The World of the CounselorAn Introduction to the Counseling Profession

Ed NeukrugOld Dominion University

FOURTH EDITION

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To my mom,

my fi rst counselor

iv

About the AuthorBorn and raised in New York City, Dr. Ed Neukrug obtained his B.A. in psychology in from SUNY Binghamton, his M.S. in counseling from Miami University of Ohio, and his doctorate in counselor education from the University of Cincinnati.

After teaching and directing a graduate program in counseling at Notre Dame Col-lege in New Hampshire, he accepted a position at Old Dominion University, in Norfolk, Virginia where he currently is a Professor of Counseling and former Chair of the Depart-ment of Educational Leadership and Counseling. In addition to teaching, Dr. Neukrug has worked as a counselor at a crisis center, an outpatient therapist at a mental health center, an associate school psychologist, a school counselor, and as a private practice psy-chologist and licensed professional counselor.

Dr. Neukrug has held a variety of positions in local, regional, and national pro-fessional associations in counseling and human services. In addition, he has published numerous articles and has received a number of grants and contracts with school systems and professional associations.

Books he has written include: (1) Counseling Theory and Practice, (2) The World of the Counselor (4th ed.), (3) Experiencing the World of the Counselor: A Workbook for Coun-selor Educators and Students (4th ed.), (4) Theory, Practice and Trends in Human Services: An Introduction to An Emerging Profession (4th ed.), (5) Skills and Techniques for Human Service Professionals, (6) Skills and Tools for Todays Counselors and Psychotherapists, and (7) Essentials of Testing and Assessment for Counselors, Social Workers, and Psychologists (2nd ed.) Look for his upcoming new book tentatively called, Professional Orientation to the Counseling Profession.

Dr. Neukrug is currently collecting oral and video stories of the great therapists of the world. If you would like to hear these stories and compare your view of human nature to these theorists, go to: www.odu.edu/sgt.

Dr. Neukrug is married to Kristina Williams-Neukrug, who is an elementary school counselor. They have two children, Hannah and Emma.

www.odu.edu/sgt

v

Brief ContentsSECTION IProfessional Orientation 1

CHAPTER 1The Counselors Identity: What, Who, and How? 2

CHAPTER 2The Counseling Professions Past, Present, and Future 32

CHAPTER 3Standards in the Profession: Ethics, Accreditation, Credentialing, and Multicultural/Social Justice Competencies 65

SECTION IIThe Helping Relationship I: Theories and Skills 97

CHAPTER 4Individual Approaches to Counseling 98

CHAPTER 5Counseling Skills 149

SECTION IIIThe Helping Relationship II: The Counselor Working in Systems 187

CHAPTER 6Couples and Family Counseling 188

CHAPTER 7Group Work 225

CHAPTER 8Consultation and Supervision 257

SECTION IVThe Development of the Person 289

CHAPTER 9Development Across the Lifespan 290

CHAPTER 10Abnormal Development, Diagnosis, and Psychopharmacology 322

CHAPTER 11Career Development: The Counselor and the World of Work 359

vi BRIEF CONTENTS

CHAPTER 17*Clinical Mental Health Counseling 579

CHAPTER 18*Student Affairs and College Counseling 611

AFTERWORD A Look Toward Your Future: Applying for Graduate Programs and Finding a Job 640

APPENDIX AMulticultural Counseling Competencies 647

APPENDIX BAdvocacy Competencies 651

APPENDIX CAssessment of Your Theoretical and Conceptual Orientations 655

AUTHOR INDEX 665

SUBJECT INDEX 674

SECTION VResearch, Program Evaluation, and Assessment 393

CHAPTER 12Testing and Assessment 394

CHAPTER 13Research and Evaluation 429

SECTION VISocial and Cultural Foundations in Counseling 467

CHAPTER 14Theory and Concepts of Multicultural Counseling 468

CHAPTER 15Knowledge and Skills of Multicultural Counseling 500

SECTION VIISelect Speciality Areas in Counseling 541

CHAPTER 16*School Counseling 542

* Chapters 16, 17, and 18 are co-written by Tim Grothuas, Kathleen Levingston, and Hannah Bayne, respectively.

vii

ContentsPreface xvii

SECTION IProfessional Orientation 1

CHAPTER 1The Counselors Identity: What, Who, and How? 2Guidance, Counseling, and Psychotherapy: Variations on the Same Theme? 3Comparison of Mental Health Professionals 4

Counselors 5Social Workers 8Psychologists 8Psychiatrists 10Psychoanalysts 10Psychiatric-Mental Health Nurses 10Expressive Therapists 11Human Service Practitioners 11Psychotherapists 11

Professional Associations in the Social Services 12The American Counseling Association 12The American Art Therapy Association (AATA) 15The American Association for Marriage and Family Therapy (AAMFT) 15The American Psychiatric Association (APA) 15The American Psychiatric Nurses Association (APNA) 16The American Psychological Association (APA) 16The National Association of Social Workers (NASW) 16The National Organization for Human Services (NOHS) 16

Characteristics of the Effective Helper 17Empathy 18Acceptance 19Genuineness 19Embracing a Wellness Perspective 20Cultural Competence 20The It Factor 22

Compatibility with and Belief in a Theory 23Competence 24Cognitive Complexity 24

Multicultural/Social Justice Focus: Inclusion of Multiculturalism in the Profession 25Ethical, Professional, and Legal Issues 25

Knowing Who We Are and Our Relationship to Other Professional Groups 25Impaired Mental Health Professionals 26

The Counselor in Process: Personal Therapy and Related Growth Experiences 26Summary 27References 28

CHAPTER 2The Counseling Professions Past, Present, and Future 32Understanding the Human Condition: From Early Antiquity to the Present 33A Brief History of Related Helping Professions: Social Work, Psychology, Psychiatry 34

The Social Work Profession 35The Psychology Profession 37The Psychiatry Profession 39

The Counseling Profession: Its History and Trends 41Precursors to the Counseling Profession: The 1800s 41Social Reform Movements of the 1800s 41Vocational Guidance in the 1800s 41The Beginnings of the Testing Movement: Turn of the 20th Century 42Psychoanalysis and the Development of Psychotherapy: Turn of the 20th Century 42Early Vocational Guidance and the First Guidance Counselors: Early 1900s 42The Expansion of the Testing Movement: 19001950 44The Spread of Psychotherapy and Its Impact on the Counseling Profession: 19001950 46Emergence, Expansion, and Diversifi cation: The 1950s 47Increased Diversifi cation: The 1960s 48

viii CONTENTS

Multicultural Counseling Competencies 88Advocacy Competencies 88

Multicultural/Social Justice Focus: Are the Competencies Research-Based? 90Ethical, Professional, and Legal Issues: A Plethora of Standards? 91The Counselor in Process: A Lifelong Commitment to Professionalism 91Summary 91References 93

SECTION IIThe Helping Relationship I: Theories and Skills 97

CHAPTER 4Individual Approaches to Counseling 98Why Have a Theory of Counseling? 99Four Conceptual Orientations to Counseling and Associated Theories 101

Psychodynamic Approaches 101ExistentialHumanistic Approaches 108CognitiveBehavioral Approaches 115Post-Modern Approaches 126

Extensions, Adaptations, and Spinoffs of the Major Theories 133

Eriksons Psychosocial Theory 134ObjectRelations Theory 134Relational and Subjectivity Therapy 134Dialectical Behavior Therapy (DBT) 135Acceptance and Commitment Therapy (ACT) 135Constructivist Therapy 135Eye Movement Desensitization Therapy (EMDR) 135Motivational Interviewing 136Gender-Aware Therapy 136Positive Psychology and Well-Being Therapy 136Complementary, Alternative, and Integrative Approaches 137

Integrative Counseling and Psychotherapy (Eclecticism) 137Multicultural/Social Justice Focus: Bias in Counseling Approaches 139Ethical, Professional, and Legal Issues 140

Continued Proliferation of the Counseling Field: The 1970s 49Recent Changes in the Field: 19802000 51The New Millennium: 2000 and On 52

Do We Have to Memorize All Those Names? A Developmental Perspective 55Multicultural/Social Justice Focus: Learning from the Past, Moving toward the Future 55Ethical, Professional, and Legal Issues: Changing over Time 58The Counselor in Process: Looking Back, Looking Ahead, and Embracing Paradigm Shifts 58Summary 59References 60

CHAPTER 3Standards in the Profession: Ethics, Accreditation, Credentialing, and Multicultural/Social Justice Competencies 65Ethics 66

Defi ning Values, Ethics, Morality, and Their Relationship to the Law 66The Development of and Need for Ethical Codes 67Codes of Ethics in the Helping Professions 69Ethical Hot Spots for Counselors 72Resolving Ethical Dilemmas: Models of Ethical Decision-Making 72Reporting Ethical Violations 76Legal Issues Related to Ethical Violations 77

Accreditation 80The History and Development of Professional Preparation Standards 80The Council for Accreditation of Counseling and Related Educational Programs (CACREP): A Short History 80Other Accrediting Bodies 82

