Field Experience: Transitioning From Student to Professional
Instructor Resources
SAGE Journal Articles
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Chapter 1. Field Experience as Formative to Professional Identity
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Article 1:
This article reviews recent literature highlighting the challenges associated with the college-to-work transition and proposes a model for understanding the experience of workplace entry for new graduates. This model outlines three stages of development in the transition process, namely (a) anticipation, (b) adjustment, and (c) achievement, and identifies a number of challenges that can be addressed prior to college graduation. In response, this article suggests that university career counselors can play an increasingly supportive role in easing the complexities of the transition. Evidence indicates that students may benefit from a more thorough understanding of workplace realities and resources for coping with the significant change inherent in this transition experience. Implications for university career counselors are provided.
Questions to Consider:
- Identify challenges in the College-to-Work Transition discussed in this article, which parallel the challenges you face as you transition from the classroom to the field site.
- List three strategies that will help you prepare for your transition.
- What career counseling advice would you give to yourself at this stage of your transition from student to professional?
Article 2:
This article summarizes a reformulation of the main findings and perspectives from a cross-sectional and longitudinal qualitative study of the development of 100 counselors and therapists. The results are presented as a phase model and as a formulation of 14 themes of counselor/therapist development. The following six phases are described: The phases of the lay helper, the beginning student, the advanced student, the novice professional, the experienced professional, and the senior professional. The themes describe central processes of counselor/therapist development. The themes are addressing different issues such as shifts in attentional focus and emotional functioning, the importance of continuous reflection for professional growth, and a life-long personal/profession integration process. Sources of influence for professional functioning and development are described. The results show consistently that interpersonal experiences in the personal life domain (early family life and adult personal life) and the professional life domain (interacting with clients, professional elders, and peers) are significant sources of influence for professional development.
Questions to Consider:
- After reading this article, in which of the six phases would you categorize yourself: the lay helper, the beginning student, the advanced student, the novice professional, the experienced professional, or the senior professional?
- On what themes did you base your response to question #1?
- What interpersonal experiences in the personal life domain (early family life and adult personal life) are the most significant sources of influence on your professional life domain (interacting with clients, professional elders, and peers) at this phase of your training?
Article 3:
This article advocates the need for a much stronger emphasis on and commitment to the science and practice of prevention in counseling psychology. Historical and recent developments in the profession are highlighted, as are the changing U.S. demographics and societal needs that mandate an enhanced prevention focus for the field. A prevention based agenda of four fundamental goals for counseling psychology is articulated. The goals include eight training domains and objectives as well as skills needed to support a prevention agenda for counseling psychology. Barriers and adjustments needed to give renewed vitality toward prevention are discussed. Prevention resources and funding opportunities are presented.
Questions to Consider:
- What do the authors articulate as the four major goals of prevention?
- Assess yourself in each of the eight training domains …what are your strengths and growth edges in each domain?
- Provide an example from your site that supports the authors premise that “In practice, it is often difficult to differentiate between primary, secondary, and tertiary prevention” (p. 739).
Chapter 2. Matching Self to Site
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Article 1:
Heeding the call to the profession, the authors present both a definition and model of counseling competence. Undergirding the model are 15 foundational principles. The authors conceptualize counseling competence as more complex and nuanced than do traditional microskills models and include cognitive, affective, and behavioral components. The model consists of 4 superordinate competencies—determining therapeutic outcomes, facilitating therapeutic outcomes, evaluating therapeutic outcomes, and sustaining therapeutic outcomes—and 12 subordinate competencies: self-appraisal/self-evaluating, structuring the therapy, building a therapeutic alliance, applying a conceptual map of therapeutic change, using therapeutic techniques, self-correcting, surmounting obstacles, leveraging opportunities, managing special situations, working with other systems of care, consulting other sources, and terminating therapy. Integral to the model is the integrated deep structure, which consists of 5 metacognitions: purposefulness, motivation, selection, sequencing, and timing.
Questions to Consider:
- What are the four superordinate competencies detailed in this article?
- How can you create a plan for your field placement experience that moves past fostering microskills and knowledge, to opportunities which provide experience in these competencies?
- One of the subordinate competencies is self-appraisal or self evaluation. What are the other eleven subordinate competencies and how can a continuous system of self appraisal help you to gain greater competence in all twelve areas?
- What are the five metacognitions embedded in the deep structure of this model? Can you identify which are personal strengths for you and which are growth areas for your field placement experience?
Article 2:
Working from their proposed model of counseling competence, the authors address critical implications and applications of the model. First, they present a 10-parameter juxtaposition of the model of counseling competence and the microskills training model, including points of comparision and contrast. Second, they discuss implications of the model for practice, including guidelines for teaching and an application exercise. Third, they discuss implications of the model for research, including improvements over design flaws and the limited focus that has typified research on microskills training.
Questions to Consider:
- What are the 10 parameters of juxtaposition which the authors use to compare and contrast the counseling competence model with a microskills training model?
- Evaluate the Case of Jane used as an application exercise in this model and detail which model of helping Jane reflects the training you have received in your graduate program.
- Are there aspects of other models that you would like to incorporate in your work at your training site? Does your site supervisor work from a model that is different from the one used in your graduate program?
- As you enter this field placement, are you more focused on continuing development of your microskills, or are your growth areas more embedded in larger competencies as described in this article?
- Prepare a list of your growth area goals (microskills and/or counseling competencies) to share with your site supervisor and against which you can compare your progress.
Article 3:
Counselor education programs accredited by the Council for Accreditation of Counseling and Related Educational Programs (CACREP) are required to evaluate student learning outcomes (SLOs) aligned with CACREP Standards. Additionally, counselor educators have the ethical responsibility to remediate student deficiencies and gatekeep for the profession. The Counseling Competencies scale (CCS) is an instrument designed to assess counseling competencies in the CACREP core curricular areas and SLOs. The authors discuss the use of the CCS to measure CACREP objectives and SLOs within the counselor education curriculum.
