Tag Archives: Counselors Audience

Counselors Audience

Counselors: Support local police by sharing your skills

Diana Hulse & Peter J. McDermott September 1, 2012

Earlier this year, in an article for the FBI Law Enforcement Bulletin, we proposed that interpersonal skills training is fundamental to effective performance in all aspects of police work. We argued that although police officers receive expert training in tactical and legal skills, and that their mastery of these skills can be documented, it is unclear whether they are routinely taught interpersonal skills or how these skills are evaluated, if at all.

Actually, in preparing our article, we noticed that police officers rarely if ever receive basic interpersonal skills training, even though they are in dire need of developing these skills. Where can police officers find resources to assist them in the pursuit of these skills? One answer lies with counselor education programs and practicing counselors.

Counselor education programs provide curriculum and methods for teaching and evaluating foundational interpersonal skills. Counselor educators, practicing counselors and counseling interns can serve as coaches to teach, demonstrate, supervise and evaluate police recruits in the use of these skills. Counselors can also help veteran police officers to review, practice and upgrade performance in these skills.
There is no requirement for counselors to have specific knowledge of police work to help in this area. Rather, all that is needed is a willingness to share their skills. Police academy instructors are the ones who can then apply these skills to the training needs across the police academy curriculum.

Why police need to strengthen ‘talk’ skills

Police officers work with the public to create safe and crime-free communities. To be successful, they must display strong tactical and legal capabilities and also convey verbal and nonverbal interpersonal skills that communicate respect, diffuse conflicts, reduce violence, instill public partnership and demonstrate a professional demeanor.

The reality is that police engage on a daily basis in two activities: They talk to people and they touch people. The “touch” factor is represented by a concern for officer safety. Police are trained and evaluated in the handling of firearms, motor vehicle stops, self-defense, arrest and control, and responses to crimes in progress. “Talk” skills are essential to the execution of these tasks.
Talk skills are also necessary for police officers to create and maintain environments that encourage a tone of civility in their interactions with the public. It has been documented that the police and public have different expectations and attitudes that can raise tensions when the police and the public interact. These tensions can be further intensified today in an increasingly multicultural society in which a number of challenging issues and factors, including an uncertain economy, can lead to domestic or workplace violence, abuse, stealing, rage and bullying. Faced with these challenges, police officers must demonstrate a competence level with talk skills that is on par with their touch skills. Only by putting talk skills at the forefront of their training can police expect to contribute to their desire for a tone of civility, which is essential for maximizing a level of collaboration with the public that can lead to safe and crime-free communities.

Counselor educators, practicing counselors and counseling interns are an identifiable and critical resource to police in achieving a high level of training in interpersonal skills. Once basic interpersonal skills are in place, counselors can help police focus on other important skill sets, including how to give and receive feedback and how to succeed in leadership tasks.

Enhancing skills for giving and receiving feedback

Once police recruits complete classroom instruction, they enter what is called the officer field training program. This is where, under intensive supervision, police officers translate all learning experiences to date into acceptable performance in motor vehicle stops, criminal investigations, and domestic violence and conflict situations. In field training programs, officers receive mandatory feedback for a period of 10-14 weeks on their encounters with the public. This is analogous to the feedback process that counseling students engage in with site and university supervisors during their clinical training.

Here again, counselors can help supervising officers in field training programs learn effective ways of giving, receiving, clarifying and exchanging feedback, particularly if that feedback is corrective in nature. Many tools and approaches are available in the counseling literature, as well as in clinical supervision curricula, to help make the best use of supervision that leads to growth and competence as counselors. These same resources can be adapted for use in field officer training programs, allowing supervisors to enhance the professional development of police personnel, while helping officers to gain an appreciation of feedback and its link to their personal and professional development.

Enhancing skills for leadership tasks

Upon mastery of interpersonal skills and feedback skills, a natural progression is to focus on group facilitation skills. These skills are needed in a variety of situations common to police work, including debriefing meetings, block watch groups, and team or divisional commander tasks.

