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Professional Counseling A Process Guide to Helping

Eighth Edition

Harold L. Hackney Syracuse University Janine M. Bernard Syracuse University

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Library of Congress Cataloging-in-Publication Data

Hackney, Harold

Professional counseling : a process guide to helping / Harold L. Hackney, Syracuse University Janine M. Bernard, Syracuse University. — Eighth edition.

pages cm

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Revision of: The professional counselor / Harold L. Hackney, Sherry Cormier. 2013. 7th ed.

Includes bibliographical references and index.

ISBN 978-0-13-416577-6 — ISBN 0-13-416577-2

1. Mental health counseling. 2. Counseling. I. Bernard, Janine M. II. Title.

RC466.C67 2017

616.89—dc23

2015021938

10 9 8 7 6 5 4 3 2 1

ISBN 10: 0-13-416577-2

ISBN 13: 978-0-13-416577-6

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Preface

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New to this Edition

The eighth edition of Professional Counseling introduces a slightly new title and a new coauthor. Our new title (from The Professional Counselor) stresses the process of counseling as the crux of the text, which, of course, is what it has always been. With this edition, Dr. Janine M. Bernard brings her expertise in the supervision of counselors as an important lens through which to look at the fundamentals of how the counseling process is explained to counselors-in-training. As with other new editions, we set out to enhance and broaden the concepts inherent in the process of helping others. Professional counseling is a vibrant and evolving entity. It grows through the practice of skilled counselors, explorations of researchers, and musings of thoughtful scholars. This text, therefore, continues to evolve to reflect the current nuances we see in our beloved profession. Those nuances also reflect our experiences with our students as we observe their challenges, hear their questions, and see what seems to resonate with them. There is no question that our students, most of whom now represent the Millennial Generation, inform us about the counseling process, sometimes in ways we didn’t see coming! Therefore, with the helpful suggestions of independent reviewers, dedicated students and colleagues, new areas for improvement emerge. New to this edition are the following:

A revision of the 5-stage model of counseling to a 4-stage model that carries working relationship skills across all stages Adding new case examples and revising older ones to illustrate how skills and competencies are applied to clients more likely seen in mental health agencies and those who present in educational settings Updating how culture is infused into the counseling process More than 40 new end-of-chapter web-based video samples that illustrate skills and procedures discussed in each chapter A new section on how to evaluate your counseling

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Many new sections within chapters, including the introduction of “second-order” interventions A new section in each intervention chapter concerning how interventions are used in Dialectical Behavior Therapy and, where appropriate, Motivational Interviewing The addition of new forms in Appendix B

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Features of this Book

This edition maintains a number of features that have long set this book apart from most other introductory counseling textbooks and include the following:

A four-stage model that provides students with a roadmap for assessing client progress, helps students plan for interventions, and encourages students to view counseling as an intentional process with an end in sight. Clear guidelines for assessing cases using four orientations—affective, cognitive, behavioral, and systemic—that help students apply what they have learned in counseling theory courses to the actual practice of counseling. The application of the four orientations for interventions to two popular therapy approaches, Dialectical Behavior Therapy and Motivational Interviewing. Cultural dimensions of counseling viewed as positionality versus an emphasis on demographics, as well as a more nuanced treatment of culture throughout the text. Examples include the addition of what might be considered “lesser” cultural identities (e.g., urban culture, military culture) but may play significant roles in the development of problems (Chapter 1 ); the use of assessment tools, such as the genogram to track cultural dimensions for individuals and families (Chapter 6 ); references to culture through out all interventions chapters so as to remind the reader of the role of cultural identities and realities in counseling, but in a manner that does not reinforce stereotypes (Chapters 8 through 11 ). Sections throughout the text that apply chapter content to working with children.

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Identification of “meaning” as a counseling issue and how it is addressed for both spiritual and nonspiritual clients. Sections in each chapter that discuss how clients react to the stages of counseling and to different intervention orientations. Separate chapters on client assessment (Chapter 5 ) and treatment planning (Chapter 7 ) that help students incorporate specific counseling interventions as they are learning them. Discussion of treatment planning that reflects the influence of third- party payors and the necessity of knowing how to plan treatments that meet third-party criteria. Helpful boxed material throughout the chapters that summarizes and illustrates skills. A series of forms and guides (Appendix B ) that illustrate the management of counseling cases. A chart that identifies those Council for the Accreditation of Counseling and Related Educational Programs Standards (CACREP, 2016) that are addressed in each of the chapters.

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How the Book is Organized

Beginning with Chapter 1 , Conceptualizing Professional Counseling, we provide a context for counseling, including how to think about the profession and the process. We discuss the counseling relationship, conditions that facilitate positive relationships, considerations of what successful counseling is like, characteristics of effective counselors, and a case illustration for how to measure counseling outcomes.

In Chapter 2 , we explore the Language of Counseling. What is it that counselors say that sets them apart from other caregivers? What special ways do counselors use language? What is their purpose in using this language? How does this language affect the client? And how does the counselor’s language change, depending on a client’s goals? We address this professional communication through basic nonverbal and verbal helping skills, as well as advanced verbal skills.

Chapter 3 , The Essential Structure of Counseling, sets the format for the remainder of the book by discussing the counseling process as a passage through four stages of development. We give students a way to conceptualize the process, beginning with establishing the relationship while simultaneously assessing (understanding) the client’s presenting problem, helping the client recognize what can be achieved (goals), structuring the sessions (using a variety of interventions) with the problem definition and goals firmly in mind, and helping the client complete the counseling relationship successfully.

Chapter 4 , Initiating and Maintaining a Working Relationship, highlights the importance of the counseling relationship in all of counseling. We do not consider establishing a working relationship with a client as a “stage” of counseling because it permeates all stages. This chapter gives the

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reader a “place to go” regardless of what stage of counseling he or she is in to review the essential ingredients of a positive working relationship.

Chapters 5 through 7 are best viewed as a unit. Chapter 5 , Assessing Client Problems, centers on how clients present their issues and how the counselor can facilitate this process. Topics such as intake interviews and genograms are included as these help structure what the counselor is hearing. Although the focus at this point is how the client understands his or her problem and how this problem is experienced, the counselor is beginning to conceptualize what is presented by utilizing theory-based filters. These are presented briefly in Chapter 5 as components of the problem: feelings, cognitions, behaviors, and interpersonal relationships. These components become more dominant later in the book and drive the full discussion of interventions in Chapters 8 through 11 .

Chapter 6 , Developing Counseling Goals, grounds the reader in the important topic of goal setting. Goals derive from the careful assessment that has been completed in the prior stage although the very act of setting goals can open up new areas for assessment as well. It is at this stage that many counselors begin to appreciate how fluid is the process of counseling.

Chapter 7 , Defining Strategies and Selecting Interventions, serves as a transition chapter from what has come before and the intervention chapters that follow. The chapter focuses on treatment planning that uses the information gleaned from assessment and goal setting. What were described as components of the problem in Chapter 5 are now framed in a way that will lead to the selection of interventions: problems as complicated by feeling states, problems as errors in thought processes, problems as behavior patterns, and problems as interpersonal or systemic conditions.

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Up to this point in the text, we have been talking about skills and stages that are generic to all counseling. They could be called core skills and processes. Some authors refer to them as common factors. In Chapters 8 through 11 , we move into areas that are more specific to working from a particular orientation or domain. Although we believe that good counselors have some level of expertise in all of the interventions that are presented in these chapters, we also accept that each counselor will veer more toward some clusters of interventions than others.

The change to the word intervention at this point in the text is deliberate and it should be defined as different from skill or technique. As noted earlier, we view skills as core to all counseling. Regardless of one’s orientation, asking good open-ended questions, reflecting well, summarizing what the client has said, and so forth, are all endemic to the counseling process. A technique comes closer to an intervention and some authors may even use the two terms interchangeably. Still, techniques can be used for a very specific process goal and not be tied to outcome goals. For example, a counselor might use a relaxation exercise at the beginning of each counseling session because the client tends to arrive to sessions anxious. This is an excellent use of a technique, but does not fit our definition of an intervention.

By contrast, interventions are chosen only after an assessment process has been completed and outcome goals have been set. Interventions, then, are integrally connected to how the counselor views the issues being discussed and are chosen as part of a plan to address (and hopefully alleviate) these issues. Although interventions may look like and feel like advanced skills (and to some extent they are), they are used with more sense of where the counselor is headed than are the core skills. Said differently, interventions are chosen specifically because the counselor believes they will assist the client in resolving the issues that have been presented in as efficient and meaningful a way as possible.

