Search Results for: responsibility

accepting responsibility: shame, blame, guilt & resentment…

About three weeks ago I started the final segment of my educational journey: the internship.   In a series of three classes I have to complete a minimum of 700 hours over the course of approximately ten months. This will require a 60+ hour work week for almost a year.  I will continue to work full-time as a weekend night shift CNA in a float pool for large hospital system.  I will be adding 20+ hours of unpaid work as an intern at an inpatient treatment facility for recovering addicts.   As a wife and mother, this means I’m literally spending most of my waking hours in the service of others.

Keep in mind, a good majority of those I encounter will not appreciate my efforts, (and if they do, they don’t necessarily show it).
***Parenting a teen often involves being the bad guy as you set firm boundaries.
***Counseling individuals through recovery entails addressing varied levels of resistance.
***Working as a CNA requires you to provide care to individuals who often feel like crap.

I’m now in the third week of my first internship class and have finally settled into this new routine.    I’ve tried to hold onto the glimmer of hope that graduation will come sooner than I expect.  I continue to plan cautiously this new career path.  I registered for that big “exam” required for licensure. I’ve researched other internship placements that can provide experience in populations outside the addiction community.

However, as I muscle through each week, I find my mental health slipping from my grasp.

As a new student therapist, I’m running several groups on my own…

I spend approximately ten hours a week teaching subjects to residents in an inpatient treatment facility that I have little knowledge of.  Since the facility is redesigning the curriculum I’m told it’s my responsibility to come up with the subject materials myself.  I enjoy this part, but the experience of standing in front of class each day brings me back to speech class in 8th grade where my childhood bullies taunted me merciless throughout a presentation.  Despite my best efforts, my nerves always end up getting the better of me.

I conducted my first intake evaluations & individual sessions this week…

These experiences have had a perplexing effect upon me.  While appreciative of the learning opportunity a burgeoning ignorance wells up within.   As I learn more I feel I know less – if for no other reason than simply because I’m forced to face the breadth of my lack of knowledge.  More importantly,  book knowledge and interpersonal application are completely different things.   I have one but must work on developing the other.   I’ve come to an awareness that I really give to others based on who I am.

***All my efforts thus far have held a unique flavor that is very “Kathleen-like”.
***My life history and personality quirks are found throughout all l do.
***My preferred coping mechanisms (i.e. isolation & withdrawal) are not allowed.
***I must face my fears & allow others to see me fully – if I wish to succeed…

In this (& future) posts I’ve decided to share the material I’ve created for my therapy groups…

The subject matter often leaves me with much to reflect on personally. What follows is material I put together on blame, guilt, remorse & shame: concepts that all have potential to interfere with our efforts to creat lasting change.  If handled correctly they can also provide an impetus for a personal transformation.  Since this is a personal blog, I’m not sharing this information to educate or give advice.  I’m presenting it as information relevant to my life story personally….

Understanding Guilt…

Defined as a feeling if responsibility or remorse for some offense,  or wrong-doing it’s important to examine carefully how you handle it.  The following quote comes from a blog post I found online on the subject of guilt, shame, remorse, and recovery:

“Oftentimes addicts in recovery need a great deal of time before they can even begin to understand that they are not inherently defective, that it was their choices and not their true selves that caused their addiction & its related negative consequences. (, 2013)”

As this quote indicates, a monkey-wrench in the recovery process is a misinterpretation of guilt.   Interestingly, when replacing a few words, this quote applies to me as well:

[when healing from trauma], a great deal of time [is needed] before [I] can even begin to understand that  [I am] not inherently defective, that it was [my] choices and not [my] true [self]  that caused [the] … negative consequences. (, 2013)”
With this parallel clearly drawn, further contemplation is now in order: How is it I’ve managed to turn guilt into something else so self-destructive, (i.e. Resentment, Shame, or Blame)????

Misuse of guilt : shame, blame & resentment…

Unhealthy guilt carries a punitive vibe that allows us to play victim and avoid personal responsibility.  It prevents us from finding happiness in life by concealing the effective solutions to our problem.  For a convenient example, read my blog post on the “stages if change”, where I describe a four-year abusive relationship I endured while in college.  With the benefit of 20/20 hindsight, I see the clear logic in the obvious question, why did you stay so long!?!? (((I was too busy blaming others, shaming myself & resenting him)))).

When guilt is good….

Interestingly, guilt is not necessarily a bad thing (by itself).  It hast the potential to provide an impetus for lasting change.   Remorse – a characteristic of healthy guilt – encourages us to looking at past actions in order to understand their consequences.  This information has predictive value for our current decisions:  If I do “A”, then “B” is the result.  The key is in learning how to use guilt for purposes of growth.

What follows are insights on how to use guilt as an impetus for change.  
  1. Use your remorse to take a personal inventory of your life.

  2. Share your feelings of guilt & remorse with others (i.e. blog 🙂 )

  3. Examine the origins of your guilt, Is it rational or reasonable?

  4. Learn to forgive yourself & all involved.

  5. Avoid the blame, shame and/or resentment traps (See below).

  6. Change the behaviors that caused you to feel the guilt in the first place.

  7. Apologize where necessary & let go for the sake of inner peace.

  8. Commit to living in the present & moving forward.

guilt can also become healthy when misused:

As stated earlier, guilt can provide us with an understanding of how specific actions result in certain consequences.   This information, however can be misused when we focus on attributing responsibility for punitive purposes.  This punitive nature, causes us to focus on emotion instead of action.  We live in the past, rather than act in the present.  We are often blinded by a desire to complain about our problems.    Guilt becomes blame when we assign responsibility to others for the “bad thing that happened”.   In time, this blame can produce feelings of resentment.   Shame, in contrast, is the attribution of responsibility to oneself.  In time, they can produce feelings of resentment towards oneself.

when guilt becomes blame….


Blame usually involves assigning someone responsibility for the bad things that happened to you. Synonyms of blame include to condemn or accuse.  However justified we might be, it is worth noting that blame is often counterproductive.   In the short term, it allows us to escape elements of the truth which are often too painful to examine closely.  However, the price we pay in the long term is a huge well of unresolved hurt that pollutes all life decisions.   Blaming others has polluted my life with a crap-load of unresolved bullshit.  This tendency to blame misery on externalized factors has caused a lifetime of willful blindness us to even the simplest solutions.

There’s more than a grain of truth to the saying that we perpetuate what we deny.  So how did I overcome the blame that blinded me??? 

Step One – Identify your blame-laden complaints.

Listen to the words coming out of your mouth.  Start a blog and note the underlying patterns in the ways you tell your life story.  Or, if you don’t like writing, get an old digital camera and tape yourself, let the thoughts and feelings flow.  Set it aside for about a week or so, and view this video when you’re mind is clearer.  You’ll be surprised by what you say.   When you notice a blame-laden complaints that involve a sad victim-story, write them down.  Here’s a convenient example from a recent post in which I describe a minor misunderstanding between my sister and I that blew completely out of proportion….

“SHOULD I HAVE APOLOGIZED? if it means being made to feel I’m denying my reality – NO!!!. Sadly, I hate to say it but since you are all very ignorantly unaware of my reality that’s how the apology feels – to me.”

Step Two – State your complaints neutrally.

Think like Joe Friday says: “Just the facts ma’am”.  In other words, try restating your blame-laden complaining.  How might you objectively describe your concern?  The following example is a convenient neutral concern that takes any blame-laden language out of the above complaint.  It also includes a link to a post titled “Transactional Analysis… A Move Beyond Misunderstanding”, where I provide 20/20 hindsight into the “Anatomy of a Misunderstanding” post.   As I understand it now, this misunderstanding reflected larger issues pertaining to unmet needs in my childhood.

Perception is reality in the sense that the our life experiences become a fulcrum of understanding.  Nobody can truly know what it is like to live in our shoes.   

Step Three – List all contributing factors.

When you think about it, blame takes the focus off of you, and places it squarely upon others.  You can’t see effective solutions because you’re not looking at what actions you can take to create change.  Playing victim is good for the ego, but highly self-destructive.   Accepting responsibility and seeing the situation in full and complete detail has taken time as it pertains to the above examples.  My relationship with my sister has improved with time, and has required much work on my own part…..

I considered the alternatives: holding onto hurt or letting it go.

I came to realize that underlying our differences are two very different temperaments.  

I sought out the hidden lessons in this experiences & second chance opportunities

I started to work on my own healing through forgiveness.  

Resentment as a byproduct of blame…

Resentment is a bitter and angry indignation over unfair treatment or perceived wrongs.   It is the emotional cousin to blame-laden thinking.  Blame is a thought process that involves the attribution responsibility for our situation to the action of others.  Resentment results when you ruminate over this realization endlessly.  When you focus on it too much the anger can build and you can’t see further.  All you know is you hurt and they need to understand and pay.  Trust me when I tell you, resentment can eat you alive and leave you with nothing else.

It is for this reason that I believe that forgiveness is essential for healing, it is necessary in order to make room for the good stuff.  

When Guilt Becomes Shame….


As I mentioned earlier, guilt can be impetus for lasting change.  It has the potential to provide valuable and empowering insight.  However, when this insight is used to assign responsibilty for punitive purposes, it becomes highly self-destructive.  Blame is the attribution of guilt to external factors (i.e. people, events, situations).  It causes resentment.  In contrast, shame is the attribution of guilt to yourself with a punitive belief that “we are flawed and therefore unworthy of acceptance or belonging.” (Brown, 2010, p4).

  1. Shame is being rejected.

  2. Shame is feeling like an outsider.

  3. Shame is that part of yourself you hide.

  4. Shame is not belonging

Shame vs. Guilt….

Shame tells us we are bad. It is a useless emotion we are all susceptible to. Guilt tells us we have done something wrong and indicates a need for reparation?

  1. Shame = I am bad. It is about the person.

  2. Guilt = I have done something bad. It is a reaction to a person’s actions.

Shame vs. Humiliation…

Humiliation results from a situation of unequal power in which we are made to feel inferior or ashamed. Shame is a private matter. Humiliation is a public event.

  1. Shame = Is a byproduct of internalizing messages from others.

  2. Humiliation = is caused by messages from others which causes us to feel degraded.

Moving Beyond Shame….

Step One – Examining Our Shame Webs.

Shame is the consequence of our interactions with others – and society in general.  These interactions carry implicit messages of who we should be to in order to garner acceptance and belonging.  For the most part, these messages exist as unresolved expectations. The are a filter through which life experiences are examined and resolved.   With this in mind, there are several critical questions to ask yourself:

  1. What messages of perceived-worth underlie your feelings of shame?

  2. Can you describe these wanted and unwanted identities?

  3. Where do these messages of shame come from?

Step Two – Understanding the Consequences of Shame.

Shame is about fear of disconnection (Brene, 2010).  This fear of being ridiculed, diminished or ostracized can cause us to actively avoid situations that we associated with it.  However, by avoiding situations that make us feel shame, we end up re-living old messages from others about what and/or whom we should be.   Others from long ago in our past, tell us who we should be in the present whether we realize it or not.   The end result is a hamster-wheel life in which you can create no more of the same thing…

Step Three – Define Your Shame Triggers….

Individuals, who are highly resilient to shame, understand their shame triggers (Brene, 2010). These triggers reflect early messages of shame from our childhood.  For example, standing in front of my group therapy class produces heightened anxiety.  I recognize this as a byproduct of the implicit messages from peers in my speech class in 8th grade.   I feel shame and embarrassment, and want the attention focused away from me.  By acknowledging this, I am aware these emotions reflect past memories, and not the current situation.  With this in mind, ask yourself the following questions:

  1. How would you like for the world to see you?

  2. How would you hate for others to see you?

  3. How do these aspects of your self-image reflect messages you receive from others?

Shame & Belief Systems….

Shame is based on a system of belief about who we are in relation to others. This belief-system consists of a collectivity of messages about who we are. As belief system, the underlying concepts are matters of opinion and not fact.  Beliefs are opinions about how the world works & our place in it.  When we share these ideas with others, they become systems of belief.  When taken on blind faith they appear to function as objective truth.  In reality, they are simply shared systems of meaning that we support collectively as self-fulfilling prophecies with social consequences for violation.    The key to overcoming a system of belief based on messages associated with feelings of shame is in differentiating between facts and opinions….

You can change beliefs with facts but you cannot change facts with beliefs.  In other words, beliefs require a believer while facts exist independent of them.

For example, lets say you’re boiling noodles in a large dutch oven.  When they’re done you drain the noodles in a strainer.  The water goes down the drain and what remains are noodles.  Life functions like a strainer, it is the perfect reality filter.  Bullshit doesn’t hold water, and goes down the drain.  The noodles remaining are facts and/or consequences that go nowhere until you deal with them.  They are here to stay.  KNOW THE DIFFERENCE!!!

References… (2013, December, 9).  The ‘recovery value’ of shame, guilt and remorse (part one). [blog post]  Retrieved from:
Brown, B. (2015). Shame Resilience Theory: A grounded theory study on women and shame. Families in Society. 87(1), 43-48.


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MCC 662 – Play Therapy

In therapy, we give to others based on who we are, and not what we know.  Landreth, (2002), asserts this is especially true for when working with children.   Creating a therapeutic atmosphere, displays of personal courage, and self-understanding, are important for therapists when working with children (Landreth, 2002).   Below, I describe each of these qualities and discuss areas in need of improvement.

Personal Assessment

Creating a Therapeutic Atmosphere.

The adult-child relationship that exists in the context of play therapy is unique in every child’s experience (Landreth, 2002).  Rarely experienced with adults, child therapists engage in a playful interaction that is not “verbally bound” (Landreth, 2002, p96).  Child therapists display a genuine sensitivity and interest in a child’s thoughts and feelings.  Landreth’s (2002) description of the respect and sensitivity required in play therapy, reminds of Marsha Linehan’s concept of emotional validation.  When a child’s perspective is met with validation, they allowed experience acceptance, understanding, and a sense of legitimacy (Linehan, 1997).  Rather than managing or correcting a client’s feelings, a child therapist should seek to respect the validity of this experience from the child’s viewpoint (Linehan, 1997).  The intentionality required to provide this therapeutic atmosphere, requires a great amount of awareness (Landreth, 2002).

When I consider all that is required to provide this therapeutic environment, there are several areas of improvement that come to mind.  As a mother, letting go of “mommy-mode” will be a challenge as I adopt the child therapist’s perspective.   The disciplinary and limit setting elements of motherhood would need to take a back seat.  Additionally, as someone who tends to process things verbally, letting go of this mode of interaction for a play-oriented one, would be a new experience for me.  One key strength I bring is an appreciation of validation, as a critical element in all therapy (Linehan, 1997).  I feel my current profession, has provided me many opportunities to develop this basic skill.

Personal Courage.

Landreth (2002), discusses several personality characteristics essential for a child therapist.  When reviewing these characteristics, I thought personal courage presented the biggest challenge for me personally.   Landreth (2002), describes it as a willingness to admit our mistakes and shortcomings (p102).  This concept is similar to Brene Brown’s (2006), notion of vulnerability which she defines as a willingness be truly seen by risking exposure.   This sort of personal courage goes against one’s natural psychological defenses against hurt or shame (Brown, 2006).  Acting as a child therapist out of personal courage requires a non-defensive expressiveness.  On the one hand, I do have much patience, and am fairly secure in acknowledging my shortcomings (Landreth, 2002).  These qualities can help me display personal courage in my interactions with children during therapy.  On the other hand, I do believe a high degree of self-awareness and mindfulness is required.  This requires an amount of self-care that is currently hard to sustain, as a night-shift worker.   Hopefully, with a different work schedule in my future career, this could be remedied somewhat.

Therapeutic Self-Understanding.

An awareness of our “motivations, blind spots, and biases” (Landreth, 2002, p103), is critical for any therapist.  As Landreth, (2002) notes, the values and ideals underlying these issues are integral to who we are, and we should be aware of them for this reason.  Since we give to others on the basis of who we are, it is our responsibility to understand how these issues can impede or promote our efforts.   While I do consider myself to be a highly self-aware individual as a lifelong self-help junkie, this quality still presents a challenge.  The idea that my personal motivations or biases could enter a play therapy setting makes me cringe somewhat. The best solution is to make personal growth and self-care is a priority.  This would allow me to gain a awareness of how I become an integral part of the therapeutic relationship so I can act more proactively.

