Counseling Reviewer PDF: Chapter 1 Introduction

CHAPTER 1: INTRODUCTION 4. Usefulness Richard S. Sharf Not only should a good theory lead to new hypotheses that THEORY...

CHAPTER 1: INTRODUCTION 4. Usefulness Richard S. Sharf Not only should a good theory lead to new hypotheses that THEORY can be tested, but also it should be helpful to practitioners in their work. To understand theories of psychotherapy and counseling, which are based on theories of individual personality, it is A good theory suggests ways to understand clients and helpful to understand the role and purpose of theory in techniques to help them function better. science and, more specifically, in psychology. Without theory, the practitioner would be left to Theory can be described as “a group of logically organized unsystematic techniques or to “reinventing the wheel” by laws or relationships that constitute explanation in a trying new techniques on new patients until something discipline.” seemed to help. Included in a theory are assumptions related to the topic of Theory is the most powerful tool that therapists have to use the theory and definitions that can relate assumptions to along with their desire to help troubled clients in an ethical observations. manner. CRITERIA BY WHICH THEORIES OF PSYCHOTHERAPY CAN BE PSYCHOTHERAPY AND COUNSELING EVALUATED Psychotherapy and counseling are interactions between a 1. Precision and Clarity therapist/counselor and one or more clients/patients. Theories are based on rules that need to be clear. - The purpose is to help the patient/client with problems that may have aspects that are related to Theories should use operational definitions, which specify disorders of thinking, emotional suffering, or operations or procedures that are used to measure a variable. problems of behavior. - Therapists may use their knowledge of theory of Along with clear concepts and rules, a theory should be personality and psychotherapy or counseling to help parsimonious, or as straightforward as possible. the patient/client improve functioning. Theories should explain an area of study (personality or Some writers have suggested that counseling is used with psychotherapy) with as few assumptions as possible. normal individuals and psychotherapy with those who are severely disturbed. 2. Comprehensiveness - The problem with this distinction is that it is difficult Theories differ in events that they attempt to predict. to differentiate severity of disturbance, and often The more comprehensive a theory, the more widely it can be practitioners use the same set of techniques for applied, but also the more vulnerable it may be to error. clients of varying severity levels. 3. Testability Another proposed distinction is that counseling is educational and informational while psychotherapy is facilitative. Not only must experience show that a theory is valid or effective, but also research must show that it is effective in Another suggests that psychotherapists work in hospitals, bringing about change in individual behavior. whereas counselors work in such settings as schools or guidance clinics. When concepts can be clearly defined, hypotheses (predictions derived from theories) can be stated precisely The terms counseling and psychotherapy are used and tested. interchangeably, except where they have special meanings as defined by the theorist. Sometimes, when hypotheses or the entire theory cannot be confirmed, this failure can lead to development of other Traditionally, the term psychotherapy has been associated hypotheses. with psychiatrists and medical settings, whereas the term counseling has been associated with educational and, to JUNGIAN ANALYSIS AND THERAPY some extent, social-work settings. Jung placed great emphasis on the role of unconscious Theories developed by psychiatrists often use the word processes in human behavior. psychotherapy, or its briefer form, therapy, more frequently than they do counseling. Jungians are particularly interested in dreams, fantasies, other material that reflects unconscious processes, and A related issue is that of the terms patient and client. symbols of universal patterns that are reflected in the unconscious processes of people from all cultures. - Patient is used most often in a medical setting, with client applied more frequently to educational and Therapy focuses on the analysis of unconscious processes so social service settings. that patients can better integrate unconscious processes into conscious awareness. THEORIES OF PSYCHOTHERAPY AND COUNSELING ADLERIAN THERAPY Corsini (2001) summarized 69 new and innovative therapies; now there may be a total of more than 400. Alfred Adler believed that the personality of individuals was formed in their early years as a result of relationships within There has been a move toward integrating theories, as well as the family. a move toward eclecticism. - He emphasized the importance of individuals’ - Integration refers to the use of techniques and/or contributions to their community and to society. concepts from two or more theories. Adlerians are interested in the ways that individuals approach Psychoanalytic theories (those closely related to the work of living and family relationships. Freud and his contemporaries) and psychodynamic theories (those having some resemblance to psychoanalytic theories) The Adlerian approach to therapy is practical. are a popular theoretical orientation that is subscribed to by therapists from a variety of fields. - Seeks to help individuals to change dysfunctional beliefs and encouraging them to take new steps to Cognitive, and to a lesser extent, behavioral methods are change their lives. popular with a variety of mental health workers. - Emphasis is on teaching and educating individuals about dealing with interpersonal problems. PSYCHOANALYSIS EXISTENTIAL THERAPY Sigmund Freud stressed the importance of inborn drives (particularly sexual) in determining later personality A philosophical approach to people and problems relating to development. being human or existing. Others who followed him emphasized the importance of the Existential psychotherapy deals with life themes rather than adaptation to the environment, early relationships between techniques. child and mother, and developmental changes in being absorbed with oneself at the expense of meaningful Themes include living and dying, freedom, responsibility to relationships with others. self and others, finding meaning in life, and dealing with a sense of meaninglessness. Traditional psychoanalytic methods require several years of treatment. Becoming aware of oneself and developing the ability to look beyond immediate problems and daily events to deal with New writings continue to explore the importance of existential themes are goals of therapy, along with developing childhood development on later personality as well as new honest and intimate relationships