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Chapters 8 through 11 are divided into the four principal categories of interventions that counselors use: Affective Interventions, Cognitive Interventions, Behavioral Interventions, and Systemic Interventions. In each chapter, we attempt to help the reader see counseling from that particular orientation and give examples of how this is done. Prior to reading about these different categories of interventions, consider these three introductory points about them.

First, these chapters do not present a full review of the possibilities within each category. The professional literature and now the Internet offer a plethora of possibilities for either fine-tuning interventions for specific populations or expanding one’s personal collection of interventions. What we offer here is a sample and some of the most common interventions in the profession. We hope that the reader will use these chapters as a place to begin, not as an authoritative collection of what is available.

Second, although the chapters are divided by major orientations or domains, we view interventions as more flexible than they might appear. Just as a counselor can reflect affect or reflect thought, some of the interventions could be revised easily to attend to another domain. We encourage the reader to consider such possibilities as they gain experience as counselors.

Third, we repeat this point on occasion in the chapters themselves, but here we introduce the idea that a client’s dominant method of communicating is not necessarily the best orientation for intervention selection for that client. For example, a client might present with a great deal of emotion. It might be tempting, therefore, for a counselor to stay in the affective realm in working with that client. We believe that this could be an error. Because the client already has access to his or her emotions, it may be other areas that need exploration for feelings to get “under control.” Similarly, the highly cognitive client probably needs more than cognitive interventions. Our point

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is that the client’s “strong suit” is not the primary criterion for how counselors choose interventions.

We have ended each of the four intervention chapters with some attention to two popular therapy approaches: Motivational Interviewing (MI; Chapters 8 and 9 ) and Dialectical Behavior Therapy (DBT; Chapters 10 and 11 ). Of course, it is not our intent nor is it realistic for us to offer any sort of comprehensive explanation of either of these approaches. Rather, we are attempting to demonstrate the ways that different therapies use interventions and, in the case of DBT, how interventions from all four orientations can be used at different times as therapy proceeds.

Finally, in Chapter 12 , Termination and Evaluation, we return to the final stage of counseling, termination, as a process in itself rather than an event. What are the ingredients of a successful termination? What ethical issues are raised in the termination process? Who decides when termination is appropriate? How is referral to another helping source part of the termination process? We also discuss the evaluation of counseling as an important task for counselors during this stage so that they can continue to improve.

Each chapter includes exercises and discussion questions that help individual students to integrate the information they have just read. Discussion questions have also been provided to aid in group discussions. At the end of each chapter, we provide video illustrations of the skills that are available at MyCounselingLab, along with suggestions for viewing these videos.

Appendix A offers students more comprehensive practice exercises, along with a Counseling Skills Checklist that can be copied and used for feedback purposes.

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Students will find a variety of forms commonly used in counseling practice in Appendix B . These forms may be copied and used by students as they practice their craft.

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Also available with MyCounselingLab This title is also available with MyCounselingLab–an online homework, tutorial, and assessment program designed to work with the text to engage students and improve results. Within its structured environment, students see key concepts demonstrated through video clips, practice what they learn, test their understanding, and receive feedback to guide their learning and ensure they master key learning outcomes.

Learning Outcomes and Standards measure student results. MyCounselingLab organizes all assignments around essential learning outcomes and national standards for counselors. Video- and Case-Based Assignments develop decision-making skills. Video- and Case-based Assignments introduce students to a broader range of clients, and therefore a broader range of presenting problems, than they will encounter in their own pre-professional clinical experiences. Students watch videos of actual client-therapist sessions or high-quality role-play scenarios featuring expert counselors. They are then guided in their analysis of the videos through a series of short- answer questions. These exercises help students develop the techniques and decision-making skills they need to be effective counselors before they are in a critical situation with a real client. Licensure Quizzes help students prepare for certification. Automatically graded, multiple-choice Licensure Quizzes help students prepare for their certification examinations, master foundational course content, and improve their performance in the course. Video Library offers a wealth of observation opportunities. The Video Library provides more than 400 video clips of actual client-therapist sessions and high-quality role plays in a database organized by topic and searchable by keyword. The Video Library includes every video clip from the MyCounselingLab courses plus additional videos from Pearson’s extensive library of footage. Instructors can create additional

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assignments around the videos or use them for in-class activities. Students can expand their observation experiences to include other course areas and increase the amount of time they spend watching expert counselors in action. Comprehensive online course content. Filled with a wealth of content that is tightly integrated with your textbook, MyLab lets you easily add, remove, or modify existing instructional material. You can also add your own course materials to suit the needs of your students or department. In short, MyLab lets you teach exactly as you’d like. Robust gradebook tracking. The online gradebook automatically tracks your students’ results on tests, homework, and practice exercises and gives you control over managing results and calculating grades. The gradebook provides a number of flexible grading options, including exporting grades to a spreadsheet program such as Microsoft Excel. And, it lets you measure and document your students’ learning outcomes.

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Acknowledgments

Thinking about a new edition begins with the opinions of others— specifically, the persons who serve as reviewers provide invaluable insights into how the user views a text, both its strengths and its weaknesses. Insightful reviewers provide enormous value in this renewal process. We thank Jori Berger-Greenstein, Boston University School of Medicine; Vanessa D. Johnson, Northeastern Univeristy; Gulsah Kemer, Arizona State University; Yu-Fen Lin, University of North Texas, Dallas; and Oscar Sida, University of Nevada, Las Vegas, for their generous and serious attention to this responsibility. Their comments have given us a real advantage in our effort. We also wish to thank Kevin Davis, our editor, for his support in how this edition was to take shape, and to Lauren Carlson, project manager, for her expert choreography of the eighth edition. Special thanks to Mercedes Heston for her careful review of the manuscript and her good humor throughout. Finally, we wish to thank our students, past and present, who consistently give us new insights into the process of learning to become a counselor. Without their help and the help of scholars who continue to wrestle with understanding the counseling process in modern times, no new edition could be in fact new.

H.H. J.M.B.

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About the Authors

Harold (Dick) Hackney, Professor Emeritus of counseling at Syracuse University, is a nationally certified counselor and a Fellow of the American Counseling Association. Dick is past- president of the Association for Counselor Education and Supervision and former member of the ACA Governing Council, and a past- president of the Center for Credentialing and Education, an affiliate of NBCC. His areas of expertise include counselor training, training of future counseling professors, research methodology, ‐ counseling processes, and counseling theory. Hackney’s writings draw from his experiences as a school counselor, a marriage and family counselor, and his research on counseling processes. Prior to his appointment at Syracuse University, Hackney was a professor at Purdue University and at Fairfield University.

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Janine M. Bernard, Professor Emeritus of counseling and counselor education at Syracuse University, is a nationally certified counselor, an approved clinical supervisor, and licensed as a mental health counselor in New York. Bernard is a Fellow of the American Counseling Association and a long-term member of the American Psychological Association. She is a past-chair of the National Board for Certified Counselors. Her areas of expertise include clinical supervision, counselor training, multicultural aspects of supervision, and life-span human development. Prior to her appointment as department chair at Syracuse University, Bernard held faculty appointments at Purdue University and at Fairfield University.

