Professional Identity of Counselors in Mexico: A Commentary

Viviana Demichelis Machorro, Antonio Tena Suck

The authors conducted an exploratory study using cultural domain analysis to better understand the meaning that advanced students and professional counselors in Mexico give to their professional identity. More similarities than differences were found in the way students and professionals define themselves. The most relevant concepts were empathy, ethics, commitment, versatility, training and support. Students gave more weight to multiculturalism and diversity, whereas professionals prioritized commitment and responsibility at work. Prevention did not appear as a relevant concept, posing challenges for professional counselor training programs in Mexico.

Keywords: professional identity, multiculturalism, ethics, prevention, counselor training, Mexico

In the field of professional counseling, it is important to consider the benefit of developing a strong professional identity. Initiative 20/20: Vision for Counseling’s Future, represented by influential organizations such as the American Counseling Association (ACA), the Council for Accreditation of Counseling and Related Educational Programs (CACREP), and the National Board for Certified Counselors (NBCC), identifies principles that must be developed in order to strengthen the counseling profession (ACA, n.d.). These principles include sharing a common professional identity and presenting the counseling profession in a unified way. CACREP (2009) recognizes the relevance of promoting professional development in counseling programs; the organization’s standards were written to ensure that counseling student development is congruent with professional identity, as well as the necessary knowledge and skills to practice counseling effectively and efficiently.

In Mexico, steps have been taken toward developing such standards. The Mexican Association for Counseling and Psychotherapy (AMOPP), founded in 2008, has stated in its mission and objectives the promotion of counselor identity and stimulation of professional development (AMOPP, 2014). However, the process of defining professional identity for counselors has complex aspects that imply a great challenge for the Mexican counseling guild (Calva & Jiménez, 2005; Portal, Suck, & Hinkle, 2010).

First, there are few Mexican university programs that train counselors. The only such Mexican graduate program is the master in counseling (maestría en orientación psicológica) at Universidad Iberoamericana, which started in fall 2003 and was awarded CACREP accreditation in 2009. This program prepares students in prevention, evaluation and intervention using an integrative approach that includes theories and techniques, promotion of multicultural sensibility, and a focus on vulnerable populations (Universidad Iberoamericana, n.d.-a). Most students in this master in counseling program have a bachelor’s degree in psychology, which makes for a mixed psychologist/counselor identity that is not easy to separate, and that is likely experienced as a psychological specialty by faculty, students and the general public.

In contrast to countries like the United States and Canada, where a bachelor’s degree is awarded first and students professionalize afterward at the graduate level, in Mexico, students professionalize at the undergraduate level, which promotes professional identity at this point. Thus, in Mexico the possibility of studying for an undergraduate professional program in counseling does not exist, which contributes to the difficulty of counseling being recognized as an independent profession.

There are plenty of reasons to study the professional identity of counselors in Mexico. First, counseling awareness within the community could be increased, making counseling accessible to a population that needs quality mental health services. The Mexican Poll of Psychiatric Epidemiology (ENEP) of the National Institute of Psychiatry reveals that 28.6% of the population presents some type of psychiatric disorder at some point in life, mostly anxiety (14.3%), followed by the use of illegal substances (9.2%) and affective disorders (9.1%). Nevertheless, despite this high incidence of mental health problems, only 10% of the population that presents with a mental disorder receives the attention it needs (Medina-Mora et al., 2003).

Secondly, there is limited professional literature in Mexico regarding professional counseling. Searching behavioral science databases revealed only one reference in a Mexican book regarding psychologists’ professional identity (Harsh, 1994) and no articles about counselors’ professional identity. If the professional identity of counselors in Mexico were more defined, it could help prospective students who are interested in studying counseling. It also could help practicing counselors form a solid base to serve as a platform to strengthen and enrich their professional behavior and clarify their professional identity. Neukrug (2007) has stated that when counselors find out who they are, they will know their limits and relationships with other professions. Therefore, the authors explored the professional identity of counselors in Mexico to better understand their definitive characteristics.

Professional identity, according to Balduzzi and Corrado (2010), is the definition one makes about self in relation to work and an occupational guild. It begins with training, during which professional identity can be promoted or obstructed, and includes interactions with others as well as modeling. Counselors begin to develop professional identity as they are trained (Auxier, Hughes, & Kline, 2003; Brott & Myers, 1999), integrating personal characteristics in the context of a professional community (Nugent & Jones, 2009). Brott and Myers (1999) studied how professional identity is developed among school counseling graduate students in the United States and reported that counselors develop an identity that serves as a reference for professional decisions and assumed roles. These researchers used grounded theory to explain the identity development process of counselors in training. First, students go through a stage of dependence to attain the stage of independence at which the locus of control is internal and the counseling student has the opportunity for self-evaluation without external evaluation. In this advanced stage, experience is integrated with theory, joining personal and professional identities.

