Client as counselor: self-regulation strategies

Recent research in counseling suggests the efficacy of teaching the clients to be their own counselors through the use of self-regulation procedures. This article explores three primary steps involved in helping clients to control their own behavior change: self-observation, self-monitoring, and self-regulation strategies. Self-regulation provides an affirmative answer to the question: “Is the client a counselor?” by promoting client responsibility and independence in the counseling process.     

The three worlds of the counselor

The counselor is seen as one who is personally involved as he deals with his client, but in much of his counseling he cannot escape dealing with himself as well. Three dilemmas of the counselor are analyzed: Can he enter the value world of his more youthful client in order to deal with such questions as respect for authority and learning from the past without compromising his own values? Can he “care” for the client and still show concern about what the client does? Can the counselor grow as a person and at the same time achieve professional success?     

Hope as empowerment model: A client-based perspective on the process of hope development

Abstract

Research on the relationship of client hope to successful therapy outcome underlines the need to discover the processes and conditions when hope flourishes. Snyder’s Hope Theory has been applied to psychotherapy but client subjective experiences are needed to illuminate nuances in the process. The present study examined the trajectory of hope development in psychotherapy using interviews with 18 counseling clients, analyzed using grounded theory methodology. Findings were synthesized into a dynamic model titled hope as empowerment model (HEM) that shares features of Snyder’s Hope Theory. HEM introduces patterns of particular salience to psychotherapy. The compatibility of client preferences with therapist input raised faith in the process of counseling and, in turn, hope in a positive outcome. A number of conditions, including the flexibility of client role preferences and the directiveness of hope-inspiring therapeutic strategies, influenced the nature and strength of client hope. Implications for therapy and positive psychology are considered.     

New Directions in Counseling Women

A revolution in counseling women is one logical outcome of recent changes in the social, political, and economic movements that have predisposed individuals to modify their life-styles and value systems. This article discusses four facets of that revolution and concludes that new counselor training programs are required to meet the needs of emerging client populations. The conclusions are supported by research that indicates (a) new sources of knowledge about the development and functioning of women clients; (b) new groups of client populations whose needs are not being met by traditional counseling strategies; (c) innovative procedures specifically tailored to the unique characteristics of these client groups; and (d) revised standards of ethical practice to ensure competent and appropriate services for all client populations. Training programs are outlined that provide guidelines for sex-fair education for all counselors and more intensively focused training for counselors who select the counseling of women clients as a career specialty.     

Person‐Centered Counseling: The Culture Within

The variables most related to success in counseling outcome research are the client‐counselor relationship and the personal and situational resources of the client (extratherapeutic variables). When these variables are compromised, a “specificity myth” is endorsed purporting that there are specific treatments for particular groups of people. This myth is a direct result of a shift in focus from the client to the counselor as the expert who focuses on “doing” counseling rather than “being” a counselor. Person‐centered counseling cuts to the core of therapeutic success: the relationship of the counselor‐client and the utilization of the client's resources.     

Psychological Distress with Direct-to-Consumer Genetic Testing: A Case Report of an Unexpected <Emphasis Type="Italic">BRCA</Emphasis> Positive Test Result

We report a case of a client who discovered she had a BRCA mutation following direct-to-consumer (DTC) genetic testing in the absence of genetic counseling. After testing she presented for genetic counseling with anxiety, distress, and a deficit of knowledge about what the DTC genetic testing revealed. Genetic counseling helped alleviate distress while empowering the client to apply the results of testing to improve medical management. Despite recent studies demonstrating no negative psychological impact of DTC genetic testing on the consumer, this case illustrates that significant psychological distress and confusion can occur as a result of DTC genetic testing for highly penetrant single gene disorders. Pre- and post-test genetic counseling in conjunction with DTC genetic testing may alleviate consumers’ distress and empower clients to proactively utilize their result information.     

Building on an Empirical Foundation: Strategies to Enhance Good Practice

Reviews of the research literature on outcomes in counseling agree that counseling works. It is also possible to use research to identify strategies for increasing the probability of successful counseling. Such strategies include careful assessment of the client, matching the client and counselor on demographic and attitudinal variables, and maintaining a productive working alliance through open disclosure to the client of the counselor's background and procedures, inquiry into the client's experience of counseling process, and management of client resistance.     

