Volume 13 Number 1 Spring 2018

North Carolina

THE

Volume 13 Number 1 Spring 2018

Counseling Journal Editor Angel Dowden

The Official Journal of the North Carolina Counseling Association

Editor

Editorial Board

Dr. Angel Dowden LPC, NCC, ACS Department of Counseling NC A&T State University 325 Proctor Hall 336-285-4484 [email protected]

Dr. Jeff Warren UNC Pembroke

Associate Editor Dr. Mark J. Schwarze, Ph.D., LPCS, NCC, LCAS, CCS Department of Human Development and Psychological Counseling Appalachian State University 828-262-6046 [email protected]

Dr. Dominique Hammonds Appalachian State University Dr. Lucy Purgason Appalachian State University Dr. Angela Banks-Johnson Capella University Dr. Angela Smith North Carolina State University Dr. Elizabeth Vincent Campbell University

Dr. Hank Harris UNC Charlotte Dr. Rolanda Mitchell North Carolina State University Production Manager Emilie Hite Appalachian State University Editorial Assistants Meghan Rock Appalachian State University Briana Taylor NC A&T State University

THE NORTH CAROLINA COUNSELING JOURNAL is a publication of the North Carolina Counseling Association for the purpose of informing our members of current research and practice in the field of counseling. Both scholarly and practical application manuscripts are selected for publication through a peer review process. Manuscripts accepted for publication describe (1) research in the field of counseling, (2) review of the literature, (3) innovative therapeutic techniques (4) current issues in the field, (4) multicultural understanding and inflences, (5) book reviews of North Carolina authors, and (6) individuals or groups that have positively impacted the North Carolina counseling profession in some capacity. Manuscripts: Please submit manuscripts electronically in word document to the editor at [email protected]. Guidelines for author submissions can be found here. Permissions: All materials contained in this publication are the property of the North Carolina Counseling Association (NCCA). NCCA grants reproduction rights to libraries, researchers, and teachers who wish to copy all or part of the contents of this issue for scholarly purposes provided that no fee for the use of these copies

NC Counseling Journal • Spring 2018 • Volume 1

NORTH CAROLINA COUNSELING JOURNAL THE

Volume 13 Number 1 Spring 2018

From the Editor 1 Articles 2

Diversity Within Unity: A Pilot Study of Issues in Professional Counseling Identity

Bailey P. MacLeod, James W. McMullen, and Laura J. Veach

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Utilizing Asset Mapping to Strengthen the Comprehensive School Counseling Program

Jennifer Barrow

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What is Your Body Saying? The Use of Nonverbal Immediacy Behaviors to Support Multicultural Therapeutic Relationships Nicole A. Stargell and Kim Duong

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Equine Assisted Psychotherapy in the Addictions Counseling Field

Jill Van Horne, Geri Miller, and Catherine Clark

From the Editor Dear NCCA Members: The North Carolina Counseling Journal (NCCJ) is the official journal of North Carolina Counseling Association (NCCA). Previously, the journal was called North Carolina Perspectives. The new name, NCCJ, is indicative of the journal’s renewal. This letter is to make members aware of the renewal process and to encourage your commitment to and participation in the journal. Philosophically, the journal is committed to publishing conceptual and empirical work that promotes counseling in North Carolina and other areas, and represents diversity in authorship. The journal is committed to being inclusive and encourages submissions from students, practitioners, and counselor educators. NCCJ publishes theory, practice and research articles bi-annually. Each journal edition will publish 4-6 articles. Visit https://nccounselingassociation.org and click the “Journal” tab to learn more about NCCJ. Contact Angel Dowden (Editor) for additional journal information- [email protected] Best, Angel Dowden, Editor Associate Professor, North Carolina A&T State University

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Diversity Within Unity: A Pilot Study of Issues in Professional Counseling Identity Bailey P. MacLeod, Charlotte, NC, James W. McMullen, University of Wisconsin-Stout, and Laura J. Veach, Wake Forest Baptist Medical Center The purpose of this pilot study was to investigate the perceptions of professional counselor identity amongst North Carolina counselors and to explore the face validity of a new assessment instrument. Participants were a sample of convenience that consisted of 21 professional counselors attending a state conference for professional counselors. Participants endorsed licensure and a higher degree as important to the profession. Even though treating symptoms was highly promoted, there was also a high endorsement of the American Counseling Association’s 20/20 definition of counseling that focuses on accomplishing wellness-based goals. Participants also discussed their opinions about differences between counseling and other helping professions. Implications for future research are also discussed. Keywords: professional counseling identity, mental health professions, advocacy, ACA 20/20 initiative, pilot study

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ith over 1.8 billion dollars in cuts to mental health services from 2009-2011 across the United States (NAMI, 2011) and the existence of other competitive mental health professionals (i.e. social workers and psychologists) with similar services, it is imperative that professional counselors are aware of their collective identity when delivering services and marketing themselves to the public. A Delphi panel of 20 experts in the field of counseling was created to discuss the current ethical issues facing the field of counseling (Herlihy & Dufrene, 2011). Among several issues related to ethical guidelines, fostering social justice, and ensuring competence in counseling practice, the need to strengthen professional identity was identified as an important current issue. In order to fit among the ranks of other mental health professionals, professional counselors in North Carolina need to define and promote their identity as a unique profession that provides strengths-based and wellness-oriented services from a developmental perspective (Herlihy & Dufrene, 2011). There is also a growing need to implement portability of licensure from state to state, recognition of third party payers, and national and statewide recognition for mental health parity in order to gain credibility in the mental health market (Calley & Hawley, 2008; Reiner, Dobmeier, & Hernandez, 2013). NC Counseling Journal • Spring 2018 • Volume 1

A call for advocacy for the field of professional counseling has been made in the profession in order to increase professional counselors’ credibility among other mental health professionals (Kaplan & Gladding, 2011; Myers, Sweeney, & White, 2002; Reiner et al., 2013). Professional Counseling Identity A professional identity consists of how a profession is different, distinct, and credible among other professions. The history of professional counseling shows that it is an interdisciplinary profession that integrates psychology and education, based in counseling research and practices to create a unique orientation (Gale & Austin, 2003; Pistole & Roberts, 2002). It involves the distinct values of the profession, ethical guidelines, scope of professional activities, focus on scholarship, theoretical orientation, and credentials and training of counselors (Calley & Hawley, 2008; LaFleur, 2007). Calley and Hawley (2008) conducted a survey of 70 counselor educators on aspects of their professional identity and related activities in order to better understand the professional identity of counseling. Their results revealed that 93% were members of the American Counseling Association (ACA) and half invited professional counselors to speak in classrooms to counselors-in-training 2

Diversity Within Unity as part of the course curriculum. Calley and Hawley also surveyed counselor educators’ theoretical orientation and the results revealed that 41% aligned with a humanistic theory, 23% to a constructivist theory, 15% to cognitive-behavioral theories, and 6% to psychodynamic theories. This shows that the majority of professional counselors align with postmodern constructivist and humanistic orientations. These theories are inherent and unique to the counseling profession of holistic, wellness-based practice that emphasizes the therapeutic alliance, promotion of client as expert, and belief that the client possesses the resources for change. In order to be seen as a separate and distinct profession, it is important for professional counselors to be able to distinguish themselves from other mental health professionals. Based on the history of counseling, some believe that counselors’ knowledge of assessment distinguishes them from social workers, and foundations in career counseling and working with less severe populations distinguishes counselor educators from other mental health professions (Gale & Austin, 2003). A survey of practicing counselors from a variety of specialties about how they perceive the counseling profession as distinct from psychology and social work found that counselors believed they provided counseling services and education focused on wellness and growth, and with distinct credentials (Mellin, Hunt, & Nichols, 2011). The participants defined counseling as more focused on personal growth, empowerment, and development versus the medical model of pathology in psychology. Some knowledge of assessment in counseling has also been seen as separate from social work (Gale & Austin, 2003) but is not seen as much of a focus as psychology (Mellin et al., 2011). Barriers to Professional Identity Although there is some agreement about what constitutes a professional identity, there are many barriers to a unified professional identity that need to be addressed in order to strengthen and advocate for the profession. Even though the counseling field has professional standards, organizations, ethical codes, state-specific credentialing and licensing boards, and an accrediting body, there is still a lack of unity that is unique to the counseling profession. There are differences in training, specialization, professional affiliations, and credentialing between programs and licensing (Gale & Austin, 2003). The different specialty areas (i.e., school counseling, marriage and family therapy, career counseling, addictions NC Counseling Journal • Spring 2018 • Volume 1

counseling, and clinical mental health counseling) have further fragmented the field because they create associations aligned with that specialty and may have different training (Gale & Austin, 2003; Mellin et al., 2011). These divisions may contribute to confusion within the counseling field as a whole and among North Carolina counselors specifically trying to understand the role of professional counselors and mental health services. Another issue that threatens the collective identity of professional counselors is a unified body of research (Gale & Austin, 2003; Pistole & Roberts, 2002; Reisetter et al., 2004). A profession needs to establish a body of research to support the skills and specialized techniques of the field (Pistole & Roberts, 2002). Counseling, especially at the doctoral level, is a scientist-practitioner model with an emphasis on scholarship and research in a specific area (Dollarhide, Gibson, & Moss, 2013). Criticisms of research in counseling include a lack of enthusiasm for and production of research, which may be due to the traditional, positivistic approach of doing research that does not align with the postmodern view of human behavior (Reisetter et al., 2004). Gale and Austin (2003) found through expert interviews that there was too much programmatic emphasis on licensing requirements, especially specialization, and not enough emphasis on research. Counselors also engage in research with a short-term focus that lacks depth and fails to establish a well-proven base of research knowledge (Gale & Austin, 2003). The issue of research in professional counseling is further complicated by the differences in demands on master’s-level clinicians and doctoral-level counselors. Master’s-level counselors are trained in a practitioner setting with less emphasis on conducting research and doctoral-level counselors in academia focus on research and training (Dollarhide et al., 2013). A survey of licensed professional counselors found that there were no differences in professional identity for those who saw professional scholarship (i.e., reading and producing research) as important and those who did not (LaFleur, 2007). This suggests that professional counselors may not view research as a critical piece of their everyday professional identity, even though it is imperative for establishing and maintaining a credible profession (Pistole & Roberts, 2002). A final issue related to the identity of the profession involves the fit of the counselor’s orientation and values with the knowledge and needs of their potential clients. Myers et al. (2002) view the public image of, and access to, counseling and counselors as one of the four areas of concern for the success of professional advocacy 3

MacLeod, McMullen, &Veach in the field. Even though a professional counseling orientation involves a humanistic perspective that emphasizes preventative and holistic mental healthcare, a society that is increasingly partial toward the medical-model treatment may not support these views (Hansen, 2003). This forces professional counselors to practice from the medical/pathological standpoint that is similar to other mental health professions, especially in hospital and rehabilitation facilities. Hawley and Calley (2009) created a template for developing professional identity by capitalizing on faculty hiring practices to transmit professional identity, harnessing legislative strength, reconciling our humanistic roots, promoting title ownership, and conducting research that articulates the profession’s strengths. This template was designed to provide a way to create a concrete definition of a professional counselor. In 2005, in order to unify counseling as a profession, presidential teams from ACA and the American Association of State Counseling Boards (AASCB) organized 20/20: A Vision for the Future of Counseling, an initiative to strengthen professional counseling by the year 2020 (Kaplan & Gladding, 2011). Delegates from 19 divisions of ACA and 11 major organizational stakeholders were present at the annual ACA Conference in Detroit, Michigan in 2007. The principles for Unifying and Strengthening the Profession was endorsed by 29 of the 30 organizations, which included 22 issues under seven principles that would advance the profession. The issues represented were: strengthening identity, presenting ourselves as one profession, improving public perception/recognition and advocating for professional issues, creating licensure portability, expanding and promoting the research base of professional counseling, focusing on students and prospective students, and promoting client welfare and advocacy. These Principles were a historic landmark in the counseling profession and were created to provide a guideline for counselors to unify the profession with a common vision. Based on calls for unity across the field of counseling (Gale & Austin, 2003), strategies should exist for improving the counseling profession’s advocacy of the field (Myers & Sweeney, 2004; Ostvik-de Wilde, Hammes, Sharma, Kang, & Park, 2012) and how to define and promote a distinct professional identity (Kaplan, Tarvydas, & Gladding, 2014; Pistole & Roberts, 2002). In order to align with this call to the field and to better understand professional counselor identity, this pilot study aimed to survey North Carolina professional counselors about the qualities of a professional counselor identity, differences between counselors and NC Counseling Journal • Spring 2018 • Volume 1

other mental health professionals, and the new 20/20 consensus counseling definition. The following research questions were examined: (a) What do professional counselors see as important qualities of professional counselor identity? (b) How do professional counselors view the differences between counseling and other mental health professions? (c) What do professional counselors perceive as the needs of the profession? In an effort to reach this goal and answer the research questions, a pilot study was conducted in order to obtain information about the perceptions of counselor identity in the state of North Carolina as well as to gain feedback about the face validity of the survey instrument. Method This research was a survey of descriptive information and opinions concerning counselor identity of professional counselors. The pilot study design was used to evaluate future research feasibility, collect preliminary data, and develop a research protocol (Van Teijingen & Hundly, 2001). This pilot study allowed researchers to improve the face validity of the developed questionnaire through feedback by expert reviewers in the field. Feedback of specific questions allowed for adjustment or elimination of unnecessary or confusing test items. In addition to pilot testing the survey instrument, the study also gathered information about the opinions and perceptions of professional counselors on professional counseling identity, and how professional counselors differed from other mental health professionals. Participants In order to survey the opinions of professional counselors, the researchers recruited participants from the North Carolina Counseling Association Conference, a state conference, on February 21-22, 2013. This annual conference allows counselors to network and share ideas relevant to current trends in counseling. Surveying counseling professionals allowed for a better understanding of how counselors in North Carolina view their roles, tasks, and focus as a mental health professional. It also allowed for professional counselors to articulate how they view the professional counseling field compared to other mental health professions, such as social work, psychology, and psychiatry. Finally, the study allowed participants to rate their opinion of the ACA definition of counseling as well as their opinions on mental health in the United States. 4

Diversity Within Unity A convenience sample of 21 participants randomly recruited at the conference was used for the pilot study. The mean age of the participants was 45.75 (SD = 11.98) and ranged from 26 to 65 years old. The majority of the sample was female (71.4%, n = 15) and White (90.5%, n = 19), with one (4.8%) African-American and one (4.8%) Hispanic/Latino/a participants. All participants but one (95.3%) held a master’s degree or higher. Ninety-five percent (n = 20) of the participants indicated that they were currently employed, of whom 55% (n = 11) were employed as clinicians in counseling. The remaining worked in other counseling related fields; one as a counseling supervisor, three as counselor educators, three as administrators, and two were graduate students in counseling (see Table 1).

