Introduction to Clinical Mental Health Counseling – Notes
Text – Counseling: A Comprehensive Profession 8th Edition
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Chapter 1: Personal and Professional Aspects of Counseling
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Counseling as a profession grew out of the progressive guidance movement of the early
1900s
o the emphasis was on prevention and purposefulness
one distinction between guidance and counseling is that guidance focuses on helping
individuals choose what they value most, whereas counseling helps them make changes
psychotherapy (or therapy) traditionally focused on serious problems associated with
intrapsychic disorders (like hallucinations and delusions), internal conflicts, and
personality issues (like dependency)
o it emphasized: the past more than the present
o insight more than change
o detachment of the therapist
o the therapist's role as an expert
psychotherapy historically involved a long-term relationship (20 to 40 sessions over six
months to two years) rather than a short-term relationship (8 to 12 sessions over less
than six months)
counseling: a professional relationship that empowers diverse individuals, families, and
groups to accomplish mental health, wellness, education, and career goals
o Counseling works with personal and interpersonal issues, as well as finding
meaning, adjustment, fulfillment, and achieving goals
Counseling is a dynamic process: it focuses on clients’ goals and helping them
accomplish them
a counseling specialty is an area that is narrowly focused and requires advanced
knowledge in the field
effective counselors practice “alonetime” – an intentional practice of devoting periods in
their lives to silence, solitude, and reflectivity
counselors who have experienced painful life events and have adjusted positively can
usually connect and be authentic with clients in distress – these are called wounded
healers
synchronicity: two simultaneous events that occur coincidentally and that result in
meaningful connection
o this is a productive way for counselors to perceive and deal with unexpected life
experiences
strategies for counselors dealing with crisis situations:
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o finding meaning in potentially problematic areas
o remaining objective
o accepting and confronting situations
o asserting their own wishes
o participating in a wellness lifestyle
o grieving
Compassion fatigue: indifference and apathy to those who are suffering as a result of
frequent or overexposure to people in need
burnout: a state of being emotionally or physically drained to the point that one cannot
perform functions meaningfully. There are three components to burnout:
o emotional and physical exhaustion
o cynicism
o decreased perceived efficacy
there are four types of professional credentials
o inspection – a state agency periodically examines the activities of a profession’s
practitioners
o registration – practitioners voluntarily submit information to the state concerning
the nature of their practice
o certification – an agency or association grants recognition to an individual for
having met certain predetermined professional qualifications
o licensure – statutory process by which an agency of government (usually state)
grants permission to a person meeting qualifications to engage in an occupation
or use of a particular title to perform specified functions
attribution: what the counselor attributes the cause of a client's problem to
o i.e., an external circumstance or an internal personality flaw
System: a unified and organized set of ideas, principles, and behaviors
there are four main attribution models
o medical – the client is not blamed or held responsible for their problems. Clients
may become dependent on the counselor
o moral – the client is held responsible for causing and solving their problems
o compensatory – the client is seen as only responsible for solving but not causing
their problems. The client partners with the counselor for solutions
o enlightenment – the client is held responsible for causing their problems but not
solving them
the development/wellness perspective is based on stages that people go through as a
normal part of human growth
o counseling is premised on whether the problem is part of a developmental task
of life or not
Piagetian concepts of cognitive levels
o i.e., sensory motor, concrete, formal, post-formal
developmental counseling therapy (DCT) specifically addresses the sequence and
process of development as it occurs in the natural language of the interview
Wellness emphasizes the positive nature and health of human beings
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o it identifies and builds on strengths
Resilience, wellness, and disorders are integrative constructs. How people and
communities achieve and sustain health and well-being in the face of adversity is
complex because the developmental process exists on a continuum
Resilience: personal qualities and skills, either dynamic or trait, that allowed the
individual to make a healthy, successful, or adaptive response to a disruptive or
adversarial life event
Solution-focused theory is a wellness model approach that has an emphasis on health
and strength
stress inoculation training (SIT) is a proactive, psychoeducational intervention
o it is an example of a present and future wellness emphasis approach
the medical/pathological model is represented by those whose treatment plans are
based in the Diagnostic and Statistical Manual of Mental Disorders (DSM)
o the DSM is compatible with the International Classification of Diseases (ICD)
manual
the DSM is an atheoretical model that frames mental disorders as dispositional:
something that is within the individual and part of their psychological makeup
DSM terminology should be mastered because:
o It is universally used and forms a basis for common dialogue between those in
helping professions
o it helps counselors recognize patterns of mental distress in clients needing
specific treatment or referrals
o it encourages accountability, credibility, uniform record keeping, research, and
treatment plans for counselors
Cognitive complexity: the ability to absorb, integrate, and make use of multiple
perspectives
o This provides the ability to tolerate ambiguity, listen carefully, suspend
judgments, look for evidence, and adjust opinions with new information
continuing education units (CEU) are needed due to new ideas in treatment and practice
that are always evolving and must be evaluated, incorporated, and even mastered
advocacy: promoting an idea or cause through public relations such as networking and
education
social justice: the idea of creating a society or institution that is based on the principles
of equality, values human rights, and recognizes the dignity of every human being
a portfolio is a form of communication that documents an individual’s training, work,
and pertinent life experiences
o a working portfolio is a continuous collection
o a presentation portfolio is limited to materials for a specific project
Health Insurance Portability and Accountability Act (HIPAA)
o the standardization of electronic data
o includes unique health identifiers
o sets security standards for confidentiality
Chapter 2: Ethical and Legal Aspects of Counseling
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Values are orienting beliefs about what is good and how it should be achieved
ethics: a philosophical discipline that is concerned with human conduct and moral
decision making
o professional ethics are beliefs about behavior and conduct that guide
professional practices
morality: judgment or evaluation of action
law: the precise codification of governing standards that are established to ensure legal
and moral justice
examples of unethical behavior:
o violation of confidentiality
o exceeding one's level of professional competence
o negligent practice
o imposing values on a client
o sexual activity with the client
o dual or multiple relationships (conflict of interest)
The Association for Spiritual, Ethical, and Religious Values in Counseling (ASERVIC) is a
division of the ACA that is concerned with the values and ethics of counselors
the purpose of ethical codes:
o to protect the profession from government
o to help control internal disagreements
o to protect practitioners from the public
the ACA code of ethics has nine topical section headings
o Counseling Relationship
o Confidentiality and Privacy
o Professional Responsibility
o etc., etc., etc.