Plan for Improvement

As I read through the above descriptions of three essential qualities, I realize  improvement is unlikely to occur overnight.   As a student therapist, I believe personal development should be an ongoing concern.  The following goals can help me develop these essential skills for working with children in therapy.

  1. Goal One: Seek Opportunities to Work with Children.   While this class can provide a vital foundation of knowledge to begin working with children, experience is essential.   I need to seek opportunities to work with children, in order to better understand how to be of a therapeutic benefit in this community.  This can include seeking work-related opportunities, volunteering, and choosing my internship placement carefully.
  2. Goal Two: Be Mindful of How You Respond to Others’ Emotions. The therapeutic environment child therapist’s seek to create provides clients with a unique respectful and validating experience.  Being mindful of how I choose to “attend” to the emotions and thoughts of all children in my life is a good start.  How do I take time to listen and acknowledged the grain of truth in my sons’ feelings and thoughts?  Do I rush to correct any misperception without listening?   Considerations such as these, can help me understand how realistically develop this unique way of relating to children and adolescents.
  3. Goal Three: Display Personal Courage in Conversations with Sons.  My oldest son is 15 and lately I’ve found the personal dynamic between us changing.  He is very bright and observant, and can at times bring up issues that touch upon my own mistakes and shortcomings.  While he doesn’t do so in a disrespectful way, I find I may react with occasional twinges of defensiveness.  I’ve currently practiced, the vulnerability that is integral to personal courage in these conversations.  This effort has taught me what Landreth (2002) says about how we give to children on the basis of who we are and not our internal knowledge bank.
  4. Goal Four: Journal Regularly & Seek Therapy As Needed.  Prior to entering this program, I had been in therapy for about five years.  I still remain in contact with my therapist, and as needed, I may still visit her from time to time throughout my career.  I believe self-understanding requires commitment in the form of adequate self-care coupled with time for reflection.  I enjoy journaling and blogging, and these efforts have provided great insight into myself.  I will continue doing these things in order to promote greater self-understanding in my new role as a therapist.


Landreth, G. (2002) Play therapy: The art of the relationship (3rd Ed.). New York, NY: Oxford University Press.

Linehan, M. (1997).  Validation and psychotherapy. Washington, D.C.: American Psychological Association.

Brown, B. (2006). Shame resilience theory: A grounded theory study on women and shame. Families in society: The journal of contemporary social services,87(1), 43-52.




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Studying for the NCE – Behavioral Therapies – A Closer Look

For the second part of this paper, an article will be reviewed that is titled: “Behavioral Couple Therapy:  Building a Secure Base for Therapeutic Integration” (Gurman, 2013).   This article begins with a historical overview of how individual and couples-oriented behavioral therapies have developed.  At the conclusion of this paper, are comments on how Integrative Behavioral Couple’s Therapy can help a practitioner provide a secure base for couples.

A Historical Perspective

n an effort to dispel a historically negative caricature of behavioral therapy Gurman (2013) provides a historical review of behavioral therapy’s course of development.  According to Gurman (2013), despite the historical distrust of this method, approximately 80% of all couple and family therapists now utilize it (p115).   Next is a review of Gurman’s (2013) description of behavioral therapy’s development and application.

Individual Behavioral Therapy

Behavioral therapy’s origins begin with Pavlov’s classical condition and Skinners operant conditioning models.  During individual behavioral therapy’s first wave of development in the 50’s and 60’s, efforts were being undertaken to address the deficits of psychoanalysis (Gurman, 2013).  The stimulus-response learning perspectives of early behavioral therapy were nonetheless criticized as emphasizing first-order changes and a mechanistic in orientation (Gurman, 2013).  Bandura’s social learning theory introduced behavioral therapy’s second wave of development (Gurman, 2013).  In an effort to address a wider range of difficulties, cognitive variables were incorporated with behavioral therapy methods.   Finally during behavioral therapy’s third wave of development cognitive behavioral approaches were applied to an ever increasingly range of issues.  The influences of eastern thought and Buddhist practices were then integrated into many third wave therapies, including Acceptance and Commitment Therapy, and DBT (Gurnman, 2013).  In reaction to the early first-wave behavioral therapies, these third wave CBT therapies emphasized a holistic perspective that considers the importance of context.

Behavioral Couple’s Therapy (BCT).

Interestingly, the development of Behavioral Couples Therapy (BCT) followed a similar path as its individualized variant.  During its first wave of development Gurnman, (2013) describes Operant-Interpersonal Treatment for Marital Discord (OMIT, and Traditional Behavioral Couple Therapy (TBCT).  OMIT, closely resembling early forms of individual behavioral therapy and focuses on each partner’s responsibility.  OMIT focuses on changing behavior with techniques that include techniques and marital token economies, and Quid Pro Quo Contracts (Gurnman, 2013).  TBCT, also a first wave couples behavioral therapy, includes a rewards vs. cost perspective.   Skill development became the focus for TBCT, based on the notion that “nastiness begets nastiness” (Gurnman, 2013, 119).   Since Gotmann’s research has confirmed the uselessness of these early interventions, BCT has developed well beyond its historical origins.

Cognitive-Behavioral Couple’s Therapy (CBCT) constitutes the second wave of BCT’s evolution and development (Gurnman, 2013).   With this perspective the emphasis on skills training was now considered too limiting.  Internal psychological process including automatic thoughts and schemas gained attention in BCT’s ongoing development.  Internal belief structures, and each partner’s attachment history, gained new attention through CBCT.

Integrative Behavioral Couple’s Therapy (IBCT)– The Third Wave

Gurnman, (2013) concludes his paper with a description of BCT’s third wave approach: Integrative Behavioral Couple’s Therapy.  IBCT is a unique form of behavioral therapy that appreciates individual differences and facilitates empathy (Gurnman, 2013).  Central to this approach is non-judgmental perspective in which a holistic analysis is given priority.  The context of a given situation, is important in understanding why behaviors and interactions persist.  In IBCT, context refers to “the term used for changeable steams of events that can exert an organizing influence on behavior” (Gurnman, 2013).  Understanding the function and purpose of behavioral patterns means examining context.  This requires a close examining of a early child experiences, attachment histories and recurrent core themes or patterns in a relationship.

Unlike the earlier forms of Behavioral Couple’s Therapy (BCT) in its third wave of development, insights have been incorporated to address effectively Gotmann’s perpetual problems (Gurnman, 2013).   Functional analysis is useful in explaining how the effects of context and the causal historical underpinnings of ongoing interpersonal relationship patterns.  Techniques and skills taught therapy, can provide a secure and safe place to discuss issue openly during a session.  For example, carefully wording one’s words, by using “I” to discuss one’s feelings and “it” to describe problems in a neutral third-part context are convenient examples (Gurnman, 2013).   Other unique interventions include tolerance-building, which involves a process of learning to find new experiential meaning in the midst of ongoing unsolvable conflicts.  This technique is quite intriguing since it reflects an insight of the Gottman’s regarding masters and disasters and how they take in life experiences.

IBCT – Providing a Secure Base

In conclusion, I would like to make a few comments on IBCT and its ability to provide a secure base during therapy (Gurnman, 2013).  While earlier versions of BCT involve interventions that involve directly modifying thoughts and behaviors, IBCT utilizes a new approach (Gurnman, 2013).  The goal in IBCT appears to involve linking individual experiences with relational ones in an order for the couple to understand each other better.  A mutual understanding of context, provides for the development of more adaptive interactions, and greater empathy.  As a result, alongside pragmatic behavioral changes, are deeper insights that allow partners to develop a greater appreciation for one another.

Underlying this transformation, I’m quite intrigued by how Gurnman (2013) describes the therapist’s role in this process.  As Gurnman (2013) states, rather than micromanaging clients’ behavior, the therapist is watching ongoing functional patterns throughout therapy, and allowing this to play-out.  Gurnman, (2013), describes therapists as barometers, who are wholly present, maintaining a non-defensive and mindful stance throughout sessions.   From this perspective, Gurnman (2013) states that the functional analysis is enriched with the underlying meaning and affective functions of behaviors.  By “wondering aloud” (Gurnman, 2013, p133), within a safe environment, the therapist can introduce these insights to couples in session.

Finally, Gurnman (2013) concludes his article with the following comment:  “The therapist’s emotional resonance to such implicit experiences can greatly facilitate the identification of controlling variables in the couple’s problem themes” (p133).   This insight reflects a comment by Dr. Heitler in the assigned “Angry Couple” video (Holland & Schein, 1995).  In this video, we see Dr. Heitler becoming frustrated at one point during therapy with this angry couple.  She uses this emotional reaction, as a way of understanding and facilitating the variables that underlying their ongoing conflicts (Holland & Scheiin, 1995).  I had great appreciation for how Dr. Heitler was able to remain present and non-defensive throughout this process.  She used this emotional reaction as a guidepost for her interventional techniques (Holland & Schein, 1995).


Gurman, A. S. (2013). Behavioral couple therapy: Building a secure base for therapeutic integration. Family Process, 52(1), 115-138. doi:10.1111/famp.12014
Holland, J. (Director & Schein, L. (Producer. (1995).  The Angry Couple [Video File]. Retrieved November 11, 2015, from The Collection.
Lebow, J. (2006, Sep). FROM RESEARCH TO PRACTICE, scoreboard for couples therapies. Psychotherapy Networker, 30 Retrieved from   ?accountid=28125

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NCE – Assessment Stuff (Midterm Review Notes???)


What are the five basic steps in the problem solving model: Pages 6-8

“Because performing an assessment is similar to engaging in problem solving, the five steps in a problem solving model can be used to describe a psychological assessment model.” (Page 6).

  1. Problem Orientation: stimulate counselors and clients to consider various examples….

    1. Instruments promoting self-awareness & self-exploration
    2. Group survey’s used to identify problems/concerns
  2. Problem Identification: Clarify the nature of a problem or issue

    1. Screening inventories or problem checklists assess the type and extent of client concerns
    2. Personal diaries and logs identify situations in which problems occur.  Personality inventories can help counselors understand personality dynamics in relationships and work.
  3. Generation of Alternatives: Suggest alternative solutions for a client’s problems, and help them view problem differently….

    1. Assessment interview used to determine what techniques have worked in the past to solve a problem…
    2. Checklists or inventories can also yield data that can be used to generate alternatives….
  4. Decision Making: Determine appropriate treatment for the client…

    1. Expectancy tables can show success rate of people with different types of scores or characteristics…
    2. Balance sheets or decision making grids enable clients to compare the desirability and feasibility of various alternatives
  5. Verification: evaluate the effectiveness of a particular solution:

    1. Readministration of tests
    2. Satisfaction surveys

The definition of an assessment procedure

  1. PURPOSE OF ASSESSMENT – (page 6) – “serve diagnostic purposes, help evaluate client progress and are useful in promoting awareness”

    1. Classification (program placement, screening and certification)
    2. Diagnosis and Treatment Planning
    3. Client self-knowledge
    4. Program evaluation
    5. Research to guide theory and technique development

    1. “Assessment is an umbrella term for the evaluation methods counselors use to better understand characteristics of people, places, and things….”(Morrison, page 4)
    2. Assessment is any systematic method of obtaining information from tests and other resources used to draw inferences about characteristics of people, objects, or programs” (Morrison, p4)
  3. EXAMPLE OF ASSESSMENT PROCEDURES: “standardized tests, rating scales, observations, interviews, classification techniques, records. (Morrison, p.4)

What makes a test standardized?

  1. Non-standardized Assessment Programs

    1. “Use self-ratings to help clients organize their thinking about themselves and various opportunities and include computer-based programs and career education workbooks.”
    2. “include rating scales, projective techniques, behavioral observations and biographical measures…(26) less reliable and valid…
  2. Standardized tests:

    1. Standardized tests must meet certain standards during the testing process. These standards include:
      1. Uniform procedures for test administration
      2. Objective scoring
      3. Use of representative groups for test interpretation.
    2. Most standardized tests have clear evidence of reliability/validity
    3. Standardized tests can include the following:
      1. Intelligence tests
      2. Ability tests
      3. Personality inventories
      4. Interest inventories
      5. Value inventories…
  3. “A test is said to be standardized when it has clearly specified procedures for administration and scoring, including normative data…” (page 117)

    1. test developer defines a target population for test use
    2. This target pop has an observable characteristic that varies and needs to be measured
    3. Then developer administer tests to the population to a sample
    4. This is administered in accordance with specific instructions
    5. Then developer provides descriptive statistics against which to compare results including measures of central tendency, standard deviation, and variability…

What is the difference between qualitative and quantitative assessments? What kind of information does each type yield? 

  1. Qualitative Assessments – Qualitative procedures provide a verbal description of a person’s behavior or situation and place the results in a category. More open-ended and adaptable in counseling…Collects data that does not lend itself to quantitative methods but rather to interpretive criteria (EXAMPLES)

    1. Nominal scales – does not possess magnitude, equal intervals or an absolute zero. Nominal scales provide descriptive criterion… Utilized to classify and name…
    2. Ordinal scales: Refers to the rank ordering of nominal categories..Likert scale responses are an example.  Can’t average or create a mean for these…with not zero or equal intervals…
  2. Quantitative Assessments – Quantitative procedures yield a specific score on continuous scale. They provide greater reliability and validity Collects data that can be analyzed using quantitative methods, i.e. numbers, statistical analysis

    1. Interval measures – possess magnitude and equal measures. You can add and subtract but not divide or multiply since there is no absolute zero.
    2. Ratio scales have magnitude, equal intervals, and an absolute zero. Can utilize all statistical techniques in this…

Measures of Central Tendency: the average score for a distribution of scores

  1. MEAN = the average, it is equal to the sum of the scores divided by the number of individuals in the group

  2. MEDIAN = middles core below which one half or 50% fall above and below

  3. MODE = the score that appears most frequently in a set of scores.

Know the normal curve and standard:

  1. MEASURES OF VARIABILITY: indicate the extent of individual differences around a measure of central tendency.

    1. RANGE – indicates distance between highest and lowest
    2. INTERQUARTILE RANGE: range around the median.
  2. STANDARD DEVIATION: most frequent measure of variability and represents a standardized number of units from a measure of central tendency.

    1. The larger the value, the greater the dispersion of scores and variability.
    2. Popular because basis for standard scores and helps represent scores accurately.
    3. Calculated by dividing the sum of squares from the sample size minus one and taking the square root of the value…
  3. NORMAL CURVE: In a perfect world and well-distributed set of scores around measures of central tendency would yield a bell curve.  (P110)

    1. The value of the standard deviation divides the raw score range into approximately six parts, with 3 above and 3 below the mean..
    2. Scores outside these 3 deviations above/below rare
      1. 34% of sample between the median and 1SD above
      2. 34% also occurs between median and 1SD below
      3. An additional 14% occurs between with SD above /below
  4. NO SKEWNESS – titling to one side

  5. NOT TOO MUCH KURTOSIS – narrow or broad (see SD’s above)

What are twelve broad factors of test user competencies? (page 44)

  1. Avoid errors in scoring and recording
  2. Refrain from labeling people with personally derogatory terms like dishonest on the basis of a test score that lacks perfect validity
  3. Keep scoring keys and test materials secure
  4. Seeing that every examinee follows directions
  5. Using settings for testing that allow optimal performance
  6. Refraining from coaching or training individual’s/groups on test items.
  7. Being willing to give interpretation and guidance to test takers in counseling situations
  8. Not making photocopies of copyrighted materials
  9. Refraining from using homemade answer sheets that do not align properly with scoring keys.
  10. Establishing rapport with examinees to obtain accurate scores
  11. Refraining from answer questions from test takers in greater detail than the test manual permits
  12. Not assuming that a norm for one job applies to a different job.