Procedure

After approval from the Institutional Review Board, the researchers recruited participants at a table outside of seminar rooms at the conference. After participants agreed to the study and signed the informed consent form, they were given an anonymous, paper-and-pencil assessment. The questionnaire included demographic and counseling knowledge survey sections required to be completed by participants. The survey took approximately 15 minutes to complete. After completion, the participants placed the survey inside of a manilla envelope. All of the quantitative data were uploaded to the Statistical Package for Social Sciences (SPSS) software and descriptive data were reported. A section was included at the bottom of the survey for participants to Materials give feedback. Feedback data was assessed using a qualitative, exploratory design. Free-response questions were The participants completed an 18-item survey creat- also analyzed for commonalities across participants used by the co-investigators for the purpose of assess- ing qualitative thematic analysis in Atlas.ti (Version 6). ing perceptions of professional counselor identity. The survey included forced-choice and free-response items Results to assess demographic information, perceptions of different mental health professions, and perception of Important Qualities of Professional Counselor Identhe counseling field. For the forced-choice items, each tity question was followed with a list of common responses the participants could choose. The survey also asked This preliminary pilot survey collected quantitative participants to rank order their preference for mental and qualitative data from professional counselors about health professionals amongst a list of common mental their perceptions of the counseling profession and prohealth professionals (i.e., counselor, psychiatrist, so- fessional identity. Quantitative descriptive statistics cial worker, psychologist). Responses to survey items were analyzed using SPSS. Qualitative data from the that were not specific to participants’ opinions of pro- free-response questions were entered into Atlas.ti (verfessional counseling are not included in this study. An sion 6) for ease of trending analysis across participants. example of a free-response question about percep- Participants were asked about their opinions and expetions of different helping professions includes: “What riences related to the counseling profession and profesmakes a counselor different from a psychiatrist/social sional identity. Participants were asked to endorse qualworker/psychologist?” An example of a forced-choice ities they believed were important for a mental health question related to the perception of the counseling professional to possess (Table 2). All of the participants field includes: “In your opinion, what is the focus of indicated that licensure/certification is an important counseling?” and included a list of common aspects of professional quality (100%), followed by having a higher counseling that participants could choose. A 7-point degree (76.2%, n = 16), and experience (71.4%, n = 15). Likert-scale was used for the American Counseling The least endorsed qualities were being published in the Association’s 20/20: Consensus Definition of Counsel- field (9.5%, n = 2) and public exposure (4.8%, n = 1). ing (Kaplan, Tarvydas, & Gladding, 2014) statement, When asked what they believed to be appro“Counseling is a professional relationship that empow- priate focuses of counseling, the majority indicated to ers diverse individuals, families, and groups to accom- treat symptoms (81%, n = 17) and support (81%, n = plish mental health, wellness, education, and career 17; see Table 2). Other frequently endorsed aspects of goals,” where participants rated the degree to which counseling included prevention (76%, n = 16), advothey agreed (1 = Strongly Disagree, 7 = Strongly Agree). cacy (62%, n = 13), and brief services (48%, n = 10), with “giving advice” as the least endorsed focus (14%, NC Counseling Journal • Spring 2018 • Volume 1

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MacLeod, McMullen, &Veach n = 3). Participants were also presented with the new 20/20 consensus definition of counseling and asked to indicate how well the definition fits with their idea of professional counseling on a 7-point Likert scale (1=Strongly Disagree, 7=Strongly Agree). The mean score was 6.05 (SD = 1.47), with 90.5% (n = 19) of participants endorsing a 6 or 7. These scores indicate a strong acceptance of the new counseling definition that aligns with their views of professional counseling. Finally, participants were asked to rank order various mental health professionals based on their personal preferences for mental health services on a scale from 1 to 6 (1 = Most Preferred and 6 = Least Preferred). Their options included psychiatrist, social worker, psychologist, master’s-level counselor, doctoral-level counselor, and other. Over 66% (n = 12) of the participants indicated that they would most prefer a master’s-level counselor as their most preferred mental health professional, followed by doctoral-level counselors (Table 3). The participants ranked psychiatrists as their least preferred mental health professional, with 62% (n = 8) ranking psychiatrists as 5th or 6th. Overall, participants preferred seeing professional counselors to any other profession for mental health services. Differences Between Counseling and Other Mental Health Professions Qualitative data were also collected in the survey in order to assess how the participants viewed the differences between mental health counselors and other mental health professionals. Participants were asked to indicate what makes a counselor different from a psychologist, psychiatrist, and social worker. Thematic analysis using the qualitative software system, Atlas.ti, was used to identify common themes among the responses for each mental health profession. Counselors versus psychiatrists. When asked about the differences between counselors and psychiatrists, participants’ responses indicated the differences in educational training/credentials and what psychiatrists do and do not do as professionals. Participants indicated that psychiatrists are medical doctors who use the medical model to treat clients using diagnosing and medication. One participant responded, “I, as a counselor, cannot prescribe medication and do not have a medical degree.” Participants’ responses indicate that they believe psychiatrists do not conduct mental health counseling. For example, “[Psychiatrists] can do psychotherapy but often leave that to counselors.” Participants NC Counseling Journal • Spring 2018 • Volume 1

who compared psychiatrists to counselors indicated that counselors are more holistic and developmental in their approach to helping clients. As one participant explained, “Counselor[s] focus on a developmental, whole person model, while a psychiatrist is rooted in the medical pathology model and prescribes medication more than offering therapy.” All participants described psychiatrists as differing from counselors based on these themes, indicating a consensus of the differences. Counselors versus psychologists. When asked about the differences between counselors and psychologists, individual responses varied more widely. Overall, the responses focused on themes concerned with the differences between counselors’ and psychologists’ professional orientation (wellness model versus medical/pathological model, respectively) and psychologists’ training in assessment and testing. Participants viewed psychologists as focusing on the medical model approach to helping, which includes diagnosing, testing, and pathology. Participants viewed counselors as more focused on the therapeutic relationship from a wellness and strengths-based orientation. One participant noted, “A counselor focuses more on strengths of a client toward resilience and wholeness, while a psychologist focuses more on pathology and testing.” Participants also indicated that counselors focused more on the process of counseling compared to psychologists: “Counselors really focus more on the relationship between client and counselor and helping the client through specific therapeutic techniques and theories built upon a relationship.” Other responses included psychologists’ focus on research, education, and status, with one participant indicating that psychologists have a higher status in the professional community than counselors. One participant described psychologists as having a medical degree. Counselors versus social workers. Participants were also asked about the differences between counselors and social workers. There was less agreement among participants on the differences between these two fields, which indicated more ambiguity between the roles and responsibilities of these two professions. Overall, participants indicated that social workers conduct more case management and advocacy, have more access to community resources, and focus less on counseling. They also indicated a difference in orientation, with counselors focusing more on a person-centered approach and social workers using a systems-based approach: “Social workers incorporate from within a systems based approach whereas counselors operate from individual perspective.” Participants did not indicate a sharp dif6

Diversity Within Unity ference between the two fields in these areas, only that social workers do more case management and advocacy and less counseling than counselors: “The focus for social work is more on the case management of other resources in the community, although other counselors are also proactive in providing those resources to clients.” Once again, participants acknowledged the status differences between the two fields, with social workers having more access to jobs than counselors. Based on the participants’ responses, it appears that they alluded to more similarities between counseling and social work, with each profession having a different level of focus in the same areas associated with helping clients (i.e., counseling, case management, advocacy). Needs of the Profession Finally, participants were asked to give their opinions about professional counseling in the United States. Participants responded based on the needs of the profession concerning identity and public acceptance. Most participants agreed that current changes in the profession are making these issues better; however, there are still issues that need to be addressed. Specifically, participants indicated a need for national standards and recognition for professional counselors (35%, n = 7), licensure portability (4.7%, n = 1), better public awareness of professional counseling (24%, n = 5) and more regulation and unification in the field (24%, n = 5). Some participants indicated that the lack of unification negatively affects the counseling profession: “We are divided as a profession therefore reducing our professional recognition and respect.” Others believe that the profession needs more advocacy and public recognition in order to be properly compensated for the services: “Professional counseling in the United States is very effective to reach those in need of life change, however it needs more professional and monetary recognition from payer sources such as the government.” Participants described many of the issues echoed in the literature about the weaknesses, like a lack of unity among different counseling specialties (Gale & Austin, 2003; Mellin et al., 2011), and needs of the counseling profession, such as the desire for public recognition (Calley & Hawley, 2008; Kaplan & Gladding, 2011) and a collective understanding of what it means to be a professional counselor (Pistole & Roberts, 2002; Reiner et al., 2013).


Discussion The goals of this pilot study were to pilot test a survey instrument for the future research and survey professional counselors in North Carolina about professional identity. Participants were asked to answer the survey items based on their opinions and to give survey feedback based on the their experiences as professional counselors. The survey attempted to understand what the participants viewed as important aspects of the counselor professional identity and the differences between counselors and other mental health professionals (i.e., social workers, psychiatrists, and psychologists). The results of the study warrant discussion in terms of professional identity and other mental health professions. Professional Identity In terms of professional identity, participants unanimously endorsed licensure as an important professional quality, followed by a high agreement about obtaining a higher degree and experience. Professional counselors in this sample appear to highly value the requirement for licensure in order to practice. Licensure is considered the minimal requirement for independent practice in all U.S. states. Licensure is important for designated standards in order to regulate the quality of services provided to the public, as well as allowing counselors to bill for third-party reimbursement (Gale & Austin, 2003). Therefore, this perception aligns with the professional identity standards already established by different states. A higher degree, such as the minimum requirement of a master’s degree for licensure, and experience in the field are also related to licensure requirements. However, each state differs in the name of counselor licenses (i.e., LPC, LMHC) and the amount of experience needed for licensure. The sample saw the higher-level training and experience as important to professional identity. LeFleur (2007) also found that counselors endorsed high importance of licensure for professional identity. Similar to LaFleur’s results, this study also revealed low endorsement of publication and research for professional identity. The reason for this finding may be the demographics of the sample. The majority of the participants were master’s-level counselors employed in clinical work, who may not focus on research. Therefore, research or publications may not be seen as an important aspect of their professional identity. Others in the field have called for higher-quality research by counselors in order to advance the field (Gale & 7