with others. uses of the therapist’s relationship. The emphasis is on issues and themes. PERSON-CENTERED THERAPY RATIONAL EMOTIVE BEHAVIOR THERAPY Carl Rogers emphasized understanding and caring for the Developed by Albert Ellis, rational emotive behavior therapy client, as opposed to diagnosis, advice, or persuasion. (REBT) focuses on irrational beliefs that individuals develop that lead to problems related to emotions (e.g., fears and The approach to therapy are therapeutic genuineness, anxieties) and to behaviors (such as avoiding social through verbal and nonverbal behavior, and unconditionally interactions or giving speeches). accepting clients for who they are. The most common method is to dispute irrational beliefs and Concerned about understanding the client’s experience and to teach clients to challenge their own irrational beliefs so communicating their understanding to the client so that an that they can reduce anxiety and develop a full range of ways atmosphere of trust can be developed that fosters change on to interact with others. the part of the client. Clients are given responsibility for making positive changes in their lives. COGNITIVE THERAPY Belief systems and thinking are seen as important in determining and affecting behavior and feelings. GESTALT THERAPY Developed by Aaron Beck to help individuals understand their Developed by Fritz Perls which seeks to help the individual to own maladaptive thinking and how it may affect their feelings become more aware of self and others. and actions. Emphasis is on both bodily and psychological awareness. Cognitive therapists use a structured method to help their clients understand their own belief systems. Therapeutic approaches deal with being responsible for oneself and attuned to one’s language, nonverbal behaviors, - By asking clients to record dysfunctional thoughts emotional feelings, and conflicts within oneself and with and using questionnaires to determine maladaptive others. thinking. - They also make use of affective and behavioral - Therapeutic techniques include the development of strategies. creative experiments and exercises to facilitate self- awareness. REALITY THERAPY BEHAVIOR THERAPY Reality therapists assume that individuals are responsible for their own lives and for taking control over what they do, feel, Based on scientific principles of behavior (such as classical and think. and operant conditioning, and observational learning) that applies principles of learning such as reinforcement, Developed by William Glasser, reality therapy uses a specific extinction, shaping of behavior, and modeling. process to change behavior. Emphasis is on precision and detail in evaluating A relationship is developed with clients so that they will psychological concerns and then assigning treatment commit to the therapeutic process. methods that may include relaxation, exposure to a feared object, copying a behavior, or role playing. Emphasis is on changing behaviors that will lead to modifications in thinking and feeling. Techniques include those that change observable behavior and those that deal with thought processes. Making plans and sticking to them to bring about change while taking responsibility for oneself are important aspects of reality therapy. CONSTRUCTIVIST THERAPY FAMILY THERAPY Constructivist therapists see their clients as theorists and try Family therapists attend to interactions between family to understand their clients’ views or the important constructs members and may view the entire family as a single unit or that clients use to understand their problems. system. Three types of constructivist theories: Treatment is designed to bring about change in functioning within the family rather than within a single individual. - Solution-focused therapy centers on finding solutions to problems by looking at what has worked in the Some approaches focus on the impact of the parents’ own past and what is working now, and using active families, others on how family members relate to each other techniques to make therapeutic progress. in the therapy hour, and others on changing symptoms. - Personal construct theory examines clients’ lives as stories and helps to change the story. Some family systems therapists request that all the family - Narrative therapies also view clients’ problems as members be available for therapy, whereas others may deal stories but seek to externalize the problem, unlike with parents or certain members only. personal construct theory. They help clients re-author or change stories, thus finding a OTHER PSYCHOTHERAPIES new ending for the story that leads to a solution to the problem.  Asian therapies often emphasize quiet reflection and personal responsibility to others.  Body therapies work with the interaction between FEMINIST THEORY psychological and physiological functioning.  Interpersonal therapy is a very specific treatment for Feminist therapists emphasize the role of politics and society depression based on a review of research. in creating problems for individuals.  Psychodrama is an active system in which clients, along with group and audience members, play out They are concerned about gender and cultural roles and roles related to their problems while therapists take power differences between men and women and people responsibility for directing the activities. from diverse cultural backgrounds.  Creative arts therapies include art, dance They have examined different ways that gender and culture movement, drama, and music to encourage affect development throughout the life span (including social expressive action and therapeutic change. and sexual development, child-raising practices, and work roles). INTEGRATIVE THERAPY Differences in moral decision making, relating to others, and roles in abuse and violence are issues of feminist therapists. Integrative therapists combine two or more theories in different ways so that they can understand client problems. By combining feminist therapy with other theories, feminist therapists take a sociological as well as a psychological view - They may then use a wide variety of techniques to that focuses not only on gender but also on multicultural help clients make changes in their lives. issues. Prochaska and Norcross’s transtheoretical approach Among the techniques they use are those that help examines many theories, selecting concepts, techniques, and individuals address gender and power inequalities not only by other factors that effective psychotherapeutic approaches changing client behavior but also by changing societal groups have in common. or institutions. - examines client readiness for change, level of problems that need changing, and techniques to bring about change Paul Wachtel’s cyclical psychodynamics combines o In unipolar depression, a manic phase is not psychoanalysis and behavior therapy, as well as some other present. theories.  