Tag Archives: Counselor Educators Audience

Counselor Educators Audience

Home is where the client is

Dawn Friedman September 1, 2012

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

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

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

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

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

Safety first

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

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

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

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

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

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

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

Understanding services

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

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

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

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

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

Mandate for the profession

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

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

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

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

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

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

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

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

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

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

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

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

Letters to the editor: ct@counseling.org

Proof positive?

Lynne Shallcross

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

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

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

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

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

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

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

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

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

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

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

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

‘A theoretical basis is not enough’

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

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

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

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

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

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

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

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

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

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

Widening the scope

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

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

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

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

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

Making research relatable

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

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

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

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

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

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

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

‘Voices from the field’

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

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

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

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

Research in a humanities profession

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

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

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

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

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

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

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

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

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

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

 To contact the individuals interviewed for this article, email:

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

Letters to the editor: ct@counseling.org

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

A home for research

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

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

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

What will its goals be?

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

What do you hope to see the center accomplish?

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

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

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

— Lynne Shallcross

 

Leaving room for creativity

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

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

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

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

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

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

— LS



Sidebar: Counselors weigh in on evidence-based counseling

Lynne Shallcross

In this sidebar to the September cover story, two counselors with different backgrounds share their thoughts on evidence-based counseling.

Click here to read the cover story, “Proof Positive?”

A view from across the pond
Johanna Sartori is a British Association for Counselling and Psychotherapy-accredited counselor/psychotherapist working in private practice in London. To contact her, email johanna.sartori@o2.co.uk.

Share your view on evidence-based practice.

My thoughts are that any profession from medicine to management benefits from collecting, reviewing and sharing evidence. What worries me about therapy in the United Kingdom right now — and from what I read, it seems this is further along in the U.S. — is that the pressure for diagnosis, treatment plan and quantifiable results means that public funds are diverted nearly entirely toward CBT (cognitive behavior therapy). The benefit of more relational-based therapy is best studied by qualitative rather than quantitative research, and this does not fit with the general payment-by-results policy. Yet it is the nuance of the therapeutic relationship that we learn time and time again is crucial to any benefit being realized. In essence, I think evidence-based counseling is a good thing, but it needs to be expanded to take in different research methods and different therapy models. This takes time and effort, and we ought to be working together to start producing this.

Explain how the situation stands in the United Kingdom.

The current situation in the U.K. means that a choice in talking therapies is only available to those with enough money to pay for private therapy. Otherwise, the National Health Service (NHS) offers a very limited range of services based around CBT. I feel strongly that public money should be made available to facilitate NHS patients working with the many existing experienced and professional practitioners in private practice, but that we in return have to demonstrate our efficacy. Given that there are thousands of private practitioners doing good work throughout the U.K., it seems to be a fantastic opportunity to agree [on] an acceptable way of monitoring this and learning from the aggregate data. I know from discussions on LinkedIn that Clinical Outcomes in Routine Evaluation (CORE) is used by many practitioners, and I think there are opportunities to share findings from this. CORE measures the experience of the client, and if used at the assessment and ending sessions, shows the increase in well-being resulting from therapy.

Are there any drawbacks to evidence-based practice?

The drawback I see is that a conviction that “evidence is king” appears to override the need to examine that evidence. Public funds in the U.K. are channeled into the Improving Access to Psychological Therapies Programme (IAPT), mainly because it demonstrates outcome through regular reporting. However, if you look closely at what that evidence actually says, you see that IAPT services do not actually demonstrate good results. Waiting times for some are over three months, a course of treatment may be as little as two sessions and success rates overall are as low as 15 percent. Despite this, because these services are measurable, they are approved by the National Centre for Clinical Excellence and publicly funded.

— Lynne Shallcross

A practitioner’s take

American Counseling Association member Jason Menegio is a counselor and evidence-based practice specialist working at a nonprofit organization in Greensboro, N.C. To contact him, email jason.menegio@monarchnc.org.

What does your work encompass?

My primary responsibilities are to research and oversee the implementation of evidence-based and emerging best practices in assigned service areas including, but not limited to, providing training, monitoring, mentoring and continuing education. I also ensure that each individual who receives services has access to treatment/services/supports that are based on an evidence-based practice or emerging best practice, which is the basis for all service provision.

Why is evidence-based practice important?

Learning what treatments are effective and evidenced and backed up by research helps to guide our treatment decisions and to promote the overall well-being of clients being served, as evidenced by improved outcome measures. In other words, evidence-based practice helps to ensure that clients are getting the best service possible.

