Chapter 2: Counseling Theory, Competency, Research & You: Connecting the Dots Flashcards
Counselors
Use counseling theory to
Develop a specific form of helping relationship
Articulate more useful understandings of clients’ situations
Identify effective means to resolve clients’ presenting problems
Theory
Primary tool that counselors and psychotherapists use to help people; provides a means for quickly sifting through the tremendous amount of information clients bring; then targeting specific thoughts, behaviors, or emotional processes for change and finally helping clients to effectively make these changes to resolve their initial concerns
Major Movements in the Recontextualization of Counseling and Psychotherapy Theory
Competency
Research and Evidence Base
Competency
Common Threads in Competent Use of Theory Diversity and Multicultural Competence Research Competence Laws and ethics Person-of-the-counselor
Research & Evidence Base
Reframing and Redesigning Theory
Common factors (across theories) research
Evidence-based practice and treatments
Diversity & Multicultural Competence
Application and applicability varies on the basis of diversity issues such as age, ehtnicity, sexual orientation, ability, socioeconomic status, immigration status, etc.
Research and the Evidence Base
To be competent, counselors must be aware of the research and the evidence base related to their theory, client populations, and presenting problem
Ethics
The counselor must have a firm grasp of legal and ethical standards that relate to professional health practice; confidentiality
Person-of-the-counselor/Person-of-the-therapist
Specific personal qualities are identified as competencies of mental health professionals
Diversity
Factors inform the selection of the theory, development of the counseling relationship, assessment and diagnosis process, and choice of interventions; some groups experience far more traumatic and painful forms of marginalization than others, and to further complicate matters, each individual responds to these pressures differently; involves paying close attention to the unique needs of the unique needs of each person
Research & Competency
Understanding and using research to inform treatment and to measure one’s effectiveness and client’s progress
Key Practices in Becoming More Evidence Based in Mental Health Care
Using existing research to inform clinical decisions and treatment planning
Learning to use evidence-based treatments, which are specific and structured approaches for working with distinct populations and issues
Legal Issues
Confidentiality Diversity Scopes of Competence and Practice Dual Relationships Defining the Client Children's Rights to Confidentiality Personal Concerns Mandated Reporting
Person-of-the-Counselor & Competency
Integrity, Honesty, and Diligence;
Therapeutic Presence
Therapeutic Presence
A Quality of self considered to have intrapersonal, interpersonal, and transpersonal elements, including elements of empathy, compasion, charisma, spirituality, transpersonal communication, patient responsiveness, optimism, and expectancy
Common Factors Debate
Questioning of the role of theory; Common Factors Proponents contend that effectiveness of counseling has more to do with key elements found in all theories rather than the unique components of a specific theory
Michael Lambert
Developed the Common Factors Model; compared models to the generic treatment as usual or a no-treatment control group
Lambert’s Common Factors Model
Client Factors (40%)
Therapeutic/Counseling Relationship (30%0
Therapeutic/Counseling Model (15%)
Hope/Placebo Effect (15%)
Client Factors
Incluede client motivation, resources, etc.
Therapeutic/Counseling Relationship
Quality of the Counseling relationship as the client evaluates it
Therapeutic/Counseling Model
Counselor’s specific model and techniques used
Hope/Placebo Effect
Client’s level of hope and belief that counseling will help
Wampold
Conducted a meta-analysis and compared only studies that included two or more bona fide counseling models
Wampold’s Common Factors Model
Therapeutic/Counseling Models 8%
General Factors 70%
Unknown Factors 22%
Lambert’s Research
Emphasizes theimportance of activating client resources such as encouraging clients to create and use support networks and increasing client motivation and engagement process
General Categories for Client Factors
Client Characteristics
Extratherapeutic Factors
Client Characteristics
Client Motivatin to change, attitude about counseling/change, commitment to change, personal strengths and resources (cognitive, emotional, social, financial, spiritual), duration of complaints, etc.
Extratherapeutic Factors
Social sup
divport, community involvement, fortuitious life events, etc.
Effective Counseling Relationship
Characterized by accommodating to the client’s level of motivation, working toward the client’s goals, and demonstrating a genuine, nonjudgmental attitude
Client’s Evaluation of the Relationship
More strongly correlated with positive outcome that the counselor’s evaluation
Theory-Specific Factors
Refer to the doing of counseling: what the counselor says and does to facilitate change;
Placebo Effect
Refers to the client’s belief that counseling will be helpful to them in resolving their problem
Diversity
Implies unique client resources and challenges, particularly for the counseling relationship, choice of approach, and strategies for instilling hope
Theory
Still plays a critical role for new seasoned clinicians; the catch is that it is not in the role one might initially expect it to play; Role of theory is to provide a system to help clients alleviate their sumptoms and resolve their problems; It is a tool that helps the counselor help the client; may be most relevant for the counselor, not the client; gives clinicians a systematic way of dealing with the wide range of difficulties clients bring; cou on how best to relate and respond to clients
Evidence-Based Therapies
Developed through research and randomized clinical trials (RCT’s)
Evidence-Based Therapies
Developed through research and randomized clinical trials (RCT’s)
Criteria That EST’s (Empirically Supported Treatment) Meet
Subjects are randomly assigned to treatment group
In addition to a group receiving the treatment being studied, there must also be: a no-treatment control (subjects who are on the waiting list) or an alternative treatment (for comparison; treatment as usual) or placebo treatment
Treatment is significantly better that no-treatment control and at least equally as effective as an established alternative
Treatment is based on a written treatment manual with specific criteria for including/excluding clients
A Specific population with a specific problem is identified
Researchers use reliable and valid outcome measures with appropriate statistical measures
Requirements for Efficacious Treatment (Including Criteria of EST’s)
Two independent investigations (studies conducted by someone wo is not closely involved in the development of the treatment or invested in the outcome of treatment)
Efficacious and Specific Treatments (Includes criteria of EST’s and Efficacious Treatment)
Superior to alternative treatments in at least two independent studies
Disdadvantages of ESTs and Efficacious Treatments
Limited applicability: targets a specific and therefore limited population
Expensive: counselors need highly specific training in the model and need to be trained in a number of models to function effectively in most work environments
Disdadvantages of ESTs and Efficacious Treatments
Limited applicability: targets a specific and therefore limited population
Expensive: counselors need highly specific training in the model and need to be trained in a number of models to function effectively in most work environments
Obstacles to Clinical Training in EST’s
Uncertainty about how to conceptualize training in EST’s
Lack of time
Shortage of trained supervisors
Inappropriateness of established EST’s for a given population
Philosophical opposition
Written treatment manuals and narrowly defined population
Five Steps in Employing Evidence-Based Practice
Develop an answerable question to focus the search for information
Search the literature for the best empirical evidence to answer the question
Evaluate the validity, impact, and applicability of the research to determine its usefulness in this case
Determine whether the research findings are applicable to the current client’s situation
After implementing the EBP, evaluate the effectiveness in this client’s individual case
Five Steps in Employing Evidence-Based Practice
Develop an answerable question to focus the search for information
Search the literature for the best empirical evidence to answer the question
Evaluate the validity, impact, and applicability of the research to determine its usefulness in this case
Determine whether the research findings are applicable to the current client’s situation
After implementing the EBP, evaluate the effectiveness in this client’s individual case