GAD - Associated with excessive worry and apprehension. Arnold Lazarus’s multimodal therapy uses techniques from o Individuals may experience restlessness, many theories to bring about client change but uses social irritability, problems in concentration, learning theory as a way to view personality. muscular tension, and problems sleeping. o Excessive worry about a variety of aspects of life is common, with anxiety being diffuse HISTORY/BACKGROUND rather than related to a specific fear (phobia), rituals or obsessions (obsessive- To understand a theory of helping others, it is useful to know compulsive disorder), or physical complaints how the theory developed and which factors were significant (somatoform disorder). in its development.  characterized as neuroses, as they all are associated with anxiety of one type or another PERSONALITY THEORIES o The term anxiety disorder can be said to include nonspecific neuroses or anxiety. Personality theories are important because they represent  Borderline Disorders - One of a number of different the ways that therapists conceptualize their clients’ past, personality disorders (such as narcissistic). present, or future behavior, feelings, and thoughts. o Characterized as being inflexible, of long duration, and including traits that make Methods of changing these behaviors or thoughts all derive social or vocational functioning difficult. from those factors that theorists see as most important in o Earned a reputation as being particularly understanding their patients. difficult to treat psychotherapeutically. o Characterized by having unstable interpersonal relationships. THEORIES OF PSYCHOTHERAPY o View of themselves and their moods can change very rapidly and inexplicably in a From goals follows an approach to assessment and theorists short period of time. vary widely in their use of techniques. o Such individuals have fears of being abandoned and often feel let down by others who do not meet their expectations. PSYCHOLOGICAL DISORDERS  OCD - Individuals experience persistent and uncontrollable thoughts or feel compelled to repeat  Depression - Signs of depression include sadness, behaviors again and again. feelings of worthlessness, guilt, social withdrawal, o Obsessions are recurring thoughts that and loss of sleep, appetite, sexual desire, or interest cannot be controlled and are so pervasive. in activities. o Compulsions are behaviors that are o Severe depression may come slow speech, repeated continually to reduce distress or difficulty in sitting still, inattention to prevent something terrible from happening. personal appearance, and pervasive feelings o Should be distinguished from obsessive- of hopelessness and anxiety, as well as compulsive personality disorder, which suicidal thoughts and feelings. refers, in general, to being preoccupied with o Major depression affects about 16% of the rules, details, and schedules. population.  they do not experience obsessions o Bipolar depression, a manic mood in which and compulsions the individual becomes extremely talkative,  Somatoform Disorders - There is a physical symptom distractible, seductive, and/or active occurs but no known physiological cause, and a along with episodes of extreme depression. psychological cause is suspected.  o Includes hypochondria, which is diagnosed o Physiological dependency - developing when a person is worried about possibly withdrawal symptoms having a serious disease and there is no o Substance-dependent or addicted - when evidence for it. physiological dependence exists o Conversion disorder is also a type of o substance abuse is used broadly and somatoform disorder. includes psychological and/or physiological  psychological disturbances that dependence on a variety of drugs take a physical form, such as  Narcissistic Personality Disorder - Showing a pattern paralysis of the legs of self-importance, the need for admiration from  Freud called hysteria others, and a lack of empathy.  PTSD - Extreme reactions to a highly stressful event. o Believing that others should treat them o Stress reactions last for months or years favorably, they become angry when this is and often include physiological symptoms not done. such as difficulty in sleeping or  Schizophrenia - Severe disturbances of thought, concentrating. emotions, and behaviors. o They may re-experience the event through o Individuals may think and speak in illogical nightmares or images that remind them of fragments that are very disorganized and the event. may have delusions. o Another aspect of PTSD is attempting to o Hallucinations are prevalent among avoid feeling or thinking about the trauma individuals with schizophrenia. or event. o Psychosis is a broader term including  Eating Disorders schizophrenia and other disorders in which o Anorexia is diagnosed when individuals do individuals have lost contact with reality. not maintain a minimally normal body weight.  individuals are very afraid of BRIEF PSYCHOTHERAPY gaining weight and view parts of their body as too big, others may Length of therapy has become an issue of increasing see them as emaciated importance to practicing psychotherapists. o Bulimia refers to binge eating and inappropriate methods of preventing Session limits may range broadly from 3 to more than 40, weight gain. depending on the agency’s resources and philosophy.  includes excessive consumption of Clients often seek treatment that will take several weeks or food at meals or other times months rather than several years.  inappropriate methods of controlling weight gain include Terms used to refer to brief approaches to psychotherapy: self-induced vomiting, misuse of laxatives or enemas, or excessive  Brief and short-term therapies refer to limits placed fasting or exercise on the number of sessions, for example, no more  individuals with bulimia often are than 20 sessions. of normal weight  Time-limited therapy represents a theoretical o Some individuals have experienced both approach to therapy that takes a certain number of anorexia and bulimia at various times in sessions for completion, such as 12, with specific their lives. issues being addressed in each phase of the 12-  Substance Abuse -Individuals use drugs to such an session limit. extent that they have difficulty meeting social and occupational obligations. Most of the other theoretical approaches acknowledge the o Psychological dependency - relying on a importance of brief psychotherapy and demonstrate under drug because it makes difficult situations what circumstances these therapies can be applied briefly. less stressful CURRENT TRENDS o Another goal is to develop and evaluate research-supported psychological  Treatment Manuals - Guidelines for therapists as to treatments (RSPT) for therapists. how to treat patients with particular disorders or o pretest-posttest control group design and problems. meta-analysis o they describe skills and the sequence of  Gender