MacLeod, McMullen, &Veach Austin, 2003; Pistole & Roberts, 2002; Reisetter et al., 2004). These results may show a discrepancy between master’s-level and doctoral-level counselors on the importance of research for professional identity. An alternative explanation may be that master’s-level and doctoral-level counselors have different goals related to their professional identities depending on their roles, such as practitioner versus academic. This may further confuse the meaning of professional identity in counseling. Given the differences in training and experience, master’s-level counselors and doctoral-level counselors may perceive their professional identities differently. Participants also endorsed treating symptoms, providing support, prevention, and advocacy as the top areas counselors focus on in practice. These professional goals of counselors are similar to the results of Mellin et al. (2011) concerning tasks and services commonly endorsed by counselors. It is worth noting that treating symptoms was endorsed more than prevention and advocacy, despite high endorsement of the 20/20 definition of counseling that focuses on accomplishing wellness-based goals. The counselor participants in LaFleur’s (2007) study also endorsed low importance to advocacy as a part of professional identity. One of the unique aspects of counseling is the focus on prevention and advocacy (Myers & Sweeney, 2004). The results may show a discrepancy between the values of the counseling profession as a prevention and wellness-based model, and the actual work of counselors from an insurance-based system that values the medical model view of treating symptoms. It may be difficult for counselors to engage in prevention and advocacy due to the societal emphasis on treating symptoms (Mellin et al., 2011), which could further prevent a strong counselor identity to stand out amongst other professionals (McLaughlin & Boettcher, 2009). The participants may work in areas that emphasize the latter view, which would make it difficult to work from a preventative and advocacy perspective. Therefore, participants may see their role as focusing more on support and treating symptoms, which influenced how they responded to the survey. However, their professional identity is still supported through the endorsement of the 20/20 definition of counseling. The sample participants were asked to rank order the mental health professional they would prefer for mental health services. The ranking showed a higher preference for master’s-level counselors with the lowest preference for psychiatrists. These results are NC Counseling Journal • Spring 2018 • Volume 1

reflected in the descriptions of psychologists and psychiatrists as less likely to provide mental health counseling, work from a medical model perspective, and are more concerned with medical interventions. Also, it may reflect their view that counselors focus more on individual counseling rather than systemic advocacy they endorsed for social workers. Given that the sample consisted mostly of master’s-level counselors, these results may reflect the participants’ strong endorsement and loyalty to their own profession. The participants also ranked master’s-level counselors slightly higher than doctoral-level counselors. The majority of the participants held master’s-level counseling degrees, which may have reflected their preference for master’s-level counselors over doctoral-level counselors. An alternative explanation for this preference may be based in the participants’ understanding of the differences in training between master’s-level and doctoral-level counselors; a doctorate in counselor education does not necessarily equate more clinical training. Comparisons of the Mental Health Professions and Needs of the Profession Finally, the qualitative data about the differences between counselors and psychiatrists, psychologists, and social workers revealed that some differences were more easily discernible than others. Participants were largely unanimous about the differences between psychiatrists and counselors in terms of roles, responsibilities, and training. However, the differences between counselors and psychologists, and counselors and social workers, were more varied and overlapping. Similar to psychiatrists, psychologists were seen as dealing more from a medical model through testing and diagnosing. Psychologists were viewed as also working therapeutically with clients, but from a different perspective. Social workers were also distinguished from counselors in their emphasis on case management and systems approach; however, some participants acknowledged that counselors also work in similar capacities with clients. The participants’ perceptions of the differences between these fields, especially social workers and psychologists, were similar to those found in Mellin et al. (2011). The similarities between counseling, social work, and psychology may make it difficult for the public to understand the differences between the professions and could contribute to professional identity issues in counseling. Being able to discern 8

Diversity Within Unity how professional counselors are different from other mental health professionals may be important in how they market their services to the public. Therefore, a clearer delineation between these fields may enhance public perception of professional counseling. Participants cited other issues related to professional identity of counseling in the U.S., including the lack of licensure portability, national standards in counseling, and unity within the field. These issues were also reflected in the current literature on professional counselor identity (Gale & Austin, 2003; Hawley & Calley, 2009; Myers et al., 2002). Despite these issues, the participants were largely in favor of the 20/20 definition of counseling and were optimistic that the counseling profession is moving in a positive direction in its public identity.

may influence their professional identity. Future research could also assess how professional counselors view some goals or aspects of the therapeutic process compared to other mental health professionals. Given participants’ endorsement that professional counselors are not as recognized as other mental health professionals based on private and government insurance endorsement, future work could survey the public to better understand how they view the field of professional counseling compared to other mental health professions. People outside of the realm of mental health may have very different perceptions of the roles of professional counselors and other helping specialists. By looking at the perceptions of clinicians in the State of North Carolina, the researchers were able to get a better understanding about professional counseling identity. Limitations and Future Research The information gained might in turn help inform future advocacy efforts, training and clinical practices of Results should be considered in light of the limitations of professional counselors and the individuals they serve. the study. The study used a small sample of professional counselors at a state counseling conference. Therefore, the results may be limited to counselors in this area who attend professional conferences. These counselors may possess unique views of professional identity that may not be generalizable to the overall population of counselors in North Carolina. Also, the perceptions of the differences between counselors and other mental health professionals may be influenced by the participants’ professional identity as counselors. It is unknown if professionals from the other mental health professions would give similar perceptions. Future research could focus on the perceptions of the differences from participants in different fields. Finally, the survey instrument was a test questionnaire that included forced choice items where participants were asked to endorse one or multiple items from a list based on their perceptions. This does not provide any information about the degree of endorsement or rank between the items. The lack of validity and reliability of the survey instrument may affect the results. The purpose of this study was to pilot test a research survey on professional counselors and gather information about how counselors in North Carolina view their professional identity. However, the findings about the professional counselors’ perceptions of the counseling profession may warrant future study, especially comparing professional identity of CACREP and non-CACREP counselors and doctoral- versus master’s-level counselors. Even though both educational levels share the same worldview and orientation towards helping, different roles and responsibilities NC Counseling Journal • Spring 2018 • Volume 1

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References Calley, N. G., & Hawley, L. D. (2008). The professional identity of counselor educators. The Clinical Supervisor, 27, 3-16. doi: 10.1080/07325220802221454 Dollarhide, C. T., Gibson, D. M., & Moss, J. M. (2013). Professional identity development of counselor education doctoral students. Counselor Education & Supervision, 52, 137-150. Gale, A. U. & Austin, B.D. (2003). Professionalism’s challenges to professional counselors’ collective identity. Journal of Counseling Development, 81(1), 3-10. Hansen, J. T. (2003). Including diagnostic training in counseling curricula: Implications for professional identity development. Counselor Education and Supervision, 43, 96-107. doi: 10.1002/j.15566978.2003.tb01834.x Hawley, L. D., & Calley, N. G. (2009). Professional identity of counseling: A template for action. Michigan Journal of Counseling, 36(1), 1-12. Herlihy, B., & Dufrene, R. L. (2011). Current and emerging ethical issues in counseling: A Delphi study of expert opinions. Counseling and Values, 56, 10-24. doi: 10.1002/j.2161-007X.2011.tb01028.x Kaplan, D. M., & Gladding, S. T. (2011). A vision for the future of counseling: The 20/20 principles for unifying and strengthening the profession. Journal of Counseling and Development, 89, 140-147. doi: 10.1002/j.1556-6678.2011.tb00101.x

MacLeod, McMullen, &Veach ment, 48, 132-143. doi: 10.1002/j.2161-1939.2009. tb00074.x Mellin, E. A., Hunt, B., & Nichols, L. M. (2011). Counselor professional identity: Findings and implications for counseling and interprofessional collaboration. Journal of Counseling & Development, 89, 140-147. doi: 10.1002/j.1556-6678.2011.tb00071.x Myers, J. E., & Sweeney, T. J. (2004). Advocacy for the counseling profession: Results of a national survey. Journal of Counseling and Development, 82(4), 466471. doi:10.1002/j.1556-6678.2004.tb00335. Myers, J. E., Sweeney, T. J., & White, V. E. (2002). Advocacy for counseling and counselors: A professional imperative. Journal of Counseling & Development, 80, 394-402. doi: 10.1002/j.1556-6678.2002. tb00205.x National Alliance on Mental Illness. (2011, March). State mental health cuts: A national crisis. Retrieved from http://www.nami.org/ContentManagement/ ContentDisplay.cfm? ContentFileID=125018 Ostvik-de Wilde, M., Hammes, J. P., Sharma, G., Kang, Z., & Park, D. (2012). A student perspective on 20/20: A vision for the future of counseling. Counseling Today, 54(12), 46-48. Pistole, M. C., & Roberts, A. (2002). Mental health counseling: Toward resolving identity confusions. Journal of Mental Health Counseling, 24(1), 1-19.

Kaplan, D.M., Tarvydas, V. M., & Gladding, S. T. (2014) 20/20: A vision for the future of counseling: The new consensus definition of counseling. Journal of Counseling & Development, 92, 366-372. doi: 10.1002/j.1556-6676.2014.00164.x

Reiner, S. M., Dobmeier, R. A., & Hernández, T. J. (2013). Perceived Impact of Professional Counselor Identity: An Exploratory Study. Journal of Counseling and Development, 91(2), 174-183. doi: 10.1002/j.1556-6676.2013.00084.x

LaFleur, L. B. (2007). Counselors’ perceptions of identity and attitudinal differences between counselors and other mental health professionals. University of New Orleans Theses and Dissertations, Paper 554. http://scholarworks.uno.edu/td/554

Reisetter, M., Korcuska, J. S., Yexley, M., Bonds, D., Nikels, H., & McHenry, W. (2004). Counselor educators and qualitative research: Affirming a research identity. Counselor Education & Supervision, 44, 2-16. doi: 10.1002/j.1556-6978.2004.tb01856.x

McLaughlin, J. E., & Boettcher, K. (2009) Counselor identity: Conformity or distinction? Journal of Humanistic Counseling, Education and Develop-

Van Teijingen, E. R., & Hundly, V. (2001, Winter). The importance of pilot studies, Social Research Update, 35.


10

Diversity Within Unity Table 1. Participant Sample Demographics Demographics Gender Female Male Race White/Caucasian African-American Hispanic/Latino/a Education Some postgrad Master’s Other advanced degree Employment Clinical Supervision Counselor education Administration Graduate students

n

Percentage

15 6

71.4 28.6

19 1 1

90.5 4.8 4.8

1 11 9

4.8 52.4 42.9

11 1 3 3 2

55.0 5.0 15.0 15.0 10.0


11

MacLeod, McMullen, &Veach Table 2. Sources of Mental Health Information, Professional Qualities, and Focus of Counseling Items Sources of MH Information Medical Doctor Mental Health Facility Family/Friends Online News Magazines Other Professional Qualities Licensed/Certified Higher Degree Experience Published Personality Public Exposure Other Counseling Focus Prevention Treat Symptoms Give Advice Support Advocacy Quick/Brief Services Other


n

Percent

12 13 11 15 4 2 7

57.1 61.9 52.4 71.4 19 9.5 33.3

21 16 15 2 6 1 1

100 76.2 71.4 9.5 28.6 4.8 4.8

16 17 3 17 13 10 4

76.2 81 14.3 81 61.9 47.6 19

12

Diversity Within Unity

Table 3. Rank Order of Mental Health Professional Rankings* Profession n 1 2 3 4 Psychiatrist 13 7.7 0 0 30.8 Social Work- 14 14.3 14.3 35.7 21.4 er Psychologist 14 7.1 14.3 42.9 28.6 Master’s-lev- 18 66.7 16.7 11.1 0 el Counselor 18 50 44.4 0 0 Doctoral-Level Counselor 2 0 0 0 50 Other *Note: Rankings are presented in percentages


5 46.2 14.3

6 15.4 0

7.1 5.6

0 0

5.6

0

50

0

13

Utilizing Asset Mapping to Strengthen the Comprehensive School Counseling Program Jennifer Barrow North Carolina Central University This paper describes the use of asset mapping in the development and maintenance of a comprehensive school counseling program. A feature of asset mapping is the identification of community strengths in order to enact change. Current models of school counseling are focused on needs-based data to implement programming for targeted populations. Introducing the use of asset mapping to school counselors may allow them to extend the reach of their comprehensive school counseling program through the identification of community partnerships for the development, implementation, and evaluation of their programming for the benefit of all students. A step-by-step approach for the application of asset mapping in schools is presented. Keywords: asset mapping, asset team,comprehensive school counseling programs, school counselor

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ecent trends in school counseling have resulted in higher caseloads, expanding work demands, and fewer resources resulting in disturbing trends: increasing numbers of high school dropouts; high-profile violent incidents; and labor shortages for qualified workers with specialized training. The American School Counselor Association (n.d.) recently published state-based data and North Carolina has a school counselor to student ratio of 1:379 exceeding the 1:250 recommendation. As a result, there is a need for schools to develop community partnerships in order to supplement and support existing programs being offered through their Comprehensive School Counseling Program (CSCP) (Bardhoshi, Schweinle, & Duncan, K., 2014; McCarthy, Kerne, Calfa, Lambert, & Guzmán, 2010). Involving community agencies will allow schools to offer programing to meet the needs of more students. Currently, there seems to be a focus on counseling programs designed for select students with a demonstrated need based solely on academic performance data and the academic mission of the school (ASCA, 2012; Hartline & Cobia, 2012; Watkinson & Gallo-Fox, 2015; Wilder & Ray, 2013). Utilizing the ASCA National Model School counselors are provided a framework for guidance programming designed to address the personal/social, academic, and career needs of students in NC Counseling Journal • Spring 2018 • Volume 1

the K-12 setting. With a focus on accountability data and process evaluation, school counselors are evaluating the efficacy of programming in order to develop and deliver relevant and effective programs (ASCA, 2012). Utilizing the components of a CSCP professional school counselors demonstrate their essential role to support school improvement efforts, including closing the achievement gap, with a focus on primary prevention. In order to serve larger numbers of youth through primary prevention, partnerships need to be established. In addition to serving greater numbers, schools and community agencies may make better use of their resources by not duplicating programming for youth. No one program or entity can offer enough to support every school-aged child, therefore, schools that want to be more efficient and effective may need to find ways to connect to individual community resources to create a single system of support for school-aged children. Asset Mapping (AM) facilitates collaboration to improve educational and employment opportunities of community members which aligns with the mission of schools to prepare career and college ready students (Marcketti & Karpova, 2014; Moore-Thomas & Day-Vines, 2010). Designed to serve all students, a CSCP is a data-based, systemic approach to addressing the personal/social, academic, and career needs of the students it is designed 14

Asset Mapping and School Counseling Programs to serve (ASCA, 2012). Aligning the CSCP’s mission and vision statement and programming with that of the school, seeks to increase promotion rates, decrease maladapted social behaviors, and generate students prepared for the rigors of postsecondary life. This article seeks to introduce the use of Asset Mapping in the development and enhancement of the CSCP in order to build stronger school-community partnerships through strategic planning and program implementation.

