COUNSELORS' PERCEPTIONS OF FEMALE AND MALE CLIENTS: DO WE
REINFORCE TRADITIONAL GENDER ROLES?
A DISSERTATION PRESENTED TO THE GRADUATE SCHOOL OF THE
UNIVERSITY OF FLORIDA IN PARTIAL FULFILLMENT OF THE
REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY
UNIVERSITY OF FLORIDA
I would like to thank Dr. Franz Epting whose insights and
encouragement made this manuscript possible. I would also
like to acknowledge Dr. Martin Heesacker whose mentorship
and friendship were invaluable in my development as a
psychologist. I also am indebted to my wife and parents
whose love, support, and belief in me made this goal
TABLE OF CONTENTS
ACKNOWLEDGEMENT ..................................... ............................................................................. ii
ABSTRACT ................................................................................................................................ iv
INTRODUCTION ............................................................................................ ............................... 1
REVIEW OF LITERATURE ............................. ... ............... ................................... 8
Historical Overview ............................................................................................ 8
Perceptions of Women in Counseling .............................................. 14
Perceptions of Men in Counseling .......................................... ........... 17
Grounded Theory Overview ................................... ............. ............. 19
Summary ................................. ......................................... ........................... 23
M E T H O D S ........................................................................................................................ 2 6
Participants ........................................ .................................................................... 26
Researchers ........................... ................................................................................... 26
Procedures ............................................................................... ............................... 27
Analysis ............................ ............. ........................................................ 28
RESULTS ................................................................................................................................... 34
Counselors' Perceptions of Their Clients ............................. 35
Perceptions of Female and Male Clients .................................. 45
DISCUSSION .................................................................................................................................. 49
REFERENCES ........................................................................................................................... 59
APPENDIX A ............................................................................................ ..................................... 72
APPENDIX B ..................................................................................................................................... 90
APPENDIX C .................. ................................................................................................... 94
BIOGRAPHICAL SKETCH .................................................................... ............................ 96
Abstract of Dissertation Presented to the Graduate School
of the University of Florida in Partial Fulfillment of the
Requirements for the Degree of Doctor of Philosophy
COUNSELORS' PERCEPTIONS OF FEMALE AND MALE CLIENTS: DO WE
REINFORCE TRADITIONAL GENDER ROLES?
Chairman: Dr. Franz Epting
Major Department: Psychology
This qualitative study investigated counselors'
perceptions of their female and male clients. Data from the
intake interviews of 59 client cases (36 female and 23
male) were analyzed using a grounded theory approach. After
submitting a preliminary description to a peer audit, a
final description of these counselors' perceptions was
constructed. The description included two core categories
that helped shape several themes regarding counselors'
perceptions of their clients. The core categories were (a)
counselors' attempts to describe their clients and (b)
counselors' descriptions of what counseling or the
counseling relationship is like. Additionally, while the
counselors' perceptions were for the most part similar for
their female and male clients a few differences emerged.
For the female clients the themes of "vulnerability" and
"paying attention to how much the client asserts herself"
were more pronounced than for the male clients. For the
male clients the themes of "being stuck" and "paying
attention to how much the client is connected to others"
were more pronounced than for female clients. Based on the
results of this investigation, recommendations for practice
and implications for research are addressed.
Counselors are not passive in their attempts to
understand their clients. They actively seek information,
integrate it, and form impressions about their clients
(Leary & Miller, 1986), in order to decide on the most
effective counseling interventions (Strohmer & Shivy,
1994). However, as human beings counselors may not be able
to conduct this process fully value free (Katz, 1985). For
example, prior research has indicated that counselors form
impressions of their clients very quickly (Sandifer,
Horden, & Green, 1970) and thus may make inaccurate
assumptions and decisions based on easily identifiable
One such easily identifiable cue is gender. Deaux
(1976) suggested that counselors "have expectancies for the
behaviors of a . male or female which derive from
stereotyped assumptions" (p. 336). Testing this idea
researchers (e.g., Broverman, Broverman, Clarkson,
Rosenkrantz, & Vogel, 1970; Ciano-Boyce, Turner, & Turner,
1988; Hampton, Lambert, & Snell, 1986; Hare-Mustin, 1983;
Karasu, 1980; Kirshner & Johnston, 1983; Korner & Goldberg,
1996; Lemkau, 1983; LoPiccilo, Heiman, Hogan, & Roberts,
1985; O'Malley & Richardson, 1985; Russell, 1986) have
found that counselors' perceptions of a healthy woman and a
healthy man are different and that these judgments are in
sex-role traditional directions. Based on a recent series
of studies, Garb (1996) concluded that when differences in
counselors' perceptions of women and men occur in psycho-
diagnosis, they occur because of the counselor's beliefs,
and not because of base rates.
Knudson-Martin (1996) therefore suggests, that
counselors need to take an active approach in becoming
aware of their values and beliefs, and how they impact
their perceptions of women and men the therapeutic process
(Knudson-Martin, 1997; Knudson-Martin & Mahoney, 1996).
Both Fitzgerald and Nutt (1986) and the APA Ethical
Principles of Psychologists (1992) also strongly emphasize
the ethical responsibility of therapists for competent,
informed, nondiscriminatory, and respectful
treatment/research/theory along gender lines. If we fail to
look or ask, previous gender patterns will remain
unexamined and are likely to be reinforced (Knudson-Martin,
However, previous studies have found that most people
avoid dealing with gender issues, in general (Hochschild,
1989; Hood, 1983; Whitbourne & Ebmeyer, 1990; Zvonkovic,
Greaves, Schmeige, & Hall, 1996), and their impact on
counseling, specifically (Knudson-Martin, 1997, Margolin,
Talovic, Fernandez, & Onorato, 1983). For example, Van
Buren (1992) reported that gender issues are rarely
addressed in graduate training programs. Therefore, it may
be that gender-stereotypical patterns of perceiving women
and men, so ingrained by our social development, remain
unidentified or unchallenged (Stabb, Cox, & Harber, 1997).
This has the potential to harm the client (Tsui & Shultz,
1988), as counselors may unintentionally convey restrictive
notions about women's and men's roles (Hare-Mustin, 1983),
which wind up limiting, rather than expanding, the range of
behavior available to their clients (Shields, 1995).
Because of the potential for harm to a client most
researchers and clinicians agree that this is an area that
needs further study (Stabb et al., 1997). However,
counselors' perceptions of actual clients have been largely
unstudied (O'Donohue & Crouch, 1996). Instead researchers
have relied on analogue research (see Fischer, 1989, for an
exception) which assumes that the judgment processes used
by counselor participants are similar to what they would
use in a real-life counseling session. However, this
assumption may not be valid because counselor participants
may be more interested and invested in a real client than
in an experimental client (Strohmer & Shivy, 1994). The
extent to which a laboratory experiment resembles the
actual counseling process is an important consideration in
assessing the relevancy of the findings (Heppner,
Kivlighan, & Wampold, 1992). Consequently, these designs
may not be applicable to examining gender and counseling
In addition, these analogue studies have been plagued
by a number of methodological and conceptual problems
(Barak & Fisher, 1989; Lopez, Smith, Wolkenstein, &
Charlin, 1993). These problems include (a) unrepresentative
samples, (b) use of different and even inappropriate
measures across studies, and (c) covert, political, social,
or value agendas that lead to selective reviews of the
literature (Barak & Fisher, 1989). Similarly, the
understanding of gender issues in counseling has mostly
been limited by the researchers intending to focus on one
sex at a time, thus making it difficult to understand how
the sexes are different or alike in certain respects (Cook,
Therefore, while reviews of the literature (e.g.,
Lopez, 1989) have suggested that therapists might make
differential judgments of women and men in analogue
settings, one cannot be sure that counselors do, in fact,
perceive women and men differently in real life counseling
(Barak & Fisher, 1989). As a result, it may be important to
use counselors' perceptions of actual clients and to
reexamine the way researchers have been examining these
issues. Researchers may need to develop better ways to
conceptualize and measure counselors' perceptions of their
One of the ways to examine counselors' perceptions of
actual clients is the use of archival data such as
previously written intake assessments. Counselors'
judgments made about clients during the initial intake
interview have been found to influence the type and length
of services made available to clients and thereby affect
the outcomes of counseling (Tomlinson-Clarke & Cheatman,
1993). Furthermore, use of the archival intake assessments
has been suggested to be less artificial than analogue
research (Atkinson, 1985) and more ecologically valid
(Tomlinson-Clarke & Camilli, 1995). Archival data and
intake assessments, in particular, have also been cited as
a possible source of useful information for this type of
gender research (Stabb et al., 1997; Tomlinson-Clarke &
Therefore, the current study will use archived intake
assessments, written by counselors at a University
Counseling Center, to understand counselors' perceptions of
real clients. Further, in an effort to understand better
how the sexes are perceived as different or alike, the
present study will examine the intake assessment of both
women and men. This will allow for an understanding of how
counselors perceive both sexes.
In addition, there is a growing recognition in
psychology that qualitative methods are needed and are
appropriate for many types of research questions (e.g.,
Hoshmand, 1989; Jacob, 1987; Lincoln & Guba, 1985; Patton,
1990; Polkinghorne, 1991; Sprenkle, 1994). This recognition
in the field is largely based on the idea that the use of a
qualitative approach allows for new conceptualizations and
innovative ways to understand and assess the phenomena
involved (e.g., Patton, 1990; Polkinghorne, 1991).
