Foundations of Counseling and Psychotherapy: Evidence-Based Practices for a Diverse Society - Hardcover

Sue, David; Sue, Diane M.

Hardcover

ISBN 10: 0471433020 ISBN 13: 9780471433026

Publisher: Wiley, 2007

Synopsis

Foundations of Counseling and Psychotherapy provides an overview of the most prevalent theories of counseling within the context of a scientific model that is both practical and up-to-date. Authors David Sue and Diane Sue provide you with the best practice strategies for working effectively with your clients using an approach that recognizes and utilizes each client’s unique strengths, values, belief systems, and environment to effect positive change. Numerous case studies, self-assessment, and critical thinking examples are included.

About this title

About the Author

DAVID SUE, PhD, is a Professor of Psychology and an associate at the Center for Cross-Cultural Research at Western Washington University in Bellingham, Washington.

DIANE M. SUE, PhD, has twenty-eight years of experience in the fields of school counseling and school psychology and is a Nationally Certified School Psychologist.

From the Back Cover

A provocative and contemporary exploration of counseling theories

The drive toward evidence-based practices and the related debate among practitioners has translated into a time of significant change in the fields of counseling, psychotherapy, and social work with an evolution underway that is significantly shifting the practice of counseling and psychotherapy.

Foundations of Counseling and Psychotherapy: Evidence-Based Practices for a Diverse Society provides an overview of the most prevalent theories of counseling within the context of a scientific model that is both practical and up-to-date. Employing a scientist-practitioner model, with an emphasis on connecting theory with empirically supported therapies, and a strong diversity and contextual perspective, this text prepares readers with a solid sense of how the various therapeutic approaches differ and how each can be applied in clinical practice.

Authors David Sue and Diane Sue provide readers with the best practice strategies for working effectively with clients using an approach that recognizes and utilizes each client's unique strengths, values, belief systems, and environment to effect positive change.

Highlights include:

• Unique conceptual framework recognizing individual diversity and the need to consider individual variables when applying specific theoretical models and counseling strategies

• Integrates theory with intervention and discusses research findings, critical thinking, and evidence-based practice guidelines

• Covers special topics not covered in other texts, including crisis, suicide, violence assessment, and psychopharmacology

• Combines theory and research with hands-on therapeutic skills training, covering intake interviews, assessment, diagnosis, and treatment

• Filled with numerous case studies, self-assessment and critical thinking examples, this thought-provoking text skillfully equips students and practitioners with the tools to feel confident in the use of empirically supported techniques in the practice of counseling and psychotherapy.

From the Inside Flap

A provocative and contemporary exploration of counseling theories

The drive toward evidence-based practices—and the related debate among practitioners—has translated into a time of significant change in the fields of counseling, psychotherapy, and social work—with an evolution underway that is significantly shifting the practice of counseling and psychotherapy.

Foundations of Counseling and Psychotherapy: Evidence-Based Practices for a Diverse Society provides an overview of the most prevalent theories of counseling within the context of a scientific model that is both practical and up-to-date. Employing a scientist-practitioner model, with an emphasis on connecting theory with empirically supported therapies, and a strong diversity and contextual perspective, this text prepares readers with a solid sense of how the various therapeutic approaches differ—and how each can be applied in clinical practice.

Authors David Sue and Diane Sue provide readers with the best practice strategies for working effectively with clients using an approach that recognizes and utilizes each client's unique strengths, values, belief systems, and environment to effect positive change.

Highlights include:

• Unique conceptual framework recognizing individual diversity and the need to consider individual variables when applying specific theoretical models and counseling strategies

• Integrates theory with intervention and discusses research findings, critical thinking, and evidence-based practice guidelines

• Covers special topics not covered in other texts, including crisis, suicide, violence assessment, and psychopharmacology

• Combines theory and research with hands-on therapeutic skills training, covering intake interviews, assessment, diagnosis, and treatment

• Filled with numerous case studies, self-assessment and critical thinking examples, this thought-provoking text skillfully equips students and practitioners with the tools to feel confident in the use of empirically supported techniques in the practice of counseling and psychotherapy.

Excerpt. © Reprinted by permission. All rights reserved.