Credentialing 83Registration 83Certifi cation 83Licensure 84Credentialing in Related Helping Professions 84Credentialing for Counselors 86

Multicultural/Social Justice Standards: Multicultural Counseling Competencies and Advocacy Competencies 88

CONTENTS ix

SECTION IIIThe Helping Relationship II:The Counselor Working in Systems 187

CHAPTER 6Couples and Family Counseling 188Couples and Family Counseling: A Brief History 189View of Human Nature 192Key Concepts 193

General Systems Theory 193Cybernetics 194Boundaries and Information Flow 194Rules and Hierarchy 196Communication Theory 196Scapegoating and Identifi ed Patients 197Stress 198Developmental Issues 199Social Constructionism 200

Models of Couples and Family Therapy 200Human Validation Process Model 200Structural Family Therapy 202Strategic Family Therapy 202Multigenerational Family Therapy 206Experiential Family Therapy 207Psychodynamic Family Therapy 210CognitiveBehavioral Family Counseling 211Narrative Family Therapy 212Solution- Focused Family Therapy 213

Multicultural/Social Justice Focus 214Points to Consider when Working with Minority Families 214Why Are the Professional Associations Not Being Inclusive? 215

Ethical, Professional, and Legal Issues 216Ethical Concerns 216Professional Issues 218Legal Concerns 219

The Counselor in Process: Understanding Our Clients Family, Understanding Our Family 219Summary 220References 221

The Counselor in Process: Embracing a Theory but Open to Change 142Summary 143References 144

CHAPTER 5Counseling Skills 149The Counseling Environment 150

The Offi ce 150Nonverbal Behavior 151Counselor Qualities to Embrace/Counselor Qualities to Avoid 152

Counseling Skills 153Foundational Skills 153Commonly Used Skills 158Commonly Used Advanced Skills 164Advanced and Specialized Counseling Skills 168

Conceptualizing Client Problems: Case Conceptualization 168Stages of the Counseling Relationship 170

Stage 1: Rapport and Trust Building 170Stage 2: Problem Identifi cation 171Stage 3: Deepening Understanding and Goal Setting 171Stage 4: Work 172Stage 5: Closure 172Stage 6: Post- Interview Stage 173

Theory, Skills, Stages, and Case Conceptualization: A Reciprocal Relationship 174Case Notes 175Multicultural/Social Justice Focus: Applying Skills Cross- Culturally 176Ethical, Professional, and Legal Issues 177

Ethical and Legal Issues Relative to Case Notes and Records 177Confi dentiality of Records and Privileged Communication 178The Clients Rights to Records 179Security of Record Keeping 179Professional Issue: Crisis, Disaster, and Trauma Counseling 180

The Counselor in Process: The Developmental Nature of Counseling Skills 181Summary 181References 183

x CONTENTS

The Counselor in Process: Allowing Groups to Unfold Naturally 251Summary 252References 253

CHAPTER 8Consultation and Supervision 257Consultation 258

Consultation Defi ned 258A Brief History of Consultation 259Theories of Consultation 261The Consulting Process: Stages of Consultation 263The Counselor as Consultant 265

Supervision 270Supervision Defi ned 270Who Is the Supervisor? 272Who Is the Supervisee? 272Individual, Triadic, or Group Supervision? 274Models of Supervision 274Supervision of Graduate Students 278Supervision of Practicing Counselors 279

Multicultural/Social Justice Focus 280Multicultural Consultation within a System 280Multicultural Supervision 280

Ethical, Professional, and Legal Issues 281Ethical Issues in the Consulting Relationship 281Ethical Issues in the Supervisory Relationship 281Professional Issue: Professional Association 282Legal Issue: Liability in Consultation and Supervision 283

The Counselor in Process: Committed to Ongoing Consultation and Supervision 283Summary 283References 285

SECTION IVThe Development of the Person 289

CHAPTER 9Development Across the Lifespan 290A Little Background 291Understanding Human Development 292

Development Is Continual 292

CHAPTER 7Group Work 225Groups: A Systemic Perspective 226Why Have Groups? 227The History of Group Work 228

Early History 228The Emergence of Modern-Day Groups 229The Popularity of Groups Surges 230Recent Trends 231

Defi ning Modern-Day Groups 232Self-Help Groups 232Task Groups 233Psychoeducational Groups 234Counseling Groups 235Group Therapy 235

Comparing Psychoeducational, Counseling, and Therapy Groups 236The Use of Theory in Group Work 237

Psychoanalytic Group Therapy 238CognitiveBehavioral Group Therapy 239Person-Centered Group Counseling 240Solution-Focused Group Counseling 241

Preparing for the Group 242Getting Members 242Group Composition 243Closed or Open Group 243Size of Group 243Duration of Meetings 243Frequency of Meetings 243Securing an Appropriate Space 244Group Leadership Style 244

The Stages of Group Development 244The Pregroup Stage (Forming) 245The Initial Stage (Forming) 245The Transition Stage (Storming and then Norming) 246The Work Stage (Performing) 247The Closure Stage (Adjourning) 247

Multicultural/Social Justice Focus 248Principles for Diversity-Competent Group Workers 248Social Justice in Group Work: Understanding the Place of Privilege 248Prejudice and the Group as a Microcosm of Society 248Cultural Differences between a Group Member and the Group Leader 249

Ethical, Professional, and Legal Issues 249Ethical Issues 249Professional Issues 250Legal Issue: Confi dentiality and the Third-Party Rule 251

CONTENTS xi

CHAPTER 10Abnormal Development, Diagnosis, and Psychopharmacology 322Why Study Abnormal Development, Diagnosis, and Medication? 323You Cant Have One without the Other: Abnormal Behavior, Diagnosis, and Medication 325Personality Development and Abnormal Behavior 325

Genetic and Biological Explanations of Development 326Freuds Model of Psychosexual Development 327Learning Theory and the Development of the Person 329The Humanistic Understanding of Personality Development 331Post-Modernism and Social Constructionisms View of Development 334Comparison of Models 335

Diagnosis and Mental Disorders: What Is DSM-IV-TR? 337

Axes I and II: The Mental Disorders 338Axis III: General Medical Conditions 341Axis IV: Psychosocial and Environmental Problems 342Axis V: Global Assessment of Functioning (GAF) 342Making a Diagnosis 342

Psychopharmacology 344Antipsychotics 344Mood-Stabilizing Drugs 346Antidepressants 346Antianxiety Medications 347Stimulants 347

Multicultural/Social Justice Focus 348The Misdiagnosis of Underrepresented Groups 348DSM-IV-TRs Attempt to Address Cross-Cultural Issues 348

Ethical, Professional, and Legal Issues 349Ethical Issues 349Professional Issues 350Legal Issues 351

The Counselor in Process: Dismissing Impaired Graduate Students 352Summary 353References 355

Development Is Orderly and Sequential and Builds upon Itself 292Development Implies Change, but Our Core Remains More or Less the Same 293Development Is Painful, Yet Growth-Producing 293Developmental Models Are Transtheoretical 293Development Is Preventive, Optimistic, and Wellness-Oriented 293

A Brief Overview of Physical and Psychosocial Development in Childhood 294Development in Adolescence and Adulthood 296The Development of Knowing: Cognitive and Moral Changes in Childhood 296

Jean Piaget and Cognitive Development 297Kohlbergs Theory of Moral Development 298Gilligans Theory of Womens Moral Development 299Comparison of Cognitive and Moral Development 301

Adult Cognitive Development 301Kegans Constructivist Developmental Model 302Perrys Theory of Intellectual and Ethical Development 304Comparison of Adult Cognitive Development Theories 305

Lifespan Development 305Eriksons Stages of Psychosocial Development 306Levinsons Seasons of a Mans Life/Seasons of a Womans Life 307Comparison of Lifespan Development Theories 309

Fowlers Theory of Faith Development 310Other Developmental Theories 312Applying Knowledge of Development 313Comparison of Developmental Models 313Multicultural/Social Justice Focus 315

Bias in Developmental Models 315The Development of Cultural Identity 315

Ethical, Professional, and Legal Issues 315The ACA Code of Ethics: A Developmental Emphasis 315Professional Associations 316Legal Issue: Missing Problems Because We Are Too Positive 316

The Counselor in Process: Understanding Your Own Development 316Summary 317References 319

xii CONTENTS

The Counselor in Process: Career Development as a Lifespan Process 386Summary 387References 388

SECTION VResearch, Program Evaluation, and Assessment 393

CHAPTER 12Testing and Assessment 394Defi ning Testing and Assessment 395Why Testing and Assessment? 395A Little Background 397Types of Assessment Techniques 398

Assessment of Ability 398Personality Assessment 401Informal Assessment Procedures 402The Clinical Interview 406

Norm- Referenced, Criterion- Referenced, Standardized, and Non- Standardized Assessment 406Basic Test Statistics 408