Questions to Consider:
- Using Figure 1 on page 121 of this article, check off the boxes on the extreme left that represent areas of strength for you as an emerging counselor. Highlight those that are growth areas for your field placement experience. Based on these, which of the five factors requires the most attention for continued growth in your placement?
- In your opinion, did your counselor preparation program cover all of the competencies deemed essential by CACREP? If not, what is your personal remediation plan foster these for yourself?
- What do the authors mean when they state “Additionally, counselor educators have the ethical responsibility to remediate student deficiencies and gatekeep for the profession” and what “gates” have you passed through on your journey thus far?
Chapter 3. From the Ideal to the Real
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Article 1:
School administrators are not always as familiar as they might be with the education and training of school counselors. As a result, school counselors may be assigned non-counseling activities such as supervision or paperwork tasks that would be more closely suited to the duties of an assistant principal or member of the clerical staff. These non-counseling duties are time consuming and allow school counselors less time to spend with the students assigned to them. Resources and creative thinking are needed to reduce or eliminate many of the non-counseling functions that school counselors are required to assimilate into their workday, so that they can spend their time helping students. This case study examines the dilemma faced by the principal of a large high school as she confronts an unhappy counseling staff and the culminating desire of one school counselor to leave the profession and return to the classroom. She realizes the difficulties have been growing for some time and she has not adequately addressed the counselor’s concerns. Upon overhearing a hallway discussion about one of her counselors, she decides it is time to find out what is going on in the counselor’s office.
Questions to Consider:
- Do you think that Frank, the counselor in this case study, expected to be fulfilling all the roles and functions described, based upon his understanding of ASCA’s list of School Counselor Activities? Would you accept a position similar the one described here? Why or why not?
- How might a counselor in a similar situation use a mission statement to support a request for modification of roles and functions? Would you accept a position in a school or agency that did not have a formal mission statement for your division?
- Based on your knowledge of the ASCA guidelines presented in this chapter, what are some of the functions presented here that seem unrelated to the education and training received by counselors?
- What are the school culture and climate issues in this case? How might this scenario be viewed differently if Frank were not a well-liked and respected counselor?
Article 2:
Various professional organizations have called for a standardized, developmental approach to the assessment of the internship experience (e.g., American Counseling Association’s call for multicultural competent assessment) and the need for a standardized assessment of internship skill acquisition. In response to these calls and the data collected in this participatory action research study, the authors developed an assessment system to monitor the school counseling trainee’s skill development throughout the internship experience—the Professional School Counseling Internship: Developmental Assessment of Counseling Skills.
Questions to Consider:
- Review the items on the CIDACS Evaluation 1 & 2 beginning on page 65 of this article. If you are entering a school placement, would you benefit from using this assessment with your supervisor(s)? why or why not? How is it different from the assessment currently used in your program? If you are in a counseling field placement outside of school systems, is there a similar instrument for your specialty area or do you use a general counseling assessment with your supervisor(s)?
- How might an instrument such as this one serve both trainees and their supervisors? What misunderstandings might be avoided if all parties had a clear job description and mission statement, well defined roles and functions, and agreed upon evaluation criteria? Would such a structured placement suit you, or do you prefer more flexibility in your placement? How might you negotiate the best of both for yourself when selecting a site?
- The authors state that future researchers using and developing such instruments “…should also focus on the importance of standards-based assessment instruments as ‘living’ documents that remain current and relevant.” What do the authors mean by this and how can you contribute to this goal?
Chapter 4. The Ethics of Practice: More Than Knowing, Being
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Article 1:
The new ethics section editor discusses ethical dilemmas facing professional counselors in today’s society and invites readers to contact him about their ideas, perspectives, and ethical situations. Ethics is discussed as a means of professional unification, whereas counselor identity and counselor wellness are identified as being integral to ethical behavior.
Questions to Consider:
- The author begins by asking “Are we counselors who specialize through our training to work in various settings while still carrying the title ‘professional counselor?’” or “Are we, if we are in specialized settings, such as education, an educator first and a counselor second?” “Who are we?” “What is our ‘professional identity?’” After reading this article, what are your personal thoughts regarding your identity as a counselor? Is that identity shaped by your code of ethics?
- Do you agree that it is a counselor’s professional duty to attend to self-care and wellness? Why or why not? Is your client’s state of wellness more important than your own? Whether you agreed or disagreed, are your behaviors congruent with your stated belief?
- As a counselor in training, you might often ask yourself “Can I do that? Is it ethical?” “What about confidentiality?” “Who needs to sign this release form?” “Did you lock the file cabinet?” What three responses would the author suggest you give to yourself? Are these congruent with your understanding of your ethical decision making steps?
Article 2:
Acting in the best interests of students is central to the moral and ethical work of schools. Yet tensions can arise between principals and school counsellors as they work from at times opposing professional paradigms. In this article we report on principals’ and counsellors’ responses to scenarios covering confidentiality and the law, student/teacher relationships, student welfare and psychological testing of students. This discussion takes place against an examination of ethics, ethical dilemmas and professional codes of ethics. While there were a number of commonalities among principals and school counsellors that arose from their common belief in education as a moral venture, there were also some key differences among them. These differences centered on the principals’ focus on the school as a whole and counsellors’ focus on the welfare of the individual student. A series of recommendations is offered to assist principals to navigate ethical dilemmas such as those considered in this article.
Questions to Consider:
- How might these scenerios play out differently in a US school system? What aspects of this article parallel our US system?
- Applying the 2014 American Counseling Association Code of Ethics, what would you add to this discussion?
- What are your biggest concerns regarding balancing ethical principles, laws and obligations to your contract with an employer? How will you resolve these concerns?