To analyze the development of professional identity in counseling students in the United States, Auxier et al. (2003) developed their research from a constructivist model that assumed reality is socially developed, determined by the place where it is elaborated and based on the participants’ experience. They developed the model of “recycling identity formation processes” (p. 32). This model explains that for constructing an identity, a person needs to go through (a) conceptual learning via classes and lectures; (b) experiential learning by practices, dynamics and internship; and (c) external evaluation from teachers, supervisors, coworkers and clients.

Nelson and Jackson (2003) wanted to better understand the development of professional identity among Hispanic counseling students in the United States. They conducted a qualitative study and found seven relevant topics: knowledge, personal growth, experience, relationships, achievements, costs, and perceptions of the counseling profession (Nelson & Jackson, 2003). Although the results were congruent with other findings, such as the need to be accepted and included, relationships such as those available from caring faculty or the support of family and friends were identified as meaningful factors that contribute to formation of a professional identity.

Similarly, du Preez and Roos (2008) used social constructivism to analyze the development of professional identity in South African students between the fourth and last year of their studies as undergraduate counselors. Participants elaborated on visual and written projects regarding their professional development training. Through an analysis of this work, four professional identity themes were identified: capacity for uncertainty, greater self-knowledge, self-reflection and growth (du Preez & Roos, 2008).

Skovholt and Ronnestad (1992) explained that identity development implies progress of attitudes about responsibility, ethical standards, and membership in professional associations. According to the Skovholt and Ronnestad (1992), a counselor’s identity differs from other professional identities because a therapeutic self is shaped by a mixture of professional and personal development. The researchers explained that professional identity is a combination of professional self (e.g., roles, decisions, applying ethics) and personal self (e.g., values, morals, perceptions) that create frameworks for decision making, problem-solving patterns, attitudes toward responsibilities, and professional ethics.

In one of the few quantitative investigations on the topic, Yu, Lee and Lee (2007) used the concept of “collective self-esteem” (p. 163) as a synonym for collective and professional identity. They conducted a study to learn whether the collective self-esteem of counselors influences or mediates their work satisfaction and how they relate to clients. The researchers found that “job  dissatisfaction is negatively related to greater levels of private collective self-esteem, and in turn, greater private collective self-esteem is positively related to better client relationships” (p. 170). Based on their conclusions, it is important to study the professional identity of counselors in Mexico, who must work from a place of job satisfaction and good client relationships in order to successfully address their clients’ social needs.

Hellman and Cinamon (2004) performed a series of semi-structured interviews for 15 professional school counselors with a consensual qualitative research (CQR) strategy to classify counselors through the stages of Super’s (1992) career theory: exploration, establishment, maintaining and specialization. The classification was made according to the perceptions the researchers described about counseling, professional identity, work patterns, and resources and barriers at work. In the beginning stages of their career, counselors describe school counseling as a job or a role, but later they consider counseling a profession. Furthermore, counselors start by depending on external recognition, specific techniques, and highly structured programs. As they become more experienced, counselors gain self-confidence and rely more on their professional judgment.

In general, researchers have described subjective experience to explain the development of professional identity. Furthermore, findings suggests that counselors in their identity development gain more self-knowledge, confidence in their abilities and judgment, knowledge and involvement in their profession and its standards, and a combination of personal and professional characteristics and experiences.

Method

Cultural domain with free listing was chosen as the data collection technique. Cultural domain is “the set of concepts chosen by memory through a reconstructive process that allows participants to have an action plan as well as the subjective evaluation of the events, actions or objects, and it has gradually become one of the most powerful techniques to evaluate the meaning of concepts” (Valdez, 2010, p. 62). It has been accepted in Mexico and applied principally in social psychology and education to define and delineate several concepts such as psychologist (García-Silberman & Andrade, 1994); love, men and women (Hernández & Benítez, 2008); parenting (Medina et al., 2011); the rich and poor (Valdez, 2010); family (Andrade, 1994, 1996; Camacho & Andrade, 1992); and corruption (Avendaño & Ferreira, 1996), among others. This methodology was chosen because “professional identity” is a subjective concept to which different meanings are granted based on personal experiences; the idea was to show the concepts related to the meaning counselors give to their identity.

In this study, the authors posed the following question: What meaning do Mexican counselors give to their professional identity? The dependent variable was professional identity and the attributive variable was level of preparation (student or professional). The study was transversal (data recovery at a unique time frame) and descriptive.

Participants

The participants in the study included advanced students in at least their third semester in the master’s counseling program at Universidad Iberoamericana and professional counselors who graduated from the program at least one year ago. Fifteen of 17 advanced students (88.23%) participated, including 3 men and 12 women with an average age of 29.40 years. Twelve of 29 graduates (41%) participated, including 1 man and 11 women, with an average age of 42.75 years.