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Brief Contents Chapter 1 Conceptualizing Professional Counseling 1

Chapter 2 The Language of Counseling 20

Chapter 3 The Essential Structure of Counseling 36

Chapter 4 Initiating and Maintaining a Working Relationship 54

Chapter 5 Assessing Client Problems 75

Chapter 6 Developing Counseling Goals 98

Chapter 7 Defining Strategies and Selecting Interventions 116

Chapter 8 Affective Interventions 131

Chapter 9 Cognitive Interventions 157

Chapter 10 Behavioral Interventions 183

Chapter 11 Systemic Interventions 212

Chapter 12 Termination and Evaluation 240

Appendix A Integrative Practice Exercises 259

Appendix B Forms and Guides for Use in Counseling Practice 266

References 284

Index 291

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Contents Preface iii

About the Authors viii

Chapter 1 Conceptualizing Professional Counseling 1 What Is Counseling? 2

The Parameters of Counseling 3

Counseling Conditions and Their Effects 8

▶ Case Illustration of Possible Counseling Outcomes 11

Characteristics of Effective Helpers 12

The Developmental Nature of Learning to Counsel 16

Summary 18

Exercises 18

Discussion Questions 19

MyCounselingLab Assignment 19

Chapter 2 The Language of Counseling 20 Communication in Counseling 21

Nonverbal Skills of Counseling 21

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Basic Verbal Skills of Counseling 23

Advanced Verbal Skills of Counseling 26

Summary 31

Exercises 34

Feedback for Exercise III, Recognizing Different Counselor Responses 34

Discussion Questions 35

MyCounselingLab Assignment 35

Chapter 3 The Essential Structure of Counseling 36 The Counseling Process 37

The Client’s Experience in Counseling 48

Summary 51

Exercises 52

Discussion Questions 52

MyCounselingLab Assignment 53

Chapter 4 Initiating and Maintaining A Working Relationship 54 Characteristics of a Therapeutic Relationship 55

Communicating Empathy 59

Relationship-Building Skills 60

Conditions That Convey Genuineness 65

Conditions That Convey Positive Regard 67

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Functions of a Therapeutic Relationship 68

Effects of Therapeutic Relationships on Clients 69

▶ Case Illustration of Relationship Building 70

Children and the Counseling Relationship 71

Summary 72

Exercises 73

Discussion Questions 74

MyCounselingLab Assignment 74

Chapter 5 Assessing Client Problems 75 Purposes of Assessment 76

Dimensions of Assessment 77

Clinical Assessment with Children 81

Clinical Assessment with Couples and Families 83

Using Assessment Information 85

Skills Associated with Assessment 85

Effects of Assessment on Clients 90

▶ Case Illustration of the Intake Interview 91

Crisis Assessment 94

Integration of Problem-Definition Information with Treatment Planning 95

Summary 95

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Exercises 96

Discussion Questions 97

MyCounselingLab Assignment 97

Chapter 6 Developing Counseling Goals 98 Functions of Counseling Goals 99

Parameters of Goal Setting: Process and Outcome Goals 100

Three Elements of Good Outcome Goals 101

Obstacles in Developing Specific Goals 102

Skills Associated with Goal Setting 102

Effects of Goal Setting on Clients 107

Goal Setting with Children 107

Crises and Goal Setting 108

Goal Setting and Culture 108

Client Participation in Goal Setting 109

Resistance to Goal Setting 110

Assessing Counseling Goals 111

▶ Case Illustration of Goal Setting 111

Summary 114

Exercises 114

Discussion Questions 115

MyCounselingLab Assignment 115

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Chapter 7 Defining Strategies and Selecting Interventions 116 Case Conceptualization Skills 117

Theory and Case Conceptualization 117

Worldview and Case Conceptualization 118

Conceptualizing Presenting Problems 119

Diagnosis and Case Conceptualization 121

Time Orientation and Case Conceptualization 121

Goals and Treatment Planning 122

Strategy Selection 123

Categories of Counseling Interventions 123

▶ Case Illustration of Strategy and Interventions Selection: Angela 125

Defining a Counseling Strategy 126

Strategies for Working with Children 128

Summary 128

Exercises 129

Discussion Questions 130

MyCounselingLab Assignment 130

Chapter 8 Affective Interventions 131 Theories That Stress the Importance of Feelings 132

Affective Interventions 133

Helping Clients Express Affect 134

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Nonverbal Affect Cues 135

Verbal Affect Cues 136

Helping Clients Sort Feelings 140

Focusing Intervention 143

▶ Case Illustration of Focusing 144

Helping Clients Integrate or Change Feeling States 145

▶ Case Illustration of Integrating Feelings 146

Role Reversal 147

▶ Case Illustration of Role Reversal 147

Alter Ego 148

▶ Case Illustration of the Alter Ego 149

The Empty Chair 150

▶ Case Illustration of the Empty Chair 151

Client Reactions to Affective Interventions 152

Applying Interventions to Dialectical Behavior Therapy and Motivational Interviewing 152

Summary 155

Exercises 155

Discussion Questions 156

MyCounselingLab Assignment 156

Chapter 9 Cognitive Interventions 157

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Theories That Stress the Importance of Cognitive Processes 158

Goals of Cognitive Interventions 158

Assessment of Cognitive Problems 159

Eliciting Thoughts 160

Cognitive Interventions 161

▶ Case Illustration of A-B-C-D Analysis 163

▶ Case Illustration of Injunctions and Redecision Work 168

Second-Order Interventions 173

Meaning-Making Interventions 175

▶ Case Illustration of Meaning Making 177

Client Reactions to Interventions 177

Applying Interventions to Dialectical Behavior Therapy and Motivational Interviewing 179

Summary 180

Exercises 180

Discussion Questions 182

MyCounselingLab Assignment 182

Chapter 10 Behavioral Interventions 183 Behavioral Interventions and Theory 184

Goals of Behavioral Interventions 186

Basic Behavioral Skills 187

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Using Behavioral Interventions 188

▶ Case Illustration of Skill Training 195

▶ Case Illustration of Anxiety Reduction 201

▶ Case Illustration of Self-Management 206

Client Reactions to Behavioral Interventions 209

Applying Interventions to Dialectical Behavior Therapy 209

Summary 209

Exercises 210

Discussion Questions 211

MyCounselingLab Assignment 211

Chapter 11 Systemic Interventions 212 System Properties 213

Therapies That Stress the Importance of Systems 214

Systemic Skills and Interventions 215

Establishing a Therapeutic Relationship and Assessing System Issues 216

Goal Setting 220

▶ Case Illustration of Reframing for Goal Setting 221

Systemic Interventions 223

Communication Skill Building 223

Altering System Properties 229

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▶ Case Illustration of Altering Hierarchy and Boundary Making 231

▶ Case Illustration of Enactment 233

Second-Order Interventions 235

▶ Case Illustration of Prescribing the Symptom 235

Client Reactions to Systemic Interventions 237

Summary 238

Exercises 238

Discussion Questions 238

MyCounselingLab Assignment 239

Chapter 12 Termination and Evaluation 240 The Termination Stage 241

Termination as a Process 244

The Referral Process 246

Blocks to Termination 249

▶ Case Illustration of Termination 250

Evaluation of Counseling 254

Summary 256

Exercises 256

Discussion Questions 257

Appendix A Integrative Practice Exercises 259

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Appendix B Forms and Guides for Use in Counseling Practice 266

References 284

Index 291

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Chapter 1 Conceptualizing Professional Counseling

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Introduction to Professional Counseling We have an ambitious goal for the reader of this text. We hope to provide you with the tools to move you from someone who knows little about the actual process of providing professional counseling to someone who is ready to see her or his first client under supervision. Therefore, this book includes discussion of basic skills of counseling but goes beyond this to give you frames of reference that will assist you in knowing what skills to use when and for what purpose. However, before we begin this exciting (and occasionally intimidating) journey, it is important to spend some time trying to deconstruct the term professional counseling and to understand a number of concepts and conditions that are fundamental to the counseling process.

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Purpose of this Chapter

In this chapter, we consider some important topics that should be contemplated before you begin to learn specific skills for the process of counseling. Foremost to our discussion is that counseling must be viewed in context. The factors that contribute to that context include philosophy, theoretical premises, and cultural realities—in other words, the intellectual and social milieu. In addition, we address different ways client problems can be assessed and counselor qualities that are universal, crossing theoretical approaches, cultures, and time. Our ultimate objective is to help you, the reader, begin to identify yourself within these parameters and to do some introspection regarding how your thinking and your personal qualities match those of the professional counselor.

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Considerations as You Read This Chapter

How do you view life? Do you believe that most things that happen to people are unplanned and coincidental, or do you believe that life events tend to fit a “larger plan”? Is life’s challenge a matter of analyzing situations and developing successful responses to those situations? Or is it to become the best person one can be, given the circumstances life presents? How do you describe yourself culturally? From whom have you learned the most about yourself as a cultural being? What do you believe is most misunderstood about you culturally? As you read about each of the personal qualities required of professional counselors, how does the explanation describe you? How would you edit the explanation to be a better fit to how you see yourself?