Chapter 5. Reflecting on Practice
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Article 1:
A good case conceptualization should effectively link a client’s presenting problem to a treatment plan as well as provide the basis for tailoring treatment to client need and expectations. Case conceptualization can also provide a tangible marker of a trainee’s capacity to link or integrate theory and practice. Unfortunately, family therapy has been notably silent about case conceptualizations and either of these links, despite the fact that case conceptualization is probably indispensable when health issues impact couples or family dynamics. This article discusses these considerations. It then describes pattern analysis, a clinically useful strategy for case conceptualization and sequencing treatment for individuals, couples, and families and applies it to the impact of health issues on family dynamics. A case example illustrates the linking functions of a case conceptualization and the application of pattern analysis to the planning and sequencing of treatment involving adolescent diabetes in a family context.
Questions to Consider:
- What is case conceptualization? Has it been central and valued in your graduate training program?
- What are the three dimensions of case conceptualization as briefly described in this article?
- What are the roles of deductive and inductive reasoning in the case conceptualization-treatment planning process as discussed in this article?
- What is pattern analysis and how can it be a useful strategy for conceptualizing cases and planning and sequencing treatment?
- The article provides a sample case study of a family medical issue. Write your own brief case study describing a familiar case type in your placement setting. Try using the guidelines presented in this article to work through your case study.
Article 2:
This case study describes the integration of cultural values into the cognitive-behavioral therapy (CBT) of a Latino with depression to illustrate culture-based modifications in the use of CBT treatment with this client. Cultural values of familismo, personalismo, respeto, and machismo are defined and weaved into the case conceptualization and treatment process, to build a culturally competent treatment approach. The article describes challenges in the treatment of the individual and provides culture-specific strategies to modify the traditional CBT approach and increase the prospects of successful treatment outcomes. It acknowledges the heterogeneity of the Latino population and cautions against broad generalizations. Treatment implications; limitations relative to gender, education, and socioeconomic status; and recommendations for practice and research are also included. The article further provides a discussion on the status of intervention research with racial and ethnic minority groups and Latinos in particular.
Questions to Consider:
- The article describes challenges in the treatment of the individual and provides culture-specific strategies to modify the traditional CBT approach and increase the prospects of successful treatment outcomes. How can you learn from what the authors present here without falling into a knee-jerk pattern of stereotyping clients based on culture?
- What culture(s) do you need to learn more about to serve the communities represented at your placement site? Are there aspects of difference or exceptionality beyond culture that you to reflect upon in your placement?
- How can greater knowledge of a client’s background assist you in working from a strength based perspective?
- What self reflection exercises might help you avoid complicating factors based on your unique worldview and cultural factors that influence your conceptualizations?
Article 3:
Individualized learning plans (ILPs) are being implemented in high schools throughout the United States as strategic planning tools that help students align course plans with career aspirations and often include the development of postsecondary plans. Initial indications are that ILPs may be an important method for helping students achieve both college and career readiness. Parents, teachers, and students indicate that ILPs result in students selecting more rigorous courses, better teacher–student relationships, and positive parent–school relations. This article describes the emergence and nature of ILPs, promising practice strategies as well as challenges associated with gaining whole school buy-in, and the potential for career and vocational research.
Questions to Consider:
- Your text advocates using SMART goals for your clients…and for yourself. Using this article as inspiration, what other aspects of you field placement might be aided by taking the time to create SMART goals?
- What strategies might you employ to facilitate buy-in to SMART goals for reluctant clients, supervisors and systems?
- What aspects of this school based system might you implement in other settings when working with clients with career concerns?
Chapter 6. Growing Through Supervision
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Article 1:
Two studies were conducted to revise and empirically test Ellis’s framework for inadequate and harmful supervision, and to determine the occurrence of inadequate and harmful clinical supervision from the supervisees’ perspective. For Study 1, we delineated 10 criteria for minimally adequate clinical supervision and defined inadequate and harmful supervision by differentiating self-identified and de facto supervision for each. Ratings from 34 supervision experts were used to generate a taxonomy of 16 de facto inadequate and 21 de facto harmful supervision descriptors. Because harmful supervision was distinct from, yet subsumed by, inadequate supervision, we revised the taxonomy and definitions accordingly. In Study 2, the occurrence of inadequate and harmful supervision was assessed for 363 supervisees; 93.0% were currently receiving inadequate supervision and 35.3% were currently receiving harmful supervision. Over half of the supervisees had received harmful clinical supervision at some point. Implications for research, training, and practice are discussed.
Questions to Consider:
- According to these authors, what distinguishes inadequate supervision from harmful supervision?
- As per Figure 1 criteria on page 439, do you believe that your site supervision meets the criteria for minimally adequate clinical supervision? If it does not, with whom can you discuss this discrepancy?
- In examining clinical supervision, what is the difference between adequate and effective supervision or inadequate and ineffective supervision? Which is the difference between necessary and sufficient conditions in supervision?
Article 2:
Seventeen clinical supervisors were interviewed regarding their experience of providing difficult feedback in cross-ethnic/racial supervision, and their responses were analyzed using consensual qualitative research (CQR). European American supervisors described supervisees of color who had difficulty in their clinical work with culturally different clients. These supervisors then shared with supervisees their concern that supervisees’ interpersonal skills may negatively affect their clinical and/or supervision work. Supervisors of color described European American supervisees who exhibited insensitivity toward clients of color in session or during supervision. These supervisors shared their concern that supervisees’ lack of cultural sensitivity may negatively affect their clinical work. These contrasting feedback experiences had a profound effect on supervisory relationships and the processes within supervision.
Questions to Consider:
- What different concerns were expressed by European American supervisors who described supervisees of color and the supervisors of color who described European American supervisees?
- What effects did the contrasting feedback experiences have on supervisory relationships and the processes within supervision?
- Are you aware of any cultural differences between you and your field placement supervisor which may be impacting you’re your supervisory relationship and processes?
