Using Evidence-Based Practices
Journal of Counseling & Development ■ July 2014 ■ Volume 92366 © 2014 by the American Counseling Association. All rights reserved.
Trends Received 12/06/12
Revised 03/11/13 Accepted 04/09/13
DOI: 10.1002/j.1556-6676.2014.00164.x
For well over half a decade, the counseling profession has been actively planning its future through the initiative, 20/20: A Vision for the Future of Counseling. Often referred to in abbreviated form, 20/20 was cited as “the largest gathering of counseling organizations in history” (Kennedy, 2008, p. 42). Currently involving 31 participating organizations (for a com- plete list, see 20/20: A Vision for the Future of Counseling, 2010), 20/20 promulgated the historic Principles for Unify- ing and Strengthening the Profession (Kaplan & Gladding, 2011), which established the core set of principles that unify the various membership, certifying, accrediting, and honor society groups within the profession of counseling. Kaplan and Gladding (2011) provided a history of the development of 20/20 and detailed the development of the principles.
This article presents the second historic achievement of 20/20: the consensus definition of counseling. We describe the Delphi process used to develop the definition and discuss the implications of having established a profession-wide de- scription of professional counseling to be used with clients, the public, and legislators.
Background When 20/20: A Vision for the Future of Counseling first began, the delegates generated a list of 22 issues to address that would advance the future of professional counseling (Kaplan & Gladding, 2011). The list was grouped into seven areas: (a) strengthening identity, (b) presenting ourselves as one profession, (c) improving public perception/recognition
David M. Kaplan, Department of Professional Affairs, American Counseling Association; Vilia M. Tarvydas, Department of Reha- bilitation and Counselor Education, The University of Iowa; Samuel T. gladding, Department of Counseling, Wake Forest University. The authors wish to thank Jason Wilke for his assistance. Correspondence concerning this article should be addressed to David M. Kaplan, Department of Professional Affairs, American Counseling Association, 5999 Stevenson Avenue, Alexandria, VA 22304 (e-mail: [email protected]).
20/20: A Vision for the Future of Counseling: The New Consensus Definition of Counseling David M. Kaplan, Vilia M. Tarvydas, and Samuel T. Gladding
With the promulgation of the 20/20: A Vision for the Future of Counseling consensus definition of counseling, there is finally profession-wide clarity as to what it means to engage in professional counseling. This article describes the development and discusses the implications of the definition: “Counseling is a professional relationship that empowers diverse individuals, families, and groups to accomplish mental health, wellness, education, and career goals.” This consensus definition has been endorsed by 29 major counseling organizations.
Keywords: counseling, definition, 20/20, consensus, professional identity
and advocating for professional issues, (d) creating licensure portability, (e) expanding and promoting the research base of professional counseling, (f) focusing on students and prospec- tive students, and (g) promoting client welfare and advocacy. These areas provided the framework for the Principles for Unifying and Strengthening the Profession (Kaplan & Glad- ding, 2011). The first three (strengthening identity, presenting ourselves as one profession, and improving public perception/ recognition and advocating for professional issues) focused on unifying and promoting professional counseling, and the delegates identified one of the 22 issues as critical to all three of these areas: The counseling profession should develop a clear definition of counseling for the public. Therefore, after the promulgation of the Principles for Unifying and Strengthening the Profession, the delegates decided that the next project would be to develop a definition of counseling that all professional counselors and counseling organizations could use with external audiences.
Although there are numerous scholarly definitions of coun- seling in the literature, the purpose of this initiative was not to critique or reconcile these representations that are intended to guide and communicate within the professional and scholarly communities of counseling or to develop a formal professional scope of practice statement for the counseling profession. Rather, the 20/20 delegates intended to derive a new, consensus- based definition suitable for communicating with external constituencies. As such, the focus was on developing a concise definition of counseling that could be easily understood by those without a professional background in counseling.