Relativity and Meaningfulness of Test Scores 408Measures of Central Tendency 408Measures of Variability 409Derived Scores 411Correlation Coeffi cient 413

Test Worthiness 414Validity 414Reliability 416Cross- Cultural Fairness of Tests 417Practicality 418

Where to Find Tests and Assessment Techniques 418Writing Assessment Reports 419Multicultural/Social Justice Focus 419

Caution in Using Assessment Procedures 419Take A StandDo Something! 420

CHAPTER 11Career Development: The Counselor and the World of Work 359Some Defi nitions 360Is Career Development Developmental? 361Why Career Development and Career Counseling? 362A Little Bit of History 363Theories of Career Development 364

Trait-and-Factor Approach 364Ann Roes Psychodynamic Theory 365John Hollands Personality Theory of Occupational Choice 367Supers Lifespan Development Approach to Career Counseling 369Social Cognitive Career Theory 371Constructivist Career Counseling: A Post-Modern Approach 372

Integrating Models of Career Development 374Trait-and-Factor Theory and Hollands Personality Theory 374Developmental Theory 374Psychodynamic Theory (e.g., Roe) 375Social Cognitive Career Theory 375Constructive Development Theory 375Bringing it all Together 376

The Use of Career-Related Information 376Occupational Classifi cation Systems 376Assessment Instruments 379Computer-Assisted Career Guidance 380Other Sources of Occupational Information 380

The Clinical Interview: The Lost Child in Career Development 381Integrating Theory, Career Information, and Career Assessment 381Multicultural/Social Justice Focus 382

Multicultural Theory of Career Development 382Multicultural Career Counseling and Development Competencies 383Social Justice Focus: Reshaping Clients Stories 383

Ethical, Professional, and Legal Issues 384Ethical Issues 384Professional Issues 384Legal Issues: Important Laws 385

CONTENTS xiii

SECTION VISocial and Cultural Foundations in Counseling 467

CHAPTER 14Theory and Concepts of Multicultural Counseling 468What Is Multicultural Counseling? 469Why Multicultural Counseling? 470

Diversity in America 470Counseling Is Not Working for a Large Segment of Our Population 470

Some Defi nitions 474Culture 474Discrimination and Microaggressions 474Ethnicity 475Minority and Nondominant Group 475Power Differentials 476Race 476Religion and Spirituality 477Sexism, Heterosexism, and Sexual Prejudice 477Sexual Orientation 477Social Class (Class) 478Prejudice, Stereotypes, and Racism 478

Political Correctness, or, Oh My God, What Do I Call Him or Her? 478Understanding Your Diverse Client: Conceptual Models 479

Existential Model of Identity 480Tripartite Model of Personal Identity 480Interpersonal Model of Racial/CulturalIdentity 481Developmental Models of Racial/Cultural Identity 482White Identity Development 483

Working with Diverse Clients in the Helping Relationship 486

Using the RESPECTFUL Acronym 487Using the Multicultural Counseling Competencies 487

Multicultural/Social Justice Focus 489Multicultural Counseling as the Fourth Force 489

Ethical, Professional, and Legal Issues 420Ethical Issues 420Professional Issues 422Legal Issues: Laws That Have Had an Impact on Testing 423

The Counselor in Process: Assessment as Holistic and Ongoing 424Summary 424References 426

CHAPTER 13Research and Evaluation 429Research 430

The Purpose of Research 430Literature Reviews and the Statement of the Problem 431Distinguishing Between Quantitative and Qualitative Research 432Quantitative Research Designs 433Qualitative Research Methods 442Statistics and Data Analysis in Quantitative and Qualitative Research 447Issues of Quality in Research Studies 448Reading and Writing Research 453

Evaluation 454The Purpose of Evaluation 454Formative and Summative Evaluation 454

Summarizing Quantitative Research, Qualitative Research, and Evaluation 456Multicultural/Social Justice Focus 456

Bias in Research and Evaluation 456White Researchers Conducting Multicultural Research: An Unnatural Fit? 457

Ethical, Professional, and Legal Issues 459Ethical Issue: Code of Conduct 459Professional Issue: Standards in Research 459Legal Issues 460

The Counselor in Process: Discovering New Paradigms 460Summary 460References 463

xiv CONTENTS

SECTION VIISelect Specialty Areas in Counseling 541

CHAPTER 16School Counseling 542What Is School Counseling? 543A History of School Counseling 545

Early Developments 545Modern Day School Counseling: Becoming a Profession 547Recent History: Transforming School Counseling in the Twenty- First Century 548

Roles and Functions of School Counselors: The ASCA National Model 552

The Four Elements: Foundation, Delivery, Management, and Accountability 553The Themes: Leadership, Advocacy, Collaboration and Teaming, Systemic Change 555The Emergent Model 556

Theory and Process of School Counseling 556Counseling Theory 556Career Development Theory 558Human Development Theory 558Systems Theory 558

Settings for School Counselors 559Elementary School Counselors 559Middle School Counselors 561Secondary School Counselors 562

Multicultural/Social Justice Focus 563Creating a Multicultural School Environment 563Assessing Multicultural Competence 565

Ethical, Professional, and Legal Issues 567Select Ethical Issues: ASCAs Code of Ethics 567Select Professional Issues in School Counseling 567Select Legal Issues in School Counseling 569

The School Counselor in Process: Adapting to the Twenty- First Century 571Summary 572References 573

Can We Have Multicultural Counseling Without Social Justice Action? 490

Ethical, Professional, and Legal Issues 490Standards and Multicultural Counseling 490Training Models and Checklists 492Association for Multicultural Counseling and Development 493Knowledge of Legal Trends 493

The Counselor in Process: Working with Culturally Different Clients 493Summary 493References 495

CHAPTER 15Knowledge and Skills of Multicultural Counseling 500The Changing Face of America 501Understanding and Counseling Select Culturally Diverse Groups 502

People from Varying Cultural/Racial Heritages 503Religious and Spiritual Diversity in America 509Gender Differences in America and Gender- Aware Therapy 513Differences in Sexual Orientation 519Individuals Who Are HIV Positive 522The Hungry, the Homeless, and the Poor 524Older Persons 525The Chronically Mentally Ill 527People with Disabilities 529

Multicultural/Social Justice Focus 530Is All Counseling Multicultural? 530Client- Counselor Match versus Cultural Competence 531

Ethical, Professional, and Legal Issues: Making Wise Ethical Decisions 531The Counselor in Process: The Ongoing Process of Counseling the Culturally Different 532Summary 532References 534

CONTENTS xv

Professional Issues 600Select Legal Issues 602

The Clinical Mental Health Counselor in Process: Growing, Changing, Accepting 603Summary 603References 605

CHAPTER 18Student Affairs and College Counseling 611What Is Student Affairs? 612The History of Student Affairs 612

The Beginning 612The Expansion of Student Affairs Practices 612Recent Trends 613Current Practices 614

Roles and Functions of Student Affairs Specialists 614The Counselor: Guiding, Supporting, and Advising Students 615The Educator: Fostering Intellectual and Personal Growth 615The Campus Ecology Manager: Creating a Successful Student Development Climate 616The Administrator: Designing and Managing Programs 617

Theories of Student Development 618Developmental Theory 618Chickerings Seven Vectors of Student Development 619Perrys Scheme of Intellectual and Ethical Development 620

Settings Where You Find Student Affairs Specialists 621

Academic Support Services 621Career Development Services 621Counseling Centers 622Disability Services (Offi ce of Educational Accessibility) 623Health Services 623Human Resources 623Multicultural Student Services 624Residence Life and Housing Services 624Student Activities Services 624Other Student Services Offi ces 626

CHAPTER 17Clinical Mental Health Counseling 579What Is Clinical Mental Health Counseling? 580A History of Clinical Mental Health Counseling 581

The Beginning of the Mental Health Movement 581Expansion of Mental Health Services 582Recent Events 583

Roles and Functions of the Clinical Mental Health Counselor 585

Case Manager 585Appraiser of Client Needs 585Counselor 585Consultant 585Crisis Responder 586Supervisor and Supervisee 586A Professional Who Is Accountable 586Other Roles 586

Theory and Process of Clinical Mental Health Counseling 587Settings Where You Find Mental Health Counselors 588

Career and Employment Agencies 588Community Mental Health Centers 588Correctional Facilities 589Family Service Agencies 590Gerontological Settings 590HMOs, PPOs, and EAPs 591The Military and Government 592Pastoral, Religious, and Spiritual Counseling Agencies 593Private Practice Settings 593Rehabilitation Agencies 595Residential Treatment Centers 596Substance Abuse Settings 597Youth Services Agencies 598Counselors in Other Settings 598

Multicultural/Social Justice Focus 599Broad Issues Hindering Multicultural Mental Health Counseling 599Assessment of Clients at Mental Health Agencies 599Limited Numbers of Counselors from Diverse Cultures 600

