overview CPCE Purple book

CAREER CHOICE

Computer-assisted career guidance (CAGC) such as SIGI. To use CAGC, the counselor should: Screen the client to make certain this modality and computer program or online program is appropriate. Give the client an orientation to describe the pros and cons of the system. Follow-up to make certain an appropriate plan of action is evident. Dictionary of Occupational Titles (DOT) listed over 20,000 job titles; with nine digit codes for the occupation. The DOT has been replaced by O*NET also known as O*NET online. A text version of O*NET known as O*NET Dot or O*NET Dictionary of Occupational Titles is available; however, as of this writing it is not published by the Department of Labor. OOH or Occupational Outlook Handbook gives job trends for the future with salaries, and can be accessed over the Internet. Richard Bolles's book, What Color is Your Parachute? is a fine tool for job hunting.Eighty percent of all jobs are not advertised and thus job seekers need to network. This is referred to as the hidden job market. Key trend: women moving into careers that were traditionally occupied by males. Sex-wage discrimination/earnings gap: women make $0.80 for each dollar earned by men. African American women earn $0.68, and Latina women earn $0.60 for every dollar earned by white men. One in five workers still secure a job based on chance factors and 60% of all workers would like more information if they had to do it all over again. However, overall college students are avoiding career counseling services. Underemployment occurs when a person takes a job below his or her level of skill, expertise, and training (e.g., a PhD who works in an entry-level fast food position). Dislocated worker is a term that describes a person who is unemployed due to downsizing, a company relocation, or the fact that the company closed the business. Displaced homemaker describes women who enter or reenter the workforce after being at home. This often occurs after a divorce or the death of a partner or spouse. Outsourcing takes place when U.S. companies rely on labor from another country in order to save money (i.e., the salaries would be lower). This can also result in fewer jobs in the United States. Online career counseling is a growing trend. While helpful, the practice is not as effective as the traditional face-to-face model. The average worker has nine jobs by age 36. Networking helps clients secure jobs and can help them find gay-friendly employers. In two-parent families, if both parents work this is called a dual-career or dual-income family. Strictly speaking: Dual earner—there is no chance for advancement; dual career—consists of a managerial or professional position with the possibility for advancement. Supervisors who rate workers often suffer from rater bias. When a supervisor erroneously rates the majority of workers as average, it is called the central tendency bias. The recency effect occurs when the rating reflects primarily the worker's recent performance (rather than the entire rating period) since this effect suggests we remember best things that are presented last. A supervisor generalizing about an employee based on a single characteristic (e.g., giving a worker who is kind a higher rating than a worker who is just as good but isn't kind) is the halo effect. Positive and negative halo effects are possible. Supervisors often rate workers higher if the supervisor hired that particular worker. Quality circles. Employees with identical or similar jobs meet as a group to solve problems and come up with solutions to help management. Job interviews, personality tests, and reference letters are not excellent predictors of whether a person will do well in a job. Structured job interviews usually fare better than unstructured job interviews. The contrast effect suggests that if a job seeker is interviewed after a superb candidate he or she will not seem as desirable. On the other hand, if a very weak candidate is interviewed it will make the next job applicant appear more competent. Interest inventories do not predict job success well, but they do predict job satisfaction.

SOCIAL AND CULTURAL FOUNDATIONS

Culture is defined as habits, customs, art, religion, science, and the political behavior of a given group of people during a given period of time. Cultures are said to be dynamic: each culture changing or evolving at its own rate. The dominant or major culture in a country is the macroculture, often contrasted with the smaller microculture. Learning the behaviors and expectations of a culture is known as acculturation. Cultural humility is a way to view cultural competency as an ongoing process and not an end product. The construct suggests you need a lifelong commitment to self-evaluation; fix power imbalances where they should not exist; and develop partnerships to advocate for others. Universal culture implies that we are all genetically and biologically similar "biological sameness" (i.e., we all need air, food and water); national culture can determine our language, political views, and our laws; regional culture gives us the behavior for a certain region; and ecological culture where factors such as earthquakes, floods, and food supply may influence our behavior. Racism occurs when one race views itself as superior to others. A given race has a set of genetically transmitted characteristics such as white, African American, or Asian. Ethnocentrism means that a given group sees itself as the standard by which other ethnic groups are measured. Emic versus etic distinctions. In the emic approach the counselor helps the client understand his or her culture. In the etic approach the counselor focuses on the similarities in people; treating people as being the same. Autoplastic-alloplastic dilemma. Autoplastic implies that the counselor helps the client change to cope with his or her environment. Alloplastic occurs when the counselor has the client try to change the environment. Tests and nosological systems such as the DSM can have a Eurocentric or Euro-American bias. Paralanguage implies that the client's tone of voice, loudness, vocal inflections, and speed of delivery, silence, and hesitation must be taken into consideration. It is part of the study of nonverbal communication and is usually considered more accurate than verbal communication. Low context communication versus high context communication was postulated by anthropologist Edward T. Hall. Low context implies that there will be a precise explicit verbal explanation and possibly repetition such as summarizing at the end of a class, meeting, or a group counseling session. Popular in the U.S., UK, Canada, and Germany. High context communication is implicit. It is common in the Middle East, Italy, Spain, and Asian countries. It relies on nonverbal over verbal, respect for tradition and the past, and is readily understood by others in the culture with a shared frame of reference. Stereotyping is the act of thinking that all people of a group are alike. Stereotypes can be good or bad. Prejudice occurs when we have an opinion based on insufficient evidence. Androgynous/androgyny is the notion that psychologically healthy people possess both masculine and feminine characteristics. 473 Proxemics addresses the issue of personal space, also known as spatial relations. A counselor who sits •too close to a client, for example, may make the client uncomfortable. Communication and social relations are impacted by proxemics. Means tests determine whether a client is eligible for a social program or benefit such as temporary assistance for needy families (TANF) or food stamps. Income and assets such as bank accounts are often used to make this determination. Often contrasted with social insurance programs such as social security for which an extremely wealthy person could still be qualified. Social comparison theory, popularized by early research conducted by Leon Festinger, simply postulates that we evaluate our behaviors and accomplishments by comparing ourselves to others. Festinger is also well known for his cognitive dissonance theory, asserting that individuals will change their beliefs to match their behavior when there is a mismatch. This reduces the tension created by the initial inconsistency. Confirmation bias is to acknowledge information that supports your point of view and ignore that which does not. Counselors strive to understand a client's worldview (the way the client sees the world due to attitudes, value systems, and beliefs). Socioeconomic factors must be taken into account. Nearly 15% of the U.S. population lives below the poverty threshold set by the U.S. government. Social comparison theory means we compare ourselves with others to evaluate ourselves. High self- monitoring individuals care about their self-image and what others think of them. The affiliation statement misery loves company (or literally miserable company!) is often true according to Stanley Schachter. Women are more apt to talk to others (especially other women) in a social situation. Anglo-Conformity Theory asserts that people from other cultures would do well to forget about their heritage and try to become like those in the dominant macroculture. The Five-Stage Atkinson, Morten, and Sue's Racial/Cultural Identity Development Model (R/CID) aka the Minority Identity Model: (1) conformity (lean toward dominant culture and prefer a counselor from the dominant culture); (2) dissonance (question and confusion, prefer a counselor from a minority group); (3) resistance and immersion (reject the dominant culture while accepting one's own culture); (4) introspection (mixed feelings related to the previous stage, prefer a counselor from one's own racial/ethnic group); and (5) synergetic articulation and awareness (stop racial and cultural oppression, prefers a counselor with a similar attitude or worldview over merely a counselor who is the same race/ ethnicity, but has different beliefs). Not everyone goes through all stages and some individuals never progress beyond the second or third stage. An individual can also go backward.

