An Exploration of Young Clients' Experiences in Counseling With Post‐Master's Counselors

This phenomenological study adds to current literature about clients' meaningful experiences in counseling by exploring the experiences of eight young clients (ages 8–18) in individual counseling with post‐master's counselors in an outpatient setting. Interviews with these clients revealed the following six themes: (a) the process of growth, (b) having a safe place to talk, (c) counselor accepts and meets the client where they are, (d) counseling is a team effort, (e) supportive accountability from the counselor, and (f) understanding self and others. The final theme includes two subthemes: learning coping and emotion management skills, and learning better ways to communicate and behave. Findings and implications for counselors are discussed.     

A Grammar of Love

Abstract

Recently researchers in the family therapy field have encouraged a focus on aspects of therapy common across all models that are important to therapeutic change. The purpose of this study was to build on the “common factors” literature by exploring clients' perspectives of what was useful to their therapeutic experience. Quantitative and qualitative measures were used to collect data from 41 clients who participated in therapy at a university-based family therapy clinic. Quantitative results indicated that therapeutic relationship, client motivation, extratherapeutic factors, and hope and expectancy accounted for 49% of the variance of clients' perception of change and 73% of the variance of clients' perceptions of therapy helpfulness. Qualitative results indicated the therapeutic relationship to be the most helpful aspect of clients' therapeutic experience.     

Metaphor and Change in Counseling

Increased general interest among counselors in the way language, narratives, and stories influence clients' personal and social realities has drawn particular attention to metaphorical language and its facilitative role in counseling. In this article, the authors suggest that metaphors and metaphorical knowing may play a significant role in facilitating at least 5 developmental change processes in counseling: relationship building, accessing and symbolizing client emotions, uncovering and challenging clients' tacit assumptions, working with client resistance, and introducing new frames of reference.     

Clients' experiences of online therapy in the early stages of a COVID-19 world: A scoping review

The emergence of the COVID-19 pandemic in 2019 forced an abrupt shift in the modality through which psychotherapy was delivered and online therapy became the only viable option for clients. Research regarding experiences of online therapy during the early stages of the COVID-19 pandemic is minimal, however, and has largely focussed on therapists' experiences of delivering online treatment, as opposed to clients' experiences of receiving it. A scoping review was undertaken to establish what is known from the existing literature about clients' experiences of online therapy during the initial stages of the COVID-19 pandemic and identify gaps in the current knowledge. Searches were conducted across four academic databases: Scopus, EBSCO CINAHL Complete, EBSCO MEDLINE and OVID PsycInfo; the literature was excluded based on established PICOS criteria. Data were summarised through data charting and synthesised by way of inductive content analysis. A total of five articles were identified. All articles focussed on online therapy using video or audio conferencing, and four of the five studies examined clients with eating disorders. Inductive content analysis identified seven categories, as follows: preference for face-to-face therapy; appreciation of accessibility and convenience; online format hindered connection; positive experience of online therapy; individual client differences impacted experience; strong therapeutic alliance indicative of positive experience; and gratitude for continuation of treatment. Future research could explore clients' experiences of online therapy in a “post-pandemic” world and include a broader range of client populations and online therapy approaches in the COVID-19 context.     

Putting It on the Line: Telephone Counseling for Adolescent Smokers

Adolescent smokers need cessation help, but the question of how best to intervene remains unanswered. This article describes the empirically validated protocol of an established, well‐utilized adolescent telephone counseling program for smoking cessation, tailored to adolescent developmental needs and shown to increase clients' 6‐month prolonged abstinence rate significantly. Clinical issues addressed include client assessment, motivation, self‐efficacy, familial and social support, planning, coping, relapse‐sensitive call scheduling, and self‐image. Counselor training considerations are also discussed.     