Ethical, Professional, and Legal Issues 600Ethical Issue: Ethical Complaints and Ethical Concerns 600

xvi CONTENTS

APPENDIX AMulticultural Counseling Competencies 647

APPENDIX BAdvocacy Competencies 651

APPENDIX CAssessment of Your Theoretical and Conceptual Orientations 655

AUTHOR INDEX 665

SUBJECT INDEX 674

Multicultural/Social Justice Focus 627Applying Student Development Theory to Students from Diverse Backgrounds 628Implementing a Cultural Environment Transitions Model 628Becoming a Cultural Broker 628Removing the Barriers to Academic Excellence of Underrepresented Students 629Creating a Social Justice Environment 629

Ethical, Professional, and Legal Issues 630Ethical Concerns 630Professional Issues 630Legal Issues 631

The Counselor in Process: The Student Affairs Practitioner 633Summary 633References 635

AFTERWORD A Look Toward Your Future: Applying for Graduate Programs and Finding a Job 640

xvii

Preface

Purpose of TextThey brought the fi reman (now fi refi ghter) to my school. I wanted to be just like him. They brought the policeman (now police offi cer)thats a pretty fun job, I thought. My father, a building contractor, came and talked about building bridges. I was very proud. Maybe I would be a building contractor. The doctor, of course, was very impressive also. But they didnt bring the counselor. In fact, few of us knew about counselorswhat they did, who they were. Despite this, I became one. And now, I want the world to know who they are and what they do. That is what this book is about.

After teaching for over thirty years, I have found that new students have a deep desire and longing to be counselors. I have also found their knowledge of the counseling profession to be minimal. It has been my experience that most students understand the importance of listening to a person who is experiencing distress, but know little about the broad knowledge needed to be a counselor or about the important professional, eth-ical, and cross-cultural issues that underlie so much of what counselors do. Thus, the purpose of this book is to enlighten students concerning the depth of the counseling pro-fession so they can make an informed decision about whether they want to enter it and to help them begin their journey as a professional counselor with important knowledge and skills.

Since publication of the fi rst three editions of The World of the Counselor, many re-viewers, faculty, and students have remarked that the text is one of the most comprehen-sive, yet readable, of its kind. Often, faculty and students have suggested that it is a book that could be used when studying for comprehensive exams or when taking a certifi cation or licensing exam. In revising the text I have attempted to maintain its comprehensive-ness. In addition, I have updated information to ensure accuracy and relevance and have increasingly added ways for you to electronically access information (e.g., URLs).

xviii PREFACE

Organization of the TextThe text presents an overview of the counseling profession by offering relevant con-tent, vignettes, and think pieces for students to ponder. The book loosely follows the common-core curriculum guidelines of the Council for Accreditation of Counseling and Related Programs (CACREP): (1) professional orientation and ethical practice, (2) so-cial and cultural diversity, (3) human growth and development, (5) career development, (2) helping relationships, (4) group work, (6) assessment, (7) research and program evaluation, and (8) professional orientation (see www.cacrep.org). The text also offers specifi c content in the specialty areas of clinical mental health counseling, school coun-seling, and student affairs and college counseling. Adhering to the CACREP-accredited common-core areas ensures that the text is in compliance with a standard in the profes-sion and offers the student a broad knowledge base.

The book is separated into seven sections and an Afterword. In writing the text, I have attempted to weave all of the eight common-core areas listed above into the fi rst six sections, with the seventh section spotlighting the three specialty areas that students commonly enter: school counseling, clinical mental health counseling, and student affairs and college counseling. The Afterword offers tips for applying to masters or doctoral pro-grams and for applying for a job.

Sections and AfterwordSection I, Professional Orientation. The section encompasses much of the content high-lighted in the CACREP common-core curriculum guideline, Professional Orientation, and more. There are three chapters in this section:

Chapter 1: The Counselors Identity: What, Who, and How?Chapter 2: The Counseling Professions Past, Present, and FutureChapter 3: Standards in the Profession: Ethics, Accreditation, Credentialing, and Multicultural/Social Justice Competencies

Section II, The Helping Relationship I: Theories and Skills. Section II loosely follows the CACREP common-core curriculum guideline entitled, Helping Relationships, al-though consultation, which is listed under this guideline, is covered in Section III. The two chapters in this section are:

Chapter 4: Individual Approaches to CounselingChapter 5: Counseling Skills

Section III, The Helping Relationship II: The Counselor Working in Systems. This sec-tion draws from a number of CACREP curriculum guidelines that in some fashion address

www.cacrep.org

PREFACE xix

counseling within systems, including couples and family counseling (from CACREP spe-cialty guidelines called Marriage, Couple, and Family Counseling), group work (from CACREP common-core curriculum guideline Group Work), and consultation and su-pervision (drawn from CACREP common-core curriculum guideline Professional Orien-tation and Ethical Practices). The three chapters in this section are:

Chapter 6: Couples and Family CounselingChapter 7: Group WorkChapter 8: Consultation and Supervision

Section IV, The Development of the Person. The broad spectrum of human devel-opment issues in counseling are examined in Section IV. Loosely following two of the CACREP common-core curriculum guidelines of Human Growth and Development and Career Development, this section includes the following three chapters:

Chapter 9: Development across the LifespanChapter 10: Abnormal Development, Diagnosis, and PsychopharmacologyChapter 11: Career Development: The Counselor and the World of Work

Section V, Research, Program Evaluation, and Assessment. This section is based on the two CACREP common-core curriculum guidelines: Research and Program Evalua-tion, and Assessment. The two chapters in this section are:

Chapter 12: Testing and AssessmentChapter 13: Research and Evaluation

Section VI, Social and Cultural Foundations in Counseling. Section VI loosely follows the CACREP common-core curriculum guideline entitled, Social and Cultural Diver-sity. The two chapters included in this section are:

Chapter 14: Theory and Concepts of Multicultural CounselingChapter 15: Knowledge and Skills of Multicultural Counseling

Section VII, Select Specialty Areas in Counseling. This fi nal section examines the three most popular specialty areas in counseling: School Counseling, Clinical Mental Health Counseling, and Student Affairs and College Counseling. Each of these chapters provides history, defi nes roles and functions, presents theory and practice issues, and provides the counselor with specifi c examples of what its like to work in each of these specialty areas. Places of employment and potential salaries are also given. The section includes the fol-lowing chapters:

Chapter 16: School CounselingChapter 17: Clinical Mental Health CounselingChapter 18: Student Affairs and College Counseling

xx PREFACE

Afterword. The Afterword provides students with tips on how to get into a masters and doctoral program in counselor education and related fi elds and how to apply for jobs in the helping professions.

A Focus on Multicultural and Social Justice Issues; Ethical, Professional, and Legal Issues, and The Counselor in Process

The counseling profession has zeroed in on the importance of understanding the critical knowledge and skills related to multicultural counseling and social justice and has also focused on the importance of acting ethically, professionally, and legally. Thus, at the end of each chapter, you will fi nd a special section that highlights multicultural and social jus-tice issues and another section that focuses on important ethical, professional, and legal issues related to that chapters content. Finally, I conclude each chapter with a segment entitled The Counselor in Process, which stresses how the self-refl ective counselor who is willing to risk change might deal with issues related to the chapter content.

Pedagogical Aids

The World of the Counselor is fi lled with material that highlights the content of each chap-ter in the text. These include:

1. Personal vignettes from the author and co-authors concerning their experiences in the fi eld of counseling and in related professional fi elds

2. Vignettes that highlight specifi c chapter content 3. Testimonials from individuals in the fi eld about their work 4. Experiential exercises that are peppered throughout the text that students can

do in class or at home 5. References to Web sites that can highlight specifi c course content 6. Tables and graphs that elaborate what is in the chapter content 7. For the instructor, there are numerous instructional aids (see Ancillaries to

Text near end of this preface)

In addition, there is a companion workbook, entitled Experiencing the World of the Coun-selor: A Workbook for Counselor Educators and Students that can be used in addition to the text. This manual is fi lled with experiential exercises that highlight each chapters content.

Specifi c Changes to This EditionIf youve seen past revisions of this text, youll know that I do not take a revision lightly. Thus, in an effort to keep the content updated and to better the quality of the text, there have been numerous changes to each chapter in the book. Each chapter has updated

PREFACE xxi

references, and each chapter has expanded the section on multicultural issues to include a social justice focus. Many changes were made in each chapter, but some of the more substantive changes are listed below:

Chapter 1: The Counselors Identity: What, Who, and How?: In addition to the vari-ous types of counselors and related helping professionals discussed in previous editions, I have added information about addiction counselors and human service professionals. As usual, based on the research, I have updated the list of characteristics most important for counselors to embody. The list now includes: empathy, acceptance, genuineness, being wellness oriented, being culturally competent, having the it factor, being compatible with and believing in your theory, being competent, and being cognitively complex.

