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Is the counselor an "active ingredient" in substance abuse rehabilitation? An examination of treatment success among four counselors.

The impact of the counselor in substance abuse rehabilitation has been questioned. The unexpected resignations of two counselors provided a natural opportunity to examine the effects of counselor assignment in a methadone maintenance treatment program with the effects of the medication philosophy, program rules, and supplementary services held constant. Sixty-one patients who had been assigned to these two counselors were assigned to four other counselors in a virtually random manner. It was reasoned that if the new counselor had relatively little impact, then there would be little difference in performance from pre to posttransfer or among the four caseloads during the 6-month period following the transfer. Performance measures included urinalysis results, methadone dosage, prescriptions for psychotropic medications, employment, and arrest rates. Results indicated statistically significant and clinically meaningful differences in the posttransfer performance of the four caseloads. One counselor significantly reduced the average methadone dose of his/her caseload as well as the number of patients prescribed ancillary medications, while concurrently reducing positive urine tests, unemployment and arrests. In contrast, another counselor significantly increased the average methadone dose in his/her caseload but still showed increases in positive urine tests and unemployment. As has been found in prior studies, background and formal education differences among the counselors were not related to the observed performance differences. However, differences in the content and process of counseling among the counselors were associated with the differences in patient outcome. These process differences are discussed in relation to earlier studies of professional psychotherapy.

Combined Modality Therapy↗

Treatment attitudes of recovered alcoholic counselors and nonalcoholic counselors.

The advent of the profession of alcoholism counseling has generated concern about the clinical treatment attitudes of counselors who are recovered alcoholics. The treatment attitudes of eight recovered counselors and eight nonalcoholic counselors at a U.S. Navy alcohol treatment facility were compared by rating the counselors' perception of client clinical characteristics, diagnosis, and preference for treatment modality and goals. Recovered counselors perceived: greater psychological dependence on alcohol, higher probability of substitution of another drug for alcohol, psychologists as less helpful, Antabuse as more helpful, abstinence as a more necessary treatment goal, and transactional analysis as a more helpful treatment. No significant differences remained between the attitudes of both groups of counselors after intervening counselor characteristics (e.g., Alcoholics Anonymous activity and alcohol training experience) were controlled. The findings may indicate reticence among nonalcoholic counselors to challenge traditional alcoholism treatment methods and theories.

Adult↗

Paraprofessional versus professional drug abuse counselors: attitudes and expectations of the counselors and their clients.

Three groups of methadone maintenance and drug-free outpatient counselors, ex-addict paraprofessionals (EXAs), non-ex-addict paraprofessionals (NEAs), and degreed professional counselors (PROs), were contrasted in terms of their views of drug abuse and drug treatment, their attitudes toward and expectations for their clients, and in terms of their clients' attitudes toward them. Across groups, counselors agreed on the major cause of drug abuse, the critical factor in treatment, the definition of treatment success, and their expectations for client success. While clients of the three groups viewed their counselors are equally able to understand them and were equally confident of the counselors, the clients of EXAs saw their counselors as more knowledgeable about critical issues of drugs and the street scene, were more willing to bring personal problems to their counselors, and expected and desired more participation from their counselors in both counseling-related and personal problems.

Adult↗

Counselor and client personality as determinants of counselor expectancy effects.

Seventy-eight students enrolled in summer-session college courses were randomly assigned to serve either as counselors or as clients for a 20-min, role-played peer counseling session. All of the subjects completed a battery of standardized personality measures. Each counselor interacted with two clients. Prior to the sessions, the counselor was led to believe that one of the clients was especially introverted and that the other client was especially extraverted. Dependent measures were based on clients' change scores on a mood adjective rating scale administered before and after the peer counseling sessions. Analyses showed that counselors who were more successful at biasing their clients in the direction of their expectancies (a) scored higher on measures of Dogmatism, Nurturance, and Social Recognition, (b) scored lower on Impulsivity, and (c) were more likely to be women. Clients who were more susceptible to counselor bias scored higher on the Self-Monitoring Scale, the Self-Monitoring Other-Directedness subscale, and Social Recognition. These results are discussed in light of previous research and their implications for research on interpersonal expectancy effects.

Adolescent↗

The pastoral counselor as mental health professional: a comparison of the training of AAPC Fellow Pastoral Counselors and Licensed Clinical Social Workers.

Compares the academic and clinical training requirements for Fellow level members of the American Association of Pastoral Counselors (AAPC) with those of Licensed Clinical Social Workers (LCSWs). Concludes from the empirical findings that AAPC Fellows receive more education, clinical training, and continued supervision than do Licensed Clinical Social Workers. Notes a need for additional and similar types research comparing education and clinical requirements of pastoral counselors with those of other mental health professionals.

Clinical Competence↗

The interactive effects of counselor gender, physical attractiveness and status on client self-disclosure.

Investigated client self-disclosure and client perception of counselors (as expressed in counselor evaluations) as a function of the sex, attractiveness and status of the counselor, and the sex of the client. Counselor gender and attractiveness were established by means of stimulus photographs; counselor status was defined in terms of education and experience. Ss (160 college students) first rated their counselors on intelligence and empathy; they then completed Jourard's Self-Disclosure Questionnaire while role-playing clients in therapy. A four-factor between-Ss analysis of disclosure scores revealed that clients disclosed more of themselves to male than to female counselors when the counselors were high in either status or attractiveness. Results supported the hypothesis that the effect of counselor gender on client disclosure depends on an interaction of counselor gender with other counselor variables.

