16 SECTION. Profesional Orientation Characteristics of the Effective Helper A growing body of evidence indicates thatthe personal qualities of helpers are as significant for the positive growth of helpees as are the methods they use. (Brame & MacDonald, 2003, 9.26) In 1952, Eysenck looked at 24 uncontrolled studies that examined the effectiveness of psy- chotherapy on treatment outcomes and found that “roughly two-thirds of a group of new- rotic patients will recover or improve to a marked extent within about two years of the ‘onset of their illness, whether they are treated by means of psychotherapy or not” (p. 322, italics, added). Although Eysenck’s research was justifiably criticized for methodological problems, idid lead to debate conceming the effectiveness of caynseling and resulted in hundreds of studies that examined its usefulness. The results of over 40 yeats of research showed: When counseling feciveness is calculated by determining the ruber of clients who Improved, the results are amazingly similar across various studies. On the basis ofboth client and counselor ratings, approximately 22% of cents made sigfcane gains, 43% ‘made moderate changes, while 27% made some imgrovement .. (Sexton, 1953, p82) Bur wha i it chat makes counseling effective? In recent years it has become increas- ingly evident that certain kinds of treatment methodologies work more effectively with certain kinds of presenting problems. Called “evidenced-based practice” (Norcross, Beutler, & Levant, 2006; Stout & Hayes, 2005), or using “treatment methodologies for which there i scientifically collected evidence that the treatment works" (Hayes, 2008, p. 1), this practice is quickly becoming commonplace It has also become clear that certain personal qualities of the counselor can create the best climate for the use of these methodologies. In fact, a number of articles have reviewed the literature and examined the qualities that seem to be important for an effec tive counseling relationship (Beutler et al, 2004; Lambert & Ogles, 2004; Sexton, 1999; Sexton & Whiston, 1991; Sexton & Whiston, 1994; Sexton, Whiston, Bleuer, & Wale, 1997; Wampold, 2001). Based on these reviews and others, as well as what has become general acceptance in the field, | have generated a list of eight characteristics that seem to be either empirically or theoretically elated to counselor effectiveness. There is little doubt that as research in these areas becomes more refined, some of these characterities will change. The characteristics | have identified include (1) che therapeutic alliance, (2) empa- thy, (3) genuineness, (4) acceptance, (5) open-mindedness, (6) cognitive complexity, (7) psychological adjustment, and (8) competence. The Therapeutic Alliance ‘The relationship between the counselor and client may be the most significant factor in creating client change (Beutler et al, 2004; Horvarth & Bedi, 2002; Norcross, 2001; Orlinksy, Ronnestad, & Willutski, 2004; Safran & Muran, 2000; Sexton & Whiston, 1991, Vocisano etal, 2004; Wampold, 2001; Whiston & Coker, 2000). Gelso and Carter (1994) state that the “working alliance” is related to how the client presents and aligns his or her ego for the counseling relationship and how the client's ego is, of is not, joined with the counselors “therapizing’ self or ego” (p. 296). Such a relationship is closely related to the ability ofthe client and counselor to build an emotional bond and to workCHAPTER 1 The Counselor's entity: What, Who, and How? 17 ‘on attaining goals. The working alliance exists throughout the counseling relationshi regardless of whether itis acknowledged by the counselor and the client. ‘Most well-known theorists acknowledge the importance of the therapeutic alliance. For instance, Carl Rogers (1957) highlighted the notion that the therapeutic relationship was critical to positive client outcomes. William Glasser, founder of Reality Therapy, ‘mphasized the importance of having the personal qualities necesary for a good working felationship (Glasser, 2000b). Most behavior therapists now even make use of the client therapist relationship in facilitating change (Corey, 2005), and many well-known family therapists talk about the importance of connecting with the family. For instance, Salvadore Minuchin (1974) used the term “Joining” to describe the building of the rela- tionship with the family “The therapists methods of creating a therapeutic system and positioning himself as its leader are known as joining operations. These are the wnderpinnings of theraby Unless the therapist can join the family and establish a therapeusic system, resructr- ing carmot occur, and any attempt to achieve the therapeutic goals wil fai. (123) Generally the fonging of this therapeutic alliance is based on the theoretical orien tation of the counselor in conjunction with aspects of his or her personality. However, simply adhering to an approach that stresses the importance of the therapeutic alliance ‘does not automatically assure that the counselor