Monthly Archives: November 2017

@TechCounselor: There’s no escaping technology

By Adria S. Dunbar and Beth A. Vincent November 13, 2017

Do you pay for your drive-through latte with your iPhone app while streaming Spotify through your Bluetooth speakers and double-checking your GPS for traffic notifications? Or are you the stalwart who prefers to park and go inside to order your coffee because drive-throughs seem so impersonal and face-to-face communication is an endangered art? Whether you’re the early adopter who embraces technology usage in every aspect of your life or the skeptical laggard who argues that we would all be better off if we were less plugged in, you can’t escape the question of whether (or how) to integrate technology into your life and work.

For those of us who are counselors, our technology habits in our personal lives likely influence how we use technology in our professional lives, including in our relationships with colleagues and clients. Yet it can be difficult to remain self-aware about our habits and choices surrounding technology use. Constant advances in new technologies ensure that as soon as we have a solid grasp on current technology, a new innovation bursts onto the market and changes everything. This is lifelong learning to the extreme.

Why does it matter which technologies we use and how? If technology is a means to an end — be it increased efficiency, convenience, communication, transparency or organization — then it matters whether those ends are achieved. Email enables us to communicate from the convenience of our smartphones, but not when the messages pile up too fast for us to read and reply to them. Cell phones make us accessible 24/7 from any location, but only until our signal gets dropped. PowerPoint helps us stay on track in meetings, but not when the presenter falls back on reading slide after slide of black bullet point text from a plain white background. When technology fails — when it does not get us to the desired end — we can end up feeling lost, frustrated or even betrayed.

The downsides of technology can arise from our own abuse of technology or be inherent in the technology itself. We see the human tendency to abuse technology every time a co-worker consistently replies to all when they think they are replying to one. Or when we sit in a meeting that is filled with the incessant tapping of keyboard keys as colleagues refuse to unplug long enough to attend a one-hour meeting. Or, perhaps worst of all, when we sit silently while a lunch companion stares at a screen rather than paying attention to the human being seated directly across from them. At times, we may catch ourselves being less present in the company of others, distracted by social media, email or notifications. Some of the ways people use software may even be categorized as addictive or criminal.

In addition to these human failings, other pitfalls are inherent to the technologies themselves. Important emails wind up in spam folders, text messages never make it to their intended audience, and software crashes a moment before we hit save, just as we are entering the final case note of the day. Just as we all benefit from technology, we also struggle to navigate its challenges.

As counselors, our choices around technology use are laden with our professional responsibilities. Federal laws dictate what we can do and say in online and digital formats. Our social media must be monitored carefully to avoid the creation of dual relationships or unintentional self-disclosure to clients. Our behaviors must be models of healthy boundaries in front of those we serve. Ethical standards exist to help guide our professional behaviors, but as counselors, we are confronted with an ever-changing technology landscape that affects our personal and professional lives and the lives of our clients.

In this shifting landscape, how do counselors make decisions about which products to use and which to avoid? How can we leverage technology to make us more efficient and effective without allowing technology to steal the spotlight away from the real work we are doing with clients? We must keep returning to the question: “What is the end goal, and how can technology help us get there?”

Each column in this new monthly series for CT Online will explore this question in the context of a different type of mobile and online software technology that counselors use.

Future column topics will include:

  • Email
  • Productivity software
  • Communication software
  • Site blocking software
  • Record-keeping software
  • Online counseling platforms
  • Chat and texting
  • Mobile devices

 

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Adria S. Dunbar is an assistant professor in the Department of Educational Leadership, Policy and Human Development at North Carolina State University in Raleigh. She has more than 15 years of experience with both efficient and inefficient technology in school settings, private practice and counselor education. Contact her at adria.dunbar@ncsu.edu.

 

Beth A. Vincent is an assistant professor at Campbell University in Buies Creek, North Carolina, in counselor education. She is a counselor educator, licensed school counselor and former career counselor who is driven to learn everything there is to know about innovative productivity software to help counselors be their most present selves. Contact her at evincent@campbell.edu.

 

Our Instagram is @techncounselor.

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

 

Bringing Syrian hospitality into your counseling practice

By Shadin Atiyeh November 8, 2017

In a small village resting in a valley watched over by a medieval castle, the women made their morning rounds. At each house, they were met by the same ritual. A warm greeting with a kiss on each cheek, an invitation to sit and at least three rounds of offerings: sweets, coffee and fruit. This is an obligation, to express hospitality to guests, but the host treats it as an honor and a joy.

Between each offering, conversation flows about family members, friends and occurrences in the village. The host asks intentionally about each person in the guest’s life. Silences are reserved to hold sadness, grief or political sentiments better left unsaid. These silences are broken with “May God help,” or “baseeta,” translating literally to “simple,” but used to acknowledge the futility of talking about a topic and moving on to the next one.

The Arabic language is vast but vague. One word can carry many meanings, but translated without context, it can lose all meaning. Another example is “Yalla,” which the women will use to indicate that they are ready to leave and move on to the next visit. It can mean “let’s go,” and “hurry up” or “come on.” The goodbyes are drawn out, with invitations to stay longer, kisses and hugs. The guests invite the host to visit them next time.

These morning visits serve multiple purposes. There is no one in the village who will not have a visit from a neighbor, a friend or a family member each day. There is no household task that won’t have a helping hand. There is no meal that anyone in the village will eat alone. There is no newcomer who is not welcomed with multiple visits from each neighbor offering food and conversation. There is also no misstep, family argument or fashion mistake that does not get aired out with the dirty laundry in rooftop conversations. In English, there are many words for aloneness, and each word can have either positive or negative connotations (e.g., solitude and loneliness). In Arabic, “wahida” has a mostly negative connotation: sadness, loneliness, pity.

The values of hospitality, community and honor are central to Syrian and many Middle Eastern cultures. Growing up as an American of Syrian Arab descent, my father told us one story to teach us true hospitality. This story did not involve a fellow Arab but rather a Jewish man who helped my father when he arrived in the United States from Syria at the age of 18. This Jewish business owner gave my father his first job in the United States and supported him in his first years.

When I visited Syria for the first time with my father, I experienced the hospitality and community that he knew. These values can be hard to find in the United States — a primarily individualistic culture where privacy is paramount and the belief that we must make it on our own is prominent. I can imagine the culture shock when my father came to the United States and possibly went a few days without a knock on the door from a neighbor. I felt a similar shock in Syria. I remember craving some privacy or solitude in which to think and read, some freedom from feeling scrutinized.

 

Bridging cultural boundaries

As a licensed professional counselor and approved clinical supervisor working with refugee populations, I try to hold on to an empathy for how culture shock feels and to encourage that empathy among my supervisees. I have an appreciation for my father’s story because I currently work at a Jewish agency expressing Jewish values by resettling Middle Eastern refugees. I have a firsthand experience of the power of this work to bridge cultural boundaries.

