Other 10 3.7 Divorced 7 2.6 Separated 1 .4 Widowed 1 .4
Ethnic Identity White 224 82.4 African American 15 5.5 Hispanic 10 3.7 Asia/Pacific Islander 8 2.9 Latino/Latina 6 2.2 Biracial/Multiracial 3 1.1 Other 3 1.1 Black 2 .7 American Indian 1 .4
Program Specialty Clinical Mental Health/Community 131 48.2 School Counseling 77 28.3 Marriage, Family & Couple 34 13.0 Other 29 10.7 Note. N = 272
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Table 2 GSSS Pattern Matrix
Instrument Item 1 2 3 4 I often feel there is not enough time in the day to .723 accomplish all that is expected of me. (2R ) I find myself neglecting outside obligations to keep .612 up with school work. (11R )
I sacrifice sleep to complete school work. (13R ) .599
I am taking on too many tasks that are not imperative .519 for graduation. (1R ) I fantasize about quitting school to escape the work .495 load. (14R ) I am confident in my ability to contribute at the - .893 professional level. (17) I feel confident in my interactions with professionals - .597 at conferences. (21)
I worry that I do not know enough. (5R ) - .576
I feel secure in my identity as an emergent counselor, - .518 counselor educator, or supervisor. (10) I transition easily from one role to another - .455 seamlessly. (16)
I feel supported by faculty. (18) - .810
The program's faculty takes time to connect with - .784 students. (22) I can be transparent with faculty. (20) - .564
The people in my life are currently pressuring me to .858 focus my efforts elsewhere. (9 R) The people in my life have a difficult time accepting .463 how much time I am dedicating to this degree. (7R )
Note . N = 272. Principal Axis Factoring with Direct Oblimin rotation δ = 0. “R” = Reverse-coded item.
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Table 3 GSCS Pattern Matrix
Instrument Item 1 2 3 4 I have time built into my week for self-care. (30) .785
I make time to take care of my needs and myself. (54) .752
I take time for myself to cope. (45) .712
I have the freedom to take personal time when needed. .680 (26) I employ strategies that are helpful for me in .407 maintaining balance. (59) I have the freedom to not check/reply to emails when .404 needed or on weekends. (49) I have a sense of purpose in my life. (58) .766
I trust myself. (57) .713
I engage in self-reflection. (56) .463
I have realistic beliefs/expectations for myself. (55) .463
I have a strong social support system. (33) .855
Generally, I have a high level of support from my .596 friends. (23) I think establishing a social support system is .438 important. (32) I utilize social media to keep in touch with family and .628 friends to cope. (43) I take pictures and share them with my friends to cope. .529 (47) I consistently listen to music. (37) .481
Note . N = 272. Principal Axis Factoring with Direct Oblimin rotation δ = 0.
101 A Pilot Survey of the Integration of The Journal of Counseling Research and Practice (JCRP) Volume 4, No. 1 Technology into Counseling Practice (102-118) Courtney Holmes Virginia Commonwealth University Kelly A. Kozlowski Walden University Dorcille M. Jernigan Independent Researcher
Abstract A random sample of 218 American Counseling Association members responded to a survey related to the integration of technology into the field of counseling pertaining to perceptions of possible barriers and benefits to providing online counseling. Results indicate that 11% of respondents currently provide some type of online counseling and that less than 20% of respondents would consider providing online counseling. Respondents identified both potential barriers and benefits of online counseling indicating that while counselors can recognize benefits to online counseling, they are still wary of potential challenges. Implications for the counseling field and future research directions are discussed.
Online counseling, or flourish. Researchers show positive technology-assisted counseling, has become outcomes related to counselor/client an established option for clinical service working alliance, overall effectiveness of provision (Gatti, Brivio, & Calciano, 2016). therapy, client improvement, and client According to the American Counseling satisfaction (Holmes & Foster, 2012; Association’s Code of Ethics, the Knaevelsrud & Maercker, 2006; Leibert, professional counseling relationship “may Archer, Munson, & York, 2006; Morgan et no longer be limited to in-person, al., 2008; Reynolds, Stiles, & Grohol, 2006; face-to-face interactions” (ACA, 2014, pg. Salleh, Hamzah, Nordin, Ghavifekr, & 17). Online counseling holds particular Joorabchi, 2015). promise for making mental health services more accessible, effective, and useful for However, the extent to which both clients and counselors (Barak & counseling professionals are integrating Grohol, 2011; Lehavot, Barnett, & Powers, digital services into practice is not clearly 2010; Richards & Vigano, 2013). Research understood (Centore & Milacci, 2008; regarding potential treatment options (Barak Menon & Rubin, 2011; VandenBos & & Grohol, 2011; Richards & Vigano, 2013), Williams, 2000). Additionally, practitioner treatment efficacy (Barak, Hen, attitudes toward the integration of digital Boniel-Nissim, & Shapira, 2008, Morgan, services are complex, varying according to Patrick, & Magaletta, 2008) and other individual preferences and experiences, variables (e.g., client and counselor personal opinions, therapeutic factors, and perceptions of online counseling, client demographic variables. These myriad behavior and motivation; Gatti et al. 2016; factors make it difficult to ascertain how Layne & Hohenshil, 2005) continues to attitudes impact clinical practice (Centore &
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Milacci, 2008; Cipolletta & Mocellin, 2018, in clinical practice. In more recent years, Lazuras & Dokou, 2016). Currently, the data has shown that an increasing number of field does not have an accurate national practitioners are integrating online representation of digital service provision counseling modalities. Several studies and attitudes toward online counseling, examined online counseling provider which may impact the overall understanding websites to determine what types of of the integration of digital technologies modalities were being provided. Shaw and within the counseling profession. Shaw (2006) found that email counseling services were provided on 38% of Modalities of Online Counseling participant sites. Over half (56%) of clinician websites offered a combination of Online counseling has been defined email plus other services (synchronous chat, as the delivery of counseling services in telephone, and/or videoconferencing). A cyberspace, where the counselor and client small number of sites (7%) offered only one are not in the same physical location and service: synchronous chat, telephone, or communicate using computer-mediated videoconferencing (Shaw & Shaw, 2006). communication technologies (Richards & In their survey of 136 online counseling Vigano, 2012). Mental health practitioners websites, Heinlen, Welfel, Richond, and Rak can integrate and utilize technology several (2003) found that asynchronous email was ways including text-based chat, email, and the most utilized modality. videoconferencing (Barak & Grohol, 2011; Goss & Anthony, 2009; Richards & Vigano, Menon and Rubin (2011) surveyed 2013). Services can either be synchronous 14 practitioners who advertised in an online (client and counselor are communicating at forum that they offered online counseling the same time; for example, through services. Results showed that email was the videoconferencing) or asynchronous (client primary choice for providing counseling and counselor are communicating separately services to clients (86%) while instant at different times; for example, through messaging (synchronous chat) and email; Rummell & Joyce, 2010). All videoconferencing were tied for second with modalities can serve as standalone or 57% of respondents using those modalities supplementary services used in conjunction for online counseling provision. The with face-to-face services (Abbot, Klein, & majority (79%) of respondents reported Ciechomski, 2005; Barak & Grohol, 2011; using both face-to-face and online Barak et al., 2008). counseling in conjunction with one another to meet their clients while 21% stated that Several studies have attempted to they used online counseling as a standalone quantify how practitioners are integrating modality. Centore and Milacci’s (2008) online counseling technologies into their survey data of 854 mental health practices. In 2000, VandenBos and professionals showed that 28% of Williams completed a random survey of 569 respondents used email for service American Psychological Association provision, 5% used text chat, and only 1% members related to their use of telehealth (or used videoconference. Cipolletta and online counseling). When the telephone was Mocellin (2018) found that 18% of 289 not included as a modality, only 2% of respondents provided online counseling and respondents disclosed the use of telehealth endorsed videoconferencing as the most
