TPC-Journal-V4-Issue4

The Professional Counselor \Volume 4, Issue 4 399 The second finding of health insurance status contributing to improvements through counseling is particularly intriguing given that counseling services in the present study were offered at no cost. Arguably, access to health insurance provided a safety net, a positive external resource that allowed low- and high-income clients alike to focus on the internal work of change in counseling. That is, health insurance fulfilled a basic need, which in turn seemed to aid clients in benefiting from counseling. This finding is important given the recent attempts to obtain mental health parity. The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (2008) was passed in an effort to reduce costs of mental health services by offering treatment continuously. Recent research highlights the political and societal complexity of mental health parity (Hernandez & Uggen, 2012). Within counseling, there is a lack of research focused on client outcomes and perceptions of healthcare. And in the present study, the finding of a relationship between perceptions of healthcare and outcomes was unexpected. Outside the counseling literature, recent studies focused on parity at the macro level have found disconnects between providers and consumers related to education. In a 2009 study in California, many consumers stated a need for increased education about parity (Rosenbach, Lake, Williams, & Buck, 2009). The current research direction focuses more on utilization and access issues and less on the impact on outcomes. The implications for counselors lie in the ability to provide individuals with easy access to mental healthcare and to reduce or remove the stigmatization often associated with receiving mental health services. Furthermore, current research suggests the need for service providers to educate clients on mental healthcare options. The myriad of choices, rules and requirements can be overwhelming for clients already experiencing elevated distress. In conclusion, counselors benefit the profession by advocating for clients and not being silent stakeholders. Further research is necessary to understand this finding and its implications for policy and service provisions. The present results show that subjective and objective measures collectively predicted outcomes. Within the counseling literature, there are few studies that both empirically study subjective and objective measures, as well as examine SES measures with clinical outcomes in counseling. The results also support the premise that SES is a complex variable warranting further empirical inquiry in counseling research (Liu, 2011). If SES is predictive of client outcomes in a counseling training program, then further research to investigate discrete variables and causal relationships is necessary. Current trends in SES health research involve the inclusion of subjective measures. Studies have shown that subjective low SES is linked to poorer health outcomes (Adler et al., 2000). Professional counselors can both emulate the current health research already using both subjective and objective measures in clinical outcomes and forge their own SES research agenda. Limitations Several methodological limitations warrant attention. First, the small sample size, comprised mostly of Caucasian and female clients, limits the generalizability of this study. Given that SES is linked with race and gender (Pope-Davis & Coleman, 2001), a heterogeneous sample would enrich the study’s findings. Along those lines, it is conceivable that the health insurance–outcome link in this study was a spurious correlation that might be accounted for by a third unmeasured variable. In short, the sample of convenience and the naturalistic correlational design reduces internal validity. Though each counselor had similar coursework prior to practicum, counselor trainees were not the same. We made no attempt to control variables such as counseling approach, counselor competence or client diagnosis; each of these variables may have changed the results of this study. Finally, a possible confounding contextual factor was that this study occurred within a time of significant economic challenge. Similar to mandated healthcare and parity, the economic contexts in which SES studies occur are important areas for further study. Despite these limitations, the study provides important contributions and has implications for further research.