The Roles of Negative Career Thinking and Career Problem-Solving Self-Efficacy in Career Exploratory Behavior

Oct 6, 2014 | Article, Volume 2 - Issue 2

Emily Bullock-Yowell, Sheba P. Katz, Robert C. Reardon, Gary W. Peterson

The respective roles of social cognitive career theory and cognitive information processing in career exploratory behavior were analyzed. A verified path model shows cognitive information processing theory’s negative career thoughts inversely predict social cognitive career theory’s career problem-solving self-efficacy, which predicts career exploratory behavior. The model suggests an intervention sequence to facilitate college student career development and exploration. A hypothetical case is provided as well as a depiction of the cycle of information processing in career decision making.

Keywords: career exploratory behavior, self-efficacy, negative career thoughts, college student career development, career problem-solving

Case of Sue

Sue, a young woman about to graduate from college with a degree in finance came to the university career center seeking career assistance in finding employment. Given some uncertainty about her interests and goals, she completed an interest inventory that produced a summary code (Holland, 1997) of IAS indicating interests in the investigative, artistic, and social areas. However, when occupational alternatives were identified for exploration following the assessment, she slumped in her chair and indicated that she was unable to concentrate on careers or the future and was unsure about the benefits of career counseling. At this point, the counselor invited her to complete the Career Thoughts Inventory (Sampson, Peterson, Lenz, Reardon, & Saunders, 1996) and the results revealed considerable negative career thinking across several domains. Further exploration in counseling revealed that a music teacher in high school had advised her to abandon her dreams of a music career because of a poor audition performance. She immediately decided to major in business finance without resolving the apparent loss of her future in music, or undertaking careful contemplation regarding viable career options.

This hypothetical case (although not an uncommon one) suggests that Sue was not ready to engage in a job campaign because she was mired in an emotional state that precluded her focusing on herself (goals, interests) or potential career options. In terms of cognitive information processing theory (CIP; Sampson, Reardon, Peterson, & Lenz, 2004), she lacked readiness (Sampson, Peterson, Reardon, & Lenz, 2000) to engage in career decision-making. She was unable to pursue the process of analyzing alternatives related to self and option knowledge because of longstanding emotional aftereffects associated with grieving the loss of an anticipated career in music performance. In effect, she was not emotionally available to engage effectively in the career problem-solving and decision-making process. This study examines how a negative emotional state, coupled with a lack of career decision self-efficacy, interferes with environmental and self-exploration precursors to the formulation of viable career options.

The CIP approach differentiates between career-related problem-solving and decision-making. Sampson, Reardon, Peterson, and Lenz (2004) defined problem-solving as “a series of thought processes in which information about a problem is used to arrive at a plan of action necessary to remove the gap between an existing and a desired state of affairs” (p. 5). Sampson et al. state that decision-making “includes problems solving, along with the cognitive and affective processes needed to develop a plan for implementing the solution and taking the risks involved in following through to the complete the plan” (p. 5). Difficulties in career decision making (as in Sue’s case) may stem from a variety of factors, including emotional distress, a lack of confidence in ability to perform certain tasks, lack of experience in varied life roles, lack of self-insight, negative expectations associated with a particular pursuit, fear of failure and conflicts with important people. Some career decision-making theories emphasize the use of self-knowledge (e.g., values, interests, and skills) and options knowledge (e.g., what jobs or majors of study are available), but they have less to offer regarding how beliefs, stress and affect associated with these two areas can impede progress in career decision-making. CIP (Sampson et al., 2004) and SCCT (Lent, 2005; Lent, Brown, & Hackett, 1994) address these issues.

Cognitive Career Theories

CIP (Peterson, Sampson, & Reardon, 1991; Sampson et al., 2004) and SCCT (Lent et al., 1994) have focused on the role of thinking in career decision-making. Independent of each other, these theories have defined types of dysfunctional cognitions, speculated about the role of these cognitions on academic and career decidedness, and developed self-report measures pertaining to these cognitions.

Within the career field, some career theorists have expressed the value of incorporating multiple career theories to provide the field with a more integrative framework for understanding career decision-making (Borgen, 1991; Hackett & Lent, 1992; Osipow, 1990). Specifically, such theorists have suggested that theories should integrate conceptually related constructs, further examine the relationship between dissimilar constructs and clarify commonly theorized outcome objectives within career decision-making. There are multiple cognitive constructs presented in CIP and SCCT career theories, but few studies have explored the interrelationships between them (Bullock-Yowell, Andrews, & Buzzetta, 2011).

Cognitive Information Processing Theory
CIP theory can be applied to understand the link between deficits in psychological functioning and career indecision (Peterson et al., 1991; Peterson, Sampson, Lenz, & Reardon, 2002). CIP theory utilizes the information-processing pyramid to explain the components involved in a career decision (Peterson et al., 1991). Four domains comprise the pyramid (Figure 1).

Figure 1. Information processing pyramid. Reprinted from Career development and services: A cognitive approach by G. W. Peterson, J. P. Sampson, and R. C. Reardon. Copyright ©1991 Brooks/Cole Publishing Company, Pacific Grove, CA 93950, a division of International Thomson Publishing, Inc.

At the base of the pyramid are two knowledge domains, self-knowledge and occupational knowledge. Self-knowledge is knowledge about one’s values, interests and abilities, while occupational knowledge is knowledge about the world of work and specific occupations (e.g., work setting, income and occupational tasks). These two areas provide the basic information that needs to be acquired in order to formulate appropriate occupational alternatives.

The decision-making skills domain is at the second level of the pyramid and involves individuals moving through the five phases of the cycle to process information for career decisions. The five-cycle phases include communication, analysis, synthesis, valuing and execution (Figure 2). These phases are referred to as the CASVE cycle. During the communication phase, individuals realize that they need to make a decision based on internal (e.g., anxiety) and external (e.g., notice from the university a major must be declared) cues they receive from themselves and their environment.

Figure 2. Cycle of information processing skills used in career decision-making. Reprinted from Career development and services: A cognitive approach by G. W. Peterson, J. P. Sampson, and R. C. Reardon. Copyright ©1991 Brooks/Cole Publishing Company, Pacific Grove, CA 93950, a division of International Thomson Publishing, Inc.

In the analysis phase, individuals seek to fully assess their career problem or the gap between their existing state of indecision and a desired state of decidedness. This phase involves determining the cause of the career problem and understanding the problem’s relationships themselves, their options and the factors that influence both themselves and their options (Sampson et al., 2004). This phase typically entails understanding assessments of interests, skills, values and engaging in occupational exploration. (Sue was unable to move from the communication phase to the analysis phase in the case example.)

In the third phase of the CASVE cycle, synthesis, individuals seek to determine a possible course of action which may involve developing alternatives for making a decision, including brainstorming an exhaustive list of options (synthesis elaboration) and narrowing this list to obtainable options (synthesis crystallization). (Sue was unable to successfully engage this phase of the CASVE cycle.) Throughout the fourth phase, valuing, individuals make judgments about these options based on their personal beliefs and preferences and arrive at a first choice. Finally, individuals put their thoughts into action in the execution phase of the CASVE cycle (e.g., completing a major field of study, applying for a job; Sampson et al., 2004).

The apex of the information processing pyramid consists of the executive processing domain. In this domain, people examine cognitions regarding the career decision process itself. There are three skills that need to be developed in order to engage in executive processing: self-talk, self-awareness, and control and monitoring. Self-talk is the internal conversation that individuals have about their decision-making abilities, e.g., “I can make good decisions for myself.” Self-awareness is the perception of one’s self as the performer of a task (Peterson et al., 1991), e.g., “I am nervous about meeting the timeline of my plans.” Control and monitoring is using self-awareness and understanding of the problem to guide and evaluate decision-making. For example, individuals are aware of anxious feelings about meeting a deadline and they decide they need more time. The executive function failed to operate in Sue’s case by allowing her to go prematurely from communication to synthesis without thoroughly becoming aware of her thoughts and feelings in the communication phase, and by not clarifying and acquiring adequate self and occupational knowledge in the analysis phase.

The strength of the CIP theory of career development is that it offers a framework of the cognitive and behavioral factors that guide career decidedness. Specifically, it provides a structure and sequence for gathering, transforming and utilizing information, while acknowledging the importance of thoughts and feelings.

Social Cognitive Career Theory

The framework for SCCT was derived primarily from general social cognitive theory (Bandura, 1986), and focuses on three variables: self-efficacy beliefs, outcome expectations, and personal goals. Self-efficacy is defined as beliefs about one’s ability to successfully perform given tasks or behaviors required to produce specific goal attainments (Bandura, 1977). It is hypothesized to be composed of beliefs linked to specific tasks or performance domains that vary across situations. Self-efficacy can be attained through four primary sources: (a) personal performance accomplishments, (b) vicarious learning (e.g., modeling), (c) social persuasion, and (d) the individual’s physiological and affective states (Bandura, 1977; Lent, 2005). According to SCCT, self-efficacy is a mediating factor for proactive behavior and behavioral change, regardless of ability level (Bandura, 1986).

Outcome expectations are defined as “beliefs about consequences or outcomes of performing particular behaviors” (Lent & Brown, 2006, p. 17). More specifically, outcome expectations influence behavior—when individuals expect that a behavior will lead to positive results, they are more likely to engage in the behavior. For example, if students expect that career options exploration will be helpful in their career decision-making, then they are more likely to engage in seeking and acquiring information (e.g., theory of reasoned behavior).

Personal goals refer to the individual’s intention to engage in a particular activity or produce an outcome (Bandura, 1986). The two types of goals identified by SCCT are choice-content goals and performance goals. Choice-content goals are goals related to activities or interest areas the individual wishes to pursue (e.g., choosing an academic major). Performance goals are goals regarding the individual’s level of performance needed to obtain the choice-content goal (e.g., maintaining a certain GPA to get into a particular field of study).

Choice and performance goals are theorized to be related to one’s self-efficacy and outcome expectation (Lent, 2005). Figure 3 provides a graphic depiction of the interrelationship among these constructs and an SCCT explanation of how interests develop over time. Additionally, SCCT outlines three related, yet distinct choice models related to the development of career-related interests, formation of career-related choices, and career/work-related performance. Strengths of SCCT theory include the acknowledgment of one’s confidence or self-efficacy associated with the development of interests and willingness to pursue and maintain work-related tasks. SCCT also acknowledges the many barriers to career development that exist in the environment, while promoting a sense of self-agency in clients.