Therefore, with questions still unanswered, in the
counseling literature, as to whether or not counselors'
perceptions of clients differ on the basis of gender, and
if so, in what ways, a qualitative approach may be well
suited to increase our understanding of these questions.
The results of a qualitative study of counselors'
perceptions of female and male clients could be helpful not
only in detecting possible differences in counselors'
perceptions of the genders but also allow a richer
understanding of which specific features are more or less
important in their perceptions.
As a result of the possible gains of using a
qualitative method in this area (e.g., Stabb et al., 1997),
the archival intake assessments will be analyzed using the
basic principles of grounded theory (Glaser & Strauss,
1967; Strauss, 1987; Strauss & Corbin, 1998). Grounded
theory (Glaser & Strauss, 1967; Strauss, 1987; Strauss &
Corbin, 1998) may be particularly useful, in this endeavor,
as it is especially designed for understanding the
complexity of social phenomena (e.g. Lark & Croteau, 1998;
Strauss, 1987) such as the task of trying to understand
counselors' perceptions of real clients. Grounded theory
will be used to answer two questions: (a) how counselors
perceive their clients, in general, and (b) and how
counselors perceive female and male clients, specifically.
REVIEW OF THE LITERATURE
The literature review is divided into five sections.
The first section gives a historical overview of the study
of counselors' perceptions of the genders. The second
section reports the research that has specifically focused
on counselors' perceptions of women. The third section
reports the research that has specifically focused on
counselors' perceptions of men. The fourth section gives an
overview of the process of doing a grounded theory
analysis. Finally, the last section gives a brief summary
of the research examining counselors' perceptions of women
and men in counseling and provides a rationale for the
Gender has been an important research topic in
counseling for the last 30 years (Nelson, 1993). At the
core of this literature is the belief that counselors'
judgments, behaviors, and treatment strategies may be
influenced by the deeply held views that they have about
women and men. In fact, initial studies suggested that
counselors perceived women and men differently and that
these differences had negative affects for their clients,
in particular, women (e.g., Abramowitz, Abramowitz,
Jackson, & Gomes, 1973; APA Task Force, 1975). Researchers
suggested that the different perceptions of what was proper
behavior for women and men led to negative effects for
women through the subtle rewarding of women's passive
behaviors and punishing of their assertive behaviors (e.g.,
One of the most influential studies in the field was
conducted by Broverman et al. (1970). Broverman and
colleagues (1970) developed a measure to assess counselors'
clinical judgments. Their results showed that not only were
counselors' perceptions of a healthy woman and a healthy
man different but that these judgments were in sex-role
stereotypic directions. The Broverman and colleagues'
(1970) results spurred a lot of research on this topic
which initially supported their findings (e.g., Abramowitz
& Abramowitz, 1977; Delk, 1977). For example, Bowman (1982)
found that clinicians developed treatment plans that were
different for women and men and that showed bias against
women acting in ways inconsistent with sex-role stereotypic
notions. These findings led researchers to suggested that
there is a need for counselors to counterbalance society's
messages about gender, but that they currently do not
However, by the 1980s these initial studies were
coming under fire by several investigators who claimed that
the findings no longer supported the conclusion that
counselors' perceptions of women and men were different
(e.g., Davidson & Abramowitz, 1980; Whiteley, 1979). In
particular, studies did not always confirm that counselors
differed in their perceptions of women and men (Oaks,
1984). For example, Farmer (1983) found no differences in
counselors' perceptions of women and men. Further, studies
such as that conducted by Smith (1980) found that
clinicians did not prescribe different treatments to women
In addition, influential studies such as the Broverman
et al. (1970) study were starting to be criticized for
methodological limitations (e.g., Gove, 1980; Phillips &
Gilroy, 1985; Stearns, Penner, & Kimmel, 1980; Stricker,
1977; 1980) such as that it was an analogue study (e.g.,
Smith, 1980) and that it used an unbalanced ratio of male-
valued and female-valued items (e.g., Widiger & Settle,
1987). Other conceptual and methodological problems were
also identified in most of the studies that found
differences such as (a) overuse of analogue research; (b)
unrepresentative samples; (c) use of different and even
inappropriate measures across studies; and (d) covert,
political, social, or value agendas that lead to selective
reviews of the literature (Barak & Fisher, 1989; Betz &
Fitzgerald, 1987; Fisher & Barak, 1989; Lopez et al., 1993;
Phillips & Gilroy, 1985).
These concerns continue to generate controversy,
research, and contradictory results (Stabb et al., 1997),
because despite the problems, most of the studies that have
continued to examine these issues have found differences in
counselors' perceptions or treatment of women and men
(e.g., Nelson, 1993; Nutt, 1992). For example, O'Malley and
Richardson (1985) used a modified version of the original
Broverman et al. (1970) scale and still found differences
in what healthy behaviors were associated with women and
men. Other studies also addressing some of the
methodological problems of the Broverman et al. (1970)
study have found that ratings of what is healthy behavior
for a woman and a man differ in sex-role stereotypic
directions (e.g., Ciano-Boyce, Turner, & Turner, 1988).
Researchers have also shown that individuals who do not
conform to these sex-role stereotypes are rated as more
pathological than those who do conform (e.g., Fisher, 1989;
Counselors and clinicians have also been found to
exhibit diagnostic biases (e.g., Becker & Lamb, 1995;
Caplan, 1992; Garb, 1997). For example, Becker, Dana, and
Lamb (1994) found that in a case with an equal number of
criteria for both borderline personality disorder and post-
traumatic stress disorder female clients were more likely
to be given the diagnosis of borderline personality
disorder and male client the diagnosis of post-traumatic
stress disorder. Ford and Widiger (1989), controlling for
base rates of the diagnosis, also found that women were
more likely to get a diagnosis of histrionic personality
disorder and men a diagnosis of antisocial personality
disorder. A finding also found by Hamilton, Rothbart, and
Dawes, (1986) and Kass, Spitzer, and Williams (1983).
Wakefield (1987) also found sex differences in the
diagnosis of orgasmic dysfunction.
Still other studies have continued to show differences
in the actual treatment of women and men. For example,
Kirshner and Johnson (1983) found differences in the
criteria used in deciding whether or not a woman or a man
should be admitted or discharged from a hospital setting.
Stein, Del Gaudio, and Ansley (1976) found that counselors
prescribed different medication to women and men in
therapy. Hardy and Johnson (1992) also found that female
clients were seen as needing more sessions than male
clients dealing with the same issues.
However, the recognition of these issues has not
necessarily changed how we train counselors as Twohey
(1992) found several instances of gender bias in an
analysis of a transcript of a widely used training tape.
Consistent with this, when researchers have focused on
possible reasons for why differences in counselors'
perceptions and judgments exist they have found they are
largely based on the counselors' stereotypic beliefs. For
example, Garb (1996) showed that, when gender bias occurred
in clinicians' judgments, it was because of the clinicians'
stereotypes and not because of their paying attention to
differences in base rates. Korner and Golberg (1996) also
found that differential judgments in regard to gender were
affected by the counselors' personal beliefs such as their
specific theoretical orientation.
Therefore, while problems in the literature clearly
exist, it may, in fact, be the controversial and
contradictory results that have continued to spur the
research into this area. Most of this research on
counselors' perception of women and men in counseling has
focused on the concern that they may not be treated fairly
(Chesler, 1972; Fabrikant, 1974) and the need for
counselors to understand when and how this happens. This
research has not always confirmed the presence of
differences in counselors' perceptions of women and men
(e.g., Cummings, 1990; Farmer, 1983; Funtowicz & Widiger,
1995; Garb, 1995; Gilbertson, 1992; Widiger & Spitzer,
1991) but reviews of the literature (e.g., Lopez, 1989;
Garb, 1996) have generally concluded that these perception
differences do exist and have been suggested to lead to
misdiagnosis, improper treatment, and even exacerbation of
client's problems (e.g., Darley & Gross, 1983).
Perceptions of Women in Counseling
Historically, much of the research examining
counselors' perceptions of their clients has focused on
counselors' views of women and the impact that negative or
stereotypical beliefs have for women (e.g., Gilbert, 1992;
Nelson, 1993; Nutt, 1992). Early studies of counselors'
perceptions of women suggested that counselors perpetuated
negative sex-role stereotypes and devalued women for their
attempts to transcend those stereotypes (e.g., Chesler,
1972; Tennov, 1975). For example, several studies (Beyard-
Tyler & Haring, 1981; Haring & Beyard-Taylor, 1984; Haring,
Beyard-Tyler, & Gray, 1983; Marini & Brinton, 1984)
revealed that counselors' views of appropriate career
choices for women were sex-role stereotypical and that
counselors' attitudes were a possible barrier for women
considering nontraditional career choices.
Early studies also revealed differential treatment of
women and men in counseling situations. For example, women
received more prescriptions for psychotropic medications
and were seen for more therapy sessions than men (Stein et
al., 1976). In 1975, the American Psychological Association
(APA) Task Force concluded that, despite the advances of
feminism, there were still four areas in which women
continued to be slighted by the professions of psychology:
(a) counselors fostering traditional sex roles; (b)
counselors devaluing women; (c) over-reliance on sexist
psychoanalytic concepts; and (d) sexual seduction of female
clients. Hare-Mustin (1983) suggested that the differences
assigned to women reflect the views of society at large.
Therefore, as part of the society, counselors may
unintentionally convey restrictive notions about women,
women's roles, and women's abilities.