Survey Development and Procedure

Each participant was asked to list 10 words or brief terms to describe the concept counselor professional identity. Afterward, participants were asked to rank each word from 1–10, assigning 1 to the characteristic word considered the most relevant and 10 to the word considered least relevant. Advanced counseling students were given the survey in their classrooms and graduate counselors were sent the survey via e-mail. The surveys were analyzed following Valdez (2010), obtaining the definitions with the semantic weight (M), for both students and professionals, considering the frequency with which the words were mentioned, as well as the assigned rankings. The authors used a mathematical procedure called el valor M total [Total M Value] (VMT; Valdez, 2010), which entails multiplying the frequency of occurrence times the weight of each defining word. Next, a cross-multiplication was done, considering the highest VMT as 100% in order to obtain the semantic distance between each concept and the stimulus concept (i.e., counselor professional identity). This procedure is referred to as FMG (Valdez, 2010).

Results

For the students, the defining terms for the stimulus counselor professional identity, listed in the order of the frequency and relevance with which the participants used and ranked them, were as follows:

empathic, understands, sensitive, ethical, honest, sincerity, fair, prepared, knowledge, trained, updated, flexible, adapts, support, help, backup, listening, human, warm, congruence, authentic, mental health, well-being, trustable, integrative, responsible, commitment, intervening, implementing, action, professionalism, respect, tolerance, multicultural, contextualized, diversity, observer, acceptance, non-judgment, structure, organizes, collaboration, design, planning, creativity, patience, goal recognition, positive view, growth, development, contention, service attitude, dedication, different, brief, social commitment, interdisciplinary, reflective, analyzes, guides, communicates, open, wide view, curious, scientific, relationship, psychotherapist, therapist, educates, prudent, diagnoses, prevention, dynamic, specialized, assertive, personal, practical, resilient, facilitator, personal therapy, strategic and consultant.

Consensually, the researchers separated these concepts into semantic categories, taking into account terms that are synonyms or that have a very similar meaning, leaving 57 definitions. Similarly, those concepts with more semantic weight were detected, resulting in the Semantic Association Memory (SAM) group according to Valdez (2010), which refers to the 15 categories with the most relevance (M total). This process is done considering frequency and weight. This group includes 17 categories since the last 3 present the same value. Table 1 shows terms that counseling students used to define counselor identity, weighted in order of relevance.

Table 1

Counseling Students’ Identity

 

For graduated professional counselors, the defining terms for the stimulus counselor professional identity, listed in the order of frequency with which participants used and ranked them, were as follows:

empathic, commitment, dedicated, responsible, ethical, serves vulnerable populations, social service, prepared, experienced, updated, supervised, studious, research, listening, authentic, genuine, congruent, support, assistance, orientation, guidance, honesty, integrity, integrative, trustable, educates, informative, professional, versatile, adaptable, flexible, active, guide, creative, discipline, work, therapeutic relationship, curious, healthy, motivated, reflective, framing, intelligent, strength, ecological, humble, sensitize, acceptance, verbal, focused, aware, systemic, problem-solving, catalyze, assertiveness, decision-making, practical, positive, growth, development, fair, influence, self-knowledge, respectful, tolerant, reflects, cheerful and certified.

Once more, the defining words were classified into semantic categories, obtaining 48 definitions, as well as detecting those with the most semantic weight, resulting in a SAM group with the 15 most relevant categories. The authors derived these categories by considering higher frequencies and weight. The participants indicated that being empathic was the closest concept to counselor professional identity. The authors established empathic as FMG = 100, and cross-multiplied the other concepts to obtain their distance. Table 2 shows terms that professional counselors used to define counselor identity, weighted in order of relevance.

Table 2

Professional Counselors’ Identity

 

The resulting defining concepts also were divided into two categories: (a) the way counselors work and (b) the way counselors are. The authors believe it is important to understand how counselors actually perceived their role in their work (e.g., professional behaviors, attitudes, approaches, roles, and functions) and also the way they identify themselves personally (e.g., characteristics and abilities; see Table 3).

Table 3

Counselors’ Roles and Characteristics

 

Discussion

It is possible to distinguish professional identity with common themes that begin during counselor training and continue as a process (Auxier et al., 2003; Balduzzi & Corrado, 2010; Brott & Myers, 1999). More similarities than differences were found comparing students and graduates.

For students and professionals, empathy occupies the most relevant place when describing counselor identity. It is interesting to observe how counselors, students and professionals prioritize values and concepts that come from a humanistic approach (e.g., empathy, authenticity, being genuine, congruent, warmth). This finding coincides with what Hansen (2003) expressed in that the counseling profession has its roots in the humanistic model, which is an undeniable part of its identity. This is also congruent with the values that the Universidad Iberoamericana promotes with students.

