Book Review—Counseling in the Family Law System: A Professional Counselor’s Guide

Dec 2, 2014 | Book Reviews

When most experts in a field state that they “wrote the book” on a topic, it is merely a complimentary figure of speech; however, Dr. Virginia B. Allen has literally written the book on professional counselors working within the legal system. Drawing on more than 20 years of experience as a professional counselor working within the family court system, Dr. Allen has developed a comprehensive review of the field of forensic counseling titled Counseling in the Family Law System: A Professional Counselor’s Guide. At first glance, I thought this book would detail how counselors could collaborate with other professionals working within the legal system to advocate for clients, but that impression was only partially correct. I did not realize that professional counselors could play an integral role within the family court system as advocates for children and evaluators in custody suits, work as mediators between aggrieved parties, and operate as case managers within the judicial system.

In the first part of the guide, Dr. Allen explores the foundations of forensic counseling and the family law system, defining forensic counseling and providing a greater understanding of legal terminology and the various functions that professional counselors can perform in this venue. She works to dispel many myths associated with working in the family law courts, and also highlights the realities of these positions. As with any area of specialization in the counseling field, it is important to understand the scope of practice for such work, and Dr. Allen clearly outlines the types of training needed to prepare for this area of counseling. Likewise, she discusses ethical considerations for the positions of case managers, mediators and custody evaluators. Additionally, she explores the standards of practice outlined by the Association of Family and Conciliation Courts.

The second part of the book focuses on the basics of counseling practice within the field of family law. This section is extremely useful to beginning counselors in this field or to those who might be contemplating a transition to this area of practice, as it provides practical examples of interviewing basics and the forms of report writing required. Continuing to draw on her own expertise, Dr. Allen guides the reader through the process of working a case, as well as understanding and conducting special circumstances cases. She describes how to provide testimony, prepare for a case, professionally present oneself in court, and build professional relationships with lawyers and judges within the system.

The only limitation of this book, if it could be called that, is the fact that there is little published material to which one can compare it. Counseling in the Family Law System is the first book of its kind to guide professional counselors through the family court system and to provide an understanding of how to prepare for and practice within this specialized field. Overall, I came away with a new perspective on the possibilities for practice as a professional counselor. I admit that I was not aware of this specialty area and the degree to which counselors are already prepared to enter this field, possessing the ability to communicate effectively with others from varying age groups and culturally diverse populations, the skill to advocate on behalf of clients of all ages, and the experience to evaluate clients and to appropriately mediate disparate views or competing interests. Based upon her training and extensive experience in the profession, Dr. Allen opens the field of forensic counseling to new practitioners and to established professionals alike, and to the possibilities for expanded practice in the field of professional counseling.

Allen, V. B. (2014). Counseling in the family law system. New York, NY: Springer.

Reviewed by: Michael A. Keim, NCC, University of West Georgia, Carrollton, GA.

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Book Review—Multiculturalism and Diversity in Clinical Supervision: A Competency-Based Approach

Dec 2, 2014 | Book Reviews

Multiculturalism and Diversity in Clinical Supervision: A Competency-Based Approach, the potential for mixing two very complex domains into one complex book is certainly present.

Fortunately, there are portions of this book that break down both multiculturalism and supervision into realistic ideas that can be infused into anyone’s personal counseling or supervision style. Whereas some supervision texts are hyperfocused on steps and actions that must be taken to become a competent supervisor, Multiculturalism and Diversity in Clinical Supervision: A Competency-Based Approach takes a step back, instead invoking a more wide-angle view of the supervision process and how multiculturalism is central throughout it. This comprehensive approach is most readily apparent in Chapter 2, where the authors illustrate supervision and culture as interwoven circles in which the client’s, the counselor’s and the supervisor’s personal and cultural values collide within every interaction. Furthermore, the author breaks down each of these levels using vignettes and examples to show the reader how these different areas connect and collide with one another. While this information does not give a map or guideline of how to conduct supervision, it does invoke further contemplation about how one’s own personal tendencies and others’ backgrounds can affect the supervision process, a topic that is often skimmed over in traditional supervision literature.

While the focus of this book is unique and much needed in the supervision literature base, there are some limitations to how the authors structured the text, the most notable of which is that this book is clearly geared toward psychologists and not counselors. For a new or novice supervisor, this omission may prove problematic, as the basic building blocks of supervision for counselors are absent.

The second critique of this book is the creation of its chapters. Instead of following a traditional outline in which each chapter builds toward the next, further elaborating and clarifying ideas from the previous chapter, this text reads more as a series of disconnected articles that have been compiled into one volume. Therefore, each chapter is self-contained, with its own beginning, middle and end, as well as its own particular writing style. The lack of continuity makes this text a somewhat arduous read at times.

But overall, the macro-level focus of Multiculturalism and Diversity in Clinical Supervision: A Competency-Based Approach is a refreshing outlook on how the personal and cultural qualities of counselor and supervisor intertwine within the supervision process. On one hand, the manner in which this book is written may make it a difficult selection for counselors and counselors-in-training who do not yet have a solid foundation in counseling supervision. On the other hand, counselors and supervisors who are up to date on the current counseling supervision literature may find that the ideas within this book can spark self-reflection on how their own personal qualities and cultural orientation arise in the supervision process.

Reviewed by: Mark P. Eades, NCC, University of North Carolina at Greensboro, Greensboro, NC.

Falender, C. A., Shafranske, E. P., & Falicov, C. J. (Eds.). (2014). Multiculturalism and diversity in clinical supervision: A competency-based approach. Washington, DC: American Psychological Association.

Book Review—Spiritual Competency in Psychotherapy

Dec 2, 2014 | Book Reviews

Philip Brownell starts Spiritual Competency in Psychotherapy with a quote from the Bible, which may put off some non-Christian counselors. However, he issues a disclaimer early in the text that although he brings in excerpts from other religious leanings, he generally discusses what he knows best—Christianity. The book, divided into three parts, has eighteen chapters that describe spirituality and religion according to both older and more recent religious beliefs.

The first part of the book includes the first through the fifth chapters. Brownell delves into spirituality through the lenses of three faiths—Judaism, Christianity and Islam. He journeys with the reader through Eastern philosophies to the New Age movement. Brownell then discusses the similarities and differences between spirituality and religion, and makes it clear that though many apply the two terms interchangeably, clear differences exist. He touches on spirituality and religion from the psychological, philosophical, theoretical and coherentist points of view. He ends the first part of the book by discussing the process of personal spirituality and ethical issues for the various helping professions. Brownell uses the diagram of a strand of DNA to explain spirituality and religion as both a process and a relationship. Using personal anecdotes, he takes the reader through the process of spirituality and religion, and growth in spiritual maturity. Though Brownell does not advocate counselors necessarily sharing their clients’ spiritual and religious practices, he implores counselors to understand how these play a part in clients’ make-up.

In part two of the book, Brownell writes about how spirituality looks in therapy, providing a face for therapy in practice, especially from the Christian perspective. He admonishes counselors to “treat religious experiences as legitimate” (p. 50), but encourages them to question these experiences respectfully enough to know which aspect can be used to help clients. He avers that spirituality is more personal and individual, whereas religion is a communal experience. He provides examples from various religious beliefs to explain these differences to the counselor inclined towards spiritual competency. Much as researchers in multicultural competency in therapy advocate areas for counselor concentration, so Brownell urges counselors to be aware of their own assumptions, biases, behaviors and values, as they recognize how similar and/or different they may be from their clients.

