Contributing Factors to Early Premature Termination at a College Counseling Center

The authors investigated the relationships between clients' early premature termination of counseling and ratings of their counselors' expertness, trustworthiness, and attractiveness and the extent to which clients believed that they were understood by their counselors. A follow-up survey was conducted to assess the clients' reasons for terminating prematurely. Participants were 148 students who sought individual counseling at a university counseling center. The two groups did not differ on the variables investigated. Most of the participants who terminated prematurely reported that they did so because they did not have time for further sessions, did not need further sessions, or forgot their appointments.     

The helping alliance and premature termination

The study was conducted to determine the relationship between strength of the helping alliance and type of client termination (premature or with mutual knowledge of client and counselor). Participants were 102 client-counselors dyads at a university counseling center. After an average of 8 sessions, clients and couneselors completed Alexander & Luborsky's (1986) Helping Alliance Questionnaires. Clients terminated after an average of 19 sessions. Clients who later terminated with mutual knowledge of their counselors gave significantly higher strength of helping alliance ratings than did clients who later terminated unilaterally and prematurely. Counselors' ratings of strength of helping alliance were only modestly related to clients' ratings and unrelated to type of client termination.     

A study of engagement and premature termination in a university counseling center

Differences between engaged (clients seen for at least two counseling sessions) and nonengaged clients, and between post-engaged premature terminators and clients who terminated with counselor knowledge at a university counseling center were investigated. Five practicum trainees, four professional counselors, and 308 college student clients participated. Professionals had higher rates of engagement and lower rates of premature termination than trainees. Engagement was positively associated with understanding and teaching the client and with longer intake interviews. Premature termination was associated with counselor attractiveness, expertness, and trustworthiness. These characteristics related to premature termination in opposite directions for professional and practicum counselors. Results are discussed in terms of possible different mechanisms operating at the beginning and end of counseling.     

Intrafamilial Separations in the Immigrant Family: Implications for Cross-Cultural Counseling

A structural family therapy (SFT) approach is combined with the paradigm of acculturation to increase counselors' sensitivity to a subcase of immigrant families, namely those whose members arrive at different times in the United States. The focus is on those families in which parents have preceded children in the immigration experience, which creates the challenging scenario of parents being more adapted to the host culture than their children. Written primarily for family counselors working with immigrant children and their parents, the article provides culturally sensitive counseling strategies based on a structural conceptualization of families, as well as suggestions for future research directions.     

The Experience of Genetic Counselors Working with Patients Facing the Decision of Pregnancy Termination after 24 Weeks Gestation

Prenatal genetic counselors are health care professionals who counsel women making reproductive decisions which include decisions such as terminating pregnancies due to fetal anomalies. Little is known about the experiences and practices of prenatal genetic counselors working with women who have the option of termination after 24 weeks gestation. In this national survey of 168 genetic counselors who have practiced prenatal genetic counseling, we asked about their general practice patterns, including indications for which termination is offered and types of abortion care services that are coordinated by genetic counselors. We report respondents’ self-assessments of level of understanding of federal abortion law and abortion procedures. Seventy-six percent of respondents have offered and counseled on termination after 24 weeks and 93% of respondents believe it is the responsibility of the counselor to discuss this option with patients. However, one-third report that they have some or no understanding of the procedures and three-quarters report that they have some or no understanding of federal abortion law. The results of this study provide insight into knowledge and experiences of genetic counselors working with these patients, allowing for improved genetic counselor training and continuing education to provide better guidance and develop more effective means of assisting patients.     

Attitudes Towards Prenatal Genetic Counseling,Prenatal Genetic Testing,and Termination of Pregnancy among Southeast and East Asian Women in the United States