Article 3:
Since clinical supervision has become recognized as a distinct professional practice, competency based supervision has gained considerable traction internationally. Competency-based supervision enhances accountability and is compatible with evidence-based approaches. Competency-based supervision is defined by supervisor and supervisee collaboratively and explicitly identifying the knowledge, skills and attitudes comprising each clinical competency, determining specific learning strategies, and monitoring and evaluating the development of those. Recommendations for supervision practice are described based on the growing evidence base for practice and responsive to emerging ethical and legal issues.
Questions to Consider:
- Compare and contrast competency-based supervision and evidence-based approaches.
- This author explains that since supervision is a distinct professional practice, it requires specific training, however, there is still a significant lag in recognition of this internationally such that training in clinical supervision is not widely offered in all graduate training programs. Using this article as a talking point, ask your supervisor(s) to share his/her/their graduate training in supervision.
- Explain the supervision of supervision process. Is/are your supervisor(s) currently under supervision? Do you know your supervisor’s supervisor and if so are you comfortable with these layers of supervision?
- What are the components of the supervision process? How were you prepared to know your roles and functions in the supervisory relationship? Do you have a detailed supervisory contract with your supervisor(s)?
Chapter 7. Multicultural Counseling in Practice
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Article 1:
This article examines current and historical trends in psychotherapy research and practice with racial/ethnic minority populations. Initially, research on Derald Sue’s multicultural counseling competencies is provided as a foundation to further examine the evidence regarding effective cultural adaptations to mainstream treatment approaches, such as cognitive-behavior therapy and interpersonal psychotherapy. Next, a brief outline of Carl Rogers’s psychotherapy research tradition is presented, with a focus on both past and present evidence suggesting that person-centered therapy may be effective across diagnoses, as well as cultures. Using psychotherapy evidence from both the latter half of the 20th century and the initial decades of the 21st century, cultural adaptations to previously hypothesized person-centered therapy mechanisms of change are proposed. In particular, this culturally adapted person-centered approach is suggested to provide a competent and effective treatment system for racial/ethnic minority clients and families.
Questions to Consider:
- According to the author, “In all, the effectiveness of a culturally adapted person-centered approach is dependent on the therapist and his or her willingness to be a person, flawed yet genuine, in the presence of the client.” What does this statement mean to you as you enter the field?
- Compare and contrast the historical and current trends in psychotherapy research and practice with racial/ethnic minority populations as discussed in this article.
- Summarize Sue’s multicultural counseling competencies and assess your current level of proficiency and comfort with each one.
- Do you have a case at your field site where a culturally adapted person-centered approach would be appropriate? How can you work with your supervisor to implement this approach to provide a competent and effective treatment system for a racial/ethnic minority client?
Article 2:
The construct of multicultural competence has gained much currency in the counseling psychology literature. This article provides a critique of the multicultural counseling competencies and argues that counseling psychology’s operationalization of multicultural competence must be grounded in a commitment to social justice. Such a commitment necessitates an expansion of our professional activities beyond counseling and psychotherapy. While counseling is one way to provide services to clients from oppressed groups, it is limited in its ability to foster social change. Engaging in advocacy, prevention, and outreach is critical to social justice efforts, as is grounding teaching and research in collaborative and social action processes.
Questions to Consider:
- Do you agree with the following statement from this article: “If counseling psychology is to be committed to an agenda of multiculturalism, and there is no doubt that this commitment exists, then the field must also be committed to social justice.” Please explain how you would (or would not) interpret this statement as a personal/professional call to action?
- What are the 7 multicultural counseling competencies (of the total 31) that explicitly or implicitly articulate ways in which counselors should attend to issues of oppression?
- A later approach to social justice embraced by several contemporary social justice scholars is referred to as a communitarian model of justice or deliberative justice. How is this model of social justice different from older models in terms of decision making and resources?
- After reading this article, how has your understanding of multicultural competence grown? Do you believe that your obligation as a counselor reaches further than your actual clients of record? Where is your boundary of personal/professional responsibility to social justice?
Article 3:
Intimate partner sexual assault is a prevalent form of violence against women and outnumbers both stranger and acquaintance sexual assault. However, very little information is available on intimate partner sexual assault, let alone the experience and perception of different ethnicities in sexually violent relationships. To be effective, it is necessary for multiculturally competent counselors to understand the unique cultural, social, and economic experience of each couple to implement appropriate interventions.
Questions to Consider:
- Were you surprised to see this article in the multicultural section of these materials? As you read chapter 7 of your text, did you consider gender to be part of multicultural counseling competency? Does your gender identity have a part in this multicultural equation?
- This article reads as if the victim/survivor will always be female. Is that what you would expect as well? Would anything change if the victim/survivor were male?
- Would it be difficult for you to to initiate the discussions detailed in this article? Would there be clients from cultures that would be more difficult for you help effectively? Why or why not? How can you use supervision to process this article?
Chapter 8. Crisis Prevention and Intervention: Suicide and Homicide
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Article 1:
Crisis intervention is a role that fits exceedingly well with counseling psychologists’ interests and skills. This article provides an overview of a new crisis intervention model, the Integrated Problem-Solving Model (IPSM), and demonstrates its application to a specific crisis, sexual assault. It is hoped that this article will encourage counseling psychologists to become more involved in crisis intervention itself as well as in research and training in this important area.
Questions to Consider:
- Compare and contrast the definition of crisis presented in this article and that shared by the authors of your textbook. What is your understanding of the process of growth as outcome of a crisis situation?
- List the 10 stages of the Integrated Problem-Solving Model (IPSM) detailed in this article. How do these stages parallel (or diverge from) the Counselor Trainee Crisis Intervention plan you have developed with your supervisor?
- The authors demonstrate this model using a sexual assault case scenario. How might the steps (particularly 6 and 7) require additional sensitivity and also present additional challenges in an educational setting?
- Ask your site supervisor about a crisis that occurred at your site and explore the IPSM with the supervisor as a guideline for dealing with a similar situation. Evaluate the IPSM in terms of usefulness in dealing with crises which may arise at your site.