Part three of the book deals with common spiritual issues encountered in therapy. Brownell approaches this part from an existential perspective and establishes that every counselor can grow in spiritual competency to help clients achieve the help they need. The section would have been complete with case studies of counselors applying spiritual competencies with clients from various religious orientations, but Brownell provides additional information. He urges counselors to work especially in the here-and-now with clients and reaffirms what most research on client outcomes indicates as helpful—making connections with clients. Brownell demonstrates how spiritual competency endows counselors with skills necessary to help clients take bold steps and explore uncertain areas in their lives. Finally, Brownell addresses a sensitive topic in religious circles—the abuse of clients by religious leaders. He emphasizes the burden upon counselors in upholding the trust of clients, and also encourages counselors to work with religious leaders to benefit clients. Brownell points out that counselors deal with clients as well as their faith community and what that faith teaches. Counselors are not to act as theologians or evangelists but are encouraged to discover how clients interpret their faith and how this interpretation manifests in therapy. He ends the book with a look at death—that of both clients and their loved ones—and counselors’ role in providing support for clients’ meaning making.

In summary, Brownell’s book advocates for the need to combine ethical codes in any helping professional field with good judgment and knowledge of various religious beliefs. Though many examples are Christian-based, the book is still relevant for both the beginner and expert counselor. It is fashioned in a way that allows the reader to move to any chapter that addresses his or her particular needs. Although Brownell discloses his Christian background early on, he does not approach the subject of spirituality with the emphasis one might have expected from a minister.

Reviewed by: Hannah E. Acquaye, doctoral student in counselor education, University of Central Florida, Orlando, Florida.

Brownell, P. (2015). Spiritual competency in psychotherapy. New York, NY: Springer.

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Effects of School Counselors’ Cognitive Behavioral Consultation on Irrational and Efficacy Beliefs of Elementary School Teachers

Oct 15, 2014 | Article, Volume 3 - Issue 1

Jeffrey M. Warren, Edwin R. Gerler, Jr.

Consultation is an indirect service frequently offered as part of comprehensive school counseling programs. This study explored the efficacy of a specific model of consultation, rational emotive-social behavior consultation (RE-SBC). Elementary school teachers participated in face-to-face and online consultation groups aimed at influencing irrational and efficacy beliefs. A modified posttest, quasi-experimental design was utilized. Findings suggested face-to-face RE-SB consultation is useful in directly promoting positive mental health among teachers and indirectly fostering student success. Implications and recommendations for school counselors are presented.

Keywords: school counseling, irrational beliefs, rational emotive behavior therapy, consultation, efficacy beliefs, cognitive behavioral therapy

 

Professional school counselors are largely responsible for developing and maintaining comprehensive school counseling programs. Comprehensive programming includes collaboration and consultation aimed at supporting teachers and influencing student achievement. The recently released third edition of the ASCA National Model further supports collaboration and consultation to help teachers influence student achievement (ASCA, 2012).  Consultation has been defined by Caplan (1970) as “a process of interactions between two professional persons—the consultant, who is a specialist, and the consultee, who invokes a consultant’s help in regard to a current work problem” (p. 19). More recently, Kampwirth and Powers (2012) noted that engaging in collaborative endeavors during the consultation process fosters egalitarian relationships and often yields the greatest degree of change. School counselors engaging in consultation with teachers from a collaborative perspective are typically successful in advancing educational opportunities and fostering student growth (Baker & Gerler, 2008; Schmidt, 2010; Schmidt, 2014; Sink, 2008).

 

Parsons and Kahn (2005) describe an integrated consultation model in which school counselors are agents of change and students are influenced systemically. In this model, for example, school counselors may provide consultation to a teacher or group of teachers in efforts to identify goals, solutions and resources aimed at meeting the needs of the school. School counselors also may engage in consultation when providing information, instructing or resolving adversities (Purkey, Schmidt, & Novak, 2010; Schmidt, 2010; Schmidt, 2014). Consultation can be conducted using various theoretical paradigms of counseling (see Crothers, Hughes, & Morine, 2008; Henderson, 1987; Jackson & Brown, 1986; Warren, 2010a). Regardless of the process or approach, however, it is important that school counselors consider consultee factors (i.e., training, culture, and emotional and cognitive characteristics) that may hinder or promote the consultation process (Brown, Pryzwansky, & Shulte, 2011).

 

In a review of the literature, Warren (2010b) suggested rational-emotive behavior consultation (REBC) was a viable means for addressing thoughts and emotions of teachers.  REBC is a model of consultation based on rational-emotive behavior therapy (Ellis, 1962). In REBC, school counselors help identify and challenge irrational beliefs that impede teachers’ classroom performance. An irrational belief is considered a strong, unrealistic cognition that leads to self-destructive emotions and behaviors (Dryden, 2009). In a study conducted by Warren and Dowden (2012), relationships between teachers’ irrational beliefs and emotions were confirmed. REBC was effective in addressing irrational beliefs and promoting healthy emotions (Warren, 2010b, 2013a). Teachers who participated in face-to-face and asynchronous, online group consultation across eight weeks reported more flexible and preferential thought patterns as well as decreases in stress.

 

In addition to finding relationships between irrational beliefs and emotions, Warren and Dowden (2012) also noted that irrational beliefs and efficacy beliefs were strongly correlated. Efficacy beliefs are “beliefs in one’s capacity to organize and execute the courses of action required to produce given attainments” (Bandura, 1997, p. 3). Due to emerging research on irrational beliefs and efficacy beliefs, Warren and Baker (2013) explored the potential for school counselors to incorporate components of social cognitive theory (SCT; Bandura, 1986) in REBC. This integrated model of consultation uses converging aspects of SCT and REBT to comprehensively conceptualize cognitions and responses of teachers and students.

 

The present study builds on current literature and research related to school counselor consultation with teachers. Based on the work of Brown and Schulte (1987), Bernard and DiGiuseppe (1994), Warren (2010a, 2010b, 2013a), and Warren and Dowden (2012), rational emotive-social behavior consultation (RE-SBC) was employed in elementary schools via face-to-face and online formats. It was hypothesized that both modes of consultation would reduce the irrational beliefs of teachers. It also was hypothesized that efficacy beliefs would increase as a result of the consultation.

 

Method

 

Participants

Teacher participation was solicited during weekly staff meetings at three elementary schools in the southeastern United States. Information, including a recruitment letter about the study, was provided to prospective subjects during staff meetings. Across the three schools, 42 out of 67 teachers agreed to participate in the consultation; thirty-five teachers completed the study titled, Performance Enhancing Strategies and Techniques-Teachers (PEST-T). Thirty-two (91%)of the participants were female and three (9%) were male. The median years of teaching experience for the participants was between a range of six and fifteen.