Figure 3. Social Cognitive Career Theory (SCCT). Reprinted from Lent, R. W., Brown, S. D., & Hackett, G. (1994).Toward a unifying social cognitive theory of career and academic interest, choice, and performance. Journal of Vocational Behavior, 45, 79–122.

Exploratory Behavior in Career Decision-Making

In the case of Sue, she was unable to engage in exploratory behavior associated with career problem-solving and decision-making, specifically identifying an appropriate job opening. In this section, career exploratory behavior is examined from the standpoint of CIP and SCCT theories. Only one study was found examining exploratory behavior in relation to CTI scores (McHugh, Lenz, Reardon, & Peterson, 2012) which indicated that viewing a 10-minute model-reinforced video led to increased information-seeking behavior.

SCCT (Lent et al., 1994) suggests that self-efficacy beliefs influence behavioral intentions (e.g., planned career exploration) because it affects an individual’s perceived outcome expectation. Blustein (1989) found that self-efficacy and goal-directedness were related to environmental and self-exploration, but domain-specific self-efficacy proved to be a stronger predictor of exploratory behavior than goal stability. This finding provided evidence that self-efficacy does influence behavioral intentions and performance of an action so that a desired outcome is achieved (i.e., exploratory behavior).

Several studies provided empirical support for the application of SCCT in the examination of exploratory behavior (Bartley & Robitscheck, 2000; Betz & Voyten, 1997; Blustein, 1989; Fouad & Spreda, 1996; Ochs & Roessler, 2001, 2004). These studies examined how career decision-making self-efficacy and related variables (e.g., behavioral intention and outcome expectation) can contribute to the completion of career decision-making activities (e.g., career exploration). In one study, self-efficacy was found to aid students in developing and maintaining a commitment to career goals (i.e., behavioral intention; Blustein, 1989). As previously noted, behavioral intention is theorized to be the best predictor of actual behavior (Ajzen, 1988; Ajzen & Fishbein, 1980). Career exploratory behavior in undergraduate students was examined by Betz and Voyten (1997), and the results indicated that career outcome expectation was the best predictor for behavioral intentions (r =.50) in both males and females with academic outcome expectation and career decision-making self-efficacy accounting for some of the variance. The overall model for behavioral intention accounted for 25–29% of the variance. Taken together, research indicates that self-exploration and options exploration are related to career decision-making self-efficacy and other related SCCT constructs (Bartley & Robitscheck, 2000; Betz & Voyten, 1997; Blustein, 1989).

The Present Study

Both CIP and SCCT theories hypothesize that career beliefs influence goal development and ultimately behavioral outcomes. In CIP theory, the influences of meta-cognitions that regulate the career decision-making process are components of the executive processing domain of the information-processing pyramid (Peterson et al., 1991). As noted earlier, CIP theory suggests there are three key skills that need to be developed in order to examine and alter one’s thoughts: self-talk, self-awareness, and control and monitoring. CIP theory identifies three aspects of dysfunctional career thinking using the Career Thoughts Inventory (CTI): (a) decision-making confusion, (b) commitment anxiety, and (c) external conflict (Sampson et al., 1996), which can function to improve self-awareness. These thoughts can lead to avoidance in career problem-solving, insufficient processing of information during the phases of the CASVE cycle, and failure to complete the career problem-solving process. These difficulties can affect individuals’ abilities to progress through the CASVE cycle, thus increasing career indecision. The current study utilizes the CTI subscale scores to determine the extent to which the cognitive constructs presented in CIP theory predict for successful engagement of exploratory behavior in the analysis phase of the CASVE Cycle.

SCCT identifies three types of beliefs including self-efficacy, outcome expectations, and behavioral intention. One instrument, the Career Decision Self-efficacy Scale (CDSE; Betz & Luzzo, 1996) further defines these beliefs related to career decision-making self-efficacy into the subtypes of self-appraisal, occupational exploration, goal selection, planning, and problem-solving. These beliefs reciprocally interact to influence behavior. For example, past experience influences individuals’ current thoughts about themselves and their environment (e.g., self-efficacy beliefs and outcome expectations). These beliefs then influence goal setting (e.g., behavioral intention) and ultimately behavioral outcomes (e.g., self-exploration, environmental exploration and career decidedness).

Although the basic definitions of these cognitive variables are different across the two theories, the item content on the respective measurement scales appears to be very similar. CTI items to which test-takers are asked to rate their level of agreement (e.g., “My interests are always changing.” “Even though I’ve taken career tests, I still don’t know what field of study or occupations I like”) are similar to items on the self-appraisal subscale of the CDSE in which test-takers are asked to rate their confidence that they could accomplish the task (e.g., “Determine what your ideal job would be.” “Accurately assess your abilities”). In addition, items from the CDSE problem-solving subscale (e.g., “Persistently work at your major or career goal even when you get frustrated.” “Change occupations if you are not satisfied with the one you enter.”) are similar to “If I change my field of study or occupation, I will feel like a failure” and “I’ll never find a field of study or occupation I really like” on the CTI.

In the only study found to explore relationships among CIP and SCCT constructs, Bullock-Yowell, Andrews, and Buzzetta’s (2011) research demonstrated that negative career thoughts as measured by the CTI, along with three of the big five personality factors, explained 45.8% of the variance in career decision-making self-efficacy. This study provides a basis for better understanding the overlap and distinctness of these theories’ constructs. The five self-efficacy dimensions have some similarity to the CIP executive processing domain as they bear on the higher order regulation of the lower order decision-making process. In the case of Sue, she failed to engage in sufficient problem-solving and self-appraisal. As stated earlier, the CIP approach differentiates the career problem-solving process from the more comprehensive career decision-making process (Sampson et al., 2004). As Sue’s issues seem to be more directly related to the problem-solving process and her self-concept, the current study also examined the relationship between self-efficacy and the problem-solving process.

Within the context of CIP theory, the relationships between career indecision, exploratory behavior and negative career thoughts have theoretical support, but still need further empirical support. Research has consistently found moderate to strong correlations between career indecision and negative career thoughts (Saunders, Peterson, Sampson, & Reardon, 2000). Correlations between career decidedness and exploratory behavior are significant, but weak (Barak, Carney, & Archibald, 1975). In addition, no published articles have focused on the relationship between negative career thoughts and career exploration. Many career theorists have suggested that information processing is influenced by attitudes, values and cognitions (Kinnier & Krumboltz, 1986; Osipow, 1973; Sampson et al., 2004), and that the relationship between exploratory behavior and career decidedness may be mediated by career thoughts. Further research is needed to examine the theorized relationship between these variables. Thus, this study sought to address this gap by exploring the relationship between negative career thoughts and career exploration.

In order to better inform practitioners about effective ways to assist their clients using cognitive career theories, the following research question was posed: When are clients ready to move from the communication phase to the analysis phase of the CASVE cycle? More specifically, do negative career thoughts and career problem-solving self-efficacy predict successful engagement of self-exploration and environmental exploration in pursuit of self-knowledge and occupational knowledge? Three constructs of negative career thoughts from CIP theory (i.e., decision-making confusion (DMC), commitment anxiety (CA), and external conflict (EC) and two domains of career decision-making self-efficacy from SCCT (i.e., self-appraisal and problem-solving) were selected as predictors of career exploratory behavior (i.e., self-exploration and environmental exploration). These were framed in terms of a causal model amenable to analysis through structural equation modeling (SEM). Therefore, a model was proposed (See Figure 4) with a bi-directional relationship between the career thinking and career problem-solving self-efficacy latent variables, as well as career thinking and career problem-solving self-efficacy predicting career exploratory behavior.

This theorized model can be illustrated by returning to the case of Sue. Her level of negative thought together with the lack of perceived competency in self-appraisal and problem-solving severely impeded her ability to engage in self-exploration and environmental exploration. The model graphically portrays Sue’s circumstance and the hypothetical relationships among these theoretical constructs.

Method

Participants
Participants were 145 undergraduate students (51% female and 49% male, age range 18–36, mean age 21.8) enrolled in multiple sections of an introductory career development course at a research university. The common reason for enrolling in this elective course was to receive assistance in making a career decision or to solve a problem related to career issues. Ethnicity and classification demographics of the sample include: European American 71%, African American 21.4%, Hispanic American 5.5%, American Indian 0.7%, Other 1.4%, seniors 62.1%, sophomores 16.6%, juniors 15.9%, freshmen 4.8% and graduate students 0.7%.

Procedures
College students enrolled in an introductory level career development course were recruited to participate in this study. During a regularly scheduled class period, students in the course were read consent information by a research assistant. It was explained that the purpose of the study was to learn more about college students’ experiences. Participants were then administered a demographics questionnaire, the Career Thoughts Inventory, the Career Decision-Making Self-Efficacy Scale, and the Career Exploratory Survey: Environmental Exploration and Self-Exploration. The order in which the instruments were administered was randomly alternated to control for possible order effects. Students who agreed to participate received extra credit in the course. All measures were simultaneously collected on the first or second day of class to help control for missing data and environmental factors.

Instruments
Demographic Questionnaire. The demographic questionnaire included information such as age, gender, year in school, major, previous work experience, extracurricular activities and ethnicity. This measure was used to describe the study sample.

Career Thoughts Inventory (CTI; Sampson, Peterson, Lenz, Reardon, & Saunders, 1998). The CTI is a 48-item self-report inventory designed to measure career thoughts. The CTI measures negative thoughts that impede career decision-making using a four-point Likert scale. The CTI yields three subscale scores: Decision-Making Confusion (DMC), Commitment Anxiety (CA), and External Conflict (EC). Higher scores indicate negative career thinking. In the present study, the CTI subscales were the observed variables’ measures that defined the latent variable, Career Thinking. The CTI’s content validity is based on its consistency with the cognitive information processing (CIP) approach of career decision-making. The internal consistency for this measure is high with a coefficient alpha of r = .96 (Sampson et al., 1998) and .95 for the current sample. Subscale internal consistency for the current sample was Decision-Making Confusion (.92), Commitment Anxiety (.84) and External Conflict (.75). Test-retest reliability was measured in college and high students across 4 weeks and ranged from .74–.82 (Sampson et al., 1998). CTI total score converged with Indecision Scale of the Career Decision Scale at .70.

