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Counselors' perceptions of female and male clients : do we reinforce traditional gender roles?

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Counselors' perceptions of female and male clients : do we reinforce traditional gender roles?
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Vogel, David, 1971-
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v, 96 leaves : ; 29 cm.

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Clinical psychology ( jstor )
Gender roles ( jstor )
Marriage counseling ( jstor )
Men ( jstor )
Psychological counseling ( jstor )
Psychological research ( jstor )
Psychotherapy ( jstor )
School counseling ( jstor )
Social psychology ( jstor )
Women ( jstor )
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Psychology thesis, Ph.D ( lcsh )
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Thesis (Ph.D.)--University of Florida, 2000.
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Includes bibliographical references (leaves 59-71).
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Printout.
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Vita.
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by David Vogel.

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COUNSELORS' PERCEPTIONS OF FEMALE AND MALE CLIENTS: DO WE
REINFORCE TRADITIONAL GENDER ROLES?


















By

DAVID VOGEL


















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

2000















ACKNOWLEGDMENTS



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

possible.































ii
















TABLE OF CONTENTS

page

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




iii















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?

By

David Vogel

August 2000

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


iv









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.







































v















INTRODUCTION

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

information.

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;






1






2


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,

1997).






3


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






4


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

issues.

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,

1990).






5


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

clients.

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






6


gender research (Stabb et al., 1997; Tomlinson-Clarke &

Camilli, 1995).

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.






7


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

current study.

Historical Overview

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



8









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.,

Chesler, 1972).

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






10


messages about gender, but that they currently do not

(Kaplan, 1983).

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

or men.

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)






11


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;

Sherman, 1980).






12


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






13


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






14


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






15


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






16


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.






17


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






18


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

men.

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






19


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






20


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).






21


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






22


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)






23


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).

Summary

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






24


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.






25


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.















METHODS

Participants

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

confidentiality.

Researchers

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






26






27


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

directions.

Procedure

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






28


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.

Analysis

The intake assessments were analyzed according to the

basic principles of grounded theory (Glaser & Strauss,

1967; Strauss, 1987; Strauss & Corbin, 1998). The process






29


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






30


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.






31


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






32


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

emerged.

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.






33


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.















RESULTS

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






34






35


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

the truth.

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'






36


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






37


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

themselves.

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.






38


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

environment."

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






39


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

distress."

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






40


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






41


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






42


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






43


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






44


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






45


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

happen.

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

described.






46


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,






47


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

situation.

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

"hesitance."

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






48


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").















DISCUSSION

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



49






50


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

more pathological.






51


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






52


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






53


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,

1995).






54


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






55


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.






56


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

both sexes.

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






57


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.






58


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

develop as non-sexist counselors.















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APPENDIX A
Examples Of Open Coding


Counselor's Word(s)
Open Coding Hypothesizes
client
counseling term
as opposed to patient
yet professional (i.e.,
they didn't use their name)
setting up the type of
relationship
was verbal
talkative
good client characteristic?
as opposed to untalkative
and spoke openly
good client characteristic?
open as opposed to closed
telling truth about
themselves
not hiding, out in the open
description of what did
easy to see them
open door (metaphor) -
inviting us in showing us
around
about feelings
what open about (qualifier)
good client characteristic?
showing us important stuff
not resistant
noticing feeling as
important
cried
description of behavior
openness to showing self
sadness expression
noticing feeling as
important




72






73


ending of relationship what sad about
what talking about
ending-something that is
happening-over
as opposed to finishing not
good
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
problems
not sick just developmental
issues
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
place
needs to feel like fit in

was experiencing what has been going on
ownership this stuff is the
clients
powerful quality-this is
happening to them






74


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
to description

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
counseling terminology

is especially more so than normal
they are different in good
way

easy to relate to good client characteristic
easy to understand to get
to know to communicate with
easy to have a relationship
with






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is warm like them, good, positive
characteristic
friendly

a variety of interests positive description
healthy description
variety-not just one site
to the personality
personable

establishing need to start, build this
core condition

a counseling relationship official relationship for
their benefit

is not challenging some clients are not easy
to help them having a
relationship

client is official term

confused describes state of mind
Unsure, doesn't make sense
Cloudy muddles
Can't think straight

about marriage identifies what confused
about relationship
important

trust is lacking more specific about problem
with marriage
lacking-don't have should
have but don't

is even situation is even worse

somewhat qualifier

worried identifies feeling

that ...will find someone identifies what worried
else about in relationship i.e.
why trust is lacking






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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
excellent-very strong,
admiration of

has not found despite asset they don't
have

appropriate healthy, beneficial, useful
pejorative appropriate vs.
inappropriate
as if there is
right/correct group

peer group should have friends own age

and desires wants, needs the clients
wishes

a close friend, lover?
companion someone they can
trust
someone who won't leave

reciprocal two way street
friendship is returned
metaphor send letter and
then person sends letter
back

friendship pen pals, needs of both are
met

with a with a specific person

recommendation suggestion for help

is for short term (7-8 can help, not long-term
sessions) problem

of individual counseling one on one






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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
therapy

although qualifier, even though
awkward still may be a good
client

is very ready to tell good client characteristic
very ready- all set to,
prepared to tell-to talk
about themselves

story describe their life
narration
need to describe self to
counselor
tell what happening
counselor follows along-
like reader waiting to see
what happens
client is an author they
spin the tale

and deal metaphor- ready to put
cards on the table
take a chance on what cards
you get

deal with handle, something is going
to be hard but wants to
handle it






78


problems as opposed to issues
more serious case
more than one problem

is bright, verbal, and positive, good client
insightful characteristics

was teary briefly noticing emotion client
holding back sadness

and apologetic about it client wants to hold back
sadness
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
control counselor
identifies feelings as uses
client statement as example

overall good rapport positive
reports characteristic for
good client

showed an appropriate as if there is right or
wrong way
as if might not have
expressed themselves like
this

range of emotion focus on feeling
need to fully express self
not hold back

clear thought processes report on client
characteristics
assessment of functioning
diagnosis not needed

very motivated to seek help good client characteristic
desire a change, want help