Article 2:
In an effort to promote the social and cognitive competence of youth, school psychologists must be prepared to address a multitude of contextual factors and life events that impact children’s performance and adjustment in school and subsequent developmental trajectories. The domain of crisis preparedness and intervention has received increased attention during the past decade (as evidenced by a growing school crisis intervention literature) and is currently a training standard for school psychologists in some parts of the world. Crisis situations may emerge following natural disasters such as floods, fires, tornadoes or earthquakes and also from human generated situations such as bombings and school shootings. Each of these events is likely to affect the children and families in schools and communities by presenting them with problems that will be challenging to cope with. There are a variety of crisis preparedness and intervention models and strategies available to address crisis situations. Without a shared foundation for crisis intervention, responding to crisis situations may be further complicated, especially in situations where international colleagues are collaborating. Therefore, a shared foundation that includes both preparedness and intervention while emphasizing both developmental and school considerations will be invaluable in our efforts to facilitate collaboration among diverse colleagues across multiple contexts. The purpose of this article is to incorporate several models and frameworks in order to provide a shared foundation for school psychologists and other educational and mental health professionals regarding crisis preparedness and intervention. To establish a shared foundation for international crisis collaboration, it is also necessary to review the original works discussed in this brief overview and participate in relevant workshops.
Questions to Consider:
- Compare and contrast the guidelines in this article with those in the previous article. How does a “crisis event” plan differ from an “individual in crisis” plan? In what ways are they alike?
- How can a shared framework assist professionals in related fields to collaborate effectively?
- In discussing crisis management with your supervisor, have the two of you discussed the differences between crisis events and the emergency situation management plans of your school, institution or agency, and individuals in crisis plans as detailed in the previous article? Where might these plans overlap? And where might they contradict each other?
- Using Figure 1 on page 279 as a starting point, re-label these stages using the terminology in another model in this article, the model in the previous article and Chapter 8 of your text. Do you see similar themes expressed using different vocabulary? How might the helping professions be served by adhering to common vocabulary and models that integrate varying points of professional responsibility?
Article 3:
Development of information technology has created new opportunities and challenges in suicide prevention, research, and clinical practice. This article presents an overview of the wide range of telecommunication-based suicide prevention approaches. Interventions using the Internet, telephone, and videoconferencing are discussed, including crisis intervention, referral, and support, suicide risk assessment, psychotherapy for individuals at risk, and online-based suicide prevention training and education. Research regarding effectiveness of telecommunication-based suicide prevention in various demographic and clinical populations is reviewed, as well as concerns regarding this type of intervention. Future areas of research and development in the use of telecommunication media in prevention of suicide are discussed.
Questions to Consider:
- Have you discussed with your site supervisor a protocol of crisis intervention/suicide prevention to be followed if you client is not physically present? Even if your site does not typically offer technology based appointments, what situations might arise where you are alerted to a problem via an email, text, or social media post?
- In addition to reading this article, review Section H “Distance Counseling,
- Technology, and Social Media” of the 2014 American Counseling Association Code of Ethics. What ethical decision making challenges might you anticipate in developing remote intervention and prevention plans?
- After exploring some of the examples in this article and cited in the chart on page 239, do you see a value in technology based options? What value? At what cost? Create your personal pro/con list for using technology in counseling in general…does this list change when we add the words “crisis” and suicide” to the conversation?
Chapter 9. Reducing Risk
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Article 1:
Strategies are needed that assist both current practitioners and counselors-in-training in working safely and effectively with potentially aggressive young people and their families. To emphasize with at-risk client families the seriousness of violence, all or part of an initial or early counseling session with an at-risk family should be devoted exclusively to prescribed risk assessment and crisis planning processes. This safety session is intended to reduce the risk of client violence by opening a forthright dialogue regarding the risk of violent behavior, specifying appropriate behavior, and setting limits and consequences for noncompliance. The specific framework for a safety session and a case study illustrating its application are presented.
Questions to Consider:
- Using the environmental assessment on page 217 of your text as a starting point, rate your field placement site and discuss with your supervisor whether or not a detailed safety session as outlined in this article is warranted or if basic informed consent is sufficient at your location. If a more detailed safety session with your clients is needed, develop this plan with your supervisor.
- How can defining acceptable baseline behavior with your clients assist you in de-escalating problem situations that arise later before they become violent?
- How might the model described here be expanded for use in other systems, particularly those with complex dynamics between participants?
Article 2:
This article explores the boundaries between clinicians and clients in light of the construct of solidarity. A universal conception of boundaries is critiqued and a culturally congruent view of boundaries is examined, rooted in the concept of solidarity. The article includes case illustrations of the connection between boundaries and solidarity and concludes with suggestions for mental health professionals.
Questions to Consider:
- Define solidarity as used in this article and explain the role of solidarity in a culturally congruent view of boundaries.
- Do you agree with the “slippery slope” argument that seemingly minor boundary crossings will lead to boundary violations? Have you discussed this concept with your supervisor?
- Do you plan to work in smaller, rural, close knit or types of communities and settings where dual relationships and minor boundary crossings are expected? How might you protect the counseling relationship in these situations?
- Do you think that context or content more accurately determines the appropriate boundary in counseling relationships? Is this negotiable in your viewpoint?
- What cultural components of your worldview would it honor if you were to define for yourself a culturally sensitive view of therapeutic boundaries? Would you be comfortable discussing this in supervision?
Article 3:
Ryan and colleagues are applauded for elevating client factors in the form of motivation and autonomy to equal status with the alliance as common factors in psychotherapy. Next, client motivation and autonomy are explained to be inextricably linked with one promoting the other. Motivational methods are summarized for the major approaches, making the point that some motivational approaches are more related to the promotion of client autonomy. Change talk is explained as similar to solution talk. Both are social constructivist methods of motivating clients and overcoming impasse in therapy. Matching client beliefs, using client strengths, and providing compelling rationales are underscored as motivational techniques. Similarities between motivation and hope are drawn through Snyder’s hope theory and Frank and Frank’s contextual model of psychotherapy. Finally, motivation and the formation of the alliance are discussed as factors that overlap conceptually and interact as variables in research.
