Case conceptualizations by mental health and marriage and family counselors

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Title:
Case conceptualizations by mental health and marriage and family counselors
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viii, 235 leaves : ill. ; 29 cm.
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English
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Burch-Ragan, Kelly M
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Counselor Education thesis, Ph.D   ( lcsh )
Dissertations, Academic -- Counselor Education -- UF   ( lcsh )
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bibliography   ( marcgt )
theses   ( marcgt )
non-fiction   ( marcgt )

Notes

Thesis:
Thesis (Ph.D.)--University of Florida, 2003.
Bibliography:
Includes bibliographical references.
General Note:
Printout.
General Note:
Vita.
Statement of Responsibility:
by Kelly M. Burch-Ragan.

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University of Florida
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Table of Contents
    Title Page
        Page i
    Acknowledgement
        Page ii
        Page iii
    Table of Contents
        Page iv
        Page v
        Page vi
    Abstract
        Page vii
        Page viii
    Chapter 1. Introduction
        Page 1
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    Chapter 2. Review of the literature
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    Chapter 3. Methodology
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    Chapter 4. Results
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    Chapter 5. Discussion
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    Appendix A. Request for participants
        Page 133
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    Appendix B. Informed consent & instructions to participants
        Page 136
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    Appendix C. Student demographic information
        Page 139
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    Appendix D. Vignettes
        Page 142
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    Appendix E. Request for results
        Page 154
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    Appendix F. Permission to reprint correspondence
        Page 156
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    Appendix G. First follow-up e-mail request for participants
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    Appendix H. Second follow-up e-mail request for participants
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    Appendix I. Instructions to counseling professionals
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    Appendix J. Vignettes as rated by counseling professionals
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    Appendix K. Validation of instrument by experts
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    Appendix L. University of Florida institutional review board application
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    Appendix M. Response means
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    References
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    Biographical sketch
        Page 234
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Full Text









CASE CONCEPTUALIZATIONS BY
MENTAL HEALTH AND MARRIAGE AND FAMILY COUNSELORS












By

KELLY M. BURCH-RAGAN

















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 2003














ACKNOWLEDGMENTS

There is insufficient space to recognize the many people who helped to make the completion of this study possible. However, I would in particular thank the students who donated their time and consideration from their busy academic pursuits to participate in this study. It would not have been possible without their valuable assistance.

I also express sincere appreciation to my dissertation chair, Dr. Larry C. Loesch, for providing valuable suggestions, constructive criticism, and freely sharing his expertise and wisdom throughout this process. Dr. Loesch's patience and encouragement made the completion of this study a reality. I am grateful for both the time he devoted to my study and the copious laughter that kept everything in perspective.

Sincere thanks also are extended to the other members of my doctoral committee, Dr. Joe Wittmer, Dr. Peter Sherrard, and Dr. Cecil Mercer, for creating a supportive learning environment for this process. Each member of my committee unselfishly offered professional guidance and personal support so that I might achieve this goal.

Special appreciation also is extended to Mr. Bob Cobb and Dr. Sun Feng for sharing their expertise and passion for statistical analysis and technology. Their involvement was not only helpful but promoted a sense of comfort.

I also would like to extend thanks to the members of my expert panel for taking time to examine this survey carefully. Their review was invaluable for conducting this research.

A special thanks is extended to Barbara Loesch for her kindness and generosity.


ii








Carolyn Green, Lynda Ruf, and Dr. Joy Dias are dear friends and colleagues who offered endless support, and who generously reminded me of my abilities when my own doubts began to slow the process of this study.

An enormous debt of gratitude is given to my family. To my husband, Rink, I am deeply grateful for his continued faith in me and for never letting me lose faith in myself I thank my mother-in-law, Doris Ragan, for her endless encouragement and curiosity. To my brother, Kevin Burch, I am grateful for a lifetime of ready assistance and encouragement. To my nieces, Chelsea and MacKenzie, go thanks for reminding me that life existed outside this research. And, to my mother and father, Dr. Barbara G. Burch and Dr. Kenneth L. Burch, I am forever indebted for indulging me in my dreams and for providing immeasurable support. To them I symbolically give a personal footnote of recognition and thanks. Without their help and love, much more than this study would have never been possible. And finally very special thanks go to Gizmo, my dog, for touching my heart and life in countless ways.

This work is dedicated to my Godmother and Aunt, Judith Kathleen Gagel, who passed away before the completion of my degree. She taught me so many things, but none more important than the courage to follow the unknown path of your dreams.














TABLE OF CONTENTS

Page

ACKNOWLEDGEMENTS ............................ ii

ABSTRACT .................................... vii

CHAPTERS

I INTRODUCTION ............................. I

Overview .. .. .. .. .. .. ... ... . ... . ... 3
Theoretical Framework ........................... 7
Statement of the Problem .......................... 10
Need for the Study ............................. 11
Purpose of the Study ............................ 13
Null Hypotheses .............................. 14
Definition of Terms ............................ 15
Overview of the Remainder of the Study ................. 18

2 REVIEW OF THE LITERATURE ..................... 19

Counselor Education ............................ 19
Standards of Training ........................ 20
CACREP: Role in Counselor Preparation ............. 22
COAMFI'E: Role in Counselor Education ............. 24
CACREP and COAMFTE Compared ............... 26
Importance of Conceptualization to Counselor Development ... 28
Key Conceptual Issues in MHC and MFC/T ................ 33
Similarities Between the Disciplines ................ 34
Differences Between the Disciplines ................ 3S
Individual versus Systems Dynamics ......... ''' 36
Linear versus Circular Causality . . . . . . . . . 37
Content versus Process Focus . . . . . . . . . 40
Studies Related to Counselor Trainee's Conceptual Development .... 41
The Influence of Demographic Variables ............. 43
Challenges that Relate to Conceptualization of
MHCs and MFC/Ts . . . . . . . . . . 49
Support for Methodology and Instrumentation . . . . . . . 51
Schema Theory . . . . . . . . . . . . . 51


iv









Assessment Instrumentation ...................54
Internet and web-based survey research .. .. .. .. ...54
Use of case vignettes. .. .. .. ... .. ... ... ..57
Summary. .. .. .. .. ... ... ... ... ... ... ... ... ..

3 METFHODOLOGY. .. .. .. ... ... ... ... .. ... ... ...61

General Design .. .. .. .. ... ... ... ... ... ...........61
Population. .. .. .. .. ... ... ... ... ... ... ... ... .62
Sample. .. .. .. ... .. ... ... ... ... ... ... ... ...65
Methodological Procedures. .. .. .. .. ... ... ... ... ....66
Instrumentation .. .. .. .. ... ... ... ... ... ... .67
Human Subjects .. .. .. .. ... ... ... ... ... .....70
Data Collection .. .. .. .. ... ... ... ... ... ... .70
Research Variables. .. .. .. ... .. ... ... ... ... ... ...72
Data Analysis. .. .. .. .. ... ... ... ... ... ... ... ...73
Methodological Limitations. .. .. .. ... .. ... ... ... ....73
Summary .. .. .. .. ... ... ... ... ... ... ... .. ....74

4 RESULTS. .. .. .. ... .. ... ... ... ... ... ... ....75

Participant Demographics .. .. .. .. ... ... ... ... ... ...75
Response Rating Frequencies, Means and Standard Deviations by
Academic Program Type .. .. .. .. ... ... ... ... ...79
Intercorrelations. .. .. .. .. ... ... ... ... ... ... ....89
Analyses by Hypothesis .. .. .. .. ... ... ... ... ... .....95
Summary .. .. .. .. ... ... ... ... ... ... ... .. ....112