GROUP COUNSELING

Existential Therapy Expert and Psychiatrist Irvin Yalom Outlines 11 Reasons Groups Work So Well Altruism. Giving help to others gives members a sense of well-being. Universality. Simply the notion that you are not the only one in the world with a particular problem. Installation of hope. In plain everyday English, the members expect the group to work. Catharsis. Talking about your difficulties is beneficial. Group cohesiveness or a sense of we-ness. Imitative behavior. As you know, behaviorist Albert Bandura's social learning theory suggests that we learn by watching others. In this situation the members copy or model the leader and the other members. Family reenactment. The group helps abet family of origin issues and feelings and the group allows you to work through them. Imparting information. This could be advice or even psychodynamic insights. Interpersonal learning. Members receive feedback regarding how their behavior affects others. Socialization techniques such as feedback and instruction are helpful. Existential factors, for example discovering that life can have meaning even if it is seemingly unjust and unfair at times. Yalom is a proponent of working in the here and now and emphasizes the therapeutic alliance is a powerful ingredient. A client with anger management issues will express anger in therapy if he or she is in treatment long enough. Yalom also wrote Staring at the Sun: Overcoming the Terror of Death. Freud noted that denial of sexual impulses can lead to symptoms. In a similar fashion, Yalom asserts denial of death leads to symptoms as well. Nightmares are often manifestations of one's fear of death. Groups Ideal size is five or six to eight members, with eight being preferable. Groups that are conducted for a long time (e.g., six months or more) can function effectively with up to 10 members. Size should be smaller with children. Duration can refer to the length of the group sessions or how long the group will run. Groups can be open (new members can join after the group begins) or closed (no new members can join after the group begins). A group can have a single leader or be led by coleaders. Advantages of coleaders: having two role models (perhaps two genders), more feedback, one leader can deal with the client if there is transference and two leaders can better see what is transpiring in the group. Disadvantages: leaders can work at cross-purposes, may have conflicting models of therapy, could be in a power struggle, and may each decide to charge the client a different fee. Group work is cost effective and the counselor can see more clients in the same period of time. Most experts believe in the stage models to explain development and dynamics: The initial stage, the forming stage, or the orientation stage—this is kind of the "get acquainted" stage; the transition, conflict, or storming stage—this is characterized by power struggles for control and resistance, and some members will rate their satisfaction as lower; the working, productive, performing, or action stage—here the group works toward goals in a cohesive manner; the termination, closure, completion, or mourning and adjourning stage—members must deal with saying goodbye. Members often experience feelings of improved insight, awareness, accomplishment, and enhanced self-esteem. Referrals for additional intervention may be prescribed. Group member roles are positive, such as helping others and being a stellar role model. Other roles, such as monopolizing the group; intellectualizing too much; being silent; or attacking others are considered negative. The scapegoat is the member who is blamed for the group's problems. This term is also used in family therapy. Group Leadership StylesAdept group leaders model appropriate behavior to enhance participation. This is especially important with resistant clients. Leaders rely on a strategy called pacing to determine how rapidly the group progresses. Autocratic or authoritarian style advocates making decisions for members. It is appropriate during a crisis or when a quick decision is in order but in most situations it will foster resentment. Laissez faire or hands-off style. Here the leader has little involvement. This approach is appropriate when all members are very committed to a group outcome or goal. Democratic approach allows input from members, including input into the decisions made. This is generally the best style. Speculative leaders are often seen as charismatic. They rely on their personal power and charisma to move the group in a desirable direction. They are often adored and group members look up to them, though they are not peer oriented. Confrontive leadership style. The facilitator reveals the impact that his behavior has on himself as well as the impact that other group members have on him. • Research has not shown that the speculative style is superior to the confrontive style or vice versa. Whatever style the leader utilizes, he or she must not impose his or her personal values on group members. Types of Groups Psychoeducational/old name guidance groups provide members with information relevant to their situation. Counseling groups focus on conscious issues related to personal growth and development. Group therapy (a term coined by Jacob Moreno who founded psychodrama) can focus on unconscious material, the past, and personality change.490 T-groups (training groups) are often intended for business or personal motivation. Structured groups are centered around certain issues, such as shyness or how to prepare for a job interview. Self-help groups/mutual help/support groups (such as AA) are not led by a professional. These groups have been dubbed as support groups and those that follow the AA model are often called 12-step groups. The self-serving attribution bias in relation to groups. When the group is productive or successful the person takes credit for it, but when the group is unproductive or not successful, it is the fault of others. The leader is responsible for the safety of group members. Exercises like hitting each other with styrofoam bats, or other ways of venting anger, are not only dangerous, but research shows they often increase rather than decrease aggression! In essence, the notion that catharsis is therapeutic is largely a myth. The risky shift phenomenon. Members make more risky decisions in a group than they would on an individual basis. Group polarity suggests that members of a group make more extreme decisions than they would individually. ASGW Best Practice Guidelines are intended to specifically help counselors apply ACA's Code of Ethics to group work. The guidelines stipulate a leader should have an evaluation plan to meet the requirements of organizations, regulatory bodies, and insurance companies when appropriate. ASGW has drafted Multicultural and Social Justice Competence Principles for Group Workers. The leader allows members to discuss diversity, power, privilege, and why social justice/advocacy issues are important. Group members are not required to participate in an exercise or experiential activity and can quit during the experience. It is the leader's job to clarify this upfront; however, the leader should explore why a participant did not wish to participate or stopped in the middle of the exercise. As group members get to know each other, spontaneous touching may occur. That said, forced touching exercises are not recommended and could cause negative feelings in some members (e.g., those who have been sexually abused). Lifestyle and Career Counseling Theories Grad students and neophyte counselors often have a negative attitude toward learning about career counseling and do not want to engage in this practice. In reality, career counseling and personal counseling overlap. Nevertheless, career counseling is commonly seen as having less prestige than personal counseling and psychotherapy. Trait-and-factor theory (matching or actuarial approach). Frank Parsons (father of guidance) was the author of the seminal work in the field, Choosing a Vocation. A client needs to know his or her personal attributes and interests or traits; appropriate occupations should be investigated; finally, match the client's traits to the occupation. E. G. Williamson expanded this theory to six steps: analysis, synthesis, diagnosis, prognosis, counseling, and follow-up. The trait-and-factor approach makes the assumption that there is a single best career goal for everyone. Many experts disagree with this assumption. Anne Roe created a psychodynamic needs approach. Jobs meet our needs determined by our childhood satisfactions and frustrations. Occupations are categorized by six levels and eight fields. Our orientation 491 toward or away from other people can influence our career choices.Eli Ginzberg, Sol Ginsburg, Sidney Axelrad, and John Herma proposed a developmental theory in the 1950s with three periods: fantasy (birth to 11 years) in which play becomes work oriented; tentative (11-17 years); and realistic (17 years and up). David Tiedeman and Robert O'Hara rely on a developmental approach. In their model, career development is commensurate with psychosocial development as delineated by Erik Erikson's stages. Donald Super is well known for emphasizing the role of the self-concept in career and vocation choice and his life rainbow. John Holland's personality typology theory. The six personality types are realistic, investigative, artistic, social, enterprising, and conventional (RIASEC). He is also known for his assessment tools: the Self- Directed Search, My Vocational Situation, and the Vocational Preference Inventory. John Krumboltz, Anita Mitchell, and G. Brian Jones theorized that career decision was based on social learning theory. Today Krumboltz leans toward behaviorism in general. Four factors impact career choice: genetics and special abilities; the environment and special events; learning experiences; and task-approach problem-solving skills. Linda S. Gottfredson emphasized circumscription (the process of narrowing the acceptable alternatives) and compromise (realization that the client will not be able to implement their most preferred choices). The client adjusts aspirations to accommodate such things as hiring practices, family obligations, or educational programs. People sacrifice interests rather than sex-type or prestige. Theory created in the early 1980s. Social cognitive career theory (SCCT) by Robert Lent, Steven Brown, and Gail Hackett helps complement other theories emphasizing the role of self-efficacy and cognitive processes. Mark Savickas uses techniques popularized by narrative therapy to create a postmodern constructivist approach.