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widely used modality (45%). Finn and Rees and Stone (2005) asked 30 Barak’s (2010) survey data of 93 clinical psychologists to evaluate counseling practitioners showed that 87% offered email session videotapes and compare modalities services, 88% offered synchronous chat, and on a working alliance measure (e.g., 9% offered videoconference. In a survey of face-to-face sessions versus thirteen online counseling clients, four videoconferencing sessions). Participants respondents (30.7%) communicated with measured the working alliance significantly their counselors using videoconferencing, lower in the videoconferencing sessions and five (38.4%) communicated with expressed concern that the synchronous chat, and two (15.3%) used videoconferencing modality would email (Holmes & Foster, 2011). negatively impact the client perception of the counselor as warm, genuine, and The types of modalities used by understanding (Rees & Stone, 2005). counselors are varied. Some data suggest Ethical issues such as confidentiality, that email may be the most widely used privacy, and verifying client identification (Finn & Barak, 2010; Menon & Rubin, are perceived as a deterrent for counselors 2011), however the most recent study who consider implementing online indicates that the use of videoconferencing counseling (Rummell & Joyce, 2010). was the most preferred modality (Cipolletta & Mocellin, 2018). Goss and Anthony Centore and Milacci (2008) found (2009) suggest that as technology and access that participants had more negative than to the internet continue to improve, access to positive responses to online counseling. previously expensive or cumbersome Almost half of all respondents reported modalities such as videoconferencing may having a “negative/very negative” attitude expand. Perhaps future research will show toward counseling via email, 35% reported an increased reliance on more advanced and having a “negative/very negative” attitude synchronous modalities as these become toward videoconferencing, and 65% easier for practitioners and clients to both reported having a “negative/very negative” access and afford. attitude toward text-based chat. Concerns about being able to fulfil ethical duties were Perceptions of Online Counseling perceived for every online counseling modality (Centore & Milacci, 2008). Ten The advent of new technologies years later, Cipolletta and Mocellin (2018) continues to change the habits of clients and found that about half of respondents counselors alike (Cipolletta & Mocellin, reported that they would be open to 2018). As online counseling becomes integrating online counseling into their increasingly popular, practitioner attitudes practices and about half would not. toward and perceptions of available Additional barriers to online counseling technologies can provide information related have been identified including a lack of to the integration of technology into current perceived connection between client and practice (Lazuras & Dokou, 2016). Several counselor as well as the inability to perceive studies have attempted to gauge practitioner and use nonverbal cues in communication perceptions of challenges and benefits of (Chester & Glass, 2006; Menon & Rubin, online counseling. 2011; Rummell & Joyce, 2010).
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Several perceived benefits of online Lazuras and Dokou (2016) showed counseling have also been acknowledged. that the counseling practitioners’ perceived One benefit is that clients can access usefulness of online counseling was the counselors outside of traditional time and single most predictive factor of technology space (Richards, 2009). In a study integration, acceptance, and utilization in completed with college students who used clinical practice. Additionally, ethical an asynchronous discussion board to concern toward online counseling was communicate with a counselor, 77% of all significantly negatively correlated with client communication was logged during practitioners’ intention to integrate online nights and weekends (Richards, 2009). counseling into their practices; in other Additionally, clients may first seek support words, the higher the concern around ethical via digital communication as a way to get problems, the lower the intention to practice comfortable or gain confidence and, online counseling. In Cipolletta and eventually, transition to face-to-face services Mocellin’s (2018) study, data suggest that (Rummell & Joyce, 2010). In other words, confusion around ethical and legal online counseling may serve as a gateway components of online counseling was the modality to help clients become familiar most influential factor for practitioners when with counseling before they seek services in asked if they would be willing to open an a face-to-face context. To that end, Richards online practice. The respondents who (2009) found that 24% of participants who indicated they would be willing to provide initially sought help through the online online counseling were significantly more asynchronous chat forum went on to seek likely to believe online counseling would be face-to-face help for the first time within the beneficial to clients and rated themselves next 11 months. Another benefit may be the higher in their understanding of technology opportunity to serve clients who are in and tools for online clinical work. isolated geographical areas or have significant barriers to physically making Unfortunately, much of the current appointments (e.g., physical disability, research is impacted by sampling errors and chronic illness; Chester & Glass, 2006). low response rates (Holmes & Foster, 2012; Cipolletta and Mocellin (2018) found that Menon & Rubin, 2011). Existing the most highly ranked advantage of online information does not accurately represent a counseling was the reduction of geographic generalizable picture of national service boundaries. Practitioners voiced the provision and more research is warranted to perception that online counseling may obtain more robust information that is benefit clients that prefer an alternative reflective of integrated online modalities digital modality for self-expression, as it (Centore & Milacci, 2008; Menon & Rubin, offers increased anonymity and the 2011). Additionally, attitudes toward online opportunity to communicate in other ways counseling including perceptions of benefits (e.g., text-based chat; Layne & Hohenshil, and barriers is warranted (Centore & 2005; Menon & Rubin, 2011). Affordability Milacci, 2008). Investigation on a national and ease of access have also been noted as scale has not taken place since VandenBos benefits for digital services (Cipolletta & and Williams surveyed psychologists in Mocellin, 2018). 2000. The most recent study completed by Cipolletta and Mocellin (2018) is informative, yet was completed in Italy so
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there may be some cultural and systemic process suggested by Salant and Dillman factors inhibiting its generalizability to the (1994) as closely as possible (e.g., sending United States. As such, the current study an initial and follow-up contact). investigated practitioners’ integration of Participants were entered into a random technology in their clinical practice as well drawing for 1 of 33 Amazon gift cards in the as current perceptions of the barriers and amount of $10 to provide a monetary benefits to providing online counseling incentive. Such incentives have been shown services. to increase survey response rates (Erwin & Wheelright, 2002). This project was Method partially funded by a research grant provided by the Association for Specialists in Group Procedures Work.
