Tag Archives: Counselor Educators Audience

Counselor Educators Audience

Simple therapeutic interventions for rewiring the maladaptive brain

By Nicholette Leanza October 1, 2012

When taking my undergraduate and graduate classes many moons ago, my least favorite courses were Biopsychology and Cognitive Processes, during which our professors would lecture at great length about the structure and function of the brain. As a student embarking on a new career in mental health, I was aware I needed to know this important information, but I just couldn’t get into it. So, I skipped along in my career, content to understand the basics of the traumabrain without really applying this knowledge in any useful manner.

But a few years ago, while researching ways to keep my counseling techniques fresh, I came across several articles that covered the most recent discoveries in neuroscience. That research ignited my current love affair with the most complex organ in the universe — the human brain — and helped me to understand how people really change their behaviors.

Let’s take a moment and ponder that question: What really causes an individual to change his or her behavior? You might answer that question in many ways depending on your theoretical perspective and on your specific observations and experiences dissecting human behavior. Regardless of how you answer, one fact is that change must first occur at the neurological level before we will see it at the behavioral level.

Understanding the biology of the human brain can also assist clinicians with understanding how and why people change. Clinicians are successful at their craft when they can produce a physical change in their clients’ brains. Obviously, they cannot get inside and rewire a brain, but they can set up conditions that favor this rewiring and create an environment that nurtures it (see The Art of Changing the Brain by James E. Zull). This article will explore how individuals change their behavior neurologically and examine some therapeutic techniques to stimulate this fascinating process.

Neural networks

The human brain is constructed of a vast amount of neural networks that form every thought or experience people have in their lives. Neuroscientists have found that these networks are interconnected as an intricate web of memories, thoughts and experiences. Hearing a special song can kick-start a flurry of recollections; a particular scent can guide an individual toward a memory of a particular person or place. This phenomenon indicates how the brain is circuited for memory.

For example, take the word teacher. Each person has a specific neural net that was created on the basis of experiences with the various teachers in his or her life. Another way to look at this is as a type of associative memory. Thoughts, ideas and feelings are constructed and interconnected in a neural net that may also have a potential relationship with another network of neurons. So, mention the word teacher, and one individual may automatically picture her lovely fifth-grade teacher, while another person might think of his difficult college math instructor.

Feelings and emotions are also entangled within neural networks. For example, the word love is stored in a vast neural net that is based on an individual’s experience with that term. Subsequently, the concept of love is also created from many other ideas. For some people, love may be connected to the memory of disappointment, pain or anger. Anger may be linked to hurt, which may be linked to a specific person, which then is connected back to love (for more on this, see What the Bleep Do We Know!? by William Arntz, Betsy Chasse and Mark Vicente). Therefore, when a person thinks of “love,” she may remember the person who broke her heart and still be angry about it. In essence, the enormous number of neural nets that each human possesses color all of his or her perceptions and interactions with other people.

Neurocounseling

Insights in the field of neuroscience reveal that many emotional and behavioral disorders previously believed to be the product of environment or experiences can be rooted in neurobiology. This is what synchronizes us to the idea of “neurocounseling,” the term I use to describe therapeutic interventions that assist people in changing their maladaptive neural connections. Other terms that also describe these types of techniques are “brain-based therapy” (John B. Arden and Lloyd Linford) and “neural pathway restructuring” (Debra Fentress).

When one thinks of his or her life experiences, what is being contemplated is really the experience of that person’s neurons. The experience cannot be predicted because it comes from the complex and random events of one’s life, and it cannot be programmed. Counselors strive for their clients to understand their maladaptive behaviors, and this is accomplished through the changing of the individual’s neural connections. Unless some change in these connections takes place, no progress or understanding will occur.

One important note is that counselors cannot remove specific neural nets that already have been established in a person’s brain. According to Zull, these nets actually leave a physical imprint on the brain. Instead, counselors must let clients use the neural nets they have already built — and which are related to clients’ own life experiences — and then use those as the foundation for motivating new neural nets to blossom. This is the only way a person learns new information and changes his or her behavior.

People must be able to relate to something before they can understand it, which is why the set neural nets are so important. If no established net exists, the individual has no reference point to understand or to change. Counselors may wish for clients to have more positive connections that cradle their self-esteem in the specific neural networks or fewer connections when it comes to their addiction to gambling, but unless some change takes place in these connections, no progress or change in behavior will occur.

Changing neural networks

The first step to facilitating change in neural nets is to identify them. One way to figure this out is simply to have clients talk about previous life experiences. The counselor’s job is merely to listen and pay attention to what clients say about themselves. Even in the first therapy session, as we build rapport and gather information about the client’s history, we can begin to identify his or her neural networks. By asking numerous questions, we generally get a feel for the individual’s overall issues such as difficulty trusting others, low self-esteem or poor anger control. As we identify the client’s established neural networks, we also can begin to work within the realm of the client’s experiences.

Identifying a client’s neural networks and inspiring a physical change in the client’s brain involves seeing counseling in a different light, which can likewise encourage new counseling techniques. Remembering how personal and individual a person’s neural nets can be allows counselors to experiment in different sensory avenues such as art therapy, music, therapeutic stories, psychodrama and other creative techniques. Each of these avenues can help facilitate the process of engagement and provide interesting ways to stimulate the senses. This type of sensory input will engage the networks to be active and open to learning new information. Neurons that are repeatedly used grow stronger. The more these neurons fire, the more they send out new branches looking for fresh and useful connections. Neural networks are also flexible, meaning new experiences can be added to old ones and old ones can be blended with the new. As new and different networks fire, the brain will form new connections and will physically begin to change.

One of the best approaches good clinicians can take is to help clients feel they are in control. One way to do this is to allow clients to draw from their own experiences. Clients often come to therapy with some positive networks already established, and once those networks are understood, clinicians can build on them. As previously mentioned, engaging clients’ senses through creative therapeutic techniques can be helpful in stimulating their interest in therapy and in generating new neural networks. Furthermore, cognitive behavior techniques such as “thought stopping” and “thought replacement” can be useful in creating the framework for new nets. When fresh neural nets bloom because of an insight gained into a situation or a behavior, the counselor can be assured that the client is on the path to healing.

Case example

I recently worked with a client who was referred with issues of anger and depression. She struggled with controlling her temper and often would have outbursts of anger toward others at her job, at home and at school. She also had a tendency to become easily frustrated. In gathering information about her background and experiences, I deduced that many of her neural networks were dedicated to anger over the physical and emotional abuse her mother had perpetrated on her as a child. As I began to understand her realm of experiences and relate them to the biology of her brain, I recognized that her brain was essentially wired for anger.

During one of our initial sessions, this client shared that her mother had also been a victim of physical and emotional abuse as a child. Because the client already had an established net for what it was like to be abused, I was able to guide her toward the insight that her mother was also most likely struggling with anger and depression stemming from her own abuse issues. The client was able to identify this insight because of her already established neural net and was able to begin to work on seeing her mother from a different perspective. She blended her old neural net — anger toward her mother — with a new neural net of being able to empathize with her mother.