Career Decision Self-Efficacy Scale-Short Form (CDSES-SF; Betz & Luzzo, 1996). The CDSES-SF is a 25-item self-report inventory designed to measure career decision-making self-efficacy. Using a five-point Likert scale, the CDSES-SF measures confidence to perform decision-making tasks in five competency areas: performing accurate self-appraisals, gathering occupational information, selecting goals, making plans to implement career decisions and problem-solving. These five competency areas that make up the factor structure of the CDSES-SF are based on Crites’ (1969) theory of career maturity. The latent variable, career problem-solving self-efficacy, was comprised of two observed variables measured by the self-appraisal and problem-solving subscales of the CDSES-SF. Coefficient alphas for the self-appraisal and problem-solving subscales have been reported as .73 and .75, respectively (Betz & Luzzo, 1996). The coefficient alphas for the current sample were .79 for self-appraisal and .77 for problem-solving. The test-retest reliability for the total scale across a 6-month period was reported to be .83 (Betz & Luzzo, 1996). Concurrent validity has been established with the Career Decision Scale indecision and certainty scales (Osipow, 1980) and the My Vocational Situation: Identity scale (Holland, Daiger, & Power, 1980). Convergent validity has been established with a generalized measure of self-efficacy (Betz & Klein, 1996).

Career Exploratory Survey: Environmental Exploration and Self-Exploration (CES-EE & CES-SE; Blustein & Phillips, 1988; Stumpf, Colarelli, & Hartman, 1983). In the present study, the 6-item Environmental Exploration and the 9-item Self-Exploration scales from the Career Exploration Survey (CES) were used to measure the observed variables that defined the present study’s latent variable, Career Exploratory Behavior. The CES-SE measures “the extent of career exploration involving self-assessment and retrospection within the last 3 months” and the CES-EE measures “the extent of career exploration regarding occupations, jobs, and organizations within the last 3 months” (Stumpf et al., 1983, p.196). Internal consistency for the two scales has been adequately demonstrated in the literature (CES-SE alpha = .82 to .88 and CES-EE alpha = .88 to .89) (Blustein & Phillips, 1988; Stumpf et al., 1983) and in the current sample (CES-SE alpha = .85 and CES-EE alpha .87). In addition, Blustein and Phillips (1988) reported two-week test-retest reliabilities of .85 and .83 for the CES-SE and CES-EE, respectively. Content validity for the scales has been confirmed with a theoretically consistent factor structure (Stumpf et al.). Convergent validity for both scales has been established with a variety of constructs (Blustein, 1989; Blustein & Phillips, 1988; Hamer & Bruch, 1997; Luzzo, James, & I.una, 1996; Stumpf et al., 1983).

Results

The relationships among career exploratory behavior, career thinking and career problem-solving self-efficacy were analyzed. All analyses were conducted using AMOS 7.0 (Arbuckle, 2006) and SPSS 16.0. Structural equation modeling (SEM) served as the framework for the analysis. The majority of the correlations among the present study’s observed variables were statistically significant (See Table 1) with a few exceptions. Self-exploration, a defining variable for the career exploratory behavior latent variable, was not significantly correlated with any of the career thinking observed variables. Environmental exploration, another defining variable for the career exploratory behavior latent variable, was not significantly correlated with external conflict, one of the defining variables of the career thinking latent variable.

Table 1
Correlations, Means, and Standard Deviation of Study’s Observed Variables (N=145)

Measurement Model
The measurement model was evaluated to determine how well the observed variables combined to represent the underlying latent constructs of the model (Anderson & Gerbing, 1988). The initial measurement model was constructed with three latent constructs: career exploratory behavior, career thinking and career problem-solving self-efficacy (See figure 4). For this step, all latent variables were allowed to co-vary, and observed indicators were restricted to load only on their respective factor. Career problem-solving self-efficacy’s observed variables, problem-solving and self-appraisal, were significantly correlated (r =.71; p < .01). Career thinking’s observed variables—decision-making confusion (DMC), commitment anxiety (CA) and external conflict—were significantly intercorrelated (r =.53-.71; p < .01). Exploratory behavior’s observed variables, self-exploration and environmental exploration, were significantly correlated (r =.34; p < .01). The loadings of the measured variables on the latent variables were all statistically significant (p < .001) and ranged from .55 to .95, providing evidence that each of the latent variables was adequately measured by their respective observed variables.

Structural Models
The initial model tested (See Figure 4) proposed a bi-directional relationship between the career thinking and career problem-solving self-efficacy latent variables, along with variables explaining direct variance in career exploratory behavior. During the analysis process in AMOS 16.0, the model was deemed inadmissible. Therefore, a second path model (see Figure 5) was proposed in which the relationship between the career thinking and career problem-solving self-efficacy latent variables was modified to indicate that career thinking captured direct variance in career problem-solving self-efficacy, which in turn had a direct effect on career exploratory behavior. This path model had an adequate to low fit with the data, χ2 (11, N = 145) = 31.14, p < .001, χ2/df = 2.831, CFI = .946, TLI = .897, RMSEA = .113 (90% CI: .67, .160). Models with CFI and TLI between .90 and .94, and RMSEA values between .06 and .10, indicate an adequate fit to the data when models are not complex and samples sizes are smaller than 500 (Hu & Bentler, 1999; Weston & Gore, 2006). This path model met most of these specifications of adequate fit. The TLI and RMSEA coefficients fell slightly outside the recommended parameters.

Figure 4. Initially proposed model.

Figure 5. Final model.

Discussion

The model initially hypothesized and proposed (Figure 4) was not admissible. According to most indicators the final path model (Figure 5) was moderately verified. The model suggests that there is an important sequence of interventions when working to facilitate environmental and self-exploratory behavior in career counseling clients. The model indicates that negative career thinking explains some portion of career problem-solving self-efficacy. Also, career problem-solving self-efficacy in turn directly explains a portion of exploratory behavior, while negative career thinking does not. Self-efficacy appears to affect the relationship between negative thoughts and exploratory behavior. Thus, the presence of negative thinking appears to support a person’s level of self-efficacy. Perhaps the key for practitioners is to intervene on negative career thoughts initially to free clients for more successful building later upon problem-solving self-efficacy. Problem-solving self-efficacy can then be addressed once negative thinking is resolved through attending to the sources of self-efficacy (Bandura, 1977; Lent, 2005).

How do this model and these indicated interventions address the research question and hypotheses? It appears to be important to address negative career thinking prior to working with clients on building self-confidence in career decision-making. In terms of the CIP pyramid (Peterson et al., 1991) that would mean addressing issues in the decision-skills domain before engaging the apex or executive processing domain. Thus, the successful progression from the communication to analysis phase of the CIP CASVE cycle would first involve resolution of negative career thoughts followed by building career problem-solving self-efficacy. Upon increasing self-efficacy, the probably of engaging in career exploratory behavior to clarify self-knowledge and to acquire occupational knowledge at the base of the pyramid is enhanced.

This potentially generalizable model has direct implications for the specific case of Sue described at the beginning of this article, which will be used to demonstrate how the findings from this study could be utilized in specific counseling situations. Sue presented with low readiness (Sampson et al., 2004) to engage the career development process. She seemed frustrated and unwilling to explore her interest inventory results. This may be linked back to the disappointment, regret and perhaps even grief associated with the “loss” of her music aspirations. It is very likely she developed some negative career thoughts in that process.

The verified path model indicates the importance of identifying, challenging and altering these negative thoughts to allow Sue to act upon a new, more accurate version of these thoughts. The use of the Career Thoughts Inventory (CTI) assessment and workbook (Sampson et al., 1996) could aid Sue’s counselor in this process by identifying and challenging negative career thoughts.

When Sue’s negative thinking is transformed and becomes more realistic and positive, career-related self-efficacy should be ready for enhancement. In fact, Lent (2005) mentions that self-efficacy building attempts may be enhanced from some preliminary cognitive restructuring procedures. Bandura (1977) and Lent (2005) suggest targeting the four sources of self-efficacy to accomplish this positive change. One possible career counseling goal could target the personal performance accomplishments source of self-efficacy. Sue’s counselor could work with Sue to break down her present goal of finding employment into more discrete, attainable steps and milestones to build Sue’s confidence (or self-efficacy) in such tasks. For instance, during the next week Sue could look at the career center’s job listings and indicate three she likes and three for which she would never apply. This would allow for discussion of jobs of interest and areas to avoid in the next session as well as supporting Sue’s efforts to engage in the tasks necessary to explore career information and make an eventual choice. Sue and the counselor could work at Sue’s pace to accomplish a list of associated, small goals to build self-efficacy while simultaneously working toward Sue’s initial goal of finding employment.

This case and model indicate that even when a client presents with a need to explore career information it may not be the most prudent move for a counselor to initially engage in career exploration with the client. There may be steps that are necessary, or at least allow for the attainment of readiness in order to successfully engage in career exploration. These steps seem to include addressing negative career thinking followed by adequately addressing career problem-solving self-efficacy, indicating that both CIP and SCCT theories function in complementary ways.

Limitations and Implications

Given all of this discussion of counseling with Sue, it is important to note limitations of this research. Most SEM indicators verify the adequacy of the final model provided in this study. However, because it is not fully verified by all relevant indicators and not all possible related variables are taken into account, there may be a better fitting model that explains career exploratory behavior. Future research could focus on finding a better fitting model with a larger sample size to explain career exploratory behavior. Additionally, the sample was made up of college students, the majority of which were European American, and this may limit the generalizability of these findings to dissimilar groups. Additionally, research outside of the career realm may benefit from the consideration of such a model as it relates to other important life choices and exploration in which career counseling clients typically engage (e.g., choice of spouse, major purchases). Perhaps negative thinking resulting from regrets, disappointments, and grief have similar effects on client’s life-choice self-efficacy and exploratory behavior. There are many areas of life where clients prematurely make choices and there are ways for counselors to better prepare them for this decision-making process.

The suggested counselor interventions also are limited in several ways. The verified path model does not inform us as to whether intervention on career thinking followed by self-efficacy is necessary or if intervention on career thinking alone would be adequate. Additionally, the effects of the four sources of self-efficacy are not fully empirically supported (e.g., Alliman-Brissett, Turner, & Skovholt, 2004) and should be implemented with that in mind.