Ethics appear predominantly in both sets of participants, likely since professional identity and ethics are closely related (Nugent & Jones, 2009; Ponton & Duba, 2009; Skovholt & Ronnestad, 1992). Responsibility and commitment, as well as training and preparation, appear to be important defining words for counseling students and graduates, indicating that these concepts are considered fundamental. Furthermore, students and graduates consider flexibility as one of a counselor’s professional identity characteristics, which relates to versatility in counselor roles and functions. Attending to the vulnerable population and social commitment were prominent for graduates, which fortunately matches well with the mission of counseling at their university (Universidad Iberoamericana, n.d.-b).

According to the data, the concept of prevention does not emerge as a direct priority that Mexican counselors believe distinguishes them. Students mention this concept, but just once and with low relevance; however, it does not reveal itself at all as a defining term for professionals. This finding does not correlate well with actual course descriptions within the counseling master’s degree program (Universidad Iberoamericana, n.d.-a); therefore, changes in the program curricula may be needed. Students identified multiculturalism and diversity in the description of their professional identity; however, graduates did not. This distinction could be related to the recent teaching of this topic in Mexico and is expected to increase in the new generation of graduates.

It is important to note the limitations to this preliminary descriptive study. The sample was limited to 27 participants and no in-depth interviews were done in order to more comprehensively understand student and counselor perceptions. There is no basis for suggesting that the results can be generalized to other counselor populations, given that the study was specific to the particular context of one program at a private university. It is imperative to continue the study of counselor professional identity in Mexico with more participants and in-depth interviews.

There are several implications for Mexican counselor educators in regard to the development of counselor professional identity. First, there is the understanding that counselors are models in their professional activities including writing, affiliations and certification. It is imperative that educators invite students to get involved in national and international associations; promote practice, research and writing; and exalt the relevance of counselor certification.

Prevention—on the one hand a historic activity of many counselors—has proven to be a less important to Mexican counselors. To enhance this concept, the university curricula design may need to emphasize this topic in the thematic content of the program’s courses. Practica and internships might as well include prevention strategies in the student’s roles and functions. Furthermore, an elective course about prevention program design and implementation could be offered. On the other hand, it may be that prevention is a good idea, but not actually practiced by professional counselors because people tend to not pay for preventive services.

In summary, counseling students and graduates in Mexico share a common professional identity self-described as empathic, ethical, committed, versatile, trained and supportive. Efforts should be made to continue enhancing counseling core values as the profession continues to grow in Mexico, as well as internationally.

References

American Counseling Association. (n.d.). 20/20: A vision for the future of counseling. Retrieved from http://www.counseling.org/20-20/index.aspx

Andrade, P. P. (1994). El significado de la familia [The meaning of family]. La Psicología Social en México, V, 83–87.

Andrade, P. P. (1996). El significado del padre y madre [The meaning of father and mother]. La Psicología Social en México, VI, 337–342.

Asociación Mexicana de Orientación Psicológica y Psicoterapia. (2014). Misión y objetivos [Mission and objectives].

Auxier, C. R., Hughes, F. R., & Kline, W. B. (2003). Identity development in counselors-in-training. Counselor Education and Supervision, 43, 25–38. doi:10.1002/j.1556-6978.2003.tb01827.x

Avendaño, S. R., & Ferreira, N. L. (1996). Significado psicológico de corrupción en estudiantes universitarios [Psychological meaning of corruption in college students]. La Psicología Social en México, VI, 132–136.

Balduzzi, M. M., & Corrado, R. E. (2010). Representaciones sociales e ideología en la construcción de la identidad profesional de estudiantes universitarios avanzados [Social representations and ideology in professional identity of advanced college students]. Revista Intercontinental de Psicología y Educación, 12, 65–83.

Brott, P. E., & Myers, J. E. (1999). Development of professional school counselor identity: A grounded theory. Professional School Counseling, 2, 339–348.

Camacho, V. M., & Andrade, P. P. (1992). El concepto de familia en los adolescentes [The concept of family in adolescents]. La Psicología Social en México, IV, 295–302.

Council for Accreditation of Counseling and Related Educational Programs. (2009). 2009 CACREP standards. Retrieved from http://www.cacrep.org/wp-content/uploads/2013/12/2009-Standards.pdf

Calva, G., & Jiménez, N. (2005). En busca de la identidad del orientador psicológico en México [In search of counselor identity in Mexico]. Temas selectos en Orientación Psicológica, 1, 9–15.

du Preez, E., & Roos, V. (2008). The development of counsellor identity: A visual expression. South African Journal of Psychology, 38, 699–709.

García-Silberman, S., & Andrade P. (1994).  La imagen del psicólogo en los adolescentes [The psychologist image for adolescents]. In AMEPSO (Ed.), La Psicología Social en México (5th ed., pp. 672–678). Mexico City: AMEPSO..