Foundations of Counseling and Psychotherapy

Evidence-Based Practices for a Diverse SocietyBy David Sue

John Wiley & Sons

Copyright © 2008 David Sue
All right reserved.
ISBN: 978-0-471-43302-6

Chapter One

Science and Diversity in Psychotherapy: Important Perspectives

Whether you are currently in or preparing to enter the mental health profession, you are most likely aware that an important evolution is taking place in the field, significantly changing the practice of counseling and psychotherapy. When we first began to provide mental health services, there were few limitations on practice, such as the number of sessions allowed or the type of therapy provided. Within the last 10 years, enormous changes have occurred in the field. The impetus for change comes primarily from three forces:

1. Managed care, which demands accountability and efficiency in the provision of mental health services.

2. Research and evidence-based practice guidelines, which are becoming the touchstone of psychotherapy.

3. Culture-sensitive or diversity-sensitive therapies, which are promoted to address the needs of ethnic minorities and other diverse populations.

All of these factors have been highly influential in defining appropriate treatment and services for clients. In a survey of 62 psychotherapy experts regarding the future direction of the mental health field (Norcross, Hedges, & Prochaska, 2002), there was a strong belief that almost all systems of psychotherapy will develop short-term therapies to conform with managed-care systems and that efficient therapies will grow in importance. The expert psychotherapists predicted that of the different theoretical orientations, the eclectic and the cognitive-behavioral will assume greater importance because they are amenable to the development of concrete goals and brief treatment strategies. A survey conducted to determine the theoretical orientation of a group of psychologists revealed the following percentages: eclectic (35 percent), psychodynamic (21 percent), cognitive-behavioral (16 percent), Rogerian/Humanistic/Gestalt/Existential (6 percent), Systems/Family Systems (3 percent), and Interpersonal (3 percent) (Norcross, Hedges, & Castle, 2002). Allegiance to these orientations may change dramatically in future years depending upon the ability of each theoretical framework to meet changing demands in the mental health field.

Psychotherapies are evolving and beginning to meet demands for accountability by using efficient, research-supported treatment and accommodating diversity issues. For example, from psychoanalysis came the object relations and the self-perspective theories that led to short-term psychoanalytic approaches such as the core conflictual relationship theme method (CCRT) and interpersonal therapy (IPT), an empirically supported approach for depression. Additionally, some psychoanalysts are emphasizing the need to examine the cultural values of both the therapist and the client in the therapeutic relationship (Bucci, 2002) and increase the role of research in psychoanalysis (Schachter, 2005). Similarly, person-centered approaches have given rise to motivational interviewing, a concrete and goal-oriented therapeutic approach. In addition, some practitioners are calling for humanistic therapies to incorporate aspects of empirically supported treatments and to use quantitative documentation to evaluate treatment outcome (Joiner, Sheldon, Williams, & Pettit, 2003). Both psychodynamic and humanistic approaches are including more action-oriented techniques into their therapies. In contrast, cognitive-behavioral therapies have always stressed the importance of research and technical skills, while placing less emphasis on the quality of the therapeutic relationship in treatment outcome. However, there has been a recent shift within the cognitive-behavioral school of thought and there is now an effort to explore and incorporate relationship variables between the therapist and client in a systematic manner (Lecompte & Lecompte, 2002). These changes, which are occurring across different theoretical orientations, are important not only because they benefit the consumer, but also because they offer therapists more flexibility in the provision of services.

Evidence-based guidelines have been developed for many mental disorders and are now considered the standard of practice from which to determine the appropriateness of a selected treatment. These treatment recommendations are based on outcome research and clinical expertise and are advocated by the American Psychiatric Association, National Association of Social Workers, American Psychological Association, and the American Counseling Association. These guidelines, combined with the identification of research-based relationship variables and therapeutic techniques, will have a great impact regarding the provision of mental health services and the curricula of mental health training programs. Newcomers to the field and experienced practitioners alike will be expected to be familiar with new treatment guidelines.