MAJOR THEORIES AND THEORISTS

G Stanley Hall. Founder of psychology in the U.S. and the first president of the American Psychological Association. He popularized the study of the child and child guidance. He wrote seminal works on adolescence. Behaviorism Behaviorism was outlined by John B. Watson, Ivan Pavlov, Joseph Wolpe, and B. F. Skinner. Initially the mind is a blank slate and the child learns to behave in a certain manner. This is basically a passive theory. The mind is like a computer that is fed information. This model relies on empiricism—John Locke's view that knowledge is acquired by experience. All behavior is the result of learning. Erik Erikson's Eight Psychosocial Stages Erikson's stages are delineated in his classic 1963 work Childhood and Society. The stages are based on ego psychology and the epigenetic principle that states that growth is orderly, universal, and systematic. The stages are: trust versus mistrust (birth to 1.5 years); autonomy versus shame and doubt (1.5-3 years); initiative versus guilt (3-6 years); industry versus inferiority (6-11 years); identity versus role confusion (12-18 years);intimacy versus isolation (18-35 years); generativity versus stagnation (35-60 years); and integrity versus despair (age 65 and beyond). Jean Piaget's Qualitative Four Stages of Cognitive Development (Genetic Epistemology)Theory: sensorimotor (birth to 2 years); preoperational (2-7 years); concrete operations (7-12 years); and formal operations (11/12-16 years). Patterns of thought and behavior are called schema or the plural, schemata. Adaptation occurs qualitatively when the individual fits information into existing ideas (also known as assimilation) and modifies cognitive schemata to incorporate new information (this is called accommodation). Assimilation and accommodation are said to be complementary processes. The ages in the Piagetian stages can vary, the order is static. Object permanence occurs in the sensorimotor stage (an object the child can't see still exists). Centration is the act of focusing on one aspect of something. It is a key factor in the preoperational stage. Conservation takes place in the concrete operations stage. The child knows that volume and quantity do not change, just because the appearance of an object changes (e.g., pouring a short glass of water into a tall skinny glass does not alter the amount of the liquid). The child comprehends that a change in shape does not mean a change in volume. Abstract scientific thinking takes place in the formal operations stage. 470 Keagan's Constructive Developmental ModelKeagan's model emphasizes the impact of interpersonal interaction and our perception of reality. Lawrence Kohlberg's Three Levels of Moral Development Preconventional level—behavior governed by consequences; conventional level—a desire to conform to socially acceptable rules; postconventional level—self-accepted moral principles guide behavior. Each level has two stages. Carol Gilligan's Theory of Moral Development for Women Gilligan's 1982 book, In a Different Voice, illuminated the fact that Kohlberg's research was conducted on males. Women have a sense of caring and compassion. Daniel Levinson's Four Major Eras/Transitions Theory In a 1978 classic book titled The Seasons of a Man's Life, Levinson depicted the changes in men's lives throughout the life span. The four key eras include: childhood and adolescence, early adulthood, middle adulthood, and later adulthood. Lev Vygotsky (1896-1934) Vygotsky proposed that cognitive development is not the result of innate factors, but is produced by activities that take place in one's culture. His zone of proximal development (ZDP) refers to the difference in the child's ability to solve problems on his own and his capacity to solve them with some help from others. Sigmund Freud's Psychoanalytic/Psychodynamic Five Psychosexual Stages Freud's stages are: oral (birth to 1 year), anal (1 to 3 years), phallic (Oedipal/Electra complex (3-7 years), latency (3-5 years until age 12), and genital (adolescence and adulthood). Libido is the drive to live and the sexual instinct that is present even at birth. It is said to be sublimated in the latency stage as the individual has little interest in sex. This ends when puberty begins. Regression is the return to an earlier stage caused by stress. Fixation implies that the person is unable to move to the next stage. Freud is criticized for focusing on sex and not including the entire life span in his theory. Abraham Maslow's Hierarchy of Needs Maslow interviewed self-actualized people. Lower-order physiological and safety needs must be fulfilled before self-actualization can occur. William Perry's Three-Stage Theory of Intellectual and Ethical Development in Adults/College Students Dualism—in which students view the truth as either right or wrong. Relativism—the notion that a perfect answer may not exist. There is a desire to know various opinions. Commitment to relativism—in this final 471 stage the individual is willing to change his or her opinion based on novel facts and new points of view. James W. Fowler's Prestage Plus Six-Stage Theory of Faith and Spiritual Development Fowler conducted 350 structured interviews and drew on the work of Piaget, Kohlberg, and Erikson. Stage 0: undifferentiated (primal) faith (infancy, birth to 4 years); Stage 1: intuitive-projective faith (2-7 years, early childhood); Stage 2: mythic-literal faith (childhood and beyond); Stage 3: synthetic-conventional faith (adolescence and beyond) a stage of conformity; Stage 4: individuative-reflective faith (young adulthood and beyond); Stage: 5 conjunctive faith (mid-thirties and beyond) openness to other points of view, paradox, and appreciation of symbols and metaphors; and Stage 6: universalizing faith (midlife and beyond) few reach this stage of enlightenment. • According to Fowler, faith is not identical with one's belief in religion. "Faith can be religious faith, but it can also be centered on a career, a country, an institution, a family, money, success, or even oneself." Faith grows and changes throughout the life span. Diana Baumrind's Typology of Parenting Styles Authoritative: High expectations for the child, but is warm and nurturing. The child is given an explanation of the rules. Generally produces a child who is happy, does well in school, has good emotional regulation, and fine social skills. Authoritarian: Characterized by bossy parenting which champions "follow my orders" with no explanation. Punishment and verbal insults are used liberally. Can produce anxious, withdrawn children who are likely to engage in antisocial behavior including alcohol and drug abuse, stealing, and gang activities. Permissive Passive Indulgent: Parent has a low level of control and is easily manipulated. Rarely says "no" to a child and is nonpunitive. Very affectionate and wishes to please the child like a friend. Child can display a lack of social skills, boundaries, and can be extremely demanding. Children often use drugs and alcohol. Teen Pregnancy Although the number of teen pregnancies is declining, the U.S. still sports the highest rate of any industrialized nation. Both moms and kids have more difficulties such as preeclampsia (very high blood pressure during pregnancy), prenatal addiction, children with low birth rates, and children who are delinquent and have mental health and addiction issues. Children born to teen moms are statistically more likely to become teen moms themselves. Family therapy appears to be the best treatment of choice for those with eating disorders.

ROSENTHAL'S 44 KEY RULES FOR AVOIDING LAWSUITS, ETHICAL VIOLATIONS, AND MALPRACTICE DIFFICULTIES

Get a medical diagnosis on clients to rule out physical and organic problems. You never want to treat a problem as a purely psychological (functional) disorder when it is organic. Don't break confidentiality unless legal and ethical guidelines stipulate you should do so. Confidentiality lives on after the client is deceased. Inform the client upfront that there are times when you need to break confidentiality, for example, you are subpoenaed and asked to provide information about a client. This is known as "relative confidentiality" or the "limitations of confidentiality." Your informed consent information statement should also delineate freedom of choice issues, fees, techniques you utilize, and your qualifications. If you haven't been properly trained to treat a problem, don't treat it. If you haven't been properly trained to use an approach, don't use it. Never promise or guarantee that you will cure the client. Never have sex or become romantically involved with a current client, a client's partner, family member, or supervisee, or use the relationship for monetary gains. According to ACA you may have a romantic or sexual relationship with a former client if you wait five years after the last contact. NBCC states two years after termination. The relationship cannot be exploitative. If you don't know how to handle a case, get supervision or seek out a consultation. The "standard of practice or care" concept refers to the fact that competent peers would have handled the situation in the same usual or customary manner as you. Document your work by keeping good, accurate records. Computerized or so-called electronic records require restricted access so only appropriate staff can view them. Breech confidentiality if a client threatens to hurt himself, herself, or someone else, relying on the principle of "minimal disclosure." Always contact a hotline regarding child abuse and abuse of the elderly or a disabled adult. Counselors are mandated reporters. Counselors and counselors-in-training should peruse current NBCC Code of Ethics related to Face- to-Face Counseling, Technology Assisted Distance Counseling (i.e., Internet counseling, telephone counseling) and also peruse ACA's Code of Ethics. Practice fidelity by keeping promises and being loyal to clients. Lying, not keeping appointments, and breaking confidentiality for no good reason are examples of behavior that violates fidelity. Always ask a client before you record (audio or video) the session and explain how the recording will be utilized. Clients are not obligated to agree to this practice. Allowing supervisees and students to take recordings home could be detrimental to confidentiality. Always secure malpractice (liability) insurance. Initially provide the client with a written informed consent/disclosure statement with a transfer plan (in case you become ill, incapacitated, retire, die, or leave the practice) for the record and treatment. Do not perform conversion or reparative therapy to convert members of the LBGTQ community to 466 heterosexuals since LBGTQ lifestyles are not considered abnormal. If you are running a group, let the group know that confidentiality is crucial, but you cannot guarantee it. Refrain from giving the client a diagnosis in cases where the diagnosis might harm the client. Steer clear of dual/multiple relationships with current or former clients unless the relationship is beneficial to the client (e.g., attending a graduation or visiting the client in the hospital). Document why you feel the interaction is beneficial in advance whenever possible. If a nonprofessional situation or relationship is targeted at meeting your needs and not the client's, then you should avoid it! If you are a counselor educator you must infuse multicultural and diversity material into all courses and workshops. Never use a test, inventory, or assessment tool on a population unless that particular instrument has been normed on that population. Never use a test or inventory that is obsolete or make client decisions based on obsolete test scores. Use the title "Dr." only if your doctorate is in counseling or a closely related field. If a degree is an honorary degree (versus a degree which is earned) this must be disclosed. Do not use your regular counseling job to recruit clients for your private practice. NCCs keep records for at least five years, unless the law says otherwise. Do not make multiple or so-called duplicate submissions to professional journals. If you are working with a terminally ill client who wishes to hasten his or her death you have a right to break or not break confidentiality after you consult with appropriate professional and legal sources. Work with your clients to jointly devise a counseling plan and review the plan on a regular basis. If you are using a treatment team you must inform the client. In addition, you should reveal the composition of the team. If a client gives you a small gift based on the client's cultural norms, you could accept the gift if you feel the monetary value of the gift is appropriate ($20 or less according to most experts) and the motivation for giving the gift is acceptable. It should not be a recurrent event and should promote, not endanger, the client's welfare. Counselor educators who are book authors are permitted to use their books for classes and workshops. A wealth of new technology-related ethical imperatives now exist. If you provide technology-assisted services (e.g., telephone counseling, software, online counseling, websites, online assessments etc.) use encrypted websites and e-mail communications. If this is not possible, only use communications that are not client specific. Check legal regulations and the licensing bureau of the state where the client resides to determine if you must be licensed in that particular state. Provide language translation services for clients who communicate in a different language. Also, establish a password or set up a webcam system at the beginning of each session to verify the identity of the client. Consider taking NBCCs training to become a Distance Credentialed Counselor (DCC). If you provide technology-assisted services, give the client emergency procedures in case technology fails and let the client know what services are covered under insurance. Moreover, ensure that technological accessibility meets the Americans with Disabilities Act (ADA). If you are using a technique or treatment modality that is not proven via empirical evidence or a proven 467 scientific foundation, always inform the client that the intervention is "unproven" or "developing." Discuss the possibility of harm with the client. If you are unsure whether or not a treatment modality is unscientific, consult with a former professor, colleagues, or other expert. Keep up with the latest research by reading textbooks, journals, and attending professional workshops. Moreover, if you do harm a client unintentionally you need to show that you attempted to remedy such harm. Counselor supervisors should not counsel their supervisees. Counselor supervisors should provide an on-call supervisor to assist supervisees in his or her absence. A supervisor can legitimately recommend that a supervisee be dismissed from a training program or a professional setting. Either a supervisor or a supervisee can legitimately terminate a supervisory relationship. A referral should be given to the supervisee. Whenever possible, do not use deception with subjects in research studies. If you cannot find an alternative, then debrief the subjects as soon as possible. Avoid fee-splitting and never accept a referral fee for a client. Beware: Ignorance of ethical guidelines is not considered a valid excuse to violate them! NBCC says you should not solicit testimonials from current clients. Wait two years. ACA also agrees you should not solicit testimonials from current clients or from others who might be "vulnerable to undue influence." ACA does not mention any waiting period. Excessive self-disclosure pertaining to your own problems which will not help the client could be an ethics violation. Ethical codes protect counselors and their clients. Moreover, such codes provide an outline for professional accountability and acceptable practice. These codes are not static and therefore do change over time.