5 DISCUSSION .. .. .. .. ... ... ... ... ... ... ... ...113
Limitations of this Study. .. .. .. .. ... ... ... ... ... ...114
Implications .. .. .. .. ... ... ... ... ... ... ... .. ..117
Age. .. .. .. .. ... ... ... ... ... ... ... ....117
Gender .. .. .. .. ... ... ... ... ... ... ... ...118
Academic Major .. .. .. .. ... ... ... ... ... .....118
Academic Program Level. .. .. .. ... .. ... ... ....119
Amount of Practica and/or Internships .. .. .. .. .. ... ...120
Primary Setting for Practica and/or Internships .. .. .. .. ...121
Trainee's Professional Affiliation .. .. .. .. ... ... ....121
Program Accreditation. .. .. .. .. ... ... ... ... ...122
Professional Affiliation of Trainee's Primary
Supervisor/Educator/Instructor .. .. .. .. ... ....123
Intercorrelations .. .. .. .. ... ... ... ... ... .....123
Interpretations. .. .. .. .. ... ... ... ... ... ....124
Recommendations .. .. .. .. ... ... ... ... ... ... .....129
Summary .. .. .. .. ... ... ... ... ... ... ... .. ....131



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APPENDIX

A REQUEST FOR PARTICIPANTS .................... 133

B INFORMED CONSENT & INSTRUCTIONS TO PARTICIPANTS ... 136 C STUDENT DEN40GRAPHIC INFORMATION ............. 139

D VIGNETTES ................................ 142

E REQUEST FOR RESULTS ........................ 154

F PERMISSION TO REPRINT CORRESPONDENCE .......... 156 G FIRST FOLLOW-UP E-MAIL REQUEST FOR PARTICIPANTS ... 165 H SECOND FOLLOW-UP E-MAIL REQUEST FOR PARTICIPANTS . 168 I INSTRUC71ONS TO COUNSELING PROFESSIONALS ........ 171 i VIGNETTES AS RATED BY COUNSELING PROFESSIONALS ... 174 K VALIDATION OF INSTRUMENT BY EXPERTS ........... 186

L UNIVERSITY OF FLORIDA INSTITUTIONAL REVIEW BOARD
APPLICATION .............................. 189

M RESPONSE MEANS ........................... 198


REFERENCES ................................... 216

BIOGRAPHICAL SKETCH ............................ 234















vi















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 CASE CONCEPTUALIZATIONS BY MENTAL HEALTH AND MARRIAGE AND FAMILY COUNSELORS By

Kelly M. Burch-Ragan

May 2003

Chairman: Larry C. Loesch
Major Department: Counselor Education

Based on lack of agreement about influence of professional training on clinical data interpretation, this study explored professional training, within accredited mental health counseling (MHC) and marriage and family counseling/therapy (MFC/T) preparation programs, for case conceptual izati on and initial treatment planning of master's and doctoral students. Student members of relevant listservs participated through a survey link.

Participants responded to a demographic questionnaire and three case

simulations/vignettes. Each vignette described a situation MHCs or MFC/Ts likely would encounter in clinical practice. Respondents selected the likelihood for conceptualizing and/or planning therapeutic intervention in each of six therapeutic modalities. The weighted response scale ranged from extremely unlikely to extremely likely.





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Relationships were investigated among response values and selected professional variables. Similarities and differences were found in how students conceptualize client concerns. Education level was associated with preferred conceptual style. Gender, program enrollment, primary type of clinical experience, professional association of the respondents and respondent's supervisor/mentor did not yield significant differences in response means. There were no relationships among each student's age and amount of supervised clinical practice and preferred case conceptualization. However, there were suggestions for what shapes trainees' conceptual ization preferences. Patterns reflecting conceptual consistency were found among some professional variables and preferred client conceptualizations including between a respondent's identified academic program and conceptual dimension associated with particular specializations. Respondent's professional socialization also showed an association with preferred conceptual style. When response patterns were examined within each academic subgroup, a trend toward conceptual dimension consistency was found among master's- and doctoral-level MFC/T trainees and master's-level NMC students.

This study demonstrated that it is possible to clarify further associations among professional variables and conceptualization choices. However, additional research is necessary to understand fully factors contributing to students' conceptualization of clients' concerns and association among various training pedagogues and manners of conceptualization within MHC and MFC/T preparation programs.









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CHAPTER I
INTRODUCTION


A recent study by the World Health Organization, World Bank, and Harvard University (National Institute of Mental Health, 1996) revealed that mental health difficulties globally account for over 15% of all illnesses, which is more than all malignant diseases combined and second only to cardiovascular disease in incidence. Indeed, in any given year in the United States, an estimated one in five adults and one in ten children and adolescents experience a mental health difficulty severe enough to cause significant disruption to their normal functioning (National Institute of Mental Health [NIMH1, 2001). While mental health difficulties differ in terms of severity, duration, etiology, prognosis, and appropriate treatment, they share the function of interfering with quality of life. Few people are untouched by the direct (e.g., treatment) and indirect (e.g., loss of workplace productivity, school problems, or financial instability) costs of mental health problems (NIMH, 2001).

The diverse nature and substantial prevalence of mental health issues has

prompted many health and helping professionals to address the mental health problems that disrupt people's lives. In particular, mental health counseling and marriage and family therapy are two of the five primary disciplines recognized by the NIME as qualified to do so. These disciplines intend specifically to assist persons affected directly and/or indirectly by mental health difficulties. However, the manner in which assistance is provided presumably differs by area of specialization, preferred conceptualization of






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mental health problems, preferred approaches to treatment, and primary professional affiliation (American Association for Marriage and Family Therapy [AAMFT], 1999).

Distinguishing the nature of the differences among helping professions is difficult because of the lack of professional consensus about what is salient to differentiation, appropriate training to conduct sound inquiries, and confusion about the practitionerresearcher dichotomy (Vacc & Loesch, 2000). However, regardless of the difficulties, the nature of the helping professions is of key interest to consumers, healthcare organizations, businesses, the media, foundations, government, professional associations, students, practitioners, researchers, and educators (Doherty, 1997). For example, professional associations wish to enhance their legitimacy and professional status through research (Which services are best?); healthcare organizations want information that promotes cost-effective services (What type of therapy or intervention works best for whom and at what cost?); and the media are focused on providing information to consumers (What is new, different, and effective?).

Understanding the qualities of specialized areas of care and training is of

particular interest to educators, graduate students, the research community, and university faculty. Counselor educators strive continuously to provide the best quality training for practitioners, researchers, and future educators in the field of counseling (Anderson & Rigazio-DiGilio, 1995; Cummings, Hallberg, Martin, Slemon, & Hiebert, 1990; Fong, 1998; Wendorf, 1984). Thus, understanding if and how specialized training affects students is a key component of the counselor educator's job. Preparing students as thoroughly and responsibly as possible in endorsed standards of knowledge and competencies and in selected areas of counseling specialization is the goal. Quality of






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preparation in turn impacts consumer quality of care, status of the counseling profession, potential employability of students, possibility of third party reimbursement from healthcare organizations, and availability of funding and support resources (Doherty, 1997).

This study is concerned specifically with the impact on counselor training. Given the notable difficulties associated with accurately addressing such a formidable task completely (Vacc & Loesch, 2000), this study focuses on a professionally agreed upon key aspect of training: a counselor trainee's ability to conceptualize client situations and problems (Anderson, 1992; Cummings et al., 1990; Duys & Hedstrom, 2000; Nelson & Neufeldt, 1998; Sluzki, 1981; Tucker & Pinsoff, 1984). Johnson and Brehms noted that the manner in which counselor trainees conceptualize client systems "greatly influences their understanding of human beings, as well as their chosen type and mode of treatments" (1991, p. 133). Specifically, this investigation seeks to clarify how counselor trainees' conceptualizations are influenced by their training within an area of specialization. The areas of specialization addressed here are mental health counseling (MHC) and marriage and family counseling/therapy (MFCIT). Although there are often variations in individual preparation practices for these specialties, only students trained within the parameters and standards established by the Council for Accreditation of Counseling and Related Educational Programs (CACREP) for MI-C or MFC/T specialization are addressed in this study.