2004; McCoy & Bowen, 2015; Shoshani & Steinmetz, 2014). Because of increased demands, diminishing resources, and high caseloads, today’s school counselors can no longer work separately from the community. School-community collaboration is essential to the current “do more with less” mode in which PSCs find themselves (Militello & Janson, 2014; Palladino-Schultheiss, 2005). Recent research demonstrates the importance and benefits of school-community collaboration and school counselors are uniquely qualified to serve Defining Asset Mapping as liaisons (Bemak, 2000; Bryan & Holcomb-McCoy, 2004; Bryan, 2005; Keys, Bemak, Carpenter, & KingAsset Mapping (AM) is a specific form of community en- Sears, 1998; Militello & Janson, 2014). The scope of a gagement designed to identify strengths within a comschool counselor’s work includes leadership and collabmunity, as well as the resources available (Kerka, 2003). oration and research suggests PSCs possess the leaderAssets may include “human, financial, social, physical ship skills to identify and coordinate efforts to engage and natural assets, as well as broader community-level community agencies to enhance the delivery of their assets such as institutions…” (Kramer, Amos, Lazarus, counseling program (Janson, Stone, & Clark, 2009). & Seedat, 2012, p. 540). Asset mapping relies on the assumption that there are strengths in the community to The Process of Asset Mapping for Professional be identified and utilized in order to create greater comSchool Counselors munity participation, mobilize resources, and increase cooperation and collaboration among group members Currently, PSCs utilizing the ASCA National Model to in order to strengthen the community (Kramer et al., design, implement, and evaluate counseling programs 2012; Kretzman & McKnight, 1993). Schools are an es- are operating on a needs-based or deficit-based system sential part of a community and through community (ASCA, 2012). Asset mapping provides an alternative to engagement, school counseling departments may im- the deficit or needs-based focus of the ASCA National prove public relations through increased communica- Model by assuming the community is resourceful, retion and deeper levels of collaboration, thereby, increas- silient, and has inherent strengths that need to be coning the confidence of stakeholders (Emmett, 2000). nected in order to strengthen the community as a whole Asset mapping (AM) is designed to discover what (Kerka, 2003). Asset mapping may be used to enhance community agencies have to offer through identifying an existing CSCP or aid in development of a CSCP (Grifresources for building a comprehensive system based on fin & Farris, 2010). Incorporating asset mapping into a joint planning. Asset mapping is not designed to be a CSCP may be best completed using incremental steps and “one-shot” deal designed to build a list of referral sourc- the information that follows is designed to demonstrate es for distribution, rather it strives to be the catalyst for the merging of the CSCP with asset mapping practices. resource and cost sharing between agencies to generate programs and services (Crane & Skinner, 2003). Col- Pre-mapping laborative efforts to provide programming and direct services are in line with the work of professional school Asset mapping requires strong partnerships and clear counselors (PSCs) (ASCA, 2012; Baker & Gerler, 2008). goals that everyone supports in order to provide substantive empowerment in solving problems and goal Asset Mapping and the Professional School achievement through inter-institutional collaboraCounselor tion (Rich, Edelstein, Hallman & Wandersman, 1995). Pre-mapping is used to identify the benefits for partContinuing to adhere to traditional perspectives of PSCs nering for the coordination and alignment of resourcas “guidance counselors” limits their role in addresses in delivering the CSCP. Pre-mapping allows school ing the personal, social, and career needs of students counselors to identify the beneficiaries of the CSCP that may play a role in productive academic outcomes and to establish and develop measurable goals based for students (Bemak, 2000; Lambie & Williamson, on identified needs (Epstein & Van Voorhis, 2010; KerNC Counseling Journal • Spring 2018 • Volume 1

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Barrow ka, 2003). Further, pre-mapping reveals partners in solving students’ problems and may demonstrate that school counselors are not working alone to achieve the goals of the CSCP (Epstein & Van Voorhis, 2010). Collaboration. Currently, ASCA suggests school counselors assemble a “representative group of stakeholders” to review the program and offer suggestions for its implementation (ASCA, 2012, p. 47). ASCA suggests the council be comprised of eight to twenty members, including student members, parents, teachers, school leaders (e.g., assistant principals and principals), and community members (ASCA, 2012). Assembling a select group of stakeholders may overlook formal and informal sources of supporting networks. Expanding the participants involved in a meeting modeled after the ASCA National Model’s Advisory Council may identify sources of assistance and support in the development and implementation of the CSCP (ASCA, 2012; Bryan, 2005). A larger number of participants may be necessary to identify areas where the community may merge with the CSCP in order to serve students through enhanced program offerings. Epstein & Van Voorhis (2010) suggest members of a collaborative team may serve as a member, team leader, committee or activity leader or advisor. The goal of what may be called the asset team is to enhance and preserve what is available to students while supporting the implementation of the CSCP through the distribution of responsibilities (Epstein & Van Voorhis, 2010). Table 1 offers a sample survey the school counselor may use to assess the level of participation of stakeholders. Identifying areas where the CSCP and stakeholders intersect may allow the school counselor to reveal uncovered sources of support for school-based programming. Inviting untapped resources may allow the CSCP to provide sustainable programming designed to strengthen student outcomes and in turn, benefit the community. After utilizing a survey PSCs may identify the role each member may play in the asset team. Members are active members participating in monthly meetings and goal development. Team leaders evaluate the CSCP programming efforts and assign tasks designed to facilitate leadership. Committee or activity leaders are tasked with implementing a particular activity within the CSCP. Advisors may have limited time for active involvement in monthly meetings, but are willing to bring ideas for the development and implementation of components of the CSCP (Epstein & Van Voorhis, 2010). NC Counseling Journal • Spring 2018 • Volume 1

Perceptions and data usage. Currently schools are utilizing academic-based data (i.e., achievement levels based on testing) to generate interventions to support grade promotion leading to an increase in cohort graduation rates. Hartline and Cobia (2012) reviewed 100 closing the gap action plans and eighty-eight reports demonstrated efforts by the PSC to close achievement gaps for an identified group of students. Data based solely on academic measures may not be useful in engaging the community and may generate value-based conflicts. Lake and Billingsley (2000) suggested conflicts develop when “people interact and perceive incompatible differences or threats to their resources, needs, or values” (p. 241). Watkinson and Gallo-Fox (2015) found that elementary school counselors felt their data was of little value in demonstrating their contribution to the academic mission of the school. However school counselors were still required to submit an annual report providing data demonstrating the effectiveness of counseling-based interventions on the academic mission of the school. A school counseling department utilizing asset mapping may find it more useful to gather perception data to find out what is being done well because it is difficult to directly trace the work of the PSC to academic achievement (ASCA, 2012; Astramovich, Coker, & Hoskins, 2005; Isaacs, 2003; Watkinson & Gallo-Fox, 2015). Communicating what is already being done in the school will allow the community members, including parents, to extend the reach of the CSCP through community support. Further, conflicts may be prevented by gathering information from community members on what is deemed critical to student success and therefore, avoid discrepant views of a child’s needs. In order to gather perception data from the community school counselors may utilize poster paper with headings like, can do better, doing great, and excellent job allowing participants to identify programs that need community support. Perception data may be gathered at the school-level at a faculty meeting and at the school-community level through the asset team meeting. Quantitative data may be utilized to demonstrate the outcomes of the CSCP’s efforts through the presentation of existing needs assessment data (ASCA, 2012). Sharing existing programming outcomes and obtaining perception data will communicate to school-community stakeholders what is being done and how effective it has been, while identifying means to extend the reach and impact of the CSCP (Astramovich, Coker, & Hoskins, 2005; Isaacs, 2003). This stage of the process is interested in find16

Asset Mapping and School Counseling Programs ing out: (a) What do school counselors have? (b) needs of school counselors, and (c) realistic goals school counselors may accomplish in an established time frame? For example, school counselors collaborating with health teachers to deliver a healthy relationships guidance lesson may be interested in gaining teacher perception data in order to identify a link to enhance program delivery. Perception data may reveal a need to include a presentation using movie clips to demonstrate examples of healthy relationships. Using perception data in this example will allow the school counselor to connect with a school-based multimedia class to generate a video or identify an existing resource through a local community agency. Being responsive also means remaining sensitive to the needs of our students by evolving and changing our programmatic efforts in order to remain relevant, efficient, and effective (Astramovich, Coker, & Hoskins, 2005; Isaacs, 2003). Mapping your team Asset mapping is conducted in neighborhoods and may be defined as a geographic area in the immediate proximity of the school or within a specific radius (e.g., node, district, or school assignment area based on addresses). In order to begin building your team PSCs may find it useful to use the information from pre-mapping to digitally map resources in their identified community (Aronson, O’Campo, & Shafer, 2007). The reviewed literature would suggest school counselors look for community members as asset team members across service areas in order to identify resources belonging to an entire community (Kerka, 2003; Motes & Hess, 2006). Building your team may include utilizing existing partnerships or brainstorming potential partnerships to extend the reach of your CSCP without increasing the school counselor’s workload (Crane & Skinner, 2003; Davis & Travers Gustafson, 2015). Extending the search of support beyond the school’s walls may be made easier by dividing the search into categories to include, associations, physical space, local economy, individuals with gifts/skills/knowledge, and institutions (Davis & Travers Gustafson, 2015). Identifying support School counselors may look within their building for sources of support which may include grant writers, culinary services through a culinary arts/cooking class, website development, meeting space, or sources NC Counseling Journal • Spring 2018 • Volume 1

of physical labor (e.g., staff members and school-based service clubs). Further, school counselors may want to seek external sources of support including brain power or topical expertise, existing links to community assets, knowledge of the community, and individual interests (Bryan, 2005; Motes & Hess, 2006; Scherrer & Morrison, 2015). Through the identification of tangible and intangible support, school counselors may extend the reach of their programming by engaging (1) associations and local businesses, (2) physical space, (3) individuals, and (4) institutional support. Each community entity provides a different perspective and level of support, but when connected to one another they strengthen the larger community (Crane & Skinner, 2003; Davis & Travers-Gustafson, 2015). Utilizing Table 2 school counselors may be able to identify community agencies based on a variety of categories. Implementation of plan The plan may be based on an existing master calendar, current action plans, or perception data. In order to maximize the use of asset mapping, school counselors may want to develop action steps to support the delivery of their CSCP in the community. The focus of this stage is answering: (a) When will the programming be delivered? (b) Who will deliver the programming?; and (c) Where will programming be delivered? (Baker & Gerler, 2008). For example, a middle school counseling department seeking to decrease discipline incidents as a result of cyber-bullying may provide large group guidance on digital wellness and digital etiquette. Linking with local law enforcement, a parent-student evening program to talk about the legal aspects of cyber-bullying may be offered at a community center. Former students may participate in a virtual panel discussing the impact of cyber-bullying. Or a multimedia class may develop a public service announcement detailing the dangers of cyber-bullying to be aired on the school’s announcement system. All of these plans are designed to communicate the dangers of cyber-bullying, but not all of them are offered in the school by the school counselor (Baker & Gerler, 2008; Motes & Hess, 2006). Professional school counselors will utilize their master calendar to delegate specific tasks to asset team members in order to deliver the CSCP. Sharing the responsibilities of programming will allow the school counselor to maximize their impact, while delivering quality programming designed to improve the school experience of all students. For example, an asset team 17

Barrow member may be a local TV anchor, radio disc jockey, local celebrity, or chamber of commerce member allowing the school counselor to promote their activity to a local audience. Utilizing local media to advertise the events may increase attendance and provide a snowball effect in recruiting participants and serve as a recruitment vehicle for additional asset team members (Baker & Gerler, 2008; Motes & Hess, 2006). School counselors will want to maintain communication with asset team members in order to sustain healthy collaboration. Using technology to disseminate information will allow for effective communication in delivering the CSCP, revising goals, and measuring progress. Creating an atmosphere conducive to change will allow school counselors to better align their resources to address the challenges in implementing the CSCP (Baker & Gerler, 2008). Reporting results School counselors are urged to implement accountability measures to demonstrate their contribution to the school’s mission to improve student performance, closing the achievement gap, and effectiveness of the CSCP (Young & Kaffenberger, 2011). School counselors will want to convene the asset team on a yearly basis in order to, (a) Identify what went well, (b) discuss challenges existed, (c) identify solutions to existing challenges, and (d) communicate results. Data presented may be gathered from surveys, outcome data, and the narratives of participants (Astramovich et al., 2005; Carey & Dimmitt, 2008; Young & Kaffenberger, 2011). Reconvening the asset team will allow school counselors to prepare for unexpected challenges in the future, maintain accurate contact information, and expand the asset team. School counselors are encouraged to share the impact of the asset team in order to gain support from school leaders and other stakeholders in order to publicize the benefit of a CSCP designed to serve all students (Baker & Gerler, 2008; Kerka, 2003).

opment of all students, not just targeted populations. Utilizing asset mapping will allow school counselors to (1) identify new resources for the delivery of programming, (2) improve use of existing resources, (3) enhance coordination and collaboration among community stakeholders, and (4) improve public relations efforts on the role of the school counselor and avoid conflicts based on discrepant views of students’ needs. In summary, asset mapping demonstrates the overlapping efforts of community agencies and as a result creates a process designed to facilitate change, enhance resiliency, and create sustainable programs to support schoolage youth (Epstein & Van Voorhis, 2010; Kerka, 2003). Conclusion As the role of the school counselor continues to expand, school counselors will need to identify sources of support for the development and maintenance of a school counseling program designed to serve all students. Schools are an essential part of a community and as a result asset mapping may be used to demonstrate the intersection of school counseling programs with community initiatives. This article provided a step-bystep approach for the use of asset mapping in order to identify untapped resources for the delivery of a comprehensive school counseling program. Utilizing the tenets of asset mapping in the development of a comprehensive school counseling program enhances collaboration through the identification, goal alignment, and engagement of community resources to improve the educational experiences of all school-aged youth.