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Process During the development of the consensus definition of coun- seling, 20/20: A Vision for the Future of Counseling had 30 participating organizations (a 31st organization, the National Rehabilitation Counseling Association, was added shortly after the completion of the definition). In keeping with the rules established for 20/20 (see Kaplan & Gladding, 2011), the Oversight Committee was charged with designing a pro- cess that would result in a definition of counseling endorsed by at least 90% of voting delegates and 90% of participating organizations. This task presented quite a challenge for the Oversight Committee and posed the conundrum: How do you get delegates representing over two dozen counseling constituencies from different specialties, member bases, and turfs to agree on one definition of counseling? The an- swer lay in the Delphi method. (By the rules established for 20/20, only participating organizations that have endorsed the Principles for Unifying and Strengthening the Profession— and thus acknowledged that they are part of the counseling profession—have voice and may actively participate in dis- cussions and votes on subsequent initiatives. The American School Counselor Association [ASCA] has not endorsed the statement of principles [see Kaplan & Gladding, 2011]; so while continuing to be a participating organization, ASCA did not have voice in developing the consensus definition of counseling.)
After observation of the extensive discussions conducted to define the principles that would be used to guide the pro- fessional development of counseling, it became clear that the nature of the process selected by the Oversight Committee to determine the definition of counseling would play a major role in the success of the project. The process selected would have to be capable of marrying opinions of diverse parties in such a manner that the process would be seen as transparent and able to capture the consensus of the group. It must also be conducted in an unbiased manner that minimized issues of dominance, group-think, or intense confrontation.
The Delphi method was identified as a method that ef- fectively facilitates group consensus, because it allows for statistical analysis of responses to demonstrate transparency of group opinion, while permitting controlled feedback to the group in addition to providing for cycles of ongoing expert reconsideration and correction of the group opinion (Linstone & Turoff, 1975). The Delphi method was applied in a variety of contexts in the social sciences, education, and policy, particularly in instances where complex problems were addressed and expert opinion was divided (Stone Fish & Busby, 1996). Many approaches to the Delphi method were used in which the number of rounds, question format and rules, and structure of the panel of experts vary (Bo- berg & Morris-Khoo, 1992). Most commonly, however, the development and administration of a series of three to
five rounds of questionnaires based on expert responses to the important question or problem are used where the development and administration of the questionnaires are intertwined (Ludwing, 1997).
The Delphi method was developed in the 1940s by the RAND Corporation as a systematic means for gathering expert opinions about complex issues or problems for which there are no verifiable, evidenced-based solutions, and it was initially used to provide technical forecasts on such matters as the impact of potential nuclear war on the United States (Dalkey, Rourke, Lewis, & Snyder, 1972; Sackman, 1975; Vazquez-Ramos, Leahy, & Estrada-Hernandez, 2007). In essence, it provides for “informed group judgments . . . that are more reliable than individual judgment” (Adler & Ziglio, 1996, p. 15). Thus, the characteristics of the Delphi method for permitting converging consensus was a good fit with the need of 20/20: A Vision for the Future of Counseling.
The promulgation of the 20/20 consensus definition of counseling used a two-round Delphi study to identify concep- tual elements through gathering and organizing the opinions of the delegates to the 20/20 initiative. These delegates were defined as experts on the topic of professionalization in the profession of counseling by virtue of their appointment to the 20/20 initiative by the 31 participating organizations of 20/20.
Delphi Rounds
First round. To begin the Delphi process, the delegates orga- nized into the same seven workgroups used for promulgating the Principles for Unifying and Strengthening the Profes- sion (see Kaplan & Gladding, 2011). Each workgroup was asked to use their expertise to develop a concise definition of counseling specifically geared for the public and legisla- tors. Two of the workgroups chose to submit an additional definition, so the Delphi process began with nine first-round entries (see Table 1).
The delegates were then asked to use a 5-point Likert scale (ranging from 1 = strongly disagree to 5 = strongly agree) to rate each of the nine first-round definitions on six dimensions: the definition is brief; the definition is clear; the definition generalizes to all counseling specialties; the definition is geared toward the public; the definition is geared toward legislative advocacy; and the definition captures the imagination. All 29 of the delegates with voice submitted first-round ratings, and Table 1 lists the resultant ranking, aggregated scores, means, and standard deviations for each first-round entry.