HISTORIC NBCC ANNOUNCEMENT 12 Final Overview and Last-Minute Super-Review Boot Camp Review this material after you have completed the entire Encyclopedia of Counseling. Do not skim over this review: it is a very powerful learning device. I've even added a few last-minute concepts that can be explained in a sentence or two as exam insurance! You should begin scanning this chapter at least a week or so before the exam, and even peruse it the night before or the morning of the exam. Ideally, combine this review with the Boot Camp program in my audio program. Here is your mini-review on a little more than the head of a pin! Best wishes!

On November 17, 2014, NBCC President and CEO, Dr. Thomas W. Clawson, sent a communication revealing that NCC applications received after January 1, 2022, will only be accepted if the applicant possesses a master's degree or higher from a program accredited by the Council for Accreditation of Counseling and Related Programs (CACREP). This will reduce the difficulty of securing a license when a counselor moves. This will not affect anybody who currently has NCC status. ACA is backing this position. 464

HUMAN GROWTH AND DEVELOPMENT

The application of human growth and development theories to the practice of counseling became popular in the 1980s. In 1981, CACREP included this as a core content area. In 1983 APGA (now ACA) changed its name to American Association for Counseling and Development to help emphasize the developmental aspects of our profession. Development is ongoing, systematic, orderly, sequential, and is said to build upon itself. The term continual implies that development occurs throughout the life span. There is speculation as to whether individuals are active or passive in terms of influencing their development. Another issue centers on the nature or nurture debate. Is behavior the result of inborn tendencies/heredity (i.e., nature) or the environment (i.e., upbringing, nurture, and learning)? Current theorists insist it is both, but disagree on the amount of impact exerted. The third arm may be fetal origins, referring to what happens to the fetus during gestation. Changes can be quantitative (measured) or qualitative (change in organization or structure). Many theorists stress the notion of critical periods (also called sensitive periods or all or nothing periods) where a behavior or developmental process, for example language or types of visual acuity, can be acquired; or it is nearly impossible to develop at a later time of life. Ironically, young children have more neural connections than adults. If genetics play such a strong role in development, why are children from the same family often so much different? The current notion is that shared experiences/influences (all family members attended the same family functions, went on identical vacations, etc.) have less impact than nonshared individual experiences/influences (siblings may have different teachers, friends, etc.). Also, individuals may perceive the same event in totally different ways. 469 G. Stanley Hall