Studies, conducted since 1975, continue to indicate
that stereotyping, diagnostic and treatment biases, and
sexism are prevalent issues (Nelson, 1993; Nutt, 1992). For
example, Bowman (1982) demonstrated a counselor bias
against "active" women, that is a bias against women who
engaged in activities outside of their marital
relationships. Teri (1982) demonstrated that counselors
expected females to be more amenable to therapy. In
addition, Stabb, Cox, and Harber (1997) suggested that
counselors overpathologize women, as they discovered that
counselors made more stable and more global attributions to
women for any negative relationship event. Lopez (1989)
found that counselors ascribe more internality to women's
presenting problems, and both Deaux (1976) and Lopez (1989)
found that negative events are seen as more stable and
internal for women, whereas positive events were seen as
less stable and less internal for women.
In sum, although studies do not always confirm that
counselors perceive women differently, most of the research
examining counselors' perceptions of their clients has
found that counselors do view women in less positive ways.
Studies have found counselors perceive women as different
in relation to the number and types of pathology assigned,
the types and likelihood of successful treatment, and what
constitutes healthy behavior for a woman. Over the years,
these findings have continued to lead researchers to focus
on this area of study, in an effort to try to insure that
women are not limited or harmed by these beliefs.
Perceptions of Men in Counseling
In contrast to the examination of the impact of
counselors' perceptions on women, only recently have
counselors' perceptions of men been examined. Initially,
counselors' views of men were simply incidental in studies
examining women (Beere & King, 1980). However, recently
studies are directly assessing men in counseling (e.g.,
Levant & Pollack, 1995). For example, Lopez (1989) reported
that counselors ascribe more situational triggers to men's
presenting problems. Ford and Widiger (1989) demonstrated
that males are diagnosed with antisocial personality
disorder more often than women. Heatherington, Stets, and
Mazzarella (1986) demonstrated that counselors rated males
worse than females on measures of interpersonal competence
and social skills during psychotherapy.
In addition, McPhee (1993) noted that men face a more
restrictive, demanding set of mental health standards, and
concluded that males are generally judged more severely
than females. For example, Fling and Manosevitz (1972)
found that gender-inappropriate behaviors evoked greater
concern when exhibited by boys than by girls. Similarly,
Costrich, Feinstein, Kidder, Marcek, and Pascal (1975)
found that sex-role incongruent men (i.e., men who engaged
in behaviors inconsistent with traditionally masculine
roles) were rated as less popular and more in need of
psychotherapy. Silverberg (1986) also indicated that sex-
role incongruent behaviors are punished more severely for
In a direct test of these findings with counselors,
Fitzgerald and Cherpas (1985) reported that the counselors-
in-training demonstrated negative reactions to a male
target who acted nontraditionally. Furthermore, Robertson
and Fitzgerald (1990) demonstrated that counselors and
therapists, with several years of experience, viewed male
clients who deviated from stereotypical male occupational
roles as suffering from depression more than men in
stereotypical male occupations. Similarly, Seem and Johnson
(1998) found that counselors displayed gender biases
towards male clients who displayed nontraditional sex-role
behavior. O'Neil, Good, and Holmes (1995) in a review of a
decade and a half of research, indicated that counselors'
negative reactions to men when they diverge from
traditional male gender roles may wind up reinforcing these
traditional roles and thus limiting men's behavioral
repertoires (e.g., Brooks, 1991; Deinhart & Avis, 1994;
Margolin et al., 1983).
In sum, studies directly examining counselors views of
male clients have focused on whether or not counselors buy
into the view of men as needing to act traditionally
masculine. These studies have found that when men diverge
from traditional roles they are evaluated more negatively
and seen as more pathological than women who diverge from
traditional roles. Therefore, similar to the findings for
women, researchers have demonstrated that counselors hold
traditional views of men that affect how they understand,
evaluate, and behave towards their male clients.
Grounded Theory Overview
Grounded theory (Glaser & Strauss, 1967; Strauss,
1987; Strauss & Corbin, 1998) is a qualitative approach to
coding a set of transcripts or archival records. It
involves repeated reading and categorizing of the data, in
order to discover the intricacies of what lies within the
data (Strauss, 1987). Because it entails a series of
specific methodological steps that force an analyst to
hypothesize about specific points in the data (i.e., a word
or line) and constantly compare these developing ideas to
other instances in the data (i.e., the meaning of other
words and lines), the categories that ultimately develop
are thought to be grounded in, or based closely on, the
data. Further, the developed categories, because of their
close link to the data, best represent the complexity of
the social phenomena being examined (Strauss, 1987, Strauss
& Corbin, 1998).
The coding process involves a micro-level examination
of each point in the data (i.e., a word or a line) for
indicators of larger concepts. The analyst then 'codes'
these concepts, naming and classifying them according to
their possible meanings. The analyst, further, compares
these named concepts with other points in the data in order
to try to recognize similarities, differences, and degrees
of consistency of meaning among the data and the developing
concepts. This process of examining similarities,
differences, and degrees of consistency ultimately
generates uniformity in the concepts, which results in an
identified and named category and related dimensions or
themes. However, even these categories, once generated, are
further compared to the data allowing for them to be
changed or modified. Thus, these categories are at first
provisional and can be altered as they become more grounded
in the data. The coding process continues until the
categories and associated themes are sharpened to achieve
the best fit of the data (i.e., the reading and
modifications continues until no new information is
gathered from the data).
Specifically, the coding process happens through three
overlapping steps: (1) open coding, (2) axial coding, and
(3) selective coding.
Open coding. This initial type of coding is where the
data are scrutinized line by line or word by word. The aim
is to produce concepts that seem to fit the data by opening
up the inquiry and exploring as many possible concepts as
one can. Therefore, the emerging concepts are provisional.
The concern about the 'true' meaning of a line or about the
'real' motives of the counselor is entirely irrelevant
(Strauss, 1987). Whatever is wrong in interpreting the
lines and words will eventually be fixed through later
steps in the coding (Strauss, 1987). As such, the initial
concepts and categories are going to be quite crude and in
need of modification.
Axial coding. The second step in the coding process
consists of intense analysis, one-at-a-time analysis of the
developing categories. This results in increasing knowledge
about the particular category and its relationship with the
data. This is done by first writing down the known
properties or characteristics of the emerging category.
Second, by increasingly specifying the incidents in the
data that are associated with the category and where they
fit and do not fit the generated characteristics of the
category. Further refinement of the category is achieved by
continuing to hypothesize about other possible
characteristics and properties that may describe the
developing category and associated themes in an effort to
best represent the data.
Selective coding. The third non-independent step of
the coding process allows for a systematic and concerted
analysis of a core category or categories. "The other
categories become subservient to the key category under
focus. To code selectively, then, means that the analyst
delimits coding to only those codes that relate to the core
category in sufficiently significant ways as to be used in
a parsimonious theory" (Strauss, 1987, p. 33). While
constantly comparing incidents and concepts, the analyst
will generate many categories and related concepts and
themes, he or she needs to be alert to the one or two that
might be the core (Strauss, 1987). To be a core category
the code 1) must be central, that is related to as many
other categories and themes as possible 2) must appear
frequently in the data 3) should relate easily to other
categories and themes 4) should have clear implications for
a more general theory 5) should as the details of the core
category are worked out, move the theory forward and 6)
should allow for building in the maximum variation to the
analysis (Strauss, 1987).
In all, these three steps involve a systematic method
for conducting a detailed analysis of a set of written
data. It entails repeated close readings of the data while
continually comparing what one finds with the data to
uncover how the data are linked. As Strauss (1987) put it
the process of grounded theory relies on the importance of
doing "a detailed, intensive, microscopic examination of
the data in order to bring out the amazing complexities of
what lies in, behind, and beyond those data" (Strauss,
1987, p. 10).
In all, studies examining counselors' perceptions of
female and male clients have focused on the possibility
that these perceptions are influenced by the deeply held
views that they have about women and men. The majority of
studies in this area suggest that counselors do in fact
perceive women and men differently and that these
differences had negative affects for their clients.
However, studies do not always confirm these results, and
the debate continues to be argued on both sides.
The major criticism of the studies finding differences
in counselors' perceptions of the genders is the overuse of
analogue studies. The use of analogue studies has relied on
the assumption that the judgment processes used by
counselor participants in the study are similar to what
they would use in a real-life counseling session. However,
this assumption may not be valid because counselor
participants may be more interested and invested in a real
client than in an experimental client (Strohmer & Shivy,
1994). The extent to which a laboratory experiment
resembles the actual counseling process is also an
important consideration in assessing the relevancy of the
findings (Heppner, Kivlighan, & Wampold, 1992).
Consequently, these designs may not be applicable to
examining gender and counseling issues.
As a result, with questions still unanswered as to
whether or not counselors' perceptions of clients differ on
the basis of gender, and if so, in what ways, a qualitative
approach may be well suited to increase our understanding
these questions. The results of a qualitative study of
counselors' perceptions of female and male clients could be
helpful not only in detecting possible differences in
counselors' perceptions of the genders but also allow for a
richer understanding of which specific features are more or
less important in their perceptions.
Hence, the purpose of this study is to use a
qualitative approach to investigate counselors' perceptions
of actual clients. The basic principals of Grounded Theory
(Glaser & Strauss, 1967; Strauss, 1987; Strauss & Corbin,
1998) will be used to answer two questions: (a) how
counselors perceive their clients, in general; and (b) and
how counselors perceive female and male clients,
specifically. Grounded Theory (Glaser & Strauss, 1967;
Strauss, 1987; Strauss & Corbin, 1998) may be particularly
useful, in this endeavor, as it is especially designed for
understanding the complexity of social phenomena (e.g. Lark
& Croteau, 1998; Strauss, 1987) such as the task of trying
to understand counselors' perceptions of real clients.