 

Consultant

A doctoral candidate in counselor education and supervision provided rational emotive-social behavior consultation (RE-SBC) to both PEST-T treatment groups. The consultant’s work history included school counseling and private practice therapy. The primary theoretical orientation of the consultant was cognitive behavior therapy (CBT). The consultant, and author of this paper, completed primary and advanced practica in Rational Emotive-Cognitive Behavior Therapy at the Albert Ellis Institute in New York.

 

Study Design

A modified posttest, quasi-experimental design was implemented in this study. Participating teachers were grouped according to their school affiliation. The three groups were randomly assigned to one of three treatment conditions (face-to-face, online, or control). All participants completed a pretest. The posttest measures differed from those of the pretest.

 

Measures

The Irrational Beliefs Inventory (IBI), developed by Koopmans, Sanderman, Timmerman, and Emmelkamp (1994), was used in a preliminary analysis of the treatment groups. The IBI is a 50-item self-report measure used to assess irrational beliefs. The IBI was designed in an attempt to focus solely on irrational cognition, while isolating the construct from emotions (Bridges & Sanderman, 2002). The irrational beliefs measured on the IBI are consistent with those described in REBT (Ellis, 1962). A five-point Likert-type scale, ranging from “1” (strongly disagree) to “5” (strongly agree) is provided for respondents to demonstrate a level of agreement for each item. A sample item reads, “If I can’t keep something from happening, I don’t worry about it.” The IBI is scored by summing all item responses. Low scores reflect a tendency to think rationally, while high scores indicate a propensity to think irrationally. The IBI includes five factors: worrying, rigidity, need for approval, problem avoidance, and emotional irresponsibility. The internal consistency of the subscales of the IBI for American samples ranges from .69 (emotional irresponsibility) to .79 (worrying). When evaluated, the IBI was found more reliable and valid than other measures of irrational beliefs (DuPlessis, Moller, & Steel, 2004)

The General Self Efficacy Scale (GSES; Schwarzer & Jerusalem, 1995) is a measure of self-efficacy designed for use with general populations, but can be used as a measure for specific samples as well. Statements include “I can always manage to solve difficult problems if I try hard enough” and “I am confident that I could deal efficiently with unexpected events.” The ten self-report items are rated on a 4-point scale ranging from “1” (not at all true) to “4” (exactly true). Higher scores on the GSES indicate a greater sense of agency, or the capacity to act.  In most samples, the mean score per GSES item was around 2.9. The internal consistency of the GSES is .86. The validity of this measure is well-documented by studies and related literature (Scholz, Dona, Sud, & Schwarzer, 2002).

 

The Teachers’ Irrational Beliefs Scale (TIBS; Bernard, 1990) is used to measure irrational beliefs of teachers; its 22 self-report items are scored on a 5-point scale ranging from 1 (strongly disagree) to 5 (strongly agree). High scores on the TIBS suggest rigidity and irrationality. The irrational beliefs measured are consistent with the theory of REBT and include low frustration tolerance, ‘awfulizing,’ demandingness, and global worth/rating. The TIBS evaluates these irrational beliefs across various teaching-related areas. These areas are represented by four subscales: Self-Downing Attitudes, Low-Frustration Tolerance Attitudes, Attitudes to School Organization, and Authoritarian Attitudes Toward Students. These areas account for 41.5% of the variance, which is similar to other scales of irrationality, thus providing evidence for construct validity (Bora, Bernard, Trip, Decsei-Radu, & Chereji, 2009). Internal consistency for the English version of the TIBS ranges from .70–.85 across the subscales and the total scale score; test-rest reliability is .80.

 

The Teacher Sense of Efficacy Scale (TSES; Tschannen-Moran & Woolfolk Hoy, 2001) is a measure that captures teachers’ perceived efficacy consisting of 24 items rated on a nine-point scale anchored by  “1” (Nothing) to “9” (A Great Deal). The TSES includes three subscales; Efficacy in Student Engagement, Efficacy in Instructional Strategies, and Efficacy in Classroom Management. The mean score for the TSES is 7.1. Higher scores on the TSES and its subscales indicate a greater likelihood for perceived control during the completion of teaching-related tasks. Low scores reflect a poor sense of ability to affect student learning. Reliability estimates for the three sub-scales, Engagement (.87), Instruction (.91), Management (.90), and the total scale (.94) of the TSES are high. Scores on the TSES are positively correlated to scores of other existing validated measures of teacher efficacy providing evidence for construct validity (Tschannen-Moran & Woolfolk Hoy, 2001).

 

Procedure

Participating teachers from one elementary school met face-to-face with the consultant. All participants from another school met asynchronously, online with the consultant. The participants of the remaining school were designated as the control group. The face-to-face group met in weekly seventy-minute consultation sessions, spanning an eight-week period. The online group consultation consisted of five, asynchronous, yet interactive discussion modules, completed across an eight-week period.

 

Both formats of the group consultation (PEST-T) were derived from a consultation model implemented by Warren (2010a, 2013a). Decreases in irrational beliefs were noted as a result of providing face-to-face and online consultation to teachers based on rational emotive behavior therapy (REBT; Ellis, 1962). Warren, (2010a) also found a negative relationship exists between irrational beliefs and efficacy beliefs. As a result of this finding and the extrapolation of theoretical nuances of SCT (Bandura, 1986) and REBT (Ellis, 1962), suggested by Warren (2010a, 2010b), participants in this study received group rational emotive-social behavioral consultation (RE-SBC).

 

During the first consultation session, the face-to-face group was presented with concepts including observational learning, efficacy and reciprocal determinism. Irrational beliefs, emotions, self-defeating behaviors and other principles of REBT were explored throughout the remaining group consultation sessions. Cognitive, emotive, and behavioral strategies and techniques for increasing rational thought and efficacy beliefs were provided and demonstrated throughout the consultation (see Ellis & MacLaren, 2005). Case examples and analogies focused on teaching and classroom situations were used to explain the information presented. Interactive discussions, songs, humor and participation in demonstrations were encouraged throughout the consultation.

 

Throughout the asynchronous, online group consultation, the consultant provided the participants with select, layperson-oriented articles on REBT and SCT. During each session, participants were asked to read articles provided via the discussion module. The discussion modules focused on ways to increase self-efficacy, the ABC model, benefits of living rationally, and how to dispute irrational beliefs. Participants were responsible for commenting on the readings and responding to other participants’ comments. The consultant moderated the discussion modules. Participants could access and complete the discussion modules at their convenience due to the asynchronous format of the group consultation. Participants were required to dedicate approximately 1.25 hours a week to the group consultation, completing the online discussion modules and applying concepts discussed to daily living. At the conclusion of the study, members of the control group received copies of the articles used during online consultation.

 

Results

 

Preliminary Analysis

Univariate analyses of variance (ANOVAs) were conducted on scores of the IBI and the GSES compiled from both treatment conditions and the control group. No significant differences were found among the three conditions in terms of irrational beliefs, F(2, 39) = .37, p > .05. Pre-test equivalency also was noted for efficacy beliefs for all conditions F(2, 39) = .48, p > .05. In summation, irrational beliefs and efficacy beliefs held by elementary school teachers in this study were comparable across all groups.