Because networks grow stronger the more they are used, I knew it was important to keep the client seeing things from a new perspective. Building on the foundation of several important insights, I was able to help the client continue to change her thinking and reactions toward her mother, which in turn led to a decrease in her own anger. The biological change of her neurons directed the change in her thoughts, which ultimately changed the wiring in her brain. My role was to help her identify the neural net maintaining her anger, assist her to build a new neural net based on insight and empathy, help her to continually reinforce this healthier neural net and then help her to make the net stronger through use and application.

Conclusion

Teaming the fields of counseling and neuroscience demonstrates how these two disciplines can enhance each other. The human brain is a learning organ, and by exploring the biology of the brain, mental health professionals and neuroscientists can discover new and innovative approaches for the advancement of both fields. Mental health professionals who understand the biology of the brain will find it a valuable asset in also understanding how change occurs in human behavior. The practice of identifying established neural networks and then building on them to form positive connections will lead clients to change their maladaptive behaviors. In essence, a person’s neural nets are the building blocks that construct their thoughts, which ultimately create their reality and perceptions.

To increase the likelihood that new connections will form, it is important to work with clients’ current established neural nets, which will enable clients to gain greater insight into themselves or their situations. Therapy techniques that engage the sensory brain are often helpful in facilitating the neural creation process. Furthermore, cognitive behavior techniques can help clients use more effective and adaptive networks.

As neuroscience continues to unlock the mysteries of the human brain, it is imperative that mental health professionals pay attention to these revelations so that a more thorough understanding of the secrets to human behavior can be discovered.

 

****

Nicholette Leanza is a supervising professional clinical counselor and licensed psychotherapist with substantial experience working with children, adolescents and adults in a variety of treatment settings. She works as an adjunct instructor of psychology and sociology at the University of Phoenix, Cleveland Campus. Contact her at nleanza1@gmail.com.

Letters to the editor: ct@counseling.org

ACA keynote speakers view counseling process from different angles

Heather Rudow

The keynote speakers for the American Counseling Association 2013 Conference & Expo in Cincinnati (March 20-24) are well known in their respective fields. The circles in which they are famous and the perspectives from which they view the counseling process are quite different, however.

Actor, humanitarian and mental health advocate Ashley Judd will present the conference’s opening keynote on March 22. Allen Ivey and Mary Bradford Ivey, counselors with a strong background in neuroscience, will follow on March 23 with a keynote titled “What Counselors Need to Know About the Intersection of Neuroscience and Counseling.”

Brain-based counseling

The Iveys have been researching neuroscience and its implications for the counseling profession since the 1970s. Allen is distinguished university professor emeritus at the University of Massachusetts, Amherst and courtesy professor at the University of South Florida (USF). He is a life member and fellow of ACA and the originator of the influential microcounseling framework and developmental counseling and therapy. He has authored or co-authored more than 40 books and 200 articles, and his work has been translated into 20 languages.

Mary is a national certified counselor, a licensed mental health counselor and courtesy professor at USF. Her areas of expertise include writing, independent consulting, school guidance and applying her consultation skills to school and management environments. Mary was one of the first 13 individuals honored with ACA fellow status.

“We feel honored and excited that we will present a keynote in Cincinnati on the relevance of neuroscience to counseling,” Allen says. “The basis for our presentation is the scientific finding that counseling changes the brain and that virtually all that we are doing [as counselors] is now backed up by neuroscience research. Neurogenesis, the development of new neurons and neural connections, occurs throughout the life span, even among the most aged. This possibility for human growth never ends.”

“Counseling has always been on the right track with its emphasis on wellness and client strengths,” he says. Attendees of the Iveys’ keynote can expect to hear the phrase brain-based counseling, which, Allen says, “means that all our efforts are making distinctive differences in the client’s brain.”

The topic of neuroscience has gained much momentum in the counseling profession since the Iveys first presented on it at the 2008 ACA Conference in Honolulu. “We had a moderate response in Hawaii, but interest in neuroscience has multiplied extensively, and we feel lucky that many more counselors are now seeing its potential,” Allen says. “A lot has happened since that early presentation, and we have seen many new breakthroughs that increase our understanding of the counseling process and how we can help clients more effectively. We are eager to share some of our discoveries of the past few years. At issue is using this knowledge so that we can more effectively reach clients and help them achieve their goals.”

The Iveys will highlight empathy in their presentation as an example that counselors’ methods have been on the right track from the early stages. Says Mary, “Empathy has long been basic and central to our profession and to our personal identity as counselors. Carl Rogers has shown us the importance of empathy and seeing the client’s world as he or she experiences it. Counseling could be described as the empathic profession. Now, empathy can be identified through observation of brain activation through functional magnetic imaging. One of the more interesting studies [investigated] brain patterns of a client and a counselor in a real interview. Moments of highly rated empathic communication between the two showed in parallel brain processes.”

The Iveys emphasize that ACA members already understand the importance of working with their clients’ strengths and focusing on wellness in their practices. However, Allen adds, “knowing the power and influence of the limbic emotional system enables us to become even more aware of the need to facilitate positive emotions and effective decision-making.”

He cites strategies such as cognitive behavior therapy and stress management as “key part[s] of our practice, for we are indeed seeking to help our clients manage their thoughts, feelings and behaviors more effectively.”

Another part of the Iveys’ presentation will explain how using Therapeutic Lifestyle Changes (TLC) as a treatment option can help clients manage their thoughts and behaviors effectively.

“TLCs are all oriented toward a positive wellness approach to body, mind and human development,” Allen explains. “We have spent far too much time on repair, when a reorientation to building on existing and future strengths will move us to health and wellness.”

In their keynote, the Iveys will cover the “big six” TLCs, which include the improvement of social relationships. Allen points out that this is what much of counseling has traditionally been about. All six TLCs strengthen client cognitions and emotions, he says, leading to better mental and physical health.

Mary states that prevention activities and social justice action are also strongly supported by neuroscience research and writing. “Evidence is clear that poverty, hunger, trauma — for example, neighborhood shootings — and abuse can actually slow or even destroy brain growth,” she says. “On the other hand, children and adolescents are resilient, and counselors can facilitate normal growth, and we do much to prevent these problems in the community.”

“Thus,” Allen says, “one of our central messages is that counselors have a responsibility for neurogenesis and neural growth in our clients and in their communities. We can only do this with a positive wellness approach to human change. Through TLCs, stress management and social action, our profession can and will make a significant difference for our clients.”

The Iveys will discuss these and other topics in more detail during their keynote in Cincinnati.

The other side of the coin

Ashley Judd can speak to that “significant difference” from a different perspective. In 2006, Judd, who has starred in 30 films and multiple TV shows in her career, spent time at an intensive inpatient treatment program at Shades of Hope, an addictions center in Buffalo Gap, Texas, to help her cope with a long-standing struggle with depression.