Explain what is meant by “grade equivalent”

  1. Utilized in educational assessments to compare a child’s scores against criterion-referenced scores that indicate how a child measures up against an expected level of performance according to either age related or grade reldated criteria…
  2. A grade equivalent (GE) score is described as both a growth score and a status score both. As is common with scores that can be used in both major categories GE do not do a very good job in either category. However, what GE does is indicate where a student’s test score falls along a continuum. The GE is expressed as a decimal number (4.8). The digit(s) to the left of the decimal represent the grade. The digit(s) to the right of the decimal represent the month. We assume 10 months per school year. The GE of a given raw score on any test indicates the grade level at which the typical student earns this raw score. For example, if a seventh grade student earned a GE of 8.4 her raw score is like the raw score the typical student would likely earn on the same test at the end of the fourth month of the eighth grade.

Types of Reliability

  1. Definition of Reliability – Definition of Reliability – how consistently a test measures and the extent to which it eliminates the chance of error. (Dependability/Reproducability)

    2. ERRORS CAN INCLUDE: (a) r/t individual; (b) r/t test itself; (c) r/t test conditions
  2. Test- Retest Reliability – Measures the consistency over time. The correlation coefficient in this case indicates the relationship between scores obtained by individuals within the same group in two administrations of the test (92)

  3. Alternate/Parallel Form – comparing consistency scores of individuals within the same group on two alternate but equivalent forms of the same test (92)

  4. Internal Consistency Measures of Reliability;

    1. Split-half Reliability – a popular form of establishing reliability because it can be obtained from a single administration by dividing the test into comparable halves and comparing the resulting scores for each individual (94)
      1. test cut in half
      2. compare results from each half
      3. Spearman-Brown Formula
    2. Interitem Consistency = is a measure of internal consistency that assesses the extent to which the items on a test are related to each other and to the final score.
  5. Interrater Reliability –refers to the degree of agreement of two or more independent judges of a test.

What does validity mean and what are the different types of validity?

  1. DEFINITION OF VALIDITY: – Whereas reliability is concerned with whether the instrument is a consistent measure, validity deals with the extent to which meaningful and appropriate inferences can be made from the instrument.  (Page 96) Does the measure what it intends to measure?

    1. Face validity – not really evidence of validity, is determined if the assessment ‘looks like’ it is measuring what it is supposed to measure.
      1. Content validity – representativeness of items from a population of items…do sample items represent/reflect all major components of the domain they are trying to measure.
      2. Criterion-Related – degree of prediction of a client’s performance on a criterion assessed at the same item (concurrent) or sometime in the future (predictive). …validity of evidence obtained by comparing test scores with performance on a criterion measure…(job satisfaction, grades, diagnosis, etc as comparison)
      3. Concurrent validity test score and criterion measure same time
      4. Predictive validity test score predicts results of future criterion measure given later…
    2. Construct Validity Are the test results related to the variables they ought to be related to and not related to the variables that they ought not be? Degree to which it is r/t theoretical construct
      1. Discriminant Validity – test scores do not correlate with tests that measure something different.
      2. Convergent Validity – correlation with tests and assessments that measure the same characteristics
    3. Treatment Validity – Do results from the test make a difference in terms of treatment?

Interpret the meaning of a correlation.

  1. Correlation and Reliability:

    1. Correlation statistic assesses the degree to which two measures are related. Each correlation coefficient contains two bits of information:
      1. The sign tells whether the two variables tend to rank individuals in the same (direct relationship) or reverse order (inverse relationship)
      2. The value indicates the strength of the relationship….
    2. PEARSON PRODUCT-MOMENT( r ) is the most common and can range from +1.00, indicating a perfect positive; through .00, not relationship; to -1.00 a perfect inverse relationship
  2. Standard reliability coefficients = usually run within a range of .80 to .95 but what is considered to be acceptable varies depending on the test circumstances and type of reliability…

Four models of helping and coping.

  1. COMPENSATORY MODEL – people are not responsible for problems but are responsible for solutions = NO BLAME
  2. MEDICAL MODEL – People not responsible for problems or solutions = VICTIM OF DISEASE
  3. ENLIGHTMENT MODEL – People are not responsible for solutions but are responsible for problems = UNDERSTANDING
  4. MORAL MODEL= people responsible for problems and solutions = ATTRIBUTION OF RESPONSIBILITY

What are some instruments frequently used by community mental health counselors?

  1. WHAT IS COMMUNITY MENTAL HEALTH COUNSELOR? ((say you learned about this a bit through your experience in the particum))

    1. Community counseling is a type of counseling that is used to help communities that are suffering from psychological or social discord, for one reason or another.
    2. Professionals in this field will often try to treat individuals in the community for whatever psychological problem that ails them.
    3. They will also attempt to prevent future problems as well….Community counselors attempt to solve widespread community problems that are social or psychological in nature. In order to do this, they will often work with individuals as well as a community as a whole.
    4. There may be a number of different problems that can plague individuals in dysfunctional communities. Many of these problems are often related. Community counselors will often speak with several individuals, offering guidance, therapy, and counseling. While trying to help these individuals overcome their challenges in life, though, a community counselor will also attempt to get to the root of the problem.

    1. Firstly, would need to figure out what is wrong with people that come and visit so they can determine what services they need.

      1. This would require an intake interview
      2. Mental status exam
      3. Inventories for assessing mental disorders:
        1. Psychiatric diagnostic screening questionnaire
        2. Patient health questionnaire (129)
      4. Consult DSM manual
    2. If they have a mental health or substance abuse problem they can utilize assessments to determine this. Examples can include the following:

      1. Substance abuse assessments
      2. Depression inventories
      3. ADHD test
      4. Anxiety and fear measures
      5. Self-injury assessments
    3. Also need survey’s occasionally, to determine how the community as a whole is from time to time. Can administer these survey’s and create data accordingly.

What ten topics should most intake interviews cover?

  1. General appearance and behavior
  2. Presenting problem
  3. History of current problem and related problems
  4. Present level of functioning in work, relationships, and leisure activities
  5. Use of alcohol or other drugs, including medications
  6. Family history of mental illness
  7. History of physical, sexual, or emotional abuse
  8. Risk factors including the urge to harm self/others
  9. Previous counseling
  10. Attitude of client towards the counseling process.

What should be included in a problem checklist in counseling?

  1. INTAKE FORMS – The intake form should be kept relatively short so that it does not become an imposition in counseling. As counseling progresses the form can be supplemented with additional questionnaires designed for particular issue, such as career planning, study skills, or relationships.

  2. SCREENING INVENTORIES: “counselors often utilize brief, self-report screening instruments to obtain a preliminary overview of a client’s concerns.” (123)

    1. INVENTORY OF COMMON PROBLEMS = Assess for the Nature and intensity of concerns (PAGE 126)
    2. SYMPTOM CHECK LIST-90-REVISED – Describes client’ s symptoms and severity of them…(compulsive, sensitivity, depressed, anxiety, hostile, phobic, paranoid, psychotic)
    3. Suicide risk assessment.

    How do clients differ when they enter counseling? Differences in the degree of openness and readiness for change

    1. Precontemplation – individual not aware of problems and has no intention to change behavior in the foreseeable future
    2. Contemplation – individuals are aware of their problems but have not made a serious commitment to do anything
    3. Preparation stage – individuals have begun to make small changes in their problematic behaviors with intention of making more changes in one month
    4. Action Stage – successfully changed their behavior for periods of time
    5. Maintenance Stage – goal is to maintain changes

What is the difference between Aptitude & Achievement? Give an example of each type.

  1. Assessment of aptitude is generally thought of as an ability to acquire a specific type of skill or knowledge; aptitude tests are typically used for prediction purposes. Academic and scholastic aptitude is related to education program evaluations and admission (SAT / ACD / GRE)
  2. Assessment of achievement attempts to measure what learning has taken place under a relatively standardized set of conditions or as a result of a controlled set of experiences. Designed to measure what has already been learned. Whereas aptitude r/t learning ability, achievement r/t what is known.  (TerraNova / Iowa Basic Skills)

What steps have been taken to make sure only competent users administer tests? What are the qualifications for purchasing tests? Competence in Testing: page 49

  1. Test Publisher set guidelines for level of competency that determines who is able to utilize a test….
  1. Professional associations also create their own ethical codes.
  2. States have their own guidelines
  3. Fair Access Coalition Testing

What are the guidelines for test interpretation –

  1. Tests are not used by others to make decisions for or against a client.
  2. Are to maintain confidentiality.
  3. Test users are to ensure that information is not misused by others.
    1. Is the person receiving info qualified to understand and interpret the information
    2. Should make sure interpreted in a way the person understands
  4. Clients have right to know and understand results.

What is the role of career assessment and what are the types of career assessment? What are the types and role of educational assessments? See page 202…

  1. Role of career assessment: to help clients explore both the process and content of career development. There uses of career assessments:

    1. Prediction – future career performance
    2. Discrimination – evaluate ability and interests
    3. Monitor – assess progress
    4. Evaluate – measure goals and how well met
  2. Types of career assessments:

    1. Career readiness assessments (maturity and adaptability)
    2. Assessment of an individual’s values, interests and aptitudes
    3. Educational and career planning

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NCE – Lifestyle & Career Development

Historical Overview

  1. Frank Parsons – In 1909 wrote book called “Choosing a Vocation”.
  2. 1911 Vocational Guidance Newsletter published.
  3. 1912 Hugo Munsterberg “Psychology & Industrial Efficiency”.
  4. 1917 Army Alpha & Army Beta used for assessing mental abilities.
  5. 1927 Strong Vocational Interest Blank.
  6. 1927 Elton Mayo & Harvard Study Hawethorne Works. Worker behavior study “Hawethorne Effect”
  7. 1939 DOT Book “Dictionary of Occupational Titles”
  8. 1941 Army Classification Test came along
  9. 1942 Counseling and Psychotherapy by Carl Ransom Rogers.
  10. 1957 Donald E Super “Psychology of Careers”.
  11. 1963 Ordin/Nachman/Siegel (?) Psychodynamic Career Counseling
  12. 1966 Krumboltz application of Skinnerian Principles in Career Counseling
  13. 1973 John O Kreitz career maturity inventory.

Career Counseling Theories


An Overview by ROSENTHAl (2005)

You match the worker and the environment. Should have matching traits in each.  Ultimate job occurs when an individual’s traits match the requirements and the characteristics of the job environment.
  1. Draw heavily on psychological testing “psychometric data”
  2. Construed as a one time decision where the right person & job
  3. Influenced and molded by the psychological testing movement.
  4. Differential diagnosis key here (i.e. what makes job bad)
  5. Studies indicate that different judges, form different opinions.
Key Figures
  1. E.G. Williamson –  how diagnose career decision
  2. Frank Parsons.
    1. Try to understand yourself in terms of interests, abilities, aptitudes, resources and other qualities.
    2. Know the requirement of various careers and conditions
    3. Use reason to determine compatability of the two.
    4. 1939 How to Counsel Students
    5. Some say, Minnesota Viewpoint is the only approach to general counseling
    6. 1941 Minnesota Occupational Rating Scales. Is a statistical tool to use to match students with jobs. Relied on probability that a certain match would be compatible.
    7. Emphasized vocational and educational concerns.
    8. Counselor is like a tutor, ultimate decision is left up to client.
    9. Critics – minimizes most important thing, client’s perception of self. This is ignoring.  Also ignores affective aspect

An Overview by Sharf, (2006)

  1. In 1909, Frank Parsons described his concept of vocational guidance in his book Chosing a Vocation. Became the foundation for Trait and Factor Theory…..
    1. Trait refers to a characteristics of an individual that can be measured through testing (i.e. Myers Briggs)
    2. Factor refers to the assessment of characteristics of the person and the job they are interested in.
  2. When selecting an occupation the individual should ideally have the following information:
    1. A clear understanding of yourself
    2. A knowledge of the requirements and conditions of success, advantages and disadvantages, compensation, opportunities, and prospects in different lines of work.
    3. True reasoning on the relations of these two groups of facts.
  3. Parson’s…century-old concepts have been embellished by integrating tests and occupational information with his precepts, described as follows:
    1. STEP ONE: GAINING SELF-UNDERSTANDING (attitudes, abilities, interests, ambitions, resources limitations and causes).
      1. Parson’s Interview on Self-Understanding – In parson’s time relied primarily on interviews and client discussion:
        1. Asked client what they enjoyed doing (interests)
        2. How well they did it (aptitude & achievement)
        3. As clients talked about aspects of their life that were important to them (personal values)
        4. The counselor then observed the client’s personality traits.
      2. Five basic traits and factors can be assessed by testing and interviewing are aptitudes, achievements, interests, values and personality.
        1. ACHIEVEMENT TESTS– real how much the person has learned (NESA testing)
          1. Include academic accomplishments ….
          2. Supervisory ratings of tasks completed.
          3. Certification for entry into a job.
        2. ABILITY TESTING– measures the maximum performance and a person’s level of present ability on a specific set of tasks.
        3. APTITUDE TEST– person’s future probable level of ability to perform a test. (SAT/ACT/ASVAB)….
        4. INTERESTS– often the most important trait used in occupational selection. Important to note, however that interests and abilities do not always correlate.
          1. KUDER Career Search –
          2. Strong Interest Inventory
          3. California Occupational Survey
        5. VALUES – Most often neglected. Should consider general values and work-related values.
        1. OCCUPATIONAL INFORMATION– 2ndIngredient of Trait and Factor Theory.Three Aspects of Information Important to Consider:
          1. Description of occupation, Work Conditions & Salary
          2. Classification Systems of Occupations.
          3. Know the trait and factor requirements for each occupation that a person is seriously considering.
        2. TYPES OF OCCUPATIONAL INFORMAITON –to gather information that describes occupations, the work conditions, and salary.
          1. Booklets by trade associations.
          2. Computer-based Information Systems / Websites
          3. Occupational Outlook Handbook.
          4. National Career Development Association
        3. CLASSIFICATION SYSTEMS– to organize information available on various occupation types.
          1. Holland’s Classification of occupations has six categories.
          2. Dictionary of Occupational Titles (DOT) 12,741 occupations
          3. ONET – Occupational Information Network – 1,170 occupations
            1. Worker Characteristics
            2. Worker Requirements
            3. Experience Requirements
            4. Occupational Requirements
              1. General work activities
              2. Organizational contexts
              3. Work contexts
            5. Occupational Specific Requirements – skills, knowledge, duties, machines, tools, and equipment.
            6. Occupational Characteristics – job opportunities and payscale….
        4. TRAIT & FACTOR REQUIREMENTS– occupational information related to client’s traits. Information on aptitudes, achievements, interests, values and personality is vital to consider….
          1. Strong Interest Inventory….
          2. ASVAB / SAT = Etc…
        1. Integrating information about oneself and occupations is a major goal of career counseling. The match between self and occupation is built into the first two steps of trait and factor theory.
          1. Firstly abilities/interests etc suggest occupations
          2. Secondly, researching occupations suggest optimal traits
        2. Inventories combining this information include SIG Plus and DISCOVER. Allow opportunity to measure interests, values, and self-reported competencies. Provide occupations that match this information.

Rogers never directly theorized this. These techniques focus on the client’s inner self and this opposes the trait-factor theory which deals with the outer self. (Rosenthal, 2005).  

  1. DIAGNOSIS – is unnecessary here and detriment here oftentimes.
  2. The problem is lack of congruence between self and experience.
  3. When occupational used only when client asks for it. Not volunteered.