 

Treatment Efficacy

Means and standard deviations for the face-to-face, on-line and control groups are presented in Table 1. Teachers who received the treatments were expected to respond by maintaining fewer irrational beliefs than the control group. Analysis revealed statistical significance for teachers’ irrational beliefs, F(2, 33) = 8.80, p < .001, which accounted for approximately 35% of the variance among the three groups. Post hoc analyses using Tukey HSD criterion for significance indicated the average level of irrational beliefs was significantly lower in the face-to-face treatment (M = 49.33, SD = 15.57), when compared to the control group (M = 65.95, SD = 9.66). Contrary to the hypothesis, the effect of the on-line treatment on teachers’ irrational beliefs (M = 74.2, SD = 13.41) was not statistically different from the control group.

 

Table 1

 

Means and Standard Deviations of Pre-Intervention Measures

 

Further analyses on the items from the subscales of the TIBS provided additional insight into the effects of the treatments on specific irrational beliefs. Analysis of the three groups indicated statistical significance for self-downing attitudes (SDA), F(2, 35) = 5.97, p = .006. Post hoc comparisons indicated the mean for the face-to-face group (M = 16.89, SD = 4.57) statistically differed from the control group (M = 22.95, SD = 4.49) in terms of SDA. An omnibus ANOVA indicated that means for low frustration tolerance attitudes (LFTA) were not significantly different across groups, although a slight trend toward significance was present, F(2, 33) = 3.13, p = .057. Another analysis indicated statistical significance across groups for attitudes of school organization (ASO), F(2, 33) = 4.78, p =. 015. However, criterion for significance in a Tukey HSD analysis was not met when comparing the mean of the control group (M = 16.95, SD = 2.36) with the mean of either treatment, face-to-face (M = 13.89, SD = 5.95) or online (M = 20.0, SD = 2.74). Group means for authoritarian attitudes toward students (AATS) also were found to be statistically significant when an ANOVA was conducted, F(2, 33) = 6.35, p = .004. Post hoc comparisons using the Tukey HSD analysis indicated the mean scores of the face-to-face treatment (M = 10.78, SD = 3.67) were significantly different from the control group (M = 15.43, SD = 4.07). However, the effect of the online treatment on AATS (M = 17.4, SD = 2.61) was not statistically different from the control group. The effects of the treatments on the participants’ irrational thoughts are presented in Table 2.

 

Table 2

 

Means, Standard Deviations, and Group Comparisons on Measures of Teachers’ Specific and General Irrational Beliefs at Posttest

 

It also was expected that participants receiving the treatments would report higher levels of efficacy than the control group. Results indicated no statistical significance across groups in terms of teacher sense of efficacy (TSE), F(2, 33) = 1.56, p = .225. Additional analyses were conducted on the subscales of the TSES. Analyses measuring the group differences in terms of efficacy in instructional strategies (EIS), F(2, 33) = .29, p = .752, and efficacy in classroom management (ECM), F(2, 33) = .38, p = .685, yielded no significant difference. A statistically significant difference was found on efficacy in student engagement (ESE) when the three groups were compared, F(2, 33) = 4.52, p = .018, accounting for 22% of the variance. A post hoc comparison indicated the mean of the face-to-face treatment (M = 7.03, SD = .74) was not significant in terms of ESE when compared to the control group (M = 7.09, SD = .77). However, the mean of the online group (M = 5.94, SD = .87) was significantly less than the mean of the control group. The effects of the treatments on the participants’ irrational thoughts are presented in Table 3.

 

Table 3

 

Means, Standard Deviations, and Group Comparisons on Measure of Specific and General Teacher Efficacy at Posttest

 

Discussion

 

The findings of this study contribute to the literature on consultation as an indirect, responsive service school counselors can incorporate in comprehensive programs. In this study, teachers participating in the face-to-face RE-SBC group reported fewer irrational beliefs as compared to the control group. While low frustration tolerance attitudes (LFTA) and attitudes of school organization (ASO) were not statistically different, participants reported significant differences in irrational beliefs related to self-downing attitudes (SDA) and authoritarian attitudes toward students (AATS). The face-to-face RE-SB consultation appeared successful; however, the online consultation was not found to be effective in decreasing teachers’ irrational beliefs. Inconsistent with expectation, the online group consultation appeared to increase irrational beliefs experienced by participants. Therefore, the hypothesis that both modes of consultation would reduce the irrational beliefs of teachers was partially supported.

 

The apparent impact of the face-to-face RE-SB group consultation on teachers’ irrational beliefs is consistent with previous studies exploring face-to-face REBT group consultation (see Forman & Forman, 1980; Warren, 2010b, 2013a). In each of these studies, group consultation was found to reduce irrational beliefs and promote positive mental health among teachers. In this study, the influence of RE-SB on specific teacher beliefs is particularly noteworthy, given the negative impact of self-downing and authoritarian teaching styles on student success (see Bernard & DiGiuseppe, 1994; Phelan, 2005).

 

RE-SB face-to-face group consultation did not appear to influence teacher efficacy beliefs. Efficacy beliefs remained relatively unchanged for this consultation group, as compared to the control group. This finding is important to note when considering concurrent lack of change in LFTA among face-to-face group consultation participants. In an explanation of school counselors’ use of cognitive behavioral consultation, Warren and Baker (2013) posited that teacher efficacy beliefs and low frustration tolerance beliefs converge. Teachers with low self-efficacy for engaging students, for example, essentially think student engagement is “too hard” or “unbearable,” signature thoughts of low frustration tolerance. Warren and Dowden (2012) supported this claim in a study exploring the relationships between irrational beliefs and efficacy beliefs of teachers. In short, since low frustration tolerance beliefs were not impacted by the consultation, a lack of change in efficacy beliefs is expected. The findings of this study may further support the relationship between these constructs. However, an alternative explanation for the lack of change in efficacy beliefs and LFTA of teachers participating in the face-to-face group consultation may lie with the presentation of the consultation. It is plausible that the delivery of the consultation, related to these constructs, was slightly flawed. Positive relationships have been noted between teacher efficacy and student achievement (Goddard, Hoy, & Woolfolk Hoy, 2004; Henson, 2001; Pintrich & Schunk, 1996; Ross, 1998). More emphasis on low frustration tolerance and teacher efficacy beliefs may be needed in this consultation model if a goal for school counselors is to indirectly impact student achievement.

 

Regarding the online group consultation, decreases in efficacy beliefs were found among these participants. The difference in efficacy in student engagement (ESE) was significant for participants in this group as compared to the control group. On-line consultation participants reported decreases in efficacy beliefs. This finding was contrary to the hypotheses that the consultation groups would increase teachers’ efficacy beliefs. Because neither consultation group was deemed to significantly increase efficacy beliefs of teachers, this hypothesis was not supported.

 

Implications and Recommendations for School Counselor

This study offers promise for school counselors eager to implement responsive services that have the potential to support teachers and effect systemic change. The study is consistent with current literature on school counseling practices suggesting the value of multilevel, responsive interventions that support teachers and students (see ASCA, 2012; Erford, 2011; Lee & Goodnough, 2011). Maximizing the success of students is a crucial role of professional school counselors (Dahir & Stone, 2012; Lapan, Gysbers, & Kayson, 2007). School counselors providing group consultation to teachers systemically influence student success (Parsons & Kahn, 2005). This consultation model, in its face-to-face format, has the potential to offer multilevel support, directly promoting positive mental health of teachers and indirectly influencing the success of students and parents. Teachers who think in rational ways will respond more favorably during encounters with students and parents, thus enhancing the relationship and the potential for educational success.