There are limitations to ethical codes, and ethical codes of different professional
organizations can conflict (like the APA and ACA)
ethical reasoning is the process of determining which ethical principles are involved and
then prioritizing them based on the professional requirements and beliefs
six ethical principles of counselors:
o beneficence – doing good and preventing harm
o nonmaleficence – not inflicting harm
o autonomy – respecting freedom of choice and self determination
o justice – fairness
o fidelity – faithfulness/honoring commitments
o veracity – truthfulness
four main ethical issues in the area of research ethics:
o informed consent
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o coercion and deception
o confidentiality and privacy
o reporting the results
the only time the law overrides a professional code of ethics is when it is necessary to
protect the public health, safety, and welfare
confidentiality: the ethical duty to fulfill a contract or promise to clients that the
information revealed during therapy will be protected from unauthorized disclosure
Privacy: an evolving legal concept that recognizes individuals’ rights to choose the time,
circumstances, and extent to which they wish to share or withhold personal information
privileged communication regulates privacy protection and confidentiality by protecting
clients from having their confidential communications disclosed in court without their
permission
risk assessment takes variables into account including situational aspects, behavioral
patterns, and foreseeable events or stressors
liability: issues concerned with whether a counselor has caused harm to clients
malpractice: harm to a client resulting from professional negligence (departure from
acceptable professional standards)
three ways to protect oneself from malpractice:
o follow professional codes of ethics
o follow normal practice standards
o act professionally, attentively, and courteously for enhanced communication and
so that the client sees that the counselor cares about them
three main types of liability
o civil liability: when one can be sued for acting wrongfully toward another or for
failing to act when there is a recognized duty to do so
 i.e., a lawsuit for gross negligence
o criminal liability: the counselor is working with the client unlawfully
 i.e., not reporting child abuse, engaging in a sexual relationship,
committing insurance fraud
o administrative liability: when the therapist’s license to practice is threatened by
an investigation from the licensing board
a landmark court case that reflects the importance of limiting confidentiality is the 1976
case Tarasoff v. Board of Regents of the University of California
o the counselor reported to the police that a student threatened to kill another
student, and two months later he followed through on his threats
o the “Duty to Protect” was called into question in this case
The concept of civil liability rests on the concept of tort, a wrongdoing that legal action is
designed to set right
5 areas where counselors may face civil liability malpractice suits
o malpractice in particular situations (unprofessional or unethical treatment)
 i.e., birth control or abortion
o illegal search
o defamation
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o invasion of privacy
o breach of contract
3 areas where counselors may face criminal liability suits
o accessory to a crime
o civil disobedience
o contribution to the delinquency of a minor
there are two main types of client rights: implied and explicit rights
o Implied rights are linked to substantive due process  when a person has been
denied this, it means a rule has been made that arbitrarily limits an individual
o explicit rights focus on procedural due process, which is violated when an explicit
rule is broken, and the person is not informed about how to remedy the matter
there are six types of documents and client records:
o identifying or intake information
o assessment information
o treatment plan
o case notes
o termination summary
o other data (signed consent, correspondences, notations)
 altering records is a criminal act
counselors usually come to court either voluntarily or professionally
an expert witness is an objective and unbiased person with specialized knowledge, skills,
or information who can assist a judge or jury in reaching an appropriate legal decision
o counselors are financially compensated for their time when acting in this
capacity
a counselor may be court ordered, and will receive a subpoena to appear in court at a
certain time for a case
o this takes place with the intent of having the counselor testify on behalf of or
against a former or current client
o counselors should seek attorney advice before responding to court orders
Chapter 3: Counseling in a Multicultural Society
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The therapeutic alliance is usually easier to achieve if the counselor and client are from
the same culture or similar to each other in beliefs
It is imperative that counselors be acutely sensitive to their clients’ backgrounds and
special needs and equally attuned to their own values, biases, and abilities
Understanding and dealing positively with differences in cultures is a matter of
developing self-awareness (from the inside out) as well as developing an awareness of
others (from the outside in)
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Research indicates that clients who perceive their counselors as being more culturally
responsive report higher levels of trust and alliance, as well as more positive counseling
outcomes
As a group, ethnic minorities underutilize counseling services because of the treatment
they receive or fail to have been provided
Culture includes ethnographic variables (ethnicity, nationality, religion, language),
demographic variables (age, gender, place of residence), and status variables (social,
economic, educational background)
o Culture structures our behavior, thoughts, perceptions, values, goals, morals, and
cognitive processes on an unconscious or conscious level
Culture = any group of people who identify or associate with one another on the basis of
some common purpose, need, or similarity of background
The most prominent foci of multiculturalism are distinct group uniqueness and concepts
that facilitate attention to individual differences
Multicultural counseling = counseling in which the counselor and client differ
Two multicultural perspectives
o Etic = universal qualities exist in counseling that are culturally generalizable
o Emic = assumes counseling approaches must be designed to be culturally specific
A culturally encapsulated counselor is one who disregards cultural differences and works
under the mistaken assumption that theories and techniques are equally applicable to
all people
Multicultural counseling is often called “the fourth force” following psychoanalysis,
behaviorism, and humanistic concepts of counseling
An acronym model for assessing cultural components of a client is the RESPECTFUL
counseling framework
o R: religious/spiritual issues
o E: economic class issues
o S: sexual identity issues
o P: psychological development issues