will be able to connect with his or her ‘lients, and conversely, counselors who do not adhere to such an approach may still be suc ‘cessful in building good relationships with their clients. For example, although psychoan- lytical therapy stresses anonymity and distance on the part of analysts early in the felationship, many analysts ate stil able ro quickly build a strong bond wich thei clients. Similarly, although humanists stress the importance of the relationship, there are many hhunanistically oriented therapists who have difficulty maintaining emotional bonds with Clients because of their own personality style. The challenge for all counselors is to be Capable of building strong relationships with their clients within the context of their the retical frameworks, and to understand and appreciate how these bonds dramatically affect work with clients “Another quality that has been heavily researched and consistently shown to be related to positive client outcomes is empathy (Bohart, Elliot, Greenberg, & Watson, 2002; Carkhuff, 2000; Elliott, Greenberg, & Lietaer, 2004; Luborsky, Crits-Christoph, Mintz, & Auerbach, 1988). Understanding clients, or being empathic, means that the therapist senses accurately the feelings and personal meanings that the client is experiencing and communicates this accepuant understanding tothe client. When functioning best, the therapist isso much inside the private world of the “other that he or she can clarify no only the meanings of which the cents aware but tven those just below the level of awareness. Listening, of this very special, active Find, is one of the mast potent forces of change that I know. (Rog, 1985p. 136) Whether or not one could truly understand the inner world of another has been dis cussed for centuries and was spoken of by such philosophers as Plato and Aristotle (Gomperts, 1960). However, Carl Rogers (1957) is given credit for bringing this concept to life in the twentieth century. With respect to the counseling relationship, understanding8 SECTION Genuineness Acceptance Professional Orientation ‘through empathy is seen as a skill that can build rapport, elicit information, and help the client feel accepted (Egan, 2002; Neukrug & Schwitzer, 2006). ‘Whereas Rogers felt that empathy was a skill that should be used throughout the counseling relationship, some research (Gladstein, 1983; Kegan, 1982, 1994; Ridgway & Sharpley, 1990) suggests that its value may be contingent on (1) the state ofthe counseling relationship (more important in relationship-building stages), (2) the kind of cliene prob. lem (e.g. depression), (3) the ability ofthe clinician to be empathic, (4) the cognitive com. plexity ofthe clinician (another characteristic discussed in this chapter), and (5) the ability cof the client to recognize empathy (e.g., person who is psychotic may not have this capac. ity). Because empathy is seen as an important personal attribute as well as a critical coun- seling skill to tear, it will be discussed in more detail in Chapter 5: Counseling Skills. Genuineness refers to the willingness of the therapist to be authentic, open, and honest within the helping relationship. Genuineness may also be related to emotional intelli gence, which is the ability to monitor one's emotions, a quality that counselors and coun seling students seem to have more than others (Martin, Easton, Wilson, Takemoto, & Sullivan, 2004). Humanists often speak of the importance of authenticity or genuineness in the establishment of healthy relationships (Miars, 2002; Rogers, 1957). On the other hhand, they note that those who are not genuine are closed off to their feelings and live fake, false lives. Rogers (1957) popularized the term genuineness (or congruence) and noted ‘hat it wasa core condition in the counseling relationship, along with empathy and uncon- ditional positive regard. While Rogers and other humanists have sung the praises of gen uuineness in the relationship, psychoanalysts and some behaviorists have traditionally downplayed the importance of a genuine relationship. Gelso and Carter (1994) believe that regardless of one’s theoretical orientation, there exists an ongoing “real” relationship in which the client, to some degree, will see the therapist realistically, “even when the therapist tries to hide or make ambiguous his ot her self” (p. 298). This real relationship has at its core the ability ofthe client to recognize the genuine (or nongenuine) self of the counselor. Although research on the relationship between genuineness and client outcomes has shown mixed results, genuineness is clearly an important quality forall clinicians to acknowledge (Beutler et al., 2004; Klein, Kolden, Michels, & Chisholm Stockard, 2002). Being accepting means being able to regard clients unconditionally, despite differences in cultural heritage, values, or belief systems. Rogers (1957) emphasized the value of uncon. ditional positive regard, which is being able to accept clients “without strings attached Leo Buscaglia (1972) called this “responsible love": Responsible love is accepring and understanding. . . [Llove helps us to accepe the {fact thatthe other individual is behaving only as he [or she] is able to behave at the ‘moment. (p19) Unconditional acceptance ofa client does not necessarily mean that one likes or con- ddones everything the person does; however, such acceptance does show a deep understanding for another. For instance, one would assuredly not like the actions of a murderer or rapist,CHAPTER 1 The Counselor's Identity: What, Who, and How? 19 however, being accepting of this client would mean that the counselor would have an under- standing ofthe felon's world and how he or she came to be. This acceprance of another person. is a likely by-product of the counselor's ability to be nondogmatic, empathic, and open- minded. The manifestation of these attitudes allows the client to fe! safe enough to open window into his or her soul, allowing the helper to see the client's hurts and pains. Research ‘on acceptance and postive regard shows a relationship between these characteristics and pos- itive client outcomes (Farber & Lane, 2002; Patterson, 1984; Pope & Kline, 1999). Closely related to the ability to accept others is whether or not an individual is open- minded. Belkin (1988) notes that “open-mindedness in the counseling setting may be defined as freedom from fixed preconceptions and an attitude of open receptivity to that which the client is expressing” (p. 66). The open-minded counselor is nondogmatic; he or she isnot trying to convince the client ofa certain point of view (Rokeach, 1960). Instead, the counselor is able to hear the client, be with the client, and be open to whatever the client might say. Dogmatic and closed-minded counselors are poor at showing empathy, are persistent in thelr way of viewing che world despite evidence to the contrary, and have dificult forming positive counseling relationships (McAuliffe, Neukrug, & Lovell, 1998; Neukrug & McAuliffe, 1993). Probably one of strongest indications that a person is dogmatic isa belief in absolute truth. This individual sees no alternatives to his or her ways of viewing the world and believes, there is jst one right way of understanding reality. This absolutist, unequivocal thinking is highlighted by Carl Rogers in his review of a book by the theologian Reinhold Niebuhr: ‘As Tay the Book down, I find hat Lam impresed most of all by the awesome ce. tainty with which Dr. Niebuhr knows. He knows, with incredible assurance, what is wong with the thinking of St. Thomas Aquinas, Augustine, Hegel, Freud, Marx, Dewey, and many, many others. He also knows wha are the errs of com munis, existentialism, psychology, and all che socal sciences. His favorite term {forte formations of others is “absurd,” but such oher terms a “erroneous, “blind,” “naive,” “inane,” and inadequate” also are useful. Ropes, 1996, 208) Cognitive Complexity ‘Cognitive complexity refers to a broad range of cognitive skills related to the manner in which one makes sense ofthe world. Cognitively complex individuals are able to view an individual within both an individualistic and systemic framework, understand that know- edge isnot fixed, remain open to feedback, and comprehend different points of view. In ref: erence to clinical work, counselors who are cognitively complex are likely to be more empathic, more open-minded, more self-aware, more effective with individuals from diverse cultures, and able to examine a client’ predicament from multiple perspectives (Benack, 1984, 1988; Bowman & Allen, 1988; Bowman & Reeves, 1987; Brendel, Kolbert, & Foster, 2002; Granello, 2002; King, 1978, 1994; Kegan, 1982, 1994; McAuliffe & Eriksen, 2000, 2002; Milliken, 2004; Neukrug & MeAulife, 1993; Reeves, Bowman, & Cooley, 1989). In the Piagetian tradition of development (Piaget, 1954), cognitive development theories propose that cognitive development occurs in a sequential and hierarchical ‘manner and that all individuals are capable of moving to higher levels of development.20 SECTION Professional Orientation For such movement to occur, the individual must lear in an environment that is nurtur ing and supportive, on the one hand, but also challenging to the individual’ view of the world. Counselor training programs hope to offer such an environment—one that sup- ports students, yet challenges them ro think about new ways to view the world and new ways of being with oneself and others (MeA liffe & Eriksen, 2000), With cognitive com- plexity so closely connected to some ofthe important characteristics highlighted in this chapter (eg, empathy, open-mindedness, competence), one can see why one's ability to think in complex ways is so critical to being an effective helper (Duys & Hedstrom, 2000, Heibert & Johnson, 1994; Little, Packman, Smaby, & Maddux, 2005; Sexton, 1999) Psychological Adjustment My involvement in this [my oun] therapeutic process brought about a tering point ‘nm illness and a radical sift n my personal lif. Asa therapist