What are some of the benefits to evidence-based practice?

Some of the primary advantages include its ability to be data-driven, and [it] can be evaluated for its degree of effectiveness. It exposes potential gaps [in] what was studied and what needs further research. And it identifies effective interventions based on reviews of multiple rigorous studies rather than on subjective interpretations of the reviewer or clinician.

— LS

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

Cincinnati is full of surprises

Heather Rudow

In the past, tourists looking for a vacation hotspot in the Midwest tended to overlook Cincinnati in favor of larger cities. But this diamond in the rough has undergone a cultural transformation throughout the past decade — so much so that well-known travel guide Lonely Planet named Cincinnati one of its top three U.S. travel destinations for 2012. Even so, counselors and their families attending the American Counseling Association 2013 Conference & Expo (March 20-24) might be surprised by all that the Queen City has to offer.

Cincinnati, the third-largest city in Ohio, sits along the Ohio River at the border of Kentucky and close to Indiana. It features unique offerings in the way of food, history and entertainment. Cincinnatians are proud of their hometown, and ACA members who live there are excited to show off all that the city has to offer to conference attendees.

Jewels of the city

G. Susan Mosley-Howard, a professor of educational psychology at Miami University of Ohio and an ACA member, has been living in Cincinnati for nearly 20 years. She says the city’s unique neighborhoods, stunning riverfront views and thriving fine arts community are some of her favorite things about Cincinnati. She hopes her fellow ACA members and conference-goers will take advantage of those features as much as possible while visiting.

When conference attendees have some downtime, Mosley-Howard says they should “definitely go to the Cincinnati Museum Center at Union Terminal, the Cincinnati Zoo [and] Botanical Garden area, explore Findlay Market, take a walk through downtown and simply enjoy a meal on Fountain Square.”

Formerly known as the Cincinnati Union Terminal, the Cincinnati Museum Center at Union Terminal was one of the last great railroad stations built in the United States. It has since been transformed into museums, theaters and the Cincinnati History Library and Archives. The Cincinnati Museum Center holds the Museum of Natural History & Science and the Cincinnati History Museum, along with an Omnimax theater. According to locals, the beautiful architecture of the 1930s art deco-style railroad station is alone worth a visit.

First opened in 1875, the Cincinnati Zoo and Botanical Garden not only is one of the oldest zoos in the United States, but also is consistently ranked as one of the nation’s best, housing everything from gorillas to polar bears to white tigers. The botanical gardens are filled with perennial flowers, native plants, trees, shrubs and various other flora that visitors can take in after they have finished seeing the fauna at the zoo.

The zoo and botanical garden are just a couple of miles from Findlay Market, the oldest continuously operated public market in Ohio. The market, which is brimming with prepared foods, local fruits and vegetables, cheeses, pastries, coffee, and wine and spirits, is open year-round except for Mondays. Visiting Findlay Market is a great way to get both a literal and figurative taste of Cincinnati’s local flavor as well as a bit of the city’s history because the market is located in the notable Over-the-Rhine district.

In the 1840s, Germans immigrated in large numbers to Cincinnati and tended to settle in the northern part of the city, which developed into today’s Over-the-Rhine neighborhood. The area began to go through a resurgence about six years ago and has developed into one of Cincinnati’s brightest cultural hotspots. Locals say Over-the-Rhine offers a plethora of great places to eat and drink and is one of the most diverse neighborhoods in the city. It is also home to Cincinnati’s arts community, including the free-of-charge Cincinnati Art Museum and the American Classical Music Hall of Fame.

ACA member Carl Grueninger, lead counselor for Cincinnati Public Schools and chair of the counseling department at Walnut Hills High School, has family ties to the area. His great-grandparents settled in Over-the-Rhine after emigrating from Germany. “[The neighborhood] has cutting-edge restaurants, the Music Hall [and] 19th-century architecture,” he says.

During that time period, German entrepreneurs built a successful brewing industry that became associated with Over-the-Rhine. Grueninger recommends heading to Moerlein Lager House, which brews its own German-style beer and gives visitors a bit of the history of the area through its drinks.

Getting a taste of Cincinnati

Additionally, Grueninger suggests that conference attendees partake in some of the city’s other unique dining experiences. First, he recommends grabbing a plate of chili — though Cincinnati’s take on the classic dish is a little different than one might expect. The chili itself is a regional take on chili con carne, with different spices and a thinner consistency, but what really sets the city’s chili apart is all of the “ways” that Cincinnatians love to get it.