Overview

As a relatively new profession, counseling emerged as a way to help people cope with rapidly changing societal and personal dynamics born of important events (e.g., the





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Industrial Revolution and the social welfare reform movement) and personal influences (e.g., Freud's development of psychoanalytic theory, Beer's attention to the deplorable conditions of mental health care in the late 1800s, and Parsons' initiation of the vocational guidance movement). An examination of the history of counseling highlights its intimate linkage to changing client needs, social concerns, philosophical perspectives about the nature of human behavior, and governmental and societal interests. These interacting dynamics produced a profession with interdisciplinary roots, one unique from psychiatry, psychiatric nursing, social work, psychology, or guidance (Aubrey, 1983; Gladding, 2000; Nugent, 2000). Counseling is a process that emphasizes development, treatment, and prevention for people concerned with achieving and maintaining a healthy style of living across the lifespan (Vacc, 1990).

Just as the aforementioned interacting dynamics have shaped counseling as a unique discipline, so too have these dynamics shaped the preparation of professionals within the counseling profession. An historical review of the counselor preparation (education) literature reveals a maze-like developmental process. Eventually, however, preparation standards came to include fundamentals not only of counseling but also of training within an area of specialization such as MHC or MFC/T (Sexton, 1998a; Sweeney, 1995). Counselor educators are charged with the task of preparing professionals to facilitate clients' development in a manner that maintains accepted standards of practice. In particular, this criterion requires counselor trainees to have "current [within the last 10 years] knowledge of outcome research literature and the ability to skillfully apply the most current practices" (Sexton, 1998a, p. 3). To assist counselors to meet this standard, counselor educators continually raise questions about






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what are the fundamental knowledge bases and skills for their students to be able to work effectively with individuals, children, families, couples, and diverse clientele in diverse settings and about the effectiveness of current educational practices (Everett, 1979; Sexton, 1998a, 1998b; Vacc & Loesch, 2000).

The professional counseling literature is rich with theoretical training models about how to prepare counselors to manage the conceptually complex variables of clients' concerns effectively. However, counselor education is only in the fledging stage of understanding and systematically inquiring into the effectiveness of these models, particularly as they relate to the primary practices of professional counselor educators: supervision, teaching, and clinical training (Avis & Sprenkle, 1990; Bradley & Fiorini, 1999; Cummings et al., 1990; Duys & Hedstrom, 2000; Goodyear & Bernard, 1998; Sexton, 1998).

Investigative overtures into counselor preparation have focused on a wide range of subjects. For example, Fong, Borders, Ethington, and Pitts (1997) investigated counselors' patterns of thought development and ability to process information. Goldberg (1974) studied the impact of counselors' levels of cognitive complexity on therapeutic interaction. Holloway and Wolleat (1980) demonstrated the direct relationship between counselors' conceptual complexity level and clarity of clinical hypothesis formulation. Borders, Fong, and Neimeyer (1986) speculated about the relationship of trainees' ego development to the client-counselor relationship. Cummings et al. (1990) studied the conceptualizations of novice and experienced counselors. Tucker and Pinsof (1984) conducted a comprehensive, empirical evaluation of a family training program. And finally, Hines (1996) investigated how well prepared graduates of an accredited AAMFT





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program considered themselves to be. Through an investigation of the literature on marriage and family training, Kniskern and Gurman (1979) found outcome research on training and factors affecting training and family therapy outcomes to be minimal at best.

Examination of the research related to counselor training clearly reveals that much remains to be explored and/or substantiated (Fong et al., 1997; Kniskern & Gurman, 1979; Stoltenberg, McNeil, & Crethar, 1994; Vacc & Loesch, 2000). One aspect of counselor education that begs for further investigation, and is the subject of this study, is the difference in the respective ways various counselor trainees conceptualize clients' problems. As noted, the manner in which a counselor trainee views client concerns has a profound impact on the manner in which s/he conceptualizes all aspects of the therapeutic process (Sluzki, 1981). It follows that inquiry into the influence of training will contribute to the knowledge base of how to prepare counselors effectively to think deeply and adequately about client concerns and the counseling process (Cummings et al., 1990; Holloway & Wolleat, 1980; Huber & Carlson, 1994; Gladding, 2000; Johnson & Brehms, 1991; Sluzki, 1981; Stevens-Smith, Hinkle, & Stahmann, 1993; Stoltenberg, McNeil, & Delworth, 1998).

This study focuses on the relationship between conceptualization of client

concerns and training within the specializations of MHC and MFC/T. Several factors influencing the counseling profession present unique challenges to this inquiry, including the limited existence of reflective and systemic evaluation of concepts guiding counselor education, overlapping epistemological issues of MHC and MFC/T, and multiple standards of training and accreditation (CACREP or COAMFTE), among others. Each of these issues is explored further in Chapter 2 of this study.






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Theoretical Framewo

While professionals agree that a solid foundation in theory is essential to

counselor preparation, a diversity of opinions in regard to an appropriate theoretical basis exists amongst researchers and educators and therefore about key factors influencing trainees' development, acquisition, and application of new concepts (e.g., Blocher, 1983; Lipson, 1998; Vacc & Loesch, 2000). However, as a general orientation, Guzzetti and Hynd (1998) noted that clarity of understanding conceptual change dynamics is best attained through cross-disciplinary theoretical research, thereby creating a broader lens for understanding notable learning issues.

Each potentially applicable theory has its strengths and lin-fitations, and each conceptual change perspective is only "one slant on reality" (Cooper, 1996, p.60). For example, multicultural conceptual change theory explores how the meaning of membership within a marginalized culture influences conceptual change. Similarly, Feminist theory analyzes gender interactions and various views of feminism in conjunction with conceptual change. From the perspective of domain literacy, an individual's conceptual change varies among differing domains in regard to interdependency among the variables of content knowledge, domain breadth, and motivation. Sociocultural theorists highlight the influence of student-teacher interactions and society's role in shaping new learning. From a social psychological perspective, conceptual change is subject to the influence of affective and cognitive variables. The postmodernists question traditional views of learning (Guzzetti & Hynd, 1998), and instead suggest that conceptual change results from an illumination of power, structures of interaction, and oppressive discourses that shape the way knowledge is "continually






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constructed, situated, and negotiated" (p. 196) among contentious cultures. The salient point is that one theory should not be viewed as superior to another nor should its situational application marginalize other theoretical positions and approaches. However, it should provide the best analysis of a set of facts in relationship to one another (Dewey, 1986; Myers & Alvermann, 1998; Soltis, 1984).

Historically, conceptual learning research focused on cognitive factors (e.g., an individual's knowledge), with little attention being paid to other dynamics such as affect and nature. However, extensive study clearly demonstrated the limitations of a strong, rational-cognitive approach, thereby emphasizing the need for alternative approaches to understanding conceptual learning. Thus, for hundreds of years, researchers from various disciplines demonstrated and continued to disclose the value of alternative theoretical models (Sinatra & Dole, 1998). For example, through the use of selected vignettes, Guzzetti and Hynd (1998) presented multiple theoretical interpretations of the same data. Their work clearly demonstrates the value of multiple interpretations and selection of the best theoretical fit for a specific research situation.