Here again, counselors possess the skills to provide training and supervision on a range of basic leadership competencies, including how to build interaction and gather information; how to draw members out, cut off extraneous conversation or shift the conversation to focus on the desired topic in a meeting; and how to use attention to the hereand now to address nonverbal behaviors that might negatively affect the work of the group.
Group work literature offers many models and ideas for counselors to use in helping police officers understand group dynamics and assemble a skill set that supports success in their leadership duties.

Sharing our skills: Who benefits?

With a solid grasp of basic interpersonal skills, police are in a better position to respond with competence and sensitivity to potentially volatile situations in their daily work. Additionally, as police gain mastery of interpersonal skills, feedback skills and skills for facilitating leadership tasks, they can model and transfer these skills to all members of the organization. A new generation of trained police personnel will emerge with proficiency both in human relations skills and tactical skills.

The timing is excellent for this type of collaboration between counselors and police. The medical profession is already addressing the need for physicians to learn how to communicate with patients and work as a team. Like doctors who listen carefully to their patients, police officers must listen to and understand the public to gather pertinent information, supplement their technical knowledge and build more civility and trust between themselves and the public they are sworn to serve.

By pursuing partnerships with police personnel, counselors will be fulfilling a call to share their skills with others in their communities. In addition, counselors will gain visibility for their expertise and contribute to the betterment of their communities.

Together, police officers and counselors will benefit through improved communication and increased understanding of what the other group does. In the end, communities will reap exponential benefits as a result of the collaboration between these two disciplines.

Contact your local police department today

You might believe that police organizations are insulated and difficult to reach as a counselor. We think such connections are possible, however. The key concepts to consider are creativity and opportunity.

Do you know a school resource officer in the local schools who might be willing to exchange ideas about training, or is there a training division within your local police department? You could take a copy of our 2012 FBI Law Enforcement Bulletin article, “Interpersonal Skills Training in Police Academy Curriculum,” and offer your assistance in providing skills training to young recruits or refresher sessions for veteran officers. We have written two other articles (one in print, the other in press) for the FBI Law Enforcement Bulletin that could serve as resources for your outreach efforts, and we are available to talk about our initiatives in the state of Connecticut.
The potential rewards for collaboration across the disciplines of counselor education and law enforcement are many. Such collaboration is a great way for counselors to share their important skills, helping police personnel to use improved interpersonal skills to achieve their mission of better communication with the public and safer, crime-free communities.

 Diana Hulse is professor and chair of the Counselor Education Department at Fairfield University in Fairfield, Conn. Contact her at dhulse@fairfield.edu.

Peter J. McDermott is a retired captain from the West Hartford and Windsor, Conn., police departments and a retired instructor from the Connecticut Police Academy. Contact him at pete06422@yahoo.com.

Letters to the editor: ct@counseling.org

ArtBreak: creative counseling for children

Katherine Ziff, Sue Johanson & Lori Pierce

The elementary school counseling model used in the Athens (Ohio) City Schools is one in which our counselors serve several schools, so I (Katherine Ziff) structure my work with priority to offering preventive and developmental services to groups of children. Three years ago, in consultation with our school psychologists and administrators, I began offering studio art-based group counseling sessions that we call ArtBreak to children. The program has evolved into an ongoing, choice-based studio art counseling intervention that allows children to relax and express their feelings, practice prosocial behavior and develop problem-solving skills and creativity. The program now serves 35-45 students each year. For the past two summers, supported by Integrating Professionals for Appalachian Children (IPAC) and Project LAUNCH, an initiative funded by the Substance Abuse and Mental Health Services Administration through the Ohio Department of Health, I have also been able to offer ArtBreak through public libraries in two communities. Project LAUNCH promotes the improvement of the health and wellness of children from birth to age 8, and the summer groups were composed of children in this age group.