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This is a text about the process of counseling. In the hands of a skilled and sensitive person, this process can be used to enhance the lives of people who are seeking to cope with difficult life challenges, to change their relationships, or to develop self-understanding. Although it is almost impossible to define precisely what the experience of providing counseling will be for you, some general parameters of the counseling process will certainly be part of your experience. There are several ways to consider the counseling process, beginning with a clear sense of what the process is, how counseling is applied to human problems, how the client and the client’s circumstances influence the process, and what constitutes successful counseling. In this chapter, we examine these and other fundamental issues as they relate to the practice of counseling.

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What is Counseling? At its core, counseling is the process of offering assistance. It is for this reason that we hear of credit counselors, investment counselors, camp counselors, and retirement counselors, to name just a few. This book is about professional counseling as used by mental health professionals in general and specifically those whose professional home is with the American Counseling Association and its affiliates. In this text, we use the terms professional counseling and counseling interchangeably. Often, mental health agency settings refer to therapy, short for psychotherapy. Again, these terms refer to the same processes that we address in this text.

Counseling is a combination of having specialized knowledge, interpersonal skills, and personal dispositions that are required to assist clients in facing or understanding successfully what is interfering with their lives, assisting clients in identifying attainable goals to improve their situation, and offering interventions that assist clients in goal attainment. You might be asking, “What knowledge? What skills? What dispositions?”; we begin addressing each of these questions in this chapter. But we could also include, “What clients?” because clients can be individuals, groups, families, or institutions. As an example of having an institution as a client, when a mental health counselor convinces agency staff to provide service at times more convenient to clients in a community or when a school counselor offers a new psychoeducational program, he or she is using counseling skills to intervene at an institutional level to arrive at a goal the counselor has assessed as worthy. Most counseling, however, is confined

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to persons in a room where a professional is listening intently, checking in to be sure that the client(s) is understood in both a cultural and psychological sense, and moving toward some outcome that enhances the client’s well-being.

The content of professional counseling tends to include both internal and relational concerns. Internal (intrapersonal) concerns can range from issues of self-concept or self-defeating habits to severe mental impairment. Relational (interpersonal) concerns can range from communication and perceptual problems between the client and others to issues of hostility, aggression, and criminal activity toward others. These problems cross all age groups and developmental stages. It is important to note that these issues, even the “lesser” ones, are diagnostic in nature—that is, the problems must be understood both in their expression (as behaviors, feelings, or thoughts) and in the context in which they are supported (what keeps the problem alive).

Finally, although our definition is generic in nature, this is not to suggest that a professional counselor might be a provider of services for any type of problem. Within the counseling profession are many specialties, including mental health counselors, marriage and family counselors, school counselors, rehabilitation counselors, pastoral counselors, creative arts counselors, and career counselors. Each specialty is based on knowledge that is specific to working within certain institutions or with particular populations. Still, despite differences, the actual process of counseling shares the common elements of relationship, communication, conceptualization, and intervention skills that are covered in this text.

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Why Counseling?

It may be necessary to remind some aspiring counselors that the problems of life can be solved in many ways, counseling being only one of those ways. The vast majority of the human race has never experienced professional counseling. Does that mean that they are functioning at some sublevel of life? Of course not. Many people adapt to life’s challenges by using personal resources, friends and family, or religious faith. But even with these resources, challenges can sometimes accumulate to the point that an unencumbered and skilled helper can facilitate the process of growth and adaptation to such challenges.

Viewed in this way, counseling can assume the function of change, prevention, or life enhancement. As change, counseling is concerned with situations that, for whatever reason, have become so disruptive that people are unable to continue through the normal passage of life without excess stress, dissatisfaction, or unhappiness. As prevention, counseling is able to take into account those predictable life events that produce stress, cause people to draw on their psychological resources, and, ultimately, demand adaptation to changing life forces. Finally, a third form of counseling, enhancement counseling, goes beyond life’s challenges and predictabilities. As a counseling goal, enhancement attempts to open clients’ experiences to new and deeper levels of understanding, appreciation, and wisdom about life’s many potentialities.

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The Parameters of Counseling Counselors can talk about counseling as change or growth, or they can talk about counseling as a process or product. If counselors go very deeply into an examination of these alternatives, it also becomes apparent that they are beginning to talk about philosophical, cultural, and even spiritual issues as well as psychological or interpersonal concerns. How counselors view these issues and concerns determines at least part of what they do in the counseling interview. If I happen to hold an optimistic view of human beings and how they adapt to life’s ups and downs, my view of what should happen in counseling will be quite different from that of the person who holds a cautious, or even pessimistic, view of human beings and how they function. If I have experienced life only in a sheltered or encapsulated environment, then I may view counseling as not involving cultural dimensions, including the extreme conditions when all some clients have known is a culture of little opportunity, survival of the fittest, and violence. If I solve my problems by careful examination and analysis of issues, decisions to be made, appropriateness of outcomes, and so on, then I might naturally assume that others should approach life problems in a similar fashion, especially if I have been fortunate enough to have the resources to make this happen. Or if I see life as a multifaceted adventure, then I might feel less urgency to identify, prescribe and, thus, control the outcomes of counseling. If I am fearful of things going in a negative direction if I make an error, then I may seek “solutions” for my clients and

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attempt to push these to conclusion. These are just some of the possibilities of how the counselor’s worldview can affect counseling when she or he enters the process.

Occurring simultaneously with the counselor’s worldview is the presentation of the client’s concerns by the client. These concerns may have a strong basis in reality, or they may be self-generated by the client’s discomfort or skewed by the client’s faulty perceptions. And it is also obvious that clients come as optimists or pessimists, bold or cautious, with personal or environmental resources, or without them. Whatever the case, the counselor must have a healthy appreciation of the very broad range of behaviors, attitudes, self-concepts, histories, cultural contexts, resources, and feelings that their clients represent. In other words, the term normal may not be very useful apart from understanding the client’s context. For any given client, it may be normal for a child to live with more criticism than love; it may be normal for a woman to live with men who are volatile and occasionally violent; it may be normal for substances to be abused to block out feelings of hopelessness. Regardless of whether something is normal to a particular client, it may not be functional, and this is where counseling can be helpful. Functional behavior is that which thwarts dysfunction and opens up new possibilities, including the possibility of growth, problem solving, and an increased ability to cope with life’s inevitable stressors. When listening to the personal concerns of clients, counselors must seek to understand life (i.e., what has been normal for them) as clients see it and the reasons they see life as they do. Only then can counselors begin to participate as helpers in the counseling relationship. Only then can clients begin to move toward more functional behavior.

Although we alluded to it earlier, it is important to stress once more that there is no way to understand human existence by separating it from the setting or environment in which existence occurs. Children cannot be fully

understood separate from their families of origin, their neighborhoods, or their peer groups; adults cannot be understood separate from their families, ethnicities, social class, belief systems, or careers; and individuals cannot be dissected into intellectual selves, occupational selves, affective selves, or whatever. Each individual is an ecological existence within a cultural context, living with others in an ecological system. One’s intrapersonal dimensions are interdependent with others who share one’s life space. A keen understanding and appreciation of this interdependence will facilitate your understanding of yourself as a counselor, and of your clients as people seeking to become healthier, to make better choices, to grow, or to enhance their lives.

Counseling and Philosophy

Before we move on to more specific aspects of counseling, including the interface between theory and counseling process, let’s step back for a moment and consider philosophical viewpoints. Few people consider themselves to be philosophers, and yet everyone has a philosophical outlook on life. Some people see life as a sequence of events and experiences over which they have little or no control; others view life as a challenge to be analyzed, controlled, and directed. Some see achievement and self-improvement as the purpose of life; others view life as a process to be experienced. Who is right? Everyone. Philosophical outlooks on life are varied, allowing each individual to choose or to identify with that outlook that seems to fit him or her best.

Counseling theory has drawn primarily from four philosophical positions (Hansen, 2004; Wilks, 2003). The first of these, essentialism, assumes that human beings are rational by nature, that reason is the natural goal of education, and that the classical thinkers are the chief repository of reason. From this orientation come the problem solvers, the analyzers, those who search for patterns in life.

The second philosophical position, progressivism, is concerned with the fundamental question, “What will work?” Knowledge is based on experimental results, truth is identified through consequences, and values are relative rather than absolute. From this orientation come the persons who rely on data and research for their truths, who believe that pragmatic solutions do exist for human problems, and who are committed to the pursuit of logical and lawful relationships in life.

The third philosophical position, existentialism, holds that life’s meaning is to be found in the individual, not in the environment or the event.