“The function of the counselor is to provide the core conditions; the function of the client is to engage in self-exploration” (Freedman, 1990)

  1. THERAPIST’S ROLE:  “There are some basic core conditions for any kind of counseling or psychotherapy…First, you must understand your client. We call that empathic understanding…Second, you have to have respect for your client, not as someone who is poor and helpless, or just as someone who is an inadequate individual…The third element is genuineness…and there is a fourth element. That is, concreteness or specificity rather than generality. Specificity is important because one thing that many counselors tend to do is generalize. They tend to interpret, for example. Interpretation is a generalization on a higher level. In counseling and therapy you need to stick to the actual specific ideas and behaviors that the client has communicated and not try to classify them and give them high sounding psychological terms or psychological textbook names.” (Freedman, 1990)
  2. CLIENT’S ROLE – “In career counseling, it is important that clients do engage in self-exploration, in a spontaneous way, at their own rate, in their own way, without being constricted and forced to limit or explain themselves in the words of the counselor….the clients themselves involved in obtaining the information, because it is more meaningful if they have to work at it than if someone just lays it on them.”(Freedman, 1990)

career choice reflects an implementation of life-style; itinvolves putting the life-style into practice via one’s career (Watkins, 1984a).It is saying, &dquo;This is who I am,&dquo; &dquo;This is how I see myselfvis-a-vis others,&dquo;&dquo;This is how I see myself vis-a-vis the world at large.&dquo; For example, theperson whose life-style is oriented around helping and assisting othersmight gravitate toward such jobs as counseling, nursing, or some otherhelping profession.Thus, in coming to understand an individual’s life-style, we come tounderstand his or her life goal, attitudes toward self, others, and the worldat large, and how the life goal and attitudes actually get implemented.

Anne Rowe

One’s job serves as a major source of unconscious needs satisfaction. (psychoanalytic)Unconscious need resulted from early parent/child interaction Families are either person or non-person centered. This influences the careers we choose.  Anne Rowe describes two types of job categories….

  1. NON-PERSON – jobs without interpersonal dynamic
  2. PERSON – counseling

Abraham Maslow hierarchy of needs also explains the career process. Our career satisfies our current hierarchical leve.Uses information from humanistic needs theory in addition to psychoanalytic principle   Anne Rowe was the first career pioneer to create a 2 dimensional classification system to categories by fields and levels.

  1. FIELDS – service, business, organization, technology, outdoor, science, general culture, arts/entertainment
  2. CATEGORIZED – power of needs satisfaction (r/t things or people): Unskilled, Skilled, Semi-Skilled, Professional, Semi-professional, Managerial (1/2)
  3. Genetic factors, intelligence, education, and ability to handle responsibility also vital….

Edward  Bordin

  1. In 1955 wrote textbook Psychological Counseling
  2. Also Psychodynamic perspective of career counseling.
  3. Worked at Univ of Minn Counseling Bureau.
  4. Career choice resolves unconscious conflict.
  5. Difficulty choosing r/t neurotic system from this p.o.v.
  6. Drew on theory of Erickson & Otto Rank…
  7. Criticized for emphasizing internal factors and not focusing on external factors enough.
  8. A.A. Brill – Ego defense mechanisms (sublimation). Job provides socially acceptable outlet for an unconscious impulse.

John Holland – Modal Orientation.

A guy named John Holland believes that career choice and adjustment of a person’s personality type. People express themselves their interests and value through their work choices and experiences People’s impressions and generalizations about work are generally accurate…for this reason he assigns people work environments and categories.
  1. JOHN HOLLANDS SIX TYPES: Measure self-perceived competencies and interests (130)
      1. Vocational Preference Inventory
      2. Self-Directed Search (SDS)
      1. REALISTIC WORK ENVIRONMENTS– Makes physical demands on the individual and have tools/machines/animals that a person must manipulate or work with. Work with things is more important than the ability to work with things is more important than ability to interact with people. (EXAMPLES auto garages, construction sites or farms….)
        1. Enjoy using tools or machines in their hobbies or work.. They tend to seek to develop competencies in areas such as plumbing, roofing, electric, auto repair, farming and technical disciplines
        2. Have little tolerance for abstract theoretical descriptions and approach problems in a practical or problem-solving manner….
        3. They are likely to value money, power, and status while placing lesser value on human relationships (131)
          1. Resistant to expressing their feelings about their career choice and prefer to move directly to answer the problem of choosing a career.
          2. When discussing activities they enjoy, they are likely to enjoy talking about such activities as hunting, fishing and fixing cars.
          3. They are apt to discuss things they have done that show expertise in tools and discuss possessions such as cars, etc they can tinker with
      1. INVESTIGATIVE ENVIRONMENT: Require people to develop solutions to problems through mathematical and scientific interests. Encourages abstract thinking to solve problems creatively. (EXAMPLES include computer programmer, biologist, veterinarian, etc)… (132)
        1. Enjoys puzzles and challenges that require the utilization of intellect.
        2. Seek to work independently to solve problems such as mathematical or scientific questions.
        3. Favorite courses are chemistry, math, physics, geology…
        1. Enjoy the challenge of the unanswered question.
        2. Excited by a problem and want to work hard to find a solution, even though there are relatively little financial reward.
        3. When the career problem itself is seen as a challenge, they may feel better if they view the counselor as a fellow investigator rather than as an expert who is telling them what to do.
      1. ARTISTIC ENVIRONMENT– one that is free and open, encouraging creativity and personal expression….Offering freedom in developing products and answers….Allowed to dress as they wish, structure their own time, and keep few appointments. (EXAMPLES:freelance writer, fine artist, musician)
      2. ARTISTIC PERSONALITY– like opportunities expressing themselves in a free and unstructured way through art, music or writing. Originality and creativity are important.  (133)
        1. Clearly describe how art, music and writing is in their lives.
        2. Enjoy discussing the expression and development of an artistic product.
        3. Enjoy using humor and other methods of expression to show that they are unique….
      1. SOCIAL ENVIRONMENT –Encourages flexibility and understanding of others and the ideas of spirituality and social responsibility. Idealism, kindness, friendliness, and generosity are important here.  (EXAMPLES:teacher, counselor, psychiatrist, social service professions)
      2. SOCIAL PERSONALITY– interested in helping people through teaching, or providing personal services. Prefer to talk to and resolve complex problems that may be ethical or idealistic in nature.
        1. Altrustic in nature, are concerned with contributing a better world than with economic achievement for themselves.
        2. May good for counseling career, however frequently are too verbal, because they value talking, making it difficult for the counselor to assist them and other career group member
      1. ENTERPRISING ENVIRONMENT– People manage and persuade others to attain organizational or personal goals. Finance and economic issues are of prime importance.  People tend to be self-confident, sociable and assertive. Promotion, power and persuasion are critical (EXAMPLES:business management, real estate, politics, insurance, and lobbying)
      2. ENTERPRISING PERSONALITY TYPE – Acquisition of wealth is particularity important for enterprising people. They tend to be assertive and popular, tending to take leadership positions.
      3. ENTERPRISING BEHAVIOR: Enterprising people present themselves in a self-assured manner.  They may appear more self-concident than they feel… about their goal to accomplish wealth…value persuading others….
      1. CONVENTIONAL ENVIRONMENT– organization and planning oriented environment that involves record keeping, filing papers, coping materials and organizing reports.(EXAMPLES:bookkeeping, clerical jobs, etc).
      2. CONTENTIONAL PERSONALITY TYPE – Conventional personality is one who values money, being dependable, and the ability to follow rules and orders….They prefer controlling situations.
      3. BEHAVIOR OF CONVENTIONAL TYPES: Present themselves as organized, yet dependent on others for direction. Difficulty being open to new situations proud of organizational abilities
    8. COMBINATIONS OF TYPES – Resources including “The Occupational Finder” and “Strong Interest Inventory” utilize codes to stand for these types of jobs.  Page 136).
      1. Textbook suggests thinking in terms of the six Holland’s types….
      2. Discuss these types with the client and what is most interesting to them.=
    9. EXPLANATORY CONSTRUCTS – for Holland’s Types are important to discuss :
      1. CONGRUENCE– relationship between personality and the environment. The greater the congruence, the better.
      2. DIFFERENTIATION– both people and environments may differ in terms of how clearly they belong to one of several types. Holland determines this score by  subtracting lowest and highest scores
        1. Undifferentiated people have difficulty making career decisions and don’t have one solid preference they can think of.
        2. One goal of counseling is to help clients to differentiate and broaden their interests, abilities and values within these six types.
      3. CONSISTENCY: Refers to the degree of similarity/dissimilarity between types.  For example social and artistic are similar….
        1. Consistency in personality characteristics
        2. Consistency in aspiration…
        3. Consistency in environment.
      4. IDENTITY –Identity refers to the clarity and stability of a person’s current and future goals. It also refers to the stability of the working environment.  Measured by the my vocational situation form.
    1. Congruence is the most importance of Holland’s concepts and the one that is most widely research. Significantly related to job satisfaction.
    2. The personality inventory that is most frequently paired with Holland’s typology is the NEO five-factor model that assesses (extraversion, neuroticism, agreeableness, conscientiousness, ad openness to experience.
    3. THE ROLE OF ASSESSMENT INSTRUMENTS: inventories have two purposes in Holland’s system….
      1. PURPOSE #1:“Development of the Theory”… For example Vocational Preference Inventory is utilized to validate Holland’s Theory.
      2. PURPOSE #2: for individuals needing career assistance, to establish their personality type and what careers fit with it.  Examples of these assessment intruments


based his theory on the work of Henry Murray who developed a technique for an in-depth personality assessment in various dimensions: “Personology”. Led to formation of the Thematic Apperception Test, “TAT”.  Need & Press – terms explain the function of the personality
  1. Needs – needs of the person
  2. Press – needs of the environment
  3. They must match “Needs Press Hypothesis”.
A career is intended to satisfy and meet one’s needs and an occupation change may sometimes occur as needs change throughout the life span.
  1. Occupations are chosen to meet needs.
  2. The occupation that we choose is the one that we believe will best meet the needs that most concern us.
  3. Needs may be intellectually perceived, or they may be only vaguely felt as attractions which draw us in certain directions. In either case, they may influence choice.
  4. Career development begins when we first become aware that an occupation can help to meet our needs.
  5. Career development progresses and occupational choice improves as we become better able to anticipate how well a prospective occupation will meet our needs. Our capacity thus to anticipate depends upon our knowledge of ourselves, our knowledge of occupations, and our ability to think clearly.
  6. Information about ourselves affects occupational choice by helping us to recognize what we want and what we have to offer in exchange.
  7. Information about occupations affects occupational choice by helping us to discover the occupations that may meet our needs, what these occupations offer to us, and what they will demand of us.
  8. Job satisfaction depends upon the extent to which the job that we hold meets the needs that we feel it should meet. The degree of satisfaction is determined by the ratio between what we have and what we want.
  9.  Satisfaction can result from a job that meets our needs today, or from a job that promises to meet them in the future, or from a job that we think will help us to get the job we want.
  10. Occupational choice is always subject to change when we believe that a change will better meet our needs.

An Overview

Career choice is a process that occurs throughout the lifespan.  Major contributors come from many different fields.  Work is a reflection of who we are. Link up the personality with a matching occupation.  We gravitate and seek out others who work at the job have similar values We are attracted to skills that are in synch with our skills and knowledge of self.
  1. 1951 “Occupational Choice, An Approach to General Theory” – originally thought it was a one-time thing, and an irreversible thing.  He set this is not true
  2. 1972 “Toward a Theory of Occupational Choice, A Restatement” – began to feel that career choice didn’t end at 20, it is a lifelong thing. It is not irreversibility.  Not a matter of compromise but a matter of optimization.  We continue to improve our match between career and self throughout the life.
Donald Super – career development allows us to express our self-concept. Data from a career pattern study following a group of 9th grade boys into adulthood, a longitudinal study.
  1. Individuals implement their self-concepts into the career and it is a matter of self-expression.
  2. Life-Stage Structure – five vocational developmental stages.
    1. Stage one – Growth (birth – 14) person develops interests and needs related to the self-concept
    2. Stage two – Exploration (15-24) career choices are narrowed down.
    3. Stage three – Establishment (25-44) trials and stabilization.
    4. Stage four – Maintenance (45-64) adjusting to improve your work position and situation.
    5. Stage five – Decline (65 – beyond) working less pre-retirement and retirement.
  3. Are a developmental framework for the five activities “Super’s developmental tasks”. Aren’t linear but cyclical.
    1. Crystalization – (14-18) individual goes through cognitive process of picking a general area of interests and using resources to plan something.
    2. Specification – (18-21) the move from tentative choices to a specific career pick
    3. Implementation – (21-24) securing training and securing employment
    4. Stabilization – (24-35) actual work experience to determine of choice good
    5. Consolidation – (35 and beyond) establish yourself into a career through status, advancements, and security.
  4. Career Patterns –
    1. Conventional Pattern – Trying several and picking one.
    2. Multiple Trial Pattern – person hops from entry level position to entry level position.
    3. Unstable Pattern – lots and lots of jobs more than normal, but finally settle and make choice.
    4. Stable pattern – people highly skilled, and educated. Choice is permanent and may occur at a rather early age.
  5. John Kreitz – Career Maturity Inventory used heavily by followers of Donald Super’s Model.
  6. Super formulated concept of career rainbow. Average person plays nine life roles. These roles played at home, work, school, community.   The meshing of the nine roles and four theaters tell the story of one’s career a career pattern.  Individuals may play several roles simultaneously causing success/failure.
    1. The child
    2. The student
    3. The leisure-ite
    4. The citizen
    5. The worker
    6. The spouse
    7. The homemaker
    8. The parent
    9. The pensioner.
David Tidemann and Robert O-Harra – Developmental theorists anticipation stage and induction stage in decision-making with regard to careers. Holistic based on Erickson with regard to ego identity.  Took Super’s stages and added personal theory to it.
  1. Anticipation / Fantasy Stage – Exploration / Crystalization / Clarification Occur. Try to Imagine what it would be like to work in a particular career.
  2. Induction Stage – Reformation & integration. The self-concept and job expectations are modified.
Social Learning / Behavioristic
Sociological Theories – state that the person’s social culture and class can influence a person’s boundaries and expectations. Based on Bandura to explain career dynamics assumes that people are reinforced for tasks they perform well and will choose careers that they have been reinforced for in life.  Rely on site visits to jobs so the person can try out the job in person.   Do believe in genetics and innate tendencies but tend to focus on what can be worked with and not the genetics.  The trick is to expose the person to as many job possibilities as possible in order to find good learning experience.
    • Decision Approaches – Evolved from Economics and the law of mathematical probability. May classify Tideman’s as this possible.  Zeroes in on decision making rather than any other things.  Decision theories operate on notion that person coming for counseling has a number of viable alternatives already.  Values clarification exercises may be useful.  Personal values must be used to make a healthy decision.  When you make a choice you assume a given choice yields a specific outcome
    • Expectancy-X values – likelihood that a given act will be followed by a given outcome. Many have written about expectancy x values in career counseling
    • Bandura – Self-efficacy approach. Person’s believe regarding him/herself have great impact on outcome.
    • Gelatt Decision Model – information is the fuel of the decision. Three types of information required for decisions depend on which of three systems are operating.
    • Predictive System – fueled by alternatives and the probability of outcomes.
    • Valuing System – personal likes / dislikes / preferences.
    • Decision System – fueled by personal rules and information about priorities related to the two aforementioned systems.
    • Gelatt feels that mathematical game theory, used in economics will ultimately be utilized to counseling in a scientific way to help aid the decision procedures that are made in counseling.
    • Berglund – When making a sound decision one should find the problem, brainstorm alternatives, get necessary information, process the information, make plans, set goals, and then implement the plans and evaluate the effectiveness.
    • Pitts & Herron – all decision dilemmas have four elements to assessed: (1) objectives; (2) choices; (3) outcomes; (4) assessments
Resources for Career counselors
    1. OOH – Updated q2 years. 250 occupations listed.  90% of high schools utilize this “Occupational Outlook Handbook”.  Has information on requirements; conditions; availability of jobs; earnings; and related occupations.  Helps predict economic trends in future and job employment opportunities.  Can be accessed online.
    2. DOT – Dictionary of Occupational Titles. Multivolume guide with 30,000 titles.  Acquainting with huge variety of jobs with nine-digit code.
    3. GOE – Guide for Occupational Exploration – Groups jobs according to one’s interests, abilities and traits. It tells you how these best fit a given job.  Companion guide to the DOT.
    4. O’NET – O’Net Online. Occupational Information Network. Will replace the DOT.  Has over 950 occupations, classified by the standard occupation classification (SOC) System.  O’Net has 275 standardized descriptors of skills, knowledge, tasks, occupational requirements, work abilities, interests, and values to help employers create accurate job descriptions.  All people can use for various reasons.
    5. Discover 2 / Choice / Sigi+ – interactive guidance systems. Can access information and data very quickly.
    6. Spillover – life satisfaction and job satisfaction are very closely related. Spillover effect says that the feelings of one bleed or spill over into the other.
    7. Compensatory Effect – hypothesizes that we compensate for poor job satisfaction by trying to achieve high life satisfaction.