Issues - Virtually all theories of using these skills that therapists should use psychotherapy discussed in this book have been o they specify procedures in a clear manner developed by men (except feminist therapy). o provide an opportunity for researchers to o The theory that has been most frequently investigate the effectiveness of a particular criticized for negative values regarding method women is psychoanalysis. o goal is to have a specific approach that has o Another issue regarding gender that is not been proven to be effective that therapists frequently addressed by theories is that of can use to help clients attitudes and values toward gays, lesbians, o vary in their content depending on whether bisexual people, and transgendered people. the treatment manual is written  Multicultural Issues - Therapists deal with clients  Research-Supported Psychological Treatments - whose cultural backgrounds are very different from Known by the terms evidence-based psychotherapy their own. and empirically supported therapy. o Theories may reflect the culture and o purpose is to find out if psychotherapy background of the theorist. research supports that the therapy has  Group Therapy - Has the advantage of being more been effective in providing efficient than individual therapy because it serves psychotherapeutic treatment more people at the same time. o the most extensive review of RSPT is A o They frequently have between 6 and 10 Guide to Treatments That Work members and 1 or 2 leaders.  Postmodernism and Constructivism - A very o Participants can learn effective social skills different influence than treatment manuals and and try out new styles of relating with other RSPT. members of the group. o postmodernism does not assume that there is a fixed truth o modernism takes a rationalist approach that emphasizes scientific truth and is a ETHICS reflection of advances in technology and Therapists must behave in an ethical and legal way to help science clients with psychological problems and these ethical codes o constructivism view individuals as creating are in substantial agreement as to actions that constitute their own views of events and relationships ethical and unethical behavior on the part of the therapist. in their lives o social constructionism focuses on the Ethical codes also discuss limitations on social and personal shared meanings that people in a culture or relationships with clients such as relationships with clients society develop outside of therapy. Confidentiality and the issue of releasing information about clients are also major issues addressed in ethical codes. USING A THEORY WITH OTHER THEORIES Other issues include concerns about referrals and record  Research - Psychoanalysts and Jungian analysts keeping while competency to practice and to help clients with questioned the value of research in determining the many different issues can raise ethical dilemmas. effectiveness of psychotherapy. o A major goal of psychotherapy research is Difficult issues, such as the need to protect people a client to understand how different forms of intends to harm, have required much attention and have treatment operate. complex solutions. CHAPTER 2: THE COUNSELOR: PERSON AND PROFESSIONAL PERSONAL CHARACTERISTICS OF EFFECTIVE COUNSELORS Gerald Corey  Effective therapists have an identity.  Effective therapists respect and appreciate INTRODUCTION themselves.  Effective therapists are open to change. By remaining open to self-evaluation, you not only expand  Effective therapists make choices that are life your awareness of self but also build the foundation for oriented. developing your abilities and skills as a professional.  Effective therapists are authentic, sincere, and honest.  Effective therapists have a sense of humor. THE COUNSELOR AS A THERAPEUTIC PERSON  Effective therapists make mistakes and are willing to admit them. Counseling is an intimate form of learning, and it demands a  Effective therapists generally live in the present. practitioner who is willing to be an authentic person in the  Effective therapists appreciate the influence of therapeutic relationship. culture. - within the context of such a person-to-person  Effective therapists have a sincere interest in the connection that the client experiences growth welfare of others. - our own genuineness can have a significant effect on  Effective therapists possess effective interpersonal our relationship with our clients skills. - if we model authenticity by engaging in appropriate  Effective therapists become deeply involved in their self-disclosure, our clients will tend to be honest work and derive meaning from it. with us  Effective therapists are passionate.  Effective therapists are able to maintain healthy Who the psychotherapist is directly relates to his or her boundaries. ability to establish and maintain effective therapy relationships with clients. Do not think of these personal characteristics from an all-or- nothing perspective; rather, consider them on a continuum. Abundant research indicates the centrality of the person of the therapist as a primary factor in successful therapy. The person of the psychotherapist is inextricably intertwined PERSONAL THERAPY FOR THE COUNSELOR with the outcome of psychotherapy. Counselors can benefit greatly from the experience of being Techniques themselves have limited importance in the clients at some time, a view that is supported by research. therapeutic process. A review of research studies on the outcomes and impacts of Contextual factors are the primary determinants of the psychotherapist’s own psychotherapy revealed that more therapeutic outcome: than 90% of mental health professionals report satisfaction and positive outcomes from their own counseling - the alliance, the relationship, the personal and experiences. interpersonal skills of the therapist, client agency, and extra-therapeutic factors Orlinsky and colleagues suggest that personal therapy contributes to the therapist’s professional work in the Both the therapy relationship and the therapy methods used following three ways: influence the outcomes of treatment, but it essential that the methods used support the therapeutic relationship being 1. as part of the therapist’s training, personal therapy formed with the client. offers a model of therapeutic practice in which the trainee experiences the work of a more experienced therapist and learns experientially what is helpful or not helpful  2. a beneficial experience in personal therapy can The counseling process is not about your personal values; it is further enhance a therapist’s interpersonal skills that about the values and needs of your clients. are essential to skillfully practicing therapy 3. successful personal therapy can contribute to a therapist’s ability to deal with the ongoing stresses The Role of Values in Developing Therapeutic Goals associated with clinical work It is