 

The findings of this study offer several implications for school counselors. First, school counselors should embrace the consultative role in their comprehensive school counseling programs. This includes intentional demonstrations of leadership, advocacy and collaboration. School counselors must play a leadership role when assessing and conceptualizing the social-emotional needs of teachers and students. Preparing, establishing and implementing systemic services such as group consultation also require leadership (Schmidt, 2014). School counselors providing consultation must possess adequate knowledge of school and classroom settings and how these environments interact with the social-emotional wellness of teachers and students. Advocacy for the success of teachers and students is inherently demonstrated by the leadership displayed when implementing responsive services such as consultation. School counselors should diligently and methodically find productive ways to advocate for students when engaging in RE-SB group consultation with teachers. As suggested by Kampwirth and Powers (2012), school counselors will find consultation with teachers is most effective when a collaborative approach is taken. Collaborating and teaming encourages teachers to be proactive and invest in the goals of the consultation efforts. School counselors can support teachers and students through consultation most readily, and ultimately effect systemic change when demonstrating these necessary roles of comprehensive services.

 

Next, school counselors will need to have a basic understanding of recent research and assessment procedures in order to determine the overall social-emotional health in their schools. By understanding the social-emotional climate, school counselors can tailor consultation efforts to meet individual and group needs of teachers and students. Based on recent research (Nucci, 2002; Pirtle & Perez, 2003) and data collection at the school level, school counselors may want to target beginning teachers, for example, for participation in RE-SBC. There are several models and approaches of RE-SBC that school counselors can use depending on the needs of the school (Warren & Baker, 2013).

 

Finally, school counselors must be knowledgeable of and understand how cognitive behavioral theory, specifically REBT, can be applied to the school setting. Some of the core tenets of REBT appear to debunk the typical mindset of teachers and school counselors. For example, teachers usually think that “students should listen and follow directions” or “parents should help their children with homework.” However, these thoughts are desirable, but not mandatory as the word “should” implies. Therefore, teachers may be skeptical, experience cognitive dissonance, or simply reject the content of the trainings altogether. School counselors will need to navigate theoretical concerns carefully, accepting teachers’ positions, yet providing clear alternative perspectives. While advanced training in REBT-CBT may not be required, it is vital that school counselors prepare and equip themselves appropriately for conducting group consultation (Warren, 2013b). Failure to adequately prepare will likely impact the effectiveness of the consultation.

 

Limitations and Future Research

The current study was limited in several ways. First, based on school affiliation, participants were grouped in either a control, face-to-face or online group. This cluster, convenience sampling may have led to non-equivalent groups. Preliminary analyses were conducted to control for this threat and to determine the level of homogeneity across groups. A two-stage random sample also may have been useful in ensuring randomness and equivalent groups (Ross, 2009).

Second, history is typically a threat to the validity of a study when the design includes only one group (Heppner, Kivlighan, & Wampold, 2008). Aspects of this study may be influenced by history, despite a three-group experimental design. Levels of stress for each group potentially increased toward the conclusion of the consultation due to upcoming end-of-grade testing. If this occurred, the posttest responses may have reflected the influence of the upcoming event, thus negating the true effects of the consultation. It also is important to note other factors that may have influenced the outcomes of this study, such as socio-cultural factors, the mean age of staff members, and the “culture” or “personality” each school assumes as a result of administrative leadership.

 

Next, experimenter expectancies may have influenced the responses of the participants beyond the effects of the consultation. If this occurred, the scores of the measures may be elevated, implying the training was more effective than it actually was. While the face-to-face group was most vulnerable to this threat due to the format of the consultation, differential attrition (44%) may have influenced the findings of the online group consultation.

 

Finally, all types of irrational beliefs were decreased, to some degree, for participants of the face-to-face consultation group. Teacher efficacy beliefs were not influenced and remained consistent with mean scores proposed by Tschannen-Moran and Woolfolk Hoy (2001). Due to the size of the sample of the face-to-face group, Type II errors may exist for LFTA and ASO and teacher efficacy beliefs. A significant difference may have existed, although not detected because of the limited number of participants.

 

Moving forward, this study may lead researchers in several directions. For example, conducting classroom observations or interviews of teachers post-consultation would provide insight into the lasting effects of the training. Ellis (2005) and Dryden (2009) have emphasized that cognitive change occurs most readily when individuals continue to challenge irrational beliefs and practice rational thinking. Replicating this study, while exploring the influence of the addition of homework assignments on irrational beliefs and efficacy beliefs of teachers, would also offer additional insight into the amount of practice required for cognitive change.  Additionally, conducting a six-month follow-up may help answer questions related to level of teacher engagement, consultation duration and degree of support needed for teachers to maintain cognitive-behavioral change.

 

As advancements in technology occur, a redesigned online group RE-SBC model may be warranted. School counselor researchers should explore additional ways to design online RE-SBC models that are supportive and accommodating of teachers. For example, the inclusion of synchronous sessions within an asynchronous online design is worth exploring. Researchers also may want to explore synchronous, online models of consultation using technology such as webinars or three-dimensional, virtual worlds. YouTube, in particular, seems to be a useful online tool for improving online offerings for school counselors and teachers. The Halo Rational Emotive Therapy (2011) video, for example, shows the creative possibilities offered by YouTube. Apps for cell phones and tablet computing devices offer seemingly endless possibilities for convenient, online consultation and collaboration strategies for school counselors. Additionally, a modification of the face-to-face consultation to include online components may be a viable option and worth studying.

 

Advancements in the preparation of school counselors also may influence and increase the effectiveness of school counselors’ use of technology for RE-SBC. Counselor education programs need to challenge and support graduate students in creative and inventive applications of technology in the practice of school counseling. Gerler’s (1995) early challenge for school counselors to explore the edges of technology, and then later challenges by Hayden, Poynton, and Sabella (2008) for using technology to apply the ASCA National Model offer hope that the preparation of school counselors will improve online and other technological strategies in school counseling, including the use of technology for RE-SB consultation.

 

School counselor researchers also may want to explore the effects of RE-SB group consultation on various critical school issues. RE-SB group consultation may impact factors that influence student success, including academic achievement, bullying, disciplinary problems, motivation and teacher burnout. Warren and Stewart (2012) also suggested cognitive behavioral approaches to school counselor-teacher consultation may be effective in reducing student dropout rates. Research in these areas will be invaluable as school counselors continue to refine their roles as consultants.