THE HELPING RELATIONSHIP

There are over 400 approaches to psychotherapy and counseling worldwide. Most counselors claim they use several approaches and thus would be classified as eclectic or integrative. Very important: Research illuminates that the therapeutic relationship contributes to 30% of the client outcome. The Helping Myth Research demonstrates that having a counselor and a client of the same gender and ethnicity does not necessarily produce a better therapeutic relationship. The data are not strong and clearly more research is necessary. Happiness Most people overestimate the impact an event will have on their degree of happiness or unhappiness. For example, individuals believe that marriage or winning the lottery will make them happy. The happiness boost for marriage lasts roughly two years, while the increase from winning the lottery spans about six months. In general, people are poor at forecasting affective/ emotional reactions. Psychotherapy and Counseling are Cost Effective Cost-Benefit Analysis (CBA) reveals that therapy reduces mental health expenditures in the community. Unfortunately, insurance and managed care firms primarily push medication as a first line of treatment for mental health issues. Sigmund Freud's Psychodynamic Psychoanalysis Psychoanalysis is a theory of personality and a form of psychotherapy. It is a long-term form of treatment often lasting three to five years or more. In classical analysis the patient (the analysand) is seen four of five times per week. This form of therapy is said to be historic since it focuses on the past. Patient is asked to engage in free association, which is saying whatever comes to mind. Dreams are very important and generally viewed as a process for wish fulfillment. Research does not support the Freudian wish fulfillment notion. Unconscious material is examined. Freud emphasized ego defense mechanisms: repression (most important)—something that is too painful to face is totally forgotten; displacement—taking your anger out on a safe target rather than the source of your anger; projection—you can't accept a quality about yourself so you attribute it to others (i.e., you think that you are looking out a window but you are really looking in a mirror); reaction formation—you deny an unacceptable unconscious impulse by acting in the opposite manner; sublimation (often cited with career counseling)—you express an unacceptable impulse in a socially acceptable manner; rationalization—when a person overrates or underrates a reward or outcome; identification—joining a feared person (such as a gang) to relieve your anxiety; suppression or denial (not unconscious or automatic)—occurs when you purposely don't think of a situation. Transference is also a key principle. The analysand (client) behaves as if the analyst is a parent or caretaker from the past. The discharge of repressed emotions is called abreaction or catharsis. According to Freud's structural theory, the personality has three systems: a superego (the moral seat of the mind housing two entities the conscience and the ego ideal); the ego or reality principle that balances the id and the superego; and the id, which houses biological forces, especially sex and aggression: The id operates on the pleasure principle striving for immediate gratification and tension reduction. Eros is the life instinct; thanatos the death instinct. Critics charge that Freud used only case studies to test analysis rather than using true scientific experiments. Carl Jung's Analytic Psychology Carl Jung broke away from Freud in 1914 because he felt Freud overemphasized the role of sexuality. His approach, like Freud's, is psychodynamic. The unconscious has two parts: a personal unconscious (very similar to what Freud postulated) and the collective unconscious (an unconscious that one inherits which is common to all individuals). The collective unconscious is composed of archetypes passed down through the ages. Archetypes include the persona: a social mask the person wears. To explain gender, Jung cites the animus or the masculine side of the female and the anima or feminine side of the male. Individuals are said to be androgynous, having both male and female characteristics. He also speaks of the shadow or the so-called dark side of the personality related to animal instincts. The self is symbolized via a mandala (a magic circle in Sanskrit) or a balance between the personal unconscious and the collective unconscious. Jung created the extroversion/introversion typologies. Jung felt that we possess both; however, one is dominant. The Myers-Briggs Type Indicator (MBTI) has its roots in Jung's work. Individuation was Jung's term for becoming a unique human being. Alfred Adler's Individual Psychology Alfred Adler broke away from Freud to create his own theory. Adler's individual psychology is a psychodynamic approach that focuses on the fact that behavior is one's unconscious attempt to compensate for feelings of inferiority. An individual constructs a lifestyle which is chosen. Adler stressed the "will to power" to generate feelings of superiority. The theory adheres to the principle of fictional finalism or the notion that behavior is motivated primarily by future opportunities rather than the past. Adler felt birth order (also called place in the family constellation) was important. First-born children are conservative leaders. Second-born kids tend to be more competitive and rebellious. Sibling interaction can have a greater impact than parent-child interaction. Since Adler felt behavior is highly influenced by future goals rather than one's past, this is a teleological theory. Behaviorism, Behavior Modification, and Behavior Therapy Key reminder: Newer exams often refer to behavior modification as applied behavior analysis (ABA). ABA looks at observable behavior, rather than hypothetical constructs. The key concept is that behavior is learned and not pathological. John B. Watson coined the word behaviorism while Arnold Lazarus created the term behavior therapy. Counselors who use these approaches assume that behavior is based on learning rather than insight into the unconscious mind. The criticisms of behavior therapy are that it does not yield insight, it treats symptoms not the root cause, and it can be manipulative and often changes behavior but not underlying feelings. B. F. Skinner's radical behaviorism purports that behavior is molded solely by its consequences. This paradigm is known as operant or instrumental conditioning. A positive reinforcer is a stimulus that raises the probability that a behavior will be repeated. The reinforcer must come after the behavior (or operant). Negative reinforcers also raise behavior. For example, a recruit in the military makes a bunk bed to avoid being yelled at by a drill instructor. All reinforcers, whether positive or negative, raise behavior. All reinforcers are said to follow or come after a behavior (e.g., a youngster gets a prize after she completes a math problem). Albert Bandura speaks of social learning theory. Here the person's own behavior increases when he or she sees somebody else getting reinforced for it; also referred to as vicarious learning or modeling. Punishment is intended to lower behavior by suppressing it. Behaviorists champion role-playing (e.g., assertive behavior). Extinction (such as time-out) will lower behavior after an initial extinction burst or response burst. Ratio schedules of reinforcement rely on work output whereas interval schedules rely on time. Ratio schedules are more effective than interval schedules. Continuous reinforcement occurs when each behavior is reinforced. Good when first learning a new behavior. Intermittent reinforcement or variable reinforcement occurs some of the time, but not all of the times the desired behaviors are reinforced (e.g., a child gets a treat for every third math problem he completes). Variable reinforcement is more effective than a fixed schedule where you always reinforce in the same manner (e.g., after every instance of the behavior). Shaping with successive approximations is reinforcing small chunks of behavior that lead to the desired behavior. Differential reinforcement of other behaviors (DRO)/differential reinforcement of alternative behavior (DRA) takes place when the helper reinforces behaviors other than the dysfunctional behavior to reduce the dysfunctional target behavior (e.g., you want a child to quit talking in class so you give him a gold star only when he is doing his work and not talking). Procedure relies on reinforcement and extinction. In Skinnerian operant conditioning, the behavior is affected by the consequences that come after the •behavior. Ivan Pavlov popularized what is now known as classical conditioning. John B. Watson's work was also significant. Behavior modification/applied behavior analysis is generally based on Skinner, while behavior therapy usually has its roots in Pavlov. Interventions based on classical conditioning include: sensate focus, systematic desensitization, flooding (aka in vivo exposure with response prevention or deliberate exposure with response prevention), implosive therapy, and assertiveness training. Classical or respondent conditioning = learning by pairing things together. Operant conditioning based on the work of Skinner and Thorndike = learning by consequences occurring after a behavior. Joseph Wolpe's systematic desensitization can be conducted individually or in a group to curb fears and abate anxiety. Wolpe believed his technique of counterconditioning was based on Pavlov and relied on relaxation and imagining feared stimuli. That said, newer research using dismantling (which deconstructs a procedure) revealed that relaxation is not necessary and therefore it is extinction and not counterconditioning that is making the difference. Along those same lines, it has also been discovered that Dr. Francine Shapiro's eye movement desensitization and reprocessing therapy (EMDR) can be effective for ameliorating conditions caused by trauma or disturbing events without the eye movement, once again indicating that extinction is likely the curative factor. Behaviorists may also use implosive therapy where the client imagines scary or feared stimuli in the safety of the counselor's office. Biofeedback devices are used to enhance the client's self-control of the autonomic nervous system. Examples include heart rate, brain waves, or warming cold hands with thermal training for migraine headaches or Raynaud's Phenomenon. This is a form of operant conditioning. Biofeedback is popular in neurocounseling in which the practitioner attempts to understand the brain's role as it relates to counseling. Criticisms of behavior therapy: Does not yield insight; mechanistic; treats symptoms and not the cause; can be manipulative; generally ignores developmental stages; often changes behavior but not underlying feelings. This approach deals with behaviors rather than the whole person. Hint: A great way to determine whether a question is referring to reflexive classical conditioning or Skinner's operant conditioning is to ask yourself a simple question: Is there a reflex with every member of the species who is not disabled? If the answer is yes, then it is most likely Pavlovian conditioning (e.g., all dogs salivate (an unconditioned/unlearned response or UR) when they see meat (an unconditioned stimulus or US)—so it's Pavlovian). Carl R. Rogers's Person-Centered Humanistic Therapy This approach has also been called client-centered, Rogerian, nondirective, or self-theory. The basic notion (a very positive one) is that human beings can self-actualize and reach their full natural potential in a therapeutic setting that fosters growth; classified as an optimistic form of therapy. • Three conditions for effective helping: The therapist must show empathy; be genuine/congruent; and 481 display unconditional positive regard (UPR). Empathy is not sympathy! It is the ability to subjectively understand the client's world in the here and now—to walk in his or her shoes—and convey this to the client. Robert Carkhuff created a five-point empathy scale with a level-five response as the best response. The counselor must be genuine/congruent. The counselor cannot be a phony. Words must match (i.e., be congruent) with actions. The counselor accepts the client regardless of his or her behavior. This does not imply that you necessarily agree with the client. This is called unconditional positive regard. The counselor will often use reflection or open-ended questions. Counselor strives to improve congruence so that the person is more like his or her ideal self. Rogerians are not big fans of traditional diagnosis and testing. Moreover, they do not believe in the unconscious. Humans can control their own behavior. Critics are concerned that this approach is too optimistic and may not be the treatment of choice for severely disturbed individuals or very young children. Natalie Rogers, daughter of Carl Rogers, created person-centered expressive arts therapy (PCEA). This method strives to generate a creative connection with inner feelings via such things as movement, sound, art, writing, and journaling, which are shared with the helper. Albert Ellis's Active-Directive Rational Emotive Behavior Therapy (REBT) Previously known as RET, this is a cognitive-behavioral (CBT) form of therapy. Change your thinking (cognitions) and you can change your life. Essence of the treatment captured in the saying of Epictetus, a first-century Stoic philosopher, "Men are disturbed not by things, but of the view which they take of them." Irrational beliefs (IBs) are replaced by rational beliefs (RBs) via the counseling process. Uses the ABC or ABCDE model of personality. A is an activating event. B is the client's belief system. C is the emotional consequence. At D the counselor disputes the irrational belief at B. E is a new emotional consequence that occurs when B becomes rational. Humans have an innate tendency to think in an irrational, illogical, unscientific manner. Thought is referred to as self-talk or internal verbalizations. Shoulds, oughts, musts, terriblizing, and awfulizing causes irrational thought. This is an active directive form of therapy utilizing lots of homework, bibliotherapy and even rational imagery (RI). Critics charge that the approach does not emphasize feelings, the counselor client relationship, and that REBT is mechanistic or even sterile. It may be too complex for those with psychosis or thought disorders. Aaron T. Beck's Cognitive Therapy Beck's cognitive therapy is similar to REBT, emphasizing that the client has automatic thoughts which are distortions of reality such as polarized black or white thinking, overgeneralizing based on a single event, personalization—wrongly attributing an event to yourself and drawing conclusions without real evidence. Not as confrontational as Ellis. Socratic questioning is sometimes employed. Clients are urged to keep a record of dysfunctional thoughts.Fritz Perls's Gestalt Therapy This experiential/existential approach focuses on the here and now in an attempt to help the client become whole again. Gestalt