largely the client’s responsibility to decide upon goals, Norcross (2005) states that lasting lessons practitioners learn collaborating with the therapist as therapy proceeds. from their personal therapy experiences pertain to interpersonal relationships and the dynamics of Counselors have general goals, which are reflected in their psychotherapy. behavior during the therapy session, in their observations of the client’s behavior, and in the interventions they make. As therapists, we should be aware of what these conflicts are and how they are likely to affect us as persons and as Setting goals is inextricably related to values. counselors. Therapy ought to begin with an exploration of the client’s Personal therapy can be instrumental in healing the healer. expectations and goals. As we increase our self-awareness through our own therapy, In some cases clients have no goals; they are in the therapist’s we gain increased appreciation for the courage our clients office simply because they were sent for counseling by their display in their therapeutic journey. parents, probation officer, or teacher. The initial interview can be used most productively to focus on the client’s goals or lack of them. THE COUNSELOR’S VALUES AND THE THERAPEUTIC PROCESS When a person seeks a counseling relationship with you, it is The Role of Values in Counseling important to cooperatively discover what this person is expecting from the relationship. Personal values influence how we view counseling and the manner in which we interact with clients, including the way we conduct client assessments, our views of the goals of counseling, the interventions we choose, the topics we select BECOMING AN EFFECTIVE MULTICULTURAL COUNSELOR for discussion in a counseling session, how we evaluate progress, and how we interpret clients’ life situations. It is an ethical obligation for counselors to develop sensitivity to cultural differences if they hope to make interventions that Although total objectivity cannot be achieved, we can strive are consistent with the values of their clients. to avoid being encapsulated by our own worldview. Diversity in the therapeutic relationship is a two-way street. You may not agree with certain of your clients’ values, but you need to respect their right to hold divergent values from - As a counselor, you bring your own heritage with yours. you to your work, so you need to recognize the ways in which cultural conditioning has influenced the Bracketing - managing your personal values so that they do directions you take with your clients. not contaminate the counseling process Effective counseling must take into account the impact of Value imposition - counselors directly attempting to define a culture on the client’s functioning, including the client’s client’s values, attitudes, beliefs, and behaviors degree of acculturation. - unethical for counselors to impose their values in the - Culture is the values and behaviors shared by a therapeutic relationship group of individuals. Value exploration is at the heart of why many counselor Culture also includes factors such as age, gender, religion, education programs encourage or require personal therapy sexual orientation, physical and mental ability, and for counselors in training. socioeconomic status. Acquiring Competencies in Multicultural Counseling ISSUES FACED BY BEGINNING THERAPISTS Effective counselors understand their own cultural 1. Dealing With Anxiety conditioning, the cultural values of their clients, and the o A certain level of anxiety demonstrates that sociopolitical system of which they are a part. you are aware of the uncertainties of the future with your clients and of your abilities It begins with counselors’ awareness of the cultural origins of to really be there for them. any values, biases, and attitudes they may hold. o A willingness to recognize and deal with these anxieties, as opposed to denying It takes a concerted effort and vigilance to monitor our biases, attitudes, and values so that they do not interfere them, is a positive sign. with establishing and maintaining successful counseling 2. Being Yourself and Self-Disclosure relationships. o Inexperienced therapists too often fail to appreciate the values inherent in simply Becoming a diversity-competent practitioner is not a being themselves. destination that we arrive at once and for all; rather, it is an o If we are able to be ourselves in our ongoing process, a journey we take with our clients. therapeutic work, and appropriately disclose our reactions in counseling Sue, Arredondo, and McDavis (1992) and Arredondo and her sessions, we increase the chances of being colleagues (1996) have developed a conceptual framework authentic. for competencies and standards in multicultural counseling. o Judging the appropriate amount of self- disclosure can be a problem even for - Their dimensions of competency involve three areas: seasoned counselors, and it is often 1. beliefs and attitudes especially worrisome for new counselors. 2. knowledge o Consider what to reveal, when to reveal, 3. skills and intervention strategies and how much to reveal. o The most productive form of self-disclosure is related to what is going on between the Incorporating Culture in Counseling Practice counselor and the client within the counseling session. It is a good idea for counselors to ask clients to provide them 3. Avoiding Perfectionism with the information they will need to work effectively. o Although we may well know intellectually that humans are not perfect, emotionally Incorporating culture into the therapeutic process is not we often feel that there is little room for limited to working with clients from a certain ethnic or error. cultural background. o To be sure, you will make mistakes, It is critical that therapists take into account the worldview whether you are a beginning or a seasoned and background of every client. therapist. 4. Being Honest About Your Limitations No ideal therapeutic approaches because different theories o It takes honesty to admit that you cannot have distinct features that have appeal for different cultural work successfully with every client. groups. o It is important to learn when and how to make a referral for clients when your Practical Guidelines in Addressing Culture - If the counseling limitations prevent you from helping them. process is to be effective, it is essential that cultural concerns o There is a delicate balance between be addressed with all clients. learning your realistic limits and challenging what you sometimes think of as being “limits.” 