Hansen, J. T. (2003). Including diagnostic training in counseling curricula: Implications for professional identity development. Counselor Education and Supervision, 43, 96–107. doi:10.1002/j.1556-6978.2003.tb01834.x

Hellman, S., & Cinamon, R. G. (2004). Career development stages of Israeli school counsellors. British Journal of Guidance & Counselling, 32, 39–55. doi:10.1080/03069880310001648085

Hernández, C., & Benítez, M. (2008). El amor, las mujeres y los hombres [Love, women and men]. Archivos Hispanoamericanos de Sexología, 14, 103–135.

Medina, J., Fuentes, N., Escobar, S., Valdez, V., Farías, P., Guerrero, I., . . . Manjarrez, A. (2011). Orientación que transmiten los padres a sus hijos adolescentes [Orientation transmitted from parents to their adolescent sons]. Revista Mexicana de Orientación Educativa, 8, 2–9.

Medina-Mora, M. E., Borges, G., Muñoz C. L., Benjet, C., James, J. B., Bautista, C. F., . . . Aguilar-Gaxiola, S. (2003). Prevalence of mental disorders and use of services: Results from the Mexican National Survey of Psychiatric Epidemiology. Salud Mental, 26, 1–16.

Nelson, K. W., & Jackson, S. A. (2003). Professional counselor identity development: A qualitative study of Hispanic student interns. Counselor Education and Supervision, 43, 2–14. doi:10.1002/j.1556-6978.2003.tb01825.x

Nugent, F. A., & Jones, K. D. (2009). Introduction to the profession of counseling (5th ed.). Upper Saddle River, NJ: Pearson.

Neukrug, E. (2007). The world of the counselor: An introduction to the counseling profession (3rd ed.). Belmont, CA: Brooks-Cole.

Ponton, R. F., & Duba, J. D. (2009). The ACA Code of Ethics: Articulating counseling’s professional covenant. Journal of Counseling and Development, 87, 117–121. doi:10.1002/j.1556-6678.2009.tb00557.x

Portal, E. L., Suck, A. T., & Hinkle, J. S. (2010). Counseling in Mexico: History, current identity, and future trends. Journal of Counseling and Development, 88, 33–37. doi:10.1002/j.1556-6678.2010.tb00147.x

Skovholt, T. M., & Ronnestad, M. H. (1992). The evolving professional self: Stages and themes in therapist and counselor development. Chichester, England: Wiley.

Super, D. E. (1992). Toward a comprehensive theory of career development. In D. H. Montross & C. J Shinkman (Eds.), Career development: Theory and practice (2nd ed., pp. 35–64). Springfield, IL: Charles C. Thomas.

Universidad Iberoamericana. (n.d.-a). Maestría en orientación psicológica [Master in Counseling]. Retrieved from http://www.uia.mx/web/site/tpl-Nivel2.php?menu=mgPosgrado&seccion=M_orientacionPsicologica

Universidad Iberoamericana. (n.d.-b). Misión y visión [Mission and vision]. Retrieved from http://www.uia.mx/web/site/tpl-Nivel2.php?menu=mgPerfil&seccion=mgPerfil

Valdez, J. L. (2010). Las redes semánticas naturales, usos y aplicaciones en psicología social [Cultural domain, uses and applications in social psychology]. (4th ed.). Mexico City: Universidad Autónoma del Estado de México.

Yu, K., Lee. S-H., & Lee, S. M. (2007). Counselors’ collective self-esteem mediates job dissatisfaction and client relationships. Journal of Employment Counseling, 44, 163–172. doi:10.1002/j.2161-1920.2007.tb00035.x

Viviana Demichelis Machorro is a doctoral student at Universidad Iberoamericana in Mexico City. Antonio Tena Suck is the Director of the Psychology Department at the Universidad Iberoamericana in Mexico City. Correspondence can be addressed to Viviana Demichelis Machorro, Universidad Iberoamericana, Departamento de Psicología, Prolongación Paseo de la Reforma 880, Lomas de Santa Fe, 01219 México Distrito Federal, viviana.demichelis@amopp.org.

Video Review — ACT in Action: 6-Video Series

Whether a counselor is working with a mother experiencing anxiety and depression, a man presenting with severe social anxiety, a teacher with panic symptoms, an individual battling chronic pain, or a recovering alcoholic, Hayes and other contributing therapists in the ACT in Action DVD Series provide a solid foundation for practitioners to understand the main principles and processes involved in Acceptance and Commitment Therapy (ACT). Hayes effectively delivers in each of his 6 DVDs, providing extensive details and instruction. For each DVD, Hayes further created an instructor’s manual resource that includes a complete transcript, summarizes basic treatment principles and strategies, offers discussion questions, and provides information on additional websites, readings, and videos.