The focus of this study, i.e., the influence of MIFT/C and MHC training on

trainees' conceptualization of client problems and treatment planning, is integrally related to the practice of counseling. Counseling practice, as well as the counselor's development, is commonly characterized as highly ambiguous, emotionally loaded, complex, contextual, and constructive in nature (Guzzetti & Hynd, 1998; Pace, 1988; Sluzki, 1981). The generally accepted complex and ambiguous nature of the counseling process has been compared to a circus performance in which a performer must simultaneously juggle bowling pins, blow bubbles, and spin a wheel atop his/her head






9

while bicycling an obstacle course of seemingly impossible to overcome obstacles (Johnson & Heppner, 1989). Given the nature of conceptual development, practice of counseling, and the importance of conceptualization in the counseling process (Sluzki, 1981), it can be safely assumed that the training of counselors is an equally complex task (Johnson & Heppner, 1989; Pace, 1988). Accordingly, the theoretical foundation of a study of such a process must account for the idiosyncratic and multifaceted nature of conceptual development and counseling practice (Guzzetti & Hynd, 1998; Pace, 1988).

Schema theory was selected as the foundation for this study. Schema theory does not explain all aspects of conceptual change; however, it does explain the key aspects, including the influence of social and natural factors upon cognitive development (Pace, 1988; Sinatra & Dole, 1998). The relevance of schema theory to this study is illustrated through its metatheoretical foundation and specific application to conceptual development, and therefore to the processes of counseling and counselor training.

Schema theory allows researchers to account for variables characteristic of the complex nature of conceptual development. Chinn (1998) and Pace (1988), among others, provided a strong argument for the use of schema theory in the study of conceptual development, particularly as related to counseling processes. Counselor preparation is a complex, dynamic, and often ambiguous process. However, schema theory serves well as a way to understand the process because it provides a framework for developing, evaluating, and synthesizing the complex dynamics that influence trainees' development of conceptualizations congruent with an area of specialization.






10


Statement of the Problem

Given counseling professionals' substantial support for the need for evidence of the impact of training, it might be assumed that the relationship between specialized training (e.g., MHC or MFCIT) and counselor trainees' conceptualization and treatment planning abilities has been thoroughly investigated. However, this is not the case. Several studies have investigated the clinical practice profiles of various licensed professionals (e.g., relationships between academic training and selected fields of clinical practice, differences among expert and novice counselors' ability to conceptualize client concerns effectively and subsequently plan treatment, and treatment outcome as related to professional practice approach and affiliation) (Beutler, Machado, & Neufeldt, 1994; Cummings et al., 1990; Doherty & Simmons, 1996; Knesper, Pagnucco, & Wheeler, 1985; Simmons & Doherty, 1995; 1998). However, there is little evidence about how specialized training influences the clinical tasks of case conceptualization and treatment planning among counselor trainees (Falvey, 2001; Vacc & Charkow, 1999).

The problem addressed in this study is that the difference in case

conceptualization and initial treatment planning abilities of master's and doctoral students in CACREP-approved MHC and MFCIT programs is unknown. Also explored in this study are the influences of counselor trainees' age, gender, education level, primary professional affiliation, previous course work, current course enrollment, amount and type of practicumlinternship experience, and the primary affiliation of their mentors/supervisors.








Need for the Study

"Comparison of identification along theoretical or conceptual systems is

meaningful because it is therapists' orientation that greatly influences their understanding of human beings, as well as their chosen type and mode of treatment" (Johnson & Brehms, 1991, p. 133). Epistemological distinctions, although not clearly defined, between MHC and MFC/T encompass alternative views of causality, symptom behavior, and methods of intervention. For example, a client's concern could be viewed as "What's wrong with Bob?" or "What purpose or meaning does Bob's behavior have within the relational system?" The point is not to determine which perspective is better, but rather how a person trained within a particular specialization and at a particular level of training understands client concerns, which will in turn dramatically shape the conditions for change within the client (Huber & Carlson, 1994; Presbury, McKee, & Moore, 1983; Sexton, 1994; Smith, Carlson, Stevens-Smith, & Dennison, 1995).

In the current environment of required therapeutic efficacy and cost effectiveness, providers of mental health services are monitoring closely the value of their work (Pinsof & Wynne, 1995; Simmons & Doherty, 1998). In order to survive in a health care system whose gatekeeper is managed care (Lawless, Ginter, & Kelly, 1999), practitioners of all professional affiliations and academic training backgrounds must continue to establish the value of their work. Because the future of many helping professionals remains unclear (Falvey, 2001; Pinsof & Wynne, 1995; Simmons & Doherty, 1998), it is important that the training of counselors be understood from the perspective of professional values relevant to a specialization (Falvey, 2001; Vacc & Charkow, 1999). Therefore, the benefits of this line of inquiry extend beyond facilitating counselor educators to better






12


prepare counselors. Indeed, information from this study is pertinent to students considering counseling careers, to employers selecting among job candidates, and to researchers, practitioners, and educators in generating resources (Vacc & Charkow, 1999).

Few studies have attempted to evaluate the quality of trainees' conceptual abilities in relationship to specialized preparation in CACREP-approved programs. More importantly here, no studies have been found that evaluated comparatively the conceptual capabilities and subsequent treatment planning of trainees in CACREP-approved programs for the specialized training of mental health counselors or marriage and family counselors/therapists. When conceptualization constructs and abilities have been examined, the research has tended to explore differences between novice and expert counselors (e.g., Borders, Fong-Beyette, & Cron, 1988; Etringer, Hillerbrand, & Claiborne, 1995; Hillerbrand & Claiborn, 1990; Kivlighan & Quigley, 1991; Martin, Slemon, Hiebert, Hallberg, & Cummings, 1989), propose training and supervision modalities that are epistemologically consistent with specialization area (e.g., Britton, Rak, Cimim, & Shepherd, 1999; Epstein, Bishop, & Levin, 1978; Guntern, 1981), or investigate training from a within specialization perspective (e.g., Simmons & Doherty, 1998).

While these studies have shown relationships among various aspects of

counselors' conceptual abilities and counseling, much remains unknown. For example, what is the association between trainees' conceptualizations of presenting problems and academic training? How are the goals of therapy and modalities of treatment, along with the assignment and frequency of diagnoses, associated with academic taining? How are






13

a trainee's disciplinary association and other counselor development variables associated with conceptualization? And at what points in the counseling program do conceptual changes occur?

As noted, no studies have been found that focused on the conceptual abilities of trainees in differing programs and levels of training. Accordingly, along with the consistently significant attention by professionals addressing the importance of trainees' conceptual abilities (Nelson & Neufeldt, 1998), this study contributes to better understanding of counselor trainee conceptualization and treatment planning within an area of specialized counselor training and as influenced by relevant educational, experiential, and personal variables. This study also may be beneficial to students considering the counseling profession, employers, managed care professionals' understanding of professional distinctions and abilities to provide viable services, and researchers, educators, and practitioners seeking resources to support the advancement of the helping professions.

Eg-Wse of the Study

The purpose of this study is to examine the relationship between academic

training and conceptual ization of clients' concerns among master's and doctoral-level students currently enrolled in CACREP-approved mental health counseling or marriage and family counseling/therapy preparation programs. This line of inquiry is important because conceptual differences imply differing views of causality, composition of client systems, and focus of therapeutic interaction among mental health service providers (Huber & Carlson, 1994; Sluzki, 1981; Worden, 1994). This study also will contribute to the available knowledge about current training procedures and counselor trainees'






14

conceptualizations in regard to area of specialization, level of training experience, and self-identified professional orientation preference (Murdock, Banta, Stromseth, Viene, & Brown, 1998; Prochaska, & Norcross, 1983).

It is important to note that this study will not examine the relative merits of either area of specialization, nor does it address the longstanding debate about whether each specialization area is a freestanding profession or a specialization within a broader profession. The demonstrated efficacy of both specializations is acknowledged. mental health counseling and marriage and family counseling/therapy are viewed here within the framework established by CACREP, a perspective not intended to support either view of the profession-specialization debate.