As the Syrian refugee crisis continues, refugees are forced to flee their communities and are placed in third countries for resettlement when there is no opportunity to return home. In the United States, a network of nonprofit agencies is responsible for meeting families at the airport, securing housing and providing basic services and cultural orientation. I have learned that we can accomplish these steps either by checking off the boxes or by approaching these refugee families with the same spirit of hospitality and welcoming that they most likely would afford to us. Doing so demonstrates respect and honor and eases the culture shock of being in a new country.

How could you incorporate hospitality into your counseling practice to make it more welcoming for those of Middle Eastern descent? You can follow some rituals that might help to evoke a sense of respect and suggest that your practice is a place to sit and talk.

Many therapists in the United States put effort and thought into how the room is set up. This traditionally involves a private and quiet setting, dim lighting, plants and the therapist’s chair facing a couch. You might have a table with drinks available, but it is important to insist that these clients partake because they would not think it appropriate to take a drink on their own or accept a drink on the first offer. Going through the ritual of making and pouring coffee for your client further demonstrates care and respect. Having a candy dish or sweets tray can also be useful, but it is important to hold the dish and offer it to these clients.

Giving gifts acknowledges the value of relationships to these clients, so you might consider giving small gifts at the first and last sessions. These gifts might be cards, representational items, journals, bookmarks or books. These gifts can serve a therapeutic purpose.

Artwork on the walls can include Arabic writing, such as the words “Ahlwan wa Sahlan,” meaning “Welcome and Health.” Some therapists have their name in Arabic next to the English writing on their doors. If your client speaks English as a second language, make an effort to learn some words that can communicate empathy for the difficulty of learning a new language and having an accent. One of my favorite moments with a client was when my position as the all-knowing authority was shattered by my broken attempts to speak French.

Be careful not to assume what language your clients speak. Instead, ask. Iran, Afghanistan and Somalia, for example, are not Arab countries and speak languages other than Arabic. There are also different ethnic groups such as the Kurds, Armenians, Jews and Chaldeans within Arab countries who may not speak Arabic as their first language.

Don’t expect your client to teach you about their culture. Obtain supervision and consultation and read from credible sources. Hisham Matar’s In the Country of Men is a novel that offers raw insight into the experience of a child growing up in Libya and being forced to leave. Bint Arab: Arab and Arab American Women in the United States, by Evelyn Shakir, portrays the diversity of Arab American cultures and the dissonance women of Arab descent experience living in the United States.

Poetry is another window into cultures and is a highly revered art in Arab traditions. Some famous Arab and Arab American poets include Nizar Qabbani, Adonis, Khalil Gibran and Maram al-Massri. These poems might also be therapeutic tools.

The Arabic language is also ornate, formal and elaborate. It is not enough to say, “Welcome”; you should say “Two welcomes.” When someone says, “Good morning,” the response should be more extravagant, such as “Morning of light.”

There are many sayings and poems that could hold the extreme sadness, loss and loneliness attached to leaving one’s country, home and community. Qabbani wrote: “My son lays down his pens, his crayon box in front of me and asks me to draw a homeland for him. The brush trembles in my hands and I sink, weeping.” My clients might spend a lot of time talking about how loss of homeland has affected their children, parents and other family members. I honor my clients’ positions in their families and allow them to discuss these other people in session because these family members might be extensions of self.

Your clients are the experts on their experiences of their culture and their perspectives on it. Many clients from racial or ethnic minorities might be walking into your office with the same questions: Will the therapist understand my culture? Will the therapist respect my culture?

As the counselor, you have the power to initiate a conversation about these unspoken questions, make these concerns explicit and address them. Respect and acknowledge differences while also connecting on commonalities such as the feelings of loss, guilt and shame.

Counselors working with this population must also acknowledge the political and social climate in which these refugees are entering the United States. Experiences and fears of discrimination and prejudice have contributed to increased anxiety, depression and traumatic stress among Arab Americans in the United States. Adding clients’ past traumatic experiences to these experiences can lead many to isolate themselves further.

Therapists in the United States inundated with negative images of the Middle East might be at risk of holding unexamined negative stereotypes and beliefs about Middle Eastern people and their cultures. The therapeutic space can become a place of risk for further harming vulnerable clients, or it can provide an opportunity to give clients a chance to experience understanding and support.

In bringing a spirit of Syrian hospitality into my work as a counselor, I am able to communicate a warmth and welcoming to my clients. As my clients walk a tightrope over an ocean — behind them loss and in front of them both danger and opportunity — I hope the therapeutic space offers rest and reflection. A good host is usually invited as a guest. I attempt to be invited as a guest into my clients’ lives so that I can work with them to build bridges over those oceans.

 

“Light is more important than the lantern. The poem more important than the notebook.” — Nizar Qabbani

 

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Shadin Atiyeh is a master’s-level licensed professional counselor in Michigan, national certified counselor and approved clinical supervisor. She is currently a doctoral student in counselor education and supervision and a department manager within a refugee resettlement and social services agency. She has five years of experience providing clinical services, case management and employment services with vulnerable populations, including refugees and other immigrants, survivors of domestic violence and sexual assault, and families experiencing homelessness. She also serves as a clinical supervision for counseling interns and prelicensure counselors. Contact her at shadin.atiyeh@waldenu.edu.

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Technology Tutor: Revisiting the ethics of discussing clients online

By Rob Reinhardt November 7, 2017

If you have given even a cursory observation to the advertisements that appear on Facebook, during Google searches or on many of the websites that you visit, you will have noticed that these advertisements are targeted at you. The ads might be related to web searches you have performed, the area you live in or something that is generally popular with your age group.

This is how companies such as Facebook and Google make almost all of their money. They gather information about you (and everyone else) and sell advertising to companies that want to target you. They make a lot of money doing this because they are very good at letting those companies get very specific with their targeting. (Google reported revenues of $26 billion in the fourth quarter of 2016 alone.) For a glimpse into the kinds of details that Facebook collects about people, check out the great infographic at bit.ly/FBTargetOptions. That list keeps growing and getting more refined. It is especially important to note this passage from Facebook’s overview of how to target ads: “Behaviors are constructed from both someone’s activity on Facebook and offline activity provided by data from Facebook’s trusted third-party partners.”

In other words, to target advertising to their users, Facebook is collecting data from many different sources about both online and offline activity. So, this is not restricted only to the activity on Facebook.

What does this have to do with our clients (and potential clients)?

