Counseling Practice and Development

What is Counseling?

Professional counseling as we know it today emerged from more than a century of professionalization and advocacy efforts. Kaplan and colleagues (2014) completed a Delphi study of 29 prominent experts in the field of professional counseling to create a consensus definition of counseling. The Delphi method was developed in the 1940s as a systematic means of gathering expert opinions about complex issues that currently have no verifiable, evidenced-based solutions. Completed in two iterative rounds of survey, the authors produced a consensus definition of counseling accepted by the expert delegates:

Counseling is a professional relationship that empowers diverse individuals, families, and groups to accomplish mental health, wellness, education, and career goals.

Included in this reproduction of various artifacts created and gathered from my doctoral program, as well as reflections on my process of practicing counseling, my personal theory and approach to counseling is presented.

IV. Counseling

a. Scholarly examination of theories relevant to counseling
b. Integration of theories relevant to counseling
c. Conceptualization of clients from multiple theoretical perspectives
d. Evidence-based counseling practices
e. Methods for evaluating counseling effectiveness
f. Ethical and culturally relevant counseling in multiple settings

artifacts IV.A,B - Theories of psychotherapy in clinical applications

Counseling professional identity (CPI) has been linked to a counselor’s theoretical orientation and their methodology as each is consistent with their personal values. An organization known as the Council for Accreditation of Counseling and Related Educational Programs (CACREP) has sought to unify the understanding and teaching of these values throughout counselor education. Similarly, professional organizations like the American Counseling Association regularly publish standards, competencies and ethical guidelines to maintain the highest standard of best-practice ethical behavior. The present work seeks to articulate the development and current practice of the author as is relevant to CPI, CACREP and the ACA.

artifacts IV.b,c,f - Case conceptualization in professional counseling

Case conceptualization has been identified as a core competency area for professional counselors (Sperry & Sperry, 2020). As a core competency for general practice, the council for the accreditation of counseling and related education programs (CACREP) doctoral standards insists that “conceptualization(s) of clients from multiple theoretical perspectives” are taught and demonstrated throughout doctoral curriculum (CACREP, 6.B.1.c). Seeking to demonstrate competence in this standard, the present work includes two conceptualizations for clients M and T, including demographics, presenting problem(s) and their history, behavioral impressions, biopsychosocial history, formal and informal diagnoses, and client impressions. Additionally, a trauma-informed treatment plan is presented including a theoretical approach, ethical and multicultural considerations, and assessment information.

While case conceptualization has been recognized with such high importance in professional counseling, current scholarship consistently suggests that a consensus definition be established that includes an integrative approach of theory and technique while maintaining the identity roots of professional counseling in holistic wellness (Hansen, 2022; Ohrt et al., 2019; Moe et al., 2012; Ridley et al., 2017; Sung & Skovholt, 2019). The present work seeks to support this effort towards a consensus definition in highlighting a grounded holistic wellness approach that integrates theory and technique.

artifacts IV.b,d - Evidence-based practice

As a professional counselor, I utilized a triarchic approach of evidence-based practice based in Pragmatic Psychodynamic Psychotherapy (Summers & Barber, 2010):

  1. Mental life involves ongoing conflict and compromise formation. Behavior is multiply determined.

  2. Mental processes - affect, cognition, drives - operate in parallel.

  3. Behavior is determined by thoughts and feelings and in turn shapes thought and feelings.

  4. Traumatic experiences in the past pregifure later perceptions and experience. Traumatic scenarios are repeated.

  5. There is an interweaving of dynamic factors with biological, psychological, and social factors in wellness and in the development, maintenance, and resolution of psychopathology.

  6. Change occurs in therapeutic relationship with increase self-awareness and insight, emotional reexperiencing, specific empathic attunement between patient and therapist, and development of alternative perceptions and new behaviors.