Null Hyp2theses

The following hypotheses will be tested in this study:

1. There is no difference in trainees' conceptualization ratings based on a trainee's
age category.

2. There is no relationship between ratings of conceptualization and the number of
practice and/or internships trainees have completed.

3. There is no difference in trainees' conceptualization ratings based on gender.

4. There is no difference in trainees' conceptualization ratings based on academic
major (i.e., professional specialization).

5. There is no difference in trainees' conceptualization ratings based on academic
program level.

6. There is no difference in trainees' conceptualization ratings based on their
professional affiliation.

7. There is no difference in trainees' conceptualization ratings based on type of
program accreditation.

8. There is no difference in trainees' conceptualization ratings based on primary type
of practice. and/or internship experience.






15



9. There is no difference in trainees' conceptualization ratings based on professional
orientation of their respective primary supervisor/educator.

Definition of Terms

The following terms are defined here as they pertain to this inquiry.

Professional counselors are uniquely trained to focus on and find effective

solutions for the normal developmental conflicts of clients and/or to provide remediation, prevention, or educational counseling services (Gladding, 2000; Seiler, 1990). Professional counselors are typically trained in one or more areas of specialization, including but not limited to mental health and marriage and family counseling/therapy. They possess a minimum of a master's-level degree in counseling and are certified at the national level and/or licensed, credentialed, or certified in accordance with state law (Nugent, 2000; Vacc & Loesch, 2000).

Counselor trainee is a person currently enrolled in a master's or doctoral-level

counselor preparation (training) program, with a specialization in either MI-C or MFC/T.

Mental health counseling trainee is a person currently enrolled in a CACREPapproved program with a specialization in MHC.

Marriage and family counseling/therapy trainee is an individual currently enrolled in a CACREP-approved program with a specialization in marriage and family counseling/therapy.

Standards of preparation are professionally identified guidelines that ensure, through educational requirements and supervised experiences, that counselor trainees receive the minimum knowledge and skills necessary to perform effectively in the subsequent counseling work environment (Sweeney, 1995).






16

Specialty standards identify minimum levels of knowledge, skill, and supervised practice necessary to represent a designated specialty in the counseling profession (Seiler, 1990).

Accreditation "is awarded to professional programs within institutions or to occupational schools offering specific training skills and knowledge. Specialized accrediting bodies define standards of excellence in educational training programs for recognized professions. In addition to CACREP, other well-known specialized accrediting agencies include the American Bar Association, the American Medical Association, and the American Psychological Association" (CACREP, 2002, http://www.counseling.org/cacrep/student.htm) and the Commission on Accreditation for Marriage and Family Therapy Education.

Council for the Accreditation of Counseling and Related Educational Progrms (CACREP) is one of several counselor preparation program accrediting bodies. The CACREP orientation views effective counselor preparation to include educational and supervised training experiences in specified core curriculum areas and at least one area of specialization (e.g., MHC or MFCFI') (Vacc & Loesch, 2000).

Commission on Accreditation for Marriage and Family Therapy Education

(COAMFTFE) is an accrediting body for the preparation of marriage and family therapists. The standards of MIT preparation focus on understanding the concerns of clients from a contextual basis, to explore patterns of interaction, roles, rules, beliefs, life cycle development, and social, cultural, and familial influences (AAMFT, 1999).

Counseling speialty is a term that refers to a specific area of counseling in which a distinct body of knowledge and expertise has been identified (Remley, 1995).






17


Mental health counseling (MHC) is a counseling specialty that emphasizes

services to individuals, groups, or families in community, business, and private practice settings. Counseling services include prevention and treatment of client problems, as well as consultation services, vocational assistance, and provision of individual and/or family counseling services (Vacc & Loesch, 2000).

Marriage and family counseling/therapy (MFC/T) is a counseling specialty that emphasizes prevention of family/couple problems and intervention to help families/couples alleviate existing obstacles effectively to promote healthy growth and development of the family and/or couple unit. This focus, along with a systemic orientation, is presumed to be critical to effective counseling (Gladding, 2000; Nugent, 2000; Vacc & Loesch, 2000).

Conceptual system is "a schema that provides the basis by which the individual relates to the environmental [therapeutic situation] events [one] experiences" (Harvey, Hunt, & Schroder, 1961, p. 245).

Conceptualization is the manner in which a counselor trainee organizes the

multifaceted and variable concerns of clients (Harvey et al., 1961). It is intimately linked to treatment planning (Falvey, 2001).

Conceptual development is a process through which counselor trainees become able to formulate relevant clinical hypotheses, demonstrate increased ability to describe clients in interactive terms, and provide more prudent conceptual izations of specific counseling situations (Fong et al., 1997).

Treatment planning is a process in which counseling goals and objectives are

developed and progress is monitored. Treatment plans are designed to meet the assessed






18


needs of clients specifically (Johnson, 1997). The particular plan selected and followed is strongly connected to the counselor trainee's conceptualization. of clients' concerns (Falvey, 2001).

Training, for the purpose of this study, encompasses all aspects of counselor preparation including the dissemination of knowledge, clinical supervision, and curriculum development (Anderson & Rigazio-DiGilio, 1995).

Overview of the Remainder of the SNdy

Chapter I provided an overview of this study, including attention to the problem upon which this study is focused. Chapter 2 provides a review of literature pertinent to this study, including factors influential to the counseling profession and how counseling is conceptualized and practiced. The research methodology is presented in Chapter 3 and the results are presented in Chapter 4. Discussion of the research and its implications are presented in Chapter 5.














CHAPTER 2
REVIEW OF THE UTERATURE



This chapter presents a review of relevant literature and seeks to clarify how counselor trainees' conceptualizations are influenced by their training in counseling specializations represented by mental health counseling (NMC) and marriage and family therapy/counseling (MFC/T). Also included is a summary of the purpose and functions of the methodology and instrumentation employed.

Counselor Education

The profession of counseling, given life from the guidance movement and in opposition to traditional psychotherapy, is comprehensive and continually evolving (Gladding, 2000; Hollis, 1997). The profession's developmental history thus reflects a dynamic interaction between the needs of clients and society and how counseling professionals work to apply mental health, psychological, or human development principles effectively and ethically. These principles are applied through "cognitive, affective, behavioral or systemic interventions, [or] strategies that address wellness, personal growth, or career development, as well as pathology" (ACA, 2002, http://www.counseling.org/consumers-media/servingallpeople.htm). Effective preparation of counseling professionals demands "quality education and supervision in all work settings" (ACES, 2002, http://www.siu.edu/-,epsel/aces/). The types of courses,





19






20


settings in which courses are implemented, amount of client contact, and type and amount of supervision are some of the critical components of counselor education.

Professional accreditation plays a central role in the counselor education process (ACES, 2002; Hollis, 19917; Stevens-Smith, Hinkle, & Stahmann, 1993) and two accrediting associations are of particular relevance here. These two nationally recognized entities establish criteria and procedures to ensure the satisfactory preparation of counseling professionals: the Council for Accreditation of Counseling and Related Educational Programs (CACREP) and the Commission on Accreditation for Marriage and Family Therapy Education (COAMFTE). Standards of Training

Designating and continually evaluating the minimum proficiency levels for master's, doctoral, and post-degree clinical training programs in marriage and family therapy is the purpose of COAMFTE, which gained official recognition in 1978 by the U.S. Department of Education (COAMFTE, 1994). While CACREP and COAMFTE share the goal of assuring adequate preparation of professional counselors, they differ in philosophy and approach.

In 1949, the Commission on Accreditation for Marriage and Family Education (COAMFI'E) developed the first training standards for professionals seeking entry into the field of marriage and family counseling/therapy (Touliatos & Lindholm, 1992). For almost four decades, COAMFTE standards represented the exclusive path by which marriage and family counselors/therapists could obtain standardized training and establish a professional identity within the family of helping professionals.