is an experiential form of therapy and it relies on dream work, role-playing, confrontation, the top dog/underdog concept, hot seat, and the empty chair technique. Modern gestalt therapists are not as abrupt with clients as Perls. The therapy is now considered a softer gentler treatment. Gestalt is a German word that basically means "organized whole." The view of human nature is that humans want to be self-actualized and complete (whole). Dreams are the royal road to integration. Counselor asks client to recount the dream as if it is occurring in the present moment. What and how questions are used more than why questions (e.g. "What is your foot doing now?"). Goal is for the client to take responsibility and achieve awareness in the here and now. Doing is emphasized over just talking about problems. Laura Perls (Fritz Perls's wife) helped develop the approach and made it more popular with women in therapy. Critics charge that this approach is "gimmicky," puts little or no stock in diagnosis and psychological testing, and at times is "antitheoretical." On occasion, the approach can lead to self-centeredness. Eric Berne's Transactional Analysis (TA) A here-and-now approach that took Freudian terminology and made it fun and easy to understand. The theory took into account transactions between individuals. It is often combined with gestalt. Critics charge this is like mixing water and oil since TA is cognitive and gestalt is experiential. Others say this is desirable since the two complement each other. The person unconsciously develops a life plan at an early age called a life script. Script analysis assumes the person is at least partially living the preprogrammed script. The script concept is also used in narrative therapy. Ego states are the Parent, Adult, and Child (PAC). These states roughly correspond to Freud's superego, ego, and id. Uses Tom Harris's life positions. I'm OK, you're OK (healthy); I'm OK, you're not OK; I'm not OK, you're OK; and I'm not OK, you're not OK. Games are played to avoid intimacy. Somebody is always hurt in a game. Stephen B. Karpman's drama triangle (aka Karpman's triangle). A person changes his or her position from victim to persecutor to rescuer during the discussion. Critics note that TA promotes game calling. William Glasser's New Reality Therapy with Choice TheoryThis therapy focuses on present behavior. Clients are taught that they create their own personal reality with the behaviors they choose. Glasser believes that "Behavior is the control of our perceptions" and that a success identity is the result of being loved and accepted. Glasser has been criticized for downplaying the role of the environment in terms of impacting ethnic minorities. Reality therapy has also been deemed "weak" in terms of not dealing with dreams, the past, or traumatic memories. According to Glasser, psychiatric medicines or "brain drugs" are not the answer. This paradigm challenges the medical model of psychiatry. The eight steps of reality therapy: build a relationship with the client; focus on present moment behavior; help the client to evaluate his or her current behavior; develop a contract with an action plan; have the client commit to the plan; accept no excuses; do not use punishment; and refuse to give up on your client. The approach emphasizes short-term treatment and is very concrete. Psychological needs include belonging, power, freedom, and fun. When Glasser contributed to my book Favorite Counseling and Therapy Techniques he said, "We are responsible for what we do, and we choose all we do." Robert Wubbolding expanded the theory of reality therapy with his introduction of WDEP. W for wants (belonging, freedom, fun, belonging, power, and independence), D for direction and doing (is the client doing something to take him or her in the best direction?) E for evaluation or self-evaluation (how is the behavior working for the client?), and finally, P for plan. Plan should be immediate, attainable, and measurable. Critics charge that reality therapy is a bit too simplistic, does not take into account developmental stages, and has changed its focus over the years. Lynn P. Rehm's Self-Control Therapy This is a self-control behavioristic paradigm of therapy which relies on self-monitoring, evaluation, and self- reinforcement. Hypnosis Helpful for pain, insomnia, anxiety, and habit control such as overeating and smoking. Can also be used to elicit repressed memories, however, the memories are often dubbed as "pseudomemories," meaning they are not accurate. Hypnosis is a controversial modality. Feminist/Non-Sexist Therapy No single theorist is the founder. Has its origins in the women's movement of the 1960s. Some similarities to multicultural counseling. A strong focus on women's rights, sex-role stereotyping, and the oppression of women. Approach postulates that most therapies have an androcentric bias (centered on men) and are not ideal and sometimes harmful to women. Postmodern Social Constructivist Theories Social constructionism emphasizes that realities are socially constructed. Brief therapy and narrative therapy are constructivist approaches. Narrative Therapy (NT) by Michael White (Australia) and David Epston (Auckland, New Zealand) Narrative therapy postulates that individuals construct their lives by stories they tell about themselves and stories others create about them. Stories create meaning and this becomes the client's identity. Therapy consists of the client describing his or her life experiences and then rewriting or reauthoring the narrative in a new way. A narrative therapist externalizes the problem in his or her progress notes and sends it to the client as a letter between sessions. Rather than saying "You are a cocaine addict," a narrative therapist will tell the client, "Cocaine has been trying to wreck your life." Again, clients reauthor their lives with new stories and fresh language. The narrative therapist sees him- or herself as a consultant or collaborator with the client. Some cultures want an expert therapist, and thus (at times) this can create a problem for multicultural counseling. Often recommended—with or without CBT—for working with refugees (those forced to leave their home country to escape a natural disaster, war, or persecution) and immigrants (persons who make a voluntary decision to leave their native country and want to reside permanently in another country) who want to tell their stories. Journaling works well with this population and more disclosure is generally possible in individual rather than group sessions. Bilingual counselors should allow the clients to choose the language spoken in the interview and language switching is often appropriate. Solution-focused brief therapy (SFBT) Steve de Shazer and Insoo Kim BergSFBT focuses on solutions and not on an understanding of the problem. The focus is on exceptions to the rule —what is working. Using so-called exception questions: a client who is depressed is asked: "When aren't you depressed?" Goals are small and realistic. The client is also asked the miracle question: "If a miracle took place while you were sleeping, how would you know the problem was solved? How would things be different?" SBFT also uses formula first session task (FFST). This is a homework assignment prescribed after the first session. Recently, this approach has gained popularity in group treatment settings. Brief therapy (BT) is becoming the norm in many instances since managed care firms (hell-bent on cutting costs!) often restrict the number of sessions the client can attend. Most counselors dislike managed care, feeling that the managed care company is micromanaging their practice. In some states managed care firms cannot be sued for their actions. Insurance and managed care policies are responsible for the fact that many counselors spend as much time dealing with business issues as they do actually counseling their clients. On the positive side, managed care forces counselors to look at outcome measures. Psychotherapy Integration by Frederick Thorne 485 Psychotherapy integration uses strategies from a number of counseling schools. Instead of merely using techniques from the approaches in eclecticism, the integrative approach assumes that using or integrating two or more theories will often produce results that are superior to a single school of therapy. Today support is mounting for this approach. Family Counseling Family counseling asserts that the pathology resides in the family system and not in an individual. The client is the family and not the identified patient. Family therapists believe in circular rather than linear causality. First-order change occurs when a client makes a superficial change to deal with a problem, but the change does not alter the underlying structure of the family. Second-order change alters the underlying structure and thus makes a difference that is longer lasting. Negative feedback loops are not necessarily bad, but keep the family in homeostasis and functioning the way the family always has. Positive feedback loops induce change in the family system. Case Integration Case integration takes place when several helpers from the same agency or different agencies work together without duplicating services to help an individual client. Milieu Therapy Milieu therapy urges helpers to change the client's entire environment (social and physical) to help the client. Hence, treatment is not limited to counseling sessions. In most instances, this takes place in inpatient treatment facilities. Famous Family Therapists Nathan Ackerman used the psychoanalytic or psychodynamic approach.Experimental conjoint family therapist Virginia Satir popularized the notion that in times of stress, family members use four inept patterns of communication. The placator (who tries to please everybody in the family); the blamer; the reasonable analyzer (who intellectualizes); and the irrelevant distracter (who interrupts and changes the topic to something irrelevant). Experimentalist Carl Whitaker could be very wild, radical, and creative, and often utilized a co-therapist. Murray Bowen is a key name in intergenerational therapy. His approach is often referred to as extended family systems therapy. Triangulation (also referred to as triangles) occurs when two people who are stressed, bring in a third party to reduce the dyad's stress level and restore equilibrium. Genograms are actually graphic diagrams of the family from a minimum of three generations. Fusion is a blurring of the psychological boundaries between the self and others. A person driven by fusion can't separate thinking and feeling well. Differentiation (the opposite of fusion) is the ability to control reason over emotion. People often 486 secure their level of differentiation from a multigenerational transmission process. Salvador Minuchin is the leading name behind structural family therapy. The technique of joining or blending in with the family is used. The therapist uses a popular strategy of joining, known as mimesis, to imitate or copy the family's communication and patterns. The therapy proposes that changes in the family system, subsystems, and family organization must take place in order for individual family members to resolve their systems. Structural therapy is directive and performed in the here and now. Jay Haley and Cloe Madanes are powerful names in strategic family counseling (also called the MRI model and the communications model). In this paradigm, the therapist gives directives or prescriptions, often paradoxical (e.g., telling a client who is afraid he will shake, to shake as much as he can; actually prescribing the symptom). Reframing and relabeling problems is common in this modality. This approach warns us that double-bind communication (e.g., a parent telling a child she loves her while beating her severely) could cause serious psychopathology, even schizophrenia. Other brief strategic therapists that champion paradox or prescribing the symptom in individual or family therapy include: Milton H. Erickson, Steven de Shazer, Bill O'Hanlon, Paul Watzlawick, Don Jackson, and Michelle Weiner Davis. Solution-focused brief therapists (SBFT) speak of first-order change, which is superficial, and second- order change, which includes actual changes in the rules and structure of the organization. SFBT or BT, brief therapy, is not the same as crisis intervention. Crisis intervention is used for persons who are experiencing an expected normal reaction to stress. Therapy on the other hand is aimed at reducing abnormal and pathological behaviors and symptoms. The Milan Model uses a treatment team with a one-way mirror. Consultation occurs when you voluntarily assist a counselor or counselors (known as consultees) who will be helping clients. Contact with the helpees is indirect. Gerald Caplan is known as the father of mental health consultation. Edgar Schein's purchase of expertise model (where you buy the person's information and knowledge); his doctor-patient model (here you aren't sure what the problem is, so you hire an expert to diagnose and treat it); and his process consultation model (where the consultant helps the consultee with the process). Process models focus on the process while content models focus on the imparting knowledge to the consultee. Brain Chemicals and Neurotransmitters Related to Neuroscience Serotonin mood. Most prescription medicines given to clients for mental health issues impact serotonin (e.g., SSRI (selective serotonin reuptake inhibitor) drugs or the old tricyclic antidepressants). Dopamine excess is thought to fuel schizophrenia, while very low levels are implicated in Parkinson's disease. Some experts believe addictive behaviors such as gambling can flood the brain with dopamine. Lithium is a trace mineral or rare earth. It helps stabilize mood, especially in clients with bipolar 487 conditions. An excess caused by prescription dosages can cause liver damage or tremors. The left hemisphere of the brain is logical, verbal, and analytic, but the right hemisphere of the brain is emotional, creative, and artistic. This notion is still controversial. The microbiome or balance of good bacteria (such as probiotics) and bad bacteria in the gastrointestinal tract can affect our mood, digestion, and general health. This is sometimes called the gut-brain connection. Popular Psychiatric MedicinesAnxiety: Benzodiazepines—Xanax, Librim, Klonopin Ativan, and Valium. Depression: Selective serotonin reuptake inhibitors (SSRIs)—Prozac, Zoloft, Luvox, Celexa, Paxil, and Lexapro. Selective and norepinephrine reuptake inhibitors (SNRIs)—Cymbalta, Pristiq, and Effexor. Tricyclics (TCAs)—Elavil, Tofranil, and Pamelor. ADHD: Ritalin and Concerta (both classified as methylphenidate), Adderall, and Vyvanse (also used for binge eating). Note: the CDC now recommends behavior therapy for ADHD before using medication for children aged 6 years or under. Bipolar: Risperdal, Zyprexa, Lithobid, Depakote, Tegretol, and Lithium.OCD: Prozac, Paxil, Luvox, Zoloft, Anafranil, and Effexor.Panic disorder: Ativan and Paxil.Antipsychotic/schizophrenia: Abilify, Geodon, Risperdal, Clorzaril, and Zyprexa.