Working with a high trauma population and practicing in an agency that is known for utilizing EMDR, the questions is not what therapy we are going to use but which part of EMDR are we going to use and when. EMDR has been incorporated in more than 20 randomized clinical studies comparing its effectiveness to treatment as usual in working with trauma (PTSD in particular) and has been found to be at least as effective as treatment as usual (Bisson et al., 2013; Watts et al., 2013). While only a category five (indicating a good-intervention and bad-theory-driven psychotherapy) treatment in David et al.’s (2018) evidence based practice framework, EMDR is still recognized as an effective treatment for patients with PTSD by organizations like the Department of Veterans Affairs & Department of Defense (2017) and the World Health Organization (2013).

Aside from its clinical effectiveness, EMDR is also a supportive therapy for clients in that it sticks to an eight phase treatment model: 1) client history; 2) preparation; 3) assessment; 4) desensitization; 5) installation; 6) body scan; 7) closure; and 8) reevaluation and use of the EMDR therapy standard three-pronged protocol.

Structure and Phases of Treatment

EMDR utilizes eight phases to guide the structure and intention of the treatment plan but the number of sessions devoted to each session are variable depending on client readiness and where the intentions of the therapeutic alliance rest. Shapiro (2018) underscores the intention of each phase as it pertains to the goal of EMDR in working with traumatized individuals.

Phase One. Client history relevant to the presenting issue is taken in phase one. This of course is amended by the biopsychosocial and spiritual assessments I conduct in my practice to gain a further understanding of the client’s life. Relevant to reprocessing traumatic memory, history taking is more so interested in identifying targets or traumatic experiences as they will become the focus of phases four through seven. Additionally, I often switch this phase with phase two out of an effort to be more sensitive to a trauma informed mode of conducting therapy – the recounting of the most overwhelming events a person has gone through isn’t the best way to begin a relationship, not to mention the risk of retraumitization in trauma processing (Roberge et al., 2019).

Phase Two. Preparation is intended to install need resources where the therapeutic alliance discovered strength deficits in going through the client’s history. Perhaps this looks like a belief that no one loves them – in this case, a nurturing internal resource could be useful in reminding the client of the feeling of being nurtured and loved so as to help them tolerate and move through the pain of affective dysregulation.

Phase Three. In the assessment phase of EMDR, the effectiveness of treatment as it pertains to the targets chosen is discussed so as to prepare the client for post-session continued processing. Unlike a cross cutting measure which measure a symptom presentation, EMDR assessment focuses on subjective units of distress (SUD) and validity of cognition (VOC) to map and measure the client’s current disturbance as it relates to the presenting issue.

Phase Four. Desensitization focuses on inhabiting the painful/traumatic/overwhelming experiences with the strength and support of the first three phases with the intention of bringing the SUD down and making space for new insight.

Phase Five. Immediately following desensitization, installation focuses on strengthening this new sense of the experience and what role the individual plays in it – this is measured by an increased VOC around a positive cognition such as “I’m able to take care of myself” instead of the original “I’m helpless” belief.

Phase Six. Scanning through the body for residual tension and unprocessed trauma, phase six makes space for further desensitization of the client’s SUD rating and continued installation of their VOC rating.

Phase Seven. Usually found at the close of a reprocessing session, closure is about assessing the effects of the first six phases on the disturbing memory and what role the newly integrated information is playing in the client’s life. This sets up the therapeutic alliance to take another pass along the target memory selection sheet.

Phase Eight. After phases one through seven have been complete, the therapeutic alliance is ready to begin the reevaluation phase which is to assess the disturbance of other localized trauma networks in the brain for continued reprocessing. Given that within EMDR there exists active assessment of current client progress (measured by the SUD and VOC rating) and that completed treatment is only made possible through the clearing of these trauma networks, EMDR functions very well in evaluating client progress.

Conducting Outcomes Assessment

Built into the eight-phase model of EMDR, outcomes assessment function in the eighth phase of reevaluation. Only once the identified trauma networks have been cleared can the therapeutic alliance complete their care – prior to this, the oscillation between phases four through seven and eight is perpetual and mutually intended. If any cross-cutting measure were utilized to further understand the diagnostic features relevant to the case, this would be a relevant place to readminister to illustrate continued increase of functioning and steady decrease in maladaptive symptomology. Additionally, these measures will be both practical and useful in assessing the need and content of an after-care plan.

