TPC Journal-Vol 9- Issue 4-FULL ISSUE

398 The Professional Counselor | Volume 9, Issue 4 cognitive processes (Wolff & Holmes, 2011). Attitudes and perceptions toward groups of people vary depending on the labels ascribed to them (Szeto, Luong, & Dobson, 2013). For example, negative attitudes and perceptions exist when describing groups of people as “homeless” (Phelan, Link, Moore, & Stueve, 1997) and “fat” (Brochu & Esses, 2011) compared to “poor person” and “overweight,” respectively. Attitudes based on labels also influence rates of stigma for individuals receiving mental health services. Terms like “psycho,” “nuts,” and “crazy” may evoke feelings of danger and unpredictability about individuals with mental illness, ultimately contributing to increased rates of stigma (Szeto et al., 2013). The use of labels to define people has been found to increase attitudes and stigma in the medical, legal, counseling, and social professions (McCoy & DeCecco, 2011; McLindon & Harms, 2011; Russell, Mammen, & Russell, 2005). To avoid marginalizing clients by referring to them by their diagnoses (e.g., schizophrenics, borderlines, autistics), person-first language was developed to separate an individual’s identity from their clinical diagnosis, disability, or chronic condition (Granello & Gibbs, 2016). Person- first language asserts that a person diagnosed with autism should be identified as a “person with autism” rather than “an autistic.” Thus, counselors must avoid labels to minimize the stigmatization of clients, especially when those labels are perceived as pejorative (American Psychological Association, 2010). A study conducted by Granello and Gibbs (2016) sought to examine the influence of person-first language on attitudes of tolerance for people with mental illness. Undergraduate students ( n = 221), adults from a community sample ( n = 211), and professional counselors and counselors-in-training ( n = 269) were each given a measurement of tolerance. Tolerance was measured using the Community Attitudes Toward the Mentally Ill scale (Dear & Taylor, 1979), which measured four subscales of tolerance: Authoritarianism, Benevolence, Social Restrictiveness, and Community Mental Health Ideology (Dear & Taylor, 1979). These subscales respectively referred to participants’ views that people with mental illnesses need to be hospitalized; the belief that society should be sympathetic and kind to people with mental illnesses; the belief that people with mental illness are dangerous; and the belief that community-based mental health care is more beneficial than treatment in residential mental health care facilities (Dear & Taylor, 1979). Within each group, half of the participants received a tolerance measure that used the phrase “the mentally ill,” while the other half completed the same tolerance measure with the person-first language “people with mental illness.” The results of this study indicated that across all three groups, the measurement using “the mentally ill” yielded lower levels of the attitude of tolerance (Granello & Gibbs, 2016). These results indicate how attitudes are related to labels. Empathy Within the Counseling Setting In a meta-analysis of 224 studies examining empathy and outcomes in 3,599 clients, empathy was found to account for more outcome variance than specific treatment methods (Elliott, Bohart, Watson, & Greenberg, 2011). The results further indicated empathy was a medium-sized predictor of psychotherapy outcome across therapists’ theoretical orientation, treatment format, and severity of clients’ presenting concerns (Elliot et al., 2011). The results of these studies identified client-perceived therapist empathy as the strongest predictor of therapeutic outcomes. Clients, including sex trafficking survivors, who experience a therapeutic environment characterized by counselor empathy feel more deeply understood (Clark, 2010), which promotes treatment satisfaction, likelihood of compliance, and involvement in the treatment process (Bohart, Elliott, Greenberg, & Watson, 2002). These findings provide evidence for the significant role of empathy as a catalyst for client change regardless of a counselor’s theoretical orientation, treatment format, or severity of client issues (Bohart et al., 2002; Elliot et al., 2011; Imel, Wampold, Miller, & Fleming, 2008; Moyers & Miller, 2013; Watson, Steckley, & McMullen, 2014). Based on the complex, multi-systemic, and unique needs of sex