Professional Practice: Assessment Lecture 16, November 2, 1998 Wrap-up Counseling as a Recursive Dynamic.

Professional Practice: Assessment

Lecture 16, November 2, 1998

Wrap-up Counseling as a Recursive Dynamic

Announcements

• Specialty areas• Administration and Supervision (Maki)• Aging and Rehabilitation (Wadsworth)• Brain Injury Rehabilitation (Tarvydas)• Community-based Rehabilitation (Townsend)• Law and Disability (Blanck)• Psychiatric Rehabilitation (O’Rourke)• School-to-work Transition/SE (Harper?)• Spanish-English Emphasis (Peterson)• Substance Abuse Counseling (Skinstead)

Review & Completion: Counseling as a Recursive

Dynamic

• Process and relationship

• Meaning

• Empowerment

Theoretical shift from vocational tradition to:

• Person-Centered Therapy

• Psychosocial counseling

• Systemic- and ecologic-oriented counseling

Broadening of Rehabilitation

Counseling’s Scope of Practice

• Community Mental Health

• Substance Abuse and Chemical

• Dependency

• Psychiatric Rehabilitation

• Proprietary Rehabilitation

• “other clinical settings”

We reviewed...

• Microcounseling Skills

• Critical factors in the counseling process:– Assist the client in deriving maximum meaning

from his or her situation (awareness)– Empower the client toward outcomes– Strategically address time limitations

Learning to Write as a Metaphor for Learning to Counsel

• Recursive writing– The whole continually refers back to parts of

itself

• Effective writing:– Must be iterative or self-referent– Generative– Invoke parallel structures

Effective Counseling Must be Recursive

• Mastering the basic use of helping skills

• Everything that happens in counseling must “loop back” to the client’s context

• This iterative process leads to greater insight through self-reflection (awareness)

The Effective Counselor...

• helps the client to make connections that are meaningful

• assures that the relationship is interactive – not dominated by the counselor

• engages in self-reflection as part of the parallel process

• This self reflection will be important for future counselors who you supervise

The Recursive Dynamic

• Using selected counseling strategies, counselor helps client to construct new self-knowledge

• Self knowledge RECURS to self-reflection

• Self-reflection generates increased self-awareness

• This self discovery predicates client action

(resuming...) Dialectical Thinking

• An event (thesis) generates its opposite (antithesis), leading to a reconciliation of opposites (synthesis)– This opposes either-or, all-or-nothing logic

• Counseling is often a nonlinear process– This requires dialectical thinking

• Art versus Science– We need theory and research, but we also need

individual sensitivity

Don’t forget the basics:Bricks held together by mortar

(science)• attending• empathy• probing• respect• understanding• warmth• genuineness• self-responsibility

Two Relationships:

1: The recursive relationship of counseling– Continue to return to the client’s context

2: The recursive relationship between counselor and client– Client and counselor are self reflective,

counselor is aware of this parallel process

Together….

• these relationships create opportunity for meaning making and empowerment

• A collaborative movement from presenting problem to successful change

Counseling is defined in terms of: Process & Relationship

• Process– Research supports the efficacy of counseling and

psychotherapy by focusing on commonalties across approaches

– Type of intervention is guided by client need and client context

– “Primary dimension” is self knowledge (awareness)• Awareness of the client’s quest

• Awareness of your helping strategy

Process• Action

• The action/change dimension of counseling must be considered carefully within a multicultural context

• Action can be behavioral or cognitive

• Change• Cognitive reframing, emotional growth, increased

awareness, • Change implies recursion

• Meaning• Existential: Meaning making is recursive (referring

back to the past to derive meaning)

Relationship

• Working alliance– Significant factor in research

• Collaboration– …with a power differential to which it is

ethically important to attend

• Holistic approach– People are cognitive, emotional, behavioral,

spiritual, social, vocational, and existential

Relationship cont.• Context

• Important to avoid assumptions, ask good questions, minimize influence during information gathering phase of the relationship

• Empowerment• Helping client discover his or her ability to change

• Using a participatory rather than directive style

• Realize the two-way influence of a helping relationship (you can learn from the client)

• Democratize the counseling process

Counseling is comprised of fluid, interactive, and recursive stages

– Constructing an effective working alliance• Generally occurs within the first few sessions

– Establish and mediate goals, initiate client change

• More elastic of the stages

– Resolution to client concerns• Takes up the last few sessions

Ivey’s Conceptualization (for comparison)

• Rapport/Structuring

• Problem defintion/identification of assets

• Defining outcomes

• Exploring alternatives, confronting incongruity

• Generalization

• You will encounter other models. Which do you prefer?

