Intro to Counseling

Counseling vs. Psychotherapy

Counseling addresses the “conscious mental state” while psychotherapy delves into the “client’s unconscious processes”

Counseling

1. Developmental – fosters coping skills to facilitate development and prevent problems

2. Focuses on short-term goals (immediate resolution)

3. Provided in a variety of settings: schools, churches, and mental health clinics

Psychotherapy

1. Client’s problems are more complex and may require formal diagnostic procedures to determine whether there is a mental disorder

2. Approaches are complex; they utilize strategies that relate to conscious and unconscious processes

The “Helping Formula”

Helpers + helpers skills = growth facilitating conditions ––> specific outcomes (client)

Qualities of effective helpers

1. Encouraging

2. Artistic

3. Emotionally stable

4. Self-aware

5. Self-acceptance

6. Positive self-esteem

7. Self-realization

8. Self-disclosure (when appropriate)

9. Courageous

10. Patient

11. Nonjudgmental

12. Tolerance for ambiguity

13. Spirituality

Professional Helpers

1. Masters (MS/MA)

2. Doctoral (PhD, PsyD, EdD)

3. Medical Degree (MD)/RN

4. School-based/specialist in education (EdS)

Professional Identity

Defined by your professional association and or licensing board. Each type of professional helper has a distinct focus of practice structures and career expectations which influence your schooling. So, even though many of these professions can overlap in the settings in which they practice, the approach is often different

Moral Foundations

1. Autonomy – people are allowed the freedom of choice and action

2. Non-maleficence – above all else, therapist will do no harm

3. Justice – humans should be treated fairly with equal distribution of good or bad

4. Fidelity – value of honoring commitments, promoting trust

5. Veracity – importance of telling the truth

6. Beneficence – promoting good

Licensure vs. Certification

1. Licensure is required to practice, is a specific legal process with required exams for qualification, therapist must meet standard set by their respective state, failure to meet these standards = legal repercussions (client can sue)

2. Certification is not required to practice; recognizes a level of competence in a specific area (ex. specific types of interventions, like play-therapy)

Duty to Warn & Protect

Counselors are legally required to report information:

(a) when they believe that a client under the age of 16 is a victim of child abuse, sexual abuse, or some other crime

(b) if the counselor determines that a client is in need of hospitalization

(c) if information is being made an issue in a court action

Dual Relationships

When a counselor engages in more than one relationship with the client

Problematic and violates ethical/legal standards when roles conflict

Complex in that they cannot always be avoided; appropriateness should be assessed

Roger’s “Core Conditions”

1. Empathic understanding

2. Unconditional positive regard – care and feeling that the client has the ability to change

3. Congruence – how is the counselor being congruent? holding space for the client

Carhuff’s “Core Conditions”

1. Respect

2. Immediacy

3. Confrontation

4. Concreteness

5. Self-disclosure

Formulation of counseling goals

Client and counselor work collaboratively to formulate counseling goals that are measurable with completion times

“Working alliance”

Client and counselor agree to a standard of goals, tasks, and an emotional bond

Session process

Counselors incorporate emotions into session time (in modern setting)

Basic & Secondary counseling skills

1. Attending behavior

2. Minimal encouragers

3. Paraphrasing

4. Reflection of feeling

5. Open-ended questioning

6. Normalizing

7. Probing

Types of assessments

Standardized – have a standardized norm group

Non-Standardized – do not have a standardized norm group

Standardized assessments

Psychological, intelligence, personality, interest, aptitude, achievement, & neuropsych

Pros: provide “objective” information as well as Validity and Reliability

Cons: potential bias, labels with negative connotations, oversimplification

Non-Standardized assessments

Observation, behavioral, & environmental assessments

Pros: flexible & individualized; not worried about comparing to a norm and whether they fit in that norm standard

Cons: opposite of the pros with standardized; loses objectivity, is biased

Validity

Degree to which a test measures what it is intended to measure

Content validity

Determines if the content in the assessment covers relevant information

Construct validity

Degree to which a theoretical construct is measured, how relevant it is (ex. diagnosis)

Criterion related validity

How well a test predicts an individual’s performance

Concurrent validity

When the criterion used is available at the time of testing

Predictive validity

How well someone could do on the assessment in the future

Testing norms

When the assessment was created, it needed to have a diverse population incorporated and considered, so the norm isn’t a singular type of person