The case of Sue demonstrated some of the specific practice implications suggested by the model. It is important to consider whether a measure of negative career thinking, such as the Career Thoughts Inventory (Sampson et al., 1996), and of career-related self-efficacy, such as the Career Decision Self-Efficacy scale (Betz & Luzzo, 1996), should be integrated into the career counseling assessments as a standard procedure to help monitor and inform treatment.

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Emily Bullock-Yowell, NCC, is an Assistant Professor at the University of Southern Mississippi. Sheba P. Katz is in private practice, Fort Myers, FL. Robert C. Reardon, NCC, is Professor Emeritus at Florida State University. Gary W. Peterson is Professor Emeritus at Florida State University. Correspondence can be addressed to Emily Bullock-Yowell, University of Southern Mississippi, Department of Psychology, 118 College Drive #5025, Hattiesburg, MS 39406-0001, emily.yowell@usm.edu.

Globalization and Counseling: Professional Issues for Counselors

Oct 6, 2014 | Article, Volume 2 - Issue 2

Sonya Lorelle, Rebekah Byrd, Stephanie Crockett

Scholars have examined globalization for many years in terms of its impact on individuals, but it remains a concept not often discussed in the counseling literature. As counseling transforms from a Western-based practice to a global phenomenon, it is important to understand professional counseling within an international and multicultural context. In this article, the ways in which the process of globalization are currently impacting the field of counseling, implications and future research directions are examined. Global mental health and wellness, culture, and access and structural limitations are also presented.

Keywords: globalization, international, multicultural, counselor education, professional counseling

As our world becomes increasingly connected economically, politically, technologically, and culturally, counseling is transforming from a Western-based practice to a global phenomenon. The globalization of counseling has placed the field on the cusp of growth and innovation. Such changes involve not only a willingness to adapt and perhaps redefine current counseling theories, but to hold our most basic assumptions regarding the nature of human change so loosely that we are willing to let counseling develop and evolve indigenously in international communities. Accordingly, this article highlights the impact of globalization on the field of counseling, with particular attention given to the spread of Western-based counseling practices to the international community. In order to do so, we begin by defining globalization and considering the progression of multicultural counseling toward a more global vision. We then examine the ways in which the process of globalization is currently impacting the field of counseling. Lastly, the implications for counseling as an increasingly global phenomenon and future research directions are considered.

Globalization

Globalization can be referred to the “McDonaldization” or “Westernization” of the world. These terms imply that globalism entails an invasion of Western capitalism into undeveloped nations and suggests the idea that the world is becoming homogeneous. Modern scholars of globalization (Featherstone, 1996; Tomlinson, 1999), however, point out that such oversimplifications only describe one aspect of globalism, and note that globalization is better defined by a series of interactions between nations than by a unidirectional Western conquest. Accordingly, we define globalization in this article as a continual process of interaction and integration among national economies, societies and cultures (Rothenberg, 2003).

There is a dynamic interplay between both global and local economies, politics, technologies and cultures in which local communities do not passively give way to outside influences, but rather actively react to the process by absorbing, assimilating, and/or resisting the worldviews, products and politics introduced by the West (Featherstone, 1996). This global-local relationship transforms the local lived experiences of the individuals and has increasing global consequences (Tomlinson, 1999).

Scholars in the counseling field have already increased their understanding of the process by which individuals in minority groups adapt to dominate cultural norms. Traditionally, it was assumed that acculturation was a one-dimensional process in which individuals demonstrated increasing adherence to the dominant culture and a lessening of adherence to the minority orientation. More recently, scholars understand this process to be multidimensional, involving both acculturation and enculturation (Kim & Abreu, 2001).

Similar to modern theories of globalization, counselors are increasingly aware of the dynamic interplay that exists between dominant and individual culture. In this manner, as the counseling profession is introduced and developed in international communities, not only will local communities and individuals living in those communities be transformed, but the practice of traditional, Western counseling may be fundamentally redefined as locals actively react and adapt to the practice. Individual views and experiences of globalization are contingent upon social location and personal experiences (Featherstone 1996; Tomlinson, 1999). In considering the globalization of counseling, the application of this assumption implies that each local community and individual assigns personal meaning and reacts differently to the experience of counseling. As a result, counseling and the implementation of counseling services in non-U.S. cultures differs significantly from country to country and community to community, with each model being a valid and effective method of helping individuals within a given social context.

Cultural Diversity and Counseling Beyond U.S. Borders

For nearly half a century, the field of counseling has gained improved awareness and understanding of the cultural differences that exist within the U.S. Counselors have specifically focused on understanding the cultural dynamics that occur on a micro level, between the counselor and an individual client or small group of clients, in order to improve the provision of services in the U.S. As counselors became increasingly alert to and accepting of the cultural similarities and differences between racial/ethnic groups, Pedersen (1991) heralded multiculturalism as counseling’s “fourth force” (p. 93), as it became a “hot” topic in the profession.

In recent years the field has begun to expand counseling beyond U.S. borders to a world that is increasingly interconnected and interdependent. This “fifth force” in counseling has been gaining speed over the past decade as many countries throughout the world express an interest in promoting the mental health of their citizens (Hohenshil, 2010). Efforts to assist the development of counseling internationally have been facilitated through the work and leadership of the U.S. counseling profession. One such effort includes the creation of NBCC International (NBCC-I), a division of the National Board for Certified Counselors (NBCC). NBCC-I was created in 2003 to promote the counseling profession on a global scale (NBCC-I, 2012). According to the NBCC website, the organization looks to “spread the availability of competent, reliable professional services to any part of the world that indicates an interest in acquiring them, . . .with utmost care and respect for the social, cultural, political, and economic realities of the various areas where [they] are invited” (Clawson, 2011, para. 2).

The winter 2010 issue of The Journal of Counseling and Development (JCD) highlighted the globalization of counseling in a special section devoted to describing development and future of counseling in eight countries (China, Botswana, Lebanon, Malaysia, Romania, Italy, Mexico, and Denmark). For the majority of countries detailed in the special section, counseling began through the need for career guidance in public school systems. Some countries had witnessed the expansion of counseling services into local communities (See & Ng, 2010; Stockton, Nitza, & Bhusumane, 2010), while others indicated the need to extend affordable counseling services beyond educational settings (Ayyash-Abdo, Alamuddin, & Mukallid, 2010). Most countries experienced a shortage of quality counselor training programs as the need for practicing counselors grew more quickly than the development of training programs. Regarding the future of counseling in these countries, most expressed that the need for counseling services would continue to grow, but expressed the need for systematic, quality counselor training programs as well as the development of national counseling associations, counselor training standards, and a credentialing mechanism (Ayyash-Abdo, Alamuddin, Mukallid, Remley, Bacchini, & Krieg, 2010; See & Ng, 2010; Stockton, Nitza, & Bhusumane, 2010).

The efforts of the counseling profession regarding multicultural competence provides the field with a solid foundation for the implementation of counseling on a global scale; however, counselors must remain alert to the broader implications that stem from promoting counseling to diverse individuals on a macro level. While the current literature acknowledges what countries need in order to incorporate counseling, it remains important to consider the impact of globalization and how the counseling profession may need to adapt to meet the needs of the local communities. The application of U.S. counseling theories and techniques, multicultural counseling included, is doubtfully sufficient to ensure the efficacy of international counseling. Instead, counselors will have to move beyond a national multicultural perspective toward a global vision for the field.

Impact of Globalization on Counseling

Heppner (1997) suggested that counseling “can play an important role in building a global village that helps people improve their well-being, alleviate distress and maladjustment, resolve crises, modify maladaptive environments, and increase their ability to live more highly functioning lives” (p.7). While we recognized the importance of considering cross-cultural understanding as counselors take on an international role, we must continuously ask who will define more highly functioning. Leung (2003) acknowledged the ethnocentric bias of Euro-American assumptions inherent in traditional counseling theories. For example, regarding attachment theory, You and Malley-Morrison (2000) confirmed the traditional definition of healthy attachment did not transfer to Asian cultures. The researchers found Korean students to score higher on the preoccupied attachment compared to American students. With an ethnocentric view, counselors might mistakenly believe they should promote the “higher functioning” secure attachment style; however, in Asian collectivistic cultures where there is greater value placed on others than the self, attachment styles present differently due to different interpretations and meanings associated with parent-child interactions (Rothbaum, Rosen, Ujie, & Uchida, 2002; You & Malley-Morrison, 2000).

It also is important to understand how globalization can impact the counseling field at the macro level as well as at the micro level where individuals are affected in ways that are relevant to counselors. In the following section, we examine three ways in which globalization may have an impact on the counseling field and on the people living in international communities. First, we will explore how globalization impacts the transfer of Western values transnationally; which in turn influences the local cultures’ ideas and experiences of mental health and wellness. Second, we will consider the commoditization of the helping relationship and how it translates internationally. Finally, through the globalization lens, we consider the issues with access and the structural limitations of international counseling.

Global Mental Health and Wellness

Early studies suggested that mental health services which were rooted in White middle-class value systems led to the misdiagnosis of racial/ethnic minorities (Adebimpe, 1981; Mukherjee, Shukla, & Woodle, 1983), decreased quality of care for racial/ethnic minorities (Ridley, 1989; Sattler, 1977; Sue 1977), and higher rates of premature termination among racial/ethnic minority clients (Ridley, 1989; Romero, 1985; Sue 1977; Yamamoto, James, Bloombaum, & Hattem, 1976). Given these documented dangers of ethnocentrism within U.S. borders, and because the local is transformed by the global in the process of globalization (Tomlinson, 1999), it is important to examine how the Western ideas of mental health and illness impact local-international communities.