At the time Judd checked in to Shades of Hope, her sister, country music star Wynonna Judd, was being treated for an eating disorder at the same center. Ashley told Esperanza that after the counselors witnessed her acting out symptoms of a compulsive disorder, such as constantly tidying up her sister’s room, they suggested that she check into the center herself. She agreed.

“What I said was, ‘I’m so tired of holding up all this pain. I’m so glad to come to treatment,’” Judd told Nightline in an interview about her time in treatment. “God saved me from being angry, and it impairs my ability to be of service to another human being.”

Judd wrote in her memoir, All That Is Bitter & Sweet, that her depression, which began at age 8, stemmed from a childhood filled with abuse and loneliness, as her mother and sister, the famed country music duo, The Judds, would leave her at home when touring across the country.

Esperanza reports that Judd went to 12 schools in 13 years, and this insecurity, coupled with feelings of loneliness, fed into her depression as well as a fear of the unknown. “I remember what it was like for me … when I was living in a perpetual state of anxiety,” she told the magazine. “It feels like you can’t breathe properly. Every thought you have brings more stress, and for me, the most frustrating part was that I felt powerless to change it. The really frustrating part is that a part of you recognizes that you are doing it to yourself. But there’s this inexorable force pushing you down, and what’s really [messed] up is that you end up hurting your own feelings. I’m good at creating these dead ends for friends and loved ones where it makes it impossible for them to help.”

Judd acknowledges acting out through fits of rage and cleaning frenzies in an attempt to cope with her feelings of depression and anxiety.

But according to Judd, her treatment experience at Shades of Hope was both successful and life changing. Following her positive experience, she became an advocate for the therapeutic process. She will be speaking about that experience during her keynote at the ACA Conference.

In 2010, Judd graduated from Harvard University with a degree in public administration and has found new meaning through charity work and spending time as a political activist and humanitarian focusing on issues such as AIDS, poverty and women’s issues.

She is a global ambassador for YouthAIDS, a global health organization targeting malaria, HIV and reproductive health, and has been a member of its board of directors since 2004. Judd has traveled with the organization to places affected by illness and poverty such as Cambodia, Kenya and Rwanda.

In 2011, Judd joined the Leadership Council of the International Center for Research on Women and is involved with other organizations such as Women for Women International and Equality Now.

In April, Judd wrote a piece for The Daily Beast slamming the media for speculating over what they called her “puffy” appearance and incessantly commenting on the appearance of women and girls everywhere. “The assault on our body image, the hypersexualization of girls and women and subsequent degradation of our sexuality as we walk through the decades, and the general incessant objectification is what this conversation allegedly about my face is really about,” she wrote.

Judd also advocates for more public acceptance of mental health issues in society. “Unfortunately, there’s still a huge stigma around all kinds of mental illness, and depression in particular,” Judd told Esperanza. “It’s odd. We don’t stigmatize people with epilepsy, which is another debilitating disease. I think the disease element of depression needs more traction. People need to understand that depression isn’t just a matter of being sad. It’s a condition and a real illness. It’s actually a full-blown public health issue. But right now … talking about depression is like coming out. And … I don’t mind being one of the first to talk about my so-called little secret.”

For more information on the ACA 2013 Conference & Expo, visit counseling.org/conference.

Heather Rudow is a staff writer for Counseling Today. Contact her at hrudow@counseling.org.

Letters to the editor: ct@counseling.org

Get to know Will Stroble, director of ACA’s new Center for Counseling Practice, Policy and Research

Heather Rudow September 24, 2012

Will Stroble is the American Counseling Association’s newest employee and the first director of ACA’s new Center for Counseling Practice, Policy and Research. The Center’s goal is to produce products and research that will increase public awareness of the counseling field, as well as materials that will result in more professionals being able to practice. He is looking forward to using his decades of experience in the counseling and passion for the profession to advocate for and empower counselors nationwide.

Where did you work before coming to ACA?
Prior to joining ACA, I worked for the Department of Defense Education Activity (DoDEA) in Arlington, Va., as a school counselor. I worked with high school students in a virtual environment around the world, including Europe and countries in the Pacific such as Japan, Korea and Australia.

As a counselor, why did you want to work for ACA? What did you think of the organization?
I have always enjoyed working with people who reach out to help others. That’s what we, as counselors, do on a day-to-day basis. When I made the decision to join the ACA staff, I believed that I was making a wise decision because, through my work at ACA, I will be able to effect systemic, positive changes for all people and make changes on a broader scale that will empower people, thereby making this world a better place for everyone, regardless of the barriers and challenges that people face in their daily lives.

What does your position entail?
My position entails developing from the ground up the infrastructure for archiving, disseminating and promoting exemplary counseling practice information and resources for professional counselors, counselor educators, supervisors, students, legislators, the media and other consumers of applied counseling knowledge. My position also allows me to advocate for optimum counselor work and training conditions. My vision for the Center is that it will be seen as both the premier place to obtain information and resources that focus on cutting-edge counseling practices and will serve as the focus of the counseling profession’s advocacy efforts for high-quality workforce conditions.

What future goals do you have regarding your position?
I have many future goals, such as networking with other well-known colleagues in the counseling profession and leading the efforts on behalf of counselors to gather information and data on best practices in the profession, working with public policy staff to advocate for my colleagues and securing grants and funding for cutting-edge research in the counseling profession.

Other thoughts?
I am humbled and honored to have joined the staff at ACA as a counseling leader in the profession. After 33-plus years in the profession, having worked at the local, state, federal and now national levels, I am excited about this challenge and look forward, with great anticipation, to working alongside my professional counseling colleagues in the field. As we collaboratively and collectively work to make this world a better place for all people through our practice, I pledge humbly to accept the charge for the challenges, expectations and confidence that have been placed before — and in — me by ACA’s outstanding and most impressive leadership team, and all ACA members and constituents who have bestowed this sacred trust in me.

Heather Rudow is a staff writer for Counseling Today. Email her at hrudow@counseling.org.
Follow Counseling Today on Twitter.

Home is where the client is

Dawn Friedman September 1, 2012

For some counselors, meeting clients where they’re at is more than a figure of speech. Counselors who specialize in home-based therapy work with clients in their living rooms and at their kitchen tables, giving much-needed assistance to families and individuals who otherwise might not be able to access mental health services. Home-based counseling eliminates barriers for families who don’t have good child care options or who have trouble securing rides to the clinic.

An ecological framework focused on family preservation shapes most home-based counseling programs, with counselors considering their identified clients in the context of the complete family and community systems. Parents at risk of losing custody of their children to social services are usually targeted for home-based services, which often involve other wrap-around help such as case management and psychoeducational support. Home-based work also makes sense for foster families who could use help navigating the intensity of the needs of the children in their care.