This study used archival data taken from intake
assessments written by counselors at a University
Counseling Center. A total of 59 intake assessments were
randomly sampled from a semester in the university
counseling centers closed files. Forty-one of the intake
counselors were female and twenty-eight were males. Thirty-
six of the intake assessments were written about female
clients and twenty-three of the intake assessments were
written about male clients. No additional demographic data
were collected in an effort to protect the client's
Qualitative researchers are the primary instrument of
data analysis (Lark & Croteau, 1998). As a result it is
important for them to have "theoretical sensitivity"
(Strauss & Corbin, 1998) which involves the researcher
having the "attributes of insight, the ability to give
meaning to the data, and the capacity to . separate
what is pertinent from that which isn't" (p. 41). Strauss
and Corbin (1998) suggested that "theoretical sensitivity"
is developed through personal experience, professional
experience, and familiarity with the literature. My
personal and professional experience with gender issues is
as a 28-year old Caucasian, male. I am currently working on
my doctorate in counseling psychology and this research is
my doctoral dissertation. My familiarity with the
literature is based on publishing three papers on the topic
and currently collaborating on a literature review of
gender and counseling issues.
Lark and Croteau (1998) also suggest it is important
to declare preexisting assumptions if one is to be able to
use one's experiences and knowledge to develop "theoretical
sensitivity." Prior to data analysis, I thought that
counselors would attempt to be gender neutral in their
perceptions of women and men but that socialized views
would emerge in stereotypical or traditional gender-role
A counseling center staff member collected and edited
the intake assessments so that all identifying information
was removed prior to being seen by the researchers. The
archival records used in this investigation were only seen
by this counseling center staff member, the principal
investigator, and his supervisor. All data were kept within
the counseling center.
To help ensure that the counselors' perceptions of
female and male clients were not confounded by the gender
of the client, the female and male intake assessments were
coded separately. In addition, while most intake
assessments could not be distinguished between female and
male intakes (i.e., with the identifying information
removed), it was possible after reading several cases to
detect female intakes from male intakes. As a result,
before coding began a third group of intake assessments
were separated from the female and male intakes. In this
group it was impossible to detect the clients' gender on
any of the intakes. This third group allowed for the
principal investigator to examine for possible biases in
the coding process by comparing the results of this third
group with the other two. These three groups (female
intakes, n = 36; and male intakes, n = 19; unknown intakes,
n = 15) were separately coded.
The intake assessments were analyzed according to the
basic principles of grounded theory (Glaser & Strauss,
1967; Strauss, 1987; Strauss & Corbin, 1998). The process
of grounded theory (Glaser & Strauss, 1967; Strauss, 1987;
Strauss & Corbin, 1998) relies on the importance of doing a
detailed, intensive, microscopic examination of the data in
order to bring out the complexities of what lies within.
This involves repeated reading and coding of the
assessments "to discover theory from data through the
general method of constant comparison" (p. 1).
Specifically, the coding process happens through three
overlapping steps: (1) open coding; (2) axial coding; and
(3) selective coding.
Open Coding. This initial step in the coding process
was conducted by the principal investigator through a close
scrutinizing of the data, word by word and line by line, to
produce concepts, hypothesis, and ideas that seem to fit
the data. Each word in the data was written down and
possible meanings, hypotheses, and concepts were written
down next to the word. These concepts were tentative with
"the aim of the coding [at this point] to open up the
inquiry" (Strauss, 1987, p. 28) and to generate as many
ideas as possible. An example of this procedure is the use
of the words "is warm." These words were hypothesized to
represent the counselors' liking of the client and an
ability to connect with him/her. In addition, the words may
show a desire, by the counselor, to express positive
characteristics about this client. Building on these ideas
this counselor then said this client has "a variety of
interests." This description seems to continue the positive
description of the client. It also may express some of the
strengths of this client. S/he does not just have one side
to her/his personality. In both of these cases, the
counselor may be describing characteristics that will help
the client have a positive outcome to therapy (see Appendix
A for examples of this open coding procedure).
Most important at this point in the coding is the
generation of hypotheses, the concern "about the 'true'
meaning of a line -- or about the 'real' motives of the
[counselor] . lying behind the scrutinized line .
is entirely irrelevant" (Strauss, 1987, p. 28). Whatever is
wrong in interpreting the lines and words is eventually
fixed during the later steps in the coding process
(Strauss, 1987). As such, the initial concepts and
categories are quite crude and in need of modification.
Axial coding. As open coding continues consistent
themes or categories emerge. The second step in the coding
process consisted of a further and more intense one-at-a-
time examination of these developing categories. This
results in greater knowledge about each of the categories
and its relationships with other categories and themes.
This was done, by continuing to compare the emerging
category with each incident in the data and further
hypothesizing about and increasingly specifying the
characteristics and properties associated with the
appearance of the category (Strauss, 1987). With one
category in mind the word(s) and related concepts written
down during open coding were reread with the purpose of
better understanding and altering the category to fit what
is actually present in the data. These emerging categories
were written down on note cards with examples from the data
of the words that represented them. These examples from the
data reflected the different characteristics and dimensions
of the category.
This process led to preliminary descriptions of the
main categories and how they are related to the data. For
example, the category described in open coding of the
counselors' desire to express positive characteristics
about their clients was modified to reflect the fact that
the counselors also described negative characteristics
about their clients (i.e., trust lacking, awkward,
guarded). Therefore, the broader category may reflect the
counselors desire to report on the characteristics that
will help or hinder the building of rapport and/or the
outcome of therapy and these can be either positive or
negative characteristics (see Appendix B for examples of
the categories developed during axial coding).
In addition, to help lesson the possibility of bias in
this coding procedure, independent descriptions of portions
of the data were developed by a peer reviewer and compared
with those developed by the principal investigator. Changes
and new possibilities were combined with the preliminary
descriptions of the principal investigator based on this
peer audit (Lark & Croteau, 1998). In this way, the
categories were continually refined, through comparison
with the data and peer review, until no new information
Selective coding. The third, non-independent step, in
the coding process consisted of a systematic and concerted
analysis of 'core categories.' "The analyst should
consciously look for a core variable when coding data.
While constantly comparing incidents and concepts, he or
she will generate many codes, being alert to the one or two
that might be the core" (Strauss, 1987, pp. 33-35). During
the process of developing categories, linkages between them
will become apparent. The goal of selective coding is to
directly compare possible connections between the
categories in order to develop a core category that best
accounts for these connections.
This process was conducted by selectively comparing a
category and its characteristics and dimensions, written
down on the note cards, with every other category and its
characteristics and dimensions. For example, the category
previously described, under open and axial coding, of the
counselors' descriptions of the positive and negative
characteristics of a client, seemed to be related to
another developing category that included the counselors'
descriptions of clients' behaviors that were positively or
negatively impacting on his/her current functioning.
Therefore, at this point in the coding process, a tentative
larger category was postulated, that included both
categories. This new larger category was, then, compared
with other categories to try to understand if it could
further describe other linkages between the categories. The
building of larger categories that best organized and
described the linkages between categories led to two
consistent core categories.
The three groups of intakes (female intakes, male
intakes, and unknown intakes) were each analyzed,
separately, according the basic principles of grounded
theory (Glaser & Strauss, 1967; Strauss, 1987; Strauss &
Corbin, 1998). Overall, across the three groups, there was
remarkable consistency in the intake counselors'
descriptions of their clients. In particular, two
consistent core categories emerged that best organized and
described the results for each of the groups: (a) the
intake counselors' attempts to describe their clients and
(b) the intake counselors' descriptions of what counseling,
or the counseling relationship, is like.
The two core categories were comprised several related
categories or themes that were also consistent across the
three groups. In particular, the intake counselors'
attempts to describe their clients included five consistent
themes: (a) the characteristics of a client that will
increase/decrease the likelihood of a positive outcome to
therapy; (b) the issues the client is dealing with; (c) the
degree of social support the client receives; (d) the
client's feelings and experiences; and (e) the client's
behaviors that are currently helping or impeding his/her
growth. The intake counselors' descriptions of what
counseling or the counseling relationship is like included
three consistent themes: (a) therapy entailing both a
professional and therapeutic relationship; (b) a need to
help the client change and grow; and (c) a need to discover
Therefore, because of the large overlap between the
groups, in the first section below, the intake counselor's
perceptions of their clients across the three groups, will
be reported together. Specifically, the two core categories
and their associated themes will be described. In the
second section, in order to better understand the
counselors' perceptions of female and male clients,
specifically, these two groups will be compared and the
differences found between the counselors' descriptions of
female and male intakes will be reported.
Counselors' Perceptions of Their Clients
Two consistent core categories emerged that best
organized and described the results in each of the three
groups examined: (a) the intake counselors' attempts to
describe their clients and (b) the intake counselors'
descriptions of what counseling, or the counseling
relationship, is like.
The intake counselors' attempts to describe their
clients. Five main themes emerged that were related to the
counselors' attempts to describe their clients. The first
main theme that emerged was descriptions of the
characteristics of a client that will increase/decrease the
likelihood of a positive outcome to therapy. This theme can
be identified in the counselors' statements such as "will
be a great client" and "conducive candidate for therapy."