There are several ways in which the local is transformed by the global regarding the mental health and wellness of individuals in international communities. First, the spread of Western notions of mental health can change how symptoms are conceptualized and manifested in local-international communities. Watters (2010) examined how the U.S.’s influence over the rest of the world does not simply impact the economic realms of individuals’ lives, but he also explored how the mental illness landscape of the world is changing as well to reflect Western ideas. For example, he interviewed Dr. Sing Lee, a Chinese eating disorder researcher, who explained that prior to the early 1990’s the local version of anorexia nervosa in Hong Kong presented differently in clients than those from the Western version. He called the local version nonfat phobic anorexia because the girls who exhibited the symptom of restricted eating did not also express the symptom of fear of being overweight, like the Western version of the disorder required. However, between 1998 and 2007 there was a significant increase in the number of cases that conformed to the traditionally Western fat phobic version of the disorder compared to the previous decade (Lee, Ng, Kwok, & Fung, 2010). The authors stated that their findings indicated “that the clinical presentation of eating disorders in Hong Kong has gradually conformed to the frequency of occurrence of eating disorders as found in Western communities” (p. 313).

Scholars have attributed this trend to the influence of the West. Watters (2010) suggested media coverage of Western mental health clinicians’ perspectives of the diagnostic symptoms of anorexia, which included the fear of gaining weight may have contributed to the shift in the presentation of symptoms. Watters suggested interviews with experts could have introduced an idea of a mental illness that was not present before, providing a new culturally acceptable symptom for psychological disturbances to be expressed by young women and girls in China. Pike and Borovoy (2004) similarly noted the correlation between the rise in eating disorders in Japan with the growing social changes brought on by industrialization in post-World War II times. While the authors questioned the impact of the Western ideals of beauty on women in Japan, they also considered the explanation to be more complex than Japanese women wholly internalizing Western ideals. The authors assumed Japanese women have their own internal conflicts and tensions, which are only complicated by the West’s influence.

Laungani (2004) noted that through globalization, the West’s value systems spread to diverse cultures, creating a more homogenized world. Not only do these Western ideas of diagnosis have the potential to create altered expression of symptoms in a local community, the very presence of the Western values in the economic and social spheres can create new tensions for individuals to resolve. For example, several scholars have noted how the value of individualism has been introduced into some aspects of the Japanese and Chinese, creating dual roles of individuality and community for people in those cultures and internal conflict in how to resolve the dual roles (Duan & Wang, 2000; Iwasaki, 2005). Iwasaki stated: “Today’s Japanese mental health problems reflect the confusion among Japanese individuals who live in an unstable period between enduring interdependent cultural values and emerging Western values of independence” (p. 129). Chen (2009) developed a counseling theory to address these interpersonal and psychological disturbances that occur in individuals in Taiwan. As individuals struggle to resolve the traditional versus the modern, Chen suggested that counselors could help clients to adjust how they resolve the conflict based on the type of situation they are in at the moment. He also suggested that incorporating the culture’s value on family can be helpful to resolve marital conflict by asking the most authoritative member in the family to serve the role of mediator to resolve the discord.

Finally, there are certain aspects involved in the globalization process itself, such as increased mobility, which also can affect the types of problems individuals in the local community may present in counseling. As economic forces shift the demand of labor to different global environments, the rate of adult migration continues to grow in countries with limited local employment options (Pottinger, Stair, & Brown, 2008). This migration of one or both parents can affect both those members who migrate and those family members who are left behind, creating special needs. Pottinger et al. (2008) noted that this migratory separation is common in the Caribbean, and children often need attention from counselors to help adjust to the loss of their parents. They also recommended counselors take a psycho-educational role when helping Caribbean families affected by this situation.

The global transmission of Western ideas of mental health can change the way international communities conceptualize and experience their own mental health, and the transmission of Western values into a culture can create internal psychological conflict. The economic forces of globalization can require families to be separated across continents, creating shifts in roles and adjustment issues for children. Understanding how the specific ways in which globalization impacts mental health conceptualizations and those individuals and families receiving these services is vitally important in order to better create international models of mental health counseling services.

Commoditization of a Relationship

The value of individualism is not the only Western concept spreading throughout the globe that will have an impact on the counseling field. Capitalism also is the driving economic force of globalization, which creates an inherent dichotomy of public and private spheres (Acker, 2004). Feminist scholars have criticized how the global economy devalues this private and informal sector and overvalues production and profit (Acker, 2004; Mies, 1994). It is important to consider how this factor influences the counseling field and individuals receiving counseling internationally.

Counseling at its very nature is an intimate exchange—sharing “secrets” behind closed doors, helping with problems of life’s most private topics of love, sex, loss and death. It is a core philosophical counseling value that the “relationship” is the vital aspect of the process. Through this relationship counselors hope to help clients grow, heal, fulfill potential, learn to cope or make other positive changes. For many cultures the idea of discussing these topics outside of the family is counterintuitive since these intimate exchanges are traditionally addressed in the relationships of the family and the private sphere of their lives. However, counselors do not only suggest people should bring these problems out of the bedroom and other private spaces, they also ask that clients pay to do so. In the U.S. this inherently private connection has been transformed into a public commodity. Sue and Sue (2003) noted that “mental health practice has been described as a White middle-class activity that often fails to recognize the economic implications in the delivery of mental health services” (p. 97).

While the counseling relationship can be very powerful and a catalyst for change, the authors are aware of and respect the counterintuitive aspects of the commoditization of this relationship. In line with the Western capitalistic framework it makes sense to charge for the services and time provided, and seems natural to translate these intimate exchanges into intimate economies. However, as the authors re-examine this phenomenon under the lens of globalization, they believe counselors should be wary of this aspect as the counseling profession develops in communities where capitalism is not the dominant world view and where the private sector of the home and family are more valued. Not only could these economic exchanges affect how the counseling relationship is viewed and experienced, but also how counseling is accessed. In the following section we will further address the access and structural limitations of counseling.

Access and Structural Limitations

Scholars have reported the fact that individuals from culturally diverse backgrounds are not as likely to seek counseling and that when counseling is used, these clients tend to terminate more rapidly (Atkinson, 2004; Sue & Sue, 2003). Atkinson outlined many reasons for the under-utilization of services and discussed cultural mistrust, social stigma associated with mental illness or counseling seeking behavior, the counseling process all together, and limited access (Atkinson, 2004). Counselors are increasingly aware of how inequity, discrimination and oppression adversely affect the lives of clients, and how these injustices can be systemically perpetuated by well-meaning individuals in privileged groups (Arredondo & Perez, 2003; Crethar, Torres-Rivera, & Nash, 2008). Many social justice and advocacy efforts continue to fight on the local, state, and federal level for services to be more accessible for all. Atkinson (2004) reported that many low-income ethnic minorities must rely on public and nonprofit mental health services since they often do not have insurance that covers these types of services.

Structural barriers such as transportation, hours of operation, and child care, as well as emotional barriers such as fears about being judged, also can create limitations for people with fewer resources to access counseling (Anderson et al., 2006). Toporek (2009) noted that there is a history of inadequate service for marginalized populations and “oppression, discrimination, inequitable policies, and lack of access and resources create environmental barriers that permeate mental health and well-being” (p.12). By ignoring these structural barriers and avoiding advocating for change in these greater systemic arenas, counselors end up colluding with the oppressive system (Toporek).

Given that these limitations are present in the U.S., the concepts of access and affordability are extremely important when discussing counseling in international spaces as well. We caution that services offered without issues of access taken into account may leave those people with the greatest need without services. If counseling is structurally established internationally with a similar economic model, and if there is limited structural support for public sponsored programs, then we risk providing services only to those with the most means. As advocacy efforts are attended to in the U.S., counselors will need to attend to similar systemic barriers internationally as well, by addressing social and socio-economic factors that may create limitations.

While considering these structural limitations for clients, it also will be important to consider how counselors are paid for their services if counseling is to grow as a profession in international communities. While the U.S. relies on private pay, insurance, governmental and private nonprofit agencies, and sliding scales, for countries that do not have a managed care system, counselors may need to advocate for their role to be added as an official job position in their vocational system.

Implications for the Counseling Field

Given the potential impact globalization can have on the counseling field and the international communities counselors will serve, an expansion of the multicultural competencies that include an international or more global perspective of counseling is needed (Chung, 2005). Sue and Sue (2003) encouraged counselors to broaden their understanding of multicultural counseling methods of treatment to include informal or natural systems of support, alternative healing methods, and culturally specific systems of helping. Sue and Sue suggested “we should actively try to find out why they may work better than Western forms of counseling and psychotherapy” (p. 44). In order for counselors to understand natural forms of helping in countries where formal “counseling” may not be available, speaking to and gathering information from individuals from other countries is imperative.

Chung (2005) addressed a more global perspective of counseling and stated that being multiculturally competent is an essential starting point for being an effective counselor on a global or international scale. Chung (2005) discussed that counselors need to keep current of cultural issues that are not Western-based and acknowledged that counselors need to be more aware of the impacts of globalization.

Training Counselors

Paredes et al. (2008) suggested that counselor education programs admit more international students in order to train them as counselors who will in turn take their information back to their countries of origin and provide services to individuals, start programs and service initiatives and educate others. However, the way in which we train counselors, whether international or not, should include global perspectives and the ways in which globalization impacts individuals and communities. Courses that examine the role of privilege and oppression should not only examine how these issues impact people within U.S. borders, but the interconnection of global systems as well. The social justice lens should be widened to include perspectives on global advocacy, including awareness of how choices people make in the U.S. impacts other individuals across the world.

International counselor education programs also need to be addressed. The need for adequate graduate training programs in counseling is great. The number of schools around the world that formally teach counseling is quickly growing (Low, 2009). One potential way to meet the need for trained service providers would be to create a tiered system of training. Hinkle and Henderson (2007) have developed a curriculum through NBCC-I for a Mental Health Facilitator program that sends trainers to international communities where there are little to no mental health services to train local people on the basic helping skills and how to recognize mental health issues (McGrath, 2009; NBCC, n.d.).

For formal counseling programs throughout the world, regulation is important to implement to ensure adequate training. Stair (2010), who presented at the American Counselor Association’s (ACA) national conference on the topic of counseling in Jamaica, discussed how there were no regulations or accreditation requirements for counselor training programs in her home country. She outlined that this void of a regulating body left clients unprotected from pseudo-professionals claiming to be counselors without holding credentials. The leaders of the Jamaica Association for Guidance Counsellors and Education (JAGCE) asked NBCC-I to partner with the counseling organization in order to work toward developing such credentials and ethical standards (W. Schweiger, personal communication, May 4, 2012). Their collaboration is especially geared toward the school counselors in Jamaica. Stair indicated that as counselor education programs develop internationally, it is vital to meet the mental health needs of a more globally connected population while considering the culture and space in which they will be educating and serving. For example, she specifically addressed how the issue of boundaries and dual relationships should be considered differently in Jamaica considering the collectivistic culture and the small spaces of the country. Schweiger stated that in order to be sensitive to cultural differences, U.S. counselors who collaborate with JAGCE leaders should ask questions about what they need so that decisions can be made as to what the standards will be specifically for Jamaica, rather than Western counselors telling Jamaica what they should be.