myself, I now know how frightening itis for clients to cake eis step from the know into the unknown, to honestly experience and lovingly evaluate what they feel and who they are. (Remen, May, Young, & Beslan, 1985p. 89) ‘With research showing that well-adjusted counselors may have better client outcomes than, counselors who are not well adjusted (Bellows-Blakely, 2000; Weaver, 2000; Williams, 1999), iis disturbing to find that therapists seem to have more than their share of psycho. logical dysfunction (Gilroy, Carroll, & Mutra, 2002; White & Franzoni, 1990). However, with 66% to 84% of varying types of therapists having participated in their own therapy (Deutsch, 1984; Gilroy, Carroll, & Murra, 2001; Neukrug, Milliken, & Shoemaker, 2001; Neulerug & Williams, 1993; Norcross, Strauss, & Faltus, 1988; Pope & Tabachnick, 1994; Prochaska & Norcross, 1983), itis heartening to see that therapists seem to want to work ‘on their own issues. Infact, some research shows that positive client outcomes may be more likely if a therapist has been in his or her own personal therapy (Bellows-Blakely, 2000; Greenberg & Staller, 1981). Ics aso interesting that although only a small percentage of professional training programs in the mental health field require participation in therapy (Sherman, 2000), an overwhelming percentage of therapists believe that therapy should be required by training programs, and a majority of therapists think it should be required by state licensing boards (Pope & Tabachnick, 1994). Participation in one’s own therapy has ‘a number of benefits for the budding counselor, including the following: * Enabling the therapist to identify and empathize with the experience of sitting in the client's seat * Helping to prevent countertransference, which is “the process of [counselors] seeing themselves in their clients, of averidentifying with their clients, or of meeting their needs through their clients,” all of which can deleteriously affect the helping relationship (Corey, 2005, p. 21). Providing counselors with a model from which to draw when they begin to do their own counseling. There is little question that modeling is a very powerful method of learning. ‘Addressing the important professional and ethical responsibility of assuring that one is providing unimpaired services, {s therapy the only road to psychological adjustment? Probably not; however, it isa very special relationship not achievable through friendships or other significant relationships,CHAPTER 1 The Counselors Mdencity: What, Who, and How? 21 (Other activities, such as support groups, meditation, exercise, and journaling, have all been shown to have positive effects on psychological adjustment. Therapy is not the only way, but it is one ofa few activities that together can lead to good mental health and more effective ‘counseling relationships. Counselor expertise has been shown to be a crucial element for client success in counsel- ing (Whiston & Coker, 2000), and perceived competence has been consistently chosen by therapists as the most important factor in picking a therapist (Grunebaum, 1983; Neukrug & Williams, 1993; Neukrug, Milliken, and Shoemaker, 2001; Norcross et al, 1988). Thus it should not be surprising that being competent isthe final characteristic I have chosen as crucial for counselors to embrace. ‘Competent counselors have a thirst for knowledge. They desire to examine the newest trends, the latest approaches, to be on the cutting edge of the field. Such coun- Selors exhibit this thirst through their study habits, cheir desite to join professional associ- ations, their reading of professional journals, their belief that education isa lifelong process, and their ability to view their own approach to working with clients as something that is always broadening and deepening. ‘Counselors have both an ethical and legal responsibility to be competent (Corey, Corey, & Callanan, 2006; Welfel, 2002). For instance, the ACA (2005b) ethical guide- lines elaborate on eight areas of competence, including (1) practicing within one’s bound: ary of competence, (2) practicing only in one's specialty areas, (3) accepting employment ‘ly for positions for which one is qualified, (4) monitoring one’s effectiveness, (5) know ing when to consult with others, (6) keeping current by attending continuing education activities, (7) refraining from offering services when physically ot emotionally impaired, fand (8) assuring proper transfer of cases when one is incapacitated or leaves a practice (ACA, 2005b, Standard C). The legal systern reinforces these ethical guidelines: Psychotherapists commit professional malpractice if they are visibly less competent than the average oftheir peers... One function of lawsuits is 1 encourage compe- tent therapy. (Swenson, 1997, p16) “Thus, being competent is our professional responsibilty and necessitates that we continue the learning process throughout our professional ives. “The eight characteristics described above, namely (1) the therapeutic