GAD-7

Measures severity of anxiety

PHQ-9

Measures severity of depression

PHQ-A

Measures severity of depression in adolescents

C-SSRS

Suicide risk assessment

CAGE-AID

Screening for substance use (drugs & alcohol)

PCL-5

PTSD checklist

DES II

Measure of dissociative experiences

Neuropsychological testing

Tests for any level of neurodivergence (ASD, ADHD); looks at certain mental health conditions that tie into neurological function

Non-standardized measures

“Qualitative assessment”

Behavioral

Environmental/Ecological

Observation

Clinical interview components

1. Listening skills

2. Client history

Client history

1. Identification

2. History of presenting problem

3. Psychiatric history

4. Trauma history

5. Family psychiatric history

6. Medical conditions

7. Current medications

8. Substance use

9. Family history

10. Social history

11. Spiritual/cultural factors

12. Developmental history

13. Educational/Vocational history

14. Legal history

15. SNAP - Strengths, needs, aspirations, preferences

Mental status exam

1. Appearance, aptitude, activity level (dress, demeanor, movement)

2. Mood (internal emotional state) and Affect (external expression of emotions)

3. Speech and language (verbal and written)

4. Thought process (how), thought content (what), perception

5. Cognition (memory, reasoning, problem solving, orientation - person, place, time)

6. Insight and judgment (higher order functioning/emotional intelligence)

7. Functional status (commonly added to clarify how well a client can achieve tasks of daily living)

Counseling research relationships

Research should inform the practice; research supports certain counseling theories, but that’s not always the case

Sometimes, research studies are so specific/irrelevant to the population being worked on/the client doesn’t like what the research has shown to work

Ex. Clinicians say “hey, the stuff that research says works, doesn’t always work” which creates a rift in the field

Evaluation and accountability

The field attempts to safeguard itself from unethical practice; we evaluate at every level, people are expected to be accountable at every level; there should be some level of intention and support in a therapy room (accountability)

Basic vs. Applied Research

Basic – Done in a lab, quantitative, norms, controlled setting

Applied – Done in the field, observational, qualitative for the most part

Ethics and research history

Unethical studies led to the development of ethics codes

Stanley Milgram’s Obedience Experiments (1961)

Subjects were ordered to deliver increasingly strong electrical shocks to another person while the person in question was an actor who was pretending; the subjects themselves fully believed that the other person was being shocked. Results showed that people were willing to inflict painful level shocks if ordered

Zimbardo’s Stanford Prison Experiment

Students participating in the study were assigned as guards of prisoners in a mock prison created in the basement of a campus building. The experiment lasted only 6 days out of a planned two weeks due to the level of cruelty displayed by the “guards” leading to distressed “prisoners” who were also not allowed to leave the experiment even though they admitted experiencing emotional issues to family/friends

The Monster Study - Dr. Wendell Johnson and his graduate student Mary Tudor (1939)

Meant to induce stuttering in non-stuttering children by telling them that they stuttered and to stop stuttering in non-stuttering children by ignoring the stutter and telling the children they spoke ‘fine’. Most of the non-stuttering children who received negative therapy in the experiment suffered negative psychological effects. and some retained speech problems for the rest of their lives

Little Albert - Dr. John B. Watson (1920)

Tested to see if you could “condition a phobia” by subjecting a 9 month old baby to loud noises every time he interacted with a white lab rat placed near him. After doing several rounds, Albert was presented with just the rat and became distressed. It was also shown that the fear was “generated” to other white objects

Institutional Review Boards (IRBs)

The accountability and evaluation piece for research; ensures that research is not unethical (USA)

Action research

one on one

ex. working with a kid, use a specific intervention, ask kid and parents if the intervention made things better

Survey studies

set of questions that are blasted out to people to fill out

Correlational studies

looking at two factors in relation to each other

Longitudinal studies

gold standard for anything developmental; long studies; looking at the same group of people or person over years

ex. looking at a baby born to a loving family in a high socioeconomic status and watching them move through life and marking milestones

Large scale review (meta analysis)

taking multiple research studies and bringing them together; looking at trends in research methods

Case studies and single subject design

what we do in therapy; looking at interviews, observations, level of self report, single case, single subject involved

Quantitative Designs

numbers, data

Qualitative Designs

looking at general themes, more human experience

Mixed-Method Designs

Mixture of both quantitative and qualitative