Freeman, S. C. (1990). CH Patterson on client‐centered career counseling: An interview. The Career Development Quarterly, 38(4), 291-301.
Rosenthal, H. (2005). Vital information and review questions for the NCE and state counseling exams. Routledge
Sharf R.S. (2006). Applying career development theory to counseling. 6th Ed. Belmont CA:  Thomson.
Watkins Jr, C. E. (1993). Psychodynamic career assessment: An Adlerian perspective. Journal of Career Assessment, 1(4), 355-374.

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I am an “Other”

INTRODUCTION:  This article is part of a series titled “In My Own Defense”

This series has served as a  writing exercise “of sorts” that can allow me to work through feelings of shame that still remain.  As is typical with a child’s-eye-view of the world, I perceived life as if it revolved around me.  This self-centered viewpoint, made it difficult, to varying degrees, for me to see others’ perspectives.  As a sensitive child, I tended to take all the bullying and ostracism of my childhood personally. By the time I reached high school graduation, all I wanted to do is put as much space (physically and chronologically) from this experience as I could.   I remember leaving for college with huge hopes.  However, it quickly became apparent that this would require a significant amount of effort on my own part.  It’s only in the last decade of my life, that I’ve taken time to look back at these experiences without feelings of self-blame and hatred welling up inside me.  I’ve learned to accept the fact that there are those from my past who may never see me beyond an outdated set of preconceived notions.  In a way, this series represents the final step in the long process of healing, forgiveness, and acceptance.

In the wound-licking phase, I simply began to work through the unresolved hurt instead of burying it…

This process started in my later 30’s when I first sought out a therapist because I felt “Stuck”.  It took a while to understand the nature of this stuckness & what was holding me back.   Until this point, my life was like an invisible minefield.  There were some things – things that reminded me of events I was trying to forget – that became excruciating.  It was all too much, so I spent time going through the motions and checked out on the basement sofa watching t.v. like a mindless blob.  Or I would nap, my other favorite maladaptive coping tool.  I began to see a therapist, I completed a DBT course, worked on the relationship with my sister and slowly, I somehow felt safe in the world.  In time, this healing allowed me to gain some clarity by viewing directly things that had previously been too  I was empowered with a solution the problem that involved action on my part.

However, more needed to be done.  Feelings of shame and invalidation had plagued me.  That is, until my mother recommended I read this book….

PART ONE:  The Consequences of being an “Other” (i.e. biracial / mixed race)…

ME = “One of those things that is not like the other”

I usually call my mother once every two weeks just to see how she’s doing.  At some point in the conversation, I am usually provided an update on the “local gossip”.  During one of these conversations, my mother mentioned an old classmate of mine: May-lee Chai.  She was a senior in high school while I was a freshman.  We didn’t know each other well and I only remember as one of the many faces I passed by in the halls between classes.  At any rate, she asked me if I heard about that book she had written: “Hapa Girl: A Memoir”.  She said bought a copy and urged me to read it, since she felt it might “resonate” with my own childhood experiences….

When I first read it, I remember reflecting on my childhood from a new perspective.  Until this point I thought it was “all my fault”.  This book helped me to contextualize my experiences.  There were forces much larger than me at work…

So where do I start? How can I begin to adequately describe my own experience of being biracial? How have I dealt with the idea that I’m not perceived as I am? What is it like to live between world’s?  What follows are random thoughts, in no particular order….

Click here for a bill of rights for people of mixed race heritage

In the video above, the narrator describes the twins as “black and white”.  Based on phenotype characteristics that each girl carries, they are so labeled.  It amazes me, how people are so quick to forget that the meatsuits we wear, don’t accurately reflect what dwells within us.  In reality, there are four abstract constructs which together are effective in developing a basic understanding of a biracial individual’s experience of race.  Together they explain what it is like to live within an unclear “in-between” space. These constructs are: (1) genotype; (2) phenotype; (3) identity; & (4) culture.  Understanding how they converge within an individual’s life can help quite a bit in explaining their racial identity.  They are useful in understanding the diversity of experiences amongst biracial experiences, as well as the issue of colorism…

FACTORS 1 & 2: Genotype vs. Phenotype…

Genotype refers to the DNA you carry within you.  You get half from your mother and half from your father.  For example, at they studies of populations around the world.  When individuals are isolated historically these populations tend to share genes for traits that are conducive to survival in that area.  When you submit a test at, they tell you what subsets of the human population are present in your genes.

Phenotype has to do with your physical features, how do you look?  What is the color of your skin, your face shape, and hair color?  The point is, you can have the same set of parents, but inherit different subsets.  Therefore, two genetically biracial individuals can have very different appearances.

Critical Point #1 – regarding these two factors, I have a genotype / phenotype mismatch problem.  This means I am not what I am.  Due to the random qualities that define my meat suit, I am classified within a preconceived ideas that do not relate to my own lived experience of self…

FACTOR 3:  What is Identity?

The DSM-5 Manual defines Identity as follows:  “[the] experience of oneself as unique with clear boundaries between self and others; stability of self-esteem and accuracy of self appraisal; capacity for, and ability to regulate, a range of emotional experience.” (American Psychiatric Association, 2013, p823).  As a biracial individual the experience of how others see us diverges from the inner knowing of who they are.  Regarding how others’ experience, I feel as if I’m a man inside a monkey suit wearing upon my being the preconceived notions of others.  I wait for somebody to see within to the real me, but it happens rarely.  R.D. Laing (1990), summarizes this experience succinctly in his book “The Divided Self”.  In contrast, the description of our inner sense of self is best described in my old course textbook (Corsini & Wedding, 2013).

Critical Point #2:  “The usual sense of the self as being who we ‘really are’ and as being continuous and consistent over time seems to be an illusory construction of imprecise awareness….similar to the ‘flicker fusion phenomenon’ by which photographs projected successively on a movie screen…we suffer from a case of mistaken identity. We are not who, or even what, we thought we were. What we take to be our real self is merely an illusory construct” (Wedding & Corsini, 2013, p467).

FACTOR 4:  What is culture?

Culture provides another set of mental programs relevant to a society (Chung & Bemak, 2002). It consists of a shared system of meanings within society that define modes of expression and communication, (Chung & Bemak, 2002; Nazir, et al, 2009). It influences how we view the world around us and sets the normative standards for behavior (Chung & Bemak, 2002; Nazir, et al, 2009). As a form of “mental programming” (Chung & Bemak, 2002, p282), it defines our value systems and preferred ways of thinking and feeling.

Critical Factor #3:  I was given two diverging, (and frequently oppositional) cultural perspectives.  Nobody fully understood this and I was largely left on my own to feel my way in the dark…

Before I continue with this random train of thought, I must apologize.  I’ve made a promise to stop intellectualizing, yet do this a bit in here.  There’s a reason for it – bear with me….

While working on my master’s degree, I was working and had little time for anything else.  On the back burner, I placed everything unnecessary and “survival” became my priority.  I remember reading various articles for homework assignments and being “highly intrigued” by the information I was taking in.  It held information that was interesting personally as well as professionally.  As I work through this blog, I continue digging through files of things I’ve save, with the intention of “bloggging on it” when time would allow.  Here I am about a year later – finally getting around to it.

“individuals who live at the juncture between two cultures and can lay a claim to belonging to both cultures, either by being of mixed racial heritage or born in one culture and raised in a second, should be considered marginal people. Park suggested that marginality leads to psychological conflict, a divided self, and disjointed person” (LaFromboise, et al, 1993, p. 395)

I have these piles of folders divided into subject categories.  Inside them are copies of assorted notes, assignments, and articles that I’ve printed with ideas jotted in the margins.  The quote above does an excellent job of describing succinctly, how I’ve felt as a biracial individual with a broad-based culturally diverse perspective of the world.  The Sesame Street video below describes my experiences as an individual who lives between worlds.  I am both my mother and father, yet I am also like neither of them….

ME = Three of these kids belong together.  Three of these kids are kind of the same.  But one of these kids (i.e. me) is doing his own thing

“The Psychological Impact of Biculturalism”

So without boring you to death, I want to quickly review this article titled: “They Psychological Impact of Biculturalism”, as a jumping off point.  This article begins by describing what individual’s need to be culturally competent to function in a society.

“In order to be culturally competent, an individual would have to (a) possess a strong personal identity, (b) have knowledge of and facility with the beliefs and values of the culture, (c) display sensitivity to the affective processes of the culture, (d) communicate clearly in the language of the given cultural group, (e) perform socially sanctioned behavior, (f) maintain active social relations within the cultural group, and (g) negotiate the institutional structures of that culture.” (Framboise, et al, 1993, p. 395).  

This article the provides an overview of different models utilized in research, to describe the varied transitions that occur between an immigrant and the country he has chosen to reside in. What follows is a “quick and dirty” overview….

  1. ASSIMILATION:  “The underlying assumption of all assimilation models is that a member of one culture loses his or her original cultural identity as he or she acquires a new identity in a second culture.” (Framboise, et al, 1993, p. 396).  
  2. ACCULTURATION:  “assimilation approach emphasizes that individuals, their offspring, or their cultural group will eventually become full members of the majority group’s culture and lose identification with their culture of origin. By contrast, the acculturation model implies that the individual, while becoming a competent participant in the majority culture, will always be identified as a member of the minority culture.” (Framboise, et al, 1993, p. 397).  
  3. ALTERNATION:  “The alternation model of second-culture acquisition assumes that it is possible for an individual to know and understand two different cultures. It also supposes that an individual can alter his or her behavior to fit a particular social context.” (Framboise, et al, 1993, p. 400).
  4. MULTICULTURAL: “The multicultural model promotes a pluralistic approach to understanding the relationship between two or more cultures. This model addresses the feasibility of cultures maintaining distinct identities while individuals from one culture work with those of other cultures to serve common national or economic needs. In this model it is recognized that it may not be geographic or social isolation per se that is the critical factor in sustaining cultural diversity but the manner of multifaceted and multidimensional institutional sharing between cultures. Berry (1986) claimed that a multicultural society encourages all groups to (a) maintain and develop their group identities, (b) develop other-group acceptance and tolerance, (c) engage in intergroup contact and sharing, and (d) learn each other’s language.” (Framboise, et al, 1993, p. 401).
  5. FUSHION:  “The fusion model of second-culture acquisition represents the assumptions behind the melting pot theory. This model suggests that cultures sharing an economic, political, or geographic space will fuse together until they are indistinguishable to form a new culture. The respectful sharing of institutional structures will produce a new common culture.” (Framboise, et al, 1993, p. 402).  

So what’s the need for this list of terms? Why is it necessary?

I simply include it to indicate that the issues that can potentially arise for individuals living in a foreign country are to great to list.  For that matter, there is a high degree of variability amongst immigrants who are trying to make a life in a new country.  Factors such as socioeconomic status, education level, language familiarity, ethnic pride, and local race relations can all have a huge impact an individual’s experience.

My mother and her sister are an excellent example of this…

My mom is from the Philippines and is the youngest of two children. Her sister Rebecca is just 18 months older. Consequently they’ve always had a very competitive relationship. My mom is describes her older sister is much more popular and much more successful in school.  She on the other hand had just a few friends and was very shy. To top this off she kind of had an inferiority complex next to her sister and was never really good in school and didn’t quite catch up to her until about seven to grade.  This sense of insecurity and competition also spilled into the issue of appearance.  My mother always described her sister as the prettier one.  Her sister was always faired skinned and curvy and this made my mother jealous. My mother on the other hand past the paper bag test and your mother I was giving her a hard time about being skinny and was constantly instituting various plans to help her gain weight – all of which never worked.  As a kid, I always found my mother’s insecurity strange, living in a “mostly-white” midwest town.  All my classmates were obsessed with tanning in the summer and could never ever be thin enough.  From this vantage point, it seemed strange to me that anybody would complain about being thin and tan…

However, I’m most struck by how my mother & her sister went about building lives in a new country.

My mother was always the “good girl” and very “values oriented” and in this respect, quiet a bit like her mother.  On the other hand, her sister was a bit rebellious and more socially adept.  She was always popular and much more knowledgeable socially.  Its interesting to now my mothers traditionalism played out in her life and how my aunts rebelliousness played in her own.   These two divergent characteristics affected their experiences as immigrants living in a new country.  My mother was alone in the midwest.  There were only a handful of non-whites so I was never exposed to Filipino culture.  In contrast, her sister lived in Texas and employed several Filipino women.  So my cousin was exposed to her mother’s culture, visited the Philippines several times, and speaks Tagalog.  However my mother’s traditionalism caused her to remain reluctant to understanding what it is like to be an an American Teenager.  This meant that I was not allowed to wear makeup, shave my legs, or wear bikini-style underwear, much less date.  When you consider the fact that I already had few friends and was bullied constantly, this made things very difficult.  I had no social guidance whatsoever.  I was the oldest firstborn of all the cousins and as a result I was kind a like the guinea pig.  My mother decided to raise me according to her own values that she knew and made them a priority. It probably wasn’t until my sister came around that she some understanding of what was needed to help the child survive socially school.   So, I was isolated, overprotected and held to social standards that made fitting in difficult.  My sister was given opportunities to experience things that I didn’t at her age.  While five years younger, she was able to date first, given spending money first, and allowed to be out with friends late – all before me.  Oftentimes, what would happen is they bought her a car and then would think, oh we never got one for Kathleen, lets do that….

So what point am I trying to make here???

I am frustrated with the lack of understanding in my family.  I talk to my mother, and she talks about how I know nothing about her culture and am basically American.  While this may be true in many respects, I blame this fact on my mother who has refused to speak Tagalog in front of me.  It is, however, the case that she held me to standards that were her cultures and not my own.  As somebody who was already bullied and ostracized quiet a bit, I needed guidance.  Yet I got nothing.  I sometimes I sacrificed my childhood and years of social development, so my mother could have her “peace of mind”.  I will never forget when I told my sister about how I had to wear granny panties to P.E.   She laughed and said, “OMG! There’s no way I would allow that to happen!!!”  And in that comment is the problem.  She didn’t have any idea how different they were with her and how she had chances for normalcy I never did.   You see, the problem is the experiences that come together to influence a biracial’s experiences can vary greatly from person to person.

My sister & cousin don’t have a genotype / phenotype mismatch problem, they are “meat-suit matching”. 

“I don’t count” due to the random qualities that define my meat-suit.  My identity feels a farce, and I had to “act as if” I was what others deemed even though this was a lie.

 My sister & cousin were allowed the opportunity to live as a normal American Teenagers.

I was cloistered way like a nun.  I had no friends & was ostracized.  My different-ness stood out like a sore thumb in my small homogeneous town.

The final thought I’d like to make comes from a few articles by Maria Root, who describes racial identity development for individuals of mixed race.   There are a few points she makes about racial identity development amongst biracial siblings that are worth noting:

“Siblings of racially mixed heritage…often identify themselves differently from one another” (Root, 1998, p. 237).
“Phenotype does not determine how people identify themselves” (Root, 1998, p. 238).
“Identity can change over the lifetime” (Root, 1998, p. 238).
“A monoracial framework is usually the guide for interpretation of behavior.” (Root, 1998, p. 238). 

An Ecological Model of Identity

“The identity [options} are (a) accept the monoracial identity society assigns, (2) actively choose a monoracial identity (congruent with the identity society would assign), (3) define self as biracial or multiracial, (4) develop a “new race” identity.” (Root, 2003, p. 115). 