Chapter 2: The Counseling Professions Past, Present, and Future: In addition to fi ne-tuning the history, in this chapter Ive added information on recent events in the fi eld, including: the most recent changes in credentialing; expansion of divisions of the Amer-ican Counseling Association (ACA); an updated view of evidence-based practice; the current emphasis on multicultural and social justice advocacy; the importance of obtain-ing training in crisis, disaster, and trauma work; the changes in the recent ACA ethical code; and the ACA 20/20 Standards, which focus on the shared professional vision that various counseling associations have adopted.

Chapter 3: Standards in the Profession: Ethics, Accreditation, Credentialing, and Mul-ticultural/Social Justice Competencies: The most important change to this chapter is the addition of a fourth standardmulticultural and social justice competencies. In adding this standard, I have focused on the multicultural counseling competencies and Advocacy Competencies that ACA has adopted and which are now infused into most counseling programs.

Chapter 4: Individual Approaches to Counseling: I have completed a major re-write of this chapter, which includes the addition of some new theories and the removal of some former ones. The chapter now covers: the psychodynamic approaches of psychoanalysis, analytical therapy, and individual therapy; the existential-humanistic approaches of exis-tential therapy, gestalt therapy, and person-centered counseling; the cognitive-behavioral approaches of behavior therapy, rational emotive behavior therapy, cognitive therapy, and reality therapy; and the post-modern approaches of narrative therapy and solution-focused brief therapy. Also new to this chapter is a brief overview of a number of exten-sions, adaptations, and spinoffs of the theories noted.

Chapter 5: Counseling Skills: This chapter has added an important method of writ-ing case notes: the Subjective, Objective, Assessment, and Plan (SOAP). In addition, I have included important information on crisis, disaster, and trauma counseling, an area in which CACREP and ACA are now strongly suggesting counselors obtain training.

xxii PREFACE

Chapter 6: Couples and Family Counseling: Like Chapter 4, this chapter underwent an important re-write. First, I expanded the history of couples and family counseling. I also added a section on the view of human nature to which most couples and family therapists adhere. This chapter now includes a focus on key concepts of couples and family therapy such as: general systems theory, cybernetics, boundaries and information fl ow, rules and hierarchy, communication theory, scapegoating and identifi ed patients, stress, develop-mental issues, and social constructionism. Finally, some theories were added, others deleted, and all updated. The theories highlighted in this edition include: human validation process model, structural family therapy, strategic family therapy, multigenerational approaches, experiential family therapy, psychodynamic family therapy, behavioral and cognitive behavioral family therapy, narrative family therapy, and solution-focused family therapy.

Chapter 7: Group Work: In this chapter, I added information about the Associa-tion for Specialists in Group Works (ASGW) Best Practice Guidelines and Professional Standards for the Training of Group Workers. I reorganized the section on theory in group work and now discuss psychoanalysis group therapy, person-centered group counseling, cognitivebehavioral group therapy, and solution-focused group therapy. Ive also added information on Tuckmans classic stages of forming, storming, norming, performing, and adjourning.

Chapter 8: Consultation and Supervision: In this chapter, Ive updated and simplifi ed the defi nition of consultation. I also added social constructionism to the different theo-ries of consultation and added information on the cube model of college counseling. Relative to supervision, Ive expanded the information on parallel process and updated the defi nitions of supervision, supervisor, and supervisee. Ive expanded the discussion on countertransference (theres a great cartoon that shows this process) and added a discussion on triadic supervision. The models of supervision offered now include: devel-opmental, psychotherapy-based, and integrative. In general, I believe the chapter is now an easier read and offers other additional information important to the consultation and supervision processes.

Chapter 9: Development across the Lifespan: This chapter offers an expanded cover-age of Kohlbergs theory by adding information on the Heinz dilemma in moral devel-opment. Also, Ive expanded the section on Carol Gilligans understanding of womens development. In addition, I re-wrote and updated the section on Eriksons eight lifespan stages. I kept Levinsons information on male development, but also included information he and his wife wrote on female development. In addition, I added a section on cross-cultural bias in developmental models.

Chapter 10: Abnormal Development, Diagnosis, and Psychopharmacology: In this chap-ter, I changed some of the information on Maslows hierarchy and how it might be used to understand abnormal development. I also added a section on the post-modernists and

PREFACE xxiii

social constructionists perspective on abnormal development. I offer an expanded sum-mary, in Table 10.1, of the different developmental theories, and although I still describe DSM-IV-TR, I note some of the likely upcoming changes in DSM-5. As always, the sec-tion on psychotropic medication needed to be revised greatly to keep up with changing medications. I also offer an alternative way of framing diagnosis from a humanistic and anti-deterministic perspective and have added a discussion relative to diagnosis and in-surance fraud.

Chapter 11: Career Development: The Counselor and the World of Work: Ive tried, in this chapter, to streamline and simplify some of the basic defi nitions used in the area of career development. Based on recent research, Ive completed a re-write of the section on social cognitive career theory. Near the end of the chapter, I offer the National Career Development Associations (NCDA) Multicultural Career Counseling and Developmental Competencies. Here, I also offer a new social justice focus that assumes forces outside the person affects their career decision-making process.

Chapter 12: Testing and Assessment: This chapter offers a new and expanded defi ni-tion of assessment procedures. Also, under aptitude testing, I have added a section on neuropsychological assessment and under informal assessment I have added information on performance-based assessment and environmental assessment. In this chapter, I offer a new section on the importance of counselors taking a stand when they see tests being used inappropriately.

Chapter 13: Research and Evaluation: This chapter has updated information on quan-titative and qualitative research. For instance, the section formerly called single-subject design is now called one-shot case study and one group pretest/post-test design and has been re-written accordingly. The section on qualitative research has been expanded and now includes information on grounded theory, phenomenological approach, ethno-graphic research, and historical research. In understanding data analysis, I have added a section on effect size. In addition, I have expanded a table that summarizes quantitative and qualitative research as well as evaluation. There is also a new discussion on bias in counseling research. Throughout the chapter, you will fi nd new and updated examples of different kinds of research and evaluation techniques.

Chapter 14: Theory and Concepts of Multicultural Counseling: In Chapter 14, I added a new defi nition of multicultural counseling offered by Sue and Torino (2005). Ive updated statistics about diversity in the United States and added or expanded upon the following defi nitions: culture; discrimination and microaggressions; ethnicity; mi-nority and nondominant group; power differentials; race; religion and spirituality; sex-ism, heterosexism, and sexual prejudice; sexual orientation; social class (class); and stereotypes, prejudice, and racism. In understanding client racial/ethnic identity devel-opment, I now offer an existential model of identity, the tripartite model of personal

xxiv PREFACE

identity, the interpersonal model of racial identity, developmental models of cultural and racial identity, and the White identity development model. At the end of the chapter, I added a section on whether one can have multicultural counseling without social justice or action. I also added a section on the ACA (2005) ethics code and how it focuses on multicultural counseling. Finally, Ive added information about ACAs ad-vocacy standards.

Chapter 15: Knowledge and Skills of Multicultural Counseling: As in Chapter 14, in this chapter, I update many of the graphs and fi gures that refl ect changing demographics in the United States and elsewhere. I also added the competencies needed when working with clients around religion and spirituality, which was developed by the Association for Spiritual, Ethical, and Religious Values in Counseling (ASERVIC). The chapter offers a major re-write of the section on gender-aware therapy. Also, many other changes can be found throughout, as I changed wording and phrasing to ensure that this chapter keeps up with current trends in multicultural counseling.

Chapters 16, 17, and 18: School Counseling, Clinical Mental Health Counseling, and Student Affairs and College Counseling: Although I kept the basic shell of these chapters, I asked experts in each of the three specialty areas to review and revise these chapters to ensure current accuracy. Although you will fi nd much of these chapters sounding similar in fl avor to the last edition, you will also fi nd many specifi c details changed and updated.

Afterword: The previous edition of the text had a Chapter 19 that included future trends in the fi eld and information about applying to graduate school and applying for jobs. Because future trends were discussed in previous chapters (especially Chapter 2: The Counseling Professions Past, Present, and Future), I removed this from the chapter and converted it into an Afterword that offers tips for applying to graduate school and for ap-plying to jobs. If you think you will be applying to a masters program, doctoral program, or for a job in the near future, I think you will fi nd this Afterword a useful resource.

Ancillaries to the TextFor students:

Some of you may be using the companion manual to this text, Experiencing the World of the Counselor: A Workbook for Counselor Educators and Students. For you who do use this manual, you will fi nd dozens of exercises to enhance your learning. Many of these can be completed on your own, while others may be facilitated by your instructor and completed with others in class.

Also, your instructor can point out how to fi nd sample test questions located on the instructors companion site of the book on the Brooks/Cole website. These questions, and

PREFACE xxv

answers, are based on chapter content and will give you a feel for the types of questions that might be asked on an exam.