Therapeutic Document in Group Counseling: An Active Change Agent

In this article, the authors provide a therapeutic document model using language as an active change agent. The practice of the therapeutic letter has demonstrated substantial power in narrative therapy to foster client change. No literature, however, has applied this construct in group counseling. Grounded in social constructionism, re-authoring therapy and the power of written language, this model transforms the usually time-consuming and frequently nontherapeutic client documentation into a functional intervention. As a competency-based intervention, this model provides counselors with principles and procedures to enhance clients' self-agency and expedite the change process in group counseling.     

Filipino Americans and racism: A multiple mediation model of coping

Although the literature on Asian Americans and racism has been emerging, few studies have examined how coping influences one's encounters with racism. To advance the literature, the present study focused on the psychological impact of Filipino Americans' experiences with racism and the role of coping as a mediator using a community-based sample of adults (N = 199). Two multiple mediation models were used to examine the mediating effects of active, avoidance, support-seeking, and forbearance coping on the relationship between perceived racism and psychological distress and self-esteem, respectively. Separate analyses were also conducted for men and women given differences in coping utilization. For men, a bootstrap procedure indicated that active, support-seeking, and avoidance coping were mediators of the relationship between perceived racism and psychological distress. Active coping was negatively associated with psychological distress, whereas both support seeking and avoidance were positively associated with psychological distress. A second bootstrap procedure for men indicated that active and avoidance coping mediated the relationship between perceived racism and self-esteem such that active coping was positively associated with self-esteem, and avoidance was negatively associated with self-esteem. For women, only avoidance coping had a significant mediating effect that was associated with elevations in psychological distress and decreases in self-esteem. The results highlight the importance of examining the efficacy of specific coping responses to racism and the need to differentiate between the experiences of men and women.     

Factors influencing failure to show for a family evaluation

Abstract

An important issue in clinical practice concerns clients' failure to keep their initial evaluation appointments, which has been termed defection (Shapiro and Budman, 1973). Research findings and clinical impressions suggest that client defection can be related to three sets of factors: actuarial variables, client psychological and motivational variables, and client-clinician interaction prior to the initial appointment (Rubinstein and Lorr, 1956; Garfield, 1971). Among the actuarial variables, the following have been suggested as being related to clients' defection: referral source, distance client must travel for the appointment, client socioeconomic status (SES), and waiting time (Brill and Storow, 1960; Raynes and Warren, 1971; Lorion, 1973).     

Toward a Bahá'í Concept of Mental Health: Implications for Clinical Practice

The author highlights the emerging interest in understanding religious beliefs as a resource for more fully conceptualizing clients' psychological functioning. Although various authors have explored religious theories of mental health in an effort to increase understanding of clients' problems, there is a dearth of information on the Bahá'í client and how this particular religion conceives of mental health. The purpose of this article is to create an initial formulation for a Bahá'í concept of mental health and to discuss its clinical implications to aid in counseling Bahá'í clients.     

Clinical Considerations in Using Mindfulness- and Acceptance-Based Approaches With Diverse Populations: Addressing Challenges in Service Delivery in Diverse Community Settings

Mindfulness- and acceptance-based strategies effectively alter clients' relationships with their internal experiences, which may have been previously restricted, avoided, or even beyond clients' awareness. Even though the scientific exploration of the psychological benefits of mindfulness in the treatment literature continues to be in its infancy, it is important to uphold best practices by exploring the applications of these therapeutic approaches in diverse community populations. In this article, we discuss recommendations for addressing challenges that have arisen while delivering mindfulness- and acceptance-based behavioral therapies to consumers of mental health services from underserved and underrepresented backgrounds (e.g., marginalized racial, religious, and socioeconomic groups). Specific case examples illustrate the challenges of promoting acceptance in the face of adversity, the acceptability of mindfulness, attending to differences in the therapist and client perspectives, and promoting the pursuit of values in the face of adversity. Clinical recommendations and suggestions for dissemination of these approaches to clinicians working with racially and ethnically diverse, underserved populations are discussed.     

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.     