Lawfulness (progressivism) and rational thinking (essentialism) are meaningless unless the individual gives them meaning. People who align with this view of life believe that values are real and individually determined, and that experiences are subjective rather than lawful or predictable. Individual responsibility is emphasized; human reactions are the result of choice or potential choice.

Finally, the fourth philosophical position, postmodernism, raises the fundamental question, “What is real?” This question is particularly relevant in terms of the client’s experience versus an external reality—or more specifically, which reality is more important—the client’s reality, or an outside reality to which the client should adapt? Although there are some similarities between postmodernism and existentialism in this regard, the important point is that one can never know a reality outside oneself and, therefore, must focus on personal reality. From this orientation come persons who believe that reality can have only a personal meaning, that reality gains meaning through one’s personal perceptions or explanations of experiences.

Obviously, all counselors enter the profession with some variation of these viewpoints. Each counselor’s philosophical view is reflected in how he or she reacts to client problems and how those problems are addressed. Similarly, clients enter counseling with some variation of these viewpoints that are reflected in how they view their problems and what they consider to be viable solutions. Keeping these variations in mind, both for yourself and for your relationship with clients, will help you to choose interventions that are relevant to the people you are trying to assist.

Counseling and Theory

Whether you are studying theories of counseling concurrently to learning about the counseling process or at a different time, at some point, you will be asked to consider how theory will inform your work. Stated simply, a theory attempts to explain how something came to be or how it works. Personality theory, from which numerous counseling theories spring, is an effort to explain the various ways that the psyche emerges, evolves, and matures, both in terms of normal development and in terms of dysfunction. Counseling theories move beyond an explanation of dysfunction in relation to normal development, and offer ideas of how corrections to this dysfunction can be accomplished. Said differently, counseling theory not only hypothesizes about how humans operate, but also how to intervene when things appear to be unraveling. What confuses many students of counseling is how differently some theories conceptualize human existence from others. It would be convenient, perhaps, if the mental health disciplines had only one theory, like relativity; however, that is not the case, and every counselor must study the extant theories available and determine which theory or combination of theories resonates with him or her.

Within the context of counseling therapies, more than 400 approaches have been identified. Most of these approaches would be better labeled as variations on a much smaller number of theoretical themes. Among the dominant theoretical approaches are psychodynamic, cognitive/behavioral, humanistic, systemic, and postmodern approaches, each of which offers a type of map of the counseling process and the route its participants should take to achieve certain goals. Rarely does a counseling theory prescribe what the specific goals of counseling should be. Because there is much room for alternative viewpoints on matters such as normal human functioning, how people change, and what is a desirable outcome, different theories have emerged to reflect these various viewpoints. On a more

practical level, counselors use theories to organize information and observations, to explain or conceptualize client problems, and to order and implement particular interventions with clients.

Counselors tend to identify with particular theories for a variety of reasons. Some counselors look for a theory that provides the most utilitarian explanation of the counseling process. Their quest is for a theory that provides concrete guidelines. Other counselors look for a theory that is compatible with their life perspective—that is, a theory that makes similar assumptions about human nature as their own private assumptions. Still other counselors seek a theory that best explains or conceptualizes the types of problems their clients present. Of course, it is possible for a counselor to obtain all three objectives with the same theory, but this realization tends to emerge only as the counselor gains experience.

Over the years, the counseling profession has witnessed an increased convergence among theorists and a growing realization that no single theory can explain or fit all client challenges. The result is an emerging view that theory is meant to serve the user, and when no single theory totally fits the counselor’s needs, then a blending of compatible theories is an acceptable practice. This is known as either an eclectic or an integrative approach. An eclectic approach is one where a counselor chooses a theory depending on each client’s needs. Hoffman (2006) noted that the challenge with this approach is that it requires that the counselor become expert in applying many theories, a feat that could take many years. Rather, Hoffman suggests that many practitioners adopt an integrative approach, where they claim a central theoretical position but pull from other theories as needed, such as a counselor who claimed to be cognitive-behavioral-integrative. Prochaska and Norcross (2014) report that a sizable number of practicing counselors prefer an integrative or eclectic approach.

Despite a variety of theories to draw from, there are common factors that are present across all counseling. The following list presents seven elements about counseling that are operative for all of the major theoretical approaches:

1. Counseling involves responding to the feelings, thoughts, actions, and contexts of the client. Existing theoretical approaches tend to emphasize one of these over the others. However, all counselors must be excellent observers and skilled in their ability to engage clients, to elicit the client’s thoughts and feelings, and to respond to these in ways that are helpful.

2. Counseling involves a basic acceptance of the client’s perceptions and feelings, regardless of outside evaluative standards. In other words, you must first acknowledge who the client is before you can begin to consider who the client might become. Clients need your understanding of their current reality and concerns before they can anticipate growth and change in a new direction.

3. Counseling is a multicultural experience. This realization affects all aspects of the process, including assessment, goal setting, and intervention selection.

4. Ethical mandates of the profession are relevant across all counseling, and include confidentiality, receiving adequate supervision, avoiding multiple relationships with clients, informed ‐ consent, and so forth. All counselors must be familiar with the ethical codes to which they are subject.

5. Counseling must include client buy-in. This is especially important when clients are mandated, but is also true of many clients who come voluntarily but have not yet made a commitment to work toward change. Therefore, counselors must be skilled in “marketing” what it is they have to offer as a first step with some clients. This can take the form of showing respect and interest in the client, even if the client appears to be disengaged; or it can take the form of

frank talk of consequences for the client if no change occurs in his or her life. Whatever is the decided approach, buy-in must be accomplished if counseling is to have positive outcomes. Otherwise, the counselor learns that counseling can be a weak intervention with a client who is unable to make a commitment to the process. This, of course, is the client’s right, and coercion is never appropriate as a means to continue with a client.

�. Generally speaking, the counselor operates with a conservative bias against communicating to the client detailed information about his or her own life. Although there are times when counselor self- disclosure is appropriate, counselors generally do not complicate the relationship by focusing attention on themselves.

7. One cluster of skills underlying all approaches to counseling is that which makes up communication. Counselors and clients alike continually transmit and receive verbal and nonverbal messages during the interview process. Therefore, awareness of and sensitivity to the kinds of messages being communicated is an important prerequisite for counselor effectiveness.

Counseling and Culture

Increasingly, society is becoming aware of the complex role that culture plays in interpersonal relationships. Furthermore, cultural awareness is endemic to the discussion of theory and philosophy already introduced. As you listen to how clients see the world (often reflecting how their families taught them to see the world and how the world taught them to see themselves), you may begin to see some similarities within cultural groups. As a result, one of your challenges as a counselor is to find a theory (or theories) that reflects your own view of the world but is not inconsistent with how your clients view the world. One of the rewarding parts of counseling is that if you listen intently to how other cultural groups think and feel, you may find that your own views about things evolve.

If you were to look up the word culture in a variety of resources, some of the words and phrases that would keep coming up are beliefs, values, way of life, shared attitudes, morals, and characteristics. For this reason, counseling is best viewed as multicultural, because most individuals are members of more than one cultural group. For example, you may be a White, Irish-American, Catholic, working-class, heterosexual woman. Each of these cultural identities includes some shared attitudes and beliefs with many (certainly not all) of other persons of the same profile. And this is only the beginning. You may also be a member of the Alcoholics Anonymous culture as a recovering alcoholic, and you may identify as a feminist. You most certainly find some of your cultural identities more central to how you view yourself than others, and these identities change depending on the context. For example, you may not find yourself focusing on your working-class background (which includes a strong work ethic) much, until you are working with a client who doesn’t seem interested in helping him- or herself. Suddenly, you are experiencing a cultural “moment” that you must work through if you are to be helpful to your client. In this

example, it’s quite possible that you never considered that part of your adopting a strong work ethic is the embedded privilege that was part of your upbringing—that is, it paid off to work hard because you were rewarded for doing so. What if this was not the case? What if you were viewed negatively even when you thought you were doing things correctly? Might this be your client’s cultural reality? If so, your awareness of this cultural difference may lead you to implementing appropriate interventions.