Benefits of Asset Mapping The benefits of asset mapping are numerous. A comprehensive school counseling program implies that all students will benefit from the program in order to have successful outcomes beyond their formal school experience. School counselors utilizing asset mapping can develop results-driven programming designed to support the personal-social, academic, and career develNC Counseling Journal • Spring 2018 • Volume 1

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Barrow counselor leaders. Professional School Counseling, 13(2), 98-106. Kerka, S. (2003). Community asset mapping. Trends and issues alert, (47). ERIC Clearinghouse on Adult Career and Vocational Education, Columbus, OH. Keys, S., Bemak, F., Carpenter, S. L., & King-Sears, M. E. (1998). Collaborative consultant: A new role for counselors serving at-risk youths. Journal of Counseling and Development, 76, 123-134. Kretzman, J.P., & McKnight, J.L. (1993). Building communities from the inside out: A path toward finding and mobilizing a community’s assets. Evanston, IL: Institute for Policy Research. Lake, J. F., & Billingsley, B. S. (2000). An analysis of factors that contribute to parent-school conflict in special education. Remedial and Special Education, 21(4), 240-251. Lambie, G. W., & Williamson, L. L. (2004). The challenge to change from guidance counseling to professional school counseling: A historical perspective. Professional School Counseling, 8(2), 124-131. Marcketti, S. B., & Karpova, E. (2014). Getting ready for the real world: Student perspectives on bringing industry collaboration into the classroom. Journal of Family and Consumer Sciences, 106(1), 27-31. McCarthy, C., Kerne, V. V. H., Calfa, N. A., Lambert, R. G., & Guzmán, M. (2010). An exploration of school counselors’ demands and resources: Relationship to stress, biographic, and caseload characteristics. Professional School Counseling, 13(3), 146-158. McCoy, H., & Bowen, E. A. (2015). Hope in the social environment: Factors affecting future aspirations and school self-efficacy for youth in urban environments. Child & Adolescent Social Work Journal, 32(2), 131-141. doi:http://dx.doi.org/10.1007/ s10560-014-0343-7 Militello, M., & Janson, C. (2014). The urban school reform opera: The obstructions to transforming school counseling practices. Education and Urban Society, 46(7), 743-772.

competent collaboration: School counselor collaboration with African American families and communities. Professional School Counseling, 14(1), 53-63. Motes, P., & Hess, P. (Eds.). (2006). Collaborating with community-based organizations through consultation and technical assistance : The mediating roles of consultation and technical assistance. New York, NY, USA: Columbia University Press. Retrieved from http://www.ebrary.com.prox.lib.ncsu.edu Palladino-Schultheiss, D. E. (2005). University-urban school collaboration in school counseling. Professional School Counseling, 8(4), 330-336. Rich, R. C., Edelstein, M., Hallman, W. K., & Wandersman, A. (1995). Citizen participation and empowerment: The case of local environmental hazards. American Journal of Community Psychology, 23(5), 657. Scherrer, J. L., & Morrison, J. (2015). Building university and community partnerships on behalf of low-income communities. Social Development Issues, 37(1), 53-65. Retrieved from http://ezproxy. co.wake.nc.us/login?url=http://search.proquest. com/docview/1661717528?accountid=14867 Shoshani, A., & Steinmetz, S. (2014). Positive psychology at school: A school-based intervention to promote adolescents’ mental health and well-being. Journal of Happiness Studies, 15(6), 1289-1311. doi:http:// dx.doi.org/10.1007/s10902-013-9476-1 Watkinson, J. S., & Gallo-Fox, J. (2015). Supporting practice: Understanding how elementary school counselors use data. Journal of Professional Counseling, Practice, Theory, & Research, 42(1), 29-39. Wilder, C., & Ray, D. (2013). Parent preferences for secondary school counselor activities. Journal of Professional Counseling, Practice, Theory, & Research, 40(1), 12-24. Young, A., & Kaffenberger, C. (2011). The beliefs and practices of school counselors who use data to implement comprehensive school counseling programs. Professional School Counseling, 15(2), 6776.

Moore-Thomas, C., & Day-Vines, N. (2010). Culturally


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Asset Mapping and School Counseling Programs Table 1. Participation levels (perceived or actual) Receive programming

Source of information

Program delivery

Decision Maker

Source of Benefit from funding/ our CSCP meeting space, equipment

Students Teachers Faith based organizations Local colleges Financial institutions Community clubs/organizations/ fraternal organizations (e.g. Rotary, DAR) Parents/family members Law enforcement Libraries Health agencies/hospitals Arts organizations Local businesses Non-profits Other (be specific in naming) Barrow, J. (2015, February).


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Barrow Table 2. Sample Asset Map of Community Agencies School-based resources: (Tangible) grant writers, child care, culinary services, construction, meeting space/ equipment, web site development, music, artwork/public relations, refreshments. (Intangible) brain power, expertise, energy, existing links to community assets, knowledge of community, individual interest/abilities Institutions: schools, universities, colleges, hospitals, social service agencies, museums, non-profits, police/fire departments, media, libraries Associations: service clubs, social clubs, fraternal organizations, anti-crime groups, neighborhood clubs, charitable organizations, civic events group, disability/special needs groups, education (tutoring) groups, environmental groups, family support, health and fitness, hobby/arts/crafts, mentoring, political, religious/faith-based, veteran’s groups, women/men/youth groups Physical space: gardens, parks, trails, parking lots, outdoor shelter space, transit stops and facilities, streets/ sidewalks, housing, playgrounds, vacant land/buildings, gyms/fitness facilities Local economy: businesses, Chamber of Commerce, banks, credit unions, foundations, business associations, construction Individuals with gifts/skills/knowledge to share: youth, older adults, artists, contractor/construction, students/former students, parents, entrepreneurs, activists, veterans, “been there and done that” populations Notes: This is a sample list of assets in a community. Using Table 1 may be useful to identify how those assets may be connected to your CSCP. Barrow, J. (2015, February).


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What is Your Body Saying? The Use of Nonverbal Immediacy Behaviors to Support Multicultural Therapeutic Relationships Nicole A. Stargell and Kim Duong The University of North Carolina at Pembroke Nonverbal Immediacy Behaviors (NIB) can be used to build effective therapeutic relationships and foster desired therapy outcomes. Nonverbal communication between therapist and client may also convey more meaning than the actual words being said. The seven categories of NIB (proxemics, haptics, vocalics, kinesics, oculesics, chronemics, and environment) are explained in relation to mental health therapy. Additionally, the culturally-bound nuances of NIB are discussed for African American, Asian, European, Hispanic, and Native American therapists and clients. Finally, clinical implications are provided. Therapists should understand the basic components of NIB, and then adjust their own nonverbals according to clients’ preferences and needs. Keywords: nonverbal, communication, therapeutic relationship, multicultural, outcomes

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ommunication is critical in the formation of any relationship and according to Young (2013), nearly 80% of communication is nonverbal. Nonverbal Immediacy Behaviors (NIB) are nonlinguistic communication behaviors that convey availability, warmth, and approachability (Andersen & Andersen, 1982). NIB are especially important to the therapeutic relationship, in which 38% of emotions are conveyed by the voice as opposed to the actual words, and 55% of emotions are conveyed through facial expressions (Andersen, 2009; Elliott, Greenberg, Watson, Timulak, & Freire, 2013; Rogers, 1957, 1958; Young, 2013). The therapeutic relationship accounts for approximately 30% of therapy outcomes, and mental health therapists can use knowledge about NIB to understand and foster the therapeutic relationship (Hill, 2010; Miller, Duncan, & Hubble, 1997; Orlinsky, Ronnestad, & Willutzki, 2004). NIB have primarily been studied in the field of communication and have consistently been identified as important components to building interpersonal relationships. In educational relationships, the NIB of classroom teachers are related to student learning outcomes (McCroskey, 2003; McCrosky, Richmond, & Bennett, 2006). In addition, student perceptions of teachers’ NIB have been positively related to student-reported motivation and affect for teacher (McCrosky et al., 2006) and student-perceived credibility and attractiveness NC Counseling Journal • Spring 2018 • Volume 1

of their teacher (McCroskey, Valencic, & Richmond, 2004). Applied to the mental health field, therapist NIB can be used to build the therapeutic relationship by increasing the quality of the bond and the degree of agreement on the goals, methods, and overall approach to therapy (Miller & Duncan, 2004; Young, 2013). All NIB contribute to nonverbal communication between therapist and client, which may have more meaning than the actual words being said (Young, 2013). Following a review of the seven categories of NIB, the importance of NIB in the therapeutic relationship is explained. Next, multicultural nuances in NIB are explored. Ways in which therapists can intentionally build the therapeutic relationship and support client outcomes using NIB are further presented. Nonverbal Immediacy Behaviors There are seven categories of NIB which will be explained in relation to mental health therapy and they include 1) proxemics, 2) haptics, 3) vocalics, 4) kinesics, 5) oculesics, 6) chronemics, and 7) environment (Andersen & Andersen, 1982). Proxemics includes the distance between one communicator and another and the angle at which the communicator is positioned. Therapists are taught to align their shoulders with the client’s and to lean toward the client in order to convey a sense of con23

Nonverbal Behaviors In Multicultural nection (Egan, 2007; Young, 2013). Different amounts of space should be left between two people in different settings. For example, two people who are 1.5 to 4 feet from each other are generally sharing personal space, whereas people who are 12 feet or more away from each other are sharing public space. Therapists should examine clients’ cultures and needs in order to determine how much personal space is therapeutic (Hill, 2010). Haptics involve the use of physical contact and touch. Although in NIB theory, increased physical contact signals interest and availability towards another person, however it is suggested that therapists use touch in a very limited, minimal way (Andersen & Andersen, 1982; Hill, 2010; Young, 2013). As opposed to other communication settings, many clients in therapy have experienced traumatic forms of touch, and it is possible that a therapist touching a client could be interpreted as an invasion of space or otherwise inappropriate (Hill, 2010). Almost 90% of practicing psychologists rarely or never used touch (Stenzel & Rupert, 2004). The only form of touch used with some frequency was a handshake. Although the use of touch is supported as a form of NIB, it was found when norming the NIB constructs that touch was not often used in communication between adults (Richmond, McCroskey, & Johnson, 2003). As such, therapist judgment is the best way to gauge the client’s needs regarding the use of haptics. Vocalics describe communication qualities such as pitch, tone, and use of minimal encouragers (e.g., “uh-huh” and “mmmm”). Therapists are taught to strategically use vocalics with clients. Sometimes therapists will use a slow, calm tone and pace in order to help the client slow down, think and process. Other times, therapists will match a client’s fast and loud tone in order to demonstrate how that affects interpersonal communication and intrapersonal processing (Hill, 2010). Therapists are also encouraged to use minimal encouragers in a non-distracting manner to demonstrate that the client is being heard (Hill, 2010; Young, 2013). Kinesics include the communicator’s use of physical movements (e.g., smiling, nodding, gestures, body posture) and oculesics refer to the communicator’s use of eye contact. Therapists are taught to use head nodding and eye contact in similar ways that allows the client to feel heard and understood in a manner that creates a positive therapeutic relationship (Hill, 2010; Young, 2013). Therapists must employ their own interpersonal judgments in order to know how and when to use kinesics. Chronemics refer to the use of time in communication, including the length of time spent with NC Counseling Journal • Spring 2018 • Volume 1

someone, the tense of communication (i.e., past, present, or ongoing), and punctuality. The length of therapy sessions is determined by client need, insurance policies, and the setting in which the therapist is practicing (Leon, 2001; Young, 2013). Regarding the use of tense, therapists are encouraged to help clients pivot between the past (e.g., telling the story) and the present (e.g., how the client feels while sharing the story); (Hill, 2010; Young, 2013). Finally, punctuality is culturally-bound; some cultures rigidly adhere to start and stop times, whereas others use them as general guidelines. Therapists must interpret and understand their clients’ chronemic needs in context. Finally, the environment in which the communication takes place is a component of NIB and include the appearance of a room, physical barriers between communicators, and other factors that influence the other six NIBs. It is important for therapy to take place in “a healing setting” in which clients feel safe and are able to process their mental health needs (Frank & Frank, 1991, p. 41). Healing settings can come in a variety of forms, but therapy facilities should be professional and welcoming to demonstrate that the therapy relationship is distinct from other interpersonal relationships, which also lends a certain amount of esteem and credibility to the therapist. Additionally, therapists are encouraged to avoid any physical barriers between therapist and client (e.g., a desk) and remain open physically to the client (Egan, 2007). NIB and the Therapeutic Relationship Person-centered therapy has been empirically supported as an effective mental health intervention in which therapists focus on communication within the relationship (Elliott et al., 2013; Rogers, 1957; Wampold, 2001). Therapists utilize the therapeutic relationship in order to communicate the core conditions of congruence, empathy, and unconditional positive regard (Rogers, 1958). However, some therapists are better at communicating these core conditions than others. Baldwin et al. (2007) found that some therapists form generally stronger therapeutic relationships with their clients than other therapists. Okiishi et al. (2006) also discovered that such differences in therapists’ outcomes could not be attributed to demographic factors such as therapist gender, training, or experience. Therefore, therapists’ use of NIB to convey the core conditions could affect the therapeutic relationship and therapy outcomes. Miller (2007) explored compassionate commu24