5. Understanding Silence o Silent moments during a therapeutic session may seem like silent hours to a  beginning therapist, yet this silence can o Countertransference includes any of our have many meanings. projections that influence the way we o The silence may be refreshing, or the perceive and react to a client. silence may be overwhelming. o Although we cannot completely free o When silence occurs, acknowledge and ourselves from any traces of explore with your client the meaning of the countertransference or ever fully resolve all silence. personal conflicts from the past, we can 6. Dealing With Demands From Clients become aware of ways these realities o Because therapists feel they should extend influence our professional work. themselves in being helpful, they often 10. Developing a Sense of Humor burden themselves with the unrealistic idea o Therapy is a responsible endeavor, but it that they should give unselfishly, regardless need not be deadly serious. of how great clients’ demands may be. o Both clients and counselors can enrich a o One way of heading off these demands is to relationship through humor. make your expectations and boundaries o It is important to recognize that laughter or clear during the initial counseling sessions humor does not mean that clients are not or in the disclosure statement. respected or work is not being 7. Dealing With Clients Who Lack Commitment accomplished. o Involuntary clients may be required by a 11. Sharing Responsibility With the Client court order to obtain therapy, and you may o It is your responsibility to discuss specific be challenged in your attempt to establish a matters such as length and overall duration working relationship with them. of the sessions, confidentiality, general o It is possible to do effective work with goals, and methods used to achieve goals. mandated clients, but practitioners must o It is not your role to assume responsibility begin by openly discussing the nature of the for directing your clients’ lives. relationship. 12. Declining to Give Advice o It is important to prepare them for the o Counseling should not be confused with process; doing so can go a long way toward dispensing information. increasing their cooperation and o Therapists help clients discover their own involvement. solutions and recognize their own freedom 8. Tolerating Ambiguity to act. o Many beginning therapists experience the o Our task is to help clients make anxiety of not seeing immediate results. independent choices and accept the o Learn to tolerate the ambiguity of not consequences of their choices. knowing for sure whether your client is 13. Defining Your Role as a Counselor improving, at least during the initial o As a counselor, you will likely be expected sessions. to function with a diverse range of roles. o Realize that the fruitful effects of the joint o The central function of counseling is to help efforts of the therapist and the client may clients recognize their own strengths, manifest themselves after the conclusion of discover what is preventing them from therapy. using their resources, and clarify what kind 9. Becoming Aware of Your Countertransference of life they want to live. o Working with clients can affect you in o You will need to consider that the personal ways, and your own vulnerabilities professional roles you assume are likely to and countertransference are bound to be dependent on factors such as the client surface. populations with whom you are working, o Beginning counselors need to learn how to the specific therapeutic services you are “let clients go” and not carry around their providing, the particular stage of problems until the next session. counseling, and the setting in which you work. - 14. Learning to Use Techniques Appropriately CHAPTER 3: ETHICAL ISSUES IN COUNSELING PRACTICE o It is important to avoid using techniques in Gerald Corey a hit-or-miss fashion, to fill time, to meet your own needs, or to get things moving. o Your methods need to be thoughtfully It is important to stimulate your thinking about the chosen as a way to help clients make importance of ethical practice so you will have a sound therapeutic progress. foundation for making ethical decisions. 15. Developing Your Own Counseling Style MANDATORY ETHICS involves a level of ethical functioning at o Be aware of any tendency to copy the style the minimum level of professional practice. of a supervisor, therapist, or some other model. ASPIRATIONAL ETHICS focuses on doing what is in the best o Your counseling style will be influenced by interests of clients. your teachers, therapists, and supervisors, but don’t blur your potential uniqueness by - It involves the highest standards of thinking and trying to imitate them. conduct. 16. Maintaining Your Vitality as a Person and as a - It entails understanding the spirit of the code and the principles on which the code is based. Professional o Ultimately, your single most important - Fear-based ethics does not constitute sound ethical instrument is the person you are, and your practice. most powerful technique is your ability to - Strive to work toward concern-based ethics, and model aliveness and realness. think about how you can become the best o Consider how you can apply the theories practitioner possible. you will be studying to enhance your life POSITIVE ETHICS is an approach taken by practitioners who from both a personal and a professional want to do their best for clients rather than simply meet standpoint. minimum standards to stay out of trouble. o Learn to look within yourself to determine what choices you are making (and not making) to keep yourself vital. o If you are aware of the factors that sap your PUTTING CLIENTS’ NEEDS BEFORE YOUR OWN vitality as a person, you are in a better Ethically, it is essential that we become aware of our own position to prevent the condition known as needs, areas of unfinished business, potential personal professional burnout. problems, and especially our sources of countertransference. o Self-monitoring is a crucial first step in self- care. Our professional relationships with our clients exist for their o As counseling professionals, we tend to be benefit. caring people who are good at taking care of others, but often we do not treat As helping professionals, we must actively work toward ourselves with the same level of care. expanding our self-awareness and learn to recognize our  If we neglect to care for ourselves, areas of prejudice and vulnerability. our clients will not be getting the It is crucial that we do not meet our needs at the expense of best of us. our clients. o Wellness and self-care are being given increased attention in professional journals and at professional conferences. ETHICAL DECISION MAKING In practice, you will have to apply the ethics codes of your profession to the many practical problems you face. You should also be aware of the consequences of practicing in ways that are not sanctioned by organizations of which you are a member or the state in which you are licensed to Informed consent involves the right of clients to be informed practice. about their therapy and to make autonomous decisions pertaining to it. There are hosts of ways to violate a client’s privacy