Grueninger’s personal recommendation is to order a “four-way,” which he describes as “chili and a generous topping of shredded cheese on a cheese coney — a hot dog [with] mustard, onions and shredded cheese on a bun.” Diners also have the option of ordering their chili served over spaghetti instead of on a cheese coney. Other options include purchasing a “three-way” (chili, spaghetti or a hotdog, and cheese), a “five-way” chili, spaghetti or a hotdog, cheese, onions and beans), a “two-way” (chili and spaghetti or a hotdog) or simply a “bowl,” with just the chili itself.

Chili parlors are abundant in Cincinnati, but Grueninger says the three most popular are Skyline Chili, Gold Star Chili and Camp Washington Chili.

After a satisfying chili dinner, conference-goers might also want to sample a scoop of Graeter’s ice cream, a much-loved regional chain that originated in Cincinnati. “The best ice cream in the world,” declares Grueninger. “My favorite flavor is the black raspberry chocolate chip.” A Graeter’s location in Fountain Square is within walking distance of the Duke Energy Convention Center, where the ACA Conference & Expo will be held.

“Cincinnati’s Fountain Square is the center of our city,” Grueninger says. “Whenever someone comes to visit the city — an important politician, when we win at sports or when the Choir Games are in town — we gather at Fountain Square. It is about two blocks from the convention center where the conference will be held, and many of the hotels people will stay at are either surrounding Fountain Square or are only a few blocks from it.”

For those conference attendees looking to unleash their inner carnivore while in Cincinnati, Grueninger suggests heading to the Ohio River to dine at Montgomery Inn at the Boathouse. “Former presidents, the late Bob Hope and many sports figures all would eat here for the famous ribs,” he says. Or attendees can check out Jeff Ruby Steakhouse, located on Walnut Street in nearby Fountain Square, for what Grueninger considers the “best steaks in town.”

A new hub of activity

Locals also recommend visiting a newly developed neighborhood called The Banks, located (logically enough) along the banks of the Ohio River. The city recently revamped this riverfront area, turning it into a stylish hub of activity that is within walking distance of the convention center. Among the neighborhood’s highlights are Smale Riverfront Park; the National Underground Railroad Freedom Center, where visitors can learn about the history of slavery in America and investigate their genealogy; the Taft Museum of Art, which features unique works of art, both from Cincinnati artists and from artists around the world; and the Cincinnati Reds Baseball Team Hall of Fame, which is the largest team hall of fame in the United States. Visitors can also tour the former home of President William Howard Taft, located in The Banks district. Additionally, Harriet Beecher Stowe, author of Uncle Tom’s Cabin, used to reside a couple of miles northeast in the Walnut Hills neighborhood of Cincinnati. Her home is available for tours as well.

There are also interesting places to drink in The Banks, such as Moerlein Lager House and Toby Keith’s I Love This Bar & Grill, owned by the country music star and presumably named after his hit song “I Love This Bar.”

Because of Cincinnati’s close proximity to Kentucky, it is also easy to venture outside of the city during one’s stay. “You can walk across the river on the Purple People Bridge” — a pedestrian-only walkway known officially as the Newport Southbank Bridge — “or the John A. Roebling Suspension Bridge, [which] Roebling designed … before the Brooklyn Bridge, and visit Newport on the Levee or Covington, Kentucky,” Grueninger says. “Riverboat cruises are available also.”

Mosley-Howard adds that getting around the city, which is 80 square miles, shouldn’t be difficult for conference attendees. “If you are staying downtown, walking is easy,” she says. “The city’s metro bus system is good, however, to get around in the city core.” For more information on Cincinnati’s metro system, visit its website at go-metro.com.

Both Grueninger and Mosley-Howard are looking forward to having others in ACA experience the charm and positive spirit they see every day in Cincinnati.

“Cincinnati is known as a friendly city,” Grueninger says, “and I hope to meet many of my fellow counselors in March.”

For more information on the ACA 2013 Conference & Expo, including tours of the city provided by ACA, visit counseling.org/conference.