In addition to rating the nine first-round entries, delegates were asked to list the most common terms that they viewed as occurring across all first-round definitions. Eighteen terms were identified, with wellness, empower, and professional cited most frequently (see Table 2).
Second round. For Round 2 of the Delphi, each of the seven workgroups was asked to create a completely new
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def inition of counseling using the most highly ranked definitions from Round 1 (the three listed in Table 1 with means equal to or greater than 19) and the most frequently cited common terms across the Round 1 definitions (the five listed in Table 2 with a frequency count of 16 or greater). Each delegate then rated the second-round definitions. The 5-point Likert scale used in the first round was used to as- sess seven dimensions: the six dimensions rated in Round 1 plus an extra dimension—whether the definition adequately incorporated the most frequently occurring words identified in Round 1 (wellness, empower, professional, lifespan, and relationship). Twenty-seven of the delegates with voice (93%) submitted second-round ratings, and Table 3 lists the resultant ranking, aggregated scores, means, and standard deviations. It is interesting to note that the three top ranked definitions in the second round were all composed of 21 words or less.
Finalizing the Definition
After the second-round Delphi ratings, one definition stood out as the most highly ranked: “Counseling involves profes- sional relationships designed to assist individuals, families, and groups toward mental health, wellness, educational, and career goals.” Table 3 shows that this definition was a full 30 aggregate points above the next most highly rated entry and had an elevated mean that placed it well above the other six definitions.
A delegate meeting was then held on March 19, 2010, at the American Counseling Association (ACA) conference in Pittsburgh, Pennsylvania, to finalize the consensus definition
of counseling. Twenty-four of the 29 delegates with voice (83%) were in attendance. Delegates were informed by the facilitator, Sam Gladding, that the Delphi process had led to a definition that stood out above the others (the definition in the previous paragraph). As a result, they could either accept the definition or make discrete modifications; they could not make wholesale changes or start over again.
After 2 hours of discussion, the delegates decided to add empowers and diverse to the definition in order to speak to the importance of diversity and social justice in the counseling profession. The delegates then adjusted the wording to final- ize the definition: Counseling is a professional relationship that empowers diverse individuals, families, and groups to accomplish mental health, wellness, education, and career goals. A formal vote was held and all delegates present voted unanimously to approve this consensus definition of counsel- ing. The delegates also unanimously approved sending the definition to all participating organizations with a request for endorsement, “with the understanding that this definition provides a basic statement and that all of the participating organizations are welcome to add statements clarifying the role of their particular specialty or area” (Kaplan, 2010, p. 2). The Appendix lists all 24 voting delegates present at the March 19, 2010, meeting.
Organizational Endorsements
Following the Pittsburgh meeting, the consensus definition of counseling was sent to the participating organizations with a request for endorsement. Endorsement was received from 29 (94%) of the 31 entities:
Note. N = 29. Higher aggregate scores and means reflect more positive ratings. AS = aggregate score. aPossible range is 174–180. bPossible range is 6–30.
TabLe 1
First-Round Delphi Results
entry
Counseling: a profession assisting people toward lifelong mental health, educational, and career goals.
Counseling: helping people deal with life’s challenges throughout the lifespan! Professional counselors create purposeful relationships designed to assist and empower individuals,
families, and groups to address life challenges. Using evidence-based practices, counseling helps people via prevention, education, and treatment, pro-
moting wellness throughout the lifespan. Counseling is a process that utilizes a professional relationship to empower others, while promoting
wellness. A professional counselor is a graduate degreed professional trained to work with individuals, groups,
and families in various settings. Professional counselors assist clients of all ages with normal devel- opmental, career, and relational concerns as well as those who suffer from serious mental health problems using evidence-based and best practices to provide ethical, multiculturally sensitive care.
Counseling is a professional relationship through which credentialed and regulated counselors assist and empower individuals, families, and groups, and communities to prevent and/or address life challenges; foster human development; and advocate for wellness, human dignity, and social justice in a healthy society.