Ecological Models of identity focus on the social and individual factors that influence Identity development. “This model of identity development acknowledges that there are many different ways people of mixed heritage may identify themselves.” (Root, 1993, p. 240).  Mixed race individuals frequently see themselves in a way that diverges significantly from how others tend to.  Root, (2003 & 1998), discusses the following concepts in her ecological model of racial identity:

  1. MACRO LENS: Gender; Social Class; Race Relations; Sexual Orientation.
  2. MIDDLE LENS:  Family Socialization Influences; Temperament; Community Relationships.
  3. PHENOTYPE:  Is a factor that influences many of the factors in the middle lens significantly

A Stage Model of Identity

“Typical behaviors of person’s of mixed heritage are…interpreted as signs of poor adjustment.  Some of these behaviors stem from ways of sorting out the meaning of race…from a mixed perspective….negative adjustment is not [related to] being mixed…but rather conflict rising in the family and environment and the lack of guidance in resolving developmental crises…” (Root, 2003, p. 113).  

Root begins discussing early stage models of racial identity development by reviewing the two primary stages which seem to encompass (1) a desire to adapt to a new culture, (2) response to inherent inequity and racism in American culture.

  1. INITIAL STAGE:   “internalization of white reference group that necessarily is accompanied by devalued messages of [minority group] values and culture.” (Root, 2003 p. 114).
  2. TRAUMATIC EVENT:  “Awakens the individual to the lack of equity and fairness…There is a retreat and immersion into the racial group of origin to gain support and…as part of the process of undoing the harm of internalized racism.” (Root, 2003, p. 114). 

Next, Root provides the following summary of stages that biracial children progress through as they address the idea of “what they are”

“In the first stage, the awareness of race and ethnicity was not necessarily attached to ethnic background….In [the] second stage, people choose a racial identity; their cognitive capacity [in childhood] usually allows a single identtity. The third stage is driven by dissonance between the chosen identity and the incomplete mismatch with ethnic and racial identity.” (Root, 2003, p. 115).

Finally, common questions that arise

  1. Who am I?”  (Idenitity)
  2. Where do I fit in?” (Is there a place in the world I fit with?  
  3. Where is my social role?” (“What cultural standard?)
  4. Who is in charge of my life?” (Who tells me what I am?)
  5. “Where am I going?”  (what goals?)

<h5><span style=”font-size: 45pt;”>Point #3: “In my own defense” the issue of racial identity added to my insecurities.  I felt as if I “didn’t count” for an assortment of reasons.  Additionally, I was dealing with things, nobody could understand when you “live between two worlds.”</h5></span>


Benet‐Martínez, V., & Haritatos, J. (2005). Bicultural identity integration (BII): Components and psychosocial antecedents. Journal of personality73(4), 1015-1050.
LaFromboise, T., Coleman, H. L., & Gerton, J. (1993). Psychological impact of biculturalism: evidence and theory. Psychological bulletin114(3), 395-412.
Root, M. P. P. (2003). Multiracial Families and Children: Implications for Educational Research and Practice. In J. A. Banks and C. A. McGee Banks (eds.), Handbook of research on multicultural education (second edition), pp. 110-124. San Francisco: Jossey-Bass.
Root, M. P. (1998). Experiences and processes affecting racial identity development: Preliminary results from the Biracial Sibling Project. Cultural Diversity and Mental Health4(3), 237-247.

Part Two:  Exploratory Paper from MCC 638 “Social & Cultural Issues”


The purpose of this paper is to closely examine my personal worldview and sociocultural background. In doing so, the goal will be to understand how this influences my future clinical judgment and client interactions. I will begin by utilizing the Addressing Model, (Hays, 2008), to provide a biographical overview of my sociocultural history. The paper will then conclude with a series of interview-style questions, to help reflect and explore my life history in detail. Any personal understanding of my values, cultural identities, and areas of privilege that come from this activity will be used to direct future growth throughout this program.


According to our textbook, a bias is simply a “tendency to think, act, or feel in a particular way.” (Hays, 2008, p24). Personal biases emerge as a result of our upbringing and sociocultural background, (Hays, 2008). Our life history provides us a worldview, value system, identity and cultural background that produce the very biases we carry into therapeutic relationships, (Hays, 2008). In light of this fact, a cultural self-assessment is the first step toward developing greater multicultural competency as a counselor. I start this self-assessment by utilizing the Addressing Model to provide a rough overview of my sociocultural history.  I then move on to a series of interview questions, which can help to shed light on areas of privilege, as well as value systems, and identities.

Utilizing the Addressing Model

Age and Generational Influences

My Parent’s Generation. My mother was born in 1938 and my father was born in 1941. They are members of the “silent generation”, born just prior to the baby boom (Martin, 2004). Their earliest years of life occurred while the world was at war. My mother, from the Philippines, grew up in the middle of war. My dad, an American, was ignorant of war altogether. They were both raised to work hard, get an education, and pursue the American Dream. For my mother’s family this meant gathering resources to put both of their two daughters through medical school and then help them to emigrate to the states. For my father’s family, this meant raising their sons in a strict household, expecting them to work hard, and then put themselves to school. In the end, they all did so, earning advanced degrees.

My Generation. I was born in 1969, and grew up in a small college town in South Dakota. Unlike many of my generation, I was spared from having to experience divorce first-hand.   With divorce rates, at the time, soaring to 50% in my childhood (Amato & Cheadle, 2005), I was fortunate to have such a realistically positive view of marriage. The experience of witnessing everyone in my extended family enjoying long and happy marriages, has caused me to place a high value in the commitment of marriage and family.

Nonetheless, I am typical of many women in generation in being skeptical of the idea of “having it all”; a popular notion existing in westernized cultures in the aftermath feminist movement (Genz, 2010). While very appreciative of the strides made, I’ve witnessed many women struggle to keep up with home and work life in frustration. Many women in my generation have chosen to put off family, or opt out all together, (Genz, 2010). Still others, such as myself, have chosen to put off career pursuits in favor of focusing on my family life, (Genz, 2010).

Developmental Disabilities

Fortunately, I have no physical disabilities or health issues whatsoever. I’ve had the privilege of ignorance that comes with living in a healthy body, and never having to think about living with disability. (Hays, 2008). Nonetheless, I’ve found plenty of opportunity in my life to learn about living with disability. As a hospital tech I have had a great deal of opportunity to work with disabled individuals. As the mother to a son with a congenital defect, I’ve gained insight into experience of raising a child with special needs. I’ve developed an awareness of what it is to deal with physical disability on a daily basis. In fact, I’ve felt a great deal of satisfaction from these experiences, and wish to explore this area as a potential career path.

Religion and Spiritual Orientation

My religious background is complicated, by the fact that my family isn’t unified in its religious beliefs. My father is an atheist, my mother is devoutly catholic, and my sister considers herself a “born-again” evangelical Christian. As an agnostic, I can see everyone’s point of view and respect each one, as right for that person. I don’t feel it is right for anyone to impose my religious beliefs on others. Nonetheless, I do find the other members of my family disagreeing on matters quite often. My sister and mother disagree with the others beliefs on the grounds that it goes against their own. My father refuses to talk about it altogether and this annoys my mother and sister.

Ethnic & Racial Identity

“The ecological model of racial identity development acknowledges that there are many different ways people of mixed racial heritage may identify themselves….These identities do not necessarily coincide with how other persons identify them. Thus the private identity may be different from the public identity assumed or validated by others.” (Root, 1998, p240).

I am a biracial individual, born to a Filipino mother and White father. A book written about my hometown, by author May-Lee Chai, titled “Hapa Girl” (2007), provides a good depiction of my childhood environment overall.   Also biracial, she was a senior in high school when I was a freshman and endured much of what I did growing up.

My racial identity can be best described as a personal knowledge I hold within.   It isn’t reflected in my phenotypic appearance and consequently is rarely acknowledged in my interaction with others. (Root, 1998). As a result, my identity as biracial is held with pride despite often being refuted and criticized by others. Additionally, because I’ve never been to the Philippines, it isn’t based on any cultural heritage. (Root, 1998) While purely American, from a cultural perspective, I claim both my Asian and American heritage from an identity viewpoint.

Socioeconomic Status

The socioeconomic status of my family of origin is solidly upper middle class. In contrast, my family of procreation would most likely be somewhere in the lower middle class. My husband comes a working class background, and had a rough home life. Adding to this, until recently, I’ve put off career pursuits in favor of family. As a result, I have experienced some downward mobility, in a matter of speaking. By marrying someone of a different socioeconomic class, I’m aware of the huge cultural divide between my husband’s family and my own. I feel comfortable in both worlds, yet my husband doesn’t enjoy being around my extended family, (despite getting along with my parents). A quote from a book titled “Reading Classes” by Barbara Jensen (2012) sums up my husband’s experiences well:

“I knew I wasn’t middle class like some others in the movement, and I believed I wasn’t as smart as they were. I knew my brain worked okay, but they knew more, lots more, and I wanted what they had. They often referred to authors I had never read or even heard of. They used words I didn’t understand, and they often talked about their college experiences, worldly travel, orchestral music, and other things with which I had little opportunity and experience. They appeared to all understand one another, but sometimes I just pretended I understood, and then I felt ashamed of both not knowing and pretending.” (Jensen, 2012, p18)

Sexual Orientation & Gender

Sexual Orientation & Cisgender Status. Regarding the issue of sexual orientation and gender identity, I happen to be a cisgendered heterosexual.  Being cisgender, I have moved through life with a body that matches my gender of identification, (Levy, 2013). Being a heterosexual, I have a sexual preference that is deemed acceptable by all facets of our society (Levy, 2013). I have never felt the need to think about my sexual orientation or gender identity to the extent I have my racial identity. Any thought I do give to such matters has been purely political in nature, since I’ve always been very supportive of LGBT rights. Having said this, I do feel simply believing in equal rights isn’t enough With ignorance, can come a lack of awareness of things such as subtleties of interaction and the imposition of our biases that can indeed be felt as discriminatory, regardless of their intention, (Hays, 2008)

Being Female. While being a female certainly implies a second-class status, it must be noted that the degree to which this is experience varies by culture. Fortunately, my sociocultural background has been one which values and empowers women.   Having said this, it would be fruitful to learn about the implications of being female in cultures other than my own, as a matter of perspective.

Indigenous Heritage & National Origin.

On the one hand, I’m an American living in the United States and have no experience living in another country. I am neither an immigrant nor of indigenous heritage. On the other hand, with a mother who emigrated from the Philippines, I’ve witnessed a bit of what it is like to balance the influences of two competing cultures. Described best as a biculturalism, (LaFramboise, et al, 1993), raising a family in a foreign culture was certainly problematic for my mom. From my perspective, the cultural gap that resulted did require time to work through. Having not occurred until well into my own adulthood, I have a relationship with my mother today, which is very different from that of my childhood.

Cultural Self-Assessment Interview

In this portion of the paper, I move on to a series of self-assessment interview questions. It is my intention to answer each within the Addressing Model framework. I will consider how each question applies to my sociocultural history as described within this model.

Social Expectation & Identity.

“When I was born what were the social expectations for a person of my identity?” (Ajuoga, 2014). My biggest struggles with social expectations associated with identity, are in the areas of: (1) gender roles, (2) race identity, (3) socioeconomic class, and (4) religious affiliation. Other addressing components such as disability, sexual orientation, and indigenous heritage, have been of little concern. I will address these areas of struggle in turn, leaving female gender roles issues, for later.

Racial & Ethnic Identity. As mentioned already, I have experienced a great deal of confusion regarding my ethnic identity. My own biracial identity has been largely met with messages of disapproval, with others needing to inform me what they believe is the correct one (Root, 1998). It has taken some time, to sort through this issue as I’ve learned to let go of the idea that validation from others is ever a realistic expectation, (LaFramboise, et al, 1993).

Religious Identity. While my mother’s family is devoutly catholic, my father’s family is predominantly agnostic and atheistic. The competing perspectives from this interfaith family background yielded an array of contradictory expectations (McCarthy, 2007). As my sister and I matured, our chosen routes diverged greatly. I came to identify myself as agnostic, while my sister has joined an evangelical church and embraced those ideals. The biggest issues in our family have come as we’ve tried to maintain a sense of integrity while also respecting others’ beliefs (McCarthy, 2007).

Socioeconomic Identity. Maria Root discusses, in her work on mixed race identity, that individuals from such backgrounds can often develop negative biases against one side of their family as result of negative treatment, (Root, 1998). Within my father’s extended family I have experienced just this growing up. The ignorance and ethnocentrism they display, alongside the pride, and unwillingness to see any other perspective has been the source of much pain. As a byproduct of this experience, I’ve developed a negative bias against their upper middle class socioeconomic ideals (Root, 1998). It’s only in my adulthood, that I’ve been aware of how much I rejected this component of my identity, while embracing husband’s working class background instead, (Root, 1998). Coming to terms with this will be essential in my growth as a counselor (Hays, 2008).

Norms, Values & Gender Roles.

“When I was a teenager, what were the norms, values, and gender roles supported within my family, by my peers, in my culture and in the dominant culture” (Ajouga, 2014)” Overall, a great deal of conflict exists with norms, values, and gender role expectations in my extended family. Additional conflicts were present between my familial and environmental norms and values growing up.

In an article an on biculturalism mentioned in our textbook, there is a discussion of the impact of living between cultures (LaFrombroise, et al, 1993). This article mentions feelings of psychological discomfort as the initial result of a dual identity-based consciousness that can have potential benefits in the long run, (LaFrombroise, et al, 1993). Having many conflicting identities, values and belief systems has resulted in much of this discomfort as well as many fruitful life lessons.

Gender roles. Within my family, gender roles brought about much confusion as a child.   Conflicting messages existed as a result of complex familial generational and cultural gaps. My dad’s family came from a traditional background, with the belief that women were supposed to stay at home. In contrast, my mother’s family was very forward thinking. Since my maternal grandparents were both teachers, it was very important their daughters go to school. Having two daughters finish medical school was a source of great pride.

These competing perspectives left me with a conflicting and contradictory array of familial gender-based role expectations. Against this backdrop, was the generational influence of being born in the aftermath of the feminist movement, (Genz, 2010). Not feeling the need to having it all, I have instead discovered a path that has worked for me.

Norms and Values. While there were many conflicting norms and values within my extended family, this wasn’t really the biggest issue in the context of day-to-day life as a child. The greatest source of conflict existed between the values and norms my parents held me to in contrast to with what was expected in my hometown. Norms and values regarding: (1) relationships and dating, (2) parental roles, (3) rules of emotional expression, as well as (4) appearance and demeanor stand at the forefront as most problematic.

In keeping with her cultural background, my mother assumed the role of matriarch, and was largely responsible for setting parental limits. My dad, busy at work most of the time, didn’t want to interfere. As a result, my mothers cultural belief systems were the standard we complied with at home. Naturally unbeknownst to them, this key factor resulted in an array of problems throughout my childhood, when it came to fitting in (Chai, 2004; Fortune, 2012).

For example, regarding the issue of appearance, my mother didn’t allow me to shave my legs or wear makeup, and I was bullied endlessly for it. In the arena of dating, I was absolutely forbidden from even considering it until college, because that’s how it was for her growing up, (Fortune, 2012). Added difficulties resulted from differences in parenting role expectations between my mom’s culture and my hometown environment, (Root, 1998). Cultural differences such as these, caused many parents and teachers to misunderstand my mother. They often thought poorly of her parenting style, because it was so different from what they knew. This added to my difficulties in trying fitting in.

Adolescent Development.

How was my view of the world shaped by the social movements of my teen years?” (Ajouga, 2014) With a population that was mostly white, middle class, and well educated, my hometown had a very ethnocentric feel to it (Chai, 2004). At school, a large portion of my classmates came from families that called this town home for several generations (Chai, 2004).. This gave many of my classmates the benefit of a large social network, as well as consistent socialization, on how to follow the values and norms of the local culture (Chai, 2004).   Without this knowledge base or support system, fitting in was difficult, and I was bullied throughout much of my childhood, (Chai, 2004). As per Brene Brown’s work on shame, my personal view of the world was based on an underlying identity of shame as she defines it:

“The definition of shame that emerged from the research is, an intensely painful experience of believing we are flawed and therefore unworthy of acceptance, and belonging.” (Brown, 2006, p45)

“When I was a young adult, what educational opportunities were available to me? And now?” (Ajouga, 2014) While I did enter college with many opportunities for learning, my ability to make the most of them limited by my problematic childhood history.   Nonetheless, having been born into an upper-middle class environment to two highly educated parents, provided me with many privileges I failed to appreciate at the time, (Hays, 2008). Today, after having come to terms with my past through counseling, I’m grateful for the opportunity to make the most of these privileges and pursue this degree.