 

In conclusion, the findings of this study provide direction for school counselors providing consultation. Cognitive behavioral consultation, such as the RE-SBC face-to-face group approach, appears to influence the irrational beliefs of elementary school teachers. Specifically, decreases in self-downing attitudes and authoritarian attitudes toward students were noted. While teacher efficacy beliefs, a predictor of student achievement, were not found, the decrease in irrational beliefs alone is important and potentially a factor in promoting student success. The online group RE-SBC effort was largely ineffective in reducing irrational beliefs or increasing efficacy beliefs. The online model of consultation should be carefully considered before implementation and deemed useless pending a significant redesign. However, both formats of RE-SBC demonstrate leadership, advocacy for the well-being of teachers and students, and collaboration among stakeholders— qualities mandatory for school counselors wishing to effect systemic change. It is hoped that this study will encourage school counselors to become familiar with and implement models of consultation that promote positive mental health of teachers and have the potential to support the educational success of students and parents.

 

 

 

 

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Jeffrey M. Warren, NCC, is an Assistant Professor at the University of North Carolina at Pembroke. Edwin R. Gerler, Jr. is a Professor at North Carolina State University. Correspondence can be addressed to Jeffrey M. Warren, UNC-Pembroke School of Education, PO Box 1510, Pembroke, NC 28372, jeffrey.warren@uncp.edu.

 

Counselors’ Understanding of Process Addiction: A Blind Spot in the Counseling Field

Oct 15, 2014 | Article, Volume 3 - Issue 1

Angie D. Wilson, Pennie Johnson

The addictions field continues to grow and is expanding beyond the area of substance abuse and substance dependence. Process addictions are now an integral aspect of addictions treatment, diagnosis, and assessment. There is a gap in the literature related to process addictions which impacts counselors and clients due to lack of literature and knowledge on this new area. It also is hypothesized that there is a gap in continued education for incorporating treatment and assessment measure into clinical practice. This initial study was conducted to initiate an understanding of levels of knowledge counselors have in diagnosing, assessing and treating clients suffering with process addictions, indicators of where and how they learned about process addictions, and how they integrate their level of the treatment of process addictions into clinical practice. The authors provide a brief overview of process addictions, a summary of original research, implications of this study, discussion, and recommendations for future research.

Keywords: process addictions, counseling, addiction disorders, compulsive behaviors, behavioral addictions

 

It is important for counselors and mental health professionals to stay current with information impacting their profession. Staying abreast of new ideas and new information can assist in providing successful and holistic treatment for clients (ACA, 2005). Specifically, the field of addictions has had many transformations over the last few decades. One of the most recent issues impacting the addictions area in counseling is process addictions (PAs) (Grant, Potenza, Weinstein, & Gorelick, 2010; Holden, 2001; Martin & Petry, 2005). For many years, mental health professionals have treated clients with systematic behaviors mimicking the disease of addiction, but many find they haven’t received adequate training in this area to be competent. The terminology of PA sweeps a wide variety of behavioral addictions or compulsive behaviors.  PA is defined as any compulsive-like behavior that interferes with normal living and causes significant negative consequences in the person’s family, work and social life. Gambling, Internet addiction, sex addiction, exercise addiction and eating addictions are among those identified as PA (Sussman, Lisha, & Griffiths, 2011).

 

The neurological changes in the brains of people who engaged in gambling, binge eating, and compulsive sex were similar to those brains of persons who abused substances such as alcohol and marijuana. Treatment observations and prevalence data, coupled with a growing body of literature, suggest the existence of PAs (Smith & Seymour, 2004), also called compulsive behaviors (Inaba & Cohen, 2011) and behavioral addictions (Grant et al., 2010). PAs may be new to some; however, PAs represent neither a new phenomenon nor new disorders. In actuality, PAs have been an area of concern in the addictions field for many years (Grant et al., 2010; Holden, 2001; Martin & Petry, 2005).

 

There is little evidence that this evolving research on PAs is being translated to those providing services to clients. Due to the gap in the literature related to PAs and the knowledge of counselors, students, and counselor educators related to PA, the International Association for Addictions and Offender Counseling (IAAOC) Process Addictions Committee (a division and committee of the American Counseling Association) conducted a survey of students, post-graduate counselors, and counselor educators with the purpose of understanding the deficiencies clinicians are struggling with in understanding process addiction.  The purpose of this article is to provide the results of a survey, which indicated the percentage of post-graduate counselors/clinicians in the study and their understanding of PAs. The information in this manuscript will specifically address the knowledge of counselors who are actively engaged in providing treatment services in community settings.

 

Review of Relevant Literature

The most recent definition of addiction was the product of research studies, which took place over four years and included over 80 experts from across the country. These research studies were spearheaded by The American Society of Addiction Medicine (ASAM). According to ASAM (2012) an addiction is not merely a behavioral problem involving the consumption or intake of substances, gambling, or sex; an addiction is a chronic brain disorder. Another definition of addiction is the behavior that occurs with continued substance use or involvement in a PA regardless of the negative impact it has on the participant’s life (Shallcross, 2011). What follows is a brief overview of several PAs that have been researched and are referenced in the Diagnostic and Statistical Manual (4th ed., text rev.; DSM–IV–TR; American Psychiatric Association [APA], 2000), and the new DSM-5 (APA, 2012a).

 

The diagnostic criteria of the various PAs are similar to those of substance addictions. Due to these negative consequences, PAs continue to disrupt the lives of significant proportions of the U.S. adult population (Sussman et al., 2011). Based upon a literature review of 83 studies, Sussman et al. (2011) estimated prevalence rates for gambling addiction (2%), Internet addiction (2%), sex addiction (3%), exercise addiction (2%), and eating addiction (2%) among the general American population. The growing concern regarding PAs may be due to the increased co-morbidity with mental health concerns and substance addictions (Sussman et al., 2011). Substance abuse co-morbidity rates for gambling addiction were approximated at 20-30%, Internet addiction 10%, love and sex addictions 40%, exercise addiction 15%, and eating addiction 25% (Sussman et al., 2011). According to Carnes (2009) most addicts have more than one addiction, sustained recovery is more successful when all addictions present are addressed in counseling, and addictions do not merely coexist, but actually interact with each other.

 

The term disorder is often used interchangeably with the term addiction. For example, one of the most widely known and recognizable PA is gambling disorder, which is also called gambling addiction and pathological gambling (Ashley & Boehlke, 2012; Jamieson, Mazmanian, Penney, Black, & Nguyen, 2011). It is believed that gambling disorder will be categorized under Addiction and Related Disorders in the DSM-5 (APA, 2012b), as the diagnosing criteria closely resemble substance use disorder. In order for one to be diagnosed with gambling disorder, the gambling behavior must disrupt the personal or work life of the affected person and cannot be related to a manic episode (APA, 2000). According to Crozier and Sligar (2010), some indicators that one’s social gambling is shifting into a PA include lifestyle changes to accommodate gambling-related activities, extreme mood fluctuations related to gambling, justifications for continued gambling, perceptible excitement when discussing gambling, as well as financial indicators such as hiding debt and frequently borrowing money.

 

Food addiction, eating addiction, and compulsive eating also are referenced as Binge Eating Disorder (BED) and is another of the PAs that may be revised in the DSM-5, from the category of Other Conditions (APA, 2000) to Feeding and Eating Disorders (APA, 2012c; Wonderlich, Gordon, Mitchell, Crosby, & Engel, 2009). Frequent episodes of uninhibited food consumption beyond the point of fullness, without being followed by purging behaviors (e.g., vomiting or the use of laxatives), are characteristics of BED. According to Karim and Chaudhri (2012), individuals with BED will typically eat without feeling hungry, spend excessive amounts of time thinking about and obtaining food, and may attempt to hide their eating from others. Although some people with BED may be obese or overweight, BED is distinct from other eating disorders, as individuals with this condition are mentally and emotionally different from individuals who are obese or overweight (Wonderlich et al., 2009).