Future Research Directions

A meta-analysis of a top counseling journal revealed a dearth of article submissions on international or global topics (Crockett, Byrd, Erford, & Hays, 2010). Given how the process of globalization can impact the incorporation of counseling into a new cultural community, the need to add international voices in the field is clear. Paredes et al. (2008) suggested that international students may be a valuable resource to gain these perspectives for counselor education programs. Research is needed that assesses current helping methods of the country and structural barriers, as well as specific models or theories that may be best adapted to the values of the culture. International perspectives also could reveal potential stigmas, misunderstandings, or reservations that individuals in any culture may have about counseling. It would be important to highlight any discrepancies between the counseling philosophy and the culture that may prevent individuals from utilizing the services.

Conclusion

As the process of globalization has impacted the world economically, politically, culturally, and socially, it is important to maintain the global perspective when examining the counseling field as well. Ng and Noonan (2012) suggested several areas to which counselors should attend when considering the internationalization of counseling. They noted that international collaborations across fields, agencies, and countries regarding training and services should be equal partnerships. Given this guideline, when countries seek consultation from outside counselors, these foreign counselors should learn what systems are currently in place in that country as far as national counseling organizations or other non-governmental organizations (NGOs) that are currently providing services for the country’s citizens. These organizations can provide insight into the mental health issues of most concern in their country as well as be potential places for counseling service delivery. Another example of this type of collaboration would be international internships or training opportunities. As a specific example, one of the authors participated in an institute for which 12 counselors were invited to Bhutan through NBCC-I in order to collaborate with schools, a psychiatric hospital, a women’s center, university counseling centers, and substance abuse service providers. During this collaboration, the U.S. counselors shared information on mental health issues such as substance abuse and domestic violence, counseling skills, and counseling programs, yet the decisions on how specifically to implement programs in their culture remains in the hands of the Bhutanese counseling leaders. The counselors also spent time learning the government’s mental health provider system and other NGO’s that were interested in collaborating on how to provide counseling services. Starting Fall 2012, counselors from the U.S. will return for a semester at a time to continue this partnership.

Ng and Noonan (2012) also recommended the theoretical foundation of counseling should have a global framework that accounts for culture and is broadened to avoid implementing “culture-specific mental health intervention models” (p. 11). As scholars have become more mindful of our Western-based practices and how they have a potential global impact, the authors believe counselors have the responsibility to not only be flexible enough to challenge personal assumptions, but maintain a willingness to learn and adapt from their international neighbors. As counselors also become more aware of the structural impact of marginalized populations and call out for a social justice and advocacy perspective, they have the obligation to widen their lens to include not only the systems of our community, but the connected world as a whole.

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Sonya Lorelle, NCC, is an Adjunct Professor at the University of North Carolina at Charlotte. Rebekah Byrd is an Assistant Professor at East Tennessee State University. Stephanie Crockett is an Assistant Professor at Oakland University. Correspondence can be addressed to Sonya Lorelle, Department of Counseling, University of North Carolina at Charlotte, 9201 University City Blvd., Charlotte, NC 28223, sonyalorelle@hotmail.com.

Addiction Counseling Accreditation: CACREP’s Role in Solidifying the Counseling Profession

Oct 6, 2014 | Article, Volume 2 - Issue 2

W. Bryce Hagedorn, Jack R. Culbreth, Craig S. Cashwell

In this article, the authors discuss the Council for Accreditation of Counseling and Related Educational Programs’ (CACREP) role in furthering the specialty of addiction counseling. After sharing a brief history and the role of counselor certification and licensure, the authors share the process whereby CACREP developed the first set of accreditation and educational standards specific to addiction counseling. The impact of CACREP on the practice of addiction counseling, quality control, and implications for the future are provided.

Keywords: addiction counseling, educational standards, CACREP accreditation, certification

Whereas counseling as a profession is relatively new (compared with the other helping professions of psychology, psychiatry, and social work), it has made great strides in a relatively short time. With the adoption of the 2009 Council for Accreditation of Counseling and Related Educational Programs (CACREP) Standards, changes in professional identity, specialty areas of practice, core curricular standards, clinical field experiences and measures of student learning outcomes likely will have long-reaching impacts on promoting the development of the counseling profession. One significant change in the 2009 CACREP Standards was the creation and inclusion of a set of specialty standards related to addiction counseling. Whereas individual standards related to the practice of addiction counseling have been around for many years (e.g., those of the National Board for Certified Counselors’ [NBCC] Master Addictions Counselor [MAC] certification), this is the first time that an accrediting body of the helping professions has both legitimized and standardized the preparation of counselors to work with clients struggling with addictive disorders. In this article, we explore the history of addiction counseling, as well as the development of the credentialing and certification processes related to addiction counseling. Next, we examine the need for educational standards related to addiction counseling and CACREP’s role in the development of these standards. Finally, we will conclude with potential implications and directions for future research.

A Brief History of Addiction Counseling

The prevalence and impacts of addictive disorders are well documented and provide a context for the rationale for the creation of an addiction counseling specialty. In terms of those affected by addiction, 22.6 million individuals struggle with chemical abuse or dependency (Substance Abuse and Mental Health Services Administration [SAMHSA], 2007), 14 to 26 million individuals suffer from an eating disorder (also known as food addiction) (APA, 2000; Hudson, Hiripi, & Pope, 2007), 6 to 9 million struggle with compulsive gambling (also known as gambling addiction) (APA, 2000), 17 to 37 million Americans meet criteria for sexual addiction (Carnes, 2001; Cooper, Delmonico, & Burg, 2000), and 17 to 41 million people are addicted to the Internet (Kaltiala-Heino, Lintonen, & Rimpelä, 2004). In considering the lower end of each range of these disorders, it becomes apparent that approximately one in four Americans struggle with some kind of addictive disorder; this number fails to account for those impacted vicariously (i.e., through the addiction of a family member or close friend). Given the noted prevalence figures, it should come as no surprise that research has shown that addictive disorders, and complications related to these disorders, have devastating impacts on individuals, families, and society (French, Roebuck, McLellan, & Sindelar, 2000; Goodman, 2001; National Institute on Drug Abuse [NIDA], 2004; National Opinion Research Council [NORC], 1999; Young, 1999). In fact, when one tallies the estimated costs and losses attributed to addictive disorders in the form of health care costs, job productivity losses, crime and punishment, mental health care, impacts on the children and partners of addicts, and monies spent on the pursuit of drugs, alcohol, and other behaviors, one conservative estimate puts the annual total at $1.1 trillion dollars (Juhnke & Hagedorn, 2006). Without a group of specially trained counselors, untreated addictive disorders will continue to perpetuate costs that many are unable to pay.

Those individuals who emerged to address the aforementioned concerns did not initially matriculate from graduate programs in the helping professions. In fact, no other counseling specialty has been more closely associated with its “recovering” clients than has the addiction field. The origins of addiction treatment come straight from what is referred to as the “lay therapy” movement of the early 1900s (White, 1999). Courtenay Baylor is considered by many to be the first lay therapist to be hired at the treatment clinic in which he was originally a client. His approach to developing a cadre of addiction treatment providers from individuals who had participated in the treatment process became the norm well into the 20th century and laid the groundwork for the concept of wounded healers (Jung, 1993; White 2000b). The wounded healer approach became a much stronger influence with the development of Alcoholics Anonymous in the 1930s. Many members of AA began developing clubhouses, “retreats” (known as halfway houses today), and treatment centers (White & Kurtz, 2008). Much of the motivation of AA members providing such services for alcoholics resulted from a general negligence toward these individuals by the medical and mental health communities (AA, 1976).

By 1950, paraprofessional helpers/lay therapists were firmly entrenched in the community of addiction treatment, with the pre-eminent model of treatment, the Minnesota Model, drawing heavily on professionals with no formal training in the helping professions (Fisher & Harrison, 2009; Libretto, Weil, Nemes, Copland-Linger, & Johansson, 2004). Following the adoption of the American Medical Association’s disease concept of addiction in 1967 (Merta, 2001), the latter half of the 20th century produced several additional steps in the treatment process for addicted clients. Formalized training programs were created by both the National Institute for Alcoholism and Alcohol Abuse (NIAAA) and the National Institute for Drug Abuse (NIDA) in the 1970s to create a group of professionals to work with addicted clients using the disease concept, in conjunction with the Minnesota Model, as the primary treatment approach (White, 2000a). Then, during the 1980s, a shift occurred where formally educated and trained professionals began entering the treatment realm, especially from the field of counseling. These individuals stood by their education and training, rather than their recovery status, as the basis for legitimately providing treatment (Hosie, West, & Mackey, 1988). What emerged was a blending of three distinct groups: minimally-educated paraprofessional helpers (with recovery as their entry point into the treatment community), master’s level counselors (without recovery status as their entry point), and a hybrid of the two: master’s level recovering counselors (Culbreth, 2000). The intersection of helpers entering the treatment arena from these three different perspectives, each with varying levels of experiences related to addiction, led to debates regarding what type of helper was best suited to work effectively with addicted clients—lay or professional helpers.

More recently, important developments in addiction treatment have evolved. For example, new treatment paradigms such as harm reduction and relapse prevention examine addiction from perspectives different from those perpetuated by earlier models (e.g., reducing negative impacts rather than solely focusing on abstinence) (Fisher & Harrison, 2009). Similarly, considering the challenges involved with the change process, Prochaska, DiClemente, and Norcross (1992) developed a stage model (the transtheoretical model of change) to examine the processes that occur in clients’ behaviors as they enter recovery while offering suggested strategies aimed at counseling them within and through each stage. Then, motivational interviewing was developed to help explore and resolve the ambivalence and resistance experienced by those entering recovery (Miller & Rollnick, 2002). Another major development, that of viewing addiction through the lens of dual diagnosis (or co-occurring disorders) has been a significant step in addressing clients with multiple mental health issues and needs. More recently, the recognition of a variety of process addictions (addictions to such things as sex, gambling, the Internet and gaming) has taken the concept of addiction to a different level, beyond the traditional scope of chemicals. Finally, there have been significant advances in psychopharmacological approaches to addiction, along with manualized treatment approaches from specific theoretical perspectives, such as Project MATCH (Merta, 2001).