21


COAMIFTE views marriage and family therapy as unique among helping

professions (e.g., social work, psychology, or counseling), a philosophy reflected in COAMFT B-accredited programs (Stevens-Smith et al., 1993) as well as by the title used by graduates to identify themselves in their work. Specifically, the preferred identity of MFCiT's trained within COAMFTE programs is marriage and family therapist; these MFCIT's are trained from an interactional and systemic perspective (Remley, 1992).

Established in 1981 by the American Counseling Association, CACREP's

accreditation standards encompass mental health counseling as well as marriage and family counseling at the master's degree level, and counselor education at the doctoral level (CACREP, 2001; Hollis, 1997). CACREP is the only accrediting body that addresses counseling needs at the master's degree level and in more than one type of counseling specialty (Sweeney, 1992). CACREP represents an alternative philosophical stance and path of standardized training for MFC/Ts; it views marriage and family counseling as a discipline within counseling (Remley, 1992). Consequently, CACREP accredited programs demand comprehensive training (e.g., foundations in career and group counseling) prior to and/or simultaneously with specialized training in marriage and family counseling (Stevens-Smith et al., 1993). Their preferred identity is as a marriage and family counselor.

Accredited programs vary in scope and curriculum content, as well as in required clinical experiences. The significance of the title distinctions influences the methodology (e.g., sampling) of this study and has implications for evaluation of findings and future research. The distinctions derived from the differing philosophies do not bring into question the competency of counselors/therapists trained in either CACREP or






22


COAMFTE-approved programs. Competency is not based on whether MFC/T is defined as a discipline unto itself or a specialty within the field of counseling. Rather, it is based on course work and practicum. and internship sufficiency, and the experience and competence of faculty providing training. Therefore, both CACREP and CGAMFTE are prepared to promote training of competent MFC/Ts (Stevens-Smith et al., 1993). CACREP: Role in counselor preparation

CACREP, the largest accreditation organization for counselor training, accredits specialties, not general counseling programs. Consistent with the philosophical stance of ACA, CACREP calls first for the preparation of individuals as counselors and secondly as counseling specialists. The CACREP standards are designed to ensure that students/trainees develop a professional counselor identity, master the knowledge and skills necessary to practice effectively, and possess at least the minimum competence for careers in counseling practice, education, and/or research. The standards also ensure development of an understanding and commitment to lifelong continuing education and review of professional standards necessary to promote effective professionals in an everchanging world (CACREP, 2001; Steinhauser & Bradley, 1983).

At the master's level, CACREP accredits five areas of specialization, including

MI-C and MFC/T. As of June 06, 2002, CACREP reported 27 MHC-accredited programs and 26 MH-C/T-accredited programs. For all specializations, trainees are required to possess demonstrated knowledge in eight common core areas and to complete supervised practica and internships satisfactorily. The required eight core elements include study in human growth and development, social and cultural foundations, helping relationships, group work, career and lifestyle development, appraisal, professional orientation, and






23


research. Masters-level training consists of at least 60 semester credit hours, within which trainees complete the required elements of the core curriculum and studies within their selected area of specialization (CACREP, 2001; Sweeney, 1995).

An important caveat of this study is that while CACREP standards generally describe programs in MHC and MFCiT, they do not define what constitutes these specialties. The CACREP specialty standards for MHC and MFC/T require similar curricular experiences, yet there is uniqueness to each area of specialization, including foundations, contextual dimensions, clinical experiences, and essential skills (CACREP, 2001).

At the doctoral level, CACREP accredits counselor education and supervision

programs; 43 programs were accredited as of mid-2002. A primary obligation of doctoral programs is to advance "the knowledge base of the counseling profession in a climate of scholarly inquiry" (CACREP, 2001;

http://www.counseling.org/cacrep/200Istandards7O0.htm). Doctoral-level trainees must meet all entry/master's-level requirements, plus an additional 36-semester hours of graduate-level study. These latter studies are designed to prepare them to work as advanced (i.e., more competent) practitioners in clinical and academic settings, to be leaders of the profession, to generate new knowledge through research, and to work as counselor educators and supervisors. "It is expected that doctoral students will have experiences that are designed to develop an area of professional counseling expertise" (e.g., MHC, MFC/T) (CACREP, 2001,

http://www.counseling.org/cacrep/2001standards7O.httn).






24


COAMFTE: Role in counselor education

COAMFTE, specializing in the accreditation of marriage and family programs, seeks to foster quality assurance and continued program improvement to graduate level training programs and post-degree clinical training centers. In cooperation with state licensing and certification boards and the Association of Marital and Family Regulatory Boards (AMFTRB), COAMFTFE operates autonomously within AAMFT, its parent organization. As such, COAMF~rE is concerned with ensuring that accredited programs are providing professional caliber training (COAMFTE, 2002a; Smith & Nichols, 1979; Wendorf, 1984). COAMFI'B aims to provide optimal objectivity in the process of program accreditation while facilitating maximum input from professionals and the public in what constitutes the continually evolving minimum level of training for competent MFTs (COAMFTE, 2002a, Smith & Nichols, 1979).

At the master's level, COAMFTE standards are designed to meet minimum level requirements for graduates to enter and effectively engage in clinical practice. Trainees thus are provided a foundation in professional development and basic clinical and didactic skills. At the doctoral level, the curriculum is focused on advanced MFT' theory, research, and supervision. This level of training is designed to prepare trainees adequately for work in academia, research, and/or advanced clinical practice and supervision. Postgraduate degree clinical institutions provide further clinical training for trainees who have achieved a master's or doctoral degree. It is not unusual for this type of training to allow trainees to focus on clinical work with a particular population and/or within a particular modality of treatment (COAMFTE, 2002a).






25


As of mid-2002, 81 programs, in 37 states and four Canadian provinces, were

accredited by COAMFTE. Of these, 50 were master's level, 15 were doctoral level, and 16 were post-graduate training centers. Eleven other programs had achieved candidacy status, with eight at the master's level and three at the doctoral level. States and provinces not having at least one accredited MF T program include Alaska, Arizona, Delaware, Hawaii, Idaho, Maine, Montana, Nevada, New Mexico, Vermont, West Virginia, Wyoming, and the Canadian province of British Columbia (COAMF TE, 2002b).

COAM~FE standards evolved and continue to develop in accordance with the unique needs of the profession of marriage and family therapy. The standards are based on a respect and understanding of diversity and non-discrimination from a relational view of life. Graduates of COAMFTE accredited programs are presumed to be qualified to "diagnose and treat mental and emotional disorders, whether cognitive, affective, or behavioral, within the context of marriage and family systems, [delivering] professional services to individuals, couples and families for the purpose of treating such diagnosed nervous and mental disorders" (COAMFTE, 2002a, http://www.aamft.org/about/coamfte/standards-of accreditation.htm).

Within AAMFT's philosophical stance, COAMFTE standards reflect two

distinctive features. First, COAMIFTE specifies that all training be relational, contextualconnected, and culturally sensitive regardless of treatment modality (e.g., individual or multiple person contact), diagnostic environment (e.g., traditional DSM IV TR or relational), and whether a client's concerns are presented as being directly related to marriage and family issues. Second, the standards emphasize relational, direct-clientcontact experience (COAMFT, 2002a; Smith & Nichols, 1979).






26


CACREP and COAMFTE Compared

The differing philosophical orientations of COAMFTE and CACREP relative to

training of counseling professionals are reflected through differences in training standards

and curriculum that contribute to the respective professional identities. Through an

analysis of the current standards established by COAMFTE (Version 10.1) and CACREP

(2001 standards) and the work of Stevens-Smith and colleagues (1993), the following are

comparative observations of COAMIFTE and CACREP programs.

