Preparing Culturally Effective Counselors

The preparation of culturally effective counselors is a familiar topic in the counseling literature. Counselor educators and practitioners have regularly discussed cultural barriers in the counseling process and have proposed models for working more effectively with multicultural populations. Still, there is no counselor education program in the United States that trains students in the special problems and advantages of counseling culturally different clients. Now more than ever, there are many compelling reasons to prepare culturally effective counselors. They include (a) the multicultural overtones of the American population; (b) the growing number of new immigrants and refugees; (c) the expressed and perceived needs of counselors working with multicultural groups; and (d) the naming of counselors as “necessary” recipients of federal training funds to develop better bilingual programs. The authors propose a counselor training program with a specialization in bilingual-multicultural education. This requires specific attitudes, skills, and competencies based on the interdisciplinary philosophies of counseling, bilingual education, and multicultural education.     

Cultural competency in genetic counseling

Incorporating a cross-cultural curriculum into genetic counseling training programs demonstrates a professional conviction of genetic counselors that cultural issues are important in genetic counseling. Funded by the Special Projects Fund in 1993 from the National Society of Genetic Counselors and the Kitson Fund from the Department of Social, Organizational, and Counseling Psychology, Teachers College, Columbia University, theHandbook of Cross-Cultural Genetic Counseling was developed to provide genetic counseling programs a curriculum to teach cross-cultural genetic counseling. The theoretical rationale for the development of a cultural curriculum is presented. By expanding cultural knowledge, developing an awareness of oneself and others, and increasing the repertoire of culturally relevant counseling skills within a socio-political context, genetic counselors will be able to better serve all clients seeking genetic counseling.     

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.     

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.     

Inclusion of Substance Abuse Training in CACREP‐Accredited Programs

Professional counselors and counselors‐in‐training continue to serve clients who have substance abuse issues, yet systematic training in substance abuse counseling is not available to many counselors. The authors investigated the extent to which students in programs accredited by the Council for Accreditation of Counseling and Related Educational Programs (CACREP; 2001) are exposed to clients presenting with substance abuse issues and the relationship between state licensure or certification in substance abuse and the resulting perception of the need for the inclusion of substance abuse training in these programs. Three methods are presented for possibly including substance abuse training in CACREP standards.     

The counselor perspective on the use of directives in counseling in China: Are directives different in China as in the United States?

Eight Chinese counselors were interviewed about their use of directives in counseling. They typically believed that directives can be beneficial in counseling Chinese clients. They used directives to extend the influence of counseling beyond sessions, meet client needs and expectations, and fit their own personality and orientation. In terms of conditions that need to be met for directives to be helpful, they identified client factors such as readiness, communication styles, past experience, and insight; the counselor factor of ability to communicate directives; and the therapeutic relationship. They emphasized the importance of clients acquiring a new perspective as a result of directives. Cultural factors in using directives are discussed.     

Ethical Implications in Cross-Cultural Counseling and Training

The nonspecificity of the ethical guidelines forces counselors to develop personal philosophies in regard to serving culturally unique clients. The resulting variability in the quality and availability of services threatens the growth and dilutes the integrity of the counseling profession. The worldview of the counselor is discussed as it affects client welfare, self-determination, and cultural autonomy in the counseling alliance. Ethical issues surrounding the development and implementation of cross-cultural training programs are reviewed and discussed.     

Predicting Dropout in Counseling Using Affect Coding of the Therapeutic Relationship: An Empirical Analysis

This study used an observational research method to examine affective counselor–client exchanges during the initial session of counseling for clients who dropped out of counseling and clients who remained in counseling. Results confirmed significant differences in the affect codes of clients and counselors between the 2 groups. Discriminant function analyses classified 77% of counselors and clients in the correct groups and correctly classified over 94% of clients who returned for 4 or more sessions.     

Counselors Under Fire: Youth Opportunity Centers

Intensive interviewing of counselors, supervisors, clients, and community workers associated with a sample of Youth Opportunity Centers led to the conclusion that assumptions of client-centered therapy are untenable in such settings. The assumptions not found tenable are: (a) client comes voluntarily; (b) client wants help; (c) client accepts counselor's authority; (d) client comes as individual; (e) counselor accepts client. Because of bureaucratic conditions of government programs, because of poverty and demoralization of clients, and because of race and other differences, counseling (except of a highly directive sort) is not possible. A group approach which takes into account the organized nature of the client population is personally recommended and described.     

Actors in the Classroom: The Dramatic Pedagogy Model of Counselor Education

Role playing is a fundamental component in the training of counselors to use counseling skills. However, role play activities commonly involve counseling students as clients or actors and hence have notable limitations. One training method widely practiced in the medical profession is the use of professional actors as patients. Although there are some examples in the literature of studies that have used actors for counselor training, most address only a specific topic or skill set. In this article, the authors propose the dramatic pedagogy model (DPM) as a comprehensive model for implementing client actors into the education of counselors. The DPM includes a set of pedagogical techniques and a structure for preparing actors and curriculum.     

Experiences of Altruism in the Therapeutic Relationship: Perspectives of Counselors‐in‐Training and Their Clients

The purpose of this phenomenological investigation was to explore experiences of altruism in the therapeutic relationship to better understand how counselors‐in‐training (CITs) and their clients mutually perceived the construct in sessions. Findings from interviews with clients (n = 14) included emotional–relational characteristics and cognitive–behavioral aspects of altruism by their counselors. Findings from interviews with CITs (n = 10) included explorations of the role of altruism in counseling, overall experiences of altruism in counseling sessions, and experiences of altruism with specific clients. Implications for practice and research are discussed.     