Categorical Ordering of Major Counseling Dynamics...

• ...that Occur Throughout Lever’s Recursive Stages– Stage 1

• professional disclosure• client role induction• establishing trust• data collection• identifying problems-identifying purpose• conceptualizing the case• initiating the working alliance

cont.

• Stage 2– developing the working alliance– refining case conceptualization/diagnosing– setting goals-marking purpose– planning interventions– meaning-making– checking progress

cont.

• Stage 3– facilitating client-acquisition of therapeutic gain– determining an end point– planning termination– potential referrals for additional or ongoing services– terminiation

• Sequential progression through stages is always recursive

Multicultural Counseling

• the “fourth force,” using sensitivity toward:– Race– Ethnicity– Gender– Disability– Spirituality– Sexual orientation

• awareness of world views, values, opinions, and concepts

The Ecological Perspective

• Larger culture

• Subculture affiliations

• Systemic relationships

Importance of Vocational Counseling Skills for the Rehabilitation Counselor

• Roessler & Rubin Ch 2

• What perspective do the authors take in the ARCA/NRCA debate over the centrality of counseling in rehabilitation counseling?

Murphy, 1988

– Focused on the vocational emphasis of rehabilitation counseling

– Psychosocial outcomes reportedly sought from other professionals

– Most salient counseling issue is stress secondary to unemployment or underemployment, supporting the vocational focus

– Summary: Quality of life strongly influenced by vocational situation

Rehabilitation Counselors & Vocational Counseling

• Rehabilitation counselors need to be skilled in vocational counseling– Create experiences that allow a person to

explore self within the context of work– Knowledge of self, educational options,

vocational possibilities enhance outcomes– Persons with disabilities job satisfaction was

strongly related to appropriate interest match with specific vocational area

Match Between Person - Environment

• Chartrand (1991) , Trait-factor approach:

• 1) People’s decisions are influenced by cognitive and affective factors

• 2) People and work environment differ on measurable and meaningful

dimensions. • 3) Matching a person’s traits and a work environment’s factors enhances

success

• 4) Congruence between person and environment is not static; people and environments have the capacity to change.

• 5) People seek and create environments that allow expression of preferred characteristics

– How does disability impact #5??

Environmental Factors in Vocational Choice Process

• Location, structure, and amount of interpersonal support.

– Example: A client has been working in supported-employment setting, where all of his or her friends reside, and was walking distance from his home. Now, he or she has gotten a new job with a major company in the community but none of his personal acquaintances are there, and it is located ten miles by bus from his home.

Individual perception of significance of his or her disability

• 1) Vocational plans, interests and work values held prior to disability

• 2) Critical variables are: returning to and maintaining employment, motivation to work, realistic self-assessment of capacities and limitations, and optimism.

• 3) Interruption in career patterns from hospitalization, medical treatment and other treatment due to disability.

• 4) The differences between invisible disability and visible disabilities.

cont.

• 5) Cultural expectations and parental and teacher expectations

• 6) Economic status affects vocational plans. • 7) Persons with physical disabilities often more

advanced than persons with developmental disabilities.• 8) Prior work experiences affects the chosen

occupation.• 9) People with congenital disabilities choose

occupations consistent with parental aspirations.

MTWA

• Let’s try to define this theory as a class, on the board

MTWA

• Individuals seek to establish and maintain correspondence with their environment

• Satisfaction, satisfactoriness, tenure• Extrinsic rewards ($), intrinsic rewards (personal

satisfaction), social rewards (contact with others in the work place)– “Pay-offs”: Achievement, comfort, status, altruism,

safety, autonomy

The Crux Model (R&R, 1980)

• Dynamics of vocational counseling process

• Two major phases– Evaluation

– Planning

– Describes the relationship between the two

• The model directs the counselor’s efforts in collecting significant social-vocational history information and relating it to work demands.

• See (Table 2.1, p.33-35, R&R)

Crux Model cont.

• Evaluation (Table 2.1)– Physical factors– Psychosocial factors– Educational-Vocational Factors– Economic Factors

Crux cont.