o E: ethnic/race identity issues
o C: chronological issues
o T: trauma and threats to well-being
o F: family issues
o U: unique physical issues
o L: language and location of residence issues
The Association for Multicultural Counseling and Development (AMCD) is a division
within the ACA dedicated to defining and dealing with issues and concerns related to
counseling across cultures within the United States
o The focus of its training is to help counselors obtain cultural expertise
(effectiveness in more than one culture) and cultural intentionality (awareness of
individual differences within each culture)
Broaching = the counselor listens for the relevance of culture and introduces issues that
influence explicitly as part of the presenting issue of the client
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Problematic areas in working across cultures
o Measurement: instruments used to measure the multicultural counseling
competencies
o Overculturalization: mistaking people’s reactions to poverty and discrimination
for their cultural pattern
o Racism: an oppressive act by which a majority culture exercises power and
privilege over those in nondominant groups
 A form of projection usually displayed out of fear or ignorance
o Language: verbal and nonverbal utterances may be misunderstood by counselors
outside the client’s own culture
o Acculturation: the process by which a group of people give up old ways and
adopt new ones
Sensitivity to cultures includes acquiring knowledge, awareness, and skills
Cultural bias = the tendency to think one’s own culture is superior to others
o This is present in majority and minority counselors
o In the past, it has spilled over into counseling theories and practices
Issues in multicultural counseling
o Predominant beliefs in counseling of Europeans/North Americans, for example,
value of individual
o Sensitivity to culture – in general and in particular (knowledge, awareness, skills)
o Understanding how cultural systems operate and influence behavior
o Providing effective counseling services across cultures
o Developing and employing appropriate counseling theories
Counseling Considerations with Specific Cultural Groups
 There are more within-group differences than between-group differences in counseling
people from specific cultural traditions
 Counselors from minority cultures need to be aware that they may harbor “historical
hostility” at either a conscious or unconscious level toward members of majority
cultures
o They have developed a within-group racial identity as well as a personal identity
that is known as minority racial identity development (MRID)
 Counselors from majority cultures may carry attitudes of superiority and privilege
o White racial identity development: a model that proposes a development
movement of those with White skin through a stage process to a nonracist White
identity
 This is the “opposite” of white privilege
o White privilege = White people have achieved societal rewards on the basis of skin
color and other socially determined indicators of race as compared with merit
o White privilege is the result of Whiteness and majority status within the United
States that has been the norm for generations
European Americans
 European Americans are more likely than not to espouse a worldview that values linear,
analytical, empirical, and task solutions and stresses that rugged individualism should be
valued, and that autonomy of the parts and independence of action are more significant
than group conformance
 Approaches that work:
o Theories that emphasize shared values, such as rational or logical methods of
understanding oneself and others
 i.e. cognitive and cognitive-behavioral approaches
Blacks & African Americans
 It is possible for counselors from different cultural backgrounds to work effectively with
black and African American clients if they understand:
o The nature of racism
o the fact that individual, institutional, and cultural racism are major quality of life
issues for African Americans living in contemporary society
o racial discrimination and self esteem are inversely related
 Although blatant racist behaviors, or racial assaults, are seldom acted out in American
Society, racial microaggressions (any action, attitude, comment, or gesture individuals
experience as inappropriate or hurtful based on their personal history and characteristics)
are prevalent
 Factors that influence their participation in counseling:
o Unwilling to voluntarily commit themselves to a counseling relationship due to a
perception of relinquishing independence to a stranger
o Perception that the relationship takes place among unequals
o The emphasis on the collective in most of their community tradition
o Spirituality and the role of the minister and the church
 Approaches that work:
o Determine what has brought clients to seek counseling
o Establish an egalitarian relationship
 Emphasis on pragmatics
o Focus on strengths and address individuals within the context of their
communities
o Tap spiritual resources, as church and spirituality are an integral part of their lives
Hispanics/Latinos/as
 Hispanics share the Spanish language as the common denominator
 Latino/a describes people of Spanish and Indian descent whose ancestors lived in areas
of the Southwest United States that were once a part of Mexico and in countries in
Central & South America where the predominant language, usually Spanish, has Latin
roots
 Part of their hesitancy to become involved with counseling includes cultural tradition
(i.e., pride) and cultural heritage (i.e., reliance on extended family ties)
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Often they perceive psychological problems as similar to physical problems
o Therefore, they expect the counselor to be active, concrete, and goal directed
Approaches that work:
o Work within cultural concepts and beliefs, such as involving families because
family loyalty is very important in Latin culture
o Filial therapy: positive behavioral or symptomatic changes result from a changed
parent-child relationship rather than specific problem-focused strategies
o Work in harmony with the client’s spiritual or religious tradition
o It is helpful if the counselor is bilingual as many individuals prefer Spanish to
English, especially when expressing their emotions
Asian Americans
 Sometimes referred to as the “model minority” due to being collectively described as
hardworking and successful, and not prone to mental or emotional disturbances
o This myth is perpetuated as a color-blind racial ideology: the idea that race and
racism do not matter and do not play important roles in the current social and
economic climate
 Color-blind racial attitudes often justify blaming the victim and rationalize beliefs that
racial minority groups who cannot succeed in this society are “culturally” inferior
 Asian Americans sometimes maintain indigenous beliefs in some Asian cultures about
the nature of mental health, mental disorders, and the need to seek counseling services
 Approaches that work:
o See and appreciate Asian Americans in the context of their cultural heritage