“What generational roles make up my core identity (eg., auntie, father, adult child, grandparent)?” (Ajouga, 2014). Key generational roles which are strongly associated with my identity, include my roles as a daughter and mother. In fact, I hold my role as parent before any others in my life. Having nearly lost my oldest after several open heart surgeries and then suffering a miscarriage before giving birth to my youngest, I value my time with my kids greatly. It’s been my goal in life to learn the lessons from my parents, and be there in ways they were not able to. Making sacrifices for my kids, showering them with affection and cherishing our time together are key priorities in my daily life.

Regarding my role as daughter, while I’m not as close to them as I’d wish, I do strongly identify with my duties to them. As the oldest child with a background in health care, its expected that I be there to care for them when they age.   I plan on trying my best to live up to this expectation as a show if respect and love, knowing action and not words work best a communicating such things with them.


In completing this assignment, I’m actually surprised at how much I learned about myself. Rereading my personal history has been quite enlightening, as a much-needed perspective within to contextualize the outcome of my life.   It’s cleared while my complex sociocultural history yielded much stress as a child, its also provided me with wonderful opportunities for personal growth. Inspired by this fact, I am committed to a lifelong process of learning as a counselor and plan to use these insights as I worked completing my degree.


Ajouga, P. (2014). Re: MCC 638 Week Two Overview. Retrieved from
Amato, P. R., & Cheadle, J. (2005). The long reach of divorce: Divorce and child well-being across three generations. Journal of Marriage and Family, 67(1), 191-206. Retrieved from
Brown ,B., (2006). Shame resilience theory: A grounded theory study on women and shame. Families in Society. 87(1) 43-52.
Fortune, B.A. (2012). Acculturation, intergenerational conflict, psychological distress andstress in Filipino-American families. Regent University, Virginia.
Genz, S., (2010). Singled Out: Postfeminism’s “New Woman” and the Dilemma of Having It All. The Journal of Popular Culture, (43)1, 97-119.
Hays, P. (2008). Addressing cultural complexities in practice. (2nd Ed.) Washington, D.C.: American Psychological Association.
Jensen, B. (2012). Reading Classes : On Culture and Classism in America. Ithaca: ILR Press.
LaFromboise, Coleman, H.L.K. & Gerton, J. (1993). Psychological impact of biculturalism: Evidence and theory. Psychological Bulletin. 114(3) 395-412.
Levy, Denise L. “On the outside looking in? The experience of being a straight, cisgender qualitative researcher.” Journal of Gay & Lesbian Social Services 25.2 (2013): 197-209.
Martin, C.A. (2004) “Bridging the generation gap (s).” Nursing2013. 34(12)62-63.
McCarthy, K. (2007). “Pluralist Family Values: Domestic Strategies for Living with Religious Difference” The ANNALS of the American Academy of Political and Social Science. 612(1) 187-208.
Root, M.P.P. (1998) Experiences and processes affecting racial identity development: Preliminary results from the biracial sibling project. Cultural Diversity and Mental Health. 4(3) 237-247.
Point #3: “In my own defense” the issue of racial identity added to my insecurities. I felt as if I “didn’t count” for an assortment of reasons. Additionally, I was dealing with things, nobody could understand when you “live between two worlds.”

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MCC 670 – Attachment Interventions

Attachment Theory Overview

Based on the work of John Bowlby and Mary Ainsworth, Attachment Theory states that early experiences with primary caretakers during infancy provide a “working model [of oneself] and others” (Broderick & Blewitt, 2006). It is also worth noting that the concept of attachment, as described here does not pertain to a specific set of observable behaviors. Instead attachment is a system of beliefs that sure the purpose of an emotional bond known as “proximity maintenance…[in addition to a] safe haven…[and]…secure base” (Broderick & Blewitt, 2006, p125) with which to interact with one’s world Instead have profound effects throughout one’s lifetime. It is for this reason, an individual’s early attachment experiences have profound affects that last a lifetime. ​It is in the early social interactions with primary caregivers during infancy that we first learn trust others and develops a capacity for emotional regulation. Mary Ainsworth’s research utilized a measure called the “strange situation test” (Broderick & Blewitt, 2006, p126). Based on her observations four types of attachment styles have been observed. Babies with secure attachments show distressed when separated with a caregiver and are easily comforted upon her return so they are able to return to their play activities (Broderick & Blewit, 2006; Ingram, 2012). Anxious-Ambivalent attachments, like securely attached babies are distressed when their caregiver leaves. However, when they return, they are more anger and resistant to their caregivers attempts to provide comfort (Broderick & Blewit, 2006; Ingram, 2012). Infants with Avoidant Attachments do not cry when separated from their caregiver and ignore them when they return in the room (Broderick & Blewit, 2006; Ingram, 2012). Finally Disorganized Attachments are seen in an infant’s tendency to avoid a caregiver when they approach while seeking them out if stressed (Broderick & Blewit, 2006; Ingram, 2012).

Goals for Attachment Interventions​

A primary goal of attachment theories, regardless of one’s developmental stage is the consistent availability and access to an attachment figure (Cassidy & Shaver 1999). However it is important to note that an individual’s “assessment of availability” (Cassidy & Shaver, 1999, p39). changes throughout life. For example, during infancy availability is equated to physical proximity and consistent responsiveness from a primary caregiver. As we mature, the perception of availability pertains to communication and the cognitive appraisal of responsibility to relationship and emotional needs (Cassidy & Shaver, 1999).

For purposes of intervention in order to address disruptions in attachments it is important to assess the individual’s “current appraisal (Cassidy & Shafer, 1999, p39) of their attachment. As a current working model that influence’s one’s relationships, this construct varies and changes in response to relationship experiences throughout life (Cassidy & Shafer, 1999, p39). Intervention goals vary in accordance with: (1) an individual’s current relationship experiences and (2) their developmentally relevant methods of assessment of an attachment figures availability and inherent trustworthiness. Overall, goals center around the disruptions in present attachments and their long-term consequences for a relationship (Cassidy & Shafer, 1999).

Attachment Theory Interventions

One example of a Parent-Child Attachment Intervention is the “Steps Toward Effective Enjoyable (STEEP) Program” (Cassidy & Shafer, 1999, p565). The primary interventional goal for this program is to address a mother’s “working model of attachment by focusing on her feelings, attitudes and representations of the mother-child relationship” (Cassidy & Shafer, 1999, p565). Involving regular home visits staring around the later trimesters of a woman’s pregnancy and into early infancy. It takes a proactive approach. Participants include those who are at greater risk for parenting issues based on prior history. Individual and group sessions allow the individual to alter their beliefs about self and relation to others in order to prevent repeat experiences of old family history.
​Attachment Interventions for adults in individual psychotherapy can include, for example the work of Mary Main who describes three types of parental attachments towards children: “autonomous, dismissing and preoccupied” (Cassidy & Shafer, 1999, p565). Interventions utilized in Mary Main’s approach include metacognitive exercises that ask individuals to consider the working models and belief systems guiding their parental efforts. “Reflective functioning” (Cassidy & Shafer, 1999, p581), is an example of another intervention that involves reviewing life events and evaluating it from everyone’s perspective. Finally, interventions can also be aimed at allowing mothers to develop an understanding of their mental state and a child’s needs (Cassidy & Shafer, 1999).

Attachment Assessments

One convenient example of attachment assessments in early infancy, includes the work of Mary Ainsworth, as described earlier. With this in mind, they involve analysis of child-parent interactions and the stability of observable behaviors over time. As individual’s progress assessments such as “The Cassidy-Marvin System” (Cassidy & Shafer, 1999, p297), are useful. This assessment involves categories of attachment styles similar to Ainsworth’s but for individuals in early child and more diverse display of behavioral responses (Cassidy & Shafer, 1999). Attachment assessments for adolescents and adults, according to the Handbook of Attachment (Cassidy & Shafer, 1999), include a series of narrative interviews. The main goal in this respect is to examine the mental constructs they utilize in current relationships and behavioral responses to these preconceptions (Cassidy & Shafer, 1999).

FINAL QUESTION: “Would a goal of therapy be to increase healthy forms of attachment? Is this possible?”

In a nutshell, based on this book review and overview of interventions/assessments/goals I believe it is possible to work on attachments. An overview of my own attachment history and my husband, shows how fundamentally important this personal construct is in all relationships throughout one’s lifetime. I also believe, in this respect, that addressing it is a worthwhile and fruitful endeavor. One ideal example of the possibility of change is my own husband. His mother was an alcoholic, who died in her forties. Married 8 times in her life, she wasn’t a source of stability for him. Additionally, my husband’s father was never around. Despite this history, and after taking time to address these issues in his own life, he is an amazing husband and wonderful father. He is motivated to create the family he never had. Therefore, I would love to address this issue in my future practice


Broderick, P. C., & Blewitt, P. (2006). The life span: Human development for helping professionals. Boston MA: Pearson.
Cassidy, J & Shaver P.R. (1999). Handbook of Attachment. New York: The Guilford Press.
Ingram, B.L. (2012). Clinical Case Formulations: Matching the Integrative Treatment Plan to the Client. (2nd ed.). Hoboken, NJ: Wiley.

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NCE – “SSI” Method


This brief paper provides a series of self-assessments utilizing the Strong Interest Inventory and SSI Method.


This paper reviews two separate assessments. The first utilizes the results of the Strong Interest Inventory, based on Holland’s six types of personalities as it pertains to career choice (Sharf, 2006). The second assessment focuses on utilizes “The SSI Method of Assessment” (Author, 2015). This methods requires an individual to a self-examination from three perspectives: (1) personal strengths, (2) areas of improvement, and (3) insight and self-understanding (Author, 2015).

Strong Interest Inventory

According to the results of a Strong Interest Inventory, I display interests in two broad occupational areas: the artistic theme and social theme (Prince, 2015). My STD score for the artistic theme is 64 and 54 for the social theme (Prince, 2015). The results of my Strong Interest Inventory describe these levels of interest as high and moderate respectively (Prince, 2015). Additionally, I display little interest in the realistic, enterprising, and conventional occupational themes with STD scores ranging from 34-39. (Prince, 2015). Finally the Investigative Theme sits in the mid-range between these extremes with a STD score of 40.

Overview of Artistic Theme

Sharf, (2006) describes the artistic personality as “creative communicators” (Prince, 2015) who prefer a free and unstructured atmosphere. The artistic environment is ideal for this temperament since it encourages self-expression and creativity (Sharf, 2006). The results of my Strong Interest Inventory add that work activities common in the artist field include music, writing, performance and the visual arts (Prince, 2015). The strongest basic interest areas within this Artistic Theme, according to my results include “Visual Arts and Design” (Prince, 2015) with an STD score of 68. The area of “Writing and Mass Communication” (Prince, 2015) follows this basic interest area with an STD score of 63. As strong as this personal interest area is, I’ve always made time for creative pursuits. However have preferred not to focus on this area as a career, since I prefer it to exist as a free form of self-expression.

Overview of Social Theme

​According to the results of my Strong Interest Inventory, the Social Personality is described as “Empathetic Helpers” (Prince, 2015). They are interest in helping others through teaching and other personal services. The Social Theme Environment encourages the values of kindness, generosity, and friendship and social responsibility (Sharf, 2006). It’s interesting to note that my current profession as a C.N.A. is classified within this profession. Additionally, my future career aspirations as a Mental Health Counselor fall within this category.

Top Occupations

​Interestingly, I find little personal interest for those occupational areas listed at the top of the Strong Interest Inventory. Surprisingly, this inventory provided the following suggestions: Librarian, Photographer, Technical Writer, Art Teacher, Musician, Translator, Mental Health Counselor, Speech Pathologist, Artist, and Reporter (Prince, 2015). On the one hand, I have no interest in being a technical writer, translator, speech pathologist, photographer, or librarian. At the same time, I do consider myself an amateur artist who is working towards a career as a mental health counselor.

Personal Style Scales

While my work style involves a balance combination of both independent and collaborative work (Prince, 2015). I enjoy research and reading as an effort that involves learning for its own sake (Prince, 2015). My leadership style involves developing personal expertise in the context of my work rather than direction (Prince, 2015). Finally, my risk taking and team orientation are skewed towards caution and independence respectively (Prince, 2015).

SSI Method of Assessment

​This section of the paper utilizes the SSI Method of Assessment, which focuses on three key areas: Personal Strengths, Areas of Improvement, and Insights (Author, 2015). I utilize these three key areas to provide a personal career counseling assessment that can help me as I progress toward a career in Mental Health Counseling.

Personal Strengths

Career Counseling requires several key strengths, including empathy, self –care, and the ability to apply theories in the form of clinical judgment. This clinical judgment, in my opinion, involves applying insights from these theories in a way that merges objective standards with subjective understanding. I feel my strengths in this area involve an orientation toward empathic engagement with others and a priority towards self-care. As a C.N.A. and Psychiatric tech, the marriage of these two strengths is essential if I desire to give the best to others. Finally, as I progress towards LMHP licensure, I work to apply the insights gained through coursework.

Areas of Improvement

I can continue to improve my skills and knowledge by working to apply what I learn throughout my personal and professional life. As a mother and healthcare worker, I spend the majority of my time caring for others. This provides many opportunities to apply the insights learned from others. Foremost amongst these is the need of self-care in order to prevent compassion fatigue.

Insights Gained

I’ve learned that I give to others on the basis of who I am as a person. For this reason, the insights gained from the assessments utilized in this paper are useful from the standpoint of personal development. As a person who aspires to a career as a mental health counselor, it is my hope to engage in this learning process as one of personal development. This involves improving my level of self-care and understanding.


Author. (2015). SII Method of Assessment. Retrieved from:

Prince, J.P. (2015, December, 16). Strong interest inventory profile with college profile. Retrieved from:

Sharf R.S. (2006). Applying career development theory to counseling. 6th Ed. Belmont CA:

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NCE – Symbolic Experimental Family Therapy

According to Metcalf, (2011) Symbolic Experimental Family Therapy “Focuses on here-and-now experiences, playfulness, humor, intuition, craziness, spontaneity, and personal growth. It is a pragmatic, atheoretical method for treating families. Incorporates growth of the therapist and clients as the ultimate motivation, and focuses on circular, recursive patterns in a family that lead to mutual benefit and interpersonal context” (p147). Another unique aspect about this theory is that it normalizes pathology.  As I see it, this theory focuses on familial cultures, (i.e. shared meanings, beliefs, thoughts, symbols, and perspectives).  Entering in the “family’s symbolic world” (Metcalf, 2011, p. 148) is the goal here since change is conceived to result from the therapeutic process.

Founder – Carl Whitaker

Stages of Therapy

Symbolic Experimental Therapy is focused on the present.  The  first of therapy begins with the clients’ first contact with the therapist.  It is at this stage, that the therapist is “responsible for setting the tone of therapy.” (Metcalf, 2011, p. 149).   Whitaker, describes the therapist as a foster mother/investigator since, at this point, family morale and information gathering are the focus (Metcalf, 2011). Once therapy has been initiated, it is the family’s responsibility to “take charge of their own experiences…[in an] anything goes  [manner]” (Metcalf, 2011, p. 149).  Interestingly, during the early stages, the therapist is a disconnected observer who, while “joined with the family”, (Metcalf, 2011, p. 149), steps back and lets the family play out their own shared reality.  However, as therapy progresses the therapist pushes the family to address the symbols and meaning that underlies their pain.  This allows them to develop a new perspective upon which to understand their shared experience.  During the termination phase, the therapist begins to disengage as the family learns to adapt to new positive shared experiences.