A random, national sample of 3,000 Measures (5% of 55,782) active members of the American Counseling Association (ACA) The researchers developed a survey was chosen after IRB approval was measure related to myriad aspects of online obtained. The researchers purchased the counseling and took between 15 and 20 U.S. mailing addresses of these members minutes to complete. All items were used and requested a national random sample that for descriptive purposes and no scales were excluded student members from ACA, as summed. Two components were included in the purpose of the study was to survey the data survey: (a) demographics, including current practitioners in the counseling field. current use of technology in clinical In the fall of 2016, all 3,000 identified ACA practice; and (b) perceptions of benefits and members received an initial letter via U.S. barriers of online counseling. Demographic mail requesting participation via digital link information was collected including the (directions were to type the link into a web race, gender, age, and type of counseling browser via computer or tablet) to complete license of the participant. A description of the survey. Study data were collected and the type of counseling practice, type of work managed using REDCap electronic data setting, and main clinical activities of each capture tools hosted at the university. participant were also collected. The REDCap (Research Electronic Data following questions were also asked: (a) are Capture) is a secure, web-based application you proving online counseling, if so what designed to support data capture for research type? (b) have clients inquired about online studies, providing 1) an intuitive interface counseling? and (c) do you believe that for validated data entry; 2) audit trails for online counseling would benefit your tracking data manipulation and export clients? procedures; 3) automated export procedures for seamless data downloads to common Questions that addressed client statistical packages; and 4) procedures for perceptions of barriers and challenges to importing data from external sources (Harris online counseling as well as potential et al., 2009). benefits of online counseling were derived from previous research (Layne & Hohenshil, Given logistical and budget 2005; Leibert et al., 2006; Rees & Stone; constraints, the researchers followed the 2005; Rochlen, Beretvas, & Zack, 2004;
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Shaw & Shaw, 2006). Barriers included deviation of 12.35; ages in the sample client/counselor resistance, client/counselor ranged from 24 to 75 years, with a modal understanding of technology, age of 30. The sample included 184 client/counselor stigma of online counseling, Caucasian practitioners (84.4%), six Asian concern with therapeutic relationship, lack practitioners (2.8%), eight Black of nonverbal communication, financial practitioners (3.7%), one Latino/a barriers, and ethical concerns. Potential practitioner (.5%), and two multiracial benefits included benefits of text-based practitioners (.9%), with 17 (7.8%) who did communication, anonymity, augmentation of not respond. Years of counseling practice face-to-face services for travel and moves, ranged from 1-40; the average number of and the ability to reach isolated clients due years that participants have been practicing to disability or geographical location. counseling was 10.11 years, with three being the modal number of years. Forty-five of Results the United States were represented in the sample with a majority response from Response Rate Virginia (16, 8%), Texas (17, 8.5%) and Ohio (18, 9%). The five states not A total of 3,000 recruitment represented were Delaware, Kentucky, invitations were distributed via U.S. mail. A Montana, New Hampshire, and Vermont. follow-up invitation was sent to all 3,000 The respondents were representative of original participants one month after the overall ACA demographics during the year initial letter. Fifty-three initial letters were the data were collected (e.g., gender returned as undeliverable due to incorrect proportion, racial proportion, degree-type mailing addresses as provided by ACA. Of proportion; ACA, 2016). the remaining 2,947 invitations, 218 people responded, thus providing an overall return Twenty-eight participants had rate of 7.4%. This response rate is low; an completed doctoral degrees (12.8%), 174 ideal survey response rate is around 20% participants had completed master’s degrees (Gall, Gall, & Borg, 2007). Although (79.8%) and sixteen (7.3%) did not respond. survey data is frequently used in social Forty-eight participants were still working science research, obtaining a strong response towards independent licensure (19.4%), 139 rate is challenging (Dillman, 1991). participants held an LPC/LPCC (63.7%), six held an LMFT (2.7%), six held a CRC Demographic Characteristics (2.7%), and 24 held other licenses. Eighty-one participants (39.7%) responded The sample included 136 female that they worked in private practice, 53 respondents (62.4%), 36 male respondents (26%) worked in a public agency, 14 (6.9%) (16.5%), and 46 (21.1%) with no response. worked in a hospital, 19 (9.3%) worked in a The sample ages are as follows: 25-30 years K-12 school, 24 (11.8%) worked on a (14.6%), 31-35 years (11.4%), 36-40 years college campus, 13 (5.9%) responded other, (9.6%), 41-45 years (7.7%), 46-50 years and 14 (6.4%) did not respond. One (11.9%), 51-55 years (7.3%), 56-60 years hundred and sixteen participants responded (7.8%), over 60 years (9.1%), and 34 that their main clinical activity was (15.6%) with no response. The average age individual adult counseling (59.2%), while of the group was 44.24 years with a standard 49 (25%) responded that their main clinical
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activity was individual child counseling. counseling services in their practices (e.g., Fifteen (7.7%) responded that family or text-based chat, email, or videoconference). couples work was their main clinical activity and 16 (8%) responded that they most often Perceptions of Online Counseling ran groups. Thirty-one (14.2%) participants Provision of Services stated that they were currently working as school counselors. Because the project was Out of the total sample, 42 (19.2%) designed to survey current mental health said that they would consider providing counseling practices with technology, individual online counseling and 28 (12.8%) practicing school counselors were branched said they would consider providing both to a separate set of questions related individual and group counseling. specifically to school counseling and were Thirty-three (15.1%) responded that they not included in the responses below. would not consider providing any online Additionally, 18 (8.3%) participants stated counseling and 48 (22%) stated that they they were not actively practicing as were unsure. When respondents were asked counselors and were not included in the if they believed their clients would benefit below data calculations. This left 169 of the from online counseling, 40 (18.3%) original 218 respondents to answer the answered yes to individual counseling, 23 questions related to their perceptions of (10.6%) responded that their clients might online counseling. benefit from individual and group, 20 (9.2%) said no, and 67 (30.7%) stated they The remaining 169 respondents were were unsure. Respondents were also asked asked several questions