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Professional Practice: Assessment

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

2 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)

3 Review & Completion: Counseling as a Recursive Dynamic
Process and relationship Meaning Empowerment

4 Theoretical shift from vocational tradition to:
Person-Centered Therapy Psychosocial counseling Systemic- and ecologic-oriented counseling

5 Broadening of Rehabilitation Counseling’s Scope of Practice
Community Mental Health Substance Abuse and Chemical Dependency Psychiatric Rehabilitation Proprietary Rehabilitation “other clinical settings”

6 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

7 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

8 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)

9 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

10 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

11 (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

12 Don’t forget the basics: Bricks held together by mortar (science)
attending empathy probing respect understanding warmth genuineness self-responsibility

13 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

14 Together…. these relationships create opportunity for meaning making and empowerment A collaborative movement from presenting problem to successful change

15 Counseling is defined in terms of: Process & Relationship
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

16 Process Action Change Meaning
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)

17 Relationship Working alliance Collaboration Holistic approach
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

18 Relationship cont. Context Empowerment
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

19 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

20 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?

21 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

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

23 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

24 Multicultural Counseling
the “fourth force,” using sensitivity toward: Race Ethnicity Gender Disability Spirituality Sexual orientation awareness of world views, values, opinions, and concepts

25 The Ecological Perspective
Larger culture Subculture affiliations Systemic relationships

26 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?

27 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

28 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

29 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??

30 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.

31 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.

32 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.

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

34 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

35 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)

36 Crux Model cont. Evaluation (Table 2.1) Physical factors
Psychosocial factors Educational-Vocational Factors Economic Factors

37 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

38 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

39 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

40 Levels of Assessment Global level Specific level More specific 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

41 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

42 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

43 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

44 Validity What the test measures, and how well it does so
Tells us what can be inferred from scores

45 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

46 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?

47 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

48 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

49 Note: Interpretation can often be far removed from the original data source Keep this in mind when consuming and interpreting data

50 Organization of Information
Assets Limitations Preferences Information that addresses the individual AND the environment

51 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

52 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

53 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

54 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

55 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

56 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


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