through The Role of Ethics Codes as a Catalyst for Improving Practice the inappropriate use of various forms of modern-day technology. Professional codes of ethics serve a number of purposes. As a part of the informed consent process, it is wise to discuss Perhaps most important, ethics codes provide a basis for the potential privacy problems of using a wide range of reflecting on and improving your professional practice. technology and to take preventive measures to protect both Self-monitoring is a better route for professionals to take you and your clients. than being policed by an outside agency. Educating the client begins with the initial counseling session, It makes sense to be aware of the legal aspects of practice and this process will continue for the duration of counseling. and to know and practice risk-management strategies, but we Informed consent in counseling can be provided in written should not lose sight of what is best for our clients. form, orally, or some combination of both. Ethics codes are best used as guidelines to formulate sound reasoning and serve practitioners in making the best judgments possible. DIMENSIONS OF CONFIDENTIALITY Confidentiality is an ethical concept, and in most states it is the legal duty of therapists not to disclose information about Some Steps in Making Ethical Decisions a client. 1. Identify the problem or dilemma. Privileged communication is a legal concept that protects 2. Identify the potential issues. clients from having their confidential communications 3. Look at the relevant ethics codes for general revealed in court without their permission. guidance on the matter. 4. Consider the applicable laws and regulations, and The legal concept of privileged communication does not apply determine how they may have a bearing on an to group counseling, couples counseling, family therapy, child ethical dilemma. and adolescent therapy, or whenever there are more than 5. Seek consultation from more than one source to two people in the room. obtain various perspectives on the dilemma, and document in the client’s record the suggestions you Confidentiality is central to developing a trusting and received from this consultation. productive client–therapist relationship. 6. Brainstorm various possible courses of action. 7. Enumerate the consequences of various decisions, Counselors have an ethical and legal responsibility to discuss and reflect on the implications of each course of the nature and purpose of confidentiality with their clients action for your client. early in the counseling process. 8. Decide on what appears to be the best possible Clients have a right to know that their therapist may be course of action. discussing certain details of the relationship with a supervisor Professional maturity implies that you are open to or a colleague. questioning and discussing your quandaries with colleagues. Ethical Concerns with the Use of Technology THE RIGHT OF INFORMED CONSENT Issues pertaining to confidentiality and privacy can become Regardless of your theoretical framework, informed consent more complicated when technology is involved. is an ethical and legal requirement that is an integral part of the therapeutic process. Exceptions to Confidentiality and Privileged Communication knowledge and skill that they can bring to bear on any counseling situation. There are times when confidential information must be divulged, and there are many instances in which keeping or It is essential to be mindful of diversity and social justice breaking confidentiality becomes a cloudy issue. issues if we are to practice ethically and effectively. In determining when to breach confidentiality, therapists Focusing on Both Individual and Environmental Factors must consider the requirements of the law, the institution in which they work, and the clientele they serve. A theoretical orientation provides practitioners with a map to guide them in a productive direction with their clients. Here are some other circumstances in which information must legally be reported by counselors: An adequate theory of counseling does deal with the social and cultural factors of an individual’s problems. - When the therapist believes a client under the age of 16 is the victim of incest, rape, child abuse, or some By using techniques from many of the traditional therapies, other crime counselors can help clients increase their awareness of their - When the therapist determines that the client needs options in dealing with barriers and struggles. hospitalization - When information is made an issue in a court action - When clients request that their records be released ETHICAL ISSUES IN THE ASSESSMENT PROCESS to them or to a third party The Role of Assessment and Diagnosis in Counseling In general, the counselor’s primary obligation is to protect client disclosures as a vital part of the therapeutic Assessment and diagnosis are integrally related to the relationship. practice of counseling and psychotherapy, and both are often viewed as essential for planning treatment. For some approaches, a comprehensive assessment of the ETHICAL ISSUES FROM A MULTICULTURAL PERSPECTIVE client is the initial step in the therapeutic process. Are Current Theories Adequate in Working With Culturally Some practitioners consider assessment as a part of the Diverse Populations? process that leads to a formal diagnosis. It is essential for therapists to create therapeutic strategies Assessment consists of evaluating the relevant factors in a that are congruent with the range of values and behaviors client’s life to identify themes for further exploration in the that are characteristic of a pluralistic society. counseling process. Is Counseling Culture-Bound? Diagnosis, which is sometimes part of the assessment process, consists of identifying a specific mental disorder Western models of counseling have some limitations when based on a pattern of symptoms. applied to special populations and cultural groups such as Asian and Pacific Islanders, Latinos, Native Americans, and - Diagnosis may include an explanation of the causes African Americans. of the client’s difficulties, an account of how these problems developed over time, a classification of any Contemporary therapy approaches are grounded on a core disorders, a specification of preferred treatment set of values, which are neither value-neutral nor applicable procedure, and an estimate of the chances for a to all cultures. successful resolution. Regardless of the therapist’s orientation, it is crucial to listen - The purpose of diagnosis in counseling and to clients and determine why they are seeking help and how psychotherapy is to identify disruptions in a client’s best to deliver the help that is appropriate for them. present behavior and lifestyle. - Diagnosis begins with the intake interview and Competent therapists understand themselves as social and continues throughout