I continue to witness counselors engaging in referrals and case consultation in online forums such as Listservs and Facebook groups. This is despite my previous article on this topic last year in Counseling Today (see bit.ly/discussingclients) in which I discussed the difficulty of maintaining confidentiality for clients and the PIT principle (permanence, identity, transferability), and even with American Counseling Association Chief Professional Officer David Kaplan clearly stating that discussing clients online is an ethics no-no. The existence of marketing databases curated by entities such as Facebook and Google adds yet another reason that we need to consider other ways of addressing client needs.

Take this example of a completely fictional situation that could quite easily refer to a real situation:

Johnny Client contacts Susie Counselor about an appointment. He provides some background, and Susie recognizes that she is not a great fit for him. She decides to reach out to her local mailing list or Facebook group of therapists to see if she can provide Johnny with a solid referral. She writes: “Looking for referral for 30-something male dealing with depression. Needs counselor in network with ABC Insurance.”

Although this may seem innocuous at first, it is likely more than enough information for Johnny to be identified. In my previous article, I pointed out the human reasons this is an issue. (For instance, what if someone who knows Johnny or even Johnny himself is in the group? What if someone copies and pastes or screenshots the information?)

Now let’s look at it from a targeted marketing standpoint. Johnny’s call to Susie didn’t happen in a vacuum. Prior to calling her, Johnny did a search for “Counselor MyTown” and visited Susie’s website. These are traceable behaviors tied directly to Johnny, and they likely will end up in the databases used by entities such as Google and Facebook to target advertising. Based on these behaviors, Johnny is likely to start seeing ads on his computer for mental health treatments, counselors in the area and self-help books.

It is important to note that Susie Counselor is now probably connected to Johnny in these databases because he visited her website and placed a call to her. So, when she posts about the 30-something male with depression shortly after receiving Johnny’s call, it’s not a huge leap for database algorithms to figure out that this is the same Johnny Client who recently visited her website and called her — the same Johnny Client whose address, birthday and many other pieces of information already exist in the databases. Except now, thanks to Susie, those databases have learned that Johnny is dealing with depression. They may well have already known what insurance Johnny has, but if not, that’s another bonus that Susie provided for them.

What you can do

I’d like to highlight one of my suggestions from the previous article as well as provide a couple of other suggestions:

  • Make it counselor-centric: When seeking someone to refer to, focus on the counselor’s skills, not the client’s issues. For example, you might say, “I’m looking for a counselor who helps clients dealing with depression.”
  • Keep it offline: Go old school! Keep your own notebook or database of people you can refer to. Note their strengths, location, the insurance they accept, etc. Network and get to know them to elevate the quality of your referrals.
  • Raise awareness: Sometimes, counselors need to be reminded of things that we often tell our clients. For instance, just because others are engaging in a behavior doesn’t make it OK. Make others in your online forums aware of the privacy issues surrounding discussing referrals and cases online. Point them to this article and to my previous article that I referenced earlier. Point them to the pertinent passages in the ACA Code of Ethics (noted below). Even if they aren’t counselors, the ethics codes for social workers, psychologists, marriage and family therapists and psychiatrists contain similar passages, so their concern for client privacy and confidentiality should be just as great. Above all, be kind and compassionate in your approach.

Pertinent standards in the ACA Code of Ethics

B.1.c. Respect for Confidentiality

“Counselors protect the confidential information of prospective and current clients. Counselors disclose information only with appropriate consent or with sound legal or ethical justification.”

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Note the inclusion of “prospective” clients. Do you have the person’s consent before disclosing anything about them online? Can you accomplish your goal without disclosing information about them online? If so, what is your legal or ethical justification for disclosing?

B.2.e. Minimal Disclosure

“To the extent possible, clients are informed before confidential information is disclosed and are involved in the disclosure decision-making process. When circumstances require the disclosure of confidential information, only essential information is revealed.”

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Do clients (or prospective clients) fully understand the ramifications of you disclosing information about them online? Do they understand how few details it might take for computer algorithms to identify them? Are they aware of all the options for accomplishing the goal, and do they approve of online disclosure?

B.3.c. Confidential Settings

“Counselors discuss confidential information only in settings in which they can reasonably ensure client privacy.”

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Is there any way that this standard doesn’t completely rule out using online forums for any disclosure? Based on my experience and expertise, there simply is no way that counselors can reasonably ensure client privacy if they share any details about clients in most online forums.

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For an interesting discussion of this topic, including an interview with social media policy expert Keely Kolmes, check out Episode 104 of the TherapyTech with Rob and Roy podcast.

 

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Rob Reinhardt, a licensed professional counselor supervisor, is a private practice and business consultant who helps counselors create and maintain efficient, successful private practices. Before becoming a professional counselor, he worked as a software developer and director of information technology. Contact him at rob@tameyourpractice.com.

Letters to the editor: ct@counseling.org

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Bringing counselor expertise to court

By Jean Peterson

As a counselor educator, I could have done more to prepare counseling students for involvement with the court system. Pertinent discussions were usually limited to child custody, records, privileged communication, subpoenas and counselors’ vulnerability in the courtroom. I had experienced depositions and had written clinical summaries, but I had never appeared in court. My own preparation had included nothing about being an external expert witness.

Then I had an experience that underscored the importance of teaching and learning about court involvement. Although attorneys might not think of counselor educators and school and mental health counselors first when needing an expert witness, a counseling perspective might be crucial to an outcome. Apparently, mine was.

A bit of history

During the 1980s and early 1990s, a number of articles and monographs addressed court involvement for helping professionals. During that era, psychologists were growing in number, assessment was valued and psychological witnesses were increasingly used. In addition, media outlets were discussing “recovered memory,” and a high-profile case led to criteria for admissible expert testimony. However, conceptual literature noted that attorneys did not always appreciate the expertise and objectivity of therapists in the courtroom, and, because expertise was not standardized, lawyers and experts with stronger credentials could challenge witnesses.

Roles and behaviors related to court processes were also being clarified for counselors. I paid attention to Ted Remley Jr., a helpful legal voice in the field. I learned that both general and expert witness roles are possible, with the former providing facts and the latter providing opinions. An expert witness educates judge and jury by reviewing and interpreting facts and records, making inferences and then informing in neutral, understandable language. School and mental health counselors are more likely to be general, or fact, witnesses, although experience and special training might make them desirable as expert witnesses.

Journal articles about counselors’ involvement have been rare since then, but thanks to contributors such as Carolyn Stone, school counselors can access guidelines related to subpoenas, court orders and privileged communication, for example. However, media interest in bullying and the growing number of states with pertinent statutes suggest that courts will increasingly be involved in cases related to school safety. In such cases, a school counselor or counselor educator may be asked to serve as an expert witness, examining counselors’ and others’ roles or perhaps providing an opinion about the climate or culture of a school.