Questions to Consider:
- Your makes a case for respecting client autonomy as a way of reducing risk. How has this article expanded your understanding of client autonomy and its importance in the counseling process?
- What is “the matching paradigm” and how can you use this to facilitate client motivation and autonomy?
- Using both your text chapter and this article as source material, devise an outline for discussing with your supervisor the key components of client autonomy and ways to facilitate it.
Chapter 10. Documentation and Record Keeping
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Article 1:
Swartz, S. (2006). The third voice: Writing case-notes. Feminism & Psychology, 16(4), 427-444.
The article examines the activity of writing case-notes. For this purpose, case-notes are broadly defined as textual records of encounters between mental health practitioners and their clients. The primary focus is on psychotherapy notes, written for private use. It suggests that note writing is potentially a lively addition to the dialogue within the therapy room, an essential part of the unique relationship that grows between practitioner and client. In particular, it looks at the possibilities of representing intersubjectivity, the third voice, emerging from the dialogue between two subjectivities, in ways that forward both theoretical understanding and the therapeutic endeavour. It will argue that serious engagement with case-notes must of necessity tackle questions of voice, speaking rights, a variety of deafnesses, power, the inscription or oblation of race and gender in professional discourses, and reclamation of knowledge colonized by patriarchal and colonial structures of authority. It is feminist in its orientation. It speaks from a postcolonial African context, and a psychoanalytic approach, and draws on psychotherapy experience saturated with those foundational identities.
Questions to Consider:
- Your text outlines several formats for case notes and your site may request a specified form for notes, but after reading this article, journal on the “voice” present in your notes. Do your notes sound like you, or your supervisor or someone else? How much room do you leave in your notes for your subjective voice? How does this voice flavor your notes and ultimately, your conceptualization of the case?
- The article suggests that note writing should not be the somewhat tedious but necessary chore that many practitioners experience it to be. But that it is instead, potentially, a lively addition to the dialogue within the therapy room, an essential part of the analytic third. If this is true, how can you use the case note writing process to gain greater insight in reflection than you had in the session itself? As an emerging professional, how much time do you need to write carefully reflective case notes after each session? Does your site allow sufficient time for honing this skill?
- What can we learn from the description of South African note taking styles explained in this article? Open a dialogue with your supervisor about intersubjectivity and about “good enough” notes versus truly reflective notes. What are your supervisor’s expectations for your notes? What are your expectations for yourself?
Article 2:
Application of a computerized text analysis procedure is proposed that has the potential for use by psychoanalytic and psychodynamic clinicians: the systematic examination of linguistic style as reflected by clinicians in their ongoing process and case notes, which are ubiquitous in the mental health field. The studies reported here are, as far as is known, the first attempts to study treatment notes systematically using such procedures. Linguistic measures are used to track the trajectory of the clinical process throughout the treatment in two contrasting cases, one rated successful, the other not. The computerized linguistic analysis used here focuses on two analytically relevant linguistic variables: Mean High Referential Activity (MHW), a measure of the degree to which language is connected to emotional processing, and Reflection (REF), the use of words referring to logical functions. Changes in the relative position of these measures indicate nodal points in the treatment that might be analytically or therapeutically problematic, and that might be overlooked in a solely clinical reading. The analyst’s activity as reported in notes during such nodal periods is clinically examined to see how it may have affected the course of the analysis. This method has the potential for use in ongoing treatments, and may help clinicians refine their interventions.
Questions to Consider:
- After reading this article, do you believe that your linguistic style changes throughout your work with a client? Conduct a little informal analysis…review case notes for the same client from beginning to end. Did anything change about the way you discuss the client? Do these changes correspond to difficult sessions?
- Though the procedures used in this study are complicated, highly structured and carefully controlled for research purposes, how can we informally use these concepts to monitor our linguistic style and better understand its impact on our case notes and reflections?
- Ask you supervisor to review a selection of case notes with you searching for changes in linguistic style. What does it mean when you describe your client with brief phases such as “client reported…”, “client shared…” and factual descriptions of events in clients life, versus times when you describe connections and hypothesize about those connections?
Chapter 11. Termination and Closure
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Article 1:
In Freud’s technique papers, he failed to develop a systematic approach to termination. Much of the existing literature is based on psychoanalytic mythologies about the way patients are expected to end analysis. The models described in the literature are often starkly at odds with what one sees in clinical practice. A wish for idealized versions of termination underlies much of what has been written, and we need to shift to a conceptual model involving “good enough” termination. A number of different endings to psychoanalysis may, in the long run, lead to productive outcomes; these models are examined, as are various approaches to the dilemmas presented at the time of termination.
Questions to Consider:
- This article discusses “unfulfilled expectations” that both clients and counselors may have at termination when there is no “fairy tale” ending to the time together. Do you tend to have high expectations at termination? As your clients struggle to determine what is personally “good enough” are you struggling with unrealistic expectations as well?
- The author states, “As I reflected on this surprising state of unfulfilled expectation, I recognized that I was caught up in a form of psychoanalytic mythology—I was in the thrall of a narrative derived more from literature and film than from clinical reality.” Do you believe that graduate school sells us on the ideal termination process, that may not parallel the realities of various endings known to occur in counseling? Process with your supervisor the typical termination processes seen at your site. Also, discuss in supervision how far this “good enough” ending is from your ideal.
- Your text book describes several processes leading up to termination: goals accomplished, lack of progress, need for referral, etc. Process with your supervisor how these different circumstances influence both the content and affect of the closure process. How will you have closure to your unfulfilled expectations when clients “drop out” without further contact?