related to their if they believed their clients would like perceptions of the barriers and benefits to online counseling, to which 37 (17%) online counseling. The participants were responded yes to individual counseling, 15 asked to respond to each of the potential (6.9%) responded yes to individual and barriers or benefits to online counseling on a group, 14 (6.4%) responded no, and 85 five-point Likert-type scale with anchors (39%) responded they were unsure. including Strongly Disagree (SD, Disagree Twenty-two (10%) responded that their (D), Neutral (N), Agree (A), Strongly Agree clients have previously inquired about (SA). Possible barriers to online counseling online counseling. Finally, 20 respondents (in other words, what may preclude (9.2%) indicated that they had received counselors from practicing online formal, online counseling training. Of all counseling) included: (a) lack of counselor respondents, 132 (60.6%) replied that they training, (b) lack of counselor understanding used technology to keep in touch with of technology, (c) lack of counselor access clients. Of these 132 respondents, 54 to technology, (d) general counselor (40.9%) use text via cell phone, 66 (50%) resistance, (e) general counselor stigma of use email, 11 (8.4%) used other (e.g., secure online counseling, (f) client understanding message via electronic messaging system; of technology, (g) client resistance, (h) client both text and email), and one person did not stigma of online counseling, (i) lack of client respond. Twenty-four participants (11%) access to technology (e.g., financial), (j) responded that they provide online concern over how to build a therapeutic relationship, (k) concern over lack of
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nonverbal communication, and (l) ethical recently, however, six of seven respondents issues such as privacy and confidentiality. in Vincent, Barnett, Killpack, Sehgal, and Possible benefits to providing online Swinden’s (2017) study used email to counseling included: (a) ability to reach correspond with clients when establishing clients who cannot physically make initial contact and scheduling issues. These appointments due to a disability, (b) ability results highlight a social trend wherein to reach clients who may be afraid of contact via digital correspondence has face-to-face counseling, (c) ability to reach become ubiquitous. Vincent et al. (2017) clients who may be geographically isolated, discuss that digital correspondence has crept (d) client preference for anonymity, (e) into counseling practice “without conscious” client preference for text-based meetings, (f) and that this type of communication is ability to augment face-to-face services, and simply a part of day-to-day life (p. 73). (g) ability to continue with clients if they Additional technological interventions, such move away. The raw number and as the use of videoconferencing and email percentage of respondents for each response for therapeutic purposes, require more category are presented in Table 1. intentional choice and selection by practitioners (Vincent et al., 2017). Discussion Current data show that 11% of Research shows that online respondents provided some type of online counseling holds particular promise for counseling with the majority providing making some mental health services more videoconferencing sessions. Similarly, accessible, effective, and useful for both Cipolletta and Mocellin (2018) found that clients and counselors (Barak & Grohol, 18% of their sample provided online 2011; Richards & Vigano, 2013). However, services with the majority using the existing information does not fully represent videoconferencing modality. In the current the use of integrated online modalities and study, 19.2% of participants responded that attitudes toward online counseling (Centore they would consider individual online & Milacci, 2008; Menon & Rubin, 2011). counseling and 12.8% said they would When compared with past research, the consider both individual and group online current study shows increased use of text counseling. When respondents were asked if messaging (via cell phone) and email of they believed their clients would benefit counselor/client correspondence about from online counseling, 18% answered yes appointments and scheduling. Data show to individual counseling, 10% responded that 61% of participants responded that they that their clients might benefit from used technological means to keep in touch individual and group, 9% of respondents with clients regarding scheduling. Of these said no, and 30% stated they were unsure. respondents, 40% use text via cell phone, Respondents were also asked if they 50% use email, 8% used other (e.g., secure believed their clients would like online message via electronic messaging system, counseling, to which 17% responded yes to both text and email). This demonstrates a individual counseling and 7% responded yes large increase as VandenBos and Williams’ to individual and group. Overall, responses (2000) data showing that outside of demonstrating support are below 20%. It telephone conversations, there was minimal appears that counselors still seem hesitant to to no use of other technology. More integrate online modalities into their clinical
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work and are cautious to believe that online perceptions of barriers of online counseling, work may actually be beneficial to their over 50% of participants stated they agreed clients. or strongly agreed with the following items: counselor training, counselor understanding, Interestingly, these results are not counselor resistance, counselor stigma, that different from Centore and Milacci’s client understanding of technology, and (2008) study where almost half of all client stigma of counseling. Over 80% of respondents reported having a participants indicated they believed the lack “negative/very negative” attitude toward of non-verbal cues, ethical issues, and counseling via email, 35% reported having a concern with the formation of the “negative/very negative” attitude toward therapeutic relationship were barriers to videoconferencing, and 65% reported online work. Other studies have shown having a “negative/very negative” attitude similar hesitations and negative perceptions toward text-based chat. Concerns about of counselors regarding online counseling being able to fulfil ethical duties were (Cipolletta & Mocellin; 2018; Rees & Stone, perceived for every online counseling 2005). A lack of perceived connection modality (Centore & Milacci, 2008). The between client and counselor as well as the current study was done almost a decade after inability to perceive and use nonverbal cues Centore and Milacci’s (2008) study and it in communication have been discussed as does not seem as if attitudes have shifted potential pitfalls of online counseling despite the increased use of technology in all (Chester & Glass, 2006; Menon & Rubin, facets of social connection. However, 2011; Rummell & Joyce, 2010). Ethical Cipolletta and Mocellin (2018) found that issues such as confidentiality are about half of their sample reported that they consistently perceived as inhibitive when would open an online counseling service and considering the use of online counseling half would not indicating a more evenly split (Cipolletta & Mocellin, 2018; Rummell & distribution for their population. Joyce, 2010). Cipolletta and Mocellin (2018) also found