 History and unique characteristics of select groups such as the Chinese,
Japanese, and Vietnamese
o In some worldviews, psychological distress and disorders are explained within a
religious framework
o Religious tradition may play a strong role in some of their views about the origins
of mental health and mental illness
o Direct style may work with those who value collectivism, while the use of the
maintaining harmony style may work for clients with low adherence to emotional
self-control and higher adherence to European American values
Native American Indians
 Possess a plethora of unique cultures, histories, and traditions
 Common identity that stresses values such as harmony with nature, cooperation, holism
(parts of a whole are in intimate interconnection), a concern with the present, and a
reliance on one’s extended family
 Effective counseling depends in part on whether they live on a reservation, whether
other Native Americans help facilitate the counseling process, and whether their
acculturation is traditional, bicultural, or assimilated
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Native Americans who are still attached to traditions and ancestral ways of living use
healing practices that revolve around a circular and holistic model for understanding
human issues
o One way to assess the degree of cultural values is by using the Native American
Acculturation Scale
Approaches that work:
o Silence, acceptance, restatement, and general lead
o vision quest = a rite of passage and religious renewal for adult men
o the creative arts (music, visual art, dancing) as emotional, religious, and artistic
expression is an inalienable aspect of Native culture
o rituals and Wellness
o multiple counseling approaches used in a synergistic way, such as network
therapy, home-based therapy, and traditional native activities such as “the
talking stick” and storytelling
o a sense of “realness”
Arab Americans
 Potential differences among Arab Americans include social class, level of education,
language, relative conservatism of the country of origin, time of immigration, and level
of acculturation
 they emphasize social stability and the collective over the individual
 the individual's life is dominated by family and family relations
o men are the patriarchs in family life and women are expected to uphold the
honor of the family
o education is valued
 Things to be aware of:
o there is a sharp delineation of gender roles in such families
o patriarchal patterns of authority, conservative sexual standards, and the
importance of self-sacrifice prevail
o and emphasis on the importance of honor and shame
o the fallout, tension, and distrust from 9/11
 approaches that work:
o being aware of their cultural context
o being mindful of the issue of leadership and importance of authority figures
o being attentive to how extended family plays a role in decision-making
o using strength based approaches
o assist by helping them access groups where they can find support and become
members of a larger community that is dealing with similar issues
International Counselling/Counseling
 Counseling is often spelled counselling in other English-speaking countries
 International Association for Counseling (IAC) holds annual meetings in countries around
the world
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International students who attend colleges and universities in the United states may be
reluctant to receive counseling services
o they experience a host of stressors beyond those that are mainly developmental
in nature, such as difficulty with linguistics, academic, interpersonal, financial,
and intrapersonal problems
To help international students who use counseling services:
o focus on developing stress management techniques
o learning assertive communication skills
o becoming fully aware of the American educational system
o developing career and life-planning skills
Chapter 4: Counseling with Diverse Populations
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Honoring diversity in all of its many forms is fundamental to counseling
Counseling Aged Populations
 Development is traditionally defined as any kind of systematic change that is lifelong and
cumulative
o Occurs cognitively, emotionally, physically, spiritually, and otherwise
 If life events are accelerated, delayed, or failed to materialize (i.e. nonevents, such as
never marrying or having children), the well-being of persons and their associates may
be negatively affected
o Unanticipated events, such as the death of a parent at an early age or an
unanticipated job loss, may also prove to be detrimental because of the trauma
associated with them and a lack of preparation for them
 The Association for Adult Development and Aging (AADA) is the division within the
American Counseling Association (ACA) that particularly focuses on chronological
lifespan growth after adolescence, but is concerned ultimately with the entire lifespan
 The average life expectancy of a baby born in the United states is 78.8 years
 Historically, counseling older adults has been a neglected area of the counseling
profession
o in part, this situation stems from the group's unique developmental concerns,
especially those involving financial, social, and physical losses
 Erik Erikson views middle and late adulthood as a time when the individual must
develop a sense of generativity and ego integrity or become stagnant and despairing
 Carl Jung believes spirituality is a domain that only those over age 40 are uniquely
qualified to explore
 Neugarten (1978), stressing development, sees 3 major periods of older adulthood
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o Young-old: ages 65-75 (active physically, mentally, and socially)
o Old: ages 75-85 (active but less so than young-old)
o Old-old: ages 85+ (decline in activity but varies greatly)
Ageism = negative attitudes and stereotypes based on age
o Prevents intimate encounters with people in different age groups and sometimes
leads to outright discrimination
“The age mystique” = a phenomenon that Friedran (1994) refers to in which individuals
who are growing older frequently deny and dread the process
The developmental demands of older adults are probably second only to those of young
children
Older adults must learn to cope successfully with:
o Death of friends and spouses
o Reduced physical vigor
o Retirement and the reduction of income
o More leisure time and the process of making new friends
o The development of new social roles
o Dealing with grown children
o Changing living arrangements or making satisfactory ones
Domestic elder abuse = any form of maltreatment by someone who has a special
relationship with the elderly, including neglect
o i.e. physical abuse, psychological abuse, financial exploitation, and violation of
rights
Reasons counselors give for not working with older adults
o Not understanding older adults
o Investment syndrome = feeling that it is better to work with younger persons
who will contribute more to society in the long run
o Irrational fear of aging
o Problems older adults have, such as depression, are attributed to old age and not
seen as a part of life
Working with older adults:
o Incorporating logotherapy principles: “noetic” or spiritual, dimension of human
existence
 this assists them in integrating and transcending their lived experience
and making meaning in late life
o a strategy for promoting change in the aged is to modify the attitudes of people
within the systems in which they live
 many societal attitudes negatively influence older people's attitudes
about themselves
 American society equates age with obsolescence and orders its priorities
accordingly
Gender-Based Counseling
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Women and men are biopsychosocial (i.e., influenced by their thoughts, emotions, and
behaviors – the biological and psychological part of themselves – as well as
socioeconomic, socioenvironmental, and cultural – the social part of themselves)
Because men and women experience different developmental challenges, they may
need different styles of interaction from professionals
As a group, women have different concerns than men in many areas
o for instance, they differ in their interest and involvement in such fundamental
issues as intimacy, career options, and life development
“women grow and/or develop in, through, and toward relationship”
the major concerns of women as a group include development and growth, depression,
eating disorders, sexual victimization, widow hood, and multiple roles
many early theories of the nature and development of women, especially those based
on psychoanalytic principles, tended to characterize women as innately “passive,
dependent, and morally inferior to men”
the general standard of healthy adult behavior came to be identified with men and a
double standard of mental health evolved with regard to adult females
sexism is the belief (and the behavior resulting from that belief) that females should be
treated on the basis of their sex without regard to other criteria, such as interests and
abilities
o a blatant example includes limiting women's access to certain professions and
encouraging them to pursue so-called pink-collar jobs (nurse, receptionist)
Seven areas in which counselors should increase their knowledge of women:
o history and sociology of sex-role stereotyping
o psychophysiology of women and men
o theories of personality and sex-role development
o lifespan development
o special populations
o career development
o counseling/psychotherapy
feminist theory encourages individuals to become more aware of socialization patterns
and personal options in altering traditional gender roles as they make changes, and
encourages clients to become involved in social change activities that stress equality as a
way of bringing about change
two main emphases in the feminist position:
o equality in the helping relationship
o valuing social, political, and economic action as a major part of the process of
treatment
Part of men's general social behavior can be explained by the fact that men's traditional
sex roles are more narrowly defined than women's, and beginning in childhood, there
are stricter sanctions against boys adopting feminine behaviors than exist amongst girls
adopting those deemed as masculine
In childhood, boys are reinforced primarily for non emotional physical actions
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o thus, many men internalize their emotional reactions and seek to be
autonomous, aggressive, and competitive
Research on gender role conflict (GRC) found that rigid ideas about men negatively
impact men
as a group, men are oriented to display fighter rather than nurturing behavior, and they
often perceive themselves as losing power in status by changing in the direction of
androgyny, especially in young adulthood
when not focused on behavior, as a group, men operate primarily from a cognitive
perspective
o men find psychological safety in independence and as a group fear closeness
race may cause minority men to be particularly vulnerable, especially to gender role
identity
as a group, men are likely to be clear and sincere in the process of therapy and express
themselves directly and honestly
positive masculinity = positive masculine roles and traits
a group for men (ages 30 to 50) can be very effective in producing change, especially
when it follows a social-learning paradigm in which other men serve as models and
reinforcers for new behaviors
o the mythopoetic movement (the use of myths and poetry with men in groups) is
one example of the power of such a paradigm for change
Counseling and Sexual Orientation
 Sexual stigmatizing and discrimination devalues sexual minorities and may lead to
hostility (from either the dominant or marginalized group), restricted identity, exclusion,
and less access to power and resources
o The cumulative effect of all of these factors is known as minority stress
 these social empowerment model (SEM) increases the gay, lesbian, and bisexual group’s
collective and personal self-advocacy
o In such a model, clients come to know:
 the origins of sexual orientation are not clearly understood or completely
known
 lesbians and gay men have a variety of lifestyles and lead fulfilling and
satisfying lives
 being lesbian or gay is not a pathological condition
 counseling is about dealing with concerns rather than focusing on
attempts to persuade clients to change their sexual orientation
 the gender role conflict (GRC) model is recommended in working with transgenders
o The focus is on the situational constraints placed on people by their socialized
gender role while allowing for an understanding of the experience of distress
without blaming individuals for their situation
Counseling and Spirituality
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Spirituality refers to a unique, personally meaningful experience of a transcendent
dimension that is associated with wholeness and Wellness
for most people, a spiritual journey is developmental in nature
o it involves an active search toward overcoming ones current centricity to
becoming more connected with the meaning of life, including a oneness of
ultimate being
three events have profoundly affected the attitude about spirituality in America at large
and indirectly in counseling
o the informal spirituality promulgated by Alcoholics Anonymous and other 12 step
programs
o the writings of Scott Peck, whose books bridged the gap between traditional
psychotherapy and religion
o the film series featuring Joseph Campbell, in which Campbell gives respectability
to the spiritual-psychological quest itself, even in modern-times
One specific way to help clients in their spiritual quest is to assess their development
level
o the focus of the seven stages of faith approach is on universal structures that
belong to all faiths that allow the counselor to diagnose and assess the nature
and role of a person's faith apart from its specific beliefs
counselors who work best with religious issues in counseling are either pluralistic (i.e.,
recognizing the existence of a religious or spiritual absolute reality but allowing for
multiple interpretations and paths toward it) or constructivist (i.e., recognizing a client
worldview that includes God or spiritual realities)
Chapter 5: Building Counseling Relationships