Although culture-sensitive therapies do not fit under the efficiency or effectiveness models, they are expected to increase in importance as more attention is paid to the needs of our increasingly diverse society. Practitioners face several areas of controversy when dealing with diversity issues in psychotherapy. First, when considering diversity, should the major emphasis be on ethnic groups or do we need to consider additional areas of diversity (gender, age, sexual orientation, disability, religion, social class, etc.)? Second, should we modify existing psychotherapies to incorporate diversity issues, or develop specific therapies for each group? How therapy should be modified to deal with diverse populations is still a matter of debate. The culture-sensitive movement, however, has been instrumental in changing the view that mental health difficulties reside solely within an individual to include consideration of a person-environment interaction. In other words, social context is increasingly recognized as vitally important in the assessment and treatment of psychopathology.

All of these changes are both challenging and exciting. They allow therapists an opportunity to be creative and in the forefront of meeting the new demands of the field. Additional skills needed in the mental health profession are also addressed in this text. In Chapter 16, we cover best practices and specific techniques for dealing with crises confronted by many clinicians, including situations where there is a concern about suicide or violence toward others. There has been increased attention on behavioral medicine and psychopharmacology in the mental health field. Many mental health professions now require courses on and knowledge of psychotropic medications. This has become more important as medical professionals increasingly collaborate with mental health professionals and the integration of services (both mental and physical) becomes an accepted model of treatment. Medication is a topic we cover in depth in Chapters 17 and 18. For the remainder of this chapter, we will focus in greater detail on the changes occurring in the mental health field.

Impact of Managed Care

An observation made by Cohen (2003) regarding social work applies equally to other mental health training programs: "traditional curricula are no longer adequate to prepare students for practice in the era of managed-care. Managed-care's emphasis on the provision of mental health services at contained costs requires specialized practice skills, particularly rapid assessment, brief treatment, and the ability to document treatment outcomes" (Cohen, 2003, p. 41). What are the skills needed to meet the demands of a managed-care environment? In most training programs, a primary focus involves helping students develop interviewing and interactional skills. Bradley and Fiorini (1999) found that, in a survey of mental health programs, the most frequently addressed practicum competencies involved the microskills (listening, reflection of feelings, empathy, and genuineness) emphasized by Rogerian theory. Less than one third rated "readiness for employment as an entry level counselor" as an expected competency. As Bradley and Fiorini concluded, "... this heavy focus on basic listening skills may need to be questioned in light of the increasingly complex clients who are being seen by practicum students. Competence in basic attending skills may no longer be sufficient for success in practicum or internship courses" (p. 117). This observation is especially true both in terms of the more severe and chronic populations faced by mental health professionals and in meeting the requirements of insurance companies and managed-care systems.

Unfortunately, most psychotherapy textbooks and mental health training programs do not address the need for new skills in a comprehensive manner. This leaves trainees without adequate background preparation. Textbooks have been deficient in providing a bridge between the theories and the current work requirements of mental health professionals. Most texts present the theories of counseling and psychotherapy without much guidance regarding how they can be adapted to meet the challenges posed by managed-care requirements or in work with diverse populations. During internships, especially in managed-care settings, the theories of therapy learned by students are of little help in meeting assessment, therapy, and outcome requirements. Brief models and techniques that have evolved from these theories are not presented, nor is there much focus on the applicability of theory to practice. This leads to a disconnect between what students learn from texts and the skills they are expected to apply under managed care and accountability guidelines. Also, students receive little guidance in working with diverse populations.

In addition to interviewing techniques, what skills are necessary for practitioners working in a managed-care environment? According to a managed-care representative, the following are expected (Anderson, 2000):

1. Diagnosis. The ability to diagnose using DSM-IV-TR and to describe symptoms used to justify the diagnosis is essential; the diagnosis often determines whether the treatment is covered for insurance reimbursement.

2. Treatment plan. An individualized treatment plan must be developed for each client that includes goals, objectives, and interventions for treatment. The plan should include: (1) a clear statement of the client's problems, (2) specific and concrete goals, and (3) measurable criteria to evaluate goal attainment.