Additionally, the most predominant feature of this theme is
the counselors' descriptions of client characteristics that
would help or positively impact therapy (e.g., "verbal,"
"open," "talkative," "bright," "motivated to seek help,"
"likable," "insightful," "excited about change," "ready to
talk about themselves," "forthright," "animated," and
"responds readily to questions") and client characteristics
that would interfere with or negatively impact therapy
(e.g., "resistant to processing," "not interested in
change," "limited insight," "awkward," "challenging,"
"guarded," "reserved," "did not elaborate on responses,"
"did not answer questions," "reluctant to get into issues,"
"evasive," "hesitant," "gives mixed messages," "minimal
information given"). In all, positive characteristics were
those that showed a willingness to change and/or a
willingness to be open and truthful. Negative
characteristics were those that showed no willingness to be
open or no willingness, on the part of client, to exploring
A second main theme that emerged from the data was the
counselors' description of the issues that their clients
are experiencing. Counselors almost always stated the focal
issue(s) and how they impact the client's current
functioning. Common issues were relationships, loss,
developmental, identity, family of origin, eating,
adjustment, math/school, and self-esteem issues. Counselors
also reported possible causes (e.g., "family dysfunction,"
"lack of support," "expectations/pressure," "learned
messages," "traumatic history," and "medication") of the
client's issues as well as the consequences of the issue on
the client (e.g., "unhappiness," "low self-confidence,"
"worry," "anxiety," and "depression"). Furthermore,
counselors reported the severity and degree of disturbance
to the client's functioning. When warranted, the counselors
did note the presence of psychopathology but they usually
tried to downplay such statements with qualifiers and to
refer the client to a psychiatrist for any official
diagnosis of psychopathology.
Following this tone of qualifying severe issues, the
counselors mostly saw the issues the clients were dealing
with as normal or developmental issues that were hard for
the client to face (e.g., "conflicts," "struggles," "things
they were wrestling with," or "fighting with"). These
issues were often described as roadblocks that limited the
client's current functioning, but that were treatable
(e.g., "can be helped"). The counselors did, however, often
view the issues as having come from "longer-existing"
problems that had been "exacerbated by current issues." For
example, some counselors said statements like "chronic
struggles," "exacerbated by current situation," "pattern
has continued," "routed in early development," "brought to
the fore by current situation," and "enduring circumstances
which may have been exacerbated by being in a new
A third main theme that emerged from the data was the
counselors' description of the client's social support
system. Counselors noted the importance of clients having
others with whom they can talk to and depend on. For
example the counselors made statements like: "misses having
someone to talk to," "receiving support from friends," and
"isolated from social support." The counselors noted that a
lack of social support can lead to increased problems
through statements like: "lack of social support
exacerbates problems" and "erode if does not find relief
from isolation." They also implied the clients should take
advantage of their support system and reported the
likelihood that a client will use his/her support system.
Statement supporting this idea were: "[the client] actively
uses," "[the client] refrains from using," and "[the client
has social support] but unwilling to use in times of
A fourth main theme that emerged from the data was the
counselors' descriptions of their client's feelings and
experiences. Counselors reported the degree of affect
expressed, as well as noting specific emotions the client
expressed (e.g., "anxious," "worried," "sad," "guilt,"
"anger," "excitement," "unhappiness," "embarrassed,"
"lonely," "disappointed," "upset"). In reporting the degree
of affect counselors would notice when the clients held
back emotion and when they expressed it. For example, they
would write "affect was fairly broad," "depth of emotion
and feeling," "did not display much affect," and "flattened
affect." In noticing the degree of emotional expression the
counselors also seemed to imply that the clients should
express a certain amount of emotion or that being open
about their feelings was good. For example, the counselors
made statements like "appropriate affect," "should be a
range of affect," and "appropriate to content."
Finally, the fifth main theme that emerged from the
data was the counselors' description of their client's
behaviors that were helping him/her cope with his/her
situation or impeding his/her growth. These statements
appeared to be attempts to describe how the client tries to
deal with his/her situation and whether or not his/her
attempts are successful or not. Descriptions of the
client's successful attempts were often written as client
strengths such as "capacity to handle stress," "excellent
social skills," "a survivor," "good ego strength,"
"mature," and "smart." In turn, examples of statements of
how the client hinders his/her growth were "overly high
expectations of self," "self-critical," "not trying,"
"ambivalence about putting forth effort," "hides problem,"
"trouble engaging other," and "learned to settle for less."
Interestingly, this distinction set up an implied
distinction between the appropriateness or
inappropriateness of the client's behaviors. Some
counselors even made direct evaluative statements about the
client's behaviors such as "good," "bad," "right," "wrong,"
"appropriate," or "inappropriate." Some also suggested
appropriateness through statements such as "the client
should be doing," "the client will have to," or "the client
is on right track."
The intake counselors' descriptions of what
counseling, or the counseling relationship, is like. There
were three main themes that emerged that relate to the
counselors' descriptions of what counseling or the
counseling relationship is like. The first main theme was
that therapy entails both a professional and therapeutic
relationship. This combination of these two ideas suggested
that the counselor and client needed to be close but not
too close (e.g., "their needed to be some distance", "some
limits on the relationship").
The professional part of the relationship could be
seen in the counselors' formality in their statements
(e.g., use of the word client as opposed to a name or
initials), in their statements about the rules, limits, or
facts of counseling (e.g., "closed folder," "scheduled,"
"referred to," "signed release," "was informed," "will put
on wait-list"), in their stating the client's desires
(e.g., "client wants," "interested in continuing,"
"mutually desire," "a preference for"), and in their
stating their recommendations for the client (e.g.,
"suggest," "recommend," "would benefit from," "could
especially profit from," "was advised"). These different
types of statements all reflected the counselors' desire to
keep some objectivity and to be able to have the focus of
the interaction be always on the client.
In turn, the therapeutic part of the relationship
could be seen in the counselors' descriptions of the need
to establish rapport (e.g., "connected well with client,"
"established open relationship," "need a counseling
relationship," "desires to have a relationship," "to
facilitate a consistent and trusting relationship"), in the
need to have the client's agreement to the process (e.g.,
"client agreed to participate," "need their cooperation,"
"need to be hooked into therapy," "client contracted"), in
the need to support the client (e.g., "need comfort,"
"receive positive social support," "as felt supported"),
and in recognizing that forming the relationship between
the counselor and client is not always an easy process
(e.g., "relationship may not always be easy," "some
tension," "anxiety," "nervousness," "became more
comfortable as session progressed"). Sometimes these
statements about the difficulty of forming a relationship
did not directly refer to the relationship, but instead
focused on how difficult it was to just "come to the center
and ask for help." However, in all, these statements
reflected the counselors' beliefs that effective therapy
was dependent on being able to move past the initial
discomfort and build a trusting, supportive, open, and
cooperative relationship with the client.
The second main theme that emerged was the counselors'
desire to help the client change and grow. This growth
entailed a need for the client to gain insight, a need to
empower the client, and a need to help the client work
through any ambivalence. The need for insight can be seen
in such statements as "gain insight," "explore feelings and
dynamics," "had some insight into," "not aware," and "gain
some understanding." The need to empower the client can be
seen in such examples as "increasing sense of autonomy,"
"provided support for taking big steps," "learn to set
goals," and "give support for whatever decisions makes."
Finally, the need to help the client work through any
ambivalent feelings they have towards change can be seen
through the counselors' use of statements such as "need to
work through ambivalence," "draw-out so can self-disclose,"
"need to keep client on track," and "work through barriers
to further growth."
These three ideas, namely a need for the client to
gain insight, a need to empower the client, and a need to
help the client work through any ambivalence, all reflect
the counselors' desire to help their clients grow and
develop in positive directions. They also portray the
notion that they see this growth as at least partly
dependent on their "helping," "teaching," "directing," or
"facilitating" this development. Building on this idea, the
counselors also refer to their needing to possess the
ability and experience to help or work with the client
effectively. For example, the counselors reported a need to
"be comfortable with the issues" the client is facing, and
that at times it can "be hard for the counselor," or even
that the "counselor was unable" to meet the clients needs.
Finally, the third main theme that emerged was the
counselors' implied statements that one important feature
of counseling is the need to look for what is hidden or
what is not said. For example the counselors would write
statements such as "hard to pin down," "more information
needs to be gathered to ascertain whether or not the client
has," "beneath the surface," "if in fact," and "could be."
In addition, the counselors would rarely say that something
was for sure one way or another. Instead they would often
use qualifiers such as "appears to be," "may be," "although
not sure," "seems to be," "tended to be," "probably," "I
question," and "could be." Furthermore the counselors would
distinguish between what they had seen in session (e.g.,
"manner of presentation," "readily apparent," "during
intake") and what the client reports to be true but the
counselor has not seen to verify (e.g., "client says,"
client claims," "client indicated that," "reportedly").
These statements all suggest that counselors need to
uncover the real reason why the client is coming to
therapy. The truth may not be expressed right away and the
counselor may be "surprised" or something "unexpected" may
Perceptions of Female and Male Clients
In order to understand the counselors' perceptions of
female and male clients, the descriptions of these two
groups were compared. First and foremost, it was clear that
the counselors' perceptions were for the most part similar
for their female and male clients. While a few differences
emerged from the descriptions, these differences were more
a matter of degree than kind. No category or theme emerged
from the counselors' data that described one gender but not
the other gender. Instead, what differed was the degree of
emphasis, attention, or amount of time spent describing
certain aspects for female vs. male clients. However
overall, the intake interviews revealed very similar
categories and themes for women and men. In this section,
the differences in emphasis between the genders will be
Differences. Two themes emerged for the female clients
and two themes emerged for the male clients that were not
as strongly emphasized for the other gender. For the female
clients the themes of "vulnerability" and "paying attention
to how much the client asserts [herself] were more
pronounced than for the male clients. For the male clients
the themes of "being stuck" and "paying attention to how
much the client is connected to others" were more
pronounced than for female clients.