Professional counseling is a humanistic and ethical practice that occurs in the context of relationships that promote human development.
Counseling is the application of mental health, psychological, human development, or family systems principles and interventions to help clients adjust their thoughts, feelings, or actions in order to ad- dress issues of personal growth, wellness, career development, or pathology.
M b SD
19.4 19.4
19.2
17.7
17.0
16.8
16.6
15.2
13.9
5.7 5.4
4.9
4.7
3.7
4.9
5.7
4.1
5.4
Rank aSa
1 2
3
4
5
6
7
8
9
563 562
557
514
494
487
481
442
403
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aThe number of delegates listing the term as commonly occurring within the first-round definitions.
TabLe 2
First-Round Term Frequency Counts
Term
Wellness Empower Professional Lifespan Relationship Develop Challenge Human Family Group Individual Mental health Prevent Help Evidence Educate Career Culture
Frequencya
20 20 19 16 16 14 10 10 9 9 8 7 6 6 5 5 4 3
• American Association of State Counseling Boards • American College Counseling Association • American Counseling Association (ACA) • ACA Midwest Region • ACA North Atlantic Region • ACA Southern Region • ACA Western Region • American Mental Health Counselors Association • American Rehabilitation Counseling Association • Association for Adult Development and Aging • Association for Assessment in Counseling and Education • Association for Counselor Education and Supervision • Association for Counselors and Educators in Government • Association for Creativity in Counseling • Association for Lesbian, Gay, Bisexual and Transgen-
der Issues in Counseling • Association for Multicultural Counseling and Devel-
opment • Association for Specialists in Group Work • Association for Spiritual, Ethical, and Religious Val-
ues in Counseling • Chi Sigma Iota • Commission on Rehabilitation Counselor Certification • Council for Accreditation of Counseling and Related
Educational Programs • Council on Rehabilitation Education • Counseling Association for Humanistic Education and
Development, now the Association for Humanistic Counseling
• International Association of Addictions and Offender Counselors
• International Association of Marriage and Family Counselors
• National Board for Certified Counselors • National Career Development Association • National Employment Counseling Association • National Rehabilitation Counseling Association
Two of the 31 entities involved in 20/20 (constituting 6% of participating organizations)—ASCA and Counselors for Social Justice (CSJ)—declined to endorse the consensus definition of counseling. In a December 10, 2010, letter, ASCA President Brian Law stated three reasons for the as- sociation’s lack of endorsement. First, ASCA felt that a major shortcoming of the definition was that it did not explain how the practice of counseling is unique and distinct from other mental health professions. Second, ASCA took the position that “there is no research to substantiate or support this defini- tion.” Finally, Law stated that ASCA had its own definition of school counseling that the organization preferred and would continue to use.
CSJ declined to endorse the consensus definition of coun- seling because it felt that despite the inclusion of empowers and diverse in the definition, there was an inadequate focus on social justice. In an e-mail, CSJ President-Elect Michael D’Andrea expressed “strong disappointment and frustration that the 20/20 [definition] did not explicitly include statements about multicultural competence, social justice, and advocacy” (personal communication, July 7, 2010).
Dissemination After approval of the consensus definition of counseling by the participating organizations, all 20/20 entities were asked to post the definition on their websites and to promote it on an ongoing basis. In addition, the definition was sent to all 53 counselor licensure boards with a request to adopt and endorse the definition of counseling for their particular state or jurisdiction. The definition also was sent out to more than 250 counselor education programs listed in Counselor Prepara- tion: Programs, Faculty, Trends (Schweiger, Henderson, Mc- Caskill, Clawson, & Collins, 2012) for use in classes; graduate counseling programs were asked to infuse the new consensus definition of counseling throughout their curriculum.
Finally, the 20/20 consensus definition of counseling was sent to more than three dozen book and test publishers with the announcement that it is now the consensus definition of the counseling profession and should be used as such in all books, journals, and test manuals. The focus of all of the above-mentioned dissemination efforts was to standardize the profession of counseling by presenting a consensus definition of counseling as was the original intent of the 20/20 initiative.