Theresa Robinson is an American Counseling Association member who works for a community mental health agency in Tucson, Ariz. She says her clients face multiple challenges — poverty, dual diagnosis and insecure housing are common concerns — so her agency uses a team approach that allows the counselors to focus exclusively on therapy, while ensuring that clients get the extra assistance they need. Monthly team meetings focused on the child and family keep everyone on course and ensure stability of services.

“We have care coordinators who do case management and family support specialists who help with parenting skills and psychoeducation,” she explains. “For example, in a family where the children are removed and are now in foster placement, the family support specialist will be going in to help the foster parent deal with parenting issues, and I’ll help the kids deal with the emotions and feelings around missing mom and dad.”

Robinson says being able to read her clients’ environments — to see how they use their space together and how that shapes their experiences — allows her to build rapport more quickly. “I do a lot of work with teens, and they show me their rooms, what they’re doing and drawing, and the music they’re listening to,” she says. “I think it makes them feel less defensive and less likely to shut down because I’m coming to their turf as opposed to asking them to come to an unfamiliar place and talk about their feelings. I think I’ve gotten a lot further a lot quicker [with home-based counseling].”

Safety first

Al Sylvia Procter, an ACA member in private practice in Valley, Ala., spends most of her time on the road traveling to her clients’ homes, many of which are in isolated rural areas. Procter was introduced to home-based work as a student, when she worked as an intern at a family services agency. Although the agency offered both office-based and home-based counseling, she found that home-based counseling generally served her clients better. When it came time for Procter to build her private practice, going into her clients’ homes seemed like the obvious choice.

Procter acknowledges that the 20 years she spent as a military police officer make her feel comfortable going into environments that other practitioners might avoid. Mindful of safety, Procter keeps her cell phone charged and always makes sure that someone else knows where she should be at any given time. She also schedules intakes at neutral, public locations such as libraries or even laundromats so she is able to explain her expectations, secure the client’s buy-in and gauge her own comfort level with going to that particular client’s home.

“I’m old school,” Procter says. “I’m just straightforward, and I let my clients know up front what I need to work with them. If they can’t do that, then maybe they need a different therapist. I’ve gone to houses with loose dogs, and I tell [the clients] to put them up, or else we can meet someplace else. If all else fails, we can terminate the relationship.”

For counselors accustomed to controlling the therapeutic environment, home-based work can be challenging. Houses may be dirty, and there isn’t always a clear place to do counseling. The client might not have a kitchen table or a couch to sit on in the living room.

Procter says home-based counselors should be prepared to confront conditions that are less than ideal, while still remaining flexible. “I don’t want them to have to clean for me,” she says. “I want their house to look the way it normally works.” She adds, however, that if health and hygiene issues are present, such as roaches crawling on the floor with the baby, she will address those issues in session.

Counselors interested in home-based work also need to be adaptable, Proctor says, because the number of interruptions is greater than when doing office-based work. For instance, clients might need to suspend a session to attend to a crying baby or to answer a knock on the door, or they may need to get up to start dinner. Rather than regarding these circumstances as distractions, many home-based counselors view them as opportunities to witness how the family is managing and to offer interventions where appropriate.

To save on gas and to lessen the wear and tear on her car, Procter schedules her clients by county, arranging appointments around the several multidisciplinary team and committee meetings that she participates in regularly. Because she maintains a home office, she saves on rent, and a portion of her living expenses and her other business-related expenditures such as mileage, Internet and cell phone are tax deductible.

Understanding services

Christine Woods is an ACA member in Rolla, Mo., whose private practice consists entirely of home-based clients. She says home-based work has been more effective for her than meeting with clients in an office. “My colleagues think I’m completely insane, but I do not like in-office therapy,” Woods says. “I get better results because [my clients] are more relaxed and more calm.” Woods also believes she is able to build the therapeutic relationship more quickly during home visits.

She offers an example of why home-based counseling has the potential to be so effective. “There was a situation where I was doing family therapy for a kid and her mom, and they were constantly fighting about chores,” Woods says. “One day, one of the assignments I had for them was to have mom show her daughter how to actually do those chores. The daughter says, ‘Oh my gosh! I get it.’ She needed her mother to show her, and from then on, they didn’t fight about chores. If I hadn’t been right there helping them work through the exercise, I wouldn’t have had that opportunity.”

Most of Woods’ clients come to her through referrals from other agencies and have more experience with case managers than with counselors, so part of her work involves explaining what counseling is and what she can and cannot do for clients. Because Woods is in private practice, she does not work with a team. Instead, she stays updated on community resources and helps clients get referrals to additional programs when their needs go beyond her scope of practice.

Woods echoes Procter’s advice concerning the need for home-based counselors to be clear and up front about their expectations. “I’m pretty blunt. I say, this is what my role is, and if you need case management, if you need parenting skills, we can hook you up with services to address that, but what I do is strictly therapy.”

Possessing the proper attitude is pivotal to the success of home-based counseling. “When people invite me into their homes, the most private place they have and the place they feel most secure, I recognize that it’s a privilege,” Woods says. In fact, she adds, demonstrating her respect for and acceptance of her clients is even more powerful in that context. “You cannot be judgmental. If the furniture is stained or the house is run-down, for them to be able to feel like they’re treated with respect when I walk in, that’s key to helping them feel OK and trust me.”

Mandate for the profession

Greg Czyszczon is an ACA member and doctoral candidate in counseling and supervision at James Madison University who is researching home-based counseling. He says discussions about home-based work can get muddied, both for clinicians and for clients, because paraprofessionals — college graduates with little to no clinical training — are sometimes hired to do home-based work with clients, and these services are often confused with actual counseling.

“In many areas of the country, people are allowed to offer services in-home that they could not offer in an office,” Czyszczon says. “An agency might send a 23-year-old with a bachelor’s degree in sociology [who maybe] worked for a year in an after-school program, and [he or she] would be the one working with kids who have trauma history and abuse history living in homes where there is substance abuse and domestic violence. For some reason, when it’s in-home, it’s acceptable to have people in there who don’t have training.”

That scenario is bad not only for clients, Czyszczon says, but also for counselors who are offering home-based services because the resultant confusion diminishes the therapeutic work that many appropriately trained clinical counselors are doing. In a 2011 presentation at the ACA Conference in New Orleans, Czyszczon and fellow ACA member Cherée Hammond advocated for the counseling profession to recognize home-based counseling as a specialized area of practice, much like play therapy or couples counseling. Czyszczon and Hammond believe counselors should have specific training on family systems, crisis counseling, resiliency, attachment, trauma-informed care, multicultural intervention, child development, substance abuse and serious mental illness before they begin doing home-based work. They would also like for ACA and the Council for Accreditation of Counseling and Related Educational Programs to join in the discussion. “We want to say, if you’re going to be a [home-based] counselor, then these are the recommended competencies in this in-home scenario, and we need to be specific about those as a profession,” Czyszczon says.