that technological barriers In the current study, 10% responded including verification of user identity and that their clients have previously inquired frustration of technological issues were about online counseling. Finn and Barak endorsed by over 65% of respondents. (2010) showed that 67% respondents These data show that counselors are still believed there was a “strong market wary of providing online counseling and demand” for online counseling services. As maintain a heightened awareness of counselors continue to perceive an observed inhibitive ethical issues that may arise with increase in client demand of online digital modalities of counseling. counseling services, this may shift their decisions to incorporate technology into The current data also correspond their clinical practice. with information received directly from counseling clients. Young (2005) surveyed Perception of Benefits and Barriers 48 clients who participated in online addiction counseling services who Data show a high rate of agreement mentioned similar concerns. For example, to both barriers and benefits of online 52% of respondents mentioned privacy and counseling. When asked about their confidentiality as a concern while seeking
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online treatment, 38% of clients mentioned benefit (Chester & Glass, 2006). Cipolletta security as a concern, 31% of clients and Mocellin (2018) found that almost 70% mentioned being caught by a spouse or of their sample endorsed reduction of employer was a concern, and 27% of geographical boundaries as an advantage respondents noted that they had no concerns and that over half endorsed anonymity as a regarding online counseling. Young’s (2005) benefit for clients who desire it. data show that over 70% of participants agreed that counselor resistance was a Data from the current study potential barrier while only 27% of correspond with information procured from participants responded that client resistance client perception as Young (2005) found that was a barrier. In the current study, over 70% 96% of clients sought online counseling of respondents believed that counselor over face-to-face treatment for the resistance was a barrier while under 40% anonymity, 71% sought online counseling believed that client resistance was a barrier. for the convenience, and 38% sought online Perhaps, counselor resistance plays a more counseling for the ease of access to significant role than client resistance in treatment. Gatti et al. (2016) found that negatively impacting online service clients reported the accessibility without expansion. Current data suggests this time restriction to be the most positive dynamic, with less than 20% of participants feature of text-based counseling. Additional responded that they would consider researchers have cited benefit for clients providing online counseling even though who seek the perceived anonymity provided only 9% answered that they did not believe by online counseling (Layne & Hohenshil, their clients would benefit from online 2005; Menon & Rubin, 2011). counseling. Largely, the perceptions of barriers When asked about their perceptions and benefits to online counseling that were of benefits of online counseling, over 50% found in this study, have been corroborated of participants stated they agreed or strongly in previous literature (Centore & Milacci, agreed including the ability to reach clients 2008; Cipolletta and Mocellin, 2018). who may be wary of face-to-face counseling Cipolletta and Mocellin (2018) found that and prefer anonymity. Over 50% of 63% of their respondents were proponents of respondents agreed that online counseling online counseling while 35% of respondents could add benefit as an augment face-to-face were not favorable to online counseling. services and may allow more flexibility for The current study shows that the counselors to continue to see clients who respondents were not quite as favorable with move or travel during the therapeutic less than 20% responding favorably to the process. Over 90% agreed that online integration of online counseling. However, counseling would benefit clients who may in seven categories, over 20% of otherwise not seek face-to-face counseling respondents remained neutral (e.g., due to a disability or geographical location counselor resistance, counselor stigma, constraints. The opportunity to serve clients client resistance and client access). These who are in isolated geographical areas or neutral positions may showcase a shift in have significant barriers physically making strongly held negative beliefs or biases appointments (e.g., physical disability, regarding online counseling and a shift in chronic illness) is a commonly identified
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decreased apprehensive regarding the from integrating technology into their provision of digital services. counseling processes. Data show that 11% of respondents are providing some type of Counseling Implications online counseling and less than 20% would consider providing individual and/or group The use of text messaging and email counseling online. It seems as though is ubiquitous in today’s culture and these counseling practitioners are at an impasse digital types of communication are regarding online work; on one hand they can unequivocally finding their way into the identify various benefits to clients, yet on communication between client and the other they are held back by identified counselor. Approximately half of ethical concerns and barriers. Lazuras and respondents stated they use text messaging Dokou (2016) discuss that perceived (via cell phone) and email to communicate usefulness of online counseling was the with clients about scheduling, showcasing a largest predictor of future use in clinical significant trend in how clients and practice. It is possible that intentional counselors are contacting one another. This training in online work, more access to is an increase from data collected in 2008 outcome research identifying benefits of where only 5% of respondents used online counseling, and an increasing culture text-based chat to communicate with clients shift toward digital communication may all (Centore & Milacci, 2008). Vincent et al., serve to decrease counselor resistance to (2017) found that six out of seven providing online counseling. respondents used email to communicate with clients. To this end, The American Intentional training in online Counseling Association’s’ Code of Ethics counseling delivery may help to assuage (2014) addresses digital types of fears and apprehension regarding perceived communication and counselors who use barriers. Sixty-seven percent of respondents digital communication (e.g., email, text) to agreed that counselor training was a schedule with clients should be aware of significant barrier to offering online confidentiality and privacy issues as well as counseling services. Only 9% of the sample understand the importance of creating had received some type of training in boundaries around response times and providing online services even though 11% appropriate information to disclose in this of respondents reported offering online type of communication (ACA, 2014). As services. Vincent et al., (2017) report little Vincent et al. (2017) state, digital evidence that training or professional communication with clients is ubiquitous in development focused on providing online our culture. However, this does not mean counseling was offered or sought by that counselors can disregard ethical and participants. The importance of training has legal guidelines around HIPAA and client been well-documented (Anthony, 2015; confidentiality. Heinlen et al., 2003; Shaw & Shaw, 2006). ACA (2014) included the ethical mandate of Overall, the data demonstrate that training regarding online counseling service while counselors recognize that online provision stating, “Counselors who engage services may offer benefit clients, their in the use of distance counseling, perception of limitations and challenges are technology, and/or social media develop equally as strong and may inhibit counselors knowledge and skills regarding related