The Effect of Nonverbal Skills Training on Counselor Trainee Nonverbal Sensitivity and Responsiveness and on Session Impact and Working Alliance Ratings

Counselor trainees (N = 18) were randomly assigned to treatment (nonverbal sensitivity) or control (empathy training) conditions. Trainees saw a recruited client before (first 2 weeks) and after (last 2 weeks) a 15-week counseling methods class. Trainees rated their sensitivity to nonverbal behaviors, counseling self-efficacy, and the extent to which they focused on client nonverbal behavior. Clients filled out the Session Evaluation Questionnaire and Working Alliance Inventory at pre- and posttesting. Trained raters viewed videotapes of the counseling sessions and rated the extent that counselors focused on client nonverbal behavior. As hypothesized, trainees in the treatment condition, when compared with those in the control condition, increased their focus on client nonverbal behaviors. In addition, clients of treatment condition counselors showed significant differences in working alliance ratings. Trainees in both conditions increased their rating of nonverbal sensitivity and self-efficacy from pre- to posttesting. Implications are discussed.     

An assessment of teratology training provided by masters level genetic counseling programs

The increasing demand in the clinical genetics setting for information about teratogen exposures has created a need for genetic counselors to have the capabilities to appropriately address patient concerns. In order to assess how training in teratogen counseling is currently being conducted, the GLaRGG Teratogen Subcommittee surveyed all 17 genetic counseling training programs in North America in September 1993. Information was obtained from training programs about coursework, resources, and clinical training. In addition, each training program was asked to provide information about how their teratogen training needs could better be met. While all programs responded that some information in their coursework applicable to teratogen counseling was provided, there was wide variation in the amount of time devoted to this topic. The programs also greatly differed in the provision of clinical training in teratogen counseling. For both coursework and clinical work, genetic counselors were the main trainers in teratogen counseling. In spite of this, fewer than 25% of training programs have a defined teratogen clinical rotation. Data from the survey are discussed and recommendations presented.     

Does Receiving Genetic Counseling Impact Genetic Counselor Practice?

This study was an investigation of whether genetic counselors have received genetic counseling and if so, how they believe it affects their practice. One thousand genetic counselors were mailed surveys about the nature of genetic counseling services received, impact on their clinical practice, frequency and reasons for disclosing about their receipt of counseling to their clients, and demographics. Ninety-three of the 510 respondents reported receiving genetic counseling. Of these, almost three-fourths were practicing genetic counselors while receiving services. Reasons for services include prenatal concerns, family history of cancer, and history/risk of other genetic conditions. Frequently endorsed effects on practice include increased empathy and understanding of client decisions, feeling more connected with clients, greater emphasis on psychosocial support, and sympathy. Forty-six respondents disclosed to clients about their receipt of genetic counseling. Prevalent reasons include client asked, help clients feel they are not alone, demonstrate counselor understanding, decrease client anxiety, build rapport, and normalize client feelings. Practice and research recommendations are given.     

Metaphor as an Instrument for Orchestrating Change in Counselor Training and the Counseling Process

The authors explore the use of metaphors as a training tool for beginning counselors for enhancing client case conceptualization, counselor‐client relationships, and intervention strategies. The history of the use of metaphors in counseling, several definitions, and a case study are presented. The authors discuss intentional use of metaphors with students in training and with clients. How to introduce the use of metaphors into counselor training and practice is also included.     

Counseling Clients Who Self‐Injure: Ethical Considerations

This article provides an overview of ethical considerations related to counseling clients who engage in self‐injurious behaviors. Ethical issues concerning client welfare, counselor competence, countertransference, referral and consultation, informed consent, and duty to protect are discussed in relation to the American Counseling Association's (1995) Code of Ethics and Standards of Practice. Implications and recommendations for counselors who work with clients who self‐injure are provided.     

Effect of Client Expectations on the Counseling Relationship

The purpose of this study was to investigate the effect upon an initial interview of positive and negative client expectations for counseling. 30 subjects or clients were randomly assigned to 3 groups (1 positive expectation group, 1 negative expectation group, and a control group). Following a 30-minute counseling session, the counselors and clients were asked to evaluate the relationship that had been established. Despite pre-counseling differences in client expectations, no significant differences were found in the relationships established.     

Improvisation as a Meta-Counseling Skill

Counselor education tends to see the development of basic counseling and communication skills as the foundation of clinical training. Improvisation has historically and primarily been connected to theater training and as a performance mechanism. By developing skills in spontaneity and the nature of narrative (or story) one becomes more able to be in-the-moment with a client or clients and thus less anxious and more able to meet the client where they are. As such, improvisation can really be seen as a meta-counseling skill—a skill that can form a firmer foundation for the learning of the basic counseling and communication micro-skills. This article outlines the core concepts of improvisational training for counselors and includes examples of improvisational games that can specifically help in preparing counselor trainees for their future clinical work.     

THE USE OF ADVOCACY AND CONFRONTATION COUNSELING THE DISADVANTAGED

Middle-class counselors and disadvantaged clients appear to be alienated due to a basic difference in values. This alienation can be overcome by the counselor assuming the role of “social advocate.” Several examples are given to illustrate how social advocacy might be utilized. As the counseling relationship develops, and the client's trust and confidence strengthen, the counselor can begin to assert himself and confront the client concerning the unsolvable problems he presents as reasons for his unemployment and failure. Some differences exist as to counseling needs on the basis of sex and ethnic background. The confrontation program described would seem to be more effective with disadvantaged men than with disadvantaged women.