A surprising request

Eventually, I was contacted from a distance by the attorney for Wendy (pseudonym), a bright 22-year-old, in a civil case against a school district. Alleged negligence in the wake of extreme harassment had contributed to two extended traumatic experiences for Wendy.

My purpose here, in describing my experience as an expert witness, is to provoke thought about counselor court involvement, roles and behaviors, institutional cultures, ethical behavior, systemic contributors to harassment, and potential developmental impact of harassment and retaliation after reporting. Details about the process and time involved might lessen counselors’ concerns if asked to be involved.

Traumatic experiences

I was told that, during ninth grade, Wendy was assaulted physically and harassed with graphic sexual language by a school bus driver almost daily for several months. Allegedly, he had groped her when she entered and exited the bus, jerked her clothing to expose her underwear and asked about her sexual behavior. Wendy observed another student’s similar experiences.

Wendy realized that her younger sister, beginning to mature physically, soon would be vulnerable. She talked with her sister, who talked with the elementary school counselor, who contacted Wendy’s mother, who in turn contacted the school principal, superintendent and sheriff.

The second traumatic experience occurred after Wendy’s parents filed a complaint. Allegedly, the bus driver began drug- and sex-related rumors about Wendy, which were then perpetuated by students who considered the driver an ally. Their unrestricted behavior on sports-team buses (e.g., beer, pornography) matched the driver’s voyeuristic interest in their social lives. He talked with them about Wendy’s parents’ complaint, and, according to an interview during the investigation, encouraged one student to lie on his behalf. At school, Wendy, who formerly had enjoyed social ease, was harassed and marginalized. At the end of her junior year, she transferred to another school.

During the criminal case, which took place after Wendy’s transfer, the bus driver was acquitted. According to Wendy’s new attorney, who contacted me, adolescent witnesses for the prosecution had not presented themselves well in court, even in how they were dressed. Wendy would tell me later that she herself was “not prepped.” This new attorney was now preparing a civil case, focusing on the school system.

Credentials

I was initially surprised to be contacted. Then I considered my professional background. I was knowledgeable about school culture. When the attorney met with me, I told him I had been a teacher, counselor or group specialist in schools for 25 years and a counselor educator for 15, supervising school- or agency-based field experiences. I had worked closely with school administrators in several schools.

In addition, principals-in-training at the university were required to enroll in my Introduction to School Counseling course, and they interacted with the school counseling students formally and informally about their respective professional roles. As a counselor educator, I had led a national study of bullying and was acquainted with trauma literature through a 15-year qualitative study of a survivor of trauma. Beyond that were coursework and clinical experiences in family therapy. I had licenses in school and mental health counseling. Thinking about these experiences gave me confidence. Still, I had anxiety: I would be a first-time expert witness.

An educational experience

What I was asked to do fit my expertise. Training and experience in school counseling were important for my first formal opinion, whereas experience in counselor education was important for my second. The attorney initially traveled to meet with me for two hours. He described what he had learned about the bus harassment and the responses of school personnel after Wendy’s parents filed the formal complaint.

We soon communicated again by phone. I explained relevant concepts, including the developmental lens I routinely used as a counselor, examining developmental tasks (e.g., identity, direction, relationships and autonomy), “stuckness” and task accomplishment. I described findings in my study of trauma and noted literature related to posttraumatic stress disorder (PTSD). We discussed the bullying study and my study with John Littrell of a school counselor who transformed a school culture from bloody fights to harmony. In the latter, the school culture was deemed to be malleable, and a strong counselor-principal partnership was essential to the positive change. I assumed that principal and counselor roles and relationship, school culture and climate, bullying and PTSD all would be important to this case.

At that point, I formally agreed to be involved and was asked to keep track of hours. I said I would ascertain whether bullying legislation existed in that state when the alleged harassment occurred, and the attorney agreed to locate student handbooks of the school from that time. I subsequently met with a faculty member in educational administration at the university and consulted by email with a superintendent who was a former middle school principal, asking how he would respond to an anonymous scenario resembling Wendy’s. His details were helpful as the attorney and I considered what administrators did and did not do in Wendy’s case. I also received university permission to engage in the court process. This permission included a formal admonition that I be clear, both in oral and written testimony, that I did not represent the university or its perspective.

The attorney later sent me a thick loose-leaf binder containing documents and resources for me to study, including:

  • The student handbooks and the school district’s anti-harassment policies
  • Depositions from the superintendent and a teacher for the earlier trial and Wendy’s affidavit
  • Wendy’s mother’s formal complaint
  • Summaries of student statements in the sheriff’s investigation report
  • Polygraph results for Wendy and the bus driver
  • A letter regarding the bus driver’s disciplinary record and his responses to two sets of interrogatories
  • Wendy’s school attendance, academic performance and psychological evaluation records

I studied these materials in preparation for my upcoming meeting with Wendy. The attorney’s assistant arranged for my in-person interview with Wendy and clarified my focus:

1) Wendy’s experiences during the harassment

2) How experiences with the bus driver, students and staff affected her mentally, emotionally and psychologically

3) How she was treated by school counselors

4) Whether permanent damage had occurred

I then developed an interview protocol. The interview lasted 3 1/2 hours.

As I asked about Wendy’s experiences, including during the criminal case, I included questions about development. I also assessed her morale, alert to possible depression, suicidal ideation and PTSD. As directed, I asked about contact with school counselors, whether and how much administrators were aware of her distress, the responses of teachers and peers, and attendance and classroom achievement. Subsequently, I submitted a report to the attorney. Over the next three months, we conferred four times by phone as I prepared to write an affidavit.

The affidavit

Writing the actual affidavit required about seven hours. I needed to peruse the binder materials and notes from my interview with Wendy, communicate once with her by phone to verify details and develop a carefully written, facts-based document. In it, I first presented my credentials and professional employment record as well as a list of the documents I had examined. I explained that I had conducted an interview of a specific length, and I asserted that the information I had gathered from Wendy was the kind counselors rely on during assessment of concerns. Then I presented two formal “opinions.”

First opinion

The first opinion was that the district failed to exercise reasonable care to protect Wendy from a backlash of ridicule and retaliation by faculty and students that was foreseeable under the circumstances. Both action and inaction were part of this neglect. I then discussed pertinent aspects of school administration, school counseling and school culture. I first described some differences in the roles and training of principals and counselors. Pertinent to this case, a head principal sets the tone and establishes the professional culture and climate, including expectations of ethical behavior from counselors and institutional tendencies to ignore or address conflict and other systemic concerns.