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technical, ethical, and legal considerations” response rate was low, the opportunity to (H.1.a, p. 17). Additionally, CACREP survey a random representation of (Council for Accreditation of Counseling professional members is important. The and Related Educational Programs) included cost of this type of research when digital several mandatory technology-related communication is not allowable is often training standards in the 2016 iteration of prohibitive, rendering representative random program standards. Training should begin in sample research designs infrequent. master’s-level training programs so as to positively impact the development of Several small-scale studies have counselors-in-training with the been completed that showcase types of understanding of online counseling online counseling services being provided as provision. Available training programs are well as overall perceptions of this type of increasing (e.g., the Distance Counselor service provision (Heinlen et al., 2003; Credential sponsored by the National Board Menon & Rubin, 2011; Shaw & Shaw, 2006, for Certified Counselors) and continued Vincent et al., 2017). These inquiries should research should be done on their efficacy, continue on a larger scale to continue to gain impact on counselor development, and information regarding the national landscape perception of the utility of online of online counseling. Future investigation counseling. should also focus on the differences in perception between clients and counselors Limitations, Strengths, and Future regarding the use of online counseling and Directions the benefits of this type of service provision. Additionally, research should focus on the The most glaring limitation is the training of professionals in the provision of low response rate. While this does render online counseling and the impact on these data less generalizable, the sample is counseling effectiveness as well as client representative of general ACA membership and counselor perception of digital services. (ACA, 2016). The low response rate may be Research regarding online counseling a product of the inability to purchase email outcomes is also warranted as positive addresses for contacts and relying on U.S. outcome research may support increased use mail for participant recruitment and not of online counseling modalities (Cipolletta being able to click on a web link directly & Mocellin, 2018). from an email may have been prohibitive. Given the low response rate of this study, Conclusion the data can be interpreted as pilot or preliminary data, paving the way for a Online counseling is a nationally future, larger-scale study using refined and recognized option for clinical service updated measures. Future studies should provision. Currently, the field does not have improve response rates by recruiting an accurate national representation of digital participants directly via electronic service provision and attitudes toward online communication. counseling, which may impact the overall understanding of the integration of digital The strength of this study is the technologies within the counseling attempt at a random, national sample of profession. Through a random national counseling practitioners. Although the sample of ACA members, the current study
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showcases the relevance of technology in in Human Services, 29, 155-196. today’s counseling practice as over 61% of doi:10.1080/15228835.2011.616939 respondents use technology to communicate with clients in some way and 11% were Barak, A., Hen, L., Boniel-Nissim, M., & providing online counseling. While Shapira, N. (2008). A comprehensive inhibited by a low response rate, data review and analysis of the generally show that respondents can identify effectiveness of internet-based both benefits and challenges to providing psychotherapeutic interventions. online counseling. With the proliferation of Journal of Technology in Human types of technology and increase in Services, 26(2/4), 109-160. accessibility for both clients and counselors, doi:10.1080/15228830802094429 the counseling field continues to face persistent change and digital integration. Centore, A.J., & Milacci, F. (2008). A study These changes need to continue to be of mental health counselors’ use of investigated so as to inform practice and and perspectives on distance training processes. Counseling. Journal of Mental Health Counseling, 30(3), 267–282. References Chester, A., & Glass, C. A. (2006). Online Abbot, J. M., Klein, B., & Ciechomski, L. counseling: A descriptive analysis of (2008). Best practices in online therapy services on the Internet. therapy. Journal of Technology in British Journal of Guidance and Human Services, 26(2/4), 360-375. Counseling, 34, 145–160. doi:10.1080/15228830802097257 doi:10.1080/03069880600583170
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Table 1 Perceptions of Online Counseling
Perception Type StronglyDis/Disagree Neutral Agree/Strongly Agree
no % no % no %
Barrier
Co. Training* 27 16 28 16.6 114 67.4
Co. Understanding* 36 21.3 32 18.9 101 59.9
Co. Access 70 41.5 34 20.1 65 38.5
Co. Resistance* 13 7.7 35 20.8 110 71.5
Co. Stigma* 35 20.7 35 20.7 99 58.6
Cl. Understanding* 41 24.3 33 19.5 95 56.2
Cl Resistance 46 27.4 56 33.3 66 39.2
Cl. Stigma* 70 16.6 25 14.9 130 77.4
Cl. Access 13 27.1 56 33.3 66 39.2
Relationship* 18 10.7 16 9.5 135 79.9
Non-Verbal* 12 7.1 13 7.7 144 85.2
Ethical Issues* 12 6.6 15 8.9 141 84 Benefit Reach Cls. with disabilities* 3 1.3 4 2.4 162 95.8 Reach Cls. who are afraid* 21 12.5 26 15.4 122 72.2 Reach geographically isolated cls.* 2 0.1 5 3.0 162 95.9
Cl. prefer anonymity* 36 21.5 45 26.8 87 51.8
Cl. prefer text option 43 25.8 55 32.9 59 41.3
Augment services* 8 4.8 25 14.9 135 80.4 Continuity of services* 22 3.8 30 18.0 114 68.2
Note. N=169. * Indicates items that 50% of participants responded Agree/Strongly Agree
118 Cookie Friendships: School Counselors The Journal of Counseling Research and Practice (JCRP) Volume 4, No. 1 Use of Genograms as an Assessment Tool (119-128) in the Digital Age
Jennifer Barrow Suzan Z. Wasik Peggy P. Whiting North Carolina Central University
Abstract Professional school counselors play a vital role in addressing the needs of diverse populations experiencing varying degrees of crises. This article suggests best practices for utilizing genograms in the digital age to identify cookie friendships and to address varying degrees of crisis experiences of school-aged children. The use of genograms in the school counseling setting can be an easily adoptable approach and technique for use with a wide variety of students that can be implemented in various situations.