During the first video of this series, Facing the Struggle, Hayes beautifully normalizes the human condition, shows how pain represents an ally, and demonstrates the process of obtaining informed consent using an ACT approach. In his second video, Control and Acceptance, Hayes delicately illustrates techniques to help clients accept what they cannot control and behave based on personal values. This video uses appropriate self-disclosure and provides the audience with warning signs and strategies to overcome what Hayes labels “pseudoacceptance.” Similarly, in video three, Cognitive Defusion, clinicians implement a variety of thought-diffusion techniques, such as deliteralization, and physicalizing, which can be easily integrated into therapists’ toolboxes and used to reduce anxiety and depression. Appropriate metaphors allow Hayes to connect with material presented in earlier DVDs.

During the fourth DVD, Mindfulness, Self, and Contact with the Present Moment, Hayes provides the audience with a fruitful dialogue on mindfulness practices. Specifically, he demonstrates using an eyes-closed exercise with a recovering addict to promote self-mind-body connection and deeper engagement in therapy. In this DVD, ACT co-founder Kelly Wilson further demonstrates the utility of ACT in clinical supervision with another therapist working with a resistant client. In this segment, viewers observe powerful role-plays and other empowering techniques for ACT therapists.

Values and Action and Psychological Flexibility, the fifth and sixth DVD in the series, demonstrate how each prior process, component, and ACT technique build upon and work together. Values and Action highlights the significance of values in psychotherapy and the importance of identifying, incorporating, and creating meaningful goals based on personal values. In the example of working with a client diagnosed with Obsessive-Compulsive Disorder (OCD), exposure exercises are implemented and viewers observe what it means for clients to remain in the present moment without engaging in defense mechanisms, while concurrently remaining grounded and practicing psychological flexibility. These final two DVDs are highly active and show the ways that ACT can be applied across gender, age, race, socioeconomic status, disability status and cultural background.

In this DVD series, the authors do a sufficient job of demonstrating how clinicians with a variety of therapeutic styles can adopt components of ACT in their own practices, while also noting that this approach is no better than others. For example, Hayes demonstrates how ACT serves as a brief but integrative approach, combining elements from mindfulness, cognitive-behavioral therapy and interpersonal therapy. Throughout the series, Hayes provides summaries and explanations for what he is doing and why to enhance the understanding of his audience.

While this series includes numerous strengths, several caveats and limitations should be noted. At times, the terminology is complex and vague (e.g., cognitive entanglement; creative hopelessness) and it would be helpful to give visual and written definitions, or at least link audience members not as familiar with ACT to specific handouts to obtain such definitions. Another area for improvement relates to the video recording procedures; at times, the camera zooms in on Hayes and the audience may benefit from seeing the client’s non-verbal behaviors or reactions to Hayes. Third, a gun analogy is used during Control and Acceptance and the current reviewer found this technique somewhat violent and inappropriate to use with clients. Finally, the DVD series would be more complete if it included Hayes using ACT to work with a resistant client.

Watching these DVDs is probably more helpful than reading books and articles, as audience members visually observe key processes involved in ACT. Additionally, clinicians and other professionals in the field who are interested in honing his/her ACT skills can learn practical tools to use in  psychotherapy with over twelve hours of instruction, live sessions and diverse therapeutic case examples. The author skillfully enlists several ACT therapists from across the United States to participate in this DVD series, including Ann Bailey-Ciarrochi, JoAnne Dahl, Rainer Sonntag, Kirk Strosahl, Robyn Walser, Rikard Wicksell, and Kelly Wilson. In summary, viewers will develop significant insight into applying ACT with a variety of clients and in numerous therapeutic settings after watching this entire series.

Visit http://www.psychotherapy.net/ to read more about the series.

Hayes, S.C. (Ed.). (2007). ACT in Action DVD Series. Oakland, CA: New Harbinger. 

Reviewed by: Mary-Catherine McClain, Johns Hopkins University Counseling Center, Baltimore, MD.

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Book Review—Conceptualization and Treatment Planning for Effective Helping

Conceptualization and Treatment Planning for Effective Helping by Barbara F. Okun and Karen L. Suyemoto (2013) is presented as a two-section book. The chapters in section one are intended to facilitate the choice and development of a theoretical orientation for counseling trainees. These chapters intend to accentuate the connection that exists between theoretical approaches to counseling and the specific implications in formulating a case conceptualization, as well as a sound treatment plan. Section two of the book focuses on the process of conceptualization and treatment planning. This section incorporates an integrative approach and is intended to be more practically oriented.

The specific goals stated by the authors of this book are: (1) assist counselors-in-training in developing their own theoretical orientation; (2) explore the conceptualization process in light of specific theoretical approaches; (3) identify the impact that the counselors’ and clients’ worldviews, as well as their therapeutic relationships, have in case conceptualization and treatment planning; (4) assist counselors-in-training in gathering, organizing and integrating information necessary for case conceptualization and treatment planning; and (5) further develop the case conceptualization and treatment planning skills of counselors-in-training.