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The first stage involves building a relationship and focuses on engaging clients to explore
issues that directly affect them
two struggles take place at this time
o the battle for structure involves issues of administrative control (scheduling, fees,
participation and sessions)
o the battle for initiative concerns the motivation for change and client
responsibility
Microskills include atheoretical and social-learning behaviors such as attending,
encouraging, reflecting, and listening
Factors that influence the counseling process
 seriousness of the presenting problem, initiative, the physical setting, client qualities,
and counselor qualities
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Clients who come to counseling with unfinished business (unexpressed feelings, events,
and memories that linger in the background and clamor for completion) will, as a rule,
take longer to treat than clients who have just experienced a difficulty
Structure in counseling is defined as a joint understanding between the counselor and
client regarding the characteristics, conditions, procedures, and parameters of
counseling
Practical guidelines are part of building structure
o Time limits
o action limits - the prevention of destructive behavior
o role limits - what will be expected of each participant
o procedural limits - the client is given the responsibility to work on specific goals
or needs
one way for counselors to establish structure is to provide information about the
counseling process and themselves with professional disclosure statements that include
details about the nature of counseling, expectations, responsibilities, methods, and
ethics of counseling
Initiative can be thought of as the motivation to change
Counselors must understand the dynamics involved in working with difficult clients
o A role-reversal exercise can promote counselor empathy
o Scapegoating = blaming a person when the problem was not entirely his or her
fault
a reluctant client is one who has been referred by a third party and is frequently
unmotivated to seek help
A resistant client is a person in counseling who is unwilling, unready, or opposed to
change
Ways of helping clients win the battle for initiative
o Anticipate the anger, frustration, and defensiveness that some clients display
o show acceptance, patience, and understanding as well as a general nonjudgmental attitude
o Use persuasion techniques
 foot in the door = the counselor asks the client to comply with a minor
request and then later follows with a larger request
 door in the face = the counselor asks the client to do a seemingly
impossible task and then follows by requesting the client to do a more
reasonable task
o Use confrontation: point out to the client exactly what the client is doing, such as
being inconsistent
o Use metaphors and similes: comparisons of people or actions in one situation to
another
o use “mattering”: the perception that as human beings we are important and
significant to the world around us and to others in our lives
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o Use pragmatic techniques, such as silence or pause, reflection or empathy,
questioning, describing, assessing, pretending, and sharing the counselor's
perspective
An extensive review of research on the physical environment of counseling looked at
eight common architectural characteristics of space and their potential impact on
counseling sessions
o Accessories, color, furniture and room design, lighting, smell, sound, texture, and
thermal conditions
o another factor includes the distance between counselor and client (the spatial
features of the environment or proxemics)
client qualities: the most successful clients for traditional approaches tend to be YAVIS:
young, attractive, verbal, intelligent, and successful
o less successful client candidates are seen as HOUNDS (homely, old, unintelligent,
nonverbal, and disadvantaged) or DUDs (dumb, unintelligent, and disadvantaged)
counselor qualities: expertness, attractiveness, and trustworthiness
Types of initial interviews
 client- versus counselor-initiated interviews
o initiated by the client means they scheduled the session and the counselor is
unsure of their purpose
o counselor-initiated refers to a school counselor or something similar
 The initial counseling interview can fulfill two functions: (a) it can be an intake interview
to collect needed information about the client, or (b) it can signal the beginning of a
relationship
 information-oriented first interviews are structured for the counselor to focus on getting
the client to talk about specific subjects
o The counselor will respond to the client predominantly through the use of
probes, accents, closed questions, and requests for clarification. These responses
are aimed at eliciting facts
 The probe is a question that usually begins with who, what, where, or how
o Rarely uses why (it connotates disapproval, puts the clients on the defensive, and
is often unanswerable)
 An accent is highlighting the last few words of the client
 A closed question is one that requires a specific and limited response, such as a yes or
no question
o Elicits large amount of information in a short amount of time
 An open question allows the client more latitude to respond, and typically begins with
what, how, or could
 Relationship-oriented first interviews concentrate more on the client’s attitudes and
emotions
o Common counselor responses include restatement, reflection of feeling,
summary of feelings, request for clarification, and acknowledgement of
nonverbal behavior
Conducting the Initial Interview
 The two most important microskills for rapport building are basic attending behavior
and client-observation skills
o Rapport is a type of behavior in which there is a genuine interest in and
acceptance of a client
 In beginning the counseling conversation, a counselor may initiate rapport by using door
openers, or non-coercive invitations to talk
o in contrast, door closers are judgmental or evaluative responses
Empathy
 Empathy is the counselor's ability to enter the client's phenomenal world, to experience
the client's world as if it were their own without ever losing the ‘as if’ quality
o empathy involves 2 specific skills: perception and communication
o Empathy may be fostered by attentiveness, or the amount of verbal and
nonverbal behavior shown to the client
 Culturally sensitive empathy bridges the cultural gap between counselors and clients by
perceiving the cultural frame of reference from which clients operate, including
perceptual and cognitive processes
 Primary empathy is the ability to respond in such a way that it is apparent to both client
and counselor that the counselor has understood the client's major themes
o it is conveyed through nonverbal communication and various verbal responses
 advanced empathy is a process of helping clients explore themes, issues, and emotions
new to their awareness
 5 nonverbal skills involved in initial attending:
o SOLER: face the client Squarely, adopt an Open posture, Lean towards the client,
Eye contact, and Relax
 The “Touch Test”: “Would you do this with a stranger?”