I explained that a school counselor can be an oasis for troubled individuals while also staying alert to general student morale. Trained to be nonjudgmental, objective, proactive, collaborative and not a disciplinarian, the counselor is skilled in listening and responding and helping students cope with stressors and live effectively. The American Counseling Association’s 2014 code of ethics, which makes respecting the dignity and promoting the welfare of clients the counselor’s primary responsibility, guides decision-making and behavior. The American School Counselor Association’s ethical standards state clearly that school counselors’ primary obligation is to the student and that they are to inform officials about conditions that are potentially disruptive or damaging to school mission or personnel. All of these aspects were pertinent to the case against the school.

Inaction: Administrators’ inaction suggested a school culture not geared to ensuring a safe environment for learning. School became a hostile and dangerous place for Wendy. Her parents were her only adult advocates.

1) Administrators did not take Wendy’s situation seriously, even though they were aware of the sheriff’s interviews at school and an earlier complaint about the bus driver. According to a deposition, a key administrator did not read students’ statements.

2) Administrators did not suggest that Wendy see a school counselor, who could have focused on her emotional health, and did not partner with school counselors to ensure her protection after the retaliation began.

3) Administrators ignored the bullying. According to Wendy, “About 15 [students] routinely harassed me.”

4) Administrators did not direct teachers to be alert for situations needing intervention, an action that might have given teachers permission to support Wendy. She sensed distance from formerly approachable teachers. Only two teachers, over the course of two years, offered a supportive comment (e.g., “Sorry to hear about everything”).

5) The harassment was visible to teachers. On one occasion, a clique of high-profile students interrupted a class, asked for Wendy and bullied her in the hall with threats of rape.

6) An administrator did not honor Wendy’s request to see a counselor after she was accosted by the girl whom Wendy had witnessed being assaulted. The girl would not acknowledge being assaulted and denied that Wendy had been assaulted. Only Wendy was sent home.

7) Administrators and teachers never asked why Wendy was often absent in the afternoons (“because I couldn’t take it anymore”), even when they had seen her earlier in the day. One of Wendy’s parents usually came to the office while she signed out, in full view of a principal.

8) The bus driver continued to drive his school route for several weeks after the complaint.

The inaction of the counselor Wendy consulted was also pertinent. Wendy’s well-being was at issue, and an alleged sexual abuser/harasser was under investigation prior to the first trial.

1) The counselor did not intervene with the bullies/harassers (e.g., talking with them individually) and was not active on behalf of a student in crisis, especially in a complex situation that involved threats and a distressed target.

2) When Wendy wanted to talk with the counselor after being accosted (“I’d done the right thing and gone to him”), he did not advocate for her when the principal sent her home.

3) Unlike her sister’s counselor, who appropriately called Wendy’s mother, Wendy’s counselor listened during their several meetings after the retaliation began (“I was often red-faced and crying”), but did not validate feelings or speak of reporting the situation to administrators. The collaborative aspect of addressing serious problems was missing.

4) The counselor did not contact child protective services or discuss that possibility with administrators. The situation involved a school employee with responsibilities for minors (“full power,” according to the student handbook), alleged sexual harassment of a student and implied danger for other students.

Actions: The superintendent was not receptive to Wendy’s parents’ complaint and was not respectful when they initially met with him. Administrator actions suggested a toxic school culture that gave permission to school personnel to treat Wendy and the situation inappropriately.

1) After Wendy’s mother complained about the incident in which harassers/bullies asked that Wendy come into the hallway, the teacher who had deferred to them said to Wendy, “I can no longer trust you.” The implicit school-culture message was that students should not tell parents about distressing incidents.

2) Wendy’s mother learned that one junior high teacher had commented to a neighbor that “[the bus driver] always liked the young girls. … I thought it was consensual.” This indicated that at least one teacher was aware of the bus driver’s behavior and normalized it.

3) In class, a teacher compared “the bus driver thing to the McDonald’s hot-coffee case.”

Second opinion

The second opinion was that Wendy suffered long-lasting psychological injury — PTSD, depression and developmental stuckness — as a result of the school district’s failure to protect her.

Scholars have theorized that bullying inherently involves a power differential. The bully or someone with more power than the bully is responsible for stopping bullying, not the person with relatively little power. Wendy said the bus driver had “total control.” She said, “I tried to sit in back. If called to the front … I tried to laugh it off, told myself that I was just being oversensitive.”

Wendy’s behaviors make sense in that context. In addition, many adolescents do not report harassment because much is at stake, and they are not likely to know how to handle that level of embarrassment, especially in front of peers. The lack of a supportive and protective response from school administrators during the bullying had an impact on Wendy’s well-being and development.

Emotional development: Stuck in sadness, anger. With her experiences invalidated, Wendy said, “I analyzed myself to death.” Reflecting feelings of hopelessness, she said, “I feel like it’s never going to end. Why can’t I be done with this?” She was “nervous about the future,” asking, “Will I ever be able to move on?”

I concluded that her symptoms of depression did not reflect a neurological predisposition: “Other than this, nothing in my life could be called ‘unhappy’ — boyfriend, family.” All of her sad language was related to the situation with the bus driver and the consequent bullying. She felt deep anger about the situation being “pushed aside” even by people who were supportive in public. When asked to elaborate on her statement about “the system,” she referred to the school failing her and the bus driver being acquitted. She then said, “I can understand why people … seek violence instead of authority.” 

PTSD: Stuck in reactivity. Wendy described symptoms associated with PTSD in my study of trauma: hypervigilance; extreme, confusing emotions; and high reactivity to contextual reminders. She was “afraid I’ll run into the principal at a public event.” She was “terrified” when she saw the bus driver in the lobby at her worksite: “I wanted to hide in the back.” When seeing a school bus, “my hands become sweaty.”

Social development: Stuck in not trusting. Workplace relationships and friendships had been affected. In the past, she had “friends all over the place.” Now it was “hard to let people get close.”

Physical/sexual development: Uncomfortable, self-conscious. Wendy’s responses to my questions about physical and sexual development fit the literature about sexual abuse: “My body image was fine. … I wore anything, happy with myself.” Now there was doubt: “Maybe I let too much show.” She said she currently wore T-shirts and jeans with “nothing showing.” She worried, “Will they see me as provocative?” The bus driver’s comments had led to reactivity to even playful sexual comments, which affected her relationship with her boyfriend: “I’m still uncomfortable with sexuality.”

Career development: Stuck. This former honor student said her vision of her future was “absent.” When I asked where she might be now without this experience, she said, “I’d be a teacher.” About higher education, she said, flatly, “I thought about college, but I don’t know what I could do forever [as a job] to make me happy.”

Outcome and implications

After the attorney studied the affidavit, we had two conversations. Eventually, he reported that the school district had refused to settle out of court and that the defense would probably want a deposition from me. However, three months later, he sent news that the case had been resolved. The terms would remain confidential, but he added, “I do believe this case will do some good down the road for similarly situated students.” He said I could reference the case in the future, and he approved the manuscript for this article. He indicated that he had learned from me.