In short, the implications for counseling and for the counselor are quite clear: If understanding and acceptance of the client are to occur, then the counselor must understand the cultural factors that have shaped and continue to influence the client’s worldview. Even before that can happen, the counselor must understand his or her own worldview and how it is shaped in ways similar to how this occurred for the client, even when the two worldviews are substantially different from one another. To do less is to flirt with what Wrenn (1962) initially termed cultural encapsulation: defining reality according to one set of cultural assumptions and stereotypes, being insensitive to cultural variations among individuals, and assuming that one’s personal view is the only real or legitimate one. Clearly, counseling cannot go far when the counselor is handicapped by cultural encapsulation.

Finally, the greater the value of a cultural identity to the client, the more important it is to be understood by the counselor. Therefore, race, gender, sexual orientation, religious identity, ability/disability, and social class may be key cultural variables to communicating accurately and empathically with a client. That said, we should also be aware of what may be “lesser” cultural variables and how they help us to understand our clients. Urban culture, corporate culture, Y generation, “geek” culture, athlete culture—all of these may include embedded values and beliefs that enhance the counseling relationship if you take time to learn about them. Furthermore,

in attending to what appeared a “lesser” identity, you may learn that it is, by contrast, quite central to how the client views him- or herself.

Counseling Conditions and Their Effects Some clients find seeking counseling to be a major life decision. Apart from the fact that pockets of society continue to associate personal problems with weakness or inadequacy, the process of finding a person who is trustworthy, confidence inspiring, and competent is a daunting challenge. Other clients have a longer history of participating in counseling because of chronic mental health conditions, spiraling consequences of faulty decision making, living in an abusive situation, or any number of other reasons. Many clients are ill informed about counseling. If the experience is new, they may be unprepared to appraise the situation, determine the counselor’s ability to be of help, and make the judgment to commit to the process. The counselor must also make an initial assessment of the situation, determine that his or her skills are adequate for the client’s presenting concerns, and also determine that counseling holds some promise for improving the client’s situation. What conditions or events provide signals to both clients and counselors that the prospective relationship and the counseling process hold promise for success?

Clients are likely to be encouraged by factors such as feeling support and understanding from another person, beginning to see a different and more hopeful perspective, or experiencing a more desirable level of relating to others. Similarly, counselors feel reinforced as they are able to establish those conditions that lead to successful counseling outcomes. Although

different theoretical orientations emphasize somewhat different counseling outcomes, most practitioners agree on some rather basic outcomes. When counseling has been successful, clients often experience a combination of the following four types of outcomes:

1. Clients develop a more useful understanding of problems and issues. Once clients begin to view the sources of their problems more appropriately, they frequently develop greater understanding or insight into the problem and some of the ways that the problem manifests itself. Although understanding a problem differently is rarely an end in itself, it is an important beginning. There are four avenues for problem understanding that can increase client awareness: feelings and somatic reactions (affect) associated with the problem, thoughts (cognitions) related to how clients perceive or explain their problems, behavior patterns that may be associated or attributed to experiencing the problem, and interpersonal relationships that affect or are affected by the problem occurrence. Understanding these different dimensions of a problem helps clients perceive their reality more clearly and gain or experience more control over their reactions to an issue.

Example:

Joseph, a Korean-American college student, was mandated to receive three counseling sessions at the college counseling center as a result of public drunkenness on campus. Joseph noted that he doesn’t typically abuse alcohol but decided to get “wasted” when his girlfriend ended their relationship. He reported feeling down, hurt, lonely, and unlovable since the breakup a week ago. He showed no clinical signs of depression (e.g., sleeplessness, weight loss, isolation); rather, his behavior appeared to be more about letting the world (and his former girlfriend) know that he was in crisis. Through counseling, Joseph began to realize that his reaction is similar to how he would respond as a child when his mother would get on his case. Then, he reports, she would start to feel sorry for her effect on him and try to repair the obviously damaged relationship. In other words, Joseph began to understand that his style of dealing with stressful relationship events was to manipulate the other person into repairing the damage. In so doing, Joseph never had to assume any responsibility either for the initial issue or for the solution to the relationship problem. Thus, his reaction involved feelings, how he explained the problem to himself (as someone else’s doing), his irresponsible behavior (in this case, getting drunk on campus), and how he would manipulate relationships. Through counseling, Joseph also began to understand the relationship between his problem-resolution style and his resulting behaviors that reflected passivity and inertia. Finally, Joseph came to understand that his interactional patterns with his mother were intruding and controlling his relationships with women. Now that Joseph has a clearer understanding of his issues, he is in a better position to commit to a goal of changing this pattern.

2. Clients acquire new responses to old issues. Many counseling theorists now agree that, for most clients, insight or understanding of problems is not a sufficient counseling outcome. In addition to developing greater understanding of issues, clients must also acquire more effective ways of responding, verbally and/or behaviorally, to problematic situations. Otherwise, they tend to repeat their ineffective coping methods, and fail to make any connection between how they understand their problem and what they do when experiencing their problem.

Example:

Maria and Juan see a counselor because of “poor communication” in their marriage. Gradually, they are realizing that part of the problem is that Juan is at work all day in a very intense environment and wants to come home to relax, to sit down with the TV or his iPad, and to be left alone. Maria, however, has been at home alone all day with a young child. She seeks out Juan for some adult conversation until he pushes her away. Maria retreats in tearful anger. Although an understanding of the dynamics of this scenario may be useful to both Maria (she might be able to understand that it is not she, personally, whom Juan was rejecting) and to Juan (he, in turn, might realize that Maria had reasonable and understandable needs), it is unlikely that they will be able to alter or interrupt their reentry behavior patterns through understanding alone. They must also develop new behavioral patterns or interactions that meet each person’s unique end-of-the-day needs.

3. Clients begin to perceive their problems and issues contextually. Many times, clients have formulated a set of explanations for their problems. Such explanations may reflect cultural factors, societal factors, or familial factors. From an upper-middle-class privileged perspective, the issue might be one of helping clients to “own” their

problems. Owning means that clients begin to accept responsibility for themselves, their problems, and solutions. However, there are other ways of viewing the source of client problems. Clients who have experienced systematic discrimination because of disability, race, or religion—to name only a few—may not feel empowered to affect change in their lives. Some clients can appear beaten down by their experience as they view it, and muster little energy for counseling; others are angry at life in general for giving them such an unfair hand; still others tend to be in denial and present unrealistic (and often simplistic) views of how easy it will be for things to change. An important goal for the counselor, therefore, is to help clients understand the contextual factors that contribute to their issues, to fairly assess contextual restrictions and opportunities, and to offer clients both support and respect (i.e., to acknowledge discrimination and limited resources when they are apparent, and yet speak to clients’ strengths) within the counseling process.

Example:

Diane is a 30-year-old White woman who is being interviewed at a community domestic violence center. Diane’s cousin convinced her to come; it is clear that Diane is not convinced that she belongs there. Diane’s husband, Rick, hit her during a recent argument. Diane tells her counselor that he has never hit her before. When encouraged to tell their history, Diane reveals that Rick is under a lot of stress at work and is very impatient with her. But this has been restricted to verbal insults and once shoving her as he left the room, but never striking her until this recent event. Diane shares that they have a 6-month-old baby and that Rick has been less affectionate since she became pregnant. She also tells the counselor that she understands Rick’s reaction as she is still carrying pregnancy weight and feels fat and ugly. In this case, it is clear that Diane has viewed Rick’s abuse only in personal and interpersonal contexts. She does not yet appear to be aware of the role that sexism and society’s tolerance of violence against woman has played in her relationship with Rick. Between these divergent contexts, the counselor must also learn more about what Diane learned from her family of origin about the role that women play in families and their relative status to the men in the family. Without any appreciation of these broader contexts, Diane is likely to continue to blame herself and Rick’s work stress for the situation.

4. Clients learn how to develop effective relationships. For a significant number of people who end up in a counselor’s office, adults and young people alike, effective and satisfying interpersonal interactions are nonexistent or rare. Because change is often created and enhanced by a social support network, it is essential for clients to begin to develop more adequate relationships with other people.

Occasionally, the counseling relationship is the initial vehicle by which this occurs.