会谈中的当事人阻抗及工作同盟的影响因素:一项过程研究

从心理咨询过程研究视角,以38个会谈为对象,考察咨询师指导和当事人特质逆反对当事人阻抗的影响,并检验三者对工作同盟的影响。结果:指导正向预测阻抗,特质逆反则不能,二者的交互作用也不显著;阻抗负向预测工作同盟,指导则不能,二者的交互作用和中介作用都不显著,但阻抗的中介效应相对更大。结论:咨询师指导增加当事人阻抗;当事人阻抗破坏工作同盟,并在咨询师指导对工作同盟的影响过程中可能起中介作用。     

Ethics in Case Conceptualization and Diagnosis: Incorporating a Medical Model Into the Developmental Counseling Tradition

In this literature review, the author focuses on several ethical considerations in case conceptualization and diagnosis, including diagnostic training and competence. Meeting the American Counseling Association's (1995) ethical standard for diagnostic training has several ethical implications for counselors, counselor educators, and supervisors. For counselors who might struggle with how to meet their ethical responsibilities in diagnosis but who want to remain true to their developmental counseling emphases, the author discusses some of their concerns, the implications of and possible approaches to this aspect of their work. Conclusion Yalom (2002) asked a poignant question of counselors in his book, The Gift of Therapy: “If you were in personal psychotherapy or are considering it, what DSM‐IV diagnosis do you think your therapist could justifiably use to describe someone as complicated as you?” (p. 5). This question and continued dialogue about the ethics and implications of diagnosis are essential aspects of diagnostic training. Yalom's poignant and deeply personal question seems especially appropriate for increasing a counselor's empathy toward the client's sensitivity and vulnerability during the diagnostic process. Counselor educators might ask how one remains true to a developmental model of counseling while adhering to the ethical and accreditation standards of teaching the DSM's medical model of diagnosis. Counselors may also question how to use diagnosis ethically and empathically. Seligman (1999) recommended that clinicians view the DSM as one of many important sources of information about a person. Furthermore, counselors should seek to incorporate diagnostic information into a holistic context, recognizing that a diagnosis does not reflect the totality of the client. Some counselor educators have advised students to integrate the DSM model into their work with clients rather than abandoning their developmental roots (Waldo et al., 1993). Some counselors may not actually put their diagnoses in writing; Seligman believed, however, that thinking diagnostically may assist counselors in determining the best approaches to help clients and to help clients help themselves. This clinical and ethical debate about how, and in fact, whether, to integrate the medical model of the DSM and the developmental origins and distinctiveness of counseling continues. However, the CACREP (2001) standards, managed care systems, and other forces have pushed counseling professionals toward a medical model by mandating counselor knowledge and use of the DSM. Whatever a counselor's stance and behavior on client assessment and diagnosis may be, the literature presented in this review and discussion seems to suggest a need for heightened sensitivity to, preparation for, and accuracy in all facets of client assessment, especially diagnosis.     

Client Quest—A Key to Counseling

The expression quest is proposed to represent any unifying theme of client purposes. Counseling is then defined as an interview in which client quest is superordinate to counselor quest. It is suggested that client quests be classified by their direction. Thus, quests may be for understanding or change, and, at a higher level, for mastering self or environment. The identification, clarification, and management of client quests becomes central to effective counseling. Ideally, as an expert in human learning and development, the counselor is a hypothesis maker who works with his client to facilitate conquest. Dissonance is said to occur when the purposive balance is inappropriate to counselor or client quests. The congruent counselor reduces dissonance by discussing changes in the purposive balance openly with the client and by avoiding professional roles in which client quests are subordinated.     

Counseling for the transition to adulthood as joint, goal-directed action

Transition is important in the career literature as it identifies times at which people are often likely to consult counselors about issues for which they need help. However, the counseling literature has not provided a conceptualization of, or research on, the joint, goal-directed actions and projects of the counselor and the client, which explicitly reflect the goal-directed nature of the transition itself. To address this issue, 12 counseling dyads, representing 37 counseling sessions, were studied. In these dyads, counseling was observed as the joint, goal-directed action between professional counselors and youth who sought assistance with their transition to adulthood. The data were collected using the action-project method. The counseling sessions were video-recorded, then immediately played back for the counselor and client separately to gather their recalled thoughts and feeling during counseling. Detailed qualitative analysis of the data set addressed the research question, “What are the goal-directed projects that counselors and their clients jointly construct, articulate, and enact relevant to the transition to adulthood?” The findings indicated the relationship and identity are intertwined goal-directed projects within counseling as well as outside of it. These projects contributed to the reframing and reorganization of clients' transition projects outside of counseling in occupational, educational, and familial domains. The findings suggest important implications for counseling youth in transition, that is, counselors and clients explicitly address their joint relationship and identity goals in an effort to realize a mutually satisfactory and important transition to adulthood.     