Structure 

Our summer ArtBreak program offers sessions in the meeting spaces of community libraries. Participating public libraries enroll children in the program. These groups, each consisting of 10 children, meet six times during the summer for an hour each session. Sessions are held twice a week for three consecutive weeks for children up to
age 8.

The ArtBreak program in the elementary schools runs from October until the end of the school year. Each group meets weekly for 30 minutes. Groups are composed of seven to eight children from kindergarten through sixth grade. Students are referred by teachers, parents or a community mental health provider with a form that we developed based on the therapeutic goals supported by the Expressive Therapies Continuum. A parent or guardian gives each child written permission to participate in ArtBreak.

Guiding principles

ArtBreak has four guiding principles:

  • The Expressive Therapies Continuum
  • Choice-based studio art
  • The counselor as a facilitator
  • Multiage groupings and community

The Expressive Therapies Continuum is a foundational art therapy framework introduced by Vija Lusebrink and Sandra Kagin in 1978. A developmental hierarchy associated with how information is processed in relation to how images are created in a therapeutic context, the Expressive Therapies Continuum delineates three areas of therapeutic goals with associated media. Briefly stated, these are:

1) Use fluid media such as watercolor and finger paint to address kinesthetic/sensory goals such as relaxation and expression of feelings.

2) Use more resistive media such as colored pencil and crayons to address perceptual/affective goals such as improving cognition, increasing empathic understanding, identifying emotions and grasping cause and effect.

3) Use resistive media such as collage and sculpture to address cognitive/symbolic goals such as developing problem-solving skills, identifying and integrating strength, and supporting creative thinking.

In ArtBreak, we use the Expressive Therapies Continuum as a guide for stocking the studio with materials, reflecting on student work, setting goals for students, and completing documentation and evaluation. In a choice-based art studio such as ArtBreak, students are encouraged to make their own choices about media and materials. In stocking the studio, we avoid kits and preplanned projects and provide art-making materials that are high quality and safe for children. We have a few tools such as awls and mat knives for working with cardboard that are used only by the counselor or under close supervision, but everything else in the studio is for the children to use freely themselves.

The groups begin with a basic set of materials and media. Over time, we supplement these materials and media as children seem ready or ask for them. In this way, we have introduced multistep, complicated processes such as printmaking (when a student asked for a potato to carve and use to make prints), sewing (when a student asked to make a small pillow) and installations such as a whole-room, multimedia experience that the children dubbed “Winter Wonderland.”

The role of the counselor in ArtBreak is not to direct activities but rather to facilitate, model problem-solving, demonstrate the use and care of art-making materials, teach skills such as setup and cleanup, encourage and model supportive behavior and language, keep time, document student work products and process, and make decisions about new materials and processes to introduce to the children.

We find that multiage groupings of children are important to the process of building community within an ArtBreak group. This approach creates new patterns of behaviors and relationships by offering children social experiences that are different from those found in their regular classrooms. It also allows opportunities for new friendships across ages to develop. Older children sometimes are models and helpers for the younger ones, while younger children sometimes delight the older group members with their willingness to experiment and try out different materials.

Setting up the studio

We have conducted ArtBreak in a large room with a sink as well as a small room with no sink, simply outfitted with a bucket, cleanup cloths and a pitcher of water. A tile floor is much less worrisome than a carpeted one, but we have managed in a carpeted studio by reminding children about the floor when painting and cleaning up any drips quickly.

A good way to begin is to provide two or three materials from each of the three areas of the Expressive Therapies

Continuum and then to add to the supply according to what the children seem ready for. To start, include fluid media such as finger paint, chalk pastels and watercolors; more resistive media such as oil pastels, crayons, tempera paint and brushes, clay, watercolor markers and water-based oils; and resistive media such as collage materials, buttons and beads, graphite and sculpture materials.