The role of the professional school counselors require easily accessible tools counselor (PSC) has evolved dramatically designed to intervene quickly within the since its inception (Burnham & Jackson, unique social structure of schools. 2000). Many of these changes are designed Genograms may prove to be a tool used in a to address the evolving challenges including proactive manner rather than a tool used economic and social changes of students’ exclusively in moment of crisis and reaction. lived experiences that are manifested in the Additionally, because genograms may be school setting (Gysbers & Henderson, 2001; generated and explained by the Paisley & McMahon, 2001). Recent student-client, genograms may breakdown attention to an increasing incidence of the inherent power hierarchy in place in school violence has created a heightened schools and in the counseling relationship awareness for the need for crisis intervention and encourage a greater sense of in public schools (Allen, et al., 2002; collaboration in the therapeutic process. Cunningham & Sandhu, 2000). Crisis events in school settings lead to a state of Defining Genograms disequilibrium (Henning, 2011). This sense of imbalance will impact social and Bowen (1980) encouraged the use of academic outcomes of students thus the genogram initially in a family therapy demonstrating the need for immediate interview. A genogram is a convenient, support in order to facilitate recovery graphic depiction of how a family is related (Poland, 1994). to one another and is most often used in delineating parental and family influence The authors completed a across three generations (Okiishi, 1987). comprehensive literature review and noted a Originally designed as a useful assessment paucity of research on the use of genograms tool when conducting family therapy in schools. With little or no budget, high interviews, the genogram has historically caseloads, and increasing demands, school been a three-generational graphic model of a
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family of origin (Bowen, 1980; Okiishi, information to a much larger audience. In 1987). However, mental health the past, friendships may have used professionals have expanded the use of monikers denoting duration or level of genograms beyond the family therapy intimacy to define the friendship in a interview and have broadened its application vertical structure (e.g., acquaintance, buddy, in various ways including multicultural, girlfriend, friend, best friend) (see Table 1 spiritual, genetic, and career counseling graphic). However, we suggest the (Brott, 2005; Frame, 2001; Gibson, 2005; increasing use of social media has created Işık, Akbaş, Kırdök, Avcı, & Çakır, 2012; the need for a new metaphorical term to Sueyoshi, Rivera, & Ponterotto, 2001; describe friendships and we propose the use Willer, Tobin, & Toner, 2009). of the term cookie friendships. Understanding the structure of families may encourage discussion and the facilitation of The word cookies can have two change within the family dynamic. Hence, meanings. One can define a cookie as being the use of genograms may allow for a more a flat, sweet, and seemingly delicious dessert effective school-based intervention because or treat. However, despite being enticing, of clearer understanding of the familial and cookies are often filled with unhealthy social structure of students. ingredients (e.g., butter, sugar) and excessive calories that may lead to Expanding the usefulness of undesirable results (e.g., increased weight, genograms into schools may encourage spikes in blood sugar, and cavities). From a discussion around family dynamics, technological standpoint, cookies are digital generational patterns (e.g. relational packets of data found in a computer’s violence, substance abuse), career history, browser history. These cookies can make and communication patterns to name a few online searches easier and conveniently uses. Genograms allow for school store online passwords, but can also be counselors to engage students in troublesome in that some viruses and conversations within a legacy structure. malware can be disguised as cookies as well Further, genograms provide school (Symantec, 2017). In addition, unless they counselors an opportunity to collaborate are cleared from a browser history, cookies with their client and to engage in a can show exactly where the use has been conversation on a variety of issues from thereby inadvertently revealing confidential multiple perspectives. or private information without the user’s implicit consent (Whitman, Perez, & Beise, Friendships in the Digital Age 2001).
Arnett (1995) was among the first to In the digital age, cookie friendships note adolescent use of media (e.g., have several metaphorical similarities. television, music) to cope, for identity From the outside a new friend may be development, and to connect to larger peer attractive, share similar interests, and open networks through shared interests. Today’s up new social possibilities. However, these social networking has allowed school-aged relationships can also exhibit behaviors that children to connect to larger, international are unhealthy (e.g., bullying, judgment, networks with peers they may never meet distrust, relational violence. Further, digital face-to-face, while simultaneously sharing friendships can also lead to compromising
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situations (e.g., sexting, public shaming, addressing the needs of students in crisis trolling) and have the potential to create through individual and group counseling social crises in the lives of students that can (American School Counselor Association, be very traumatic and public in nature. 2013, p. 50). In 2014, the American School Counselor Association (ASCA) introduced Unlike traditional friendships based ASCA Mindsets and Behaviors for Student on mutual experiences, shared interests, and Success and using these same mindsets as personal investments of time and energy, school counselors we can approach crisis online “friendships” are defined in much events using creative approaches (see looser terms. Being “friends” in the digital B-LS2) and critical thinking to make age might mean a large quantity of online informed choices to systematically address acquaintances that may or may not have crisis (see B-LS1). Crises events include ever met in person, however who are aware suicide, homicide, natural disasters, medical of one anothers’ posted opinions and daily emergencies, grief, abuse, and loss happenings via online posted photos and experiences (Sandoval, 2013). Crisis in a comments. Cookie friendships are school setting has unique challenges because developed in social media and may not be of the social structure and community within for the development of an intimate a community structure inherent to schools. friendship characterized by frequent A crisis in the larger external community face-to-face interactions, but instead formed may impact the day-to-day operations of the to develop social capital. As such there is school community itself affecting both staff no characterization of them on a vertical and students alike within the walls of the structure (see Table 1) to indicate duration school building. of friendships, shared interests or values. The impact of crises may become The Use of Genogram to Support more widespread in a school setting due to Responsive Counseling Services overlapping social networks in a single location as well as the use of social media Genograms can be a very effective (Allen, et al., 2002). Social media is “an and easily accessible tool to aid school umbrella term that is used to refer to a new counselors in assessing a student’s social era of Web-enabled applications that are and familial network in times of crisis. built around user-generated or Creating a genogram serves to (1) engage user-manipulated content, such as wikis, the client, (2) organize the student’s blogs, podcasts, and social networking sites” thoughts, (3) detect patterns, (4) present (Pew Internet and American Life Project, complex material in a concise manner, (5) 2010). During crises, social media usage allows student to creatively engage increases leading experts to conclude that presenting problem, (6) allows the school communicating through social media is the counselor to look for patterns (e.g. strengths, new norm in crises (Baron, 2010). Students weaknesses), and (7) provide points of who actively use social media or become intervention and discovery for the school active during crises assign a higher level of counselor. credibility to social media coverage than to traditional mass media coverage (Procopio School counselors are uniquely & Procopio, 2007). Additionally, social positioned to play a “vital” role in media users indicate social media provides
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emotional support by sharing information piece of paper and drawing three rings on and forming virtual support groups that are the page. The school counselor explains that instantaneous and easily accessible (Choi & the concept of the genogram serves as a Lin, 2009). representation of their family/friendship system, of which the student is the center. Providing an Invitation to the Genogram The student places themselves on the center of the page. The student is then asked to The use of a genograms is an rate who she/he considers to be closest affordable and engaging tool that provides family/friend relations and place them on the the school counselor with an effective closest surrounding rings. Those method to connect with students while relationships that are not as close are placed collecting pertinent information. Genograms on outer rings of the genogram. Students are a mutually developed, process-oriented may then use standard genogram symbols map and school counselors may introduce (i.e., squares and circles) to indicate gender. the use of the genogram when the student The school counselor may direct the student begins to talk about their family and /or to color who lives in the same home as a friends. School counselors may introduce means of understanding the family dynamic. the genogram as a way to gather a lot of Students are invited to add as many rings as information in a short amount of time and necessary to create a visual representation of allowing for the client to visualize the their family/friendship system. presenting issue and the contextual impact. Genograms also acknowledge the After obtaining consent to develop a uniqueness of each client’s family and social genogram, school counselors may use the networks. Genograms will help identify and following questions to collect information in better articulate a student’s system of a written format and incorporate into the influence both in and outside of school. genogram structure. What family members These systems may provide the school may be involved? Are their half-or counselor with some direction as to where to step-siblings involved? Divorced parents? take the conversation without limiting the Who lives in the home? What social circles, content of the counseling session to the friends, club/team members may be presenting issue that is generating a crisis impacted? Are there authentic friendships response. Utilizing a graphic form of their (e.g., face-to-face interaction, long-term support system may aid in the identification personal relationships) or cookie friendships of support systems, as well as sources of (i.e., those developed and limited to social chaos that allow for points for counseling media interactions) involved? Are there intervention by the school counselor siblings at other schools? What other (Chrzastowski, 2011). schools need to be engaged? What school-based stakeholders may assist? What Recognizing there are layers of school-based staff may be impacted? Is there chaos leading to a crisis response allows for a faith-based youth group that may be the school counselor to use a genogram to impacted? What community-based identify the system at play in order to direct organizations or members may be able to intervention (Anderson, 1994). The school assist or are impacted (e.g., churches/youth counselor may guide the student through the groups, hospice, law genogram exercise by providing a blank enforcement/emergency management)?
