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