 Nonhelpful interview behavior: there are 4 major actions that usually block clientcounselor communication
o Advice giving, lecturing, excessive questioning, and storytelling by the counselor
 When a counselor gives advice, especially in the first session, it may in effect deny the
client the chance to work through personal thoughts and feelings about a subject and
ultimately curtail his or her ability to make difficult decisions
o However, this may be necessary in situations such as crisis counseling
Exploration and the Identification of Goals
 Rule (1982) states that goals are the energizing fabric of daily living but are often elusive
 unfocused goals are not identified, too broad, or not prioritized
 unrealistic goals include happiness, perfection, progress, being number one, and selfactualization
o they have merit but are not easily obtained or sustained
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uncoordinated goals, according to Rule, are generally divided into two groups: those
probably really uncoordinated and those seemingly uncoordinated
o goals in the first group may be incompatible with one another or with the
personality of the client (i.e., resistant clients)
o in the second group our goals of clients who appear to have uncoordinated goals
but really do not (i.e., may be afraid of taking personal responsibility and engage
in a “yes, but…” dialogue)
Seven specific criteria for judging effective goals in counseling:
o goals are mutually agreed on by client and counselor
o goals are specific
o goals are relevant to self defeating behavior
o goals are achievement and success oriented
o goals are quantifiable and measurable
o goals are behavioral and observable
o goals are understandable and can be restated clearly
Chapter 6: Working in and Closing a Counseling Relationship
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A working alliance is a conscious and purposeful aspect of the counseling relationship
and includes affective or bonding elements such as “liking, respect, and trust,” along
with a collaborative spirit between counselor and client in establishing tasks and goals of
treatment
the Johari window is a conceptual device used to represent the way in which most
individuals enter the counseling relationship
o this simple diagram depicts what clients know about themselves and what others
know about them
o usually, clients have limited or distorted information about how others see them,
and they have substantial hidden areas of themselves that they avoid exposing
o they live a rather constricted life that is freely known to themselves and others
but is not fulfilling, and they are often unaware (as are others) of their potential
Counselor skills in the working stage of counseling: understanding and action
 changing perceptions
o functional fixity means seeing things in only one way or from one perspective or
being fixated on the idea that this particular situation or attribute is the issue
 Counselors can help clients change distorted or unrealistic objectives by offering them
the opportunity to explore thoughts and desires within a safe, accepting, and nonjudgmental environment
 goals are altered using cognitive, behavioral, or cognitive-behavioral strategies such as
o redefining the problem
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o altering behavior in certain situations
o perceiving the problem in a more manageable and less stressful way and acting
accordingly
by paying attention to both verbal and nonverbal metaphors, counselors can help clients
become more aware of where they are and where they wish to be
o they can also enhance counselor-client relationships and intervention strategies
as well as improve their own competence in moving beyond jargon and fixed
interpretations that may be less than accurate
reframing is a technique that offers the client another probable and positive viewpoint
or perspective on a situation
o reframing can reduce resistance and mobilize the client's energy to do something
differently by changing their perception of the problem
leading is when the counselor uses persuasive skill and direction to change client
perceptions
o a good analogy is that a good quarterback anticipates where the receiver will be
on the field and throws the ball to that spot
o counselors anticipate where their clients are and where they are likely to go, then
they respond accordingly
o minimal leads, or minimal encouragers, are best used in the building phase of a
relationship because they are low risk
 i.e., “hmm,” “yes,” or “I hear you”
o maximum leads, such as confrontation, are more challenging and should be
employed only after a solid relationship has been established
counselors can enhance their effectiveness by remembering that individuals receive
input from their worlds differently and that preferred styles influence perceptions and
behaviors
o the importance of responding in a client's own language can be powerful
affective responses focus on a client's feelings, behavioral responses attend to actions,
and cognitive responses center on thought
accurate empathy is achieved when counselors see clients’ worlds from the clients’ point
of view and are able to communicate this understanding back
Two factors that make empathy possible are:
o realizing that an infinite number of feelings does not exist
o having a feeling of personal security so that you can let yourself go into the world
of this other person and still know that you can return to your own world
everything you were feeling is ‘as if’
empathy involves 3 elements: perceptiveness, know how, and assertiveness
self-disclosure is a conscious, intentional technique in which clinicians share information
about their lives outside the counseling relationship
o Sidney Jourard did the original work in the area of self-disclosure
o he labeled reciprocal self-disclosure the dyadic effect
according to Egan, counselor self-disclosure serves 2 principal functions: modeling and
developing a new perspective
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o clients learn to be more open by observing counselors who are open
o counselor self-disclosure can help clients see that counselors are not free of
problems or devoid of feelings
counselor self-disclosure should be brief and focused, should not add to the client's
problems, and should not be used frequently
hesitancy may take the form of refusing to discuss issues, changing the subject, being
silent, and talking excessively
Immediacy involves a counselor’s and a client’s understanding and communicating at
the moment what is going on between them in the helping relationship, particularly
feelings, impressions, and expectations
o there are two kinds of immediacy:
 overall relationship immediacy – “How are you and I doing?”