The theme of vulnerability can be seen in the
increased number of words used to describe the female
clients such as "feeling overwhelmed," "desperate," "hurt,"
"feeling inferior," "insecure," "premature," "need a safe
place," "self as vulnerable," and "feels vulnerable." In
addition, some counselors implied ideas such as the female
client were "younger" and thus needed to be taken care of.
In turn, the male clients were more often described as
being stuck or not having the ability to change things.
Examples of this idea were "if doesn't learn may not
continue," and "[he is] stuck because [he has] not learned
to." This idea can also be seen in examples of male
clients' need to keep control of themselves: "something had
under control," "balance lifestyle with emotions under
control," and "not be okay to let it go." Taken together,
these two themes seem to suggest that there was a tendency
to see female clients as emotionally vulnerable and needing
help, while seeing male clients as deficient in ability or
self-control and needing to learn how to handle the
The theme of paying attention to how much the client
asserts herself can first be seen in the counselors'
tendency to use words that described female clients as
being unassertive (e.g., "passivity," "dependent,"
"reluctant," "denial," "avoidance"). The theme can also be
seen in the counselors noticing of how comfortable the
female client was in asserting her needs in the counseling
session. This idea can be seen in examples such as "felt
uncomfortable and unsure," "pacing will be important,"
"became more comfortable as the session progressed," and
Finally, the theme of paying attention to how much the
male clients are able to connect to others can be seen in
the counselors' use of the word "difficulty" in describing
the social skills of male clients. The counselors used the
difficulty 17 times to describe male clients and only twice
to describe female clients. Examples of the counselors' use
of the word difficulty include "difficulty to contain
anger," "rapport was difficult," "has difficulty engaging
others socially," "difficulty putting words together to
express self," "difficulty speaking," and "difficulty in
interpersonally relating." Furthermore, the counselors
spent a lot more time writing about whether or not they
were able to establish a therapeutic relationship with
their male clients than their female clients (e.g.,
"difficult to establish contact," "it is unlikely will
engage in therapeutic relationship," "will likely engage,"
and "rapport developed quickly").
The current study investigated two questions: (a) how
counselors perceive their clients, in general, and (b) and
how counselors perceive female and male clients,
specifically. In examining the first question the results
of the study showed that, overall, there was remarkable
consistency in the ways that the intake counselors
described their clients. Specifically, the intake
counselors consistently described their clients' presenting
concerns, how the clients are coping with these concerns,
the clients' willingness to be open about their experience
and emotions, the clients' degree of psychopathology, the
clients' social supports, and the feelings expressed by the
clients. Intake counselors also consistently described the
characteristics of the counseling relationship, their
desire to help the client grow, and the need to keep
looking for what is important to work on in therapy.
In describing the above characteristics of the client
and of the counseling relationship the counselors' tended
to view the client's concerns as changeable and tended to
not want to label or diagnose the client. Further, in
describing the characteristics of the relationship between
the counselor and the client they expressed a strong need
to develop rappore, to maintain a professional
relationship, and to work with the client. The counselors'
descriptions of the client and the relationship also showed
their ideas about what characteristics are beneficial for
therapy such as having client's who are verbal, interested
in change, open about themselves, willing to express their
emotion, and willing to use their social support networks.
These findings are interesting in that they suggest
that counselors learn shared ideas about what to look for,
what to write about, and what types of clients are likely
to have the most growth in therapy. However, while this is
probably a natural phenomena, and for the most part,
beneficial to the counselors and their clients, it also
leaves a question as to how clients who does not fit the
"ideal client" expectation are reacted to in the session.
The results of this study can not ascertain if these
perceptions lead to any changes in behavior but future
research may want to examine this question as studies have
already shown (i.e., Robertson & Fitzgerald, 1990) that
clients who do not fit counselors' expectations are seen as
In examining the second question of how counselors'
perceive women and men, the intake counselors described
women and men similarly in all of the above situations. For
example, they described women and men similarly in regard
to severity of issues, types of issues, willingness to
change, and their desire to help. These findings support
the recent work of researchers such as Keutzer, Morrill,
Holmes, Sherman, Davenport, Tistadt, Francisco, and Murphy
(1998) who found that counselors at counseling centers
report no differences in pathology for women and men.
However, despite these similarities in the intake
counselors' descriptions of women and men, two themes
emerged for each gender that were not as strongly
emphasized for the other gender. For example, the themes of
"vulnerability" and "paying attention to how much the
client asserts [themselves]" were more pronounced for
female clients than for the male clients. Additionally, the
themes of "being stuck" and "paying attention to how much
the client is connected to others" were more pronounced for
the male clients than for female clients.
Interestingly, these differences in the intake
counselors' descriptions seemed to occur in traditional
gender-role directions. For example, the idea of
vulnerability is similar to findings that counseling and
reassurance are seen as more appropriate for females (e.g.,
Wilcox & Forrest, 1992). The focus on men's connectedness
is consistent with the widely held belief among counselors
that male counseling clients usually need to work on
expressing their emotions, whereas female clients usually
do not (e.g., Heatherington, Stets, & Mazzarella, 1986).
Also, Robinson and Johnson (1997) found that individuals
tended to rate women as being "emotional" (i.e.,
vulnerable) whereas they rated men as being "stressed"
(i.e., stuck). Therefore, while these differences also
reflect the counselors' desire to help the client (i.e.,
asserting self, building connections), this help seems to
be, at least partly, based on traditional gender-roles.
These results may help explain many of the
contradictory findings of previous studies examining
possible differences in counselors' perceptions of the
genders. The large majority of the counselors' perceptions
in this study were similar for women and men. However, it
seems that even counselors, who mostly saw their clients in
similar ways, can still, possibly unintentionally, accept
certain traditional gender stereotypes of how women and men
should act. This suggests that most counselors attempt to
see female and male clients as similar. However, subtle
differences may be found when deeply held societal notions
about how women and men should behave are tapped.
It should be mentioned, that just because gender
differences were found in this study, does not prove that
counselors are actually biased against women or men (Barak
& Fisher, 1989). The gender differences present in the
counselors' intake reports may reflect real differences in
the presentations of the clients. However, by reporting
these differences as their own perceptions of the client
the counselors were showing a level of acceptance of these
stereotypical ideas, particularly since they did not appear
to try to conceptualize the clients differently. This
acceptance of the stereotypical notions of women and men
could reduce the number and variety of counseling options
provided (i.e., only emotional expression for women and
only behavioral change for men). Therefore, regardless of
whether the counselors were simply accepting clients
traditional gender roles or directly biased in their
understanding of clients' behaviors, it seems likely that
counselors were unintentionally reinforcing the status quo
(Chesler, 1972) and limiting, rather than expanding, the
range of behavior available to their clients (Shields,
This may be happening in counseling, because,
although, counselors are likely to be knowledgeable about
counseling dynamics, their graduate training programs have
tended to ignore gender issues (Scher & Good, 1990; Van
Buren, 1992). There is also a tendency to avoid dealing
with gender issues, in general (Hochschild, 1989; Hood,
1983; Whitbourne & Ebmeyer, 1990; Zvonkovic, Greaves,
Schmeige, & Hall, 1996), and their impact on counseling,
specifically (Knudson-Martin, 1997, Margolin, Talovic,
Fernandez, & Onorato, 1983). As a result, the possible
limiting of clients' behaviors may happen as counselors'
gender-based patterns of perceiving women and men, so
ingrained in them by social development (e.g., Stevens-
Smith, 1995), remain largely unidentified and therefore
unchallenged (Stabb, Cox, & Harber, 1997). These
unchallenged gender stereotypes may lead counselors to
unintentionally accept restrictive notions about the
appropriate behavior of women and men (Hare-Mustin, 1983).
Counseling that takes gender into account needs to
facilitate the development of clients' potentials
regardless of gender (Van Buren, 1992). Counselors may also
need to increase the range of affective and behavioral
responses that they consider healthy and appropriate for
each of the genders. These responses should reflect the
wide range of affective and behavioral variability that
women and men can demonstrate, rather than reflecting
stereotypes or traditional gender-roles. Furthermore, in
order to avoid biases during the process of gathering data
and formulating hypotheses regarding a client, Morrow and
Diedan (1992) suggest that counselors should (a) consider
alternative hypotheses; (b) check with the client regarding
these hypotheses; (c) challenge themselves to examine both
confirmatory and disconfirmatory information; and (d)
accept that their initial hypotheses may be inaccurate.
A strength of this investigation was the use of a
grounded theory approach (Glaser & Strauss, 1967; Strauss,
1987; Strauss & Corbin, 1998). The use of a qualitative
approach allowed for a more specific understanding of how
counselors perceive real clients. In particular, how
counselors who appeared to desire to see female and male
counselors similarly, might unintentionally perceive women
and men in traditional or gender stereotypical ways. In
addition, grounded theory (Glaser & Strauss, 1967; Strauss,
1987; Strauss & Corbin, 1998) was particularly useful, in
this endeavor, because it allowed for the complexity
present in trying to understand counselors' perceptions of
real clients to be present while still being able to detect
subtle differences in the counselors' descriptions.