NONPROFIT COUNSELING ORGANIZATIONS

Nonprofits must adhere to the IRS 501(c)(3) guidelines and will be exempt from paying federal income taxes. The organization will have a board of directors and this board will be legally responsible for the agency's actions. In most states you must have at least three founding board members. The board sets policies, generally is not paid, and the staff will implement the policies.

MULTICULTURAL COUNSELING

Please keep in mind that the descriptions below are broad generalizations, since no group is truly homogenous, and attributing the below statements to every or all members of that particular group can be damaging to developing a meaningful, helpful client-counselor relationship. The trend is clearly moving away from saying this group is this way or that group is that way. I've only included these brief descriptions here and a few other places in this book inasmuch as an occasional question of this ilk may still appear on a comprehensive exam since similar ones do appear in some of the major texts. Native Americans (or American Indians) and Alaska Natives may keep their suffering private, speak with few words and hesitate often. Young males have a high suicide rate. They do not engage in eye contact while talking or listening, do not live by the clock, and tend to emphasize spirituality. Consider counseling them in their own homes. Storytelling combined with advice giving is often effective. Family therapy, and extended family therapy, are often the treatment of choice. African Americans may like to be taught concrete skills and strategies for change. Systems-based family therapy that includes the nuclear and extended family, short-term counseling, and behavioral modalities are effective. Counselor self-disclosure, topics related to spirituality and group work may be beneficial. Multicultural experts assert that African Americans often drop out of treatment too soon and thus it is important to create trust during the initial sessions. Some experts worry that "schizophrenia has become a black disease" because of misdiagnosis/overdiagnosis. Asian Americans have been called the most diverse group and characterized as patriarchal. Academic and professional success is valued. They may speak very low and desire assertiveness training (because Asian Americans often do not express angry thoughts and feelings) or other behavioral strategies. Family therapy is often used to take the focus off the individual and more on the family as a whole, but do whatever is possible to ensure the client will not feel shame. Ideally, the counselor is seen as a trained authority figure and this population is known to have a high dropout rate so the counselor's authority and expertise should be evident during the initial session. Do not joke with the client. Degrees and certificates in the office and the use of professional titles (e.g., "I'm Dr. Lewis, the Program Director") may be desirable. Stress is often brought on via the idea of the model minority, which suggests that Asian Americans are extremely successful and intellectual. An Asian American therapist will help with client retention in some instances. Latino/Latina Americans often benefit from catharsis and abreaction (getting feelings out). Psychodrama techniques, active-directive family therapy with specific suggestions, and calling clients by their first names may well facilitate therapy. Separation from one's family of origin is not generally a goal of therapy. Currently the number of Latino/Latina counselors is low, as is the number of Latinos/Latinas who use the mental health system. Latino/Latina counselors, as well as counselors from other cultures, can feel uncomfortable counseling whites if they don't associate with them on a day-to-day basis or if they are not familiar with the dominant U.S. culture. Psychological symptoms often manifest themselves as physical issues. A Latino/Latina therapist will improve client retention in some instances. Gay and lesbian couples raise children who are as happy and possess good cognitive and social skills. In every area, including mental health, these children fare as well as children raised by heterosexual couples. Sexual orientation, identity, and terminology related to sexual questions on your exam. LGBTQ is the acronym for Lesbian, Gay, Bisexual, Transgender, and Questioning (unsure regarding source of attraction/identity). Transgender: Individuals whose gender expression or identity does not match gender assigned at birth. Transgender persons can be gay, asexual, bisexual, lesbian, or heterosexual. Pansexual: Attracted to persons regardless of gender. Cisgender/Cissexual: Gender assignment, body, and identity all match. Homophobia/Biphobia/Transphobia: Exaggerated, irrational fear of, or discrimination against, homosexual, bisexual, and transgender persons and behavior. Internalized Homophobia/Biphobia/Transphobia: Self-hatred and/or shame over homosexual, bisexual, or transgender identity and/or attraction. Transgender, MTF: Gender assigned at birth was male, but person identifies as a female. Transgender, FTM: Person was assigned a female gender at birth, but currently identifies as male. Crossdresser: Wearing or dressing up in clothes worn by a different gender. The word machismo may be used to describe the view that women are subservient to men and that men are expected to provide for the family. Colorism is discrimination predicated on skin tone or skin color. Colorism is often perpetrated by persons of the same racial or ethnic group, for example, African American on African American. Five Famous Experiments in Social Psychology Phillip Zimbardo (1971 Stanford Prison Experiment): A situation can control behavior as well as assigned roles, such as telling subjects to be a guard or a prisoner. Would not be ethical today. Muzafer Sherif (Robbers' Cave Experiment): Two opposing groups of boys ended up working together because they were both attempting to solve the same problem (called a superordinate goal). Solomon Asch/Asch Situation (1950s studies regarding conformity based on the length of a line): In a social or group situation people would sell out and agree with the opinions of others about the length of the line even when they knew the individuals were clearly wrong! John Darley and Bibb Latané (Bystander Effect/Apathy): The greater the number of people in a group, the less likely they are to assist a person in need (and will be slower if they do intervene)! The 1964 case of Kitty Genovese is seen as the quintessential example. Also billed as "group inhibition for helping." Stanley Milgram (1963 Obedience to authority experiment): Sixty-five percent of subjects gave painful electrical shocks to innocent victims when instructed to do so by an authority figure! None stopped even when a participant said she or he had heart trouble! Some experts insist this could explain the Holocaust.

RESEARCH

Studies clearly indicate that only a small percentage of counselors actually conduct research or use research findings in their practice. Many counselors feel that research is virtually cold, impersonal, and irrelevant to their day-to-day practice and thus say that helping, rather than research, is their top priority. A gap between research and practice is evident. A high percentage of beginning master's level students actually resent having to take research and statistics courses. It is true that a lot of studies are not helpful to counselors. What's more, it has been discovered that research articles are perused primarily by other researchers and not practitioners. Research that is considered helpful is often dubbed experience-near research or applied research. When counselors do integrate research into practice it is called Empirically Validated Treatment (EVT) or Empirically Supported Treatment (EST). Correlation is not the same as causality. Correlation is simply an association. The correlation between people who have an umbrella open and rain is very high, but opening your umbrella does not cause it to rain. Correlations go from negative 1 to 0 to positive 1. Zero means no correlation while positive 1 and negative 1 are perfect correlations. A positive correlation of .5 is not higher than a correlation of -.5. In fact, a correlation of -.8 is stronger than a correlation of .5. In a positive correlation, when X goes up, Y goes up. For example, when you study more, your GPA goes up. In a negative correlation, when X goes up, Y goes down. For example, the more you brush your teeth, the less you will be plagued by cavities. Research is quantitative when one quantifies or measure things. Quantitative research yields numbers. When research does not use numerical data, we call it qualitative research. All research has flaws, sometimes referred to as bubbles. True experiment. Two or more groups are used. True experiments must have the study participants selected randomly. This is known as random selection. In addition, the participants must be randomly assigned to the control and the experimental groups. This is known as random assignment. Systematic sampling where every nth person is chosen can also be used, however, researchers still prefer random sampling and random assignment. When the researcher cannot control the independent variable (IV), then it is a quasi rather than a true experiment. Quasi-experimental research also referred to as a natural experiment does not ensure causality. When pitted against a true experiment, the quasi gains external validity, is often not as artificial, but shows a loss in internal validity. The experimental groups get the independent variable (IV) also known as the experimental variable. There are levels of the IV such as no counseling (the control group) and counseling (provided to the experimental group). The control group does not receive the experimental IV. The outcome data in the study are called the DV or dependent variable. If we want to see if eating carrots raises one's IQ then eating carrots is the IV while the IQ scores at the end of the study would be the DV. Each experiment has a null hypothesis: there is no significant difference in people's IQs who eat carrots and those who don't eat carrots. The experimental or alternative hypothesis is: there is a significant difference between people's IQ's who do eat carrots versus those who do not. When a researcher rejects a null hypothesis that is true, it is a Type I alpha error. When a researcher accepts null hypothesis when it should have been rejected, we say that a Type II beta error has occurred. The significance level for the social sciences is usually set at .05 or less (.01 or .001). The significance level gives you the probability of a Type I error. Smaller is better! N = 1 is known as a single-subject design or case study and thus does not rely on IV, DV, control group, etc. Case studies are becoming more popular. Demand characteristics are evident when subjects in a study have cues regarding what the researcher desires or does not desire that influence their behavior. This can confound an experiment rendering the research inaccurate. If subjects know they are being observed we refer to the process as an obtrusive or a reactive measure. Observers' presence can influence subject's behavior rather than merely the experimental variable or treatment modality. When subjects are not aware that they are being measured we say that it is an unobtrusive measure. Internal validity is high when an experiment has few flaws and thus the findings are accurate. In other words, the IV caused the changes in the DV, not some other factor (known as confounding extraneous variables or artifacts). When internal validity is low, the researcher didn't measure what he thought he measured. External validity is high when the results in a study can be generalized to other settings. A t test is a popular parametric test for comparing two means. The ANOVA or analysis of variance originally developed by Ronald Fisher (also called a one-way ANOVA) is used when you have two or more means to compare. The t test and the ANOVA are parametric measures for normally distributed populations. The ANOVA provides F values and the F test will tell you if significant differences are present. Use the MANOVA or multivariate analysis of variance when you are investigating more than one DV. Use a factorial analysis of variance when you are investigating more than one IV/experimental variable (i.e., if you have two IVs it would be called a two-way ANOVA; three IVs, a three-way ANOVA, etc.). If the population is not necessarily normal then a nonparametric test such as a chi-square (the most common nonparametric test) or Kruskal-Wallis (similar to the ANOVA) can be used. If the researcher did not manipulate the variable and you are looking at after the fact data, then the research is not a true experiment but rather an ex post facto or so-called causal-comparative design. Descriptive statistics are statistics that describe central tendency like the mean, median, the mode, the range, quartiles, the variance, and the standard deviation. Quartiles are three data points dividing the distribution into four equal parts. Q1 = 25th percentile or lowest 25% of scores. Q2 = 26th-50th percentile. Remember the 50th percentile is the median. Q3 = 75th percentile and higher (i.e., 75% of scores below this value). Interquartile or IQR is 25th-75th percentile or Q3-Q1 = IQR or where approximately the middle 50% of the scores fall. If you divide the IQR by two it gives you the so-called semi-quartile statistic. Statistical analyses include correlation coefficients, t tests, ANOVAs, analysis of covariance, chi-square, Kruskal-Wallis etc. Cohort studies examine a group of people who have something in common (e.g., all soldiers who fought in Vietnam or all counselors who received their license in 2007). Longitudinal research takes place when the same individuals are evaluated over a period of time. It is usually contrasted with cross-sectional research that relies on observation or data from a given point in time. Formative evaluation takes place during treatment or while a program is going on while summative or outcome evaluation occurs at the end of a program or treatment (e.g., after the final session of counseling). Between-groups design uses different subjects in the different groups (e.g., one group of subjects for the control group and another group of subjects for the experimental group). In the within groups design (also known as the repeated measures or within-subject design) the same subjects for the control condition and then at a different time for the IV/experimental condition(s). Or to put it a different way, the subject is his or her own control. Institutional Research Board or IRB approval is required prior to conducting human research. The IRB committee will determine whether your research meets ethical, legal, and institutional guidelines so no subjects are harmed. You might need to go through more than one IRB. For example, a dissertation using community college students as subjects would need the approval of your graduate institution's IRB as well as the IRB of the community college.