alliance, (2) empathy, (3) genuineness, (4) acceptance, (5) open-mindedness, (6) cognitive com- plexity, (7) psychological adjustment, and (8) competence are qualities to which the effec five counselor should strive. Fev if any, of us are already there. Fortunately, each of these {Qualities can be nurtured and developed as we walk down our unique paths in life. Multicultural Issues The Helping Professional's Responsibility to Minority Clients Research has consistently shown that clients of color are frequently misdiagnosed, attend counseling at lower rates than clients from che majority culture, terminate counseling more ‘quickly, nd counseling less helpful, and are more distrustful of white counselors and more trusting of counselors from their own ethnic/racial/cultural background (see Section VI ofA Call to the Profession: Inclusion of Multiculturalism Professional Orientation this text). With relatively small numbers of persons from minority groups entering the help- ing professions (Axelson, 1999), itis imperative that the helping professions actively try to recruit counselors of color. Increased cultural diversity among counselors along with better training in multicultural counseling are essential if culturally diverse clients are to feel com fortable seeking out and following through in counseling, If counseling isto be an equal opportunity profession, counselors must graduate from train- ing programs with more than a desite to help all people. As a profession, we will have achieved competence in counseling diverse clients when each training program graduate hhas leamed counseling strategies that work for a wide range of clients, has worked with clients from diverse backgrounds, and leaves his or her programm with an appreciation for diversity and an identity as a counselor that includes a multicultural perspective (Bobby, 2005; D'Andrea, 2005). D'Andrea and Daniels (2005) suggest that all counselors should adopt the RESPECTFUL Counseling Model, which highlights ten factors to which coun selors should attend in their relationships with clients: R ~ Religious/spititual identity E Economic class background ‘S~Sexval identity P~ Psychological development E-Ethnicftacial identity ce Ihronologica disposition ‘T —Trauma and other threats to theie personal well-being F — Family history U— Unique physical characteristics 1L- Language and location of residence, which may afect the helping process. (p.37) Ideally, 5 you go through your training program you will attain an appreciation of these factors in yourself and learn how to attend to them in your clients Ethical, Professional, and Legal Issues Knowing Who We Are and Our Relationship to Other Professional Groups (Our professional identity is based on a specific body of knowledge unique to our profession. By knowing who we are, we also have a clear sense of who we are not. It is by having a strong sense of our identity that we are able to define our limits, know when itis appropri ate to consult with colleagues, and recognize when we should refer clients to other profes, sionals (Gale & Austin, 2003). The ACA Code of Ethics (ACA, 2005b) highlights the importance of knowing out professional boundaries: Counselors practice only within the boundaries of their competence, based on their «education, training, superised experience, state and national profesional creden. Tals, and appropriate professional experience. .. . (Standard C22)CHAPTER | The Counselors Identity: What, Who, and How? 23 and Counselors take reasonable steps to consult with other counselors or related profes- sionals when they have questions regarding thet ethical obligations or professional practice. (Standard C2.) and. If counselors determine an inabiley tobe of professional assistance to clients, they avoid entering or mediately terminate the counseling relationship. Counselors ae Inouledgeable about culturally and clinically appropriate refewal resources and suggest these alternatives... . (Standard A116) Impaired Mental Health Professionals Fora counselor to set themselves up as a helper to others, without having resolved ‘majo difficulties of their own, would appear to be farcical. (Wheeler, 191.199) ‘As noted earlier, when we discussed the important characteristic of psychological adjust ment, mental health professionals have a responsibility to be aware of the pressures and stresses that impinge on their lives and how these might affect their relationship with clients. This is stressed in the ACA (2005b) Code of Ethics: Counselors are aler to the signs of impairment from their oun physical, mental, or emotional problems and refrain from offering or Providing professional ser- vices when such impairment is likely to harm a client or others. They seek assis- tance for problems that reach the level of professional impairment, and, if necessary, they limit, suspend, oF terminate their professional responsibilities tunil such time itis determined that they may safely resume their work. (Standard C2.0) A professional who is not