All of the aforementioned developments have led to the need for a much higher level of training and education for professionals intent on working with addicted individuals. Relying solely on one’s recovery status can no longer adequately prepare a counselor to address the myriad of complex issues brought forward by today’s clients. More sophisticated and in-depth education and clinical training is needed to insure that addicted clients receive the most efficacious treatment possible—hence the purpose for the creation of addiction counseling accreditation standards. On the road toward the creation of such educational standards, the helping professions began seeking standardization through the establishment of formal credentials and licensing.

History of Addictions Credentialing

As noted earlier, addiction counselors traditionally entered the field from a great diversity of backgrounds. As a result, debates ensued as to what best qualified one to be an addiction counselor. White (1999) stated: “Because so many of the grass roots treatment models utilized people in recovery who often had more prior contact with penal institutions than educational institutions, the challenge was how to prepare and professionalize this indigenous workforce while blending it with a growing array of other professionals entering the field…” (p. 25). At that point in time, many addiction counselors had only their own sobriety as a qualification to provide treatment. Unfortunately, the term “counselor” often was used to refer to these paraprofessionals to distinguish them from trained and licensed mental health professionals (i.e., psychiatrists, psychologists, and social workers).

It was in this historical context that a small group founded the National Association of Alcoholism Counselors and Trainers (NAACT) in 1972. This group later evolved into the National Association of Alcoholism and Drug Abuse Counselors (NAADAC) (White, 2005). NAADAC enhanced the professionalism of addiction counselors by establishing ethical standards for addiction counselors, disseminating information via professional publications, and providing ongoing training and credentialing activities (White, 1999). At about the same time that NAADAC was moving forward, two events were unfolding that would further shape credentialing and training efforts. First, the Association for Counselor Education and Supervision introduced the first set of counselor preparation standards (Association for Counselor Education and Supervision, 1973). Ultimately, this led to the establishment of CACREP in 1981 to promote quality counselor preparation at the graduate level. Second, privatized certification boards began emerging at the state level (Mustaine, West, & Wyrick, 2003). A dynamic tension manifested within these state certification boards in regards to reluctance among some within the field to require formal graduate training. Into this mix, the National Board for Certified Counselors (NBCC), NAADAC, and the Commission for Rehabilitation Counselor Certification (CRCC) worked together to establish the Master Addictions Counselor (MAC) credential, a credential that provided addiction counselors with a uniform credential regardless of their original discipline (Juhnke, 2000).

Several rationales exist for the continued shift toward credentialing graduate-level clinicians. First, and most pointedly, researchers have found that effective counseling with addicted clients requires specialized training and that professional counselors trained in academic graduate programs are more effective than their less educated counterparts (Carroll, 2000). Whereas many clinicians have sought to fulfill state certification requirements through workshops or seminars, the certification requirements offered therein are typically based on the number of attendance hours and have little to no assessment of content knowledge or mastery (Mustaine, West, & Myrick, 2003). Another reason for credentialing master’s-level clinicians is that they are better prepared than their lay counterparts to meet the multiple needs of addicted clients (Sias, 2002). Lay practitioners are often solely trained to address issues of chemical abuse and dependence (Banken & McGovern, 1992; Taleff & Martin, 1996), and thus lack the fundamental knowledge and skills required of professional counselors to address concomitant needs beyond chemical abuse. With the growing recognition of the prevalence of co-occurring disorders among clients with addictive disorders, as well as the familial impacts of addiction, the need for trained mental health professionals to treat these concerns has become increasingly important (Merta, 2001; Schulte, Meier, Sterling, & Berry, 2010).

Third-party reimbursement requirements add a third reason for the lean toward graduate-level addiction counselors. Whereas state-based addiction counseling certification boards do not require a graduate degree, insurance companies have moved to such a requirement in order to receive reimbursement (Mustaine et al., 2003). A final reason for graduate-level counselors is provided by Mustaine et al., who noted that state-based addiction counseling certification boards have traditionally required no direct observation of addiction counselors by their supervisors (e.g,, through audiotape, videotape, transcript, or live observation). Accordingly, it is possible that all supervision can, in theory, be based upon supervisee self-report, a process known to be particularly problematic with novice supervisees (Campbell, 1994; Holloway, 1988; Muslin, Thurnblad, & Meschel, 1981). Given the potential for problems evolving from inadequately trained and supervised addiction paraprofessionals, the rationale for graduate training is clear.

Given the call by national certifying bodies (e.g., NBCC, NAADAC, CRCC) for more adequately prepared clinicians, individuals were faced with the choice between seeking such training through educational institutions or continuing to rely upon the seminar or self-education model. Unfortunately, many who sought such initial training through a graduate program in the helping professions found that the majority of such programs were woefully unprepared to deliver the necessary addiction-related content they required (Whittinghill, Carroll, & Morgan, 2004).

Establishing a Need for Educational Standards Related to Addiction Counseling

The need for a set of standardized educational requirements for addiction counseling is evident in light of the societal impacts of addictive disorders, the treatment complications engendered by co-occurring disorders, and the lack of standardized preparation standards for addiction counselors. There has been ongoing recognition within the counseling field of just such a need. For example, Morgan and Toloczko (1997) noted more than 14 years ago that trained and educated addiction professionals were needed to help combat the problems created by untreated addictions. Other studies have investigated the perceived need for training standards in addiction counseling among counselor educators (Whittinghill, Carroll, & Morgan, 2004), have identified curriculum components for graduate-level training of addiction counselors (Whittinghill, 2006), have examined the relationship between addiction training in counselor education programs and state licensure requirements (Mustaine, West, & Wyrick, 2003; Salyers, Ritchie, Cochrane, & Roseman, 2006), and have directly called for the inclusion of addiction counseling standards to meet the multiple needs of addicted clients (Hagedorn, 2006; 2007). Many authors have followed suit (Hagedorn & Young, 2011; Hagedorn, 2007; Horvatich & Wergin, 1998; Merta, 2001; Miller, Scarborough, Clark, Leonard, & Keziah, 2010; Robertson, 2006; Whittinghill, Carroll, & Morgan, 2004), noting the need for specialized educational standards not only for those who counsel addicted clients, but for all counselors regardless of their area of specialization.

Given the aforementioned needs, it is somewhat surprising how the helping professions have answered the call. In reviewing the professional preparation standards of the various accrediting bodies, it becomes apparent that standards specific to training students to work with addictive disorders have not been a focus. For example, the Council for Social Work Education (CSWE) does not have any specific accreditation standards for training social workers to address problems related to addiction (CSWE, 2010). Similarly, the standards of the American Psychological Association’s Commission on Accreditation (CoA) for professional psychology specifically states that program objectives for professional psychology should be “broad and general” (CoA, 2007, p. 2) in nature. To wit, practice areas described for professional psychologists include clinical psychology, counseling psychology, school psychology, and other areas of professional psychology, with no mention of an addiction practice area, nor any standards specified to psychological work with addicted clients (CoA, 2007). Whereas the Accreditation Council for Graduate Medical Education (ACGME) does have specific training standards for psychiatrists working with addicted patients, (a) all of those standards are specific to those programs that train addiction specialists (i.e., they are not for the general training of psychiatrists who see addicted clients in a variety of treatment settings) and (b) no standards include any reference to process addictions (ACGME, 2003).

Given the lack of other professions’ preparation standards specific to working with addicted clients, how has counseling faired? CACREP has made efforts at establishing minimal educational standards related to addiction counseling (such as those found in the 2001 CACREP Standards), yet these were traditionally relegated to those graduate programs with a more clinical focus (e.g., mental health counselors). Thus, students matriculating from other specialties (e.g., school counseling, marriage and family counseling, etc.) have continued to be unprepared. Even when research and clinical practice have indicated the treatment complications produced by the co-morbidity and coincidence of addiction with just about every other presenting concern (e.g., relational difficulties, depression and anxiety, unemployment, school truancy and behavioral problems, impacts of abuse/neglect, domestic violence, low self-esteem, career indecision, legal concerns) (Burrow-Sanchez, Lopez, & Slagle, 2008; Davis, Flett, & Besser, 2002; Fergusson & Boden, 2008; Florida Council on Compulsive Gambling, 2004; Hussong, Galloway, & Feagans, 2005; Ohlmeier, et al., 2008), there has continued to be a lack of training across the helping disciplines (e.g., social work and psychology) and across specialty areas within counseling itself (e.g., school counseling, marriage and family counseling, student affairs and college counseling, career counseling).

There may be several reasons why those entities that set the educational standards for their professions have been reluctant to create a set of specialty standards and/or to mandate the inclusion of core curricular experiences related to addictions. Whereas a full discussion of these reasons is beyond the scope of this article (for a detailed description, see Hagedorn, 2009c), some reasons may include (a) the lack of established diagnostic criteria for disorders related to behaviors or processes (e.g., sex, the Internet, gaming); (b) the lack of consensus as to the interconnectedness of addiction and other presenting concerns; and/or (c) the belief that addictions, and the problems they cause, are the treatment responsibility of those who have traditionally been prepared to address them. In response to these areas of potential “push back” from some in the field, there is evidence in the professional literature that (a) diagnostic criteria for process addictions are on their way into the treatment community, (b) the research shows a clear connection between addiction and other concerns, and (c) addiction, and its associated problems, will impact all clinicians regardless of their scope of practice (Hagedorn, 2009c; Kafka, 2010; Robertson, 2006).

Potentially, an additional reason why accrediting bodies may have steered clear of establishing addiction-related standards across the curriculum may be the belief that those who work with addicted clients (and/or those affected by addicted individuals) will obtain the necessary competencies through on-the-job training or through training seminars, workshops, and professional conferences. As noted earlier, the problem with such expectations is that (a) this necessitates that counselors be proactive and motivated to seek out such opportunities, (b) credit for such endeavors is granted by simple attendance at such events (rather than as a result of a formal evaluation of knowledge and/or skills as would be found in an educational institution), (c) there is no way to determine the accuracy, timeliness, or quality of the content presented by such delivery methods, and (d) not all counselors will attend the same seminar, resulting in a variety of competency levels (Hagedorn, 2009b; Mustaine, West, & Wyrick, 2003). Clearly, a more standardized delivery method will result in more comparably trained counselors to work with those people impacted by addictive disorders.