Example:

Renee, a 17-year-old African-American high school junior was referred to her school counselor after an altercation with another girl. Renee is significantly obese and says that everyone is “nasty” with her because of her weight. Renee also says that, even though she’d like to lose weight because her mother has diabetes, she doesn’t care about kids in the school liking her because the school is full of “losers.” In talking more to Renee, it becomes clear that her aggressive veneer is a thin shield covering feelings of isolation and rejection. The school counselor has a dual challenge in this case, and may call on the help of other professionals as well. Part of the issue harks back to multiple contexts as Renee’s weight may be at least in part due to poor nutrition and unhealthy eating habits in her family and her community. In addition, the counselor must assist Renee in forming relationships that allow her to discard her veneer and be more authentic. Renee and her counselor have their work cut out for them, but it is unlikely that much will change without attention to these issues.

To summarize, counseling usually results in more than one single and all- inclusive outcome for clients. Effective change is multifaceted and comprehensive, and includes keener understanding of the dynamics of problem sources and maintenance, new insights, different and more facilitative behavioral responses, and more effective interpersonal relationships.

Case Illustration of Possible Counseling Outcomes

The Case of Janet

Janet is a 35-year-old, White, single parent of two teenage girls. She has been employed as a bookkeeper for a local auto parts company for 12 years and is considered to be “the glue that holds the operation together” by her colleagues. Within her work context, Janet feels competent and comfortable. At home, her self-confidence disappears and she has overwhelming doubts about her parenting role and her relationship with neighbors “who see what a bad job I am doing.” These doubts also invade her relationship with her parents, her ex-husband and in-laws, her church, and her social relationships. The result is that she has been spending increasing amounts of time in her job, thus accentuating her feelings toward her non-work world. These feelings seem locked into a downward spiral from which she cannot escape. Lately, she has been experiencing some physical symptoms involving her digestive system, inability to sleep more than four to five hours, and a nagging sense of despair.

Given an effective counseling experience, Janet might realistically expect to see some of the following kinds of change:

Development of a more positive perception of herself away from work. Increased awareness of the relationship between her satisfying work setting and her overcommitment to time at work rather than at home. A more objective (and possibly enhanced) personal view of herself as a mother. A more realistic view of how others see her as a single parent and adult. Awareness that her physical symptoms might be related to her emotional reactions. Awareness of societal gender stereotypes that feed her reduced self- concept. A plan that would help her extract herself from the various “traps” she is experiencing at work, at home, in her neighborhood, in her church, and in

her social relationships. Interactions with her daughters that reinforce their relationship and her view of herself as a mother.

Characteristics of Effective Helpers Research on the effectiveness of counseling does not provide clear evidence of the relative contributions of factors that influence counseling (Sexton, Whiston, Bleuer, & Walz, 1997). Nevertheless, the professional literature is consistent in its emphasis on counselor characteristics as important to the success of counseling, including the following:

Self-awareness and understanding Good psychological health Sensitivity to and understanding of culture as well as the role of “positionality” Open-mindedness Tolerance for ambiguity Clear boundaries Competence Trustworthiness Interpersonal attractiveness Ethical behavior

Other characteristics that have been identified include the ability to be empathic, genuine, and accepting (Neukrug, 2007); belief in the personal meaning of another person (Combs, 1986); and power or comfort with having influence with another (Cormier, Nurius, & Osborn, 2013).

Self-Awareness and Understanding

On the road to becoming an effective counselor, a good starting place for most counselors is a healthy degree of introspection and self-exploration. We suggest you might examine and seek to understand the following four specific areas:

1. Awareness of your needs (e.g., need to give or to nurture, need to judge others, need to be loved, need to be respected, need to be liked, need to please others, need to receive approval from others, need to be right, need for control)

2. Awareness of your motivation for helping (e.g., What do you get or take from helping others? How does helping make you feel good?)

3. Awareness of your feelings (e.g., happiness, satisfaction, hurt, anger, sadness, disappointment, confusion, fear)

4. Awareness of your personal strengths, limitations, and coping skills (e.g., things you do well or things about yourself that you like, things about yourself you need to work on, how you handle difficulties and stress)

Self-awareness and understanding are important in counseling for a variety of reasons. First, they help you see things more objectively and avoid “blind spots”—that is, difficulties that may arise because you do not understand some aspects of yourself, particularly in interpersonal interactions. One such difficulty is projection. Counselors who do not understand their needs and feelings may be more likely to project their feelings onto the client and not recognize their real source (e.g., “I had a very angry client today” instead of “I felt angry today with my client”). Projection is one example of a process we discuss later in this chapter called countertransference, or the emotional reactions of the counselor to the client.

Self-awareness and understanding also contribute to greater security and safety for both counselor and client. Lack of self-awareness and understanding may cause some counselors to personalize or overreact to client messages and respond with defensiveness. For example, a client questions whether counseling “will do her any good.” The counselor’s need to be respected and affirmed are jeopardized or threatened, but the counselor is not aware of this. Instead of responding to the client’s feelings of uncertainty, the counselor is likely to respond with personal feelings of insecurity and portray defensiveness in his or her voice or to portray other nonverbal behavior. In summary, self-awareness and understanding is having a keen knowledge of one’s triggers; for counselors, it also means having the ability to moderate one’s reactions to triggers so they do not hamper your client’s progress.

Good Psychological Health

Although no one expects counselors to be perfect, it stands to reason that counselors will be more helpful to clients when they are psychologically intact and not distracted by their own overwhelming problems. In a classic study of the psychological health of mental health providers, White and Franzoni (1990) report that studies of the psychological health of psychiatrists, psychologists, and psychotherapists in general revealed higher rates of depression, anxiety, and relationship problems than the general population. Even those counselors-in-training at the master’s degree level showed evidence of higher levels of psychological disturbance than did the general public (White & Franzoni, 1990).

Unfortunately, some counselors do not recognize when their own psychological health is compromised. It is for this reason that it is generally viewed as good practice for counselors to seek counseling if there is any question of their own issues making it difficult for them to be fully present to their clients. And because we are all sometimes the last to know if we are in trouble, it is also best practice to have supervision available to us, at least at the front end of our careers, and potentially throughout our careers.

Sensitivity to and Understanding of Culture as Well as the Role of “Positionality”

As stated earlier, all clients live in multicultural worlds, as do we. Although psychotherapy began as a profession to examine the intrapersonal, it has evolved to include cultural realities as relevant to achieving psychological health and to functioning and developing as individuals, families, and communities. We have already noted that good psychological health allows the counselor to be more helpful to clients. It is just as true that awareness of one’s own multiple cultural identities and how these shape one’s worldview contributes to one’s effectiveness as a counselor. And as also noted earlier, counselors must afford their clients the space for their cultural identities to emerge.

In addition, it is essential that counselors are aware of how power and privilege play out in counseling. Alcott (1988) was one of the first scholars to use the term positionality, a term that has influenced the mental health professions. By positionality, we mean that cultural identities are indications of relative positions rather than descriptors of particular characteristics. Therefore, being lesbian or a Muslim or an amputee is descriptive largely in relationship to the position it places you in the many contexts of your life. For example, a Muslim may experience his or her position differently in their mosque than at an airport. Frequent experiences of positions, whether they are privileged or put one at a disadvantage, eventually become mingled with one’s identity.

The important concepts of culture, power, privilege, and positionality are endemic to most counseling programs at this point in our evolution as a

profession, and are embedded in many discussions on many topics. For our purposes here, it is sufficient to say that counselors must become students of the implications of cultural identities and positionality in relationship building, assessment, and all other aspects of the counseling process. This is an inherently challenging aspect of counseling but necessary for its success.

Open-Mindedness

Open-mindedness suggests freedom from fixed or preconceived ideas that, if allowed expression, could affect clients and counseling outcomes. Open- mindedness must include enlightenment and knowledge of the world outside the counselor’s world; it must also include an acute understanding of one’s inner world and how those internal standards, values, assumptions, perceptions, and myths can be projected on clients if the counselor is not vigilant.

Open-mindedness serves a number of significant functions in counseling. First, it allows counselors to accommodate clients’ feelings, attitudes, and behaviors that may be different from their own. Second, it allows counselors to interact effectively with a wide range of clients, even those regarded by society at large as unacceptable or offensive. Finally, open- mindedness is a prerequisite for honest communication.

Tolerance for Ambiguity

Conducting a counseling session is not like balancing your checkbook. No matter how many times you do it, you will never have the feeling that things have been wrapped up in a neat package (and even if you were to feel that way, you would also learn how quickly a package can unravel). This doesn’t mean that counseling is a total mystery, because it is not. But it does mean that successful counselors have a healthy tolerance for not knowing what may be around the corner even as they fully engage in a process that is intentional. Said differently, successful counselors are fascinated by the complexity of people and are fully committed to the process of counseling even if the outcome is unclear.