A sculpture/construction area can be furnished at no cost by seeking donations of cardboard boxes of all shapes and sizes as well as other cardboard and plastic odds and ends. Provide construction tools and supplies such as scissors and hole punchers, pencil sharpeners, drawing pencils, glues, a variety of tapes (including duct tape), ribbons and strings, and brass fasteners of different lengths. You’ll need paper that is suitable for both wet and dry media, as well as glossy finger-paint paper.

Old cafeteria trays are helpful to contain individual work, and a large cutting mat is useful for cutting cardboard. Smocks can be made inexpensively from old shirts. A drying rack for paintings, at $120, has been our only single item of significant cost. The materials and supplies are permanently located in our school studios. In our summer library-based program, we use a portable system of bins that can easily be packed and stored in a corner of the room.

Documentation

Written and photographic documentation is a daily task for the facilitating counselor. We keep notes describing group and individual process as well as reflections about new materials and supplies needed, changes in process and ideas to support children in their art making. Part of the documentation includes communicating with teachers and with families about what their children are making in ArtBreak and their process.

We also learn by asking children questions about ArtBreak: Tell me about ArtBreak. What do you do here? What do you learn?

Children tell us they learn about emotional regulation and sensory expression: “I learn I have to work calmly in here”; “Finger painting feels good. It is awesome and smooth. Regular paint is not so fun as finger paint.”

They describe using their cognitive skills: “We learn about tools, what you can make with them, being careful with them”; “You use your thinking. You think about what you make”; “I learned how to make a robot, how to sew.”

They tell about community and group process: “We have fun. We help each other, and that’s fun.”

And they delight in the opportunity for creativity: “We aren’t directed. Your mind is not in a can”; “We don’t get told what to do, what to make. We have ideas”; “ArtBreak is when you can express your ‘magination!”

ArtBreak has evolved to a point where we are beginning to conduct outcome research and offer school counseling interns opportunities to learn to structure and facilitate ArtBreak groups. I (Katherine) am also working with Margaret King of Ohio University to prepare a workbook detailing complete ArtBreak “how-tos” for practitioners.

“Knowledge Share” articles are based on sessions presented at past ACA Conferences.

Katherine Ziff is a school counselor in the Athens City Schools in southeastern Ohio as well as an exhibiting artist. Contact her at katherineziff@aol.com.

Sue Johanson is a school psychologist in the Athens City Schools and vice chair of IPAC. Contact her at sjohanson@athenscity.k12.oh.us.

Lori Pierce is a school psychologist in the Athens City Schools. Contact her at loripierce@athenscity.k12.oh.us.

Letters to the editor: ct@counseling.org

Resources 

  • Engaging Learners Through Artmaking: Choice-Based Art Education in the Classroom by  Katherine M. Douglas and Diane B. Jaquith
  • Studio Thinking: The Real Benefits of Visual Arts Education by Lois Hetland, Ellen Winner, Shirley Veenema and Kimberly M. Sheridan
  • Expressive Therapies Continuum: A Framework for Using Art in Therapy by Lisa D. Hinz
  • Katherine’s ArtBreak blog: briarwoodstudios.wordpress.com

 

Home is where the client is

Dawn Friedman

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

The power of story

Stacy Notaras Murphy

Write what you know.

This classic adage from creative writing class has launched many a novel. According to those who practice narrative therapy, it also can launch a counseling client into a transformative and healing process of self-reflection.

Narrative therapy refers to the work most often attributed to Michael White and David Epston. The approach emphasizes a person’s life stories and considers problems to be created out of different contexts, not as the result of who the person is. A well-worn maxim associated with narrative therapy is that “the person is not the problem, the problem is the problem.” Narrative therapy emphasizes clients’ strengths, helping them to tell the alternative personal stories that often get overshadowed by the more dominant stories about their problems. Using gentle questioning techniques, the counselor collaborates with the client to deconstruct stories and thoroughly investigate any problems together, as though they were reporters getting to the bottom of a lead.