At the master's level:

CACREP requires 60 semester-hours while COAMFTE requires 45 semesterhours. CACREP's additional hours reflect primarily further training in
individual counseling, psychotherapy, career counseling, human growth and
development, and group dynamics.

COAMFTE holds that all educational experiences will be based on a
"relational view of life in which an understanding and respect for diversity and non-discrimination are fundamentally addressed, practiced, and valued.
Based on this view, marriage and family therapy is a professional orientation
toward life and is applicable to a wide variety of circumstances, including individual, couple, family, group, and community problems" (COAMFTE,
2002a, http://www.aamft.org/about/coamfte/standards-of accreditation.htm).
CACREP attends to a systems/relational understanding of peoples' lives
primarily within educational experiences for trainees specializing in marriage and family counseling. The eight core areas of counselor training in CACREP
are not dictated to reflect a relational perspective of peoples' lives.

CACREP requires fewer client face-to-face (e.g., counselor/therapist and
client) contact hours than COAMFTE. Between the practice (40 hours) and
internships (240 hours), CACREP requires a total of 280 direct-client-contact
hours, including individual and group counseling experiences. CACREP
classifies the 240 direct-client-contact internship hours as the point at which
trainees are to work primarily with couple and family units. COAMFTE requires 400 direct client contact hours, with at least 250 of these hours
occurring with couples or families present in the therapy room.

Training in assessment, diagnosis, and treatment are required by COAMFFE
and CACREP. Neither body endorses a pathology-based perspective of mental
health.






27


"Program faculty must have an earned doctoral degree in counselor education
or a closely related field and experience (e.g., publication or clinical practice)
relevant to the specialization of marriage and family counseling in order to
meet qualifications within CACREP accredited programs. COAMFiFE faculty
must meet clinical practice standards, as established by the American
Association of Marriage and Family Therapy (AAMFf), and be actively engaged in clinical practice and scholarship. CACREP and COAMFTE
faculty respectfully identify with their professions through membership and involvement in professional organizations, ACA and AAMFT respectively.

COAMFTE programs must have at least two AAMF1' Approved Supervisors
and a third faculty member who is a Supervisor in Training (SIT). CACREP
programs require clinical instruction faculty/supervisors to have a doctoral
degree and/or appropriate marriage and family clinical preparation.

At the doctoral level:

CACREP and COAMETE assume that doctoral trainees have completed
entry-level requirements within their respective accrediting guidelines. Should
this not be the case, students must attend to entry-level requirements prior to
the doctoral curriculum.

COAMFIE requires an additional 42 semester hours of didactic experience.
CACREP requires an additional 36 semester hours of didactic instruction.

COAMFT1E requires a doctoral trainee's dissertation to be in the field of MET.
CACREP makes no such specification.

Both accrediting body guidelines are designed to promote and refine advanced
counseling skills, with trainees developing professional counseling expertise (West, Bubenzer, Brooks, & Hackney, 1995). CACREP specifies that an area (e.g., MFCiT) of counseling expertise be conceptually linked to teaching and
supervision. COAMFTE makes no such direct specification.

COAMFIE requires an additional 600 direct client contact hours above entrylevel standards and a minimum nine-month, supervised internship
emphasizing relationally focused practice and/or research. A total of 600
clock hours, not limited to face-to-face counseling, are allotted to CACREP's required internship experiences. These hours include supervised experiences
in teaching, supervision, and clinical settings. Allocation of the CACREP required clock hours, which are appropriate to a trainee's career goals, is
determined by the doctoral trainee and his/her advisor(s).

Counselor educators are dedicated to educating trainees as comprehensively and

responsibly as possible (Gerber, 2001; Hitchcock, 1986; Nelson & Neufeldt, 1998;






28


Sexton, 1998b). Standards, designed in accordance with the needs of a dynamic society, guide counselor educators in this task (Wilcoxon, 1990). As such, an established, yet fluid, set of knowledge content areas and competencies are vital to the preparation of competent counselors (Nelson et al., 1998). The ultimate reflection of these competencies is the trainee's ability to understand and address client concerns adequately and accurately.

Importance of Conceptualization to Counselor Development

The value of conceptual abilities lies in it being a means of organizing client information, providing a common language, and having a framework from which treatment plans may be guided, implemented, and evaluated (Beavers, 1981). Counseling trainees must have a theoretically sound and justifiable reason for making assessments and plans (Hitchcock, 1986). Nelson and Neufeldt's (1998) critical examination in counselor education pedagogy revealed that the development of trainees' abilities to understand and address client concerns (also referred to as conceptualization) to be a highly valued component of training.

A chronological review of the development of counseling, and subsequently the manner in which trainees are prepared to work with clients, reveals an evolving philosophical and theoretical progression of choices that correspond to the social, political, and health-related needs of a dynamic society (Gerber, 2001; Piercy, Sprenkle, Wetchler, & Associates, 1996). For example, in the 1960s, the "guidance" view of counseling, and in particular the work of E.G. Williamson (1950), yielded a "directive counseling" approach to conceptualizing a client's concerns. That is, clients were viewed through a lens of deficiency; clients lacked some knowledge, ability, or insight in which






29

the counselor was expert. Counselors who learned and utilized this perspective identified a client deficiency and "directed" (i.e., gave information and/or instruction) to the client to solve a particular insufficiency in a particular way.

An alternative view of counseling, and therefore of conceptualizing an

individual's problems, was the work of Carl Rogers (Zimring & Raskin, 1992). Rogers rejected directive approaches to individual therapy, and his counseling approach became known as nondirectivee counseling" (Corey, 1996). In it, counselors were not all knowing or even in possession of the solution to an individual's problem. Indeed, clients are viewed as possessing the basic resources to solve whatever the presenting concern might be. What clients needed from a therapist/counselor was an atmosphere of "unconditional positive regard" in which a client experienced acceptance (not judgment) from the counselor in regard to whatever feelings the client was experiencing. A counselor working from this perspective viewed his/her work as the process of clarifying a client's feelings, thereby facilitating a client's insight and subsequent resolution of a problem.

These examples are illustrative of the many ways in which counseling/therapy has been, and continues to be, evolving in relation to various forms of viewing the human condition. Indeed, many shifts in thinking and theoretical paradigms have influenced the field of counseling and the manner in which counselors/therapists conceptualize client concerns (Corey, 1996). The analytic paradigm, from which the previous examples were either derived or a reaction to, is broadly based on personality reconstruction, insight, and unconscious motivation. For example, the philosophical foundations of existentialism focus on the meaning of being "fully human" (p. 8), giving particular attention to the






30


concepts of freedom, choice, responsibility, autonomy, purpose, and the anxiety created by the need to find meaning in a world deficient in inherent meaning. The humanistic paradigm, which shares many of the philosophical underpinnings of existentialism, holds a less anxiety-based view of finding meaning in life. In essence, humanists believe that, if provided with the appropriate conditions, a person will naturally be empowered to develop his/her capacities and find meaning in life. Accordingly, a counselor/therapist would not actively intervene or give direction in a client's life. Instead, the counselor's/therapist's work would be to create an authentic relationship with the client that would empower the client's natural capacities toward positive growth.

In yet another shift in thinking, some counseling approaches emphasized action with specific behaviors. An action orientation in its infancy focused on and demonstrated that Behavioral conditioning approaches to solving client problems are sometimes considered viable alternatives to insight-oriented approaches. An action orientation represents a fundamental departure from an analytic conceptualization of client concerns and the process of therapeutic work.

A systemic paradigm, born of Bateson's studies in cybernetics (Piercy et al., 1996), represented another conceptual shift that challenged the aforementioned frameworks for understanding client concerns, the origins of the concerns, and approach to treatment. In a systemic view, an individual is best understood as being intimately connected to larger systems (e.g., family or peers). Thus it requires the larger context of an individual's life to be addressed in order to provide counseling/therapy adequately and accurately (Piercy et al., 1996).