Gerard Lawson, an ACA member and associate professor in the Virginia Tech School of Education, has conducted research on home-based counseling and supervision and asserts that it is some of the most challenging work that counselors can take on. Offering home-based services aligns with the counseling profession’s social justice mandate, he says, but too often, those tasked with doing this work are ill prepared for its many challenges. These practitioners can also be confronted by a professional stigma that says home-based work is case management rather than true counseling, Lawson adds.

“These families [clients of home-based counseling] are multichallenged, often on the verge of homelessness, often with involvement with the court system, with addiction issues and poverty,” he says. “You’re working bad hours and going out to people’s homes. Maybe your caseload isn’t as full as someone doing office-based work, and that could create the perception that this is less than counseling. But, actually, it’s counseling-plus. It was the hardest work, bar none, that I’ve ever done in my life.”

“When I talk to supervisors about home-based work, what I try to tell them is that the system is upside-down,” Lawson continues. “There is no good reason that we should be sending people out who are working on their master’s degree or who are newly graduated to attend to cases that would be challenging for a more-seasoned professional. The best and the brightest [of our profession] should be doing this work.”

Lawson says isolation and burnout are issues for home-based counselors because they spend most of their time in the field and may not get the peer support that office-based colleagues receive simply by checking in with another clinician on staff. “Counselors [who do this work] are prime for compassion fatigue and vicarious traumatization. This kind of work places them at greater risk,” he warns. “That’s a recipe for burnout, or they’re just going to become numb to it, and they’ll invest less and less of themselves. The antidote to that is good supervision, but a lot of the supervisors have never done home-based work.”

Lawson would like to see greater numbers of experienced counselors take on one home-based case to augment their in-office work. Spreading around this workload would create a larger peer group of counselors experienced in home-based work who could offer one another support, he says. It would also allow counselors who currently do mostly home-based work to see some clients in the office, supplying these counselors with the attendant peer support that comes with working on-site.

“Maybe it doesn’t become an exclusive sort of service anymore,” Lawson says. “For everybody that’s doing outpatient work, perhaps they flex their time and have one home-based client that they work with one day a week. That would decrease the stigma [of home-based counseling], and it would also mean that this would be less segregated. If everyone is doing it, then it becomes more of ‘This is what we do as a profession.’ We could say, ‘If these families haven’t been successful here [in the office], they need a more intensive level of treatment, and that should continue with the same counselor.’”

Like Czyszczon, Lawson sees home-based counseling as a matter of social justice and thus part of the counseling mandate. “The reality is that this population needs better service, but they’re given less and less attention,” he says. “As a professional, I find that troubling. And as a member of the community, I find that shameful.”

Although the work is difficult and stressful, Woods says she has no plans to go back to counseling out of an office. “Some people are made for office therapy, but I get better results when I work with people in their homes,” she says. “There’s a gift that I’m to learn from them just like there’s a gift that they’re to learn from me.”

 

****

Dawn Friedman is a writer and counselor-in-training in the community counseling program at the University of Dayton. Contact her through her website at DawnFriedman.com.

Letters to the editor: ct@counseling.org

Proof positive?

Lynne Shallcross

Offering counseling treatments that are backed by research is a personal passion for R. Trent Codd. When he founded the Cognitive-Behavioral Therapy Center of Western North Carolina 11 years ago, it was with the mission of delivering and disseminating evidence-based treatments. His practice hires only clinicians who are trained in and dedicated to delivering evidence-based treatments. It also offers training to other clinicians and agencies and produces a free podcast dedicated to evidence-based treatment and cognitive behavior therapy (CBT).

Codd believes a similar focus on evidence-based treatments should be more widely adopted throughout the counseling profession. Although the ACA Code of Ethics states that counselors will use empirically supported treatments, Codd asserts other aspects of the profession’s culture allow for training in and practice of non-validated and potentially harmful treatments.

As an example, Codd shares his viewpoint on critical incident stress debriefing (CISD). “The data here are clear that people recover following a trauma if this intervention is delivered. However, they do so more slowly than with no intervention. That is, this treatment has been shown to impede the natural recovery process,” says Codd, who is a diplomate in the Academy of Cognitive Therapy. “To be more explicit, this intervention is harmful. Delivering harmful interventions is certainly not congruent with the ACA Code of Ethics.”

The American Red Cross and other organizations promote CISD, which can contribute to confusion among counselors, Codd says. Counselors who don’t read the research literature might assume that a technique is safe and effective — even if research seems to indicate otherwise — simply because multiple organizations endorse that technique, he says. (There is ongoing debate about CISD within the mental health professions, and its proponents take issue with claims that there is no evidence of its effectiveness or that it has been proved to be harmful.)

To Codd, the ongoing use of CISD is just one illustration that research and evidence-based practice have yet to find the following they deserve within the counseling profession. “I wish I knew what to recommend to remedy this problem,” he says. “This is something that I’ve spent quite a bit of time thinking about over the years. I think the only thing that will make a difference is a change in the professional counseling culture. The bottom line is that we, as a profession, are going to have to agree that this is important. Unless that happens, I don’t think much change is going to occur.”

From his position as president of the American Counseling Association, Bradley T. Erford says he senses the push for evidence-based practice coming from multiple sides — and he hopes that push will continue to grow stronger. Externally, he says, health care providers and government organizations are increasingly demanding to see counseling practices with demonstrated effectiveness. Internally, Erford says, the counseling profession is constantly striving to identify what works, how well, with whom and under what conditions, as any scientific discipline should.

“Knowing and applying what works in counseling not only raises the integrity of professional counselors, it also serves to protect the public from ineffective or even dangerous interventions and treatments,” says Erford, a professor in the school counseling program at Loyola University Maryland.

In Erford’s view, conducting research and using evidence-based practices are important to the profession for two main reasons: adherence to professional ethics and economic survival. “The ACA Code of Ethics states [in Section C, Professional Responsibility] that ‘Counselors have a responsibility to the public to engage in counseling practices that are based on rigorous research methodologies,’” Erford says. “That statement pretty much says it all. Regarding economic survival, if professional counselors use the best available research-based approaches to help clients and students, counselor effectiveness, client satisfaction and third-party insurer satisfaction improve. When professional counselors provide effective services, our services become even more valued, and we create a market for more counseling jobs at higher pay.”

Kelly Wester, an associate professor in the Department of Counseling and Educational Development at the University of North Carolina at Greensboro (UNCG), cites credibility and accountability as two additional reasons that counselors should conduct research and then adhere to evidence-based practices. This would assure clients that whatever treatment a counselor is offering has been shown to be effective, says Wester, a member of ACA who co-chaired the development of research competencies for the Association for Counselor Education and Supervision in 2011.

“Using the medical profession as an example, if an oncologist told you that you required an invasive medical procedure to remove or minimize the cancer that was in your abdomen, you would want to know of the effectiveness of this procedure, the risks and the benefits,” Wester says. “You may even want to know who else has been through this procedure and their outcome so you [can] compare yourself, your demographics and your situation with those individuals to see how you may fare in the treatment. While counseling is typically not as invasive as some cancer treatments, our clients may have the same interests and concerns regarding their treatment. Thus, counseling research should be done so that our clients, as well as supervisees and students, know the benefits, risks and outcomes of engaging in the service we are offering them and can truly make an informed choice.”