Recognizing the heterogeneity of the Asian population with regards to acculturation, education, health awareness, and cultural values is vital for tailoring culturally sensitive and appropriate care. Prior studies show that cultural values influence perceptions of genetics within Asian populations. The reputation of the family unit factors into decisions such as pregnancy termination and disclosure of family medical history, and the nondirective model of American genetic counseling may conflict with the historical Asian model of paternalistic health care. Previous studies also provide conflicting evidence regarding correlations between education, acculturation, age, and awareness and perceptions of genetic testing. The aims of this study were to describe attitudes towards prenatal genetics among Southeast and East Asian women living in the United States for varying amounts of time and to explore sociocultural factors influencing those attitudes. Twenty-three Asian women who were members of Asian cultural organizations in the United States were interviewed via telephone about their attitudes towards prenatal genetic counseling, prenatal genetic testing, and termination of pregnancy. Responses were transcribed and coded for common themes using a thematic analysis approach. Four major themes emerged. In general, participants: (1) had diverse expectations for genetic counselors; (2) tended to weigh risks and benefits with regards to genetic testing decisions; (3) had mixed views on termination for lethal and non-lethal genetic conditions; and (4) identified cultural factors which influenced testing and termination such as lack of available resources, societal shame and stigma, and family pressure. These findings may allow prenatal genetic counselors to gain a richer, more nuanced understanding of their Asian patients and to offer culturally tailored prenatal genetic counseling.     

EMPIRICAL COMPARISONS OF COUNSELOR ORIENTATIONS

The purpose of this study was to investigate counselor behaviors related to being “counseling oriented” in one's interaction with clients as opposed to being “placement oriented.” The levels of therapeutic conditions (accurate empathy, self congruence, unconditional positive regard, and intensity and intimacy of interpersonal contact) were all positively correlated with being counseling oriented (p<.01). The multiple correlation of the therapeutic conditions with being counseling oriented was .74 with accurate empathy accounting for the major portion of the variance. Further analysis of the frequency of specific counselor responses revealed that counselors who provide high therapeutic conditions, or those who are counseling oriented: (a) manifest a distinctly different pattern of responses; and, (b) are more active in the counseling relationship in terms of total responses.     

Symptom reduction and termination: client change and therapist identified reasons for saying goodbye

Empirical efforts have focused on predicting whether or not clients prematurely terminate therapy, with nonattendance of last session equated to premature termination. However, this fails to explore the relationship between clients’ distress reduction and reasons for termination. With this study, we aimed to understand how clients’ distress change relates to premature termination and examine clients’ distress change in conjunction with therapists’ perceptions of termination reasons. We collected data from 797 clients who prematurely terminated or attended termination but completed therapy a minimum of three individual sessions provided by 38 therapists. Clients completed an assessment of psychological symptoms before each session. At the end of treatment, therapists identified the reasons they believed termination occurred for all clients in the sample. Results demonstrate that total sessions attended and missed predict premature termination, whereas distress change does not. Additionally, clients who were believed to accomplish goals do show greater change. However, therapists’ indicated that over half of clients did not reach goals at termination and they did not perceive nonattendance at last session to equate to drop out in all cases. Implications are discussed with respect to understanding why clients’ terminate, therapeutic goal conceptualization, and review of goals during termination in time-limited psychotherapy.     

A Comparison of Feminist and Nonfeminist Women's and Men's Reactions to Nonsexist and Feminist Counseling: A Replication and Extension

In Study 1 the authors examined the reactions of 159 feminist and nonfeminist college women to videotaped versions of nonsexist-humanistic, liberal feminist, and radical feminist approaches to counseling. College women rated all counselors similarly on the dimensions of attractiveness, expertness, and trustworthiness and on other measures of counselor preference. Feminist counselors, however, were rated as more likely than were nonsexist counselors to pursue various feminist goals. In Study 2 the authors used the same methods to examine the reactions of 123 men to nonsexist, liberal, and radical feminist counselors. In general, men's responses were similar to those of women.     

Predicting premature termination from counseling using the Butcher Treatment Planning Inventory

This investigation examined the extent to which premature termination from counseling could be predicted from selected scales on the Butcher Treatment Planning Inventory (BTPI). Ninety-five new clients at a university counseling center agreed to participate in the study and completed the BTPI as part of the intake evaluation. Premature termination occurred when a participant missed a scheduled appointment and unilaterally dropped out of counseling. Higher scores on Closed-Mindedness, Problems in Relationship Formation, Somatization of Conflict, Self-Oriented/Narcissism, Perceived Lack of Environmental Support, and the Treatment Difficulty Composite were associated with premature termination. The General Pathology Composite, a general index of symptomatic distress, also enhanced the prediction of premature termination by suppressing irrelevant variance in other BTPI scales. The results provide support for the validity of the BTPI in identifying clients at risk for premature termination from counseling.     