Implications As can be seen from the Process section of this article, formulating a consensus definition of counseling from the
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major organizations in the counseling profession was both an empirically based and an arduous endeavor. Delegates worked for almost 2 years to come up with a definition with a number of months passing for executive councils of these groups to discuss and endorse the proposed definition. The result of this endeavor has significant implications.
First, having 29 out of 31 major counseling associations agree on the definition of counseling is historic. Counseling associations traditionally were divided in their views of the profession and have worked more as a confederation than a federation (Sheeley, 2002, 2008). The shift of associations working together to advance the counseling profession is notable and unparalleled in the recent history of the profes- sion of counseling (Bradley & Cox, 2001).
Second, for the first time ever, diverse counseling as- sociations came to a consensus over what counseling is; that is, what counselors do. Prior to the 20/20 effort, defini- tions of counseling were constructed in political arenas or were simply formulated by authors of textbooks or articles (Nassar-McMillan & Niles, 2011; Sweeney, 2001). The result was often wordy, unwieldy descriptions of counseling that reflected the perspective of a particular group. In addition, the characterizations of counseling were often inaccurate, and many needed substantial explanation.
Third, the 20/20 definition of counseling was significant in that it came from the aggregate leadership in the profession of counseling and not from external parties that wished to define or limit the activities of counselors. Although there may not have been any ill intent of other groups—such as online dictionaries or related helping professions—it is important that the counseling profession is seen as the central author- ity in articulating the essence of what it is that professional counselors do.
Finally, by creating a 21-word definition of counseling, counseling associations demonstrated to their constituents and the public that what they do is understandable and comprehen- sive. The definition, while pithy, is also inclusive. From read- ing the 20/20 definition, consumers as well as professionals can get a sense that counseling is a professional relationship that is meant to empower diverse individuals throughout the life span to live meaningful and healthy lives.
The adoption of a consensus definition of counseling is a critical event for the professional counseling community. However, it is only a first step toward a clearly organized and coherent professionalization agenda. In terms of defining the profession, this general consensus definition was not intended to be a formal professional scope of practice statement for counseling. A more specific and technical definition is used within professional and regulatory operations, such as by licensure boards and managed care organizations. The 20/20 group made an active distinction between this consensus definition intended for the general public and the technical professional definition such as contained in a scope of prac- tice. The consensus definition is a strong foundation for future efforts to better determine the full range of elements, such as a unified scope of practice statement, necessary to address such critical professionalization issues as licensure portability.
The 20/20 consensus definition of counseling has gained visibility in the relatively short period since its promulga- tion. The definition appeared on the websites of professional counselors (e.g., Ashburner, 2014; Cedar Ridge Counseling, 2011; Fig Tree Counseling, 2010), professional counseling organization websites (e.g., Ohio Counseling Association, n.d.), commercial websites (e.g., eHow.com, n.d.), and university websites (e.g., University of Alabama, n.d.). It is being written about and promoted by counseling organiza-
Note. N = 27. Higher aggregate scores and means reflect more positive ratings. AS = aggregate score. aPossible range is 189–945. bPossible range is 7–35.
TabLe 3
Second-Round Delphi Results
entry
Counseling involves professional relationships designed to assist individuals, families and groups toward mental health, wellness, educational and career goals.
Counseling: a profession that empowers people to make healthy choices when dealing with life’s challenges.
An educational and/or therapeutic process empowering and assisting people toward well-being and lifelong mental health, academic, and career goals.
Counseling is a professional relationship, established by professional counselors, with individuals, families, and groups, to assist and empower others to address challenges in education, career development, mental health, and wellness across the lifespan.
Professional counseling is the process through which purposeful relationships are created which as- sist and empower people to address life challenges, attain mental health, achieve educational and career goals, and establish and maintain wellness throughout the lifespan.
Counseling: a professional relationship with individuals, groups, or families, from diverse cultures that advocates for mental health and wellness by fostering their development through education, clinical counseling, and career guidance across the lifespan.