Another strength of this investigation was the use of
the archival intake assessments. Intake assessments have
been suggested to be more ecologically valid (Atkinson,
1985; Tomlinson-Clarke & Camilli, 1995) and a source of
useful information for this type of gender research (Stabb
et al., 1997; Tomlinson-Clarke & Camilli, 1995). A further
strength of this investigation was the examination of the
intake assessments of both women and men as well as a group
of intake assessments where the sex of the client was not
known. Examination of these three groups allowed for a
better understanding of how counselors perceive clients of
A possible limitation of this study is the potential
for bias in the coding process. However, this potential
limitation was reduced in a number of ways including (a)
Removing of overt gender cues (i.e., he and she) from the
transcripts; (b) The use of peer reviews; (c) The use of a
third intake group where gender could not be detected in
any of the intakes; (d) The stating of the authors biases
prior to data analysis; and (e) The general procedure of
grounded theory where possible biases in how one interprets
the data are lessened through directly examining how one
interprets the data and asking questions that help remove
bias through the subsequent steps in the procedure. Neither
the peer review nor the third intake group revealed bias in
how the researcher evaluated the groups.
Future research is needed to replicate these results
and to evaluate possible counselor variables that may
effects the counselors' perceptions such as the knowledge
level of counselors regarding gender issues. The current
state of research also leaves unanswered the questions of
whether education level, age, or the amount of client
experience moderates counselors' perceptions of their
clients. Future research should identify whether these and
other individual difference variables; such as race, ethnic
background, religious beliefs, and sexual orientation
moderate subscription to, as well as the expression and
impact of, counselors' perceptions. Furthermore, for those
counselors who do perceive women and men differently, what
method would be the most effective in changing these
beliefs? For example, Orcutt and Walsh (1983) have
demonstrated that merely by pointing out to counselors
their gender-linked beliefs helped them label and reduce
those biased views during counseling. Moving beyond this
work, are there methods that facilitate these changes
completely, for a longer duration, and with greater
influence on subsequent behavior.
In all, the results of this study support the idea
that most counselors seem to perceive female and male
clients similarly, but that gender still is an important
element in counseling, that can affect the dynamics of the
counseling relationship and process (i.e., Howard, 1986;
Lewis, 1989; Robertson & Fitzgerald, 1990). Therefore, we
agree with Gilbert (1992) who wrote: "[Counselors] need to
evaluate [their] own attitudes, values, and behaviors with
regard to women and men . to go beyond personal values
and to become familiar with the rich body of literature on
gender that has accumulated over last 20 years" (p. 407).
It is only by challenging or own assumptions, stereotypes,
values, and beliefs about our clients and using the
knowledge we have gained through research about clients and
about women and men that we will be able to continue to
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family decisions. Journal of Marriage and The Family, 58,
Examples Of Open Coding
Open Coding Hypothesizes
as opposed to patient
yet professional (i.e.,
they didn't use their name)
setting up the type of
good client characteristic?
as opposed to untalkative
and spoke openly
good client characteristic?
open as opposed to closed
telling truth about
not hiding, out in the open
description of what did
easy to see them
open door (metaphor) -
inviting us in showing us
what open about (qualifier)
good client characteristic?
showing us important stuff
noticing feeling as
description of behavior
openness to showing self
noticing feeling as
ending of relationship what sad about
what talking about
ending-something that is
as opposed to finishing not
no accomplishment just ends
relationship is important
client is experiencing again formal
what they are going through
right now what dealing
with, what feeling
relationship, developmental things they are dealing
identities, adjustment, and with
self-esteem issues the issues as opposed to
problems that they need
help in counseling with
issues not as severe as
not sick just developmental
probably just need support
having been at school for qualifier, again issues not
several weeks now seems to as bad, gotten some support
have quelled some quelled-quieted, things
settling down, going
through a turbulent time
of the depressed naming feelings
(isolated/out of place needs several to describe
feelings) the person-a lot going on
again though-needs support
as isolated and out of
needs to feel like fit in
was experiencing what has been going on
ownership this stuff is the
powerful quality-this is
happening to them
has one close friend here support network
and the support of family need close people
importance of friends and
family to get them through
I first acknowledgement of
what they think as opposed
recommend what I think will help
suggestion not a mandate
ST (8-10 sessions) how long- not long term
this can be helpful
individual therapy as opposed to group
one on one best
advanced prac student not serious case can be
handled by prac student
from a supportive and type of treatment
insight-oriented needs support and insight
perspective as opposed to behavioral
training or drugs
this is developmental issue
should be contacted by official notification of
letter only how to contact
client official relationship
is especially more so than normal
they are different in good
easy to relate to good client characteristic
easy to understand to get
to know to communicate with
easy to have a relationship
is warm like them, good, positive
a variety of interests positive description
variety-not just one site
to the personality
establishing need to start, build this
a counseling relationship official relationship for
is not challenging some clients are not easy
to help them having a
client is official term
confused describes state of mind
Unsure, doesn't make sense
Can't think straight
about marriage identifies what confused
trust is lacking more specific about problem
lacking-don't have should
have but don't
is even situation is even worse
worried identifies feeling
that ...will find someone identifies what worried
else about in relationship i.e.
why trust is lacking
despite story behind- find out more
as you read on
even though, should not be
the case but
client's excellent social positive characteristic
skills should be an asset however
has not found despite asset they don't
appropriate healthy, beneficial, useful
pejorative appropriate vs.
as if there is
peer group should have friends own age
and desires wants, needs the clients
a close friend, lover?
companion someone they can
someone who won't leave
reciprocal two way street
friendship is returned
metaphor send letter and
then person sends letter
friendship pen pals, needs of both are
with a with a specific person
recommendation suggestion for help
is for short term (7-8 can help, not long-term
of individual counseling one on one
has never been to statement of clients
counseling experience identifying some
possible difficulties for
how they will do in therapy
and felt focusing on feeling
somewhat qualifier, this could be
worked past but is present
awkward identifying feeling
strange, new situation
some uncomfortableness that
needs to be addressed
coming what awkward about being in
although qualifier, even though
awkward still may be a good
is very ready to tell good client characteristic
very ready- all set to,
prepared to tell-to talk
story describe their life
need to describe self to
tell what happening
counselor follows along-
like reader waiting to see
client is an author they
spin the tale
and deal metaphor- ready to put
cards on the table
take a chance on what cards
deal with handle, something is going
to be hard but wants to
problems as opposed to issues
more serious case
more than one problem
is bright, verbal, and positive, good client
was teary briefly noticing emotion client
holding back sadness
and apologetic about it client wants to hold back
feels it may be
inappropriate to express it
as well as angry with self, inappropriate so must
saying "I hate crying." control angry when loses
identifies feelings as uses
client statement as example
overall good rapport positive
reports characteristic for
showed an appropriate as if there is right or
as if might not have
expressed themselves like
range of emotion focus on feeling
need to fully express self
not hold back
clear thought processes report on client
assessment of functioning
diagnosis not needed
very motivated to seek help good client characteristic
desire a change, want help
is caught captured, held against
one's will, trapped
metaphor caught red handed
in a conflict war, battle, engagement
they are fighting,
between the values put into them
instilled infused, part of him now
from Filipino background Filipino experiences and
and expressive history are what instilled
how became part of him
and the American value other side of the conflict
system opposing values
that prizes win, reward, what should
try to get
personal happiness personal gain over family?
Other side seen as sadness?