Wendy’s parents’ persistence and the attorney’s investment and instincts about school-system culpability were advantageous. During several years of struggle, Wendy and her parents demonstrated courage, first at school and then during two court cases. This case is a reminder to counselors and counselor educators of the potential impact of receptivity and nonreceptivity of school personnel to frustrated parents and distressed students. It also underscores the potential impact of adult and peer aggression on development.

I encouraged the attorney, when a trial was expected, to incorporate the concept of school culture, not just climate, into his argument. Cultures have norms, protocols, actual and de facto leaders, and implicit and explicit rules. Behaviors at many levels here reflected well-established constraints, permissions and toxicity. Wendy’s experiences in her new school were in stark contrast to those in the school she had left.

Counselor educators can raise awareness in their teaching that institutional cultures differ, reflect leadership and affect students’ and clients’ well-being. A school counselor’s actions and inaction can affect school culture just as any other school leader’s behavior can. Counselors elsewhere can similarly contribute to and be affected by institutional culture.

More situations such as Wendy’s are likely to generate court cases. State laws now define bullying and require school districts to address bullying behavior, giving children and their parents leverage for complaints. However, counseling professionals’ knowledge and experience, especially related to development, ethical behavior and systems, can be applied beyond bullying cases. Their expertise is potentially valuable across a wide range of cases with similar overtones.

I am now an expert witness for the second time, for another case involving bullying. Regardless of whether it goes to trial, I am reminded that counselors and counselor educators can indeed be expert witnesses. I believe that discussing such court involvement during counselor preparation can help counseling professionals be confident in that role if asked, and I hope that first-person accounts such as this one might help counselors embrace the process.

 

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Jean Peterson, professor emerita at Purdue University, focused most of her clinical work and research on the social and emotional development of gifted youth, with special interest in those not fitting common stereotypes. She received 10 national awards related to research and 12 at Purdue for teaching, research or service. Among her several books is Talk With Teens About What Matters to Them. Contact her at jeanp@purdue.edu.

Letters to the editor: ct@counseling.org

Counseling Today reviews unsolicited articles written by American Counseling Association members. To access writing guidelines and tips for having an article accepted for publication, go to ct.counseling.org/feedback.

 

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Related reading, from the Counseling Today archives:

 

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Building better counselors

By John Sommers-Flanagan and Kindle Lewis November 6, 2017

In the opening chapter of the sixth edition of Counseling and Psychotherapy: Theories and Interventions (published by the American Counseling Association), David Capuzzi, Mark Stauffer and Douglas Gross make the case that the helping relationship is central to all effective counseling. Not many counselors would argue with this idea. Nevertheless, many counseling practitioners still feel pressure to implement empirically supported or evidence-based mental health treatments. Consider this case:

Darrell is a 50-year-old Native American. He identifies as a male heterosexual. In his first counseling session, he talks about feeling “bad and sad” for the past six months and meets diagnostic criteria for a depressive disorder. Darrell’s counselor, Sharice, is trained in a manualized, empirically supported cognitive-behavioral model for treating depression. However, as a professional counselor, she values collaborative counseling relationships over manualized approaches. She especially emphasizes relational connections during initial sessions with clients who are culturally different from her.

The question is, how can Sharice be relationally oriented and still practice evidence-based counseling? The answer: She can use evidence-based relationship factors early and throughout the counseling process.

Evidence-based relationship factors

Back in 1957, Carl Rogers wrote that “a certain type of relationship between psychotherapist and client” was “necessary and sufficient” to produce positive change. In contrast, if you immerse yourself in contemporary research on counseling and psychotherapy, you might conclude that relationship factors in counseling are passé and that, instead, cutting-edge (and ethical) practitioners must use empirically supported treatments. But you would be wrong.

Most reasonable people recognize that both relationship factors and techniques contribute to positive outcomes. However, it is also true that relationship factors in and of themselves have strong empirical support. More than 60 years of scientific evidence supports Rogerian core conditions of congruence, unconditional positive regard and empathic understanding. In fact, counseling relationship factors are just as scientifically potent (and maybe more so) as so-called empirically supported treatments.

Newer terminology for acknowledging the research base for therapeutic relationships has been coming for about 15 years. In 2001, a task force from Division 29 (Society for the Advancement of Psychotherapy) of the American Psychological Association coined the phrase “empirically supported therapy relationships.” The task force’s purpose was to place therapeutic relationships on equal footing with empirically supported treatments. Despite those efforts, many (and perhaps most) psychologists value technical procedures (for example, cognitive behavior therapy) over relational factors. In contrast, because of counseling’s emphasis on therapeutic relationships, in some ways, empirically supported therapy relationships are much more relevant to professional counselors.

In this article, we use the broader phrasing of “evidence-based relationship factors” (EBRFs) to represent ways in which professional counselors can integrate research-based relationship knowledge into counseling practice. But what is an EBRF, and how can counseling practitioners implement them in ways that are more specific than simply saying, “I value the therapeutic relationship?”

EBRFs include the three Rogerian core conditions and other purposefully formed and implemented relational dimensions. Below, we provide concrete examples of 12 EBRFs that are empirically linked to positive counseling and psychotherapy outcomes. For each EBRF, we use the case of Sharice and Darrell to illustrate how Sharice can work relationally with Darrell and still engage in evidence-based practice.

Evidence-based attitudes and behaviors

Rogerian core conditions of congruence, unconditional positive regard and empathic understanding are foundational EBRFs. Although Rogers described them as attitudes, they also have behavioral dimensions. Additionally, counselors bring other relational factors into the room, such as role induction, cultural humility and scientific mindedness. Together, these EBRFs create a welcoming, safe and transparent environment that fosters therapeutic relationship development. Simultaneously, counselors are responsible for managing their countertransference throughout the relationship development process.

Congruence

Congruence implies counselor self-awareness and involves holding an attitude that values authenticity. Clients typically experience counselor congruence as the unfolding of a genuine relationship with their counselor. Genuineness involves counselors striving to be mindfully open and honest in their interactions with clients. This usually, but not always, involves self-disclosure, immediacy and offering feedback.

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Sharice displays congruence in several ways. First, she presents Darrell with an informed consent document that is written in her unique voice and that includes information on how she works with clients in counseling. She also greets Darrell with clear interest in learning more about who he is and what he wants. To focus on him, she might sit and emotionally center herself before going to meet him in the waiting room.

During the session, when Darrell talks about details of his professional work, Sharice openly expresses curiosity, “Oh, you know, I’m not sure what you mean by that. Could you tell me more so I can better understand what you’re experiencing in the workplace?” After Darrell shares details, she says, “Thank you. That helped me understand what you’re up against
at work.”