 Focuses on some particular event in a session – “What’s going on
between you and me right now?”
o As a rule, immediacy is difficult and demanding. It requires more courage or
assertiveness than almost any other interpersonal communication skill
hope is the feeling that something desirable, such as the achievement of a goal, is
possible
humor can contribute to creative thinking; promote attachment; help keep things in
perspective; and make it easier to explore difficult, awkward, or nonsensical aspects of
life
Confrontation challenges a client to examine, modify, or control an aspect of behavior
that is currently nonexistent or improperly used
o confrontation can help people see more clearly what is happening, what the
consequences are, and how they can assume responsibility for taking action to
change in ways that can lead to a more effective life and better and fairer
relationships with others
o counselors use a “you said... but look” structure to implement the confrontation
process
avoiding confrontation of clients’ behaviors is known as the MUM effect and results in
the counselors being less effective than they might be
There are two aspects of contracting: one focuses on the processes involved in reaching
a goal, the other concentrates on the final outcome
o it is useful and time saving for counselors and clients to work on goals through a
contract system
o a brief way to think of what to include in a contract is to use the acronym SAFE
 Specificity
 Awareness
 Fairness
 Efficacy
o in determining the formality of the contract, counselors must consider clients’
background and motivational levels, the nature of the presenting problems, and
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what resources are available to clients to ensure the successful completion of the
contract
o to help make clients aware of any resistance they harbor to fulfillment of the
agreement, counselors can ask how clients might sabotage the contract
Once a contract is set up, counselors can help clients maximize the chance of fulfilling it
by getting them to rehearse or practice designated behavior
o overt rehearsal requires clients to verbalize or act out what they are going to do
o covert rehearsal is imagining or reflecting on the desired goal
sometimes a client needs a counselor coaching during the rehearsal. Coaching may take
the form of providing temporary aids to help the client remember what to do next or it
may simply involve giving feedback to the client on how he or she is doing
counselors can also assign clients homework (sometimes called empowering
assignments or between-session tasks) to help them practice the skills learned in
counseling sessions and generalize such skills to relevant areas of their lives
o workbooks require active participation and provide a tangible record of what
clients have done
o some types of homework include paradoxical (and attempt to create the
opposite effect), behavioral (practicing a new skill), or written (keeping a log or
journal)
Transference and countertransference
 counselors want to avoid circular counseling, or covering the same ground over and over
again
 Transference is the client's projection of past or present feelings, attitudes, or desires
onto the counselor
 a transference pool is an image generated through the use of personality and a
particular theoretical approach
o a client reacts to the image of the counselor in terms of the client's personal
background and current conditions
 five patterns of transference behavior frequently appear in counseling: the client may
perceive the counselor as ideal, seer, nurturer, frustrated or, or non entity
 direct transference is well represented by the example of the client who thinks of the
counselor as his or her mother
 indirect transference is harder to recognize – it usually revealed in client statements or
actions that are not obviously related to the counselor (“I think counseling is the
experience I've always wanted”)
 negative transference is when the client accuses the counselor of neglecting or acting
negatively towards him or her
 both negative and positive transference are forms of resistance
o as long as the client keeps the attention of the counselor on transference issues,
little progress is made in setting or achieving goals
o to resolve transference issues, the counselor may work directly and
interpersonally rather than analytically
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countertransference refers to the counselor's projected emotional reactions to or
behavior toward the client
there are two major approaches to the problem of conceptualizing countertransference
o in the classic approach, countertransference is seen negatively and viewed as the
direct or indirect unconscious reaction of the counselor to the client
o the total approach sees countertransference as more positive – it is viewed as a
diagnostic tool for understanding aspects of the client's unconscious motivations
the manifestation of countertransference takes several forms, such as:
o feeling a constant desire to please the client
o identifying with the problems of the client so much that one loses objectivity
o developing sexual or romantic feelings toward the client
o giving advice compulsively
o wanting to develop a social relationship with the client
countertransference can be expressed in many ways, including overidentification, which
is when counselors lose their ability to remain emotionally distant from the client
(overprotective or benign), and disidentification, in which counselors become
emotionally removed from the client (rejecting or hostile)