Stargell &Duong nication in the helping profession and determined that helpers utilize empathy (one of Rogers’ [1957] core conditions), nonverbal communication, and verbal messages in order to provide assistance. Couture and Sutherland (2006) investigated the practice of advice-giving through conversational analysis and found that even the slightest change in a therapist’s or client’s communication (e.g., delivery or content of the message) changed the overall structure of an entire session. Couture (2006) conducted another study and found that therapists who communicated acceptance, varied their tone according to the situation, and invited client contributions were able to co-develop helpful therapeutic processes. NIB contribute to the therapeutic relationship, and the therapeutic relationship is directly linked to the effectiveness of therapy (Andersen, 2009; Andersen & Andersen, 1982; Duncan et al., 2003; Miller, Duncan, Brown, Sorrell, & Chalk, 2006; Richmond et al., 2003; Rogers, 1957, 1961/1995, Staemmler, 2011). Despite the fact that therapists can intentionally use NIB to create the necessary and sufficient conditions of psychotherapy (Andersen, 2009; Richmond et al., 2003; Rogers, 1961/1995), NIB have been only minimally researched and emphasized in therapist training literature (Egan, 2007; Couture, 2006; Hill, 2010; Staemmler, 2011). With a thorough understanding of NIB and cultural preferences, therapists can intentionally work toward an improved therapeutic relationship with diverse clients. In the midst of all communication, individuals strive to properly identify and accommodate one another’s NIB cues (Andersen & Andersen, 1982; Berko, Aitken, & Wolvin, 2010; Hall, 1963). For example, many Americans are very sensitive to touch, and prefer to use it minimally (Andersen & Andersen, 1982; Stenzel & Rupert, 2004). In a therapy setting, therapists are trained to use touch minimally, if at all (Hill, 2010). However, if a client prefers to use high level of touch in their NIB, the therapist should adjust accordingly, in a professional, ethical manner (ACA, 2005, A.2.c.; Andersen & Andersen, 1982; Hill, 2010). Although this generally indicates that higher levels of NIB are more helpful in interpersonal relationships, therapists must learn the various cultural nuances and strive to act accordingly. Although NIB preferences vary throughout cultures, Jones and Wirtz (2007) found that clients liked helpers who used higher levels of NIB. They also discovered that participants tended to match helpers’ NIB levels (i.e, high, moderate, and low), regardless of the NIB level displayed by the helper. This finding indicates that therapists who use higher levels of NIB could imNC Counseling Journal • Spring 2018 • Volume 1

prove the therapeutic relationship, and potentially increase their clients’ use of NIB (Jones & Wirtz, 2007). In contrast to the theory that higher levels of NIB form a stronger therapeutic relationship, Floyd and Erbert (2003) concluded in their study that the social meaning model is based upon the principle that two individuals should mimic or match each other’s nonverbal immediacy behaviors. They additionally found that communicators who intentionally matched their target’s NIB conveyed greater receptivity, greater similarity, and less dominance. Greater similarity aligns with Roger’s (1957) notion that therapists should adjust their communication according to the client’s needs and Miller and Duncan’s (2004) assertion that the therapeutic relationship relies upon agreement of therapist and client. Therapists who match their clients’ NIB can potentially improve the way in which their clients perceive them and potentially increase the quality of the therapeutic relationship (Andersen, 2009; Berko et al., 2010; Flaskerud, 2013; Floyd & Erbert, 2003; Hall, 1983; Rogers, 1961/1995). Regarding NIB, two strategies can be employed by therapists and they include, (a) use more NIB to create more genuineness and warmth or (b) match or mismatch client NIB intentionally to produce therapeutic results. As mentioned previously, some therapists form stronger relationships with their clients than other therapists, yet they still do not form strong relationships with all of their clients (Baldwin et al., 2007; Marcus, Kashy, & Baldwin, 2009). This may indicate that some therapists are generally stronger than others in using NIB intentionally and effectively. As Rogers (1957, 1958) postulated, therapists must adjust their communication in a way that the client can clearly receive and understand. Therefore, therapists should integrate multicultural considerations into their use of NIB in order to intentionally foster a strong therapeutic relationship. NIB in a Multicultural Context Therapists should understand the basic components of NIB, and then adjust their own nonverbals according to client preference and need (Floyd & Erbert, 2003; Miller & Duncan, 2004). It is important to note that there may be significant NIB differences between men and women. Richmond et al. (2003) found that women rated individuals in a position of power with higher NIB than men rated the same individuals. Additionally, Jones and Wirtz (2007) found that females tended to match the NIB of individuals in a helping position more than males. However, women and men 25

Nonverbal Behaviors In Multicultural rated the NIB of past romantic partners similarly (Richmond et al., 2003). This might indicate that women are slightly more attuned to NIB in the therapy setting, but not necessarily in their own personal lives. In addition to gender differences, NIB are culturally-bound (Andersen & Andersen, 1982; Stenzel & Rupert, 2004). As previously mentioned, therapists must choose the quantity and correspondence of their own NIB in relation to client needs and preferences. The following general cultural guidelines can be used to inform therapists’ NIB decisions when combined with additional client considerations in context. Special note should be given to the fact that the information presented regarding culture and NIB is a general guideline and does not apply to all clients of a particular culture. Even when general cultural information regarding NIB seems to apply to a certain client, their experience will inherently differ in unknown ways. African American Clients Given the tumultuous history that African Americans have faced in the United States and the many ways in which racism manifests itself, many African Americans have learned to give particular weight to the holistic content of a message rather than just the spoken word. African Americans heavily rely on nonverbal behaviors when communicating (Wilson & Stith, 1991). They may focus intently on signs of genuineness, empathy, and warmth and lend more credibility to a therapist’s NIB rather than their spoken words. Therapists should mindfully attune their posture and lean forward in order to convey interest and sincerity (Sue, 1990; Wilson & Stith, 1991). Therapists working with African American clients should sit a comfortable distance from the client that shows the therapist is fully invested and interested in becoming close to the client. Additionally, therapists should ensure they have created a welcoming therapy environment that is free from barriers (Frank & Frank, 1991). For example, a desk can serve as a barrier that reduces the ability for two people to connect and implies a power differential. Therapists should also be mindful of the barriers clients use (e.g., folded arms, purse on the lap) and notice times and circumstances in which clients let down their own barriers. Eye contact in the African American culture is used primarily when speaking rather than when listening (Sue, 1990; Toomey, 1999). Therapists should note that African American clients might lean forward and look down to show they are listenNC Counseling Journal • Spring 2018 • Volume 1

ing. Therapists might practice using this same behavior when clients are speaking and carefully limit the use of eye contact during therapeutic interactions. Family and religion are especially important aspects of African American communities; the disapproval of either, especially when communicated through NIB such as facial expression or vocal tone, is a significant reason for African American clients to discontinue therapy (Wilson & Stith, 1991). Therapists should take care to provide neutral facial expressions and a supportive lean even when discussing difficult therapy topics. Due to cultural stigma and a history of persecution, African American clients might feel as though they will be perceived inaccurately or negatively by their therapists (Jordan, Lovett, & Sweeton, 2012). This apprehension might sometimes lead to some African American clients being more rigid with their NIB, using stifled movements and even showing more negative affect. As such, therapists should note that the NIB of African American clients might shift as the therapeutic relationship improves. Therapists should take care to convey warmth and empathy through their NIB, but also work to match some of the client’s more muted NIB in order to promote similarity and comfort. Asian Clients Eye contact is a key consideration when working with clients from Asian cultures. The absence of steady eye contact from an Asian client does not necessarily communicate indifference or inattentiveness. In fact, Asian cultures defer eye contact in order to be respectful (Chen & Han, 2001; Sue, 1990; Sue & Sue, 1977; Toomey, 1999). In Asian cultures, eye contact and or staring is considered rude; eye contact can cause clients to experience anxiety, tension, and discomfort and can be misinterpreted as disdain and contempt from the therapist (Marsella, 1993). It is important for therapists to remain genuine and also divert eye contact whenever possible (Elliott et al., 2013; Rogers, 1957; Wampold, 2001). Overall, it is a sign of respect in Asian cultures for elders and authority figures to avoid direct eye contact (Chen & Han, 2001). Regarding proxemics and haptics, Asian clients might become confused if therapists use excessive amounts of touch or sit too close to clients. Physical contact and closeness can lead Asian clients to believe the therapist is acting unprofessionally or in an overly-friendly manner. (Marsella, 1993). As such, therapists should take care to be warm and inviting while avoiding the use of physical touch 26

Stargell &Duong and leaving Asian clients plenty of personal space. The use of too many hand gestures is considered distracting, rude, and undisciplined in many Asian cultures (Toomey, 1999). Therapists should maintain awareness of their kinesics and maintain disciplined, calm body movements when possible. It is important for therapists to explore how matching or mismatching clients affects the therapeutic relationship and therapy outcomes across sessions. In addition to limited eye contact, many Asian cultures value the limited use of verbal expression to convey respect and genuineness. Specifically, Asian cultures promote the use of silence as a sign of respect from elders and authority figures (Chen & Han, 2001). Additionally it is impolite to talk too much or interrupt others in Asian cultures (Chen & Han, 2001). Finally, the use of minimal encouragers (e.g., “uh-huh”, “mmm”) might be confusing or rude (Sue & Sue, 1977). Therapists should take note of this trend and exercise self-restraint when possible or appropriate. The use of silence is an effective therapeutic technique for clients from all cultures, and it is especially important when working with Asian clients (Chen & Han, 2001; Hill, 2010). It is important to note, though, that silence can also indicate a therapist’s desire to avoid disagreement (Chen & Han, 2001), so therapists should take care to use verbal expressions when challenging is necessary. Although it might be important for therapists to be directive in sessions, it is important to note that using direct and confrontational techniques in therapy can be perceived as a lack of respect or insensitivity to Asian clients (Sue, 1990). In order to balance these opposing trends, therapists should take care to use a moderate and soft tone of voice whenever verbal directiveness is necessary (Sue, 1990; Toomey, 1999). A loud voice is considered aggressive and can be used to convey anger and a lack of self-control to Asian clients. As such, therapists should use silence whenever possible or therapeutically beneficial, and should take care to provide any verbal directions in a soft, low, and slow tone. Therapists should take note that clients who use silence might wish to avoid a conflict or an expression of disagreement (Chen & Han, 2001). If therapists observes that clients are excessively silent in session, the use of immediacy may help some clients feel at ease in a manner that will help them express some of their thoughts and feelings (Hill, 2010). Otherwise, therapists should respect Asian clients’ use of silence as a sign of respect, self-control, and a desire to join with the therapist (Chen & Han, 2001; Sue, 1990; Sue & Sue, NC Counseling Journal • Spring 2018 • Volume 1

1977). Therapists should consider their own biases in order to avoid viewing Asian clients as immature, weak, shy, depressed, rude, or lacking finesse (Sue, 1990). Finally, Asian clients often inhibit their nonverbal displays of emotions in order to convey self-restraint, maturity, and wisdom (Kim, Liang, & Li, 2003; Sue, 1990). Asian clients might refrain from displaying both positive and negative emotions, such as anger, irritation, sadness, love, and happiness. This could be interpreted by therapists as a lack of emotional sensitivity or a poor therapeutic relationship (Sue, 1990). However, therapists should be mindful that Asian clients may not readily access emotions due to cultural values, and the emotions expressed could differ from a traditional American interpretation. For example, if an Asian client smiles it could indicate embarrassment, discomfort, or shyness rather than happiness (Sue, 1990). Overall, therapists should take care to understand the ways in which each unique client uses nonverbal behaviors in accordance to cultural norms and work to harness these nuances to grow the therapeutic relationship. European Clients European clients use their own culturally-bound nonverbal behaviors to support verbal communication. In regards to proxemics, two communicators who are not intimately acquainted typically maintain two or three feet of personal space (Centre for Intercultural Learning, 2011; Toomey, 1999). When interacting in more intimate ways (e.g., romantic relationships, secret-telling), this distance might become much closer (e.g., 6-8 inches). However, it would be considered rude and aggressive to enter a European client’s personal space without valid justification. Especially important for clinicians to consider when working with European clients is the differences in haptics, or messages conveyed through touch. McDaniel and Andersen (1998) reported that, like most Americans, those from Northern European countries engage in very little touch. However, people from southern European countries used touch much more frequently than their northern counterparts. Regardless of region, Europeans often greet each other with a kiss on the cheek or a handshake. In fact, European clients might even brush against or touch another person when arguing or making a point (Centre for Intercultural Learning, 2011). Regarding kinesics, individuals from Southern European countries tend to use hand gestures (e.g., arms in the air) to accompany their verbal communi27