 

The term exercise addiction was first introduced by Glasser (1976), who studied long-distance runners and found out that most of them had an obsessive-compulsive disorder. Exercise addiction, or sports addiction, is a phenomenon typically found in athletes (McNamara & McCabe, 2012). Exercise addiction has been a growing concern for the counseling field for a number of years (Parastatidou, Doganis, Theodorakis, & Vlachopoulos, 2012). Exercise dependence, obligatory exercise, compulsive exercise, and excessive exercise are other names for exercise addiction or sports addiction (Parastatidou et al., 2012). Training interferes with daily life and is diagnosed with criteria similar to those of substance abuse disorders as well as other PAs.

 

Another widely recognized addiction is Internet addiction, also called Internet Use Disorder (APA, 2012d), which is not found in the DSM-IV, but is being considered for inclusion in the DSM-5 (APA, 2012d; Ko, Yen, Yen, Chen, & Chen, 2012). The criteria used to define this addiction closely match the criteria for substance dependence. For example, the use of the Internet becomes a preoccupation or begins to monopolize the individual’s time, there is an increased need to obtain positive feelings, social relationships are negatively affected by Internet usage, and a person returns to maladaptive Internet use after a period of abstinence (Smahel, Brown, & Blinka, 2012).

 

According to Karim and Chaudhri (2012), a disproportionate amount of time spent on planning for and participating in sexual activity, participating in sexual activity to alter one’s mood or as a way to handle stress, inability to control sexual compulsions and sexual fantasies, and engaging in unsafe sexual activity can be called hypersexual disorder (APA, 2012e). Hypersexual disorder (APA, 2012e) also is called sex addiction and compulsive sex. Shifts in emotions and values; compulsive masturbation; inappropriate jokes, personal boundaries, and touching; boasting about sexual conquests; and unplanned sexual encounters are indicators of compulsive sex (Crozier & Sligar, 2010).

 

Training of Counselors on Process Addictions

 

The US Department of Health and Human Services, TAP 21 (HHS, 2006) recommends that all counselors should be competent in “understanding of addiction, treatment knowledge, application to practice, and professional readiness” (p. 5). Although this is recommended, it is often difficult for counselors to locate educational training and research related to PAs due to the limited available information. Although licensed counselors graduate from master’s- and doctorate-level universities in counseling programs, researchers (Crozier & Agius, 2012) indicate many counselor educators are not adequately equipped with recent knowledge regarding PAs and, therefore, academic organizations are not properly educating future counselors in this area. Of course, some information regarding addictions is infused into the coursework in most graduate programs, but counselors with specific interest in addictions must seek additional training and education through outside sources such as continuing education and specified certification programs. Ultimately, it is the responsibility of licensed counselors to stay abreast with clinical training and new areas related to treatment, assessment and diagnosis of maladaptive disorders. However, there are concerns regarding the accessibility of training and professional growth seminars on PAs, as many counselor educators who are the primary researchers in the counseling field are not aware of this growing area of PAs (Crozier & Agius, 2012), and many counseling students are not being taught about PAs in their counselor training programs (Nelson, Wilson, & Holman, n.d.). This creates a problem for the counseling profession in that there is continued need for training and research in this area. “The development of effective practice in addiction counseling depends on the presence of attitudes reflecting openness to alternative approaches, appreciation of diversity, and willingness to change” (HHS, 2005, p.5).

 

Methodology

 

This pilot study has helped provide structure for a national study being conducted by the IAAOC. An online survey was constructed by members of the IAAOC Committee on PAs who are all active professionals in the field. They followed methodological research guidelines (Dillman, Smyth, & Christian, 2009) to design a valid, mixed-methods design (Onwuegbuzie & Johnson, 2006) comprised of open-ended and closed-ended research questions. Upon approval from the Institutional Review Boards, counselors in NC and TX received an email requesting their participation in this initial study. The survey, statement of anonymity and confidentiality, as well as the informed consent was posted in Zip Survey and participants were prompted to review this information before proceeding with the study. The data also was collected and analyzed within the Zip Survey program. Potential participants later received two separate reminder emails prior to the survey’s closing date asking them to participate in the study.

 

 

Participants

The participants were solicited by the investigators through professional listservs, websites of professional organizations, personal communication with counseling professionals and word of mouth. Participants were asked to address the online survey, read the informed consent and begin the survey. Calculating the response rate for the survey was not possible because it was not possible to determine how many counselors actually received the survey. It also is important to note that counselors may have chosen to describe themselves as counselor educators, if they were both counselors and counselor educators. In this case, those counselors’ responses would have been included in the data for counselor educators and not counselors.

 

The total sample for our study included 37 counselors who were post-graduate clinicians/counselors. The counselors who participated in the study included the following: 59% with a master’s degree in community counseling/mental health counseling, 8 % with a master’s degree in a counseling-related field with a certificate in addiction, 3% with an educational specialist degree in a counseling-related field, and 22% with a doctorate in a counseling-related field. Fifty-eight percent graduated from CACREP-accredited programs with 2009 standards and 3% from CACREP-accredited programs with 2013 standards. Thirty percent graduated from a regionally accredited program that was not CACREP-accredited, and 9% graduated from an academic setting that was not regionally accredited or CACREP-accredited. It must be noted that five participants omitted the question regarding accreditation of their most recent counselor education program.

 

Instrument

A survey was developed to obtain counselors’ opinions and experiences with assessing, diagnosing and treating PAs. The survey questions were based on a thorough review of the literature and were relevant to the participants’ knowledge of PAs and their experiences as clinicians. The survey questions were developed in accordance to current survey methodological research guidelines (Dillman et al., 2009), and then the questions were sent to all members of the IAAOC Process Addictions Committee to asses for content validity. Finally, they were revised based on the members’ feedback. The survey included both closed- and open-ended questions and was designed to be completed in 10–15 minutes.

 

A grand tour question is a type of descriptive inquiry that provides information on an experience or phenomenon. According to Spradley (1979), using grand tour questions constitutes an emergent quality of the interview process that results in subsequent questions. One grand tour question was used: “What are your thoughts or feelings about working with clients who present with PA?” In addition to the grand tour question, descriptive survey questions and open-ended text boxes were provided for participants to elaborate on their responses.

 

Data Collection and Analysis

Zip Survey was used to post the surveys and collect responses as well as to analyze the demographic and quantitative data. Participants received an email with a link to the survey requesting their participation. Upon opening the link, participants read the informed consent and agreed that they understood the nature of the study by continuing with the survey questions. Participants were assured in the informed consent that their responses were anonymous and confidential.