Role induction

Role induction is the process through which counselors educate clients about their role in counseling. Role induction is necessary because clients do not naturally know what they should talk about and because they may have inaccurate expectations about what counseling involves. When it goes well, role induction is interactive, and counselors simultaneously exhibit Rogerian core conditions (“I hope you’ll always feel free to ask me anything you want about counseling and how we’re working together”). Role induction begins with the written informed consent form.

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Sharice includes in her informed consent document what her clients can expect in counseling. She also explores these topics with Darrell in their first session.

Sharice: I’d like to share a bit with you about what we’ll be doing in this first session. To start, I want to hear about what’s been happening in your life that brings you to counseling now. As you talk, I’ll ask a few questions and try to get to know you and your situation better. We’ll talk about what’s happening now in your life and, if it’s relevant, we’ll talk some about your past. Then, toward the end of our session, I’ll share with you some ideas on how we can work together, and we’ll start to make a counseling plan together. Please ask me questions whenever you like.

Unconditional positive regard

Unconditional positive regard involves the warm acceptance of clients. Rogers himself noted that unconditional positive regard was an “unfortunate” term because no counselor can constantly experience unconditional positive regard for clients. However, to the extent that it can be accomplished, unconditional positive regard involves acceptance of the client’s self-reported experiences, attitudes, beliefs and emotions. Unconditional positive regard allows clients to feel the safety and trust needed to explore their self-doubts, insecurities and weaknesses.

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Throughout their time together, Sharice shows Darrell unconditional positive regard by listening to his experiences, attitudes, beliefs and emotions without showing judgment. She’s open to whatever he brings into the session and encourages him when they encounter subjects he finds difficult to explore. She not only listens nondirectively but also asks questions such as, “What’s your best explanation for why you’re feeling down now?” and “What are you thinking right now?” These questions show acceptance by supporting and exploring Darrell’s self-evaluation rather than focusing on Sharice’s judgments.

Empathic understanding

Empathy is one of the strongest predictors of positive counseling outcomes. However, there is one interesting caveat. It doesn’t matter if counselors view themselves as empathic; what matters is for clients to view their counselors as empathic.

Although measuring empathic responding is challenging, there is consensus that using reflections of feeling and engaging in limited self-disclosure are effective strategies. Also, there is evidence from neuroscience research that resonating with or feeling some of what clients are feeling is part of an empathic response.

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When responding to Darrell, Sharice uses her facial expressions, posture, voice tone and verbal reflections in an effort to comprehend Darrell’s unique thoughts, feelings and impulses. She expresses empathy as he talks about work stress.

Darrell: I feel pressure coming at me from everywhere. Deadlines that need to be met, clients to make happy, bills that need to be paid, and I need to maintain this image in the community, you know?

Sharice: That sounds stressful. You have people counting on you, and it feels overwhelming.

Following an initial reflection of feeling, Sharice uses what Rogers referred to as “walking within” to emotionally connect on a deeper level.

Darrell: It’s starting to get to me in ways stress hasn’t before. Like, I can’t sleep, it’s harder to focus, and I feel like I’m going to burn out soon.

Sharice: It’s like you’re saying, “I don’t know how much more of this I can take, and I don’t know what to do.” Do I have that right?

Later, Sharice uses a reflective self-disclosure (which combines congruence with empathic understanding) in an effort to deepen her empathic resonance.

Sharice: As I listen to you, Darrell, and as I try to put myself in your shoes, I feel physically anxious. It’s almost like this pressure and pace make me feel out of breath. Is that some of what it feels like for you?

Just like Carl Rogers would do, Sharice intermittently checks in with Darrell on the accuracy of her reflections (“Do I have that right?”). Additionally, if Darrell indicates that Sharice is not hearing him accurately, she uses paraphrasing to refine her reflection and sometimes apologizes while correcting herself.

Cultural humility

Cultural humility is an overarching multicultural orientation or perspective that includes three dimensions:

1) An other-orientation instead of a self-orientation

2) Respect for client values and ways of being

3) An attitude of equality, not superiority

Like the Rogerian core conditions, cultural humility is an attitude that counselors adopt before entering the counseling office, but there are also behavioral manifestations of cultural humility.

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In their first session, Sharice creates a space for Darrell to speak about what his culture means to him. She notes that even though they come from different cultures, understanding his culture is important to her.

Sharice: Thank you for filling out the intake form, Darrell. I know it can be daunting with all the personal information we ask for. I see that you are Native American. I’m a mix of German and Swiss and grew up outside of Denver. What this means to me is that I’ll be trying my best to understand your life experiences. If at any point you think I’m not getting your perspective, I hope you’ll tell me. Sound OK? (Darrell nods.) Thanks. Also, whenever you’d like, I’d be interested in hearing more about your culture and how it informs your way of being in the world.

Scientific mindedness

Scientific mindedness is a concept and skill originally described by Stanley Sue. It refers to the process of counselors forming and testing hypotheses about clients rather than coming to premature, and potentially faulty, conclusions.

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As Sharice gets to know Darrell and the issues that brought him to her office, she uses scientific mindedness to hypothesize how culture may (or may not) be a salient factor in his experience of stress in the workplace. When he talks about “immense pressures” that he puts on himself, she’s reminded of how some individuals from minority groups can feel added stress because they view themselves as representing their entire minority community. Sharice keeps this hypothesis in the back of her mind and, eventually, when the time seems right, uses a reflective listening response to test her hypothesis.

Sharice: When you talk about the pressure you put on yourself to perform, it sounds like you’re performing not only for yourself but also for others.

Darrell: Absolutely. I can’t help but worry because my family depends on me to generate income. (Somewhat to Sharice’s surprise, Darrell doesn’t identify his tribe or the reservation community as an additional source of pressure to perform, so she explores the issue more directly.)

Sharice: I’ve read and heard from some of my other Native American clients and students that it’s possible to feel added stress because they might view themselves as representing their tribe or other Native American people. Is that true for you?

Darrell: I always tell myself that that’s not an issue for me. But if I’m totally honest with myself and with you, I’d have to say that being an Indian man in an intense business environment makes for more stress. In some ways, I think it has less to do with representing my people and more to do with how I think my colleagues — and even my friends at work — somehow expect me to be less competent. I don’t know exactly what they think of me, but I feel I need to work twice as hard to earn and keep their respect. (After listening to Darrell’s disclosure, Sharice updates her hypothesis about how race and culture might be adding to his stress at work.)

Sharice: So, it’s not so much that you feel like a representative for your people. It’s more that you’re thinking and feeling that you should do double the work to prove yourself to your colleagues. I can imagine how feeling discounted compounds the everyday workplace stress you feel.