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Genograms as a Source of Information in “auntie” is in the hospital, rather than ask Schools more questions a school counselor could use a genogram to explore the relationship Genograms are a visual further. representation of an individual’s family used to assess the impact of family and friendship An augmented genogram may ask networks (Chrzastowski, 2011). The use of student-clients to list those they consider to genograms in a school counseling setting be family members by their relationship to can be useful in communicating a student’s the student-client and not by their formal important and dynamic relationships. name (Milewski-Hertlein, 2001). School Recognizing there is no one definition of counselors may ask the student to put “friend” or family demonstrates the need for themselves in the center of a sheet of paper a genogram. This method allows for school and arrange their family members in the counselors to discover and more easily home closer to the diagram of the student understand whom students assign and place other family members around the importance, familial titles to, including periphery. Another method may be to color non-blood relatives or fictive kin code those family members that live in the (Milewski-Hertlein, 2001; Sussman, 1976). home one color and the fictive kin outside of The practice of extending familial titles is the home another color (Milewski-Hertlein, especially common in non-White students 2001; Taylor, Clement, & Ledet, Vernon, who define family as those individuals that 2009). Both methods allow for an nurture and promote the general well-being understanding of the relationships between of the individual (Milewski-Hertlein, 2001). themselves and their family members. Therefore, the use of genograms may be particularly useful in working with minority Expanding the use of genograms school populations (Milewski-Hertlein, to friendship circles in moments of crisis 2001; Vernon, 2009). will allow the school counselor to identify yet undiscovered students in need of Genograms create an opportunity for counseling services, especially those defined the professional school counselor and as cookie friends, “cousin”, “sister”, and student to develop a collaborative language “brother”. Using the example above, a designed to account for family members, student may place self at the center of the authentic friendships and cookie friendships page and arrange friends/ cookie friends and using a culturally sensitive tool. Specifically, fictive kin around self on the page. Next, augmented genograms create opportunities the school counselor could ask the student to for the use of collaborative language in color code those defined as cookie friends as order to create a space to facilitate crisis one color and those with familial titles counseling and to aid the school counselor’s another. Therefore, identifying the spatial understanding of the socially constructed relationship between the student and their meaning of family (Anderson & Goolishian, social network will allow school counselors 1988). Fictive kin refer to relatives not to expand the way they conceptualize a genetically tied to the child, but still friend system in order to provide counseling considered family (Milewski-Hertlein, services. Additionally, the use of a 2001). For example, when a child says they genogram generates more places to are sad or appear tearful because their
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intervene in a system of support (Allen, et Finally, as educators, parents, and al., 2002; Milewski-Hertlein, 2001). caregivers seek to understand friendships and the use of the term “friend” the Implications for Future Research development of assessment to measure “friendships” based on influence, shared The use of the word “friend” values, and emotional proximity may describes a wide range of relationship with operationalize the use of “friend” to define varying degrees of purpose, shared interests, friendships established and maintained level of intimacy, and duration. Previously virtually. Understanding the use of “friend” we suggested a hierarchal approach to provides educators and other adults a defining non-digital friendships (see Table window into the world of school-aged 1). The advent of digital media and children and their peer relations, exposure to specifically, Facebook, has complicated trauma and grief, and provide an opportunity matters because intimacy is being redefined. to strategically intervene through counseling Additionally, Facebook’s use of the term services. “friend” to define an established digital connection has created an overuse of the Final Thoughts for Application term and further clouds how to define the word “friend”. Further, what value is placed A counselor’s need to respond on the varying uses of the terms friend and quickly may be facilitated through the use of friendship when comparing face-to-face to genograms in identifying and locating digital-based interactions. impacted students quickly in order to provide the necessary services through the Smart (1999) suggested delivery component of a comprehensive friendships may be a tool for people and in school counseling program (CSCP) (Baker an age where digital connections lay the & Gerler, 2008; Gysbers & Henderson, groundwork for social capital friendships 2000). With increasing caseloads school may be connections to others and counselors will need accessible, effective, opportunities. Future research may focus on and affordable interventions and tools, like the use of the term “friend” in both genograms, to facilitate responsive services face-to-face interactions and in the digital in a comprehensive manner (ASCA, 2016). context. Because no one attribute defines Additionally, adopting the use of a “friend,” examining differences in how genogram as a school counseling tool does school-aged children define “friend” will not require the need for extra funding since advance the research in this area by it is an easily adoptable method requiring examining the impact of digital platforms. only a piece of paper and writing instrument. Additionally, comparing how they view Further, developing a genogram provides friends they see regularly and the students an opportunity to identify relationships they continue on-line and what themselves within a system of support and attributes define these varying friendships. simultaneously identify sources of Further, comparing this data to data of adults imbalance in their lives. Identifying these at different stages of adulthood may enrich sources of crisis provides a school counselor the body of research by examining their use an opportunity to intervene utilizing of digital media and how “friend” is defined individual counseling, peer mediation, later in life. and/or group counseling to mediate the crisis
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Table 1 Traditional (non-digital) Structure of Friendships
128 Acknowledgements
I am grateful for the hard work of many individuals; without their dedication this volume would not have been possible. First, I'd like to thank the members of the JCRP Editorial Board for reviewing our manuscripts. I'd also like to thank Dr. Amanda Winburn for serving as Co-Editor of the JCRP for the past 2 years. Thank you to Jana Frankum for her hard work as Editorial Assistant, Dylan Wren for providing his assistance with word processing and formatting, and Kristen Butler for her help with APA style checking. Carolyn Anderson has also played a vital role in continuing on the JCRP tradition.
- Dr. Rebekah Reysen