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

Letters to the editor: ct@counseling.org

Facts about Cincinnati 

  • Cincinnati was originally called Losantiville, meaning “the city opposite the mouth of the Licking River,” when it was settled in 1788. The city was renamed in 1790 after an organization formed by officers who served in the Revolutionary War called the Society of the Cincinnati.
  • Cincinnatians, extremely proud of the massive growth of their city during its first 40 years, began referring to their home as the “Queen City” or the “Queen of the West.” The nickname was memorialized in Henry Wadsworth Longfellow’s 1854 poem “Catawba Wine.”
  • Cincinnati was also known as Porkopolis for a time beginning around 1835, when it was the country’s chief hog-packing center and herds of pigs traveled the streets. Some locals speculate that this chapter of Cincinnati history is where the city’s famous Flying Pig Marathon got its mysterious name.
  • Well-known Cincinnatians include Henry Heimlich, George Clooney, Doris Day, Annie Oakley, Steven Spielberg, Jerry Springer, Bootsy Collins and the Isley Brothers.
  • The Cincinnati Reds, formed in 1869, were the first all-professional baseball team in the United States. The city also hosted the first night game in Major League Baseball history in 1935.
  • Cincinnati is home to the first professional city fire department in the United States.
  • The Oscar-nominated film Seabiscuit starring Jeff Bridges and Tobey Maguire was filmed in Cincinnati.
  • Cincinnati was the first U.S. city to establish a municipal university — the University of Cincinnati in 1870.
  • Cincinnati was the site of the first airmail transportation in the United States in 1835. The mail was carried by hot air balloon.
  • Two-thirds of the U.S. population lives within a one-day drive of Cincinnati.

— Heather Rudow

What travel sites are saying about Cincinnati

  •   Frommer’s recommends visiting the Mount Adams neighborhood for “stunning views of downtown and the Ohio River.”
  • Lonely Planet chose Cincinnati as one of its top U.S. travel destinations for 2012. Cincinnati’s “historically entertaining” American Legacy Tours, the American Sign Museum and Carew Tower, the world’s tallest standing pre-World War II tower, are just a few of the reasons the city made the list.
  • Budget Travel magazine ranked Cincinnati as one of America’s “11 Greatest Waterfront Towns.” The magazine suggests dining at Montgomery Inn at the Boathouse for its “unique riverfront setting,” as well as signing up for a historic boat cruise on BB Riverboats.
  • Midwest Living magazine says, “This historic city on the Ohio River offers top cultural institutions and a revitalized riverfront.” Among the highlights on its list of Cincinnati’s 15 top attractions are the Cincinnati Zoo and Botanical Garden, the National Underground Railroad Freedom Center (see picture above), the Cincinnati Observatory, downtown’s Contemporary Art Center, Hyde Park Square and Findlay Market.

— HR 


Q & A with a counselor: David Christian

Heather Rudow August 30, 2012

David Christian is a high school counselor in the Denton Independent School District in Texas who opts to go outside the box – literally – to better connect with his students.

Christian, who is a doctoral candidate in the counseling program at the University of North Texas (UNT) and a member of the American Counseling Association, the American Mental Health Counselors Association (AMHCA), the Association for Counselor Education and Supervision (ACES) and the Texas Counseling Association, uses a method called adventure-based counseling, which uses physical activities to get to emotional roots.

Christian explains how spending his childhood summers roughing it Colorado helped spark his interest in adventure-based counseling and why he thinks the intervention would be useful for other school counselors.

To learn about other active interventions, read Counseling Today’s December 2011 cover story, Getting off the couch.

Describe how you first got involved in adventure-based counseling?

Although I am from Texas, growing up, I spent the summers camping in Colorado with my father and grandfather. Our days consisted of hiking, fishing and chatting. Looking back, I realize that our best conversations happened while we were doing something (i.e., fishing, hiking, canoeing). Sitting around the campfire at night also gave me a great opportunity to hear of family traditions and seek advice from those I looked up to. There was something about being outside in nature; it probably had a lot to do with not being distracted by electronics that seemed to foster reflection and conversation. As I grew older, I became active in rock climbing and all types of other outdoor activities. While completing my undergraduate degree in psychology, I became interested in how to improve father/son relationships. Based on my experiences, I wanted to incorporate outdoor experiences into helping others. It was not until I was working on my master’s degree in counseling that I heard about adventure-based counseling (ABC). No one in my program at the time was into it, but I happened to stumble upon a book called Exploring the Islands of Healing. As I read it, I knew that this was what I wanted to do and was excited that others were also interested. I was teaching high school at the time, so I began to incorporate activities into my teaching. I also started leading ABC groups after school as part of my internship. Since then, I have had the honor of collaborating with some pretty awesome people — mainly, Nate Folan of Project Adventure and Torey Protrie-Bethke of Antioch University in New Hampshire. They have been amazing in helping me improve my understanding and practice of ABC. Carolyn Kern (of UNT) and I have been working to incorporate resiliency into ABC.