although qualifier, don't really
states value preference client say they believe
preference desire, wish
states say it but may not
believe it, like something
his unhappiness focus on feeling statement
with the sequalae doesn't like the
willing to seek it out of choice
seek-look for it, go get or expectations of self
it, may be hidden
as tries attempts to but may not
to fulfill obligations doesn't really seem to feel
like has a choice must
frequently a lot, persistent
worries identifies emotion
and is self-critical beats self up
puts self down
these are self-inflicted
metaphor yield sign-can go
must look out for oncoming
good thoughts may give way
low self-esteem and guilt feeling focus
result if worry and self
has been a remarkable survivor of the conflict
survivor been difficult
and has good ego strength positive client
ST can be dealt with
interested in different desires a change
perspective wants to hear different
prefers to start ASAP stating clients preference
one follow up session somethings need direct
scheduled attention, can't wait
consider group counseling needs support over long
for continuing support term as well
good interaction positive client
client counseling relationship
says is shy reporting what say may have
trouble interacting with
others opening up
does well one on one When client does well
affect was Focusing on feeling
somewhat qualifier, not totally
could be worked through
quarreled defensive, holding back
characteristic that may
client professional relationship
has grown was not always like this,
became bigger over time
to hate math identification of feeling
and the problem
defends self by Not good at math so protect
stereotyping math and view of self by seeing math
mathematicians as dull and as the problem-what client
boring...who needs it? is doing
expects to make a C Belief, assumes
States what client believes
has very high math anxiety more than normal fear
focus on feeling
statement of problem
does as little as possible states behavior engaged in
by client to avoid math
and realizes client is aware
assuming tone that know
what is correct behavior-
say client also knows
that would not do well if points out consequences for
treated other subjects the behavior
way treats math
CO challenged client metaphor-knight challenging
another to a duel must
accept or lose honor
regarding having to change if want to get better must
attitudes/defenses not be as guarded/defensive
if want to learn math what will get better is
is very much opposed doesn't want counselor to
point out resistances
possible problems in
having to learn it what client is doing to
keep self stuck
recommend group protects self
Keeps self safe by
Am taking a chance will problem with client
choose to change they are not willing to
Says will...will try to states the client is
participate...will come every willing as support for
excellent good client characteristic
client professional relationship
had good insights good client characteristics
willing to look inside self
try to understand self
and showed presented, put forth
let part of themselves be
excitement focus on feeling
about being able excited about change
to reframe to think about differently
make look better/newer,
"the problem" problem not issue,
client professional relationship
considers Metaphor-consider an offer
weigh pros and cons
ability to be very good What client thinks about
ability-can do something
I reference to self
question not sure about
ask a question-would like
more detail about
that...really believes that client could be holding
back may not be telling the
truth may be trying to
portray self in a way they
don't really believe
does not think saying what the truth is
saying what think client
has a mathematic mind statement of what true
belief refers to
seems to this is how it appears but
it could be different not
sure of how it is
cope interest in how well the
client is dealing with
problem to cope(v.)-action
of behavior in response to
with not believing..is naming the issue
excellent in math
by saying how copes-identifying the
doesn't enjoy it and that more specifics of what says
it has little or no to cope, identifying what
perceived usefulness want to change in therapy
thinks about identifying consequences of
clients behavior, fewer
options as a result
career choices more specific about
to areas which require the again consequences how it
least math has affected limited the
is aiming What trying to get
Metaphor-aiming an arrow or
a gun-look at target-get it
in your sights and then try
this takes effort don't
always hit the bullseye
Some skill and practice
for A or B specific of what aiming for
is now The result of our session
together-client is better
produced a change so that
considering change isn't drastic hasn't
taken full hold yet hasn't
made up mind totally
weighing pros and cons
aiming higher may try to hit better
missing mark raise gut to
seems to what appears to be but not
sure may be different may
need to look to see
to give up behavior in face of
difficulty what client
does-how gets what my need
and feel helpless identifying feeling
can't do anything about
may be why is stuck
under certain conditions a
doesn't solve problem right easily frustrated
away gives up if first effort
doesn't work identifying
behavior that leads to
Admits to not reading the identifying behavior that
chapter ahead of time and leads to problem
that has not worked very
hard at studies
recommend suggest in professional
that client professional relationship
be in math confidence group what recommends
group not as serious an
agreed to participate and verification that client
to come every time sees this as appropriate
verification that will be a
will have to must do this to get better
figure out ways to decipher metaphor-riddle,
put clues together make
enjoy math more to "want" what need to figure out
instead of fighting must step "back"
recommend peer counselors beliefs that interfere with
for career counseling- getting better
second issue but not
client professional relationship
was interactive and good client qualities
during the intake interview professional relationship
as they will be good client
initially qualifier at first client
may not have been as open
client was somewhat possible problem not open
reserved as described but does get there and
current concerns talks about current issues
however, as session qualifier despite initial
progressed resistance will be good
client professional relationship
was more relaxed and open getting more comfortable
about various situations with process better able to
and circumstances in life fit the mold
client professional relationship
initial first, start but implying a
change will happen
process ongoing situation evolving
to process(v.) to mix
together to get ready
of weight gain identifying issue
not for sure
have been a result what caused
led to the issue
disturbances in family life family problem led to
and ensuing anxiety that tentatively saying cause
may have felt due to and course of problem
parents separation and identifying key incident
client reported that stating what client says
was very confused unsure
difficult to understand
trouble thinking straight
about the circumstances what confused about what
that led parents divorce having difficulty with
and has only recently up until now has not known
changes are current
begun changes started but not
to understand make sense of
some of the problem between what making sense of what
parents begun to understand
may have possibly
coping how dealt with divorce and
interest in how client
deals with problem
with anxieties and problem to which they tried
confusion to cope
by repressing feelings and how coped
consuming food negative behaviors and
this process ongoing, happening put
together, get something
of coping ways of dealing with
may have not sure, hypothesis
became clients manner coping behaviors become
part of their personality
of developing safety and need to be safe need to
perseverance when survive when in
confronted with conflict conflict/war
body appearance how body looks how see self
was not acceptable to didn't like how looks
for many years for long time opening
possibility for change
may not be so now
seemed may be but also may be not
as say next
to feel unable to effect powerlessness
change in this area stuck
why have problems
Examples of The Axial Coding Categories
1. Counselors' focused on the feelings and experiences of
A) Examples from the data of the counselors' pointing out
the emotions of their clients:
"Anxious; worried; sad; crying; guilt; anger; hatred;
excitement; distress; isolated; lonely; unhappiness;
overwhelmed; desperate; ashamed; embarrassed; scared;
afraid; suffering; hurt; confused; flat affect; grief;
relaxed; disappointment; resentment; not very happy;
upset; stressed; fearful; disturbed; and depressed."
B) Examples from the data of the counselors' expressing
the need for the clients to express a range of
"Affect was fairly broad and appropriate; less need
to mask emotions; should be a range of emotion;
resistant to processing feeling; explore feelings;
open about feelings; skilled at burying feelings; did
not acknowledge own feelings at all; appropriate
affect; good range of affect; need to express true
feelings; did not show much affect or anger;
displayed a restrictive affect; flat affect; stable
affect and mood; affect was appropriate; depth of
emotion and feeling."
2. Counselors' focused on the characteristics that will
help and the characteristics that will hinder progress
A) Examples from the data of the counselors' noting
characteristics of their clients that may help the
"Verbal; open; talkative; bright; motivated to seek
help; likable; good ego strength; insightful; excited
about change; easy to relate to; warm; ready to tell
about themselves; interactive; forthright; animated;
describes concerns; relaxed; engaging; responds
readily to questions."
A) Examples from the data of the counselors' noting
characteristics of their clients that may hinder
"Resistant to processing feeling and thought; not
interested in change; limited insight; awkward; never
been to counseling before; challenging; being not
flexible with time; guarded; shy; reserved; repressed
feelings; would rather just be told how to get
better; sees little benefit in figuring out causes;
3. Counselors' assessed how much social support the person
has and whether or not they are using it.
A) Examples from the data of the counselors' assessing
the degree of social support the client has:
"Not personally close; solid support system; friends
are supportive; moderate support from family; misses
having someone to talk to; few resources; alone; very
B) Examples from the data of the counselors' assessing
the degree to which the client is using their social
"Which actively uses; difficult to reach out to others
refrains form using; doesn't share with friends; has
social support but unwilling to use in times of
distress; struggling with feeling connection to
4. Counselors' assessed the degree of severity and
disruption the clients' issues were having for the
A) Examples from the data of the counselors' assessing
the degree of severity of the client's issues:
"Short-term treatment; not as severe; can help; no
underlying pathology; normal identity issues; life
circumstances; life changes."
B) Examples from the data of the counselors' assessing
the degree of disruption the client's issues wer
having on their lives:
"very disruptive; very distressed; little down; low
energy; somewhat disruptive; want things to be
different; a fair amount of distress."
5. Counselors' listed the types of issues, possible causes,
and the consequences the clients presented with.
A) Examples from the data of the types of issues the
"Relationship; developmental; identity; food; weight;
adjustment; self-esteem; clarity; making decisions;
B) Examples from the data of the counselors' reports of
the possible causes of the clients' problems:
"conflict with value system; family
dysfunction/divorce; lack of support;
separation/individuation pains; loss; illness; social
isolation; lack of control/power; pressure; high
C) Examples from the data of the counselors' reports of
the consequences of the clients' problems:
"Unhappiness; low self-esteem; loss of confidence;
isolation; worry; anxiety; negative feelings and
thoughts; distress; feeling unable to effect
change/stuck/limited; depressed; feeling vulnerable;
5. Counselors' focused on what would helping their clients
A) Examples from the data of the counselors' focus on
what would helping their clients:
"Establishing rapport; relating to; therapeutic
alliance; pointing out what needs to be worked on;
making recommendations; setting limits; focusing on
the client; mentoring; giving options figuring out
ways to help; balance of support and challenge;
empower client; facilitate; assist formulate options;
gain understanding; reframing; be able to examine
Examples of Core Categories and Related Themes
Core Categories Related Themes Examples of Themes
The intake counselors' The characteristics of a client that Facilitative Characteristics:
attempts to describe will increase/decrease the likelihood Verbal; Open; Bright;
their clients of a positive outcome to therapy Good Ego Strength; Insightful;
Easy to relate to; Forthright
Resistant to processing feelings
and thoughts; Limited Insight;
Denies; Challenging; Guarded
The issues the client is dealing with Relationship concerns;
Developmental issues; Identity
issues; Family of origin issues;
Adjustment issues; Value clarity
The degree of social support the Moderate support from family;
client receives/uses good friends here; difficult to
reach out to others; solid
The client's feelings and experiences feeling overwhelmed; hurt and
confused; has anger towards; is
lonely; not very happy;
The client's behaviors that are Helping Behaviors:
helping or impeding their growth Being able to assert; Has
changed strategies; Self working
hard on issues; Verbally
Reluctant to get into issues;
Dependent on others for
approval; Coping through denial
The intake counselors' Therapy entailing both a professional Professional Relationship:
descriptions of what and therapeutic relationship Scheduled; Signed release;
counseling or the Informed about; Recommend;
counseling relationship, Limits & appropriateness of
service is like relationship; Client
Having them agree to the
A need to help the client change and Balance of support and
grow challenge; Empower them; Gain
Insight; Facilitate; Assist; Teach
A need to discover the truth Appears, May be; Client claims;
So it is not clear; More
information needs to be