Section one of the book mainly focuses on the strong connection between the counselor-in-training’s understanding of change, his or her theoretical orientation and the formulation of a case conceptualization. A significant emphasis is placed on the counselor’s worldview and how it affects the understanding of clients, formulation of a case conceptualization and treatment plan, as well as the course and outcomes of counseling. The authors assume an ecological perspective and stress the importance of looking at both the counselor and client contexts. From a multicultural, advocacy and a social justice perspective, this section of the book facilitates a brief but comprehensive understanding of how these very important relational factors play a concrete role in the process of understanding both the client’s and counselor’s perspective, as well as the implications for case conceptualization and intervention.

The main goal in section two of the book is to help counselors apply their self-awareness, skills in gathering and incorporating information from clients, and understanding of the process of problem formation and change to case conceptualization and treatment planning. The authors used an integrative approach to illustrate this process and emphasize the continuous nature of the case conceptualization and treatment process. This section includes several significant contributions, including the emphasis placed on integrating information provided by multiple sources in the client’s systems, the connection to issues of multicultural competent diagnosis, and the iterative nature of the conceptualization process as an event that needs to be revisited and developed continuously and collaboratively with clients.

In general, the authors do a great job of formulating the basic parameters that could be used by advanced counselors-in-training in the often-confusing process of selecting a theoretical approach. They specifically facilitate a practical and reflective context in which counselors-in-training are able to explore the influences in their personal world views. They are able to explore, for instance, the relationship between their ideas of problem formation, change, power, privilege, health, and pathology and how this influences the choice of a specific theoretical approach. A point they are trying to make throughout the book is the importance of looking at the case conceptualization and treatment planning process through the lens of both the client and the counselor, as well as considering the issues that arise because of their interaction, and the contexts in which these interactions occur.

The authors provide specific reflective and practical strategies to illustrate the process of organizing and integrating information at different points of the case conceptualization and treatment planning process. As a whole, the book provides a good integration of conceptualization and treatment planning, and explores the connection between these factors and other aspects of the counseling process, from initial assessment and establishing therapeutic rapport to evaluation and termination.

Okun, B. F., & Suyemoto, K. L. (2013). Conceptualization and treatment planning for effective helping. Belmont, CA: Brooks/Cole.

Reviewed by: Raul Machuca, NCC, Barry University, Miami Shores, FL.

The Professional Counselor Journal

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Book Review—Counseling Individuals with Life-Threatening Illness (2nd Edition)

The counselor’s role when working with an individual with a life-threatening illness is not always straightforward. Counselors sometimes do not know or fully understand how to work with these clients, as treatment is frequently exclusively biological and often ignores psychological, social and spiritual factors. However, Doka stresses the importance of interdisciplinary teams using the biopsychosocial-spiritual model in the treatment of individuals with life-threatening illness. In his book, Doka clearly outlines and demystifies the role of counselors who are working with these individuals and their families.

The second edition of Counseling Individuals with Life-Threatening Illness includes updated information, such as models of concurrent care and counseling families throughout life-threatening illness and during the grieving process. Following a brief introduction, Doka begins Chapter 2 by discussing historical perspectives on dying and illness, and then explores early and contemporary contributions on dying. Doka follows with a chapter on the seven sensitivities of effective professional caregivers: sensitivity to the whole person, pain and discomfort, communication, autonomy, needs, cultural differences and treatment goals (Chapter 3). He thoroughly depicts each of these sensitivities, and then describes the specific skills counselors need in order to work effectively with families and individuals impacted by life-threatening illness (Chapter 4). In this chapter, Doka includes a discussion on sensitivity to various age groups, populations and generational cohorts, as life-threatening illness impacts individuals in various phases of the life cycle in vastly different ways. This segment includes information on working with children, adolescents, older adults and individuals with intellectual disabilities. Chapter 5 describes possible responses to life-threatening illness, including physical, cognitive, emotional, behavioral and spiritual responses. Doka outlines the role counselors have in assisting clients with recognizing how they are impacted in each of these areas when responding to the crisis of illness. For counselors who desire to strengthen their understanding of the illness experience, Chapter 6 provides a discussion on the numerous factors that may influence the client’s experience of illness.

Chapters 7–11  recommend ways to effectively work with clients in each phase of illness: “The Prediagnostic Phase: Understanding the Road Before,”  “Counseling Clients Through the Crisis of Diagnosis,”  “Counseling Clients in the Chronic Phase of Illness,”  “Counseling Clients in Recovery,”  and “Counseling Clients in the Terminal Phase.” Doka gives a great deal of attention to assisting the client with expressing his or her feelings and fears, as well as preserving and redefining relationships with family members, friends, and caregivers. Chapter 12 explores ways to counsel families throughout each phase of a life-threatening illness, including how to continue to work with these individuals following the death of their loved one.