Nonverbal Behaviors In Multicultural cations (Toomey, 1999). European clients might also lift their chins when engaging in conversation, which is considered a refined and poised posture (Sue, 1990). However, this gesture might be interpreted as arrogant or elitist to members of other cultures. To build rapport with European clients, a sincere smile can be implemented as a non-threatening gesture that conveys a desire to help (Sullivan, Scott, & Nocks, 2011). European clients appreciate the importance of eye contact, which conveys attentiveness, honesty, openness, and confidence (Centre for Intercultural Learning, 2011). However, too much eye contact can convey aggressiveness or challenging behavior, especially while a European client is talking (Toomey, 1999). It is important to carefully balance eye contact and kinesics, because a firm handshake with solid eye contact is important for making a good first impression and building the therapeutic relationship (Centre for Intercultural Learning, 2011; Toomey, 1999). Finally, clients of European descent are likely to be emotionally engaged and open to the therapy process (Centre for Intercultural Learning, 2011; Toomey, 1999). Additionally, European clients often use an expressive tone of voice to discuss important issues (Toomey, 1999). Therapists can gauge European clients’ engagement and trust in the therapeutic relationship based upon the level of client disclosure and the nonverbal messages of investment or hesitation. Hispanic Clients Given the social nature of their culture and preference for engaging in relational learning, many Hispanic clients heavily rely on NIB in order to feel connected to the speaker and message (Martin & Mottet, 2011). Martin & Mottet (2011) found that students’ learning outcomes increased significantly when an instructor intentionally used NIB. In a therapy context, this could indicate that trust and rapport building are essential to a Hispanic client’s understanding of, and willingness to engage with, a presenting problem and the therapist. Regarding vocalic, Hispanic clients are likely to speak loudly and quickly. In Hispanic cultures, loud and expressive speech is not meant to be intimidating or offensive. The fast-paced nature reflects an individual’s level of emotion and excitement, and might indicate a positive working relationship in therapy (Centre for Intercultural Learning, 2011). Related to high levels of energy and excitement, Hispanic individuals may use gestures to illustrate their NC Counseling Journal • Spring 2018 • Volume 1

verbal messages. In addition to waving arms and expressive facial expressions, Hispanic individuals might use a pointed finger to make a difficult point, which is not meant in an accusatory or offensive way. The “thumbs up” sign indicates approval in most Hispanic cultures, but the “okay” signal is quite similar to an offensive hand gesture in some Hispanic cultures, including Brazillian (Centre for Intercultural Learning, 2011). Much like European cultures, eye contact is an important part of Hispanic culture and is used to convey interest, honesty, and attentiveness. However, Hispanic clients might actually engage in more intense and prolonged eye contact during conversation than individuals from other cultures (Toomey, 1999). Eye contact conveys assertiveness in Hispanic cultures, which can be amplified with gestures, loud speaking volume, and animated speaking (Centre for Intercultural Learning, 2011). Although certain aspects of oculesics and kinesics are exaggerated in some Hispanic cultures, it is important for therapists to use an honest and sincere smile when working with Hispanic clients (Centre for Intercultural Learning, 2011). Overly-animated smiles are likely to convey distrust and should be avoided. In general, physical touch is meant for friendly and peaceful relationships in Hispanic culture. These relationships can be personal or professional, and gender does not dictate whether a friendly handshake or kisses on both cheeks are appropriate (Centre for Intercultural Learning, 2011). Hispanic individuals tend to use a variety of haptics to convey safety and trust, such as a pat on the back or a gentle touch on the shoulder. Overall, therapists should use touch sparingly when working with any client, but should also take a client’s use of appropriate touch as a sign of respect and trust. Native American Clients Native Americans have experienced a traumatic history of oppression, and clients from this culture are keenly observing their therapists to identify any mixed messages or signs of judgment (Dana, 2000; Everett, Proctor, & Cartmell, 1983). In order to build the therapeutic relationship and address residual trauma, therapists should work to demonstrate cultural competence and an appreciation for Native American traditions (Dana, 2000; Meyer & Cottone, 2013). Overall, Native American cultures value a quiet, unassuming, and humble nature. Nonverbal behaviors are a key component to communication in this culture (Herring & Meggert, 1994). Gestures, which fall under the nonver28

Stargell &Duong bal heading of kinesics, are commonly used to create imagery during the process of storytelling, which is highly valued by many Native American cultures and subcultures. Understanding the relevance and significance of such gestures to a Native American client can vastly improve the therapy relationship. Regarding oculesics, direct eye contact is considered aggressive and rude in many Native American cultures (Everett et al., 1983; Garwick & Auger, 2000; Sue, 1990). Some Native American clients might avoid direct eye contact when speaking or listening as a sign of respect or modesty, and therapists should take care to avoid interpreting a lack of eye contact as a sign of disinterest or disrespect (Garwick & Auger, 2000; Meyer & Cottone, 2013; Sue, 1990). In the Native American culture, direct eye contact is often used with aggressive or hostile intents, and it is believed that the eye contact itself can bring harm to an individual (Everett et al., 1983; Sue, 1990). Eye contact might be used by Native American parents to direct their children, and therapists can utilize this information when working with families or youth. Related to a calm, unassuming demeanor, it is considered immodest or aggressive for Native American individuals to ask direct questions or speak out assertively (Everett et al., 1983; Sue, 1990). Instead, Native American clients might use succinct responses and avoid asking questions in session, even when invited to do so by the therapist. Native American people value a slow, intentional pace when communicating, and the use of silence can be a helpful therapy tool (Meyer & Cottone, 2013). Therapists should take care to avoid misinterpreting a Native American client’s silence and join the client in a quiet, slow journey of exploration (Garwick & Auger, 2000). Finally, although gestures are an important part of Native American culture, the use of touch in professional relationships is generally discouraged. A firm handshake or other touching (e.g., a hug) can be interpreted as aggressive or disrespectful in the Native American culture (Everett et al., 1983). Therapists should always respect clients’ personal space and boundaries, which is especially relevant when working with Native American populations.

therapeutic relationship (Floyd & Erbert, 2003). However, it has also been postulated that therapists should use higher levels of NIB to improve the therapeutic relationship (Jones & Wirtz, 2007). Ultimately, various cultural nuances in NIB exist, and therapists should become aware of their own cultural preferences and the NIB that they most often utilize in communication with clients. Therapists should also assess how clients’ NIB differ or are similar to their own NIB and utilize clinical judgment in order to intentionally choose the NIB that is most likely to be helpful in a therapy session. Therapists are also reminded to treat their clients as an individual first within the contest of their culture.

Conclusion NIB can be intentionally used to foster the therapeutic relationship in order to promote greater outcome effectiveness in clients. It has been supported that similarity in NIB between therapist and client fosters a strong NC Counseling Journal • Spring 2018 • Volume 1

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Rogers, C. R. (1958). The characteristics of a helping relationship. Personnel & Guidance Journal, 37, 6-16. doi: 10.1002/j.2164-4918.1958.tb01147.x Rogers, C. R. (1995). On becoming a person. New York, NY: Houghton Mifflin (Original work published 1961). Staemmler, F. M. (2011). How therapists and clients understand each other. New York, NY: Springer. Stenzel, C. L., & Rupert, P. A. (2004). Psychologists’ use of touch in individual psychotherapy. Psychotherapy: Theory, Research, Practice, Training, 41, 332NC Counseling Journal • Spring 2018 • Volume 1

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Equine Assisted Psychotherapy in the Addictions Counseling Field Jill Van Horne, Geri Miller, and Catherine Clark Appalachian State University

Over the past few years, the number of individuals encountering addiction and or substance abuse problems have increased. While there are a number of individual and group counseling approaches that have been used in the past to treat addicted persons such as behavioral therapy, cognitive behavioral therapy, motivational interviewing, 12-step therapy, contingency management; one of the more appealing approaches includes Equine Assisted Therapy. This article provides an overview of equine assisted therapy and the therapeutic process. In addition, application of Equine Assisted therapeutic approach to the addictions counseling field is also discussed. A specific emphasis is placed upon the stages-of-change model. Keywords: Addiction counseling, equine assisted psychotherapy, stages of change model Equine Assisted Psychotherapy (EAP) is a powerful resource for counselors working with addicted clients. Clients with alcohol and drug problems need assistance learning how to cope with their feelings and developing appropriate coping strategies in response to their feelings that will help them enter and remain in recovery (Margolis & Zweben, 1998). This also includes relapse prevention (Miller, 2015), which is significant because according to the U.S. Department of Health and Human Services (2016), thousands of lives are lost annually because of substance misuse. In addition, when compared to other developed countries the United States spends more on health care, yet ranks 27th in life expectancy and this decline has been impacted by substance misuse and associated mental health and physical problems (U.S. Department of Health and Human Services, 2016). Addiction is a chronic brain disease defined as the most severe form of substance abuse disorder associated with uncontrolled or compulsive use of one or more substances. Addiction also has the potential for relapse and recovery (U.S. Department of Health and Human Services, 2016). Services used to treat substance abuse problems include evidenced based medications and a various counseling treatment modalities. Regardless of the treatment modality used, the counseling process with addicted individuals needs to be personalized to the client from a strength-based NC Counseling Journal • Spring 2018 • Volume 1

approach that can draw them back into the human community providing support and care following the inherent isolation of addiction (Miller, 2015). In addition, because addicts often have difficulty in personal relationships and in trusting others, counselors need to establish a therapeutic relationship that is honest, direct, and collaborative. It is essential to create a relationship that focuses on setting firm and supportive limits with clients (Miller, 2015). Miller (2015) describes this as compassionate accountability where the counselor has compassion for the addicted client’s struggle, but also holds clients accountable for their behaviors. All of these highlighted components are a part of equine assisted therapy (Mandrell, 2014). This overlap of treatment components encourages the use of Equine Assisted Therapy (EAP) in addiction treatment. Prior to the specific discussion of EAP in addiction treatment, a brief commentary on addressing crisis that may lead to substance abuse warrants further discussion. According to Miller (2015), addicted individuals frequently need assistance in learning actual crisis particularly early in their recovery (i.e. less than 2 years sobriety). This assistance is further needed because of their increased sensitivity to their environment and personal feelings now that they have “thawed out” as part of their recovery. Individuals are more aware of external and internal experiences that may be unpleas33

Equine Assited Psychotherapy ant. They may have responded to these experiences by “numbing out” via alcohol/drugs. A “crisis” then, can be the result of triggers that come from a specific factor or numerous factors that are external or internal to the individual and real or imagined (Miller, 2015). Therefore, it is not critical, and it is most likely impossible, to name all the possible crises that may occur for an addicted individual. Instead, whether the crisis is “real” or “imagined”, it is the client’s perception of the event/feeling as a crisis that is most important. The counselor can assist the client in learning how to deactivate the “real” or “imagined” crisis situation triggers by learning to stay calm, reaching out to others for support, and staying sober through the experience. The counselor needs to stay calm and supportive of the client while they are experiencing the crisis (Miller, 2015). EAP therapy inherently replicates this process because it invites intense feelings and or experiences in the client that may mirror a crisis, in addition to reactions they experience in their daily living. The EAP counselor, by being calm and supportive, may use the intensity of the client’s reaction to a perceived internal or external crisis recreated with the interaction with the horse. This mirrored crisis event is similar in most ways, except the environment is safe and managed by trained professionals who are able to provide immediate support (Lanning & Krenek, 2013). The client can learn how to live sober through crisis reactions that occur in the process of EAP by providing a template of how to respond (Dell, Chalmers, Dell, Sauve, & MacKinnon, 2008). One example of how EAP can assist a client follows; a client with a fear of horses may experience that crisis fear reaction in response to interactions with the horse that occurs in the presence of the counselor who is being calm and supportive. The counselor assists the client in understanding and responding to their fear reactions. This learning experience on handling a crisis may be applied in daily living situations where the client is frightened and wants to use alcohol/drugs to numb the fear. Instead of using, the client may transfer some of the skills learned in EAP to the specific crisis. Please note that a client does not need to have a fear of horses in order to benefit from EAP. The horse is the catalyst not the focus of the session. The client often will label the horse many things such as “my relationships, my addiction, my job, my money woes” but rarely labeled a horse. This article begins with a brief review of the literature of EAP therapy and an explanation of its therapeutic process. A description for the therapeutic application to the addictions counseling field along NC Counseling Journal • Spring 2018 • Volume 1