This approach resonates deeply with Jane Ashley, a former newspaper editor and reporter who left journalism because she was disenchanted by the way that preconceived ideas often shaped how the media presented stories. “What I found in the first few years as a therapist was that the same way of listening and seeing clients was at work in the [process] of therapy,” she says. “So, I was starting to be a bit discouraged when I heard Michael White’s approach. What he had to say spoke directly to my concerns with journalism and the mainstream world of psychotherapy.”

Since discovering narrative therapy in 1995, Ashley, a licensed professional counselor (LPC) in Arlington, Va., has participated in dozens of related trainings, including a one-week intensive workshop with White. She also runs a narrative peer study group that incorporates mindfulness techniques. Ashley says it is the nonimpositional stance of the narrative therapist in particular that helps her avoid the pitfalls of preconceived notions.

“Narrative ideas inform my position in the conversation as a curious, nondirective collaborator in exploration of how the problem, or problems, have taken up more space in the lives of my clients,” Ashley says. “I try to stay curious and to keep my language and questions based on the language and expressions of the client. To me, this position is the most important aspect and hardest to learn for therapists.

“We are trained in all the other approaches to interpret and offer suggestions and interventions that come from the ‘expert’ knowledge of whatever theoretical orientation informs our interpretations. We are trained to speak from expert knowledge. In narrative work, the expertise is in listening for ‘sparkling moments’ and ‘exceptions to the problem’ in the words, attitudes and expressions of the client. It is very honoring of the lived experience and values and beliefs of the client.”

Ginny Graham, an American Counseling Association member who is one of Ashley’s counseling supervisees, agrees. “I love the accessibility of the genre,” she says. “The more I use the context of story to frame clinical discussions, the more I appreciate how its familiarity invites and grows content. Who doesn’t love a good story? By its very nature, story elevates and even celebrates conflict as the central vehicle for change.”

Graham, an LPC with offices in Alexandria and Arlington, Va., came to counseling work after a career as a high school English teacher. She acknowledges that this background likely predisposed her to an appreciation of narrative therapy. “Using story as a gateway to greater meaning in life — a key component of this approach — is a given in any English classroom. A way I’d create relevancy for my English students was to talk about all literature as a kind of ongoing conversation that people have been having since the first word was spoken,” she notes. “Finding a therapeutic approach that says the most defining story of all is each person’s own unique story felt like a natural progression for me clinically.”

Crediting her supervision work with Ashley as the spark that ignited her curiosity about narrative therapy, Graham says, “It probably sounds simplistic to explain the experience as one of being taken seriously. If that doesn’t happen in a clinical or supervision relationship, there’s something wrong, right? Yet there was something powerful about being on the receiving end of the questions she asked, as well as her encouragement to expand on and enrich the content.”

Graham also attended a workshop that Ashley led about using narrative techniques in group therapy. “After selecting witnesses to listen to a conversation between the practitioner and the client in which the client told a story, we were asked to do a few simple things: isolate a phrase or image that stuck with us and to talk about how it resonated, how we could relate it to our own story,” she explains. “After we shared our material, the client talked about how what we’d said had changed her original perceptions.

“The result was unanimous energy and enthusiasm for the creative way we had experienced each other and unwittingly grown in honing our own understanding of ourselves. … Experiencing it spoke volumes about the empowering possibilities inherent in this approach for doing group work. It was a living, breathing illustration of how stories overlap in a powerful way to inform, confirm, contradict, challenge and inspire.”

Tools for the narrative

Narrative therapy demands that counselors hone their listening skills. “I try to train myself to listen for wisps of dreams that are barely spoken — those hopeful thoughts that might be drowned out by the influences of the louder, more emphatic problem narrative,” Graham says. “What’s more, it’s not enough for me to hear it. I want to create a sense of collaboration. I want to be considerate and explicitly check out what I think I’m hearing with my client.