the duration of therapy. cultural beings and possess at least a minimum level of A danger of the diagnostic approach is the possible failure of - the therapy relationship, the therapist’s personality counselors to consider ethnic and cultural factors in certain and therapeutic style, the client, and environmental patterns of behavior. factors DSM-5 does not take into account the political, economic, EDP tend to emphasize only one of these aspects— social, and cultural factors in the lives of clients, which may interventions based on the best available research with the play a significant role in the problems of clients. aim to require psychotherapists to base their practice on techniques that have empirical evidence to support their Barnett and Johnson (2015) suggest that practitioners give efficacy. careful consideration before rendering a diagnosis and take into consideration the realities of discrimination, oppression, They emphasize that the overarching goal of EBP is to and racism in society and in the mental health disciplines. enhance the effectiveness of client services and to improve public health and warn that mental health professionals need The theory from which you operate influences your thinking to take a proactive stance to make sure this goal is kept in about the use of a diagnostic framework in your therapeutic focus. practice. Regardless of the particular theory espoused by a therapist, both clinical and ethical issues are associated with the use of MANAGING MULTIPLE RELATIONSHIPS IN COUNSELING assessment procedures and possibly a diagnosis as part of a PRACTICE treatment plan. Dual or multiple relationships, either sexual or nonsexual, Most practitioners and many writers in the field consider occur when counselors assume two (or more) roles assessment and diagnosis to be a continuing process that simultaneously or sequentially with a client. focuses on understanding the client. The term multiple relationship is more often used than the Therapists need to take into account the biological processes term dual relationship because of the complexities involved in as possible underlying factors of psychological symptoms and these relationships, but both terms appear in various work closely with physicians. professional codes of ethics, and the ACA (2014) uses the term nonprofessional relationships. When clinicians blend their professional relationship with ETHICAL ASPECTS OF EVIDENCE-BASED PRACTICE another kind of relationship with a client, ethical concerns must be considered. A shift has occurred toward promoting the use of specific interventions for specific problems or diagnoses based on Some examples of nonsexual dual or multiple relationships empirically supported treatments. are combining the roles of teacher and therapist or of supervisor and therapist; bartering for goods or therapeutic This trend toward specific, empirically supported treatment is services; borrowing money from a client; providing therapy to referred to as evidence-based practice (EBP): “the a friend, an employee, or a relative; engaging in a social integration of the best available research with clinical relationship with a client; accepting an expensive gift from a expertise in the context of patient characteristics, culture, client; or going into a business venture with a client. and preferences.” Because nonsexual multiple relationships are necessarily Norcross, Hogan, and Koocher (2008) advocate for inclusive complex and multidimensional, there are few simple and evidence-based practices that incorporate the three pillars of absolute answers to resolve them. EBP: Ethical reasoning and judgment come into play when ethics 1. looking for the best available research codes are applied to specific situations. 2. relying on clinical expertise 3. taking into consideration the client’s characteristics, Perspectives on Multiple Relationships culture, and preferences Herlihy and Corey (2015b) contend that some of the Many aspects of treatment are vital contributors to the problematic aspects of engaging in multiple relationships are success of psychotherapy. that they are pervasive; they can be difficult to recognize; Spotts-De Lazzer (2012) believes practitioners will have to they are unavoidable at times; they are potentially harmful, translate and maintain traditional ethics when it comes to but not necessarily always harmful; they can be beneficial; social media and offers these recommendations: and they are the subject of conflicting advice from various experts.  Limit what is shared online. ŠŠ  Include clear and thorough social networking policies Some of the codes of the professional organizations advise as part of the informed consent process. ŠŠ against forming multiple relationships, mainly because of the  Regularly update protective settings because social potential for misusing power, exploiting the client, and media providers often change their privacy rules. impairing objectivity. A consensus of many writers is that multiple relationships are inevitable and unavoidable in some situations and that a BECOMING AN ETHICAL COUNSELOR global prohibition is not a realistic answer. Knowing and following your profession’s code of ethics is part In determining whether to proceed with a multiple of being an ethical practitioner, but these codes do not make relationship, it is critical to consider whether the potential decisions for you. benefit to the client of such a relationship outweighs its You will have to assume responsibility for deciding how to act potential harm. in ways that will further the best interests of your clients. Herlihy and Corey (2015b) identify the following guidelines: Š Ethical decision making is an evolutionary process that  Set healthy boundaries early in the therapeutic requires you to be continually open and self-reflective. relationship. Becoming an ethical practitioner is not a final destination but  Involve clients in ongoing discussions and in the a journey that will continue throughout your career. decision-making process, and document your discussions.  Consult with fellow professionals as a way to maintain objectivity and identify unanticipated difficulties.  When multiple relationships are potentially problematic, or when the risk for harm is high, it is always wise to work under supervision.  Self-monitoring is critical throughout the process. Establishing and maintaining consistent yet flexible boundaries is necessary if you are to effectively counsel clients. One important aspect of maintaining appropriate professional boundaries is to recognize boundary crossings and prevent them from becoming boundary violations. Boundary crossing is a departure from a commonly accepted practice that could potentially benefit a client. Boundary violation is a serious breach that harms the client and is therefore unethical. Flexible boundaries can be useful in the counseling process when applied ethically.