View of the client

This perspective seems to focus on the shared symbolic meanings that underlie shared family dynamics.   Change happens by understanding the symbolic meanings that give rise to these family dynamics.  Change can happen if the client is willing to work with it.  Within each pathological dynamic is an opportunity for growth, therefore it is conceived as evidence of potential and not malady.  Individual human choices can be contextualized within a shared familial reality since it is from here that we develop our beliefs, values, and cultural identity.   “Families should preserve, protect, and maintain a sense of self while understanding how their being/growth influenced by family history (Metcalf, 2011, p. 150).”

Assumption about marriage

  1. “Marriage is a third entity. In therapy, the clients are the husband, wife and the marriage.
  2. Marriage is greater than the sum of its parts.
  3. People choose partners on the basis of set core beliefs and values
  4. Marriage is legally and emotionally binding. A marriage constrains two persons from getting emotionally involved with other people outside the marriage.
  5. Marriage must learn to grow and resolve unexpected and predictable impasses that occur occasionally. (Metcalf, 2011, p. 151)”

How Change Happens.

Change can happen simply by examining how we choose to interpret our shared experiences.  “Failure is one’s only teacher; success allows one’ the courage to fail.  [Change happens through]personal growth, symbol relief, character development, resolution of dependency, ability to experience emotion/anxiety, & increased spontaneity/creativity (Metcalf, 2011, p. 152).

Basic skills of a therapist

  1. “Able to tolerate pain, anxiety, etc in his own life
  2. Understructure of caring
  3. Able to listen to personal intuition
  4. Ability to become family’s foster parenting and balance nurturing with toughness during therapy
  5. Belief in continuous personal growth…
  6. Ability to interweave beliefs, assumptions, and biases into therapy.” (Metcalf, 2011, p. 152)

Key Concepts

  1. SYMBOLS:  comprise an unspoken underlying meaning that defines our experience.  It gives the meaning to the pain we experience and the options available to us for change and growth.
  2. CRAZINESS:  “allows a person to not be constrained by socially accepted realities, and be more spontaneous and symbolic.” (Metcalf, 2011, p 156).  There are three types of crazy: (1) driven crazy (2) going crazy & (3) acting crazy.  Driven crazy refers to being repelled from intimacy.  Going crazy refers to an intense and neurotic distress.  Acting crazy is a technique that involves regressing into crazy behavior during periods of heightened stress/anxiety.
  3. SPONTANIETY – “rooted in intuition and the use of craziness. Is an unconscious process. Is a key aspect for any personal interaction in therapy…..” (Metcalf, 2011, p 156)
  4. CONFUSION – “Confusion is a symbolic way to open up the infrastructure of the family and disrupting old patterns.”  (Metcalf, 2011, p 156).
  5. FANTASY –  “a form of play that allows the therapist and family to address their separate symbolic worlds & meanings.”  (Metcalf, 2011, p 156)
  6. GROWTH – “growth is the ultimate motivation of thus approach to family therapy. Growth occurs thru play” (Metcalf, 2011, p. 156).

A working template

Change happens by reshaping the “symbols and language used by the family[this provides a]  corrective experience for the family when discussed openly” (Metcalf, 2011, p. 157).  Essentially, this section of Metcalf’s (2011) discussion provides a reiteration of the therapy stages except in terms of the therapist’s objectives….

  1. PHASE ONE  – Build Rapport by upholding a foster parent role by stepping back and observing while relating “to the family as a peer” (Metcalf,2011, p. 157).
  2. PHASE TWO – Once rapport has been established it is possible to begin investigating the problem.  This happens by interviewing each family member without interruption individually.
  3. PHASE THREE:  The next step involves assessing the family dynamics and their desire for change.  “The goal is to understand the past symbols underlying the family’s pain” (Metcalf, 2011,p. p157)
  4. PHASE FOUR:  Develop familial goals.
  5. PHASE FIVE:  Amplifying change by  “getting into a family and then out as soon as possible is the goal, so you don’t leave any marks of your presence behind.” (Metcalf, 2011,p. p157)
  6. PHASE SIX: Termination.


Linehan, M. (1997). Validation and psychotherapy. (pp. 353-392). American Psychological Association. doi: 10.1037/10226-016
Gilbert, P. (Ed.). (2005). Compassion: Conceptualizations, research and use in psychotherapy. Routledge
McKay, M., Wood, J. C., & Brantley, J. (2007). The dialectical behavior therapy skills ​workbook. Oakland: New Harbinger.
Metcalf, L, (2011). Marriage and family therapy: A practice oriented approach. New York: Springer Publishing Company


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Nature & Limits of Confidentiality…

Confidential: Ethical & Legal Issues

“B.1.b. Respect for Privacy Counselors respect the privacy of prospective and current clients. Counselors request private information from clients only when it is beneficial to the counseling process…B.1.c. Respect for Confidentiality Counselors protect the confidential information of prospective and current clients. Counselors disclose information only with appropriate consent or with sound legal or ethical justification. B.1.d. Explanation of Limitations At initiation and throughout the counseling process, counselors inform clients of the limitations of confidentiality and seek to identify situations in which confidentiality must be breached.” (ACA, 2014 p. 6-7)

During the informed consent process, clients should be explained how privileged communication and documentation will be utilized, and what measures are taken to protect their privacy.  Corey, et al, (2011) note that confidential is both an essential right for clients and necessary for effective therapy (p. 210).  Additionally, “as a general rule, psychotherapists are prohibited from disclusing confidential communication to any third part unless mandated by law to do so” (Corey, et al, 2011, p. 211).  However, certain legal limitations exist regarding a therapist’s ability to protect a client’s information.  They must be warned of this in advance…

Defining Key Terms…

  1. Privileged Communication: “A legal concept that generally bars the disclsure of confidential communication in a legal proceeding…All states have enacted into law some form of psychtherapist-client privilege…when a client-therapist relationship is covered as privileged communication by statue, clinicians may not disclose confidential information” (Corey, et al, 2013).
    1. If the client waves this privilege, the therapist is obligted to “disclose information that is necessary and sufficient when the client requests it” (Corey, et al, 2011, p. 213).
    2. “Generally Speaking,…[this] does not apply to group counseling, couples counseling, family therapy, child and adolescent therapy.” (Corey, et al, 2011, p 214)
  2. “Privacy: as a matter of law refers to the constitutional right of individuals to be left alone and to control their personal information…Practitioners should exercise caution with regard to the privacy of their clients” (Corey, et al, 2011, p. 2015).

Steps to Protect Client Privacy…

  1. “PREPARATION: Before you explain the limits to confidentiality, it is important for you to understand these limtits yourself.  Review the relevant legal and ethical standards and contemplate/define your own moral principles.
  2. BE UP FRONT:  Tell the client the limits imposed to you  legally.  Obtain the client’s consent and have them sign relevant documentation indicating they understand these limts.
  3. OBTAIN INFORMED CONSENT BEFORE DISCLOSURE:  (should not require explanation.  However, sometimes for reasons listed below this is not always possible).
  4. RESPOND ETHICALLY TO LEGAL REQUESTS FOR DISCLOSURE:  if there is a pending legal demand for disclosure, notify the client and limit information so the extent that is legally allowed.
  5. AVOID ‘UNAVOIDABLE’ BREACHES:  monitor your recordkeeping, electronic communication, and note-taking practices to avoid unintentional breach…
  6. TALK ABOUT CONFIDENTIALITY:  Disuss with clients and fellow counselors… “(Corey, et al, 2011 p. 213)

Exceptions to Confidentiality

B.2.a. Serious and Foreseeable Harm and Legal Requirements The general requirement that counselors keep information confidential does not apply when disclosure is required to protect clients or identified others from serious and foreseeable harm or when legal requirements demand that confidential information must be revealed. Counselors consult with other professionals when in doubt as to the validity of an exception. Additional considerations apply when addressing end-of-life issues….B.2.c. Contagious, LifeThreatening Diseases When clients disclose that they have a disease commonly known to be both communicable and life threatening, counselors may be justified in disclosing information to identifiable third parties, if the parties are known to be at serious and foreseeable risk of contracting the disease. Prior to making a disclosure, counselors assess the intent of clients to inform the third parties about their disease or to engage in any behaviors that may be harmful to an identifiable third party. Counselors adhere to relevant state laws concerning disclosure about disease status. B.2.d. Court-Ordered Disclosure When ordered by a court to release confidential or privileged information without a client’s permission, counselors seek to obtain written, informed consent from the client or take steps to prohibit the disclosure or have it limited as narrowly as possible because of potential harm to the client or counseling relationship.” (ACA Code of Ethics, 2014, p. 7).

FIRSTLY: Explain to the client the Four Key Exceptions to Confidentiality….

Essentially it is the counselor’s responsibility to help the client understand that confidentiality is not absolute and there are circumsantes in which client’s must reveal confidential information.  These four key reasons are as follows:

  1. There may be occasions in which I therapist is “subpoena’ed” to testify in court.

  2. If the client expresses an intention to harm his/her self and has a plan in place, I am ethically required ot protect their well-being.

  3. If it is revealed that somebody is abusing the client, I need to inform police.

  4. If the client has a plan to harm somebody else, I must warn that person.

SECONDLY: Also explain that sharing info is essential in order to  provide “competent services” (Corey, et al, 2011, p. 221).

  1. In order to reimbursement disclosure of information may be required.
  2. Clerical assistance may occasional need to handle confidential information.
  3. Occasionally the counselor consults with her supervisor regarding this specific case.
  4. When other mental health professionals request information and client gives consent.
  5. It is also essential to communicate with other individuals involved in the treatment team.
  6. When the client requests information.
  7. Occasionally legally mandated exceptions arise: (i.e civil claim, or complaint filed.

Finally, a quick review of the “Duty to Warn/Protect”

As a result of a series of court rulings, mental health professionals have two seemingly contradictory concerns to contend with.  On the one hand, they must protect the privacy of their clients.  On the other hand, it is essential to protect the safety of the client and/or others if this information is revealed in therapy.  In other words, you have public safety on one hand, and personal privacy on the other.

DUTY TO WARN: (requires disclosure)

“Applies to those circumstances where case law or statue requires the mental health professional to make a reasonable effort to contact the identified victim of a client’s serious threats of harm, or to notify law enforcement of the threat” (Corey, et al, 2011, p. 231).

DUTY TO PROTECT: (provides ways to protect privacy)

“Applies to situations where the metnal health professional has a legal obligation to protect an identified third part who is being threatened; in these cases the professional generally has other options in addition to warning the person of harm”

Failing to warn can result in liability for civil damages

  1. Was there a failure to diagnose and predict dangerousness?
  2. Did the therapist fail to warn a victim of the client’s violent behavior?
  3. Was there a failure to commit?
  4. Was there a premature discharge?

“Client’s must do the following:  (1) identify those clients who are likely to do harm to 3rd parties, (2) protect third parties from those clients… (3) treat those clients who are dangerous.” (Corey, et al, 2011 p. 230).     

  1. Take steps to protect public and minimize liability (Corey, et al, 2011, p. 230).
  2. take careful histories and document thoroughly with those clients who are high-risk.
  3. Continually re-evaluate the potential for high risk behavior & modify TP PRN.
  4. Advise clients of their confidentiality limits.  Examine your informed consent document are terms of forfeiture of confidentiality clear as it pertains to the threat of violence to self and/or others.
  5. Regularly seek consultation (supervisor / attorney).  Know your code of ethics.
  6. Record Steps taken to protect others if necessary…
  7. In cases where client expresses desire to harm someone else, assess for suicidal ideation.
  8. Be familiar of treatment options and resources for managing high-risk clients.

Relevant Cases…

  1. Tarasoff Case – “In August 1969 PRosenjit Poddar was a voluntary outpatient at the student health service at the University of California, Berkeley and was in counseling…Poddar had confided to Moor his intention to kill an unnamed woman…Shortly after [the victim’s] return from Brazil, Poddar killed her…The California Supreme Court ruled in favor of the parents in 1976, holding that a failure to warn an intended victim was professional irresponsible….[the therapist has a} duty to exercise resonable care to protect the foreseeable victim of the serious danger of violence against him or her.” (Corey, et al, 2011, p. 232)…
  2. The Bradley Case: “A second case illustrates the duty not to negligently release a dangerous client…the patient, Wessner, had been voluntarily admitted to a facility for psychiatric care…was upset over his wife’s extramarital affair…He had repeatedly threatened to kill her…He was given an unrestricted weekend pass…met his wife and her lover in the home and shot and killed them…Georgia Supreme Court ruled that a physician had a duty to take reasonable care to prevent a potentially dangerous client from inflicting harm” (Coery, et al, 2011 p. 234).
  3. The Jablonski Case:  “The intended victim’s knowledge of a threat does not relieve therapists of the duty to protect…Melinda Jablonski filed suit for the worngful death of her mother…who was murdered by Philip Jablonski…[who] hjad agreed to a psychiatric examination at a hospital…The physicians determined that there was no emergency and thus no basis for involuntary commitment” (Corey, et al, 2011, p. 234).

HIPAA For Mental Health Professionals…

“The Health Insurance Portability and Accountability Act of 1966 (HIPAA) was passed by congress to promote standardization and efficiency in the health are industry and to give patients more rights and control over their health information…and are required to sign the appropriate forms authorizing the health care provider to provide information to other health care providers” (Corey, et al, 2011, p. 228).  The purpose of this rule is to provide a federally based uniformity to how health care facilities and workers are required to protet client’s confidentiality.  There are four main categories of requirements:

Privacy Requirements

“Practitioners take reasonable precautions in safeguarding patient information. Licensed health care providers are expected to ahve workign knowledge of and guard patients’ rights to privacy in disclosure of information, health care operation, limiting the disclosure of protected information, payment matters, protected health information, psychotherapy notes, and a patient’s medical record and treatment activities” (Corey, et al, 2011, p. 229).

Electronic Transactions

“HIPAA aims at creating one national form of communication or “language” so that health care proiders can communicate with one another electronically in this common language.” (Corey, et al, 2011, p. 229).

Security Requirements

“Minimum requirements are outlined in HIPAA that are designed to safeguard confidential information and prevent unauthorized access to health information of patients.” (Corey, et al, 2011, p. 229).

National Identifier Requirements

“It is essential that covered entities be able to communicate with one another efficiently.  Health care providers and health plans are required to have national identification numbers that identify them when they are conducting standard transactions” (Corey, et al, 2011, p. 229).

Confidentiality & Privacy in the School Setting.

Corey, et al, (2011) state that maintaining confidentiality in a school setting is especially problematic.  While “obliged to respect the privacy of minor clients and maintain confidentiality [this can] conflict with laws regarding parental rights.” (Corey, et al, 2011, p. 217)  In other words, the counselor must weight the parent’s rights to be a guiding force in their child’s lives against their client’s desire and right for privacy.  One way of handling this, is for the counselor to ask for permission of information release before and let them know about the limts to privacy.  “The basic standard of care for school counselors is clear, courts have uniformly held that school personnel have a duty to protect students from foresseable harm.” (Corey, et al, 2011, p. 236).

Considerations for Suicidal Clients

The guidelines and rules discussed here also apply to suicidal clients.  The issue here is knowing when to take the client’s serious.  “Therapists have a legal duty to make assessments from an informed position and carry out their professional obligations in a manner comparable to what other reasonable professionals would do” (Corey, et al 2011, p. 241).

Protecting Children, Elderly & Dependent Adults…

“Privileged communication doesn’t apply in case of child abuse and neglect, nor does it apply in cases of elder and dependent adult abuse…Such matters constitute a situation of reportable abuse…The professional is required to report the situation under penality of fines and imprisonment.  IF adults reveal in a therapy session that they are abusing or have abused their children, the matter must be reported….the goal of reporting is to protect a child or older person who is being abused….National Child Abuse PRevention Treatment Act (PL 93-247).  


ACA Code of Ethics as a resource for an academic work: American Counseling Association (2014). ACA Code of Ethics. Alexandria, VA: Author.
American Psychological Association. (2017). Ethical principles of psychologists and code of conduct (2002, Amended June 1, 2010 and January 1, 2017). Retrieved from
Corey, G, Corey M.S. & Callanan P. (2011). Issues and ethics in the helping professions. 8th Ed.  Belmont CA: Brooks/Cole.

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