Module 1: The Counseling Relationship
Introduction
"Helping People with disabilities to go to work"
-Delaware Division of Vocational Rehabilitation
Above is the motto of the Delaware Division of Vocational Rehabilitation (DVR). In a simple statement the value of work is highlighted, the consumer is defined as primary (note the capital P in People) and the counselor’s role is emphasized. Yes, we are helping professionals. The word choice is intentional. As workers in the rehabilitation profession we use person first language. We do not say “disabled people” or call an individual a “schizophrenic.” Instead the individual is put first and the disability afterward. Remember, we do not want to define any person, including ourselves, by a limitation. Instead, terms such as individual with a disability, person with schizophrenia and individual who uses a wheelchair are employed (refer to People First Language handout for additional information on this). Now, returning to the definition, to say that we are helping, excludes any interpretations that we may be seen as either demanding or passive. We do not presume to know what is best for our clients, nor do we assume they are fully informed of their occupational possibilities. The rehabilitation professional maintains a collaborative role to guide and facilitate the best possible plans alongside the client. This is primarily done through the development of the counseling relationship, which we will discuss in this section.
Let’s go further now and take a look at the DVR mission statement: “Our mission is to provide opportunities and resources to eligible individuals with disabilities, leading to success in employment and independent living.” This definition again highlights the counselor and client roles while delineating the dual goals of success in employment and independent living. First, as rehabilitation counselors, we value work. Work is not only valuable as a means to economic and sociological equality. Work is a therapeutic factor in itself. As Nietzsche states, “He who has a strong enough why can bear almost any how.” To parallel this with what we do in the rehabilitation field, if we assist individuals in creating purpose and meaning through their jobs (the why/purpose in life), there is much they are able to achieve and overcome (the hows of life). Second, we value independent living. This is a concept directly tied with work insofar as economic independence fosters community independence. This is a process aimed at eliminating barriers. Some barriers may lie with the individual’s perceptions of their world. However, most of these barriers exist at the attitudinal level in society.
Moving away from the values at the organizational level to the individual level, the rehabilitation counselor’s role is defined as being, “committed to facilitating the personal, social, and economic independence of individuals with disabilities.” In fulfilling this commitment, rehabilitation counselors recognize the diversity of our clients and embrace a multicultural approach in support of the worth, dignity, potential, and uniqueness of people within their individualized context. They look to professional values as an important way of living out an ethical commitment. The primary values that serve as a foundation for this process are:
- Respecting human rights and dignity
- Ensuring the integrity of all professional relationships
- Alleviating personal distress and suffering
- Enhancing the quality of professional knowledge and its application to increase professional and personal effectiveness
- Appreciating the diversity of human experience and culture
- Striving for the fair and adequate provision of rehabilitation services”
(Commission on Rehabilitation Counselor Certification (CRCC),
Currently the CRCC ethical code is the highest standard of practice that rehabilitation counselors adhere to. It maintains that not only counselors must uphold the highest duties of equality, justice, integrity and care for their clients, it emphasizes that counselors pursue a path of continuous renewal through education and ethical development. Some of the most recent emphases in competent counseling practice are the improvement of cultural competency and understanding individuals within an ecological or environmental context (see Multicultural Counseling handout).
Based on your personal background, you may already have some idea as to how to uphold these standards. The purpose of this remaining module along with the rest of the training series is to allow you to become comfortable with the standards above. This will not be achieved overnight nor is the expectation for you to memorize this series of training. The intent is to allow you to have the freedom to question these concepts, gain a basis of understanding and practice the vocational rehabilitation process and values in multiple contexts. Feel free to question and comment on any concepts you need clarification on. As part of the training experience, you will be meeting with many different rehabilitation professionals who are here to guide and assist. The Division of Vocational Rehabilitation welcomes you as a new employee and endeavors to make your experience fun, challenging and, above all, meaningful!
Counseling Style
“Eclecticism is the word. Like a jazz musician who creates his own style out of the styles around him, I play by ear.”
-Ralph Ellison
The first question to answer is: “Does counseling style matter?” And the answer to that is, it does and it doesn’t. Where counseling style does not appear to matter is in terms of your theoretical background. For instance, based on current research, it does not appear to matter whether you believe your client’s anxiety is due to internal conflicts from the individual’s youth or due to faulty perceptions. For that matter, it does not appear to matter that you choose to work with a client on discussing their past versus assisting them in correcting their faulty automatic thoughts. What do appear to matter are the general factors tied to the therapeutic relationship. These factors are eclectic and flexible. They borrow and cut across disciplines in the helping professions. These are highlighted in a recent article by McMahon and colleagues (see Common Factors handout) in which a handful of common factors were distilled as being essential to the counseling process. The message to take away from this article is that effectiveness in counseling is not tied to any single theoretical approach. Instead, effectiveness in counseling is related to an overarching set of counseling techniques that are the basis for creating a healthy relationship with anyone. Primarily, these factors are related to the counselor and client establishing a basis for understanding one another, in addition to the belief that each party is of value during the rehabilitation process. So, whether one adheres to existentialism, cognitive-behavioral or Rogerian modes of operation, it is of less significance than having the essential skills of reflective listening, being able to challenge clients, problem solving and collaborative planning (see Skilled Helper handouts).