31

Each of these theoretical paradigms can form the foundation of counseling. Yet there are many variations (e.g., theories of counseling) bom of each paradigm and/or reconstituted by virtue of the introduction of a new paradigmatic shift; they generally vary in the way an individual is viewed in relationship to the presenting problem. Simplistically, the representative paradigms focus on resolving the problem by change occurring within an individual or changing the system to address the concerns of the individual (Corey, 1996; Smith, Carlson, Stevens-Smith, & Dennison, 1995). Each of these broad paradigms offers ways to conceptualize client concerns and an approach to treatment (Nichols & Schwartz, 1998).

Case conceptualization, also known as clinical hypothesis formation, is

substantially spotlighted in the counseling literature. The literature reflects a common manner of applying the paradigms and addressing trainees' abilities to evaluate client concerns appropriately and accurately and to make sound clinical decisions through the implementation of various counseling models. Schwitzer (1996) provided a sequential clinical decision-making model to facilitate trainees' abilities to conceptualize effectively. Beavers (1981) also designed a classification system for family counselors/therapists derived from an assessment of a family's operating style and competence in task performance. Matching a particular theory and applicable intervention to a specific client concern as a method of trainee case conceptualization development thus has been proposed in multiple forms and by many different professionals (e.g., Breulin, Schwartz, & Mac Kune-Karrer, 1997; Hutchins, 1979; Murdock, 1991; Preston, 1998).






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Given society's demand for effective counseling strategies, the development of numerous conceptual models is not surprising (Mueller, Dupuy, & Hutchins, 1995). Counselor educators give considerable attention to enhancing the effectiveness of trainees' capacity to reason and to make theoretically sound clinical hypotheses and treatment/intervention decisions (Gerber, 2001; Nelson & Neufeldt, 1998). In light of the profound importance conceptualization plays in the work of MHCs and MFC/Ts, it stands to reason that a growing interest in understanding the conceptualization characteristics of professionals' therapeutic interactions with clients would be evident in the professional literature. Indeed, a growing interest can be found, particularly as it relates to conceptual skill level differentiation between novice and expert counselors (e.g., Goldberg, 1974; Holloway & Wolleat, 1980). Also present in the literature are conceptualization distinctions among the various nationally recognized helping professions (e.g., psychologists, marriage and family therapists, and social workers). A budding interest is evident in the area of trainee conceptualization development; however, there is a paucity of evidence on the conceptualization characteristics of students/trainees as they relate to their selected areas of specialized counselor training.

As noted, CACREP does not define areas of specialization other than by specific standards of training. Their standards also do not attest to how an area of specialization impacts the manner in which a trainee will conceptualize client concerns. Yet it is assumed that trainees will develop particular ways of working with clients based on the perspectives valued within a particular specialization. An understanding of the origins of these dilemmas, within the larger context of counseling, provides a foundation for






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illuminating the distinct qualities that both connect and distinguish the conceptualization perspectives and treatment planning activities of MHCs and MFC/Ts.

Key Conceptual Issues in M4HC and MFC/T

Counseling has many definitions depending on the context in which it is applied. For some, the answer to the question, "what is counseling?" is readily apparent and even axiomatic; it is a process in which a professionally trained counselor/therapist engages in a relationship with at least one other person to help resolve a problem. To others, the meaning is not so self-evident. For example, counseling, when applied to society's laws and regulations, has legal connotations. "Financial counseling" is often used to convey exchange assistance to address or enhance a person's fiscal and security base. Webster's dictionary defines counseling as "advice: opinion or instruction regarding the judgment or conduct of another" (Costello, 1995, p.3 10). Similarly, the application of counseling within the context of managing personnel commonly relates to disciplinary processes. Yet while counseling falls into a category of "semantic promiscuity" (Clare & Thompson, 1981), counseling within the context of psychotherapy practice, and regardless of the specialty or discipline, is concerned with addressing clients' personal and emotional concerns in a climate of confidentiality (Feltham, 1995).

Feltman (1995) noted that the history of counseling (e.g., separating counseling from the notion of advice-giving), semantics (e.g., inherent difficulty in defining concepts), and professionalization. (e.g., need for professions to create boundaries that ensure a place for each profession within the overall professional community) dramatically influence the meaning of counseling. In light of these integrally connected factors, a single common definition of counseling may be impossible to achieve.






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ACA, the organization from which the CACREP standards evolved and continue to be evaluated, does not define counseling. It follows that CACREP does not specifically define any of its counseling specialties. The fact that these professionals cannot come to a consensus about what specialists (e.g., MHCs and MFC/Ts) do and how they differ is not surprising. Reference to ACA's philosophy about counseling and the CACREP standards readily suggests that counselors trained in an area of specialization will be trained in many similar capacities. However, MHCs and MFC/Ts also will receive distinct training experiences. This state of affairs creates an interesting challenge particularly salient to this study. However, three specific areas, derived from professional practice, research, and education of MHCs and MFC/Ts, constitute a basis for evaluating the conceptualization qualities of trainees prepared in MHC and MFC/T programs. Similarities Between the Disciplines

While counseling has not been defined, ACA has endorsed a definition of the practice of counseling (Gladding, 2000). MHCs and MFC/Ts thus are a part of the counseling profession in which trainees complete a required course of study, adhere to ethical codes that protect the public interest, and are actively involved in addressing various concerns that clients encounter. MHCs and MFC/Ts are able to address a wide range of client concerns, including prevention, normal growth and development, and remediation of mental disorders. Trainees work with individuals, groups, couples, and families and base their work on various theories. Beyond MHFC's and MFC/T's primary role in direct client services, they also are prepared to engage in various capacities (e.g., consultation, diagnostic evaluation, education, and crisis intervention) that meet the needs of a diverse society (Gladding 2000; Nugent, 2000).






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NIHC and MFCJT share more than the aforementioned general principles;

however, in 1991, Home and Passmore noted that a major similarity between MHC and MFC/T centers on theory. Trainees in MHC and MFC/T all are provided with broad philosophical and psychological backgrounds. Theories employed in MHC also are employed in MFC/T, including Adlerian theory, reality therapies, Gestalt theory, and behavioral approaches, among others. Training in multiple theoretical approaches allows trainees to evaluate the worth of a particular approach independently (Nugent, 2000).

MHC and MFC/T also share a number of basic assumptions. Both specialties

focus on problems between the environment and the individual;

are developmental; and

acknowledge the importance and influence of family in an individual's life
(Gladding, 2000).

However, although MHC and MFCIT share many foundation elements, the philosophy within which the respectively trained student is prepared to apply the assumptions is globally different (Beavers, 1981; Gladding, 2000; Huber, & Carlson, 1994; Hurvitz & Strauss, 1991; Nugent, 2000; Smith et al., 1995). Differences Between the Disciplines

Theoretically, MFC/T trainees must learn additional theories (e.g., structural, strategic, and solution-focused) as well as new applications of shared theories. For example, shared assumptions are conceptualized differently based on the manner in which MHCs and MFC/Ts view all aspects of human behavior. These two counseling specializations tend to differ on three levels. The key dimensions, referring to MHC and MFCIT, include movement from individual to system's dynamics, a shift from linear to a circular view of causality, and a focus on content versus process dynamics.






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Conceptualization is significantly impacted when trainees view clients' concerns in these alternative ways (Huber & Carlson, 1994; Worden, 1994). Individual versus Systems Dynamics

Individual dynamics focus on the "identified client's" experiences, with particular attention given to interpersonal experiences (i.e., conscious and unconscious thought). An MHC's theoretical foundation is embedded in individual dynamics. The primary goal of this perspective is to bring about