Therapy Outcomes: Client Perception and Similarity with Therapist View

This study examined clients' perceptions of therapy outcome and how those perceptions related to therapist views. Additionally, the effects of client and therapist gender and ethnicity, and the match on these variables (e.g., female therapist-female client) were examined. Results showed that clients generally improved from both the client and therapist perceptions, although therapists' views were influenced by client ethnicity. There was no difference between gender or ethnicity matches on perception of outcome. Further examination showed that gender and ethnicity interacted to influence both client and therapist perceptions of outcome. The authors discuss the research and practice implications of these findings.     

Factors Assisting Female Clients' Disclosure of Incest During Counseling

The purpose of this study was to explore specific behaviors and characteristics of counselors that relate to adult, female clients' disclosure of incest during counseling. A total of 37 female incest victims who had sought counseling within the previous 3 years completed the study. Information about disclosure of incest during counseling and perceptions of counselors' characteristics and reactions were gathered by a structured interview and the modified Barrett-Lennard Relationship Inventory. Results suggest that factors related to initial disclosure and exploration of incest are client readiness, direct questioning by the counselor, specific counselor characteristics, and positive counselor reactions to initial disclosure. Guidelines for assisting clients' disclosure of incest are presented.     

A descriptive analysis of client outcomes associated with staff interventions in developmental disabilities

Although a large body of research supports the use of behavioral staff management interventions in developmental disabilities, the nature of client outcomes associated with such interventions has not been systematically assessed. We reviewed 59 staff management studies published over 20 years (1971–1990) in order to determine the generality or scope of the research (i. e., range of settings, types and levels of clients' disabilities, clients' ages), the frequency of inclusion of client outcome measures, the types of measures and levels of analysis selected (i. e., individual groups, combination), and the effects of the interventions on client behavior. Results indicated that: (a) over two-third of the studies were conducted in institutional settings; (b) more than one-half involved clients with profound to severe mental retardation; (c) clients of various ages were served; (d) assessment of client outcomes increased progressively over the period; (e) engagement and skill acquisition were the most frequently used measures; (f) group data were presented twice as frequently as either individual or a combination of group and individual data; and (g) staff interventions were associated with either positive or mixed client outcomes in 80% or more of the cases, although maladaptive behavior went unchanged in one-fifth of the studies in which they were reported. Based on these findings, suggestions are made for how researchers might extend the generality of staff management research, improve client outcome assessment practices, and produce even more consistently positive results.     

Experiences in difference: An exploration of the usefulness and relevance of psychoanalytic theory to transcultural mental health work

Abstract

This paper presents accounts of work with mental health service users in a multicultural residential setting and, explores some of the difficulties involved in working from a psychodynamic perspective in such a setting. It argues that a psychoanalytic understanding of the role of phantasy in the experience of difference, upon which ideas of culture and identity are constructed, can be helpful to practitioners concerned with addressing the consequences of their clients' experience of racism and other forms of discrimination. Particular reference is made to Winnicott's writings on play, transitional space and the location of cultural experience.     

Exercise and Movement as an Adjunct to Group Therapy for Women with Chronic Mental Illness

Abstract

Feminist therapists value the empowerment of clients and the appropriate sharing of the therapist's institutionalized power. As therapists who are also “mandated reporters,” we are obligated under certain circumstances to use our power to warn potential victims of harm, to prevent clients from harm to self or others, or make reports to institutions which have a great impact on clients' lives. Using four case examples, this paper will present clinical situations where the use of the therapist's power interfaces with homophobia, racism, and paternalism in the lives of low-income clients.     

Studying the vocational counseling process: A preliminary examination

In this study, we examined the effects of counselor empathic and coping/mastery self-disclosure statements on clients' impressions of an initial vocational counseling interview. A primary purpose of our study was to reconsider one aspect of the investigation of Watkins et al(1990), in which the counselor responses of self-disclosure, self-involvement, empathy and open question were found to have no differential effects on clients' impressions of vocational counseling. Even though we attempted to provide a more specific test of empathy versus self-disclosure responses, we for the most part also obtained a general lack of significance on the dependent variables. In conjunction with Watkins et al.'s findings, we provide some discussion of our results, and their potential meanings for vocational counseling and future vocational counseling research.