Client Adherence to Asian Cultural Values,Common Factors in Counseling,and Session Outcome With Asian American Clients at a University Counseling Center

Based on data from 61 Asian American clients at a university counseling center, the study found that client‐perceived match on client‐counselor belief about problem etiology was related to counselor credibility, empathy, and cross‐cultural competence; the client‐counselor working alliance; session depth; and the likelihood of the client recommending the counselor to another client. An interaction effect showed that both strong match on belief about problem etiology and high client expectation for counseling success were associated with strong client‐counselor working alliance.     

Career counseling meets motivational interviewing: A sequential analysis of dynamic counselor–client interactions

Motivational Interviewing (MI) is a client-centered communication style with the aim to resolve client ambivalence within a change-related counseling. Its potential benefit for career counseling has been discussed by several scholars but no empirical research has investigated MI in this context so far. The current study used process measures from MI to investigate dynamic interactions within a career counseling intervention. Overall, we analyzed two videotaped sessions of 14 unique counselor–client dyads. Verbal behavior of counselors and clients were coded with two observational coding schemes from MI (one for counselors and one for clients, respectively). Behavior profiles of counselors were compared with benchmarks of good MI. Furthermore, client verbal ambivalence was compared between sessions. Finally, we conducted lag sequential analyses to analyze temporal dynamics between counselor behavior and immediate client verbal responses across N = 6883 behavioral events. Our results showed, first, behavior profiles of career counselors did significantly differ from recommended counseling benchmarks of good MI practice. Second, as assumed on the basis of past studies, client ambivalence decreased across sessions. Third, MI consistent counselor behaviors showed a positive sequential association with client positive career talk, whereas MI inconsistent counselor behaviors showed the reverse pattern. Our results suggest that counseling behaviors recommended from MI are facilitating career interventions. We discuss how trainings in MI could amend career counseling interventions and provide ethical implications when integrating MI into career counseling programs.     

Soft determinism + awareness = shared responsibility Comment: More Words About Words: A Reaction to “Soft Determinism…”

This article seeks to present a viable resolution of one of the perennial ideological issues in counseling: the determinism-human freedom dilemma. That this problem is of pivotal significance to counselors is immediately evident in view of its bearing on the related professional issue of client and counselor responsibility. A conceptual model involving limited personal freedom within a framework of biological-environmental determinism is reviewed, followed by a concluding comment on the counselor's shared responsibility for the outcomes of the counseling relationship. The author rejects the notion that the counselor can function as a neutral observer in client decision-making     

The Relative Influence of Client Characteristics on the Process and Outcomes of Premarital Counseling: A Survey of Providers

To explore the influence of client characteristics in premarital counseling, a five factor model is presented that includes the social context, family-of-origin influences, individual characteristics, couple interactional processes, and motivation for attending premarital counseling. The findings demonstrate that providers believe that many client characteristics influence the degree to which couples benefit from premarital counseling. Providers rated the influence of the client characteristic factors in the following order (from most to least influential): couple interactional processes, family-of-origin influences, individual characteristics, motivation for premarital counseling, and the social context. Recommendations for future theory development, practice, and research are discussed.The findings presented in this article were part of the authors doctoral dissertation at the University of Florida.     

Searching for the Glass Slipper: A Case Study in Midlife Career Counseling

There seems to be a paucity of counseling reports written from the perspective of both counselor and client. This article is presented as a case study of the first author's experience as a career counseling client of the second author. It is intended to illuminate for students and practitioners some typical counseling practices and the theoretical foundations from which they spring, as well as how the client reacted to them.     

Reframing DSM-IV: Positive Strategies From Developmental Counseling and Therapy

Professional counselors in educational and mental health settings all must deal with so-called psychopathology. At issue is how can they work with “disorder” from a positive, developmental perspective? Developmental counseling and therapy (DCT) offers an approach to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (American Psychiatric Association, 1994) classification systems that enables the reframing of severe client distress as a logical response to developmental history. Included are specific suggestions for positive case management and practice. Special attention is given to the interface of multicultural issues, etiology, and treatment. The authors maintain that if professional counselors take a developmental approach to a so-called disorder, the positive theoretical and psychoeducational integrity of the American Counseling Association can be maintained while working with the most difficult issues.     

An Analysis of Significant Events in Counseling

Using an interview/questionnaire procedure, 19 clients reported 200 helpful, significant events that occurred in ongoing counseling. Each event consisted of one issue presented by the client, the counselor's response to that issue, and the immediate impact the client received from the counselor's response. With the use of qualitative analysis, 9 prominent patterns describing sequences of client change emerged from the data. These patterns were grouped into 3 superclusters of events: Dissonant, Question—Answer, and Congruent. These superclusters and the 9 prominent patterns were used to develop a model for counseling change. Implications for counseling theory and practice are discussed.