attending to his or her own needs is likely to be ineffective in the counseling relationship. Professional incompetence is not only unethical; it can lead to malpractice suits (Neukrug, Milliken, & Walden, 2001; Swenson, 1997). But per haps even more importantly, impaired practice can result in our clients ending up with deeper wounds than the ones they had when they initially entered counseling. The Counselor in Process: Personal Therapy and Related Growth Experiences ‘As you begin your journey in the counseling profession, I hope you have the opportunity to engage in growth experiences that will help you embody the counselor characteristics highlighted in this chapter. What kind of experiences should you seek out? First, I hope that you strongly consider undergoing your own personal counseling, for the many reasons noted earlier. In addition to counseling, you might want to consider other related growth ‘experiences, such as meditation, relaxation exercises and stress reduction, discussion and support groups, exercise, journaling, and readings,Profesional Orientation f t also hope that you are afforded experiences in your educational program that will challenge you to grow intellectually and personally. | hope that the philosophy of your program is chat students need a supportive environment in which they can feel safe enough to share, while atthe same time, be challenged to grow. This “constructive development” philosophy has become an important model for many counselor education programs, as it is buile on the belief that if afforded a nurturing environment, students can develop increased flexibility and relativist thinking in their ways of understanding the world (McAuliffe & Eriksen, 2000, 2002). Such students gain a strong sense of self, can listen to feedback about self from others, are open with others, and are generally more empathic and less dogmatic. Not surprisingly, these are also the qualities we look for in an effective counselor! In this chapter we attempted to define the somewhat elusive word counseling and distin- guish it from the words guidance and psychotherapy. We then compared and contrasted some of the training, credentialing, and roles and functions of counselors, art and creative therapists, psychiatric nurses, psychiatrists, psychologists, and social workers. In addition, we also identified some ofthe benefits of professional associations with a special emphasis ‘on the American Counseling Astciation (ACA), and identified some of the more promi- nent professional associations in related feds. ‘Next, we discussed the recent move toward evidenced:-based practice in the field, noting the importance of matching technique with symptom. We went on to highlight aspects of the effective counselor, specifically identifying eight characteristics that may be related to positive client outcomes, including the therapeutic alliance, empathy, genuine- ress, acceptance, open-mindedness, cognitive complexity, psychological adjustment, and competence. Examining some important multicultural issues, we noted that clients of color are frequently misdiagnosed, attend counseling at lower rates, terminate counseling more quickly, find counseling less helpful, and are distrustful of white counselors. We talked about the importance of recruiting @ more culturally diverse group of counselors to the field, as clients tend to respond better to counselors of their own cultural background. Finally, ve highlighted che importance of counselors obtaining a thorough knowledge of ‘multicultural issues as they go through their training program, and we presented the RESPECTFUL model of [Andrea and Daniels As the chapter neared its conclusion, we discussed the importance of a number of cthical issues, including understanding out professional identity and knowing our pro- fessional limits, practicing within one’s area of competence, consulting with other pro- fessionals, and terminating or referring clients when one is unable to work effectively with ther. We then discussed the importance of assuring that we are not working while impaired, Related co this topic, we ended the chapter discussing the importance of being in our own personal counseling and/or finding other related personal growth experi- tences. We also expressed the hope that readers of this text were in an educational pro- ssram that affords personal and intellectual growth experiences in a nurturing yet challenging environment.CHAPTER 1 The Counselor's Identity: What, Who, and How? foTrac® College Edition and Other Information Resources g., ERIC and PsycINFO) Note: When relevant, key words are in boldface type 1. Search for information about the effect of counselor characteristics on the help- ing relationship. What characteristics, other than the ones in this chapter, are shown to be important in the helping telationship? 2. Examine the possible effects of treatment of an impaired therapist working with clients 3. Review the kinds of journals published by the various professional associations.