For the instructorThere are a number of ancillaries to ensure student learning. All of the ancillaries, with the exception of the workbook: Experiencing the World of the Counselor: A Workbook for Counselor Educators and Students, can be found on the instructors companion site of the book on the Brooks/Cole Website (www.brookscole.com; then search for World of the Counselor). Some of the ancillaries include:

1. Experiencing the World of the Counselor. This companion book can be purchased by students. In it, you will fi nd exercises and activities that can enhance stu-dent learning. If you do not already have a desk copy, please consider obtaining one from Brooks/Cole to see if it might benefi t student learning in your class (call 1-800-477-3692, or type in World of the Counselor on the search engine found at www.brookscole.com).

2. PowerPoint Slides: Extensive PowerPoint slides that summarize each chapters content are available from the Brooks/Cole Web site.

3. Test Bank: An extensive test bank is available through the Brooks/Cole Web site.

4. Teaching Tips: These suggestions, found on the Brooks/Cole Web site, are based on the way I teach this course and may provide you with possible pedagogical methods as you navigate through the chapters.

5. Sample Syllabus: A sample syllabus is available in the instructors manual, which can be found on the Brooks/Cole Web site.

AcknowledgmentsThis book could not have been completed without the help of a number of people from Cengage. I had a particular treat in writing this edition of the book because of the help of Nic Albert, Associate Development Editor. Although across the country, it seemed as if he was at my side, reading and giving me comments about every chapter of the book. His help was enormous, and beyond the call of duty. Thanks so much, Nic. A special thanks to Seth Dobrin, Acquisitions Editor, whose support and continual good sense has made the process of writing this edition particularly easy.

A number of other people from Cengage were instrumental in getting this edi-tion of the book completed. They include: Matt Ballantyne, Production Manager; Dean Dauphinais, Rights Acquisition Specialist; Naomi Dreyer, Assistant Editor; Suzanna Kincaid, Editorial Assistant; Judy Inouye, Manufacturing Buyer; Bob Kauser, Rights Ac-quisition Director; Marcia Locke, Manufacturing Director; Elizabeth Momb, Associate

www.brookscole.comwww.brookscole.com

xxvi PREFACE

Media Editor; Gurpreet Saran, Marketing Coordinator; Christine Sosa, Marketing Man-ager; Tami Strang, Senior Marketing Communications Manager; and Jennifer Wahi, Art Director.

A special thanks also goes to Donna Lee Lurker, project manager of PreMedia-Global for her hard work on this project, Chris Bond, for his diligent read of the text, Sara Golden, photo researcher, Robin Kristoff, text researcher, and Christine Hobberlin, copy editor, from PreMediaGlobal.

A book like this tends to go through a number of faculty reviews, and in this case, I have the following faculty to thank for reviewing parts or all of the text. Their time and effort are sincerely appreciated. Thanks to: Joseph J. Biscoglio, the College of New Rochelle; Jesse Brinson, University of Nevada, Las Vegas; Chris Faiver, John Carroll Uni-versity; Edward A. Mainzer, New York Institute of Technology; Michael Mobley, Rutgers, the State University of New Jersey; and Zark VanZandt, University of Southern Maine.

A very special thanks to the hard work by Tim Grothaus, Kathleen Levingston, and Hannah Bayne in their revisions of chapters 16, 17, and 18. Their efforts have made these chapters considerably stronger. Finally, I would like to thank Karyn Gray, Eboyn Kirby, Kimlonte Morris, John Norris, and Jessica Washington who assisted with the Author Index.

1

SECTION IProfessional Orientation C H A P T E R 1 The Counselors Identity: What, Who,

and How?

C H A P T E R 2 The Counseling Professions Past, Present, and Future

C H A P T E R 3 Standards in the Profession: Ethics, Accreditation, Credentialing, and Multicultural/Social Justice Competencies

Overview

This fi rst section offers an overview of important professional issues in the fi eld of coun-seling. A common theme running through Chapters 1 through 3 is how the counseling profession has developed its unique professional identity. This topic is explored by looking at how we are the same as well as how we are different from other mental health profession-als, by examining our unique history, and by describing the standards of our profession.

Chapter 1 defi nes counseling and distinguishes it from related fi elds such as guidance and psychotherapy. This chapter compares different kinds of mental health profession-als who do counseling, and it concludes by examining the characteristics of an effective counselor. Chapter 2 reviews the history of the counseling profession, tracing it from the distant past, through the beginnings of the mental health fi eld, to the current status of the profession. It also offers us a glimpse into its future. Chapter 3 explores the development and implementation of four important standards in the counseling profession: ethics, ac-creditation, credentialing, and multicultural/social justice competencies.

At the conclusion of every chapter in the book, chapter content is tied in with important multicultural/social justice issues; ethical, professional, and legal issues; and, in a section called The Counselor in Process, issues involving how the counselor lives as a person and professional in the world.

2

CHAPTER 1The Counselors Identity: What, Who, and How?. . . counseling has proven to be a diffi cult concept to explain. The publics lack of clarity is due, in part, to the proliferation of modern-day services that have adopted the label counselor. They range from credit counselors to investment counselors, and from camp counselors to retirement counselors. Although their services share the common in-gredient of verbal communication, those services have little in common with . . . [psychological counseling]. (Hackney & Cormier, 2009, p. 2)

Sometimes as a child, I would have a temper tantrum, and my mother would say, I just dont understand why you get so angry; maybe I should take you to see a counselor. This threat intimated that there was something terribly wrong with me, and perhaps, in some way, also showed her love for and desire to understand and help me.

I used to wonder what it would be like to see a counselor. It couldnt be a good thing if my mom was using it as a threat, I thought! On the other hand, maybe counsel-ing would be a place where I could talk to someone who understood me, someone who could understand my moods, moods that felt normal to me yet were being defi ned as be-ing wrong, or kind of abnormal. Maybe seeing a counselor would be okay. In fact, maybe a counselor would say I was normal! But what exactly would a counselor do, I wondered?

Thankfully, over the years Ive had the opportunity to be in counseling. And, irony of all ironies, I became a counselor. Well, maybe my mom intuited early that I was going to be intimately involved in counseling in one way or another!

This chapter is about defi ning the words counseling and counselor. First, I will highlight the word counseling and distinguish it from related words such as guidance and psychotherapy. Then I will compare and contrast counselors with other mental health professionals who do counseling. Next, I will examine characteristics of an effective helper.

As we near the end of the chapter, I will provide an overview of the vari-ous professional associations in the counseling field, with particular emphasis on the American Counseling Association (ACA). I will conclude the chapter by highlighting

CHAPTER 1 The Counselors Identity: What, Who, and How? 3

the importance of multicultural issues in the fi eld of counseling and by focusing on ethi-cal, professional, and legal issues that apply to counselors.

Guidance, Counseling, and Psychotherapy: Variations on the Same Theme?

Counseling is a professional relationship that empowers diverse individuals, families, and groups to accomplish mental health, wellness, education, and career goals. (ACA, 2010a)

This statement, recently endorsed by a wide range of counseling associations, took a long time coming, as over the years, the word counseling has not been easily defi ned. In fact, for years there have been differing opinions about what counseling is and how to distinguish it from guidance and psychotherapy. Let me offer some of my own associations with these words, and see if they match your own. For instance, when I hear the word psychotherapy, I think of the following words: deep, dark, secretive, sexual, unconscious, pain, hidden, long-term, and reconstructive. The word counseling makes me think of short-term, facilitative, here-and-now, change, problem solving, being heard, and awareness. And lastly, guidance makes me think of ad-vice, direction, on the surface, advocacy, and support. Did these associations ring true for you? Now, lets look at how the literature has defi ned these words.

Over the years there have been a plethora of defi nitions of counseling that suggest it could be anything from a problem-solving, directive, and rational approach to helping nor-mal peoplean approach that is distinguishable from psychotherapy (Williamson, 1950, 1958); to a process that is similar to but less intensive than psychotherapy (Nugent & Jones, 2005); to an approach that suggests that there is no essential difference between the two (Neukrug, 2011; Patterson, 1986).

Some of the confusion among these words rests in their historical roots. The word guidance fi rst appeared around the 1600s and was defi ned as the process of guiding an individual. Early guidance work involved individuals giving moralistic and direct advice. This defi nition continued into the twentieth century, when vocational guidance coun-selors used the word to describe the act of guiding an individual into a profession and offering suggestions for life skills. Meanwhile, with the development of psychoanalysis near the end of the nineteenth century came the word psychotherapy. Meaning caring for the soul, the word was derived from the Greek words psyche, meaning spirit or soul, and therapeutikos, meaning caring for another (Kleinke, 1994).

During the early part of the twentieth century, vocational guidance counselors be-came increasingly dissatisfi ed with the word guidance and its heavy emphasis on advice giving and morality. Consequently, the word counseling was adopted to indicate that voca-tional counselors, like the psychoanalysts who practiced psychotherapy, dealt with social and emotional issues. As mental health workers became more prevalent during the mid-1900s, they too adopted the word counseling, rather than use the word guidance with its moralistic implications, or psychotherapy, which was increasingly associated with psycho-analysis. Tyler (1969) stated that those who participated in the mental health movement and had no connection with vocational guidance used the word counseling to refer to what others were calling [psycho]therapy . . . (p. 12).