What kind of an effect have you seen adventure-based counseling have on your students?

One of the main benefits I have seen from ABC is trust. As the students complete activities together, they begin to realize that they can trust each member to help the group be successful. This quickly translates to trust in other areas. The kinesthetic activity also helps students let their guard down and talk about what’s going on in their lives. I have noticed a big impact with my male participants. I’ve run groups where boys from all walks of life are sharing what they are going through, quickly realizing that they are not alone in their struggles. One of the greatest experiences I had was during a group when one of the guys stated that he didn’t have any money for lunch. None of the other members had his same lunchtime, but one offered to miss the first part of his class to run to the café and buy him lunch. These were two guys who hadn’t even met a few weeks before but were now going out of their way to help each other out. Another way I have seen ABC affect students is by helping them better understand who they are and what they have to offer society. When doing an activity toward the beginning of the groups, the “big and strong” guys are usually singled out to do the heavy lifting. We always process this and talk about why the others don’t step in and do their part. We process how everyone has a talent or gift and that by not offering it to the group, everyone missed out on it. One time, I had a group where we were doing an activity that one of the girls did not want to participate in. She decided to sit on the table and watch. Before long she was cheering on the team, offering up suggestions for success and at one point performed 25 pushups in order to help the group move forward. This same student would lead the group in funny songs during the activities and emerged as quite the humorous leader.

Describe a typical session with your students:

I always structure my sessions with a warm-up, an activity and a time for processing. The warm-up typically consists of a fun, “get to know you” activity. The main activities are sequenced to promote deeper psychological disclosure as the group progresses and trust is formed. The processing time is extremely important and is what separates ABC from [physical education classes]. I follow a modified version of David Kolb’s experiential learning cycle. First we do the activity. Next we discuss what we just did. These are just the observations everyone made. Then we talk about the so what of the activity. Why did we do that? How does it relate to what they are going through? During this time the members might come up with some metaphors for the activity. Finally we discuss the now what. During this time we talk about how they might transfer their new insights and understandings to their everyday life.

What kinds of positive results have you seen through your work?

I love seeing kids gain new insight into who they are and how their behavior is affecting their interactions with others. It’s really awesome to hear the students use the metaphors they are learning in their everyday lives. Some of the key results I have seen are new friendships and support systems in the school, improved decision making, greater self-efficacy and increased trust.

Are there any misconceptions about adventure-based counseling?

Yes! The main one is that ABC has to be done at a ropes-course or in the wilderness. Although ropes courses are a great tool, you can do ABC anywhere. I regularly lead groups inside a school classroom. I prefer to be outside and do so whenever possible, but often times I find myself confined within four walls. Another misconception is that ABC is only for young people. I have led groups with middle school students all the way up to people with 20+ years of experience in school counseling. I have led them in group homes, high schools, universities and professional development settings. I always say that the group members will have as much fun as the facilitator has, regardless of age. In one group I was leading, I had a teenage boy who was living in a residential facility. He had clearly lived a rough life and had a pretty tough exterior. I was nervous he would not participate and [would] think what we were doing was silly. However, he jumped right in and was acting silly and having fun like the rest of us. I was later reminded of how hard his life had been when I offered him a blue bandana for an activity and he exploded in a fit of anger for my even expecting him to wear such a color: a mark of a rival street gang.

What kinds of counselors do you recommend taking advantage of adventure-based counseling?

School counselors can use ABC to facilitate discussion, especially with males. Males typically struggle with emotional communication, so it is helpful if [they] can act out their feelings and then discuss what everyone experienced. I was recently working with a director of guidance to add some ABC activities to a professional development to facilitate better understanding of the concepts. Although best done in groups, I have also adapted ABC to individual and paired counseling. I think if you are a counselor, and you like having fun, you should find a way to learn more about ABC and think about implementing it in parts of your practice.

Are there techniques used in adventure-based counseling that all counselors can use with their clients?

Absolutely. There are books with fun activities that can be adapted to fit any setting. However, I think it is important to seek out workshops and learning experiences related to ABC. Further, it is important to remain within one’s scope of competence. After all, we are responsible for our clients’/students’ physical and emotional safety.

Is there anything else you’d like to add?

ABC is a wonderful way to have fun and promote growth and change in our students/clients. By using ABC, counselors are able to create a fun environment that feels more like P.E. than therapy. This allows students, especially males, to let their guard down and engage in the process. After all, what kid doesn’t like to have fun?

Looking for more information? Christian says Project Adventure has many resources and is a good place to start.

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