• Note implications of evaluation data for vocational options

• Prepare “suggestions” for discussion

• Help the client through the process of increasing awareness relative to the findings, agree on a goal

• As we’ve mentioned, the process in collaborative, your role consultative

Crux cont.

• If the client is having difficulty adjusting to his or her disability status, counseling interventions facilitate adjustment and help to create realistic expectations

• If further assessment is necessary, you are ethically responsible to understand the process yourself, and be able to clearly communicate the issues to your client

Assessment

• Berven, Maki & Riggar Chapter 10

• Assessment is basic to virtually ALL functions within the scope of practice of rehabilitation counselors– Analysis and definition of the problem– Establishing goals, identifying barriers– Strategies and comprehensive service plans

Levels of Assessment

• Global level– Basis of service plans

• Specific level– Strategies in response to encountered barriers

• More specific level– Moment-by-moment interactions, e.g., determining

an appropriate verbal response in a given context that will produce an intended response or outcome

Assessment Practice Continuum

• Medical model, counselor as expert

• Collaborative effort between counselor and consumer/client

• Counselor as consultant, consumer-driven

• Assessment….– …often associate with the rehabilitation

counselor having control of decision making and service delivery

Cronbach’s Conceptualization (1990)

• Maximum performance– Used to predict “best” performance– ability, aptitude, achievement

• Typical performance– How an individual might typically behave in

various situations– interests, values, personality characteristics

Reliability

• Degree to which scores are free from errors of measurement

• Consistency of socres obtained by the same persons when reexamined on different occasions…or under other variable conditions

Validity

• What the test measures, and how well it does so

• Tells us what can be inferred from scores

Scale example

• Get on and off a scale a number of times and record the results

• The consistency of the weight measured would reflect evidence for reliability

• The accuracy of the weight reading on the scale in comparison with an absolute standard would provide evidence for validity

Standardization

• Established normative sample

• Carefully specified procedure for administration and scoring of each member of the normative sample

• Standardized administration of the test to others can be scored and results compared to the normative sample

• Issues for people with disabilities?

Assessment Methods

• Interviews

• Standardized Tests and Inventories

• Simulations of Work and Living Tasks

• Simulated and Real Environments

• Functional Assessment– Systemic approach to describing skill, current

behavior, or both– Integration of interviews, observation, self-report,

examinations

Interpretation and Synthesis of Assessment Information

• Interpretation: Degrees of Inference– Lowest: Samples of behavior in their own right– Next higher level: Bits of information are

interrelated in search of consistencies and generalizations

– Next higher level: A hypothetical construct (e.g. depression) may be used to describe the essence of the consistencies or generalizations identified

Note:

• Interpretation can often be far removed from the original data source

• Keep this in mind when consuming and interpreting data

Organization of Information

• Assets

• Limitations

• Preferences

• Information that addresses the individual AND the environment

Synthesis of Information

• Comprehensive working model of the individual– Begins with INDUCTIVE reasoning

• inferences are drawn about individual bits of information and apparent consistencies between them

– ...then DEDUCTIVE reasoning is used...• formulate and test hypotheses regarding the

usefulness of the working model (accounting for already available info as well as predictions

Working Model revisions

• To the extent that the model does not account for or predict relevant information, the model is revised based upon new data gathered

Danger! Bias in Interpretation and Synthesis

• Nezu & Nezu, 1993• Availability heuristic

– Readily recalled past experience exerts undue influence, fail to consider other explanations

• Representativeness heuristic– Belief about individuals who share one feature will

likely share another (stereotypes)

• Anchoring heuristic– Initial impressions that are resistant to change

Final Phase of Assessment: Clinical and Service Decisions

• Common to RC practice (detail in chapter):– Selection for service– Establishment of vocational objectives– Identification of needed interventions– Formulation of case service plan– Disability determination

• Make use of the working model of the individual to make predictions corresponding to the above areas

Future Perspectives

• Number of assessment tools available is ever-increasing– Tests in Print IV (1994) indicated over 3,000

commercially available– Work sample/related systems: 18 (Brown et al.,

1994)– Job Search software systems: 12 (Berven, 1997)

• These numbers will likely increase dramatically in the years ahead

Computerized Assessment

• Burkhead and Sampson (1985) reviewed applications in rehab counseling

• Recent advances include the use of Adaptive Testing for tests like the GRE, Marriage and Family Therapy Board Exam, and even State Drivers License Bureaus– Adaptive testing decreases the number of items

administered, and bases each subsequently administered item upon the response to the former