In the training of counselors today, the word guidance has tended to take a back seat to the word counseling, while the words counseling and psychotherapy are generally

4 SECTION I Professional Orientation

used interchangeably in textbooks. Examine most texts that describe theories of counsel-ing and compare them to a text that describes theories of psychotherapy, and you will fi nd them to be nearly identical. In other words, theories of counseling and psychotherapy are indistinguishable. In fact, often both words are in the title. For example, C. H. Pat-terson noted in his very popular text, Theories of Counseling and Psychotherapy, that . . . counseling and psychotherapy are both used in the title of this book because it appears to be impossible to make any clear distinction between them (Patterson, 1986, p. xvii). In a similar vein, Corey (2009), the author of the best-known text on theories of coun-seling and psychotherapy, simply does not address the issue, choosing to use the words interchangeably.

Despite the lack of distinction made in most texts, a differentiation between counsel-ing and psychotherapy is likely to be made by the average person, perhaps by many counsel-ing students, and even by professors of counseling. Acknowledging this common usage, one model of understanding these terms would place guidance and psychotherapy on opposite extremes, with counseling falling somewhere midway on the continuum (see Figure 1.1).

Comparison of Mental Health ProfessionalsWhether we call it guidance, counseling, or psychotherapy, in todays world we fi nd a number of professionals practicing it. In fact, although differences in the training of men-tal health professionals exist, over the years their professional duties have begun to overlap (Todd & Bohart, 2006). For instance, today, some school counselors do therapy, coun-seling and clinical psychologists act as consultants to the schools, psychiatrists are social advocates, social workers and others can be psychoanalysts, mental health counselors do family therapy, and psychologists vie for the right to prescribe psychotropic medications (Johnson, 2009). Lets examine some of the similarities and differences among various professionals, including counselors, social workers, psychologists, psychiatrists, psycho-analysts, psychiatric mental health nurses, psychiatrists, human service practitioners, and psychotherapists.

F I G U R E 1.1Guidance, Counseling, and Psychotherapy Continuum

Guidance Counseling Psychotherapy

Short-term

Modifying behavior

Surface issues

Here and now

Preventive

Conscious

Helper-centered

Long-term

Personality reconstruction

Deep-seated issues

There and then

Restorative

Unconscious

Helpee-centered

CHAPTER 1 The Counselors Identity: What, Who, and How? 5

CounselorsFor many years, the word counselor simply referred to any professional who practices counseling (Chaplin, 1975, p. 5). However, today, most individuals who call themselves counselors will have a masters degree in counseling. These days, counselors are found in many settings and perform a variety of roles. For instance, they may serve as school coun-selors, college counselors, mental health counselors, private practitioners, rehabilitation counselors, and counselors in business and industry. The counselors training is broad, and we fi nd counselors doing individual, group, and family counseling; administering and interpreting educational and psychological assessments; offering career counseling; ad-ministering grants and conducting research; consulting on a broad range of educational and psychological matters; supervising others; and presenting developmentally appropri-ate guidance activities for individuals of all ages. Even though counselors do not tend to be experts in psychopathology, they do have knowledge of mental disorders and know when to refer individuals who need more in-depth treatment.

Although there are many different kinds of counselors, all tend to have had com-mon coursework in professional orientation and ethical practice, social and cultural di-versity, human growth and development, career development, the helping relationship, group work, assessment, and research and program evaluation. In addition to these com-mon core areas, counselors generally have had coursework in a counseling specialty area, which might include classes in the history, roles and functions, and knowledge and skills of that specialty area. Finally, all counselors have had the opportunity to practice their acquired skills and knowledge at fi eld placements, such as a practicum or internship.

Today, most counseling programs at the masters level will offer degrees in one or more of the specialty areas as recognized by the accrediting body for counseling programs, the Council for the Accreditation of Counseling and Related Educational Programs (CACREP) (see Chapter 3). These include school counseling; clinical mental health counseling; marriage, couple, and family counseling; addiction counseling; career coun-seling; and student affairs and college counseling. Rehabilitation counseling is accredited by a separate accreditation body, the Council on Rehabilitation Education (CORE), and follows similar curriculum guidelines to those above with an added emphasis on courses related to working with individuals with disabilities. Not all programs use the exact names that CACREP suggests and some programs offer specialty areas outside of those delin-eated by CACREP. However, most programs will offer a core curriculum and fi eld work similar to that noted in the previous paragraph.

All counselors can take an exam to become a National Certifi ed Counselor (NCC) that is offered by the National Board for Certifi ed Counselors (NBCC, 2009a). NBCC also offers subspecialty certifi cations in clinical mental health counseling, school coun-seling, and addiction counseling. In addition, today, all 50 states, Puerto Rico, and the District of Columbia have established licensing laws that allow a counselor who has a mas-ters degree in counseling, additional training, and supervision to practice as a Licensed Professional Counselor (LPC) (some states use a related term) (ACA, 2010c). Whereas certifi cation is generally seen as mastery of a content area, licensure allows counselors to practice independently and obtain third-party reimbursement for their practice (an in-depth discussion of credentialing can be found in Chapter 3). The professional associa-tion for counselors, which is called the American Counseling Association (ACA), cur-rently has 19 divisions that focus on a variety of counseling concerns (a further discussion of ACA and its divisions is provided later in this chapter).

6 SECTION I Professional Orientation

While keeping in mind that a person with a masters degree in counseling is primar-ily a counselor and secondarily a school counselor, mental health counselor, or a coun-selor in some other specialty area, the following are brief descriptions of some of the more prevalent counseling specialty areas.

School Counselors

A school counselor has a masters degree in counseling and a specialty in school counseling. Some states credential school counselors on the elementary, middle, and secondary lev-els, while other states offer credentialing that covers kindergarten through twelfth grade (K12). Today, the majority of school counseling programs are CACREP accredited, which requires a minimum of 48-credit hours for the degree. The professional association for school counselors is the American School Counselor Association (ASCA), which is a division of ACA, although one can become a member of ASCA without joining ACA. In recent years, the ASCA National Model has been used as a model for the training of school counselors (see Chapter 16). In addition, over the past few decades, there has been a push by professional training programs, professional associations, and many in the fi eld to replace the term guidance counselor with school counselor, as the latter term is seen as de-emphasizing the guidance activities of the school counselor (Baker & Gerler, 2008). If they so choose, school counselors can become NCCs, and, in most states, LPCs.

Clinical Mental Health Counselors (Agency Counselors)

A clinical mental health counselor is an individual who has obtained his or her degree in clinical mental health counseling or a closely related degree in counseling (e.g., agency counseling). Although in the past CACREP had included standards for 48-credit agency (or community counseling) programs, CACREPs 2009 standards have done away with those specialty areas and now support a 54-credit clinical mental health counseling degree, which, in 2013, will be increased to 60 credits. However, some masters programs may still be operating, and accredited, under the older 48-credit standards. As these programs ac-creditation periods expire, they will have to either expand their masters degrees to the new 54 or 60-credit requirement, or disband their programs. Although not all programs are CACREP accredited, individuals who obtain a degree in clinical mental health counsel-ing, or related degrees, are generally trained to conduct counseling or psychotherapy for those who are struggling with life problems, emotional issues, or mental health disorders. They are usually found working in a wide variety of agencies or in private practice conduct-ing counseling and psychotherapy. The clinical mental health counselors professional as-sociation is the American Mental Health Counselors Association (AMHCA), which is a division of ACA, although one can now be a member of AMHCA without joining ACA.

Marriage, Couple, and Family Counselors

Marriage, couple, and family counselors are specifi cally trained to work with couples and with family systems and can be found in a vast array of agency settings and in private practice. These counselors tend to have specialty coursework in systems dynamics, cou-ples counseling, family therapy, family life stages, and human sexuality, along with the more traditional coursework in the helping professions. The American Association of Marriage and Family Therapists (AAMFT) is one professional association for marriage

CHAPTER 1 The Counselors Identity: What, Who, and How? 7

and family counselors; another is the International Association of Marriage and Family Counselors (IAMFC, n.d.). IAMFC is a division of ACA, although one can join IAMFC without joining ACA.

Although all 50 states have some requirement for marriage and family licensure, the requirements can vary dramatically (Occupational Outlook Handbook, 20102011). While some states license marriage and family counselors who have studied from programs that follow the curriculum guidelines set forth by AAMFTS Commission on the Accredita-tion of Marriage and Family Therapy (COAMFTE), other states prefer licensing counsel-ors who have studied from programs that follow the 60-credit CACREP guidelines, and still others have set their own curriculum guidelines for credentialing. Most states that offer marriage and family counselor credentialing allow helping professionals with related degrees (e.g., counseling, social work, psychology) to also practice marriage and family counseling, as long as they follow the curriculum guidelines set forth by the state and abide by any additional requirements for credentialing.