Premature Termination from University Counseling Centers: A Review

Many clients leave counseling prematurely (i.e., without their counselors' agreement). Understanding premature termination is crucial to the effectiveness and efficiency of the counseling enterprise. The authors review research on client attrition from university counseling centers, explore implications for practice, and offer suggestions for future research. Methodological problems and sparse data on some variables preclude firm conclusions, although there are some promising directions, such as theory-based studies, exploration of cognitive-expectancy factors, and client-counselor interaction research. It is becoming increasingly clear that premature termination is not a unitary phenomenon and that dropouts are a heterogeneous group, suggesting the need for greater conceptual and methodological precision in the study of counseling attrition.     

Gestalt therapy interventions for group counseling

Much interest has been focused on Gestalt therapy in recent years. Many counselors, however, are unfamiliar with this style of therapeutic intervention. The author offers a brief introduction to some of the basic tenets of Gestalt therapy, noting goals that are similar to those in counseling theories. He also suggests several interventions from Gestalt therapy to be considered for group counseling and discusses their applications.     

The Effect of Gender and Self‐Care Behaviors on Counselors' Perceptions of Colleagues With Depression

This study examined the effects of gender and self‐care behaviors on counselors' perceptions of depressed colleagues. Three hundred and six respondents completed 1 of 8 versions of vignettes describing either a male or female counselor responding to his or her depressive symptoms through the use of antidepressants, counseling, alternative therapies, or no course of action. Target counselors who took antidepressants were perceived as more competent than counselors who practiced holistic measures and those who chose no course of action. Target counselors who sought personal counseling were perceived as more ethical than those choosing no course of action.     

Practicum and On-the-job Ratings of School Counselors

Practicum ratings of 50 school counselors were examined in relation to administrators' subsequent on-the-job ratings of their performance. The relationship proved negligible. The practicum ratings did relate, however, to retention of cognitive material in guidance and counseling (scores on a comprehensive examination). Such a relationship did not exist between scores on the same comprehensive examination and the administrators' ratings. It was suggested that cognitive standards for counselors are probably best established and maintained by training institutions. Administrators seeking assurance of at least minimum cognitive competency in counselors ought to seek endorsement of candidates from those who observe their practicum performance.     

UCLA's Career Counseling Center: A Dialogue About a Unique Service

In this interview, two counseling psychologists describe aspects of a relatively unique career counseling service that has been validated by 40 years of success in the marketplace. Composed of 3 intensive individual interviews and 15 to 25 hours of educational and psychological testing, the service assists clients in identifying and beginning pursuit of suitable educational and occupational goals. The counselors describe how they organize and sift through test results to formulate recommendations for a client's unique career circumstances, why they accept responsibility for developing and presenting concrete recommendations, and what the changes in their clients' concerns suggest about the evolution of work in the United States. Their specificity and professionalism will help counselors understand the craft of career counseling.     

Multicultural Counseling and Intrapersonal Value Conflict: A Case Study

The internal conflict between professional and personal values that counselors can experience when working with clients whose culture and values are different from their own is discussed. This is not a conflict between the counselor and the client, but is a conflict experienced within the counselor who is attempting to help resolve problems within the client's frame of reference, or worldview. A case study is presented that illustrates the senior author's experience in coping with a specific value conflict. It is suggested that as counselors become more proficient in multicultural counseling and more able to promote decision making from another's point of view, feelings of internal conflicts will decrease. Means of decreasing the likelihood of value conflicts are offered.     

Counseling Jewish Women: A Phenomenological Study

The field of counseling has paid little attention to religion in general and Jewish women's realities in particular. This article presents the findings of a qualitative phenomenological study examining 12 Ashkenazi, non‐Orthodox, Jewish American women's self‐reported understanding of their Jewish identity, revealing the themes of Jewishness and being Jewish in a broader societal context, as well as 7 related subthemes. Recommendations are offered for counselors, educators, and researchers who work with Jewish women.     

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.     

New faces of spiritual pride

Contemporary counseling and psychotherapy, including pastoral counseling and psychotherapy, frequently claim as their domain the total person, including the spiritual dimension. Within the traditions of spiritual direction is a deep concern for the phenomenon of spiritual pride, If counseling and psychotherapy are to deal with the person's spiritual development, counselors ought to be aware of this disruptive dynamic. It is suggested that the counselor's own personhood may be a primary condition for leading to spiritual pride and that the process of termination may be a specific illustration of this phenomenon. The negative power of spiritual pride is significant in that it leads to premature closure relative to the growth process.