Adult↗

Effect of peer counselors on breastfeeding initiation, exclusivity, and duration among low-income urban women.

This study examined the effect of support from trained peer counselors on breastfeeding initiation, duration, and exclusivity among low-income urban women. Training of counselors, under the supervision of a registered nurse certified in lactation, adapted education techniques from Paulo Freire to provide information about lactation management and other health care issues. The study compared infant feeding practices of women who planned to breastfeed and received support from counselors (counselor group, N = 59) to women who requested counselors but, owing to inadequate numbers of trained counselors, did not have a counselor (No-counselor group, N = 43). Women in the counselor group had significantly greater (p < .05) breastfeeding initiation (93 percent vs. 70 percent), exclusivity (77 percent vs. 40 percent), and duration (mean of 15 weeks vs. mean of 8 weeks) than women in the no-counselor group. The findings suggest that peer counselors, well-trained, and with on-going supervision, can have a positive effect on breastfeeding practices among low-income urban women who intend to breastfeed.

Adult↗

Manifest needs of prospective counselors: a comparative study.

Mean performances of 81 prospective counselors on each of the Edwards Personal Preference Schedule (EPPS; Edwards, 1959) needs were analyzed and statistically compared with performances of elementary school counselors, other school counselors, urban college students, professional women, Roman Catholic sisters, and the 1959 EPPS norm samples. Performances of the men and women in the prospective counselor group were similar. Men had a significantly higher need for achievement and dominance, but the significance did not reach .01. Two EPPS needs, intraception and nurturance, consistently differentiated the prospective counselor group. Comparisons across samples indicated that prospective counselors were most similar to the two counseling samples and, for the female subgroup of prospective counselors, to the sample of professional women. Largest across-sample differences were found between the female prospective counselors and the Roman Catholic sisters, between the female prospective counselors and norm samples of female college students and female adults, and between the male prospective counselors and the male adult norm sample.

Adult↗

Genetic counselor attitudes towards fetal sex identification and selective abortion.

Thirty-four prenatal genetic counselors (all but one non-M.D.s) in seven American cities were interviewed on attitudes which might plausibly affect counselor-client interchanges. They overwhelmingly endorse both non-directive counseling and the pro-choice ethos which supports a woman's absolute right to abortion in the early stages of pregnancy. However, they also overwhelmingly condemn using prenatal diagnosis for sex selection purposes. Therefore, counselors experience continual stress from clients who evoke the conflict inherent between these two stances. Counselors use a variety of coping mechanisms to minimize this cognitive dissonance. Avoidance through out-referral or invoking institutional policies forbidding prenatal diagnosis for sex selection purposes is a diminishing option and not possible with clients who have or offer a medical indication. More common is the use of psychological coping mechanisms. By elevating the ideals of non-directiveness and female autonomy counselors better tolerate client values in conflict with their own. Some redefine the category of 'unwanted pregnancy' to include fetuses of the 'wrong sex'; others redefine the problem as their own ethnocentricism. Empowering counselors to set the protocols they use to screen applicants for prenatal diagnosis would not remove these conflicts. Many counselors believe a ban on releasing fetal sex information while abortion is still a legal option would be organizationally or legally unacceptable, or a violation of patient automony. A complicating factor is that 60% of the counselors interviewed would prefer to know fetal sex in their own pregnancies. Counselors reflect the ambivalence of American society in balancing conflicting social goals.(ABSTRACT TRUNCATED AT 250 WORDS)

Abortion, Legal↗

Counselor effectiveness in a methadone maintenance program.

Counselor effectiveness for 253 heroin addicts in a methadone maintenance program was studied. The results of patient urinalysis for heroin use was chosen to assess counselor effectiveness. No significant differences in heroin use were found for the following groups of patients: 1. Those with multiple ex-addict (EA) counselors. 2. Those with multiple nonaddict (NA) counselors. 3. Patients with time periods with EA counselors followed by time periods with NA counselors, or vice versa. 4. Those with a single NA counselor. 5. Those with a single EA counselor. Patients with no counselor for one-third or more of each study period were found to have a significantly greater percent of urines positive for heroin.

Adult↗

Goals, benefits, and outcomes of genetic counseling: client and genetic counselor assessment.

Most studies of outcomes of genetic counseling have focused on client knowledge, reproductive plans and behavior, or satisfaction. Other measures of the "value" of genetic counseling are needed to guide research assessing the impact of genetic counseling on individuals and populations, as well as to improve the process of providing care. To obtain input from providers, we conducted telephone interviews with six experienced genetic counselors, and then we held a focus group with 10 additional genetic counselors from a variety of practice settings. To obtain input from consumers, telephone interviews were also conducted with 19 past clients of these participating counselors. We found that counselor goals focus on meeting clients' needs, usually educating and providing psychosocial support. Clients often had few goals going into a session because they were unaware of what would be discussed or how the session would be structured. They usually did not expect to receive "counseling," and when they did, it was a welcome surprise. Both clients and counselors commented that a positive interpersonal interaction and "connecting" are primary measures of success. All clients appreciated the large amount of time spent with the counselor, and the manner (clear, comprehensive, and unhurried) of providing information. Many clients said that genetic counseling resulted in improved communication with their partners and other family members. Clients view the counselor as an "expert" and value the counselor as an on-going resource for both information and support. These "outcomes"f genetic counseling need to be assessed, and new measures must be developed.

Adult↗