The second essential question is, “which styles work best with certain clients and within the VR framework?” Before we proceed with discussion of therapeutic styles I must make a cautionary note. *If a counseling approach does not adhere to your personal style: Do Not Force it Upon the Client. In other words, please take what you want and leave the rest. The task of being genuine with our clients is just as important as any other factor. To return to this question, as evidenced by the counseling literature, there are indeed specific theoretical models that have proven to be more effective with specific populations. For example, there is a strong body of literature that supports cognitive behavioral therapies for depression, generalized anxiety disorder, drug abuse, anorexia and obsessive-compulsive disorder. However, this question is inextricably linked to the second part of the question: what works best within the VR process? Within vocational rehabilitation, it is unlikely that a counselor will be able to utilize cognitive behavioral therapy, at the recommended 1-2 sessions per week, as caseloads often fluctuate between 100-200 consumers. Therefore, in many instances it is beneficial for the counselor and client to seek outside services for presenting conditions. However, it is still necessary for the counselor to be aware of empirically supported therapies. An educated referral for the best type of treatment for a client is linked to both consumer and counselor success. This topic will be covered in more detail in the upcoming chapters as we review medical and psychopathological conditions.
Setting and Maintaining the Ground
“Meanings are not determined by situations, but we determine ourselves by the meanings we give to situations.”
-Alfred Adler
Now, you may be asking yourself, “So what type of counseling will I get to do with my clients?” The answer is that you will be free to draw from the variety of proven techniques and brief therapies, using them as you best see fit to guide the VR process. Therefore, there will be nothing set in stone that says you cannot try utilize some cognitive behavioral techniques, some motivational techniques and some Adlerian techniques. You are free to be eclectic and will probably remain more enthusiastic about your work if you choose to draw from the variety of dynamic, effective therapies.
The key to creating your approach will be discerning what will be most efficacious within certain time constraints. It is well established today that the collaborative spirit is established within the initial meeting with the client. Therefore, it is seen as best practice by most counselors that the greatest concentration of skills, resources and time be dedicated to the first session. A specific technique that has established itself as most efficacious during initial sessions and within a limited time frame is Motivational Interviewing (MI). MI was developed by a psychologist and medical doctor to address the issue of client adherence to therapeutic/medical regimens (Please review the background sections at: and review the Quick Guide to Motivational Interviewing). Currently, research has indicated that MI is just as effective as any other validated therapy in treatment retention, treatment adherence and staff perceived motivation. MI’s effectiveness has been demonstrated to emerge quickly and have lasting effects, though there is currently more research needed in the realm of long term follow up studies (Hettema, Steele and Miller, 2004).
Following the establishment of the counseling relationship, other techniques may need to be employed to maintain efficacy and begin planning. It is within these later sessions that it would be in your best interest to draw from the wide array of therapeutic techniques that match best with your personality. For instance, if a client comes in and states that they are having trouble going to training because they keep thinking that they are worthless or “what’s the point?”, you may decide to draw from cognitive behavioral therapies and discuss self defeating thoughts with your client, or give them a homework assignment to write these cognitive distortions down and come back with reasons why their thoughts are faulty.
Inextricably tied to the discussion of counseling styles, there is the question of “What does not work?” First, as a counselor, we need to take into consideration the client’s presenting circumstances and characteristics. To return to the example above, if you are working with a client with a diagnosis of an educable mental disability, and a learning disability in writing, you would not want to utilize abstract cognitive elaboration or homework assignments that involve writing. In this case, you may want to do some role-playing with the client and face to face rehearsal instead. Consideration for the client is always primary. It is this focus, in addition to your own desire for education that will help you in creating your own approach to counseling. Beyond this, there should also be consideration for what has NOT proven itself as effective in the counseling literature. First, strictly talk therapies, those of the heyday of Freudian psychoanalysis, have minimal standing in the counseling community as being effective. This is not to say that talk therapy cannot be a part of your counseling repertoire. It is simply that talk therapy without the use of other strategies has little validity. A multimodal or holistic approach is currently seen as most effective. Holistic approaches focus not only on the client’s thoughts and feelings but also on behaviors, cultural characteristics, environmental and societal conditions. Also, rigid, demanding and confrontational approaches have proven themselves to be of limited efficacy. Instead, friendly, collaborative and open approaches to counseling are demonstrated as being far superior.
It is important that we make another cautionary note: There will be difficult clients no matter how considerate you are at times. We must remember that we are working with people and people are often not at their best when they are coming to see us. It is a normal experience within counseling to experience conflict and frustration. Again, it will be important that you have a self care plan in place (will be discussed in Module 8) and a knowledge of conflict resolution strategies (see Working with Difficult People handout).
To reiterate, it is important to have your own style that you feel comfortable with. You should never force a style upon a client that does not feel natural. Second, you want to have consideration for what works and what doesn’t in current practice and within the rehabilitation framework. This will be accomplished not only through continuing to educate yourself on counseling strategies, but through the feedback you receive in your sessions with the clients. Third, the client is always first. No matter which style you decide to use, be considerate of the person you are meeting with. Last, as always, do not be afraid to ask questions. Your colleagues and supervisors will have suggestions regarding the many different approaches that you can employ as a vocational rehabilitation counselor.