Clear Boundaries

Having a clear boundary between you and the client allows you to be involved with a client and, at the same time, stand back and see accurately what is happening with the client and in the relationship. Carl Rogers’ description of empathy alluded to this when he explained that empathy is the ability to experience the client’s problem as if it were your own while never losing the “as if” aspect (Rogers, 1957). It is extremely important to maintain clear boundaries for the client’s benefit. Most clients are bombarded with views and advice from many well-meaning persons, such as friends and family, who are sometimes part of the problem or perceive being helpful as seeing things as the client does. Counselors, however, give the client an additional set of eyes and ears that are needed to develop a greater understanding without the complication of a personal relationship.

When counselors have clear boundaries, they also avoid getting caught up in certain client behaviors or dysfunctional communication patterns. For example, clients sometimes try to manipulate the counselor to “rescue” them, using a variety of well-learned and sophisticated ploys. Counselors who have a clear sense of themselves are more likely to recognize client manipulation for what it is and respond with therapeutic appropriateness.

Also, boundary clarity acts as a safeguard against developing inappropriate or even dysfunctional emotional feelings about or toward a client. Counselors must learn to recognize when countertransference develops in the relationship. Countertransference involves either a counterproductive emotional reaction to a client (often based on projection) or the entanglement of the counselor’s needs in the therapeutic relationship. Some of the more common ways in which countertransference may manifest itself include the need to please one’s clients, overidentification with certain client problems, development of romantic or sexual feelings

toward clients, need to give constant advice, and a desire to form friendships with clients (Corey, 2011). Astute counselors gradually learn to identify certain kinds of clients who consistently elicit strong positive or negative feelings on their part, and also certain kinds of communication patterns that entice the counselor into giving a less helpful response.

Competence

Ethical standards of all mental health professions call for maintaining high standards of competence. According to Egan (2014), competence refers to whether the counselor has the necessary information, knowledge, and skills to be of help, and is determined not by behaviors but by outcomes. The profession generally agrees that counseling competency includes knowledge in areas such as psychological processes, assessment, ethics, and other areas relevant to professional work, as well as clinical skills, technical skills, judgment, multicultural competence, and personal effectiveness.

Counselor competence is necessary to transmit and build confidence and hope in clients. Clients must develop positive expectations about the potential usefulness to them of the counseling experience. Competent counselors are able to work with a greater variety of clients and a wider range of problems. They are more likely to be of benefit to their clients and to make inroads more quickly and efficiently. Sometimes referred to as expertness, competence is often associated with a model of counseling known as the social influence model, the two basic assumptions of which are as follows:

1. The helper must establish power or a base of influence with the client through a relationship composed of three characteristics or relationship enhancers: competence (expertness), trustworthiness (credibility), and attractiveness (liking).

2. The helper must actively use this base of influence to effect opinion and behavior changes in the client.

An increasing amount of evidence on this model suggests that clients’ respect for the counselor increases in direct proportion to their perceptions

of the counselor’s expertness or competence.

Trustworthiness

Most of us like to think that we are trustworthy. Within professional counseling, trustworthiness includes such qualities as reliability, responsibility, following ethical standards, and predictability. Counselors who are trustworthy safeguard their clients’ communications, respond with energy and caring to client concerns, and never let their clients regret having shared information. This last point is key—trustworthiness includes providing a client with a safe space to share their true thoughts and feelings. Safety includes not only a promise to honor confidentiality, but also working hard to understand the client’s world in as many contexts as possible.

We ask a lot of clients in asking them to trust us, especially because many clients have had their trust violated in the past. Trust can be hard to establish, and it can be ruptured relatively easily. For this reason, if any rupture of the therapeutic alliance occurs, we must stop the process and attempt to make repairs by reviewing what happened to diminish the client’s trust in us, sharing perspectives and motives on both sides, and (hopefully) inching toward a new working relationship with reinforcements where the break occurred. Another essential component of trustworthiness can be summarized in one sentence: Do not promise more than you can do, and be sure you do exactly as you have promised. Trustworthiness is essential, not only in establishing a base of influence with clients, but also in encouraging clients to self-disclose and reveal often very private parts of their lives. Counselors cannot act trustworthy; they must be trustworthy.

Interpersonal Attractiveness

We are all familiar with the adage that attractiveness is in the eye of the beholder. This is true in counseling as well, with a caveat or two. Clients perceive counselors as interpersonally attractive when they see them as similar to or compatible with themselves. Clients often make this assessment intuitively, although it is probably based on selected dimensions of counselors’ demeanor and attitude, particularly their likability and friendliness. In other words, it is helpful for counselors to be down to earth, friendly, and warm, rather than formal, stuffy, aloof, or reserved. Yet, here we add the caveat that counselors must take into account what knowledge they have of the history and cultural contexts of their clients. For a family used to formality, being too “down to earth” would run the risk of being seen as less professional. Male counselors must learn how to appear warm with female clients without appearing to be flirting. Supervision as one begins to work with a variety of clients is most helpful for learning how to strike the right balance. This is an important goal because counselors who are perceived as interpersonally attractive become a positive source of influence for clients and may also inspire greater confidence and trust in the counseling process.

Ethical Behavior

How the counselor performs under conflicting or challenging conditions affects all of the other conditions. But what determines ethical behavior? The American Counseling Association (ACA) has established guidelines for ethical counselor performance in a variety of settings and under a broad spectrum of problem situations. Ethical behavior is primarily a self- determined adherence to these standards. However, there are conditions in which failure to perform ethically could lead to malpractice and lawsuits. The ACA Ethical Standards may be found and downloaded at their website: www.counseling .org. For counselors who belong to counseling divisions or affiliates (e.g., American School Counselor Association, American Mental Health Counseling Association), their ethical standards must also be followed. Finally, those counselors certified by the National Board for Certified Counselors must follow its code. All ethical standards for counselors are very similar; still, it is good practice to read all of those that are relevant to your practice and to be aware of those for which you are held responsible.

The Developmental Nature of Learning to Counsel Over the years, counselor educators have participated in a recurring debate regarding the experience of learning to counsel. The two poles of this debate are (1) that potential counselors already possess the “skills” of counseling but must learn how to differentiate these skills and use them selectively with clients; and (2) that the skills of counseling have been rather specifically defined and can be taught to potential counselors with a reasonably high degree of success, regardless of whether they possessed the skills initially. Obviously, most counselor preparation programs fall somewhere between these two poles. Regardless of the source of those skills, whether they are inherent in the candidate’s personhood or are embedded in the curriculum of the preparation program (or both), the process of bringing them into dominance is worthy of attention.

Almost everyone has known someone who was untrained and yet was a “natural” counselor. In getting to know such people, one often finds that they assumed the helper role as children. They may even have been identified by their families as the peacemaker, the facilitator, the understanding one, or the one to whom other family members could turn. Such a role emerges both from temperament and from expectations. Such helpers evolve into the role as their sensitivities, skills, and confidence grow over time. (We should note that some of these helpers have also adopted the role of hero or overachiever in their families, and these roles

are not always conducive to professional counseling.) Similarly, students entering counselor preparation programs find that the process is a developmental experience. That is to say, early in the training, the focus tends to be on professional issues external to the person and the context for helping. Gradually, the focus of preparation turns to the personal qualities of helpers, and the process then becomes more personal. From this, attention turns to the skills of counseling—what effective counselors are doing and thinking as they work with clients. Finally, preparation begins to integrate these skills with the practical experience of counseling clients in professionally supervised settings.

In a seminal contribution to the professional literature, Loganbill, Hardy, and Delworth (1982) suggest that the developmental process for counselors included stagnation, confusion, and integration. Stagnation is typically seen as reliance on established social responses when learning to counsel (e.g., trying to make the client feel better rather than listening deeply to what the client is saying). Confusion follows as counselors learn professional counseling skills but do not yet feel comfortable directing the counseling process. Once counselors begin to feel more sure of themselves and to see the counseling process benefit their clients, they begin to experience some integration. This learning curve is not a speedy one; it is our experience that success occurs for students of counseling who are patient with themselves, are open to feedback, and are willing to take risks (i.e., make mistakes from which they can learn).

In summary, few beginning helpers feel prepared, either technically or personally, to