“In my collaborative, narrative mode, I might say something like, ‘It’s funny when you say that it seems like some of what you’ve said is barely written — as if it’s written with a light, thin pencil. Yet, as you talk, there’s something that has me thinking that you might want to swap that pencil for a permanent marker. Am I right? Or what am I hearing unfold here? Is this something you want to talk more about?’”

Graham has found that the narrative approach is particularly helpful with clients who are facing adjustments related to loss and major life changes, as well as when multicultural issues come into play. “I love asking questions that invite [both myself and] folks to reflect on the relative strengths and weaknesses that exist in our social discourses,” she says. “For many, examining themselves objectively as a person in history becomes a first opportunity to think critically about culture, politics and the dominant stories that inform unconscious attitudes, hold us back and dictate behavior.

“For me, undoubtedly the most satisfying aspect of this approach is that the act of inviting and encouraging authorship automatically means there will be revisions because, as every writer of story comes to know, revising is where the real story emerges,” Graham adds. “The act of revising a story is such a positive, possible task and serves to lessen the sting and stress of the change process. Some clients have likened the approach to the pick-your-own-ending books they remember delightedly from their childhood.”

Sandy Davis, an ACA member and LPC in Fenton, Mo., was drawn to narrative therapy during her graduate program. “As students, we were challenged not to just be ‘eclectic’ but to find a mode of therapy that would fit us,” she says. “I began searching for a therapy that fit me rather than forcing myself into a mold. Narrative therapy utilizes my strengths, and I am consistently adding to my skill set by seeking educational opportunities on narrative therapy through journals, articles and continuing education.”

Davis uses narrative interventions to help clients separate themselves from their problems. “I am interested in the person’s self-talk, how they describe themselves, how a ‘problem’ begins using a small truth or situation and creates a challenge to the person’s concept of self. … Learning the ability to utilize externalizing language often allows [the client] to relax and begin building self-confidence,” she explains. “They are usually relieved that they are not identified as ‘the problem’ and welcome the opportunity to have someone to team up with to address and combat the problem.”

“Asking a person how depression keeps them from having fun forces them to develop more concrete reasons,” Davis continues. “They may reply that depression tells them they are not good enough, not skinny enough, not smart enough and that they do not have energy. This gives me insight into their thought process and how the problem manipulates the person.” Other narrative tools include letters, contracts, poetry, art and addressing cognitive distortions.When using narrative techniques, Davis says, counselors should know there is always more than one version of a story. “Mapping the problem and its effects on the person is an important first task,” she says. “We assist the person in [developing] a more complete story of exceptions for when they were able to defeat the problem. We ask questions like, ‘How does the problem talk you into your behavior?’ The person is then invited to take a position on the problem, to decide how it will affect the person from that point on.”

Davis’ first homework assignment to clients asks them to consider their own self-talk. “I ask the person to create two lists of adjectives that they see as truths about themselves. I am careful to state not to include what others say about them,” she says. “One list is to contain negative [adjectives] and the other, positive adjectives. They bring the list into the safety of the office, and we together try to find evidence that these words portray what is really true. I work with the person to find exceptions for the negative words.”

Davis adds that narrative work also offers flexibility, allowing her to use it in conjunction with other models, including solution-focused and cognitive behavioral techniques.

A career context

Many agree that narrative therapy, with its invitation to consider one’s life experiences as a set of rich stories that can build off one another, is particularly applicable to career development work. Lisa Severy is an ACA member who primarily works with traditionally aged college students as assistant vice chancellor of student affairs at the University of Colorado at Boulder. She applies narrative techniques in this capacity, especially as she helps students determine their next steps after graduation.

“I often ask students to think about their favorite book or movie. When they have one in mind, I ask them to describe it to me and to tell me what is happening at the plot level and what the underlying themes are,” she explains. “While many people describe the plot of the movie in similar ways, the underlying themes often vary [because] those are a reflection of the viewer as much as of the movie itself.