Article 2:
This investigation examined the extent to which premature termination from counseling could be predicted from selected scales on the Butcher Treatment Planning Inventory (BTPI). Ninety-five new clients at a university counseling center agreed to participate in the study and completed the BTPI as part of the intake evaluation. Premature termination occurred when a participant missed a scheduled appointment and unilaterally dropped out of counseling. Higher scores on Closed-Mindedness, Problems in Relationship Formation, Somatization of Conflict, Self-Oriented/Narcissism, Perceived Lack of Environmental Support, and the Treatment Difficulty Composite were associated with premature termination. The General Pathology Composite, a general index of symptomatic distress, also enhanced the prediction of premature termination by suppressing irrelevant variance in other BTPI scales. The results provide support for the validity of the BTPI in identifying clients at risk for premature termination from counseling.
Questions to Consider:
- After reading this article, can you identify some client characteristics that might lead to premature termination from counseling? Have you noticed other specific patterns at your site that might help predict premature termination at your specific site?
- As predicting is only part of the equation, can you brainstorm some steps you would consider to prevent premature termination in clients identified as at risk to do so?
- Though conventional wisdom has typically considered premature termination to be a negative treatment outcome, can you provide some examples from this article and from your own experiences of premature termination as a neutral or even favorable outcome?
- Using this article as a talking point, open a supervisory dialog about clients at risk for premature termination. Does your site attempt outreach to reconnect these clients?
Article 3:
Termination of analysis is discussed from three perspectives. First, considered as a vicissitude of the analytic relationship, termination contains essential elements of the psychoanalytic process itself. Cycles of attachment, loss, mourning, and internalization mark moments in, as well as overviews of, every analysis from its beginning to well past its termination. Second, Freud’s approach to the subject of termination is explored and widened, with an emphasis on its relation to mourning and on the depth and permanence of analytic transference—two dimensions relatively neglected by Freud, perhaps for personal reasons. Finally, clinical issues are presented that are meaningful to the author in his work with analysands, including his work as a training analyst.
Questions to Consider:
- Rather than merely define termination as primarily the practitioner’s decision to end formal work, the author focuses on termination as the mutual decision of two people to leave an extraordinary relationship. From this respectful place, the author allows a more affective process to unfold…one in which both parties will find meaning. Have you considered the personal longer term effects of initiating and ending relationships? If you are placed in a school setting or other agency with predictable patterns of larger scale termination, how will you prepare yourself for multiple terminations in short time periods?
- After reading this article, you may be rethinking any small tendency toward viewing termination as “closing paperwork” and opening your viewpoint to view termination as the closure of a relationship which may include mourning on both sides if it was longer term and depth oriented. How does this issue of termination, present at least latently throughout the counseling process, come increasingly to manifest itself in later sessions? In other words, what does termination look like, sound like, FEEL like? How will you know when you are finished?
- Anticipating that your current supervisory relationship will also come to a close, how can you use your increased knowledge of the termination process to begin facilitating a healthy closure to this supervisory relationship? Perhaps now is the time to open that dialog with your supervisor if it has not already been initiated.
Chapter 12. Self-Care and Self-Protection—Necessary for All Counselors
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Article 1:
Faculty in counseling training programs often give voice to the importance of self-care for students during the training period and into practice after training is completed. However, few programs specifically address this issue in their curricula. To address this perceived need, a course was developed to provide students with (a) personal growth opportunities through selfcare practices and (b) professional growth through mindfulness practices in counseling that can help prevent burnout. A focus group assessed course impact on students who reported significant changes in their personal lives, stress levels, and clinical training.
Questions to Consider:
- Does your training program provide any structured programming for wellness and self care? Do you think a course like this would be helpful? Is there a student advocacy group for your program where you might consider proposing such self care programming or course work?
- What is the difference between self-care practices and mindfulness practices outlined in this article? As described in this article, would you find meditation or yoga to be the more helpful complement to your self-care efforts?
- If not provided to you, what steps have you taken to provide such opportunities for yourself? At this time, id self care a priority as you train?
Article 2:
There is burgeoning interest in secondary traumatic stress, compassion fatigue, and self-care in the helping professions. This multimethod study focused on therapists’ stress and coping in their work with trauma survivors, identifying factors related to resilience and burnout. Semistructured interviews were conducted with 20 clinicians subscribing to a systems perspective, and 104 clinicians were administered a questionnaire inquiring about their caseloads, trauma history, coping styles, emotional self-awareness, work stress, compassion satisfaction, compassion fatigue, and burnout. Interview data demonstrated that therapists detect job stress through bodily symptoms, mood changes, sleep disturbances, becoming easily distracted, and increased difficulty concentrating. Self-care strategies included processing with peers/supervisor, spirituality, exercise, and spending time with family. In the quantitative study, social support, work hours, and internal locus of control accounted for 41% of the variance in compassion satisfaction. Multiple regression procedures accounted for 54% of the variance in compassion fatigue and 74% of the variance in burnout. Implications for clinical training and organizational policy are discussed.
Questions to Consider:
- What emergent themes, including stress symptoms and coping strategies of helping professionals who specialize in the treatment of trauma survivors, were revealed in this study?
- What were the individual and contextual factors that predict compassion satisfaction, compassion fatigue, and burnout in the sample of systemically oriented therapists working with trauma survivors who participated in this study?
- What are some of the factors that seem to protect helping professionals from the deleterious effects of secondary traumatization? What steps can you take to foster these factors for yourself? Are you currently at a site where you are likely to routinely work with trauma survivors? If not, can you foresee an event that might change that? How would you prepare yourself to do that work?