ACA Chief Professional Officer David Kaplan says health care companies are beginning to suggest that they may stop reimbursing mental health practitioners who don’t use evidence-based practices. The danger if that scenario plays out, Kaplan notes — particularly if counselors don’t begin producing more evidence of effective counseling interventions — is that counselors might find themselves locked out of using helpful approaches because of a lack of research on those approaches.

CBT is often recognized as the most effective treatment in many situations, Kaplan says. This is not necessarily because CBT is the only approach that works, he says, but because it is the treatment that fits best into the prevailing research paradigm. Therefore, the evidence needed to support its effectiveness has been ample. “If we don’t generate outcome research across the entire gamut of counseling interventions,” he says, “the only approach the insurance companies are going to let us use and the only one the government will fund [in the future] will be CBT.”

‘A theoretical basis is not enough’

When it comes to conducting research and applying it to counseling techniques, a variety of terms are used. According to Codd, the term evidence-based has been applied more liberally in recent years. He understands the meaning to be “following approaches and techniques that are based on the best available research evidence.”

Kaplan says the technical definition of evidence-based research promoted by the National Institute of Mental Health and other federal agencies requires the inclusion of a manual with specific step-by-step protocols so the procedure can be replicated. The term best practices, on the other hand, implies that a counselor is looking for the one “right” approach that works better than all other approaches, he says. “That term is losing favor because we know that there’s not one absolute best approach to a problem. There are different interventions that can work,” Kaplan says.

Outcome research is another relevant term. According to Kaplan, it encompasses conducting research that speaks to Gordon Paul’s question posed in the 1960s: What works best with this particular client in this particular situation with this particular problem in this particular setting?

Wester views evidence-based practice as consisting of quality research findings, counselor skill and ability, and client desires. “I think the myth is that evidence-based counseling equates to using a manual that gives you Week One, Week Two and Week Three and that it does not allow you to account for individual clients who come into our office,” she says. “This is not my understanding of evidence-based practice. Evidence-based practice, to me, is what has been proven to work, and it typically provides more of an outline of interventions or steps that allow us to work with our clients from a method that has been proven to be accountable. Simply because the evidence-based practice indicates that we need to set goals in week one does not mean that we ignore the client who walks into our office during intake crying and in crisis. That wouldn’t be ethical on our part as counselors. It would mean that the ‘week one’ part of the evidence-based practice might take another week or two to finalize … while we stay with their emotion and work with the client to alleviate the crisis.”

Regardless of the terminology used, more research needs to be done to support the techniques counselors are using, Kaplan asserts. Historically, the counseling profession has been grounded in theory, he says, and as a result, many practitioners have thought that if they followed a particular theory, they were being successful, regardless of client outcomes. “With the push in recent years for accountability and to show that what you do works, having a theoretical basis is not enough,” Kaplan says.

As a whole, the counseling profession has been more resistant than other helping professions to the push from health care and government to back treatments up with research, Kaplan says, in part because counselors don’t generally like to do research. “Counseling tends to attract professionals who are interested in interacting with people and helping people directly,” he says. Those who are more interested in conducting research tend to gravitate toward other fields such as psychology, Kaplan says.

Counseling also attracts greater numbers of people who are creative and like to use creative interventions, Kaplan says. The downside to that is that creative interventions are often more difficult to research, he says. For example, behavior therapy approaches are more concrete — “do this, then this” — so they better lend themselves to the prevailing quantitative research model, he says.

Another factor in play is that it can be more complicated to determine what works in counseling than in other professions, Erford says. “Take medicine, for example. It is relatively simple to determine if one pill works better than another for treating a certain medical problem,” he says. “The personalities of the doctors and clients, while diverse, generally have little effect on the client’s physical system. Likewise, what the client does before and after taking the pill usually has little effect. The administration of the treatment and consequences are usually easily controlled. This is not the case in counseling. The treatment must be personalized to client needs, which means that even if a professional counselor is using a manualized treatment protocol, variations occur in how the treatment is administered. And the treatment is only a small piece of the puzzle when trying to understand clients’ complex change processes.”

Erford points to research from Michael Lambert 20-plus years ago showing that only 15 percent of the treatment outcome was due to specific techniques used. In comparison, 30 percent was due to the therapeutic alliance, 15 percent to the client’s expectations for change and 40 percent to factors outside of counseling. “So, in order to maximize client outcomes, all four facets should be the focus of the professional counselor, not just what evidence-based practice you are using,” Erford says. “On the other hand, while 15 percent may sound like a small amount, it makes a huge difference to overall client well-being and counselor effectiveness. That said, when clients perceive that counseling is working, their expectations improve, they are more likely to follow through on out-of-session activities and the therapeutic relationship improves. So, these change factors are not four discrete facets; they are synergistic and interconnected.”

No matter the reason for it, the profession’s dearth of research leaves counseling at a disadvantage in Codd’s opinion. “It pains me to say this about my profession, but I really believe we lag significantly behind these other disciplines in this area. I think it’s important for our field to catch up to these other disciplines if we are to truly mature as a field.”

Widening the scope

Finding middle ground on the topic of evidence-based practice will require a little give on both sides, Kaplan says. On one hand, counselors need to acknowledge that to advance the profession and to do the right thing for their clients, they must produce evidence that what counselors do is working, he says. On the other hand, organizations and agencies that fund research need to be more flexible concerning what constitutes acceptable research, he says. This could mean embracing qualitative research rather than focusing only on quantitative research and understanding that not all approaches will use “cut-and-dried protocols,” Kaplan says.

Wester agrees, adding that qualitative and quantitative research should be viewed on a continuum, where both have their own strengths. “Qualitative provides us more of an in-depth understanding and allows us to explore areas and opinions that we are unsure of, while quantitative provides us numerical support and evidence that something works or doesn’t,” she says. “No one methodology is better than another; they serve completely different purposes. Thus, what research should look like is less about the methodology and more about what research questions will benefit and impact our counseling field. What questions would help us to be better counselors, be more effective with our clients and train our students better? Once we have those questions, then the methodology that best answers those questions should follow.”

The counseling profession also needs to change the current focus of the research it conducts, Kaplan says. “We need to focus more on clients in research than ourselves,” he says. “The [current] research is often focusing on asking ourselves opinions about ourselves and has nothing to do with client outcomes. We need to find real clients who have real problems, and we need to find out if what practicing counselors are doing with their clients is working. And, yes, that’s hard to do.”

But before producing and applying the research these leaders say the profession needs, counselors must acquire the requisite skills, which Wester says they should be learning both in graduate school and through continuing education after graduation. “Graduate school training provides the basis and grounding for what we need to know as professionals, but the world keeps changing, our clients keep changing, and the interventions and treatments continually change — and so does research,” she says. “Thus, continuing education is important to stay abreast of knowledge and gain new skills.”