Having set the stage for the historical need for educational standards related to counseling those impacted by addictive disorders, we now turn to the direct impact that CACREP has had on the emergence of such standards. Beginning with an introduction to the atmosphere that precipitated the creation of these standards, we will follow with a description of the procedures undertaken by CACREP to ensure the integrity and quality of the creation and revision processes. We then conclude with a brief review of the implications of these standards for the counseling profession and a call for empirical research to substantiate the impacts of a trained and prepared cadre of professional counselors on the lives of addicted clients and their families.

The Impact of CACREP on the Practice of Addiction Counseling

In moving forward with the development of the 2009 CACREP Standards, the CACREP Board (“the Board”) and the CACREP Standards Revision Committee (SRC; a committee external to the Board, charged with overseeing the revision process and presenting standards for consideration and adoption by the Board) were very intentional about maintaining those procedures dedicated to the highest quality of output while remaining open to its constituents. Preserving a transparent agenda, the SRC and the Board began the revision process with a scan of the counselor education horizon as it related specifically to the addiction counseling standards.

Watching the Horizon

Four factors helped trigger the decision to proceed with the drafting of a specific set of addiction counseling standards. First, as noted earlier, there had been a consistent call from the counseling literature for CACREP to establish a set of standards related to addiction counseling (Diaz, 2008; Hagedorn, 2009c; Morgan & Toloczko, 1997; Salyers, Ritchie, Cochrane, & Roseman, 2006; Whittinghill, 2006; Whittinghill, Carroll, & Morgan, 2004). Second, on a national scope, two events were occurring: (a) states continued to move toward the mandate of a master’s degree for addiction counselors and (b) there were a number of non-accredited addiction counseling programs that existed alongside CACREP-accredited programs in community or mental health counseling (Hagedorn, 2006; Salyers, et al., 2006). Third, the International Association of Addiction and Offender Counselors (IAAOC) had commissioned an Addiction Standards Committee (ASC) with the task of drafting a set of addiction counseling standards. Members of the ARC included David Whittinghill, Gerald Juhnke, and Kenneth Coll, the three of whom drafted the initial set of addiction counseling standards. These were later reviewed and modified by ARC members Rick Gressard and W. Bryce Hagedorn. Finally, the CACREP standards themselves were poised for their regular seven-year revision process. Given the confluence of these events, the time seemed ripe to determine if the Standards accurately reflected the current type of work done by counselors in all realms of practice, as well as for the inclusion of content specifically related to addiction counseling.

Quality Control

Since an exploration of all aspects related to the development of the 2009 CACREP Standards is beyond the scope of this article, our focus will be on a quick review of the processes that occurred related to the addiction counseling standards. Activities to solicit feedback, including solicitations via the Internet (cacrep.org, acesonline.net), in print (e.g., the CACREP Connection, Counseling Today), and in person (e.g., the American Counseling Association [ACA] National Conference, the Association for Counselor Education and Supervision [ACES] National Conference, and the regional ACES conferences, among others) occurred following the national distribution of each of the three drafts of the proposed 2009 Standards. The initial call for input from the field, particularly as it related to the area of addiction counseling, was answered by the IAAOC Board in January of 2006, who presented the work of the Addiction Standards Committee to the CACREP Board and the SRC for consideration.

Formal work by the SRC began earlier the preceding year, with focus given to the writing of addiction counseling standards beginning in 2006 (after receiving the suggested IAAOC standards). Based upon the CACREP Board’s review of the counseling literature and the initial input of constituents, the Board charged the SRC with two related responsibilities: create a set of addiction counseling specialty standards and infuse content related to addiction into the core curricular standards (thus introducing such content into the preparation of all counseling students). Pending feedback received from the various drafts disseminated to the public, the SRC adjusted this charge as it deemed necessary.

In the drafting of the CACREP standards related to addiction counseling, the SRC gathered the timeliest, most relevant, and most well-documented sources available. These sources included (a) the IAAOC Addiction Standards; (b) the 1998/2005 Technical Assistance Publication (TAP) Series #21 titled Addiction counseling competencies: The knowledge, skills, and attitudes of professional practice (Center for Substance Abuse Treatment, 2006); (c) standards related to NAADAC’s National Certified Addictions Counselor credential; and, (d) standards related to NBCC’s Master Addictions Counselor credential. In the first disseminated revision of the 2009 Standards, the SRC initially integrated addiction content into the CACREP standards for the new and soon-to-be designated Clinical Mental Health Counseling specialty. In receiving feedback from the counseling field, the SRC returned to work and redesigned a specialty area dedicated specifically to addiction counseling. During the gathering of feedback based upon the second and final drafts of the Standards, CACREP’s constituents provided only favorable comments about the new specialty area. Then, as a response both to the literature (e.g., Armstrong, Phillips, & Saling, 2000; Hagedorn, 2009c; Goodman, 2001; Merta, 2001; Potenza, Fiellin, Heninger, Rounsaville, & Mazure, 2002; Young, 1999) and the field calling for more inclusive terminology to describe the complex nature of addiction counseling, language found in the Standards related to substance use disorders (SUDs) and/or chemical abuse/dependence was broadened and substituted with the term “addictive disorder,” as this was determined to be the most encompassing designation.

The final set of events germane to the current discussion involved the infusion of content related to addiction counseling into the core curricular standards. The SRC (and the resulting feedback from constituents) agreed that the most obvious fit would be in the curricular standards related to human growth and development (Standard II.G.3.g.). This resulted in required curricular experiences related to the “theories and etiology of addictions and addictive behaviors, including strategies for prevention, intervention, and treatment” (CACREP, 2008, p. 11). Whereas this may seem like a minor adjustment to the core curriculum, the fact that all future CACREP-educated counselors would be exposed to information regarding the impacts of addictions and addictive behaviors, as well as the necessary prevention, intervention, and treatment methods, may well have long standing and positive impacts on the counseling profession. We explore additional potential implications below.
Implications and Directions for Future Research

Whereas it may be too early to measure the direct implications of the aforementioned processes on the delivery of counselor education (and the resulting influence on those affected by addictive disorders), it is important to note here that three important and interrelated elements occurred in the adoption of the 2009 CACREP Standards. First, among the helping professions, CACREP became the first accrediting body to formally establish a set of national educational standards related to addiction counseling. Whereas psychiatry may have a specialty in addiction medicine, the fact that social work and psychology have no such specialty puts counseling at the forefront of providing direct care to the millions impacted by addictive disorders. Future research that investigates such things as the impact of the counseling profession itself (e.g., in comparison with other professions) on the provision of therapeutic services for addicted clients would thus be in order.

Second, in noting the interconnectedness of addictions with other client concerns, CACREP became the first accrediting organization that strongly advocated for the inclusion of addiction-related content knowledge for all students, regardless of their scope of practice. The importance of this change cannot be understated: the fact that all future counselors will be at least minimally prepared to recognize the origins of addictive disorders (i.e. etiology) as well as be able to implement prevention, intervention, and treatment strategies is significant. The counseling profession is poised to deliver the crucial front-line interventions to struggling clients in all arenas.

CACREP took a bold professional stance by recognizing that addictions occur outside the context of chemical dependency: this is the final paradigm shift ushered in by the 2009 standards. By (a) broadening the terminology used in the 2001 Standards (which was specific to substance abuse) and including language related to addictive disorders, addictive behaviors, and process addictions, as well as (b) providing glossary definitions for process addictions (those related to addictions like gambling, shopping, eating, and sex), the counseling profession is potentially the forerunner of a new form of treatment delivery. This truly represents a monumental step toward preparing competent clinicians to work with those impacted by disorders that other accrediting bodies and even the medical community have been slow (some may say “careful”) to officially recognize. As future clients make decisions about from whom they will seek treatment, they will choose the most qualified clinicians; changes such as those mentioned here only solidify their choice of a counselor.

In noting the aforementioned decisions induced by the adoption of the 2009 Standards, several implications for future research become evident. First, it will be important to investigate the various impacts of the creation of specialty standards related to addiction counseling on students, graduates, clients, client families, addiction counseling delivery systems, third party reimbursement strategies, and even policy development. Second, similar systems could be evaluated (e.g., students, clients, policy development) following the establishment of a counseling workforce that has been adequately prepared to prevent, intervene and treat addiction-related problems wherever they arise, be it in schools, hospitals, clinics, vocational settings, families or universities.

A final implication of the 2009 standards is best framed as a question: What might occur as a result of a profession officially recognizing and advocating for clients whose struggles and concerns have traditionally been left outside of the treatment realm (e.g., sexual addiction, gaming addiction, etc.)? The potential implications on a societal level could be quite remarkable. For example, studies could compare the effectiveness of those clinical mental health counselors trained to recognize the impacts of sexual addiction with those without such training; this may have the potential of lowering sex-related offenses if clients are identified and treated earlier in their addictive cycle before they offend. Marriage and family counselors also could be investigated related to how well they identify family dysfunction and debt-related concerns as a result of addressing a member’s spending addiction. Finally, studies might pursue the impact of school counselors prepared to identify and address gaming addiction on their students’ academic achievement and lowered behavioral referrals.

To conclude, the authors contend that the shared focus, determination and alliance among the CACREP Board, the SRC members, and the involved constituents will help strengthen the counseling profession and help it to forge ahead into the 21st century. More specifically, we believe that the work accomplished by the standard revision process related specifically to addiction counseling will help place counseling at the pinnacle of the helping professions and look forward to witnessing its impacts on future students and the clients they serve.

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W. Bryce Hagedorn, NCC, is an Associate Professor at the University of Central Florida. Jack R. Culbreth, NCC, is an Associate Professor at the University of North Carolina at Charlotte. Craig S. Cashwell, NCC, is a Professor at the University of North Carolina at Greensboro. Correspondence can be addressed to W. Bryce Hagedorn, University of Central Florida, College of Education ED 322C, Orlando, FL 32816-1250, Bryce.Hagedorn@ucf.edu.