Managing countertransference

Countertransference is unavoidable. Countertransference includes the counselor’s emotional reactions to any or all clinically relevant client material (transference, client personality, content presented by the client, client appearance and so on). These reactions may be related to the counselor’s unresolved personal conflicts or the client’s interpersonal behaviors. Countertransference can be a hindrance or a potential benefit to the therapeutic process; it can distort your perceptions of your client, but it can also inform your relationship with the client.

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During their work, Sharice notices that she gets impatient with Darrell’s pace of speech and finds herself feeling annoyed with him. She brings this to her consultation group to understand why this is happening and how it is affecting her work with Darrell. Talking about it with her supportive group helps her deal with her emotional reactions more effectively and build understanding for why she is experiencing frustration and how to adjust so she can provide the best service possible to Darrell.

The evidence-based therapeutic alliance

The therapeutic alliance was a psychoanalytic construct until Edward Bordin described it in pantheoretical terms. Alliance factors include three dimensions:

1) The emotional bond

2) Mutual goals

3) Collaborative tasks in counseling

Additionally, progress monitoring and rupture and repair can be viewed as EBRFs related to the alliance.

The emotional bond

Although it can be difficult to measure an emotional bond, in the counseling context it is usually defined as clients showing a positive affective response toward their counselors. In many ways, the counselor-client emotional bond is a natural byproduct of the Rogerian core conditions and of the work that counselors and clients do together. However, counselors lead in this process by greeting clients with a positive affect and consistently showing interest in what clients talk about.

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When Darrell arrives at Sharice’s office, she is visibly happy to see him. In addition, she expresses her interest in working with him and her belief that he possesses the ability to overcome the issues with which he is struggling.

After a few sessions, Darrell begins to show trust in Sharice. He no longer looks anxious to be in her office, his speech is less guarded and he smiles more during their interactions. He mentions that although counseling is difficult at times, he appreciates having time every week with Sharice to talk about his life and sort out what is troubling him. He has become emotionally bonded to Sharice and looks forward to counseling sessions.

Mutual goals

In the first few sessions, counselors and clients explicitly discuss clients’ personal problems and corresponding counseling goals. Eventually, and sometimes even in the first session, clients and counselors agree on which goal or goals to focus on in counseling.

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Sharice (after discussing Darrell’s presenting problems and possible solutions): Darrell, we’ve identified several goals that we can work on together: stress management, managing the negative or critical thoughts you have about your work performance and getting better sleep. Which of these would you like to focus on first?

Collaboration on tasks linked to goals

After working with clients to decide on counseling goals, counselors introduce tasks or activities in session (or as homework) that are meaningfully related to the agreed-upon goals. These collaborative tasks often constitute the “technical” part of counseling.

When applying techniques, relationally oriented counselors:

  • Are careful to listen closely to what clients have already tried
  • Use reflective listening to gain a mutual understanding of what has worked worse or better
  • Jointly brainstorm new options with clients
  • Ask permission to try out technical procedures
  • Jointly monitor client reactions to new strategies

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Sharice: We’ve been talking about everything you’ve tried to help yourself sleep better. It sounds like you’ve been working on this for years. How about we rank which strategies have worked better for you and which have worked worse?

Darrell: Sure. (Sharice and Darrell work on Darrell’s rankings.)

Sharice: One of the things I’ve noticed that seems to work better for you is
when you’re able to distract yourself from your thoughts about work. Does that sound right?

Darrell: Absolutely. It’s so hard for me to get my brain to stop problem-solving.

Sharice: One thing I’d add to your list of possible strategies is mindfulness meditation. It can be a powerful technique to deal with racing thoughts. What’s your reaction to that idea?

Progress monitoring

After counseling goals are established and collaborative tasks identified, counselors and clients work together to evaluate counseling progress. There’s a robust body of research attesting to the positive effects of progress monitoring.

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Sharice consistently checks in with Darrell in two ways. First, she uses the Session Rating Scale after each session to gauge her therapy alliance with Darrell. Second, she directly asks Darrell about his reactions to the counseling strategies they are working on together.

As a part of her progress monitoring efforts, Sharice asks Darrell to keep a log of his mindfulness meditation activities, along with his sleep quality and quantity. Each week, they discuss what went well and what was challenging. She offers empathy and makes adjustments to his homework as needed.

Rupture and repair

Rupture is defined as tension or a breakdown in the counselor-client collaborative relationship. Repair involves counselors making statements and taking actions to restore the therapeutic relationship. Rupture can happen at any time during counseling. Usually it involves clients withdrawing or showing irritation.

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After a few weeks of logging his mindfulness meditation, Darrell appears agitated. When Sharice asks about the log, Darrell says, “This is a waste of time, and I don’t know why you thought it was going to help. I’m done with this stupid meditation.”

Sharice responds empathically and then explores with Darrell the source of his frustration. She discusses how embracing a passive attitude during meditation can be extremely difficult, especially because of the pressured and problem-solving orientation he has at work. She apologizes for pushing the idea of mindfulness meditation.

Darrell’s response is paradoxical. He spontaneously shares how important it is for him to find time to get out of his hard-driving mentality. Sharice then tweaks the mindfulness approach they have been using. The new emphasis moves away from formal logging and embraces small moments of progress.

The relationally focused, scientifically based counselor

Beginning with Rogers and moving forward into the 21st century, counseling practitioners have embraced the therapeutic relationship as central to positive counseling outcomes. However, at times, allegiance to and emphasis on the counseling relationship has been viewed as anti-science. The good news is that, now, more than ever, we have growing empirical evidence to support the efficacy and effectiveness of a relational emphasis in counseling. In this article, we reviewed and illustrated specific ways in which you can emphasize the therapeutic relationship and be evidence-based. This is welcome progress for the counseling profession in general and counseling practitioners in particular.

 

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Knowledge Share articles are developed from sessions presented at American Counseling Association conferences.

John Sommers-Flanagan is a professor in the Department of Counselor Education at the University of Montana. He has co-authored many books, including Tough Kids, Cool Counseling (published by the American Counseling Association) and Counseling and Psychotherapy Theories in Context and Practice (published by Wiley). Contact him at john.sf@mso.umt.edu or through his blog at johnsommersflanagan.com.

Kindle Lewis is a doctoral student in counselor education and supervision at the University of Montana. She is a national certified counselor, holds a license in school counseling and has 10 years of experience working with youth in education and counseling settings both locally and internationally. Her areas of focus are youth and school counseling, community building and holistic wellness. Contact her at kindle1.lewis@umconnect.umt.edu.

Letters to the editor: ct@counseling.org

 

 

 

 

 

 

 

 

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.