 

The survey program collected the responses and aggregated them into charts and Excel files. The quantitative results are descriptive data and are reported as such in the results section. Participants also had the opportunity to utilize text boxes within the survey in order to give a rich description of their experiences. The qualitative data obtained from participants who shared their ideas and experiences through the text boxes embedded in the survey also were utilized as data in this study. According to Moustakas (1994), data must be in written form in order to organize qualitative research; the qualitative data was in written form for this study as the Zip Survey collected the written words of participants via typed text. Organizing the text responses and following Moustakas’s (1994) seven steps adapted from Van Kaam’s (1959, 1966) interview analysis process were key steps during the data organization phase of the study. Additionally, both quantitative and qualitative data were compared with one another to achieve triangulation (Onwuegbuzie & Johnson, 2006).

 

Results

 

The total sample for this study included 37 counselors. They provided information on their training and clinical experiences related directly to the assessment, diagnosis and treatment of clients with PAs. Specifically, the participants responded to questions regarding their comfort levels working with PAs and assessing, diagnosing, and treating nine different forms of PAs. Approximately 89% of the respondents indicated that learning about PA was very important for clinicians, while 6% noted that it was important and 6% indicated learning about PA was a neutral issue. Less than 13% of the participants understood that PA included compulsive behaviors such as eating disorders, exercise, Internet, gaming, gambling, relationships, sex, work addiction and compulsive spending. Sixty-four percent of the counselors surveyed acknowledged they treated clients with PAs, but where lacking the training to assess and screen for addictions.

 

Regarding comfort level in assessing, diagnosing and treating PAs, 25% of respondents reported feeling very comfortable, 42% reported feeling comfortable, 22% reported feeling ambivalent, 6% reported not feeling comfortable, and 6% selected not applicable. Counselors reported being trained to assess, diagnose and treat eating disorders more than the other PAs listed on the survey. Eating disorders, relationships and sex were the three PAs that counselors reported having the most learning experiences. Approximately 24% of the respondents had been trained to assess and screen for eating disorders. However, 36% of the participants were trained to diagnose eating disorders and only 19% had been trained to treat eating disorders. From the responses of the participants in this pilot study, it can be gathered that counselors are treating PAs without adequate training and continued education.

 

On average, a third of the participants had been trained to diagnose eating disorders, but most had little to no training in diagnosing the various other forms of PA. Yet, they knowingly are treating clients with addictions. With this admittance, the 89% of counselors who participated in the survey identified the importance of training counselors to assess, screen, diagnose and treat PAs, and 94% expressed interest in taking a process addictions seminar or course. Regarding theoretical orientation, 69% of the participants identified as cognitive behavioral, 8 % as humanistic, and 6% as psychodynamic.

 

Participants also were given the opportunity to provide qualitative responses to some questions. Overall, participants shared that they believed learning about PAs was important. Many were not prepared to provide treatment for clients with PAs, and many were not trained to adequately provide therapeutic services for clients with PAs. One participant stated, “I have never considered the term process addiction, and I could easily see myself changing that answer upon further thought and education. I find the ignorance in the counseling world regarding process addictions terrifying.” Another wrote, “I think graduate programs are very deficient in chemical and behavioral education/training. I was never taught anything in graduate school about addictions.” Overall, the majority of participants expressed their opinions about the importance of continued education and knowledge of PAs, shared that they had not been educated on PAs, or shared that their education on addictions was mainly focused on substance abuse treatment.

 

Discussion

 

“Counselors practice only within the boundaries of their competence, based on their education, training, supervised experience, state and national professional credentials, and appropriate professional experience” (ACA, 2005, p. 9) is an integral aspect of the counseling profession. By adhering to this section of the ACA Code of Ethics (ACA, 2005), all licensed professionals vow to accept responsibility to ‘do no harm’ to the physical, mental and emotional well-being of self, clients, and associates. Although most counselors intend to do no harm and strictly follow ethical guidelines, it is important to understand that by not providing comprehensive treatment for all addictive or problematic behaviors, some counselors may be unintentionally harming clients. Moreover, when the counselors’ only focus for treatment is the first behavior presented by the client, there is a danger of overlooking co-addictions. “Once the initial neural pathway is laid down, other addictions become overlays using some of the same circuitry” (Carnes, 2009, p.13). These co-addictions are often referred to as addiction interactions. Unfortunately, many factors of co-addictions can be found in PAs, which are often compounded by nature such as eating, sex and exercise, making the need or craving acceptable in society.

 

PA can be defined as any compulsive-like behavior that interferes with normal living and causes significant negative consequences, and the physiological responses in the brain are similar to chemical dependency (Grant, 2008). As aforementioned, the difficulties in recognizing PAs lie within the realm of society. For example, many of the associated behaviors are socially accepted, such as sex, spending, eating and work, all of which are an intricate part of our hierarchy of basic human needs. When assessing and diagnosing addictions, the focus is typically drug and alcohol dependency behaviors; however, PAs may mimic some of the same characteristics. Such characteristics include loss of control, compulsive behaviors, efforts to stop the compulsive behavior, loss of time, preoccupation, inability to fulfill obligations, continuation of the behavior despite the consequences, withdrawal, escalation and losses (Carnes, 2010). Other potential problems are often experienced by clients who have not been treated for all addictions and problem behaviors. Some of these include personal neglect, compulsive Internet use, isolation and avoidance of people, lost productivity, depression, dissociative states, marital and relationships problems, increased sexual risk behaviors, gambling, and academic failure.

 

Recommendations and Future Research

 

The addictions field is emerging with various types of disorders, and counselors are finding themselves to be overwhelmed and incompetent in handling the increasing demands for diagnosis, assessment and treatment of addictions in general and specifically PAs. Although counselors are expected to obtain continuing education to keep abreast of the evolution of counseling in the field, clinicians who participated in this study indicated that they were overall ill-prepared to work with clients who are living with PAs. First, it is recommended that counselor education programs implement courses that include properly assessing, diagnosing and treating PAs.

 

Second, it is important to reiterate that counselors make a professional vow to practice within their scope and to make referrals for services they are not capable of providing. Based on the information provided by participants in this pilot study, counselors who have no training with treating PAs are not making referrals for their clients, and are making the conscious efforts to continue working with clients who are living with PAs. It is recommended that workshops and continuing education programs specifically focused on PAs be provided for counselors who are active in the field. Staying current with the profession is of utmost importance when working in a field that changes based on available information. Moreover, it is an ethical violation to provide treatment services in an area that is beyond one’s scope of competency (ACA, 2005).

 

Finally, this pilot study will be replicated on a national level, obtaining further information about counselors’ knowledge and comfort level with assessing, diagnosing and treating PAs.  The IAAOC is interested in further researching the knowledge of counselor educators and graduate students in counselor education programs regarding their knowledge of PAs in order to meet the needs of this population and strengthen the knowledge base of PAs within the counseling profession.

 

 

 

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Angie D. Wilson is an Assistant Professor at Texas A&M University-Commerce. Pennie Johnson is the Vice President for Project Management at the International Institute for Trauma and Addiction Professionals (IITAP) and a doctoral student at Walden University in the Department of Counselor Education and Supervision. Correspondence can be addressed to Angie D. Wilson, 1700 Hwy 24, Department of Psychology, Counseling, and Special Education (Binnion Hall), Texas A&M University-Commerce, Commerce, TX 75429, angie.wilson@tamuc.edu.