Counseling Individuals with Life-Threatening Illness provides a practical guide for counselors who work with clients and families impacted by life-threatening illness. The language and content are appropriate for undergraduate and graduate courses, as well as workshops and trainings for professionals. Doka integrates examples from his own personal work with clients, which makes the application of concepts and theories presented in this book easy to comprehend. Doka also includes an appendix with discussion questions, role-playing scenarios, and case studies that may be used for workshops, trainings, or activities in a classroom setting. As the healthcare system continues to evolve, Counseling Individuals with Life-Threatening Illness is a valuable resource for counselors as they find themselves working on interdisciplinary teams with individuals and families impacted by life-threatening illness.

Doka, K. J. (2014). Counseling individuals with life-threatening illness (2nd ed.). New York, NY: Springer.

Reviewed by: Rebecca G. Cowan, NCC, Eastern Virginia Medical School, Portsmouth, VA.

The Professional Counselor

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Book Review—Clinician’s Guide to Psychological Assessment and Testing

Written in a clear, concise and strategically delineated manner, The Clinician’s Guide to Psychological Assessment and Testing: With Forms and Templates for Effective Practice is written for people seeking a better understanding of various psychological tests and how those tests can inform professional practice. The author of this book, Dr. John Spores, clearly meets his stated purpose, to provide practicing clinical or counseling psychologists with a reference volume to inform their testing practice. I would note, however, that this volume can also help professionals from the fields of counseling, psychology, social work, and other related fields understand more fully how standardized psychological testing can inform their clinical work.

In order to do this, Dr. Spores has divided his book into three parts. The first section reviews the process of psychological assessment and standardized testing. In the introductory chapter, he makes a clear and convincing case for the use of standardized psychological testing as a way to augment and sometimes even surpass clinical interviews. Most helpful is his delineation of how the process of testing should be done and what events need to happen for the process to be done correctly. The author is also an attorney, and this comes out in the straightforward and step-wise manner in which he describes this process.

In the first section, the reader is introduced to one of the most useful aspects of this book. The author has provided numerous forms and templates for each of the processes for psychological testing. It should be noted that the author’s in-text references to the provided forms and templates are extremely helpful. For example, when the author writes about how referral sources make a referral for testing, he provides an excellent example at the end of the chapter of a “Psychological Test Referral Form.” This is consistent throughout the book. When the author references a form or report of some type, he provides an example of that form or report at the end of the chapter. This gives readers a concrete example, something they can immediately reference to understand the ideas and concepts discussed in this guide. This invaluable resource is also available in electronic format on the publisher’s Web site.

The author continues to inform the reader in section two with concrete examples of the standardized tests used in psychological testing. Divided into subsections, the section provides the reader with information about widely known and utilized tests in the following areas: (1) intelligence tests; (2) achievement tests; (3) neuropsychological tests; (4) symptom rating scales; (5) self-report clinical and personality inventories; (6) examiner-administered personality tests; and (7) adaptive behavior tests. To help clinicians even better understand the process of selecting and administering these types of tests, each subsection has four parts: a description of the construct being measured; the diagnostic reasons for conducting such a test; insurance billing and coverage issues; and examples of common tests used to measure the described construct. The author is clear that the example tests he lists are those that he likes to use for measuring a described construct, and he gives compelling reasons why he believes that they are appropriate choices.

In the final section, section three, the author provides specific case examples of children, adolescents and adults for whom standardized tests have served as a means of identifying areas of clinical concerns. These vital case examples demonstrate how the testing process can work to a clinician’s advantage in providing the best care for clients.

The only caveat to this book is that Dr. Spores assumes that the reader is trained in diagnostic interviewing, psychometrics, and administering and scoring the tests presented and discussed in this book. Accordingly, those readers who are not familiar with the common standardized tests presented in this book (e.g., Wechsler tests, Minnesota Multiphasic Personality Inventory, Rorschach) may find themselves at a disadvantage. Dr. Spores does acknowledge his assumption in the Introduction, and those readers who are not familiar with these tests may benefit from some additional reading and training before attempting to utilize this guide.

Overall, this is an excellent guide to the use and administration of psychological tests. It provides straightforward directions and instructions on how to utilize testing in such a way as to better inform clinical practice. I could see this book as a mainstay on any counselor’s bookshelf, especially those who are seeking a way to utilize standardized testing in their practice.

Spores, J. M. (2013). Clinician’s guide to psychological assessment and testing: With forms and templates for effective practice. New York, NY: Springer.

Reviewed by:  Joseph P. Jordan, North Carolina Physicians Health Program and North Carolina Veterinary Health Program, Raleigh, NC.

The Professional Counselor Journal

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