Student Affairs and College Counselors

Student affairs and college counselors work in a variety of settings in higher education, in-cluding college counseling centers, career centers, residence life, advising, multicultural student services, and other campus settings where counseling-related activities occur. Usu-ally, these counselors will have taken specialty coursework in college student development and student affairs practices and may have attended a 48-credit CACREP-accredited pro-gram. If they so choose, counselors who work in college settings can become NCCs, and, in most states, LPCs. There are two main professional associations of counselors in higher education settings: College Student Educators International (this organization was for-merly the American College Personnel Association and has kept the acronym ACPA), which tends to focus on administration of student services; and the American College Counseling Association (ACCA), which is a division of ACA and tends to focus on counseling issues in college settings. Today, one can join ACCA without joining ACA.

Addiction Counselors

Addiction counselors study a wide range of addiction disorders, such as substance abuse (drugs and alcohol), eating disorders, and sexual addictions. They are familiar with di-agnosis, treatment planning, and understand the importance of psychopharmacology in working with this population. Today, CACREP offers a 60-credit accreditation in ad-diction counseling. Many addiction counselors can become certifi ed through their state. In addition, NBCC offers a certifi cation as a Master Addiction Counselor (MAC). Be-cause CACREP-accredited programs offer the basic curriculum in counseling in addition to specialized courses in substance abuse, addiction counselors can almost always become Licensed Professional Counselors (LPCs). In addition to AMHCA, addiction counselors often belong to the International Association of Addictions and Offender Counselors (IAAOC), which is also a division of ACA.

Rehabilitation Counselors

Rehabilitation counselors offer a wide range of services to people with physical, emotional, and/or developmental disabilities. Rehab counselors work in state vocational rehabilita-tion agencies, unemployment offi ces, or private rehabilitation agencies. The Council on

8 SECTION I Professional Orientation

Rehabilitation Education (CORE) is the accrediting body for rehabilitation counseling programs. Although the curricula in rehabilitation counseling programs largely parallel those in CACREP-approved programs, rehab programs include coursework on vocational evaluation, occupational analysis, medical and psychosocial aspects of disability, legal and ethical issues in rehabilitation, and the history of rehabilitation counseling. Although CORE and CACREP attempted to merge, these efforts have failed and merger talks, for now, been been placed on hold (The CACREP Connection, 2007). Although re-habilitation counselors can become NCCs or LPCs, many choose to become Certifi ed Rehabilitation Counselors (CRCs) through a separate certifi cation process offered by the Commission on Rehabilitation Counselor Certifi cation (CRCC). Many rehabilitation counselors join the National Rehabilitation Counseling Association (NRCA) and/or the American Rehabilitation Counseling Association (ARCA), a division of ACA. Today, one can join ARCA without joining ACA.

Pastoral Counselors

Pastoral counselors sometimes have a degree in counseling but can also have a degree in a related social service or even just a masters degree in religion or divinity. Pastoral counsel-ors sometimes work in private practice or within a religious association. Pastoral counselors, religious counselors, or counselors with a spiritual orientation might join the Association for Spiritual, Ethical, and Religious Values in Counseling (ASERVIC), a division of ACA, and/or the American Association of Pastoral Counselors (AAPC). AAPC offers a certifi ca-tion process for those who are interested in becoming Certifi ed Pastoral Counselors (CPC).

Social Workers Although the term social worker can apply to those who have an undergraduate or a grad-uate degree in social work or a related fi eld (e.g., human services), the term has recently become more associated with those who have acquired a masters degree in social work (MSW). Whereas social workers traditionally have been found working with the under-privileged and with family and social systems, todays social workers provide counseling and psychotherapy for all types of clients in a wide variety of settings, including child welfare services, government-supported social service agencies, family service agencies, private practices, and hospitals. Social workers usually have extensive training in coun-seling techniques but less preparation in career counseling, assessment techniques, and quantitative research methods.

Even though theoretical distinctions exist between the MSW and the masters de-gree in counseling, the two degrees probably have more similarities than differences. With additional training and supervision, social workers can become nationally certifi ed by the Academy of Certifi ed Social Workers (ACSW). In addition, most states have specifi c requirements for becoming a Licensed Clinical Social Worker (LCSW). The professional association for social workers is the National Association of Social Workers (NASW).

PsychologistsMany different types of psychologists practice in a wide range of settings, including agen-cies, private practice, health maintenance organizations, universities, business and indus-try, prisons, and schools. Psychologists are often found running agencies, consulting with

CHAPTER 1 The Counselors Identity: What, Who, and How? 9

business and industry, or serving in supervisory roles for all types of mental health pro-fessionals. Some of the many different kinds of psychologists include clinical, cognitive, counseling, developmental, educational, engineering, evolutionary, experimental, foren-sic, health, industrial/organizational, neuro, quantitative, rehabilitation, school, social, and sports. Today, each state determines the types of psychology licenses it authorizes as well as the requirements for obtaining those licenses (American Psychological Associa-tion, [APA], 2003).

Relative to the practice of psychotherapy, all states offer licensure in counseling and/or clinical psychology, and many states now allow individuals with a Psy.D., a rela-tively new clinical doctorate in psychology, to become licensed as clinical or counseling psychologists. Licensed counseling and clinical psychologists have obtained a doctoral degree in psychology, acquired extensive supervised experience after graduate school, and passed a licensing exam. The professional association for psychologists is the American Psychological Association (APA). Counselors are likely to have more contact with clini-cal, counseling, and school psychologists than with other types of psychologists. These specialty areas are described below.

Clinical Psychologists

Clinical psychologists have a strong background in science, theory, and practice, which enables them to alleviate maladjustment and promote psychological well-being (APA, 2003). To obtain a license as a clinical psychologist, one must graduate from an APA-accredited doctoral program in clinical psychology and complete additional requirements identifi ed by state licensing boards. The professional association for clinical psychologists is Division 12 of the APA.

Counseling Psychologists

Historically, counseling psychologists have worked with relatively healthy populations, whereas clinical psychologists have worked with seriously impaired populations. Today, however, the differences between counseling and clinical psychologists are nominal (APA, 2003). To become a counseling psychologist, one must obtain a doctoral degree from an APA-approved program and complete additional requirements identifi ed by the state licensing board. The professional association for counseling psychologists is Division 17 of the APA.

School Psychologists

School psychologists have a masters or doctoral degree in school psychology and are li-censed by state boards of education. Their work involves children, families, and the schooling process and their training tends to focus on consultation, evaluation and as-sessment, intervention, prevention, and research and planning (National Association of School Psychologists, n.d.). Many school psychologists today are found working closely with students with learning programs, their parents, and their teachers. Although most school psychologists work in schools, you can sometimes fi nd them in private practice, in agencies, and in hospital settings. The professional associations for school psycholo-gists are the National Association of School Psychologists (NASP) and Division 16 of the APA.

10 SECTION I Professional Orientation

PsychiatristsA psychiatrist is a licensed physician who generally has completed a residency in psychia-try, meaning that in addition to medical school, he or she has completed extensive fi eld placement training in a mental health setting. In addition, most psychiatrists have passed an exam to become board certifi ed in psychiatry. Being a physician, the psychiatrist has expertise in diagnosing organic disorders, identifying and treating psychopathology, and prescribing medication for psychiatric conditions. Although some states have granted psychologists prescription privileges for psychotropic medication (Johnson, 2009), cur-rently it is psychiatrists, and in some cases psychiatric nurses, who take the lead in this important treatment approach.

Because psychiatrists often have minimal training in techniques of individual and group counseling, assessment techniques, human development, and career counseling, they are sometimes not seen as experts in the delivery of counseling and psychotherapeutic services. Psychiatrists are employed in mental health agencies, hospitals, private practice settings, and health maintenance organizations. The professional association for psychia-trists is the American Psychiatric Association (APA).

PsychoanalystsPsychoanalysts are professionals who have received training in psychoanalysis from a number of recognized psychoanalytical institutes. Although the American Psycho-analytical Association (APsaA), the professional association of psychoanalysts, for-merly would only endorse psychiatrists for training at psychoanalytical institutes (Turkington,1985), they now allow other mental health professionals to undergo train-ing (APsaA, 2008). Because states do not license psychoanalysts, clients who are seeing a psychoanalyst should make sure that the analyst was trained at an institute sanctioned by the American Psychoanalytical Association and that he or she has a license in a mental health fi eld (e.g., licensed psychiatrist, psychologist, counselor [LPC], or social worker [LCSW]).

Psychiatric-Mental Health NursesPrimarily trained as medical professionals, psychiatric-mental health nurses are also skilled in the delivery of mental health services (American Psychiatric Nurses Association, n.d.). Most psychiatric-mental health nurses work in hospital settings, with lesser numbers working in community agencies, private practice, or educa-tional settings. Psychiatric-mental health nursing is practiced at two levels. The RN psychiatric-mental health nurse does basic mental health work related to nursing di-agnosis and nursing care. The Advanced Practiced Registered Nurse (APRN)