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is caught captured, held against
one's will, trapped
metaphor caught red handed
found out

in a conflict war, battle, engagement
they are fighting,
struggling

between the values put into them
instilled infused, part of him now

from Filipino background Filipino experiences and
and expressive history are what instilled
them
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
believe them

states value preference client say they believe
something
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
consequences

willing to seek it out of choice
seek-look for it, go get or expectations of self
it, may be hidden






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as tries attempts to but may not
achieve

to fulfill obligations doesn't really seem to feel
like has a choice must
fulfill obligations

frequently a lot, persistent

worries identifies emotion

and is self-critical beats self up
puts self down
these are self-inflicted
wounds

yielding causing
metaphor yield sign-can go
but slowly
must look out for oncoming
traffic
good thoughts may give way
to self-critical

low self-esteem and guilt feeling focus
result if worry and self
critical

has been a remarkable survivor of the conflict
survivor been difficult
positives

and has good ego strength positive client
characteristics

ST can be dealt with

interested in different desires a change
perspective wants to hear different
thing

prefers to start ASAP stating clients preference
Eagerness






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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
characteristics

client counseling relationship

says is shy reporting what say may have
trouble interacting with
others opening up

but qualifier

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
hinder therapy

client professional relationship

has grown was not always like this,
changed
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





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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
correct behavior

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
math grades

is very much opposed doesn't want counselor to
point out resistances
possible problems in
therapy

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
change

Says will...will try to states the client is
participate...will come every willing as support for
time trying






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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
seen

some qualifier

excitement focus on feeling
energized

about being able excited about change
gaining power/control

to reframe to think about differently
metaphor-reframing picture
make look better/newer,
refinish

"the problem" problem not issue,
client's words?

client professional relationship

considers Metaphor-consider an offer
weigh pros and cons

ability to be very good What client thinks about
himself
ability-can do something

I reference to self

question not sure about
ask a question-would like
more detail about






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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
really means

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
something/issue

with not believing..is naming the issue
excellent in math

by saying how copes-identifying the
behavior

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
has limited

thinks about identifying consequences of
clients behavior, fewer
options as a result

career choices more specific about
consequences


to areas which require the again consequences how it
least math has affected limited the
client






85


is aiming What trying to get
Metaphor-aiming an arrow or
a gun-look at target-get it
in your sights and then try
to hit
this takes effort don't
always hit the bullseye
Some skill and practice
needed

for A or B specific of what aiming for

but Qualifier

is now The result of our session
together-client is better
off
produced a change so that
new different-better

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
shooting metaphor-is
missing mark raise gut to
hit it

seems to what appears to be but not
sure may be different may
need to look to see
differences

to give up behavior in face of
difficulty what client
does-how gets what my need
to change

and feel helpless identifying feeling
can't do anything about
issue
may be why is stuck
client stuck






86


when qualifier
under certain conditions a
specific time

doesn't solve problem right easily frustrated
away gives up if first effort
doesn't work identifying
behavior that leads to
problem

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
relationship

that client professional relationship

be in math confidence group what recommends
group not as serious an
issue-confidence

agreed to participate and verification that client
to come every time sees this as appropriate
verification that will be a
good client

will have to must do this to get better

figure out ways to decipher metaphor-riddle,
put clues together make
sense of

enjoy math more to "want" what need to figure out
to study

instead of fighting must step "back"
behavior-stop

recommend peer counselors beliefs that interfere with
for career counseling- getting better
second issue but not
central






87



client professional relationship

was interactive and good client qualities
conversational

during the intake interview professional relationship
as they will be good client
in session

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

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

may possibly
not for sure

have been a result what caused
led to the issue






88


disturbances in family life family problem led to
current issues

and ensuing anxiety that tentatively saying cause
may have felt due to and course of problem
parents separation and identifying key incident
divorce

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
done yet

to understand make sense of

some of the problem between what making sense of what
parents begun to understand

client professional

may have possibly

initially started

coping how dealt with divorce and
confusion behaviors
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
feelings






89


this process ongoing, happening put
together, get something
ready

of coping ways of dealing with
problem

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
and disasters

client professional

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

however qualifier
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















APPENDIX B
Examples of The Axial Coding Categories

1. Counselors' focused on the feelings and experiences of
their clients:

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
emotions:

"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
in therapy.

A) Examples from the data of the counselors' noting
characteristics of their clients that may help the
therapeutic progress:







90






91


"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
therapeutic progress:

"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;
ambivalence."

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
isolated."

B) Examples from the data of the counselors' assessing
the degree to which the client is using their social
support system:

"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
others."






92


4. Counselors' assessed the degree of severity and
disruption the clients' issues were having for the
client.

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
counselors reported:

"Relationship; developmental; identity; food; weight;
adjustment; self-esteem; clarity; making decisions;
math/school."

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
expectations."

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;
feeling dependent."






93


5. Counselors' focused on what would helping their clients
grow.

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
perceptions."















APPENDIX C
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
Hindering Characteristics:
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
support system

The client's feelings and experiences feeling overwhelmed; hurt and
confused; has anger towards; is
lonely; not very happy;
excitement

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
articulate
Impeding Behaviors:
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



94






95


Therapeutic Relationship:
Therapeutic alliance
Establishing rappore
Having them agree to the
process

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
gathered




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