with the specific therapeutic application in the use of the stages-of-change model created by Prochaska, DiClemente, and Norcross (1992) is further provided. Note that the stages-of-change model is a part of the trans-theoretical model (TTM) that emerged alongside motivational interviewing (MI) in the 1980s (Miller, 2015). Prochaska, DiClemente, and Norcross (1992) stated that change happens for clients when the right process occurs at the right time. The knowledge of the client’s stage is crucial in the treatment of addiction because the client’s level of change guides the type and level of therapeutic intervention (Miller, 2015). Equine Assisted Therapy There are numerous terms used to describe EAP therapeutic approach. Animal Assisted Therapy (AAT) is an alternative therapy that involves animals in professional counseling (Brandt, 2013). There is research showing the benefits of using Animal Assisted Therapy (AAT) with counseling clients as summarized by Allen and Colbert (2016). “AAT is a goal-directed intervention implemented by a mental health professional” (Allen & Colbert, 2016, p. 35). An essential part of AAT has focused on improving the person’s mental, emotional, physical, and social functioning (Fine, 2010). Additional research has also indicated that by simply playing, rubbing, or watching animal activities stress levels are reduced and production of serotonin is increased (Hajar, 2015). Using horses in therapy is a subset of AAT and often is called Equine-Facilitated Psychotherapy (EFP) used to complement empirically based therapeutic interventions (Brandt, 2013). Equine Assisted Therapy is considered the Diamond Model. The Diamond Model involves the equine, typically a horse (including miniature horses) or a donkey breed, an equine specialist with the licensed mental health clinician, and the client (Allen & Colbert, 2016). Perhaps the most significant component of EAP therapy is that “therapists incorporate exercises with the client and horse to target behaviors and underlying emotions” (Jarrell, 2005, p. 41). The term chosen for this article is Equine Assisted Psychotherapy (EAP) because it is critical to stress the importance of psychotherapy in this technique. The therapeutic process of EAP is unique and complementary approach to the therapeutic process that involves horses. Horses, like humans, are very social animals and the social interaction between horse and client can facilitate client learning with regard to their interpersonal relationships (Vidrine, Owen-Smith, & Faulk34

Van Horne, Miller & Clark ner, 2002). There is an additional benefit of EAP because the nature of horses differs from that of humans. As animals of prey, horses respond to stimuli with an immediate cause-and-effect approach in order to take care of their basic needs, eliciting a separate response for each action and interaction. Horses consistently exist in the present moment and place no value on what, how, why, when, or who made the client enter treatment. Further, the horse has no knowledge of the client’s past (i.e. trauma, life experiences, etc.) (Burgon, 2011). These differences result in a series of organic exchanges between the horse and the client, with live observation by the therapist. Through their interaction with horses, clients have the opportunity to become more aware of their emotions, thoughts, and behaviors in relationship to others and their existing environment (Trotter, 2012). Therefore, an EAP model allows clients to receive immediate feedback from the equine in response to their actions. Initially, when the client enters the therapy setting (i.e., arena, farm), the horse, unlike the counselor, immediately begins working therapeutically with the client because the horse functions in the present moment without any need for formal greeting, distraction of professional dress of the therapist, or other preconceptions that entangle and distract from the therapy. It is even arguable that the therapeutic process begins when the client arrives at the farm. Horses, then, are more readily able to neutralize the differences between the client and counselor from the onset of therapy (Mandrell, 2014). Further explaining the role of the counselor and the therapeutic process, a contrast between typical counseling and EAP is required. Typically, counseling sessions are designed for the counselor to be the initiator of the therapeutic process. The counselor is perceived as the expert, while the client is the one in need of professional assistance passively awaiting the direction of the therapist. In contrast, because EAP brings the horse into the counseling relationship, the power differential between the therapist and client is neutralized and the relationship becomes more collaborative, anchored in the here-and-now experience with the horse. The client and horse present an experience observed by the counselor. The client no longer speaks to the counselor about what happened at another time and place as a personal narrative to be understood and believed by the counselor (“the ‘there and then’ experience”; Yalom, 1985). Instead, in EAP, the client has a “here and now” counseling experience (Yalom, 1985). Equine therapy invites immediacy in the observable, live experience empowering the client, not the counselor, to NC Counseling Journal • Spring 2018 • Volume 1

be the expert of the experience. The counselor assists in the therapeutic healing by making observations and processing the experience with the client using the person-centered approach (Rogers, 1951) and the counselor shares the cognitive and emotional experience of the client and guides that experience to a healing place. Because of some of its unique components, there are additional benefits to the EAP approach that broaden the counselor’s impact in therapy. First, clients have varying degrees of treatment experience, meaning that some clients with extensive counseling treatment (“treatment savvy” clients) may be especially responsive to a form of therapy other than talk therapy, particularly when every interaction between the client and the horse is unique and different. Such uniqueness leads to a spontaneity that can reduce the defensive strategies of these clients. Second, the EAP approach is suitable and appealing for clients who find that sensory techniques such as touch, smell, sight result in a stronger therapeutic experience than talk therapy (Mandrell, 2014). Addiction treatment and recovery requires clients to develop insight in terms of power and powerlessness (Miller, 2015). These insights may occur more readily in the EAP sessions with the client because the individual soon develops a sense of what will work and will not work with the horse, what they have control over, and what must be left to the equine to determine. This is a metaphor directly applicable to addiction treatment and recovery where the individual has to learn to live life on life’s terms and to determine what s/he has power over and what s/he does not. The recovering addicted client needs to learn how to live with powerlessness and one avenue for this learning is EAP (Miller, 2015). The Role of EAP in Addiction Treatment EAP may assist clients in developing positive behavior and emotional wellness through numerous activities (Brandt, 2013). More specifically, Brenna (2013) asserts that horses can exert emotional and motivational influences on clients in environments that have positive meanings. Overall, Equine Assisted Psychotherapy has demonstrated effectiveness in the addictions counseling field. Adams et al. (2015) showed the benefits of EAP when applied to a Native American youth population that misused volatile substances and this approach contributed to the wellbeing of clients in each area of the bio-psycho-social-spiritual model. Bark (2011) also found in a qualitative study that EAP was helpful to young people in overcoming their drug abuse. With the 35

Equine Assited Psychotherapy horse as the therapy tool, EAP has been shown as an effective means of assisting adolescents with behaviors and emotions (i.e., trust, self-esteem, communication, boundaries, at-risk behaviors) (Beebe, 2008). Further, EAP demonstrated the ability to help clients to stay in treatment longer and complete addiction treatment (Kern-Dodal, Arnevik, Walderhaug, & Ravndal, 2015). EAP facilitates client understanding of their addiction and addiction recovery. Self-awareness is required for addiction recovery (Miller, 2015) and EAP assists clients in developing this therapeutic skill. Horses are very sensitive and respond to human body language and subtle cues. Through interactions with the horse, clients can become more aware of their emotions, body responses, and communication with others (Johansen, Arfwedson Wang, Binder, & Malt, 2014; Mandrell, 2014). The horse serves as a device upon which the client can project their reactions to the horse’s behavior. The counselor, may help the client verbalize the experience and over time show improvements in both verbal and nonverbal communication with the horse (Johansen et al., 2014). As the client grows in understanding their reactions to the horse’s behavior, the individual can then make more self-aware choices that can be transferred readily to relationships and decision making outside the counseling setting. This aspect of EAP is especially helpful in working with addicted populations who frequently have interpersonal problems (Miller, 2015). When working in the addictions counseling field, counselors also need to determine their client’s stage level of change (precontemplation, contemplation, preparation, action, and maintenance) in order to determine the appropriate intervention (de Biaze Vilela, Jungerman, Laranjeira, & Callahan, 2009). Using an EAP therapeutic approach provides a stage assessment using the whole person in a natural environment. The interventions focus on the task that needs to be explored at that stage level in order for the client to move on to the next stage. Stage Model Precontemplation Stage When in the precontemplation stage, the client is not planning to change the behavior and does not have much awareness of a problem. During this stage, the client needs to become more motivated emotionally and intellectually as well as become more aware of the problem behavior and alternatives to that behavNC Counseling Journal • Spring 2018 • Volume 1

ior. Resistance is at the core of this stage (Prochaska & Norcross, 2002). Here, EAP may assist the counselor in helping the client become aware of a problem with alcohol and drugs by reflecting upon client interactions with the horse (i.e. communication). The counselor connects the stage with the current interaction by asking the client to consider what was keeping him/her from performing a requested task (e.g., lack of desire to accomplish the task, not seeing the need to accomplish the task, etc.). The counselor may then explore other areas in the client’s life in which there are burdensome or unnecessary requests or demands. Often, clients will narrow in on the requests of family members to consider treatment, which the client may perceive as unnecessary, or challenges, significant others may have in conveying the extent of the alcohol/drug problem to the client (de Biaze Vilela, Jungerman, Laranjeira, & Callahan, 2009). Contemplation Stage In the contemplation stage, the client knows there is a problem, but even though the individual is thinking of changing, there is no commitment to change (Prochaska & Norcross, 2002). Here the cognitive task is on helping the client focus on making some decisions regarding the time and energy a change will cost as well as the loss inherent in the change. EAP may help a client become aware of the time, energy, and risk involved in setting up a relationship with the horse which are the same issues faced when setting up relationships with individuals in recovery. Preparation Stage During the preparation stage, the client has a plan to take action within a month and although s/he has made small changes, there has not been enough action to make a significant change (Prochaska & Norcross, 2002). This stage involves more realistic goals and timelines. At this stage, the horse can help the client examine realistic goals and timelines for improving the relationship with the horse: a metaphor that translates to various addiction recovery changes. Action and Maintenance Stage In the action stage, the client changes behavior, experiences, and/or the environment to address the addiction problem. In EAP, the client can apply behavior chang36

Van Horne, Miller & Clark es, previous and current experiences with the horse, and environmental changes to improve the relationship with the horse. In addiction recovery, the client needs to change people, places, and things in order to establish a strong recovery base. The changes made in EAP can translate to specific addiction recovery changes needed. In the maintenance stage, relapse is prevented and change is consistent (Prochaska & Norcross, 2002). The client needs to have support and reinforcement to stay sober. EAP shows the client how the support of the counselor, trainer, and community involved in the therapy are similar to those components necessary for recovery. Conclusion EAP can be a powerful therapy that augments traditional addiction treatment. As a result of using experiential therapeutic activities, and addressing trust, self-esteem, communication, boundaries, and at-risk behaviors through EAP, the addicted client can develop coping strategies. EAP encourages the learning of these strategies in a supportive community beginning with a team approach: the client, the therapist, and the equine. The community has compassion for the addicted client’s weaknesses while holding them accountable for their behaviors. This experience of compassionate accountability can translate to the client’s entire addiction recovery process.


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Equine Assited Psychotherapy References Adams, C., Arratoon, C., Boucher, J., Cartier, G., Chalmers, D., Deli, C., & Wuttuneed, M. (2015). The helping horse: How equine assisted learning contributes to the wellbeing of first nations youth in treatment for volatile substance misuse. Human-Animal Interaction Bulletin, 1, 52-75. Allen, K., & Colbert, L. (2016). Ethical and safety considerations for the use of animals in a therapeutic setting. Psychotherapy Bulletin, 51, 35-45. Bark, J. (2011). Therapists working together with horses. Equine assisted psychotherapy: Treating youths with addiction (Unpublished master’s dissertation). Sweden: Gävle University College. Beebe, B. J. (2008). The use of equine assisted psychotherapy in youth chemical dependency: A new modality for nurse practitioners (Unpublished manuscript). Washington State University, WA. Burgon, H. L. (2011). ‘Queen of the world’: Experience of ‘at risk’ young people participating in equine-assisted learning/therapy. Journal of Social Work Practice: Psychotherapeutic Approaches in Health, Welfare, and the Community, 25, 165-183. Brandt, C. (2013). Equine-facilitated psychotherapy as a complementary treatment intervention. Practitioner Scholar: Journal of Counseling and Professional Psychology, 2, 23-42. Brenna, I.H. (2013). “They are part of what made my treatment positive. And maybe more meaningful.” Participants’ experience of horse-assisted therapy in addiction treatment (Master’s thesis). Sweden: University of Oslo. de Biaze Vilela, F. A., Jungerman, F. S., Laranjeira, R., & Callahan, R. (2009). The transtheoretical model and substance dependence: Theoretical and practical aspects. Revista Brasileira de Psiquiatria, 31, 362-36. Fine, A. (2010). Handbook on animal-assisted therapy: Theoretical foundations and guidelines for practice (3rd ed.). San Diego, CA: Academic Press


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Van Horne, Miller & Clark U.S. Department of Health and Human Services (2016), Office of the Surgeon General. Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health. Washington, DC: HHS. Vidrine, M, Owen-Smith, P., & Faulkner, P. (2002) Equine-facilitated group psychotherapy: Applications for therapeutic vaulting. Issues in Mental Health Nursing, 23, 587-603. doi: 10.1080/01612840290052730 Yalom, I. D. (1985). The theory and practice of group psychotherapy (3rd ed.). New York, NY: Basic Books.


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