After Care Planning

Separating from the therapeutic alliance has been found to be one of the more difficult experiences in psychotherapy (Yalom & Leszcz, 2005). In this reality, follow-up and after care planning becomes an essential task of the therapeutic alliance (Toivonen et al., 2020). The termination process is something that’s mutually discussed across the therapeutic alliance in my practice and I’m sure to tell my client’s that it’s their decision and that after we terminate care, they’re more than welcome to contact me should they ever need another appointment. Depending on their current situation, I’ve also referred them to other local resources here in the city where I have my practice.

With each individual I work with, my main goal is that they feel seen, heard and helped. No matter what they come in with or what they’re going through, that’s my main goal. Along this process, my understanding of the client I’m working with is a living idea and therefor subject to change based on our interaction. Because of this, a thorough case conceptualization is a delicate, intentional and crucially important component of effective professional counseling.

Alongside my professional academic career, I have also collaborated with other experts in the field of EMDR therapy to produce the Notice That podcast, an EMDR specific podcast.

artifacts IV.d,e - Evaluation of counseling

Evaluation in professional counseling practice and education traverses a subjective and objective spectrum making necessary a holistic conceptualization of effectiveness, maturity, strengths, and relevant growth areas specific to one’s developmental stage (Borders & Brown, 2005; Scott et al., 2014a). Growth plans can be an effective and practical way for counselors to honestly reflect on relative weaknesses and strengths and implement tangible and actionable commitments toward their own professional and personal development (Scott et al., 2014b). Additionally, evaluation of counseling skills is specifically required in doctoral programs accredited through the counsel for accreditation of counseling and related educational programs (CACREP, 2016, 6.b.1.e; 6.b.2.f; 6.b.2.i). Seeking to demonstrate competency in these doctoral standard areas, the present work includes a self-evaluation of the author’s counseling skills with specific reflection on strengths and weaknesses, methods of increasing self-awareness, and an action plan for self-growth.

Reflections

My doctoral journey has profoundly deepened my appreciation for the transformative potential of the therapeutic relationship in counseling. Through coursework and practicum experiences, I have refined my skills, enhancing my ability to embody therapeutic presence and effectively apply intervention strategies. This process has not only sharpened my practical skills but has also reinforced my commitment to my own continuous development as both a practitioner and a counselor educator.

As a professional counselor, I anchor my practice in the belief that hope and change are omnipresent forces within the therapeutic context. My clinical focus involves a dynamic and introspective approach to practice, where I consistently evaluate and refine my strengths and areas for growth. My guiding intention in therapy is to meet clients where they are—this involves creating an environment where they feel safe, seen, soothed, and secure, and ultimately, empowering them to envision and pursue an authentic life. This therapeutic approach, while deeply rewarding, also presents challenges, particularly when it's difficult to establish a connection or manage the external chaos that clients bring into the therapy room. My commitment to lifelong learning is driven by my dedication to navigate these challenges effectively and to support both my clients and myself in the journey toward transformation and authenticity.

Incorporating holistic wellness into professional counseling, where we encounter, embrace, and empower the mind, body, emotion, cognition, and spirit, is fundamental to my practice and educational philosophy. This orientation not only enriches my approach as a counselor but also shapes my identity as a counselor educator. It supports the creation of an inclusive space that accommodates both faith-based and non-faith-based perspectives, enhancing the relevance and accessibility of counseling interventions.

As a counselor educator, my focus on holistic wellness extends to how I teach and mentor future counselors. It involves guiding them to appreciate and integrate this holistic perspective into their own practices, ensuring they are equipped to handle the diverse needs of their clients. This approach is also crucial in my role as an educator because it allows me to model how counselors can use their own personal and professional self-awareness to enrich the therapeutic relationships they cultivate.

Moreover, holistic wellness encourages an ongoing assessment of the diversity within ourselves, our clients, and the relationships we co-create. As I continue to develop my counselor educator identity, I emphasize the importance of reflective practice, not only to enhance therapeutic efficacy but also to foster an educational environment that encourages personal growth, empathy, and a deep respect for the complexities of human experience. This philosophy underpins my commitment to nurturing a new generation of counselors who are thoughtful, compassionate, and well-prepared to contribute positively to their communities and the field of mental health.

references

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