Article 3:
Balancing self-care and other-care is often a struggle for career counselors and others in the helping professions. The process of caring is made up of a constant series of empathic attachments, active involvements, and felt separations. The ability to continually engage in “the caring cycle” is important for success. However, the constant need to re-create the cycle of caring can lead to counselor depletion and burnout. This article provides a developmental framework for assisting career counselors to avoid depleted caring while prolonging their professional longevity. The model of self-care includes recognizing the hazards of “high touch” work, such as limited resources and constant one-way caring. Also addressed are specific means of professional and personal sustenance, such as maximizing experiences of professional success and balancing personal wellness throughout one's career.
Questions to Consider:
- Counselor training, for better or for worse, is predominantly other focused whereby you have spent most of your time learning to care for others, and most likely have spent relatively little time focused on caring for yourself. After reading this article, how can you keep that “other focus” from depleting your resources?
- Define “high touch” work? What are the hazards of high touch work as they pertain to a model of self care for counselors?
- What are the specific means of both professional and personal sustenance as discussed in this article? How can you begin cultivating these during your field placement?
Chapter 13. Transition From Practice to Career
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Article 1:
Expertise in counseling and therapy is both desirable and elusive. Increasing our knowledge about expertise in counseling and therapy enhances understanding of the role it plays in our profession. This understanding has the potential to improve the training of counselors and therapists. Yet expertise in counseling and therapy appears to be a multifaceted and dynamic concept needing further definition and description. In this article, we outline challenges faced trying to describe expertise in counseling and therapy and present research-based factors that contribute to developing expertise in counseling and therapy. Important factors include: experience, personal characteristics of the counselor and therapist, cultural competence, and comfort with ambiguity.
Questions to Consider:
- These authors point out that there is no “gold standard” or universally held definition of an experienced master counselor. Given that ambiguity, how will you know when you have ceased to be a counselor in training and are ready to assume the role of experienced counselor? How will you know when you are sufficiently experienced to assume a supervisory role? Are you measuring in years? Number of clients? Diversity of Experiences? Or…something less tangible?
- What personal characteristics do you associate with professionalism? Have you evaluated yourself on these characteristics and processed your evaluations with your supervisor?
- What does the term “rage to master” mean when discussing your journey into your professional role? Do you have this motivational quality? Do you need it?
Article 2:
This study explored the mechanisms at play as new family counselors are learning to apply a systems approach. A qualitative case study was used to investigate the experiences of nine family counseling interns over two semesters of internship through the lens of constructive developmental theory. The findings extend our understanding by providing students’ accounts of the ways by which disequilibrium preceded development when accommodation was stimulated, and the outcomes when assimilation occurred. It also generated data about positive emotional response to clients that is new and intriguing and which may impact developmental growth. Implications for counselor education that incorporate developmental considerations are presented.
Questions to Consider:
- These authors point out that adult learning involves the evolution of new and more complex forms of awareness for organizing experiences, which is an advancement in an individual’s level of cognitive development. Following this description, internship experiences are a necessary component of training. Does this rule also apply to your early years as a new professional? How will you challenge yourself to continue growing in cognitive complexity beyond your formal graduate training?
- Summarize the concept of cognitive developmental theories (CDT), and explain their applicability to your movement through your graduate training program, field placement sequence and first professional position.
- Explain the role of disequilibrium in your development as a professional counselor. Discuss the importance of disequilibrium with your supervisor.
Chapter 14. Transitions: Self as Counselor
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Article 1:
While there is growing interest in professional identity construction (e.g. Clarke et al., 2009), little is known about how stigma may influence the development of professional identity. Professional identity is defined as one’s professional self-concept based on attributes, beliefs, values, motives, and experiences (Ibarra, 1999; Schein, 1978). Professional identity construction under conditions of stigmatized cultural identity presents an interesting puzzle. Professional roles are defined as prestigious and provide the role holder with autonomy (Benveniste, 1987) and, often, a degree of privilege. However, stigmatized persons are often accorded little prestige and/or privilege because their identities are tainted. Thus, the purpose of our research is to build and enrich theory around professional identity construction by investigating the development of professional identity under conditions of stigmatized cultural identity. To accomplish this goal, we study narratives written by 20 prominent African American journalists (Terry, 2007) who discuss what it means to be both Black and reporters.
Questions to Consider:
- Chapter 14 of your text guides your exploration of your emerging professional identity. After reading this article, explore the role of multiculturalism in your development of a professional identity. Are there aspects of your majority/minority viewpoint that will impact your professional development? Are you prepared to discuss these in supervision?
- In your opinion, is there an inherent conflict between professional identity and stigmatized cultural identity? What steps are outlined to integrate the two in a meaningful way?
- What identity affirming experiences have you had both professionally and personally that you would like to integrate into your identity as an emerging professional? Perhaps you can share these with your supervisor to practice the integration process.
Article 2:
Introduction: Role-emerging placements are increasingly used to help occupational therapy students develop the skills, knowledge, and attributes needed to become the therapists of tomorrow. Whilst literature on role-emerging placements is growing, studies have tended to be general placement evaluations, with only a limited number exploring students’ experiences in detail. Method: This study used interpretative phenomenological analysis to gain a deeper understanding of how five MSc pre-registration occupational therapy students experienced and ascribed meaning to their role-emerging placements. Findings: The role-emerging placements acted as a strong catalyst for the students’ ontological development (that is, their understanding of self and development of ways of being and enacting occupational therapy practice). Through engaging in challenging and autonomous learning experiences, students developed deeper insights into who they were becoming as professionals, leading to a professional identity of their own making. Conclusion: Having to continually reflect on and verbalize the core essence and contribution of occupational therapy, students developed clarity of understanding about the uniqueness of the profession. This is important in light of the historical difficulty occupational therapists have had in articulating their unique role and professional identity.
Questions to Consider:
- How does this article parallel your training path thus far? Would you consider your field placement to be a role-emerging placement that influences your professional identity as described here?
- Using this article as a guideline, how have you “ascribed meaning” to your experiences in your field placement?
- Discuss with your supervisor the ways in which you have used your field placement experiences to help formalize your professional identity?