Professional counseling is a process that advocates for and empowers others to deal successfully with life’s decisions in a society that fosters human dignity and wellness for all.
M b SD
24.1
22.9
22.6
22.6
22.1
21.4
20.0
6.8
6.4
5.5
6.5
4.7
6.3
5.9
Rank aSa
1
2
3
4
5
6
7
651
618
611
609
598
578
541
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tions (e.g., Francis, 2011), used in state legislative advocacy efforts (H. Tustison, president of the Idaho Counseling Association, personal communication, June 26, 2012), and included in state licensing board public presentations (A. Thomas, executive director of the Arkansas Board of Ex- aminers in Counseling, personal communication, February 2, 2012). Additionally, the 20/20 consensus definition of counseling is now appearing as a standard in counseling textbooks (e.g., Erford, 2013; Gladding, 2013).
There is evidence that the definition is being accepted by the counseling profession. A survey of 1,334 counselor educa- tors published in the Journal of Counseling & Development found strong support for the 20/20 consensus definition of counseling (Reiner, Dobmeier, & Hernández, 2013). Reiner et al. (2013) concluded, “the consensus definition of counseling carr[ies] a strong message urging unified accountability of everyone in the profession to achieve recognition of profes- sional counseling” (p. 175).
Summary One of the initial projects of 20/20: A Vision for the Future of Counseling was to craft a succinct yet comprehensive definition of counseling. The rationale behind this effort was based on the fact that if professional counselors, in a non- political atmosphere, did not come to a consensus on what counseling was, then others outside the profession would define counseling, most likely in limiting terms and to the detriment of counselors. In addition, counselors needed to unite in legislative and consumer initiatives and attract bright and caring individuals into the field.
Over a 2-year span, the delegates from the most represen- tative 30 counseling associations in the United States worked together to formulate a 21-word definition of counseling that 28 (and later 29) of the associations accepted. The effort was un- precedented and moved the profession of counseling forward.
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Note. Oversight Committee members at the time of the unanimous affirmative delegate vote were Marcheta Evans, Samuel Gladding (facilitator), Chris Greene, David Kaplan (administrative coordinator), Lynn Linde, Colleen Logan, Barry Mascari, and Vilia Tarvydas. aNow the Association for Assessment and Research in Counseling. bNow the Association for Humanistic Counseling.
aPPeNDIx
Voting Organizational Delegates in attendance at the March 2010 approval Meeting
Organization
American Association of State Counseling Boards American College Counseling Association American Counseling Association (ACA) ACA Midwest Region ACA North Atlantic Region ACA Southern Region American Mental Health Counselors Association American Rehabilitation Counseling Association Association for Adult Development and Aging Association for Assessment in Counseling and Educationa Association for Creativity in Counseling Association for Lesbian, Gay, Bisexual and Transgender Issues in Counseling Association for Multicultural Counseling and Development Association for Specialists in Group Work Association for Spiritual, Ethical, and Religious Values in Counseling Commission on Rehabilitation Counselor Certification Council for Accreditation of Counseling and Related Educational Programs Council on Rehabilitation Education Counseling Association for Humanistic Education and Developmentb
Counselors for Social Justice International Association of Addictions and Offender Counselors National Board for Certified Counselors National Career Development Association National Employment Counseling Association
Delegate
Barry Mascari Perry Francis Francene Haymon Jean Underfer-Babalis John Parkman Adriana McEachern Linda Barclay Caroline Wilde Chris Moll Brad Erford Shane Haberstroh Ed Cannon Kent Butler Burt Bertram Mike Robinson Cindy Chapman Carol Bobby Linda Shaw Cathy Malchiodi Rhonda M. Bryant Laura Veach Thomas Clawson Judith Hoppin Cheryl Sessions (substituting for Robert Chope)
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Vazquez-Ramos, R., Leahy, M., & Estrada-Her nandez, N. (2007). The Delphi method in rehabilitation counsel- ing research. Rehabilitation Counseling Bulletin, 50, 111–118.
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