In Codd’s view, graduate programs need to up their games and better train future counseling researchers. “I think our curriculums should add course work and, even more importantly, require active participation in research projects — doing the behavior as opposed to just reading and hearing about how the behavior is acquired,” he says.

Making research relatable

Codd senses a divide in counseling between those in favor of increased research and evidence-based practice and those who do not want to see the profession rely so heavily on research. Among the objections he has heard is that certain theories cannot be researched and that scientific methodology is not valuable.

He suspects, however, that much of the resistance to research has to do with how hard it can be for human beings — including counselors — to let go of deeply held beliefs. “We cling to our pet theories [and have] perhaps even built our careers around writing, lecturing [and] delivering certain interventions,” he says. “Learning whether or not we’ve been correct can be hard to take.”

Throughout the history of the counseling profession, people have argued about whether counseling is a science or an art, Erford says. He believes it is both. “We are a scientific discipline that allows practitioners to creatively adapt to the individual needs of a client,” he says.

One obstacle that may keep more counselors from adopting a pro-research attitude is that many practitioners do not view the literature base as being particularly user-friendly or helpful, Erford says. “Some counseling journals, like the Journal of Counseling & Development, have tried to address that by requiring that authors provide a section called ‘implications for counseling practice.’ But what we know about what works in counseling today is so much broader and deeper than it was 20 or 30 years ago. Most practicing counselors don’t have time to keep up with all of the published literature. They want meaningful, easy-to-read summaries that will help them to hit the ground running and create effective client or student outcomes. Some counselor researchers have begun conducting meta-analyses and systematic research syntheses to try to pull together related literature, sort of like one-stop shopping. Many of the textbooks I write have a synthesis chapter, which addresses the question, ‘What works in counseling?’”

ACA is developing two initiatives intended to address this need, Erford points out. “First, we are exploring how best to provide summaries of research-based approaches to issues encountered by counselors. Once produced, these informational summaries will be available to ACA members and will be designed to help practitioners, students and counselor educators stay abreast of effective counseling practices. Also, the new ACA National Institute for Counseling Research Task Force will identify and recognize the best counseling research produced during each year as exemplars for the counseling profession.”

Wester points to a “practitioner-researcher gap” within the counseling profession that she says has yet to be successfully bridged. “Practitioners frequently will question the applicability of our findings and our research, indicating it does not allow them to use their creativity or speak to the uniqueness of each client,” Wester says. “Interestingly, we think about evidence-based practice as research [telling] us what to do. However, if one would really explore the literature on evidence-based practices, it is the combination of a) quality research findings, b) counselor skill and ability and c) client wants and desires.”

Erford agrees, saying the push for additional research and evidence-based practices in no way diminishes the importance of creative and innovative theories, interventions and treatments. “Instead, the emphasis is on subjecting innovative and creative treatments and new theories to rigorous study in order to determine treatment efficacy, just as currently accepted evidence-based practices have been rigorously tested,” he says. “In the classic sense, after the treatment has been proposed, the new treatments are studied using randomized controlled trials on real clients with a real target condition. If the results are positive, evidence emerges that the treatment is supported. Usually, multiple clinical trials are needed to support an evidence-based practice.” Having more than one evidence-supported approach expands options for clinicians and clients, Erford says.

‘Voices from the field’

Counselor practitioners should not only be using research to inform their practices with clients, they should also consider taking part in research themselves, Erford says. “Practitioner voices from the field are incredibly powerful,” he says. “Much of the progress we have made over the past century is because practitioners noticed important things about clients, the counseling process, and the strategies and techniques used, and then shared these insights with other practitioners and researchers.”

In general, however, counselor practitioners seem less likely to participate in research and collaboration with counselor researchers than do practitioners in related professions such as psychology and psychiatry, Erford says. “Part of this is a professional orientation issue, which we are addressing in counselor education,” he says. “We need to recruit and produce graduate students who are excited and knowledgeable about research and its application to practice, and then keep them excited and engaged as they enter practice. If practitioners understand how research can be applied to clients in the field, they will notice things and question their practices more actively, thus opening their curiosities to research opportunities.”

Erford says he and a few colleagues completed meta-studies between 2010 and 2012 of 10 ACA and division journals, learning that in nearly every case, practitioner contributions to the counseling literature have declined significantly during the past 20 years. “Professional counselors, regardless of setting, are supposed to be collecting data to substantiate effectiveness and outcomes with every client or student served,” he says. “This constitutes a huge pool of existing data. If we could develop a system for collecting and using this outcome data for research, we would leap ahead in our understanding of what works in counseling. Partnerships between counseling researchers and practitioners could be mutually beneficial, meeting the needs of the researcher for access to clients and data, and the practitioner for access to research or evidence-based practices and assessments that help with screening, diagnosis and accountability. If you are a practitioner with ready access to clients or the data they generate, please reach out to counseling researchers in universities and institutes. Through networking, we can build a powerful system for research and development.”

Before counselor practitioners can team up with researchers, the lines of communication need to be opened, Wester says. “One of the things our department did [at UNCG] was to send our internship site supervisors a survey on what was needed in terms of research and [asking if they would] be interested in collaborating with our department faculty on answering any questions they were interested in or needed answered through research,” she says. “They were able to indicate what they needed in terms of current literature, what they would like in terms of research relationships, topics they needed help researching and how we could help them and their agency. The first step is setting up the lines of communication between practitioners and researchers. But practitioners should feel able to contact the local universities, or even their
alma maters, to inquire how to bridge the gap.”

Research in a humanities profession

James Hansen, professor and coordinator of the mental health specialization in the Department of Counseling at Oakland University in Rochester, Mich., agrees that research is a vital part of professional counseling. But he believes counseling should be “informed” by research — rather than “guided” or “determined” by it — for two fundamental reasons.

First, Hansen says, the essence of counseling is the relationship between the counselor and the client. “Indeed, one of the most consistent research findings over the past four decades is that the quality of the counseling relationship is the within-treatment variable that accounts for the majority of the variance in counseling outcomes,” says Hansen, a member of ACA and the Association for Humanistic Counseling, an ACA division. “Therefore, the research unequivocally informs us that the quality of the counseling relationship is the factor to which practicing counselors should be most attentive. However, every counseling relationship is unique, just like every marriage, friendship, etc., is unique. Therefore, although research informs us that the counseling relationship is vitally important, research cannot tell us how to deepen a particular counseling relationship because every counseling relationship is unique.”

Second, Hansen says, all research is conducted within a set of assumptions. “The set of assumptions in ‘evidence-based,’ ‘best practices’ or ‘empirically supported treatment’ outcome research is that researchers should attempt to find the best techniques to use with particular disorders. The findings can then be disseminated to practitioners, who will diagnose their clients and use the techniques that have been found to be most effective with their client’s disorder,” says Hansen, who wrote a “Reader Viewpoint” in the October 2010 issue of Counseling Today on this topic, as well as another article for a special issue of the Journal of Humanistic Counseling due out next month.