ASSESSMENT AND TESTING

Tests are nearly as old as the profession of counseling, but agreement over whether tests are useful has varied a great deal. According to expert Anne Anastasi, a test is an objective standardized measure of behavior. Ideally, tests measure and provide valid and reliable data regarding your clients so you can pick the effective modalities of treatment, referral, or placement. Critics note that tests can be faked, are mechanical, often measure irrelevant factors, and can invade privacy. Testing can also create prejudice in the sense that the counselor perceives the client in a different manner. Standardized tests have uniform procedures for scoring and administration. In addition, these instruments have validity, reliability, and norm data which has been investigated and analyzed. The Mental Measurements Yearbook (MMY) and Tests in Print (TIP) from the Buros Institute provide counselors with information on thousands of tests. Online versions are now available. Approximately 2,500 of the tests have been critically analyzed by Buros. A score is "raw" if it is unaltered. Raw scores can be converted to standard scores (e.g., t-scores, z-scores, percentile rank, standard deviation, or stanine) so that the scores relate to the normal bell curve. The range is the highest score minus the lowest score (some exams will add 1 to the answer). Percentile rank tells the counselor the percent of scores equal to or below the score you are investigating. Hence, a client who is at the 75th percentile scored equal to or better than 75% of the people who took the exam. It does not necessarily imply that he or she got 75% of the answers correct since a score of 20% correct might be higher than 75% of the examinees! Three measures of central tendency: the mean or arithmetic average (e.g., if your gas bill for a year is $144, then your mean bill per month is $12 or 144 divided by 12); the mode is the most frequently occurring score or category: and the median or middle score when the data are ranked from highest to lowest. In a normal curve they all have the same point in the center of the bell shape. When a curve leans, we say it is skewed. If the tail points to the left, the curve is negatively skewed; if it points to the right, it is positively skewed. Standard deviation (SD) is a measure of variability or dispersion of scores. Are the scores bunched up close to the mean or are the scores spread out? A standard deviation of 1 is a z-score or standard score of one. A standard deviation of -2 is a z-score of negative 2, and so on. T-scores have a mean of 50 and the standard deviation is 10. If your test asks: What is a t-score when the standard deviation is 2; the answer is 70. If it asks: What is the t-score for a standard deviation of -3; the answer is 20. Areas under the normal curve you should commit to memory. Sixty-eight percent of the scores will fall between +/-1 SD from the mean; 95% of all scores will fall between +/-2 SD; and 99.7% of all scores fall between +/-3 SD. It is safe to say that virtually all scores fall between +/-3 SD of the mean. This is known as the empirical 68-95-99.7 normal curve rule. Validity is the most important property of a psychological test. Does the test, test what it purports to test? The validity of standardized tests in our field is said to be on a par with instruments used in the medical field. 495 Reliability: Is the test consistent? Will it give the similar results if we administer it again and again. If an IQ test yields a score of 100 today and 130 for the same client tomorrow it is not valid! A reliable test is not always valid, but a valid test is always reliable. Inter-rater reliability describes the consistency of two or more raters. If two counselors read the same test reports and come up with the same diagnosis, then inter-rater reliability or agreement is high. If they come up with different diagnoses then it is low. A test or instrument that is only normed on the majority culture is not appropriate for cultural minorities since it is misleading and could cause discrimination. Tests can give a false positive or a false negative. Aptitude tests predict potential. For example, a high score on an aptitude test for music doesn't imply that you are a great musician but with the correct training and practice you could excel in this area. Achievement tests give you the current accomplishments, what has been learned or the level of performance achieved up to this point in time (e.g., she is reading at the sixth-grade level). Intelligence tests or IQ tests such as the Wechsler or the Binet attempt to measure mental abilities. IQ tests are very controversial and have been a source of debate for counselors. Individual IQ tests are generally more accurate than group-administered measures. Power tests. Time (slow performance) is not a factor like it is in so-called speed tests. Projective tests. There is no correct answer. The client merely looks at an inkblot, a vague picture, or an incomplete sentence. The client's answer is assumed to be a projection of his or her personality. Thus two clients look at the same Rorschach Inkblot Card or TAT picture and see something totally different. • Scoring projective tests is subjective. Thus one rater could score it differently than another rater. Again, this phenomenon is called inter-rater reliability. Regression to the mean states that if a client scores exceptionally low or exceptionally high on a test, then the client with the low score will go up on the next administration; while the client with the high score will go down toward the mean or average. Chance factors or everyday luck probably influenced the first score. Diagnosis generally implies that a label is placed on the client using a classification system, generally the DSM as an assessment tool. Insurance companies virtually always require a diagnosis with an ICD diagnosis before they will pay for treatment. Moreover, most other professionals (e.g., psychologists and psychiatrists) use diagnostic terminology and thus counselors need to use the same classification system and terminology. Assessment also helps determine admissions/selection/placement to schools (think your GRE score or perhaps an IQ score used to determine whether a child should be in a gifted class) and treatment organizations. Finally, assessment can help you determine if your client is truly making progress or not. Computer-based tests generally reduce costs, can provide immediate scoring, and cut the risk of scoring errors, when compared to traditional paper and pencil tests. However, because the Web is expanding so rapidly many measures on the Web have low validity and reliabilty. High-stakes assessment occurs when a test (say the NCE if you wish to practice counseling or the CPCE if you wish to graduate!) is used to make important decisions about the future. Licensing exams fall into this category. Thus, without passing a driver's license test you cannot drive a motor vehicle.

PROFESSIONAL ORIENTATION AND ETHICS

The term scope of practice implies that you only practice if you are adequately trained in a given area or with a given population. Hence, if you have no training running a gestalt group, then don't run one. If you know nothing about clients with eating disorders, don't treat them. A counselor's duty to warn. Initially based on a California supreme court case, Tarasoff, this principle now states that if a client is going to harm him- or herself, somebody else, or both, you will break confidentiality and contact the appropriate people (e.g., the police, the target person) to ward off this tragedy. Some states currently stipulate a counselor (even in a school) must report it to the parents if a child threatens suicide. Dual relationship/boundary issues (could also be called multiple or nonprofessional relationships, on your exam). This concept implies that you are a person's helper but you also have another significant relationship with that person (maybe you are dating them or perhaps they are a relative or business partner). Such relationships, whether in-person or virtual/eletronic, get in the way of objectivity and should be avoided whenever possible unless the relationship is beneficial to the client. Privileged communication is set by state law. Privileged communication asserts that you cannot reveal what a client said in a session in court unless the client allows you to do so. There are exceptions to this such as child abuse, suicide, homicide, and supervisory sessions or if a lawsuit is filed against you. You should never release information about the client outside of court (unless it is the exceptions just mentioned) unless the client signs a release of information consent form. Remember to disguise the identity of your clients when doing research, training, or in a work for publication. • Always check the NBCC and ACA websites for the latest information on Internet Counseling and Ethics before you take your comprehensive exam. These ethics and those related to social media are changing extremely rapidly.