An example incorporating these features for a client suffering from depression might include:

The client currently exhibits flat affect, depressed mood and reports disturbed sleep (no more than 4 hours a night for the past month) and decreased appetite (has been eating one meal a day for the past 2 weeks), and has not engaged in pleasurable activities for 3 weeks. The goals are (1) to make a list of three pleasurable activities from which client will choose one to perform 3 days out of the week, (2) to eat two well balanced meals a day for one week, and (3) to identify triggers to depression by writing in a journal three times a week. I plan to see the client in weekly individual sessions. I will be using cognitive-behavioral techniques to help identify triggers to depression as well as client-centered therapy to enhance the therapeutic relationship ... I am requesting 12 sessions. At the end of these sessions, client progress will be reevaluated. (Anderson, 2000, p. 347)

This degree of specificity is not only important for meeting managed-care requirements, but also helps both the client and therapist understand the goals for treatment and planned interventions. Although the above example involves the cognitive-behavioral perspective, other therapeutic approaches can be utilized as long as goals and treatment strategies are clearly specified. In the case of psychodynamic approaches, techniques must be adapted for managed-care. Since there is little time allowed for traditional transference analysis (client reactions to the therapist because of childhood conflicts), psychoanalytically oriented therapists may focus on transferences that exist within the client's current relationships. Instead of analyzing transference reactions to the therapist, insight techniques are employed to help the client understand core conflictual themes from childhood that are responsible for the relationship difficulties. The insight is then explained in behavioral and affective changes as indicated in the follow case:

A retired woman came into therapy complaining of sleeping difficulties, discomfort even at home, and dissatisfaction with her relationship with friends and family. The interpersonal pattern itself was life-long and had roots in her childhood as a result of a dominant and aggressive father and an attentive but passive mother. (Sperling & Sack, 2002)

The woman could have received traditional psychoanalysis with years of weekly or even more frequent sessions. However, because of managed-care constraints, therapy focused on the analysis and interpretation of interactional patterns with two of her closest friends. By understanding current relationship problems as the result of past childhood difficulties, the client was able to "chip away at the repression of negative feeling" (p. 367) and improve her interpersonal relationships. To meet managed-care requirements, psychodynamic therapists can use alternative language to describe their therapy. Instead of referring to positive transference, the process can be described as modeling. Instead of interpretation, terms such as reattribution or reframing are used to describe the process in which the therapist works to relabel the client's perceptions so that problematic situations or behaviors are interpreted in a more positive light. Not all psychoanalytically oriented therapists, or those of other theoretical orientations, agree to these changes. However, therapists of all orientations need to be willing to make modifications in their therapy if they are to participate in current health care plans. We can no longer use global statements such as "develop insight into patterns of behavior" or "help the client improve self-esteem" in our work with clients. We will be expected to describe precisely how the client will be different in terms of behaviors and life choices once the therapeutic goals have been attained.

Some mental health professionals believe that the need for specificity in treatment detracts from the human aspect of psychotherapy. As one client-centered therapist lamented, "Humanistic therapy looked like what graduate students imagined therapy should be: a sensitive, understanding, caring, supportive, and authentic person engaged in a personal encounter with the client in a manner that facilitated personal discovery and learning. Yet, many of these graduate students would eventually embrace cognitive or cognitive-behavioral or some of the 'brief' or 'strategic' approaches emphasizing therapist technique and wizardry" (Cain & Seeman, 2002). The reason for this change is due to the current "therapeutic zeitgeist" of managed-care with its emphasis on diagnosis, treatment planning, and rapid remediation of clients' symptoms. Although many therapists see managed-care as an unwelcome impediment, the positive side is that theories are continuing to evolve and incorporate these requirements. Additionally, as we will illustrate later, the need for rapid assessment and treatment does not preclude the use of empathy and other interpersonal skills when working with clients. It is essential that, as mental health professionals, we develop the ability to perform assessment, define goals, provide brief interventions, and evaluate client progress and outcome within the context of a positive therapeutic relationship.

(Continues...)

Excerpted from Foundations of Counseling and Psychotherapyby David Sue Copyright © 2008 by David Sue. Excerpted by permission.
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Edition details

• Publisher: Wiley
• Publication date: 2007
• Language: English
• ISBN 10: 0471433020
• ISBN 13: 9780471433026
• Binding: Hardcover
• Edition number: 1
• Number of pages: 456