But the set of assumptions is essentially medical, Hansen argues, and although that makes sense for medicine, it doesn’t make sense for counseling. According to Hansen, meta-analytic research studies have consistently found that specific techniques account for less than 1 percent of the variance in counseling outcomes. “Specific techniques, generally speaking, appear to be relatively unimportant to outcomes,” he says. “Therefore, a counseling research agenda that is based on finding specific techniques for particular diagnostic conditions is focused on a factor that only accounts for a minuscule portion of the outcome pie. A general research agenda for the counseling profession should be focused on factors that we know to be highly important to outcomes, not factors that are relatively trivial.”

The bigger factors in the pie, Hansen says, are the quality of the therapeutic relationship, extratherapeutic factors such as social support, and positive expectations from the client about counseling.

The truth about techniques is complex and nuanced, Hansen says. “Specifically, the evidence strongly suggests that the ‘contextual model’ of counseling is the general way of thinking about treatment that counselors should adopt. There is an important role for techniques in the contextual model, but that role is related to the overall context of counseling, not as isolated, technical interventions.”

Hansen adds a second point to support his contention that the set of assumptions often relied upon in evidence-based counseling research is faulty. He asserts that the manual many mental health professionals use to identify client disorders, the Diagnostic and Statistical Manual of Mental Disorders (DSM), is “fundamentally unsound” yet is used in evidence-based research. Hansen calls the DSM highly unreliable and believes it has virtually no validity. “Because evidence-based research operates from these deeply flawed assumptions, it is generally a harmful trend in counseling,” he says.

In Hansen’s view, counseling is a humanities profession, akin to history, literary analysis or philosophy. The raw data of all of those professions is in human meaning systems, he says. On the other hand, the sciences, such as biology, chemistry and physics, deliberately attempt to remove subjective human meaning from their investigative efforts, aiming to be objective and impartial, he says.

“Even if counseling is considered a humanities profession, science still has a valuable role in counseling, just as it does in other humanities professions,” Hansen says. “For instance, although historians study human meaning systems, they rely on scientific methods to date historical documents. However, science does not dictate or determine the activities of historians. It is simply used as a tool to help the profession along. I envision the role of science in counseling in much the same way. Science is a vital tool to help counselors determine if their interventions are working, for example. However, science should not dominate and determine the professional life of counselors or historians, because both of those humanities professions are aimed at uncovering human meaning systems — a goal which science, as an enemy of subjectivity, is grossly unsuited to accomplish.”

Although Hansen reiterates that research is vital to the counseling profession, he believes it’s important for its focus to be on enhancing understanding of the factors most known to help clients. “For instance,” he says, “we know that the quality of the counseling relationship is an important factor in counseling outcomes. However, we have a lot to learn about the nuances of the counseling relationship, how it unfolds, the points at which it is most important, etc. The primary agenda then should be to focus research attention on factors that are known to be vital to counseling outcomes.”

 To contact the individuals interviewed for this article, email:

Lynne Shallcross is the associate editor and senior writer for Counseling Today. Contact her at lshallcross@counseling.org.

Letters to the editor: ct@counseling.org

Click here to read two additional perspectives on evidence-based counseling.

A home for research

In September, the American Counseling Association will launch its Center for Counseling Practice, Policy and Research. ACA Executive Director Richard Yep, one of the driving forces behind the center’s creation, discussed what counselors can expect from this new endeavor.

Where did the idea for the Center for Counseling Practice, Policy and Research originate?

The center concept was the result of input and commentary that I heard from leadership and members for many years. To have a dedicated unit within ACA that focused on areas of the counseling profession that could have both short- and long-term impact is something that we have wanted to do. With the support of the ACA Governing Council and the excellent input of those with whom I work on staff, we are now able to realize the launch of this new entity.

What will its goals be?

In the beginning, our hope is that the center will begin building a framework that will allow ACA to more deeply explore a number of issues that include how best to position counselors for job opportunities for which they are uniquely qualified through their education and experience. However, it will also be looking at the professional counselor who will be working in the middle of the 21st century to position them for whatever they may face. And an additional aspect of the center will encompass how we can host interns and scholars-in-residence here at ACA headquarters to work on projects of critical importance to the profession.

What do you hope to see the center accomplish?

In an ideal world, within three years, I hope that the center will have produced products, research and resources that result in more professional counselors being able to practice. An additional deliverable will encompass increased awareness by the public in terms of its understanding of the impactful and important work that these tireless mental health professionals do each and every day.

Why is this an important move at this time in the profession?

Professional counseling is at a crossroads. The services and support of the center are something that we hope will move the profession in a direction that will support more job opportunities, allow the public to better understand what counselors do and inform public policy decision-makers so that they help to create an environment that allows professional counselors to deliver the best possible services to clients and students. I am extremely excited about the work that I know the center can accomplish, and I look forward to the input, suggestions and feedback from our members in regard to the efforts we will make.

— Lynne Shallcross

 

Leaving room for creativity

Exploring creativity in counseling might sound at odds with following evidence-based counseling practices, but Thelma Duffey says that doesn’t have to be the case. Duffey, the founding president of the Association for Creativity in Counseling, a division of ACA, says evidence-based counseling and creative counseling interventions are largely complementary and developmentally aligned.

“Many creative interventions and techniques are founded in an established theory or theories and are implemented with these in mind,” says Duffey, a professor and chair of the Department of Counseling at the University of Texas at San Antonio. “For example, all best practices begin with a creative thought or idea. Many times, these may develop into models, techniques or interventions that emerge from our practices. We often talk through them and collaborate or share them with others. Finally, we assess and research their efficacy.”

“Now, one way that evidence-based counseling could interfere with creative approaches would be if we were to adopt a rigid, one-dimensional perspective on our work or endorse cookie-cutter recipes of treatment that don’t allow for context or counselor and client individuality,” Duffey says. “Evidence-based counseling practices could also interfere with creative approaches if we were to discredit spontaneity, creativity or innovation in our work. I see none of these as likely. Rather, I see counselors as embracing the idea that creativity involves using available resources, while ethically attending to best practices. Using music, the cinema and books are some excellent and ready resources that are compatible with evidence-based research paradigms.”

Duffey says she supports researching creative approaches, just as she would any other counseling approach. “The same quantitative research principles apply, such as adequate counselor training, valid and reliable measurement instruments, and clear methodology,” she says.

Although some counselors are more passionate about research, while others are more passionate about practice, Duffey says there’s room for a global view that incorporates both sides. “I believe that when counselors and counselor educators are flexible in their thinking, able to look at a big picture, allow for developmental progress and acknowledge the role of creativity and innovation while respecting rigor in research, the dichotomy ceases to exist.”

To contact Thelma Duffey, email thelma.duffey@utsa.edu.

— LS