“In sharing that with students, I tell them that people seem to report being most happy and successful in their careers when the plot of their career story is closely aligned with their own life themes. Those people whom we see floating through their work lives with very little energy probably have a huge gap between what they are doing and who they are [their life themes]. Our goal, then, is to create the next chapter in the student’s story that carefully aligns plot and underlying theme. That description tends to help students understand the process and buy in to the idea.”

Severy, the incoming president-elect of the National Career Development Association, a division of ACA, adds that narrative techniques are particularly refreshing in career development contexts. “Many career counseling models are norm-referenced. … They tend to assess a ton of people and then compare an individual to characteristics of the group. The norm, of course, doesn’t really exist, so comparing people to it can often lead to frustration — ‘Why does everyone else know what they want?’ What if there isn’t some ideal career choice hidden beneath the surface that just [needs to] be uncovered?

“Asking people to write the next chapter in their lives moves them away from the idea that they are writing their entire autobiography at 22 years old,” she says. “It also allows them to use their own words, culture and experience to create the story. I think of it as a reverse funnel. Older models are reductionist … taking the breadth and depth of a person and identifying certain traits — interests, skills, values, personality type — and reducing it down through a funnel process, the end result being something that could be compared to norms or to work settings.”

“Narrative therapy is the opposite, helping people to create holistic, broad stories in context,” Severy continues. “Not only have I found it to be much more successful in helping students, it is also much more satisfying for me as a counselor.”

A worldview in practice

For treatment-wise clients — those who have been in and out of therapy throughout their lives — the narrative approach may feel strange at first. “It will just look like a rich conversation with a loving friend,” Ashley says. She finds the techniques work best with those who are “thinking and creative people. … In my view, this includes all people.”

Severy agrees: “Some clients are certainly more drawn to [narrative work] than others, but I use the principles to guide my practice either way. In college student career counseling, some students come in just wanting someone to give them an answer quickly … and this type of counseling requires a great deal of time and effort to do well. Those that put in the time and are naturally drawn to history, culture, stories, narratives, etc., find it very engaging.”

Ashley recommends that interested counselors seek training with those narrative therapists who regard this work as a “worldview” in practice. “It is not the techniques,” she says. “The techniques — externalizing the problem, deconstructing the story, etc.— are to support the position of curiosity, interest, imagination and respect for the client.” She cautions that “many people who are practicing what they call ‘narrative work’ are actually using the techniques to deliver their ‘expert’ knowledge that comes from the other therapeutic orientations.”

Similarly, Severy warns interested counselors against jumping to conclusions as the client’s story unfolds. “There is a danger within this model of trying to move too quickly, with theme identification becoming more of a diagnosis than an authorship: ‘Oh, you told me a story about getting a kitten when you were 5. You must want to be a veterinarian!’” she quips. “The co-creation model emphasizes that the counselor should continually check assumptions and conclusions with the client to avoid that trap. I like to think of the process as the client being the writer and the counselor a test audience or editor — not someone to judge, but to ask questions and help refine.”

Searching for optimistic vignettes is part of the narrative therapist’s task as well, Davis adds. “It is a wonderful way of assisting [clients] to see a more preferred story that has been lived rather than only the dominant story that includes the present problem. The challenge is to find out what is going right, to be optimistic in the face of some horrific stories [and] to see the strength in the one sitting before us.”

“We often serve a population that lives problem-saturated stories, and yet they survive with skills that they do not acknowledge,” she says. “Rewriting history can occur, and it can change the future of those we serve. As therapists, we must remember that some remnants of resiliency and hope are there, but that the dominant story is able to disguise them. Collaborating with a person to discover these other truths is a life-changing event.”

Contributing writer Stacy Notaras Murphy is a licensed professional counselor and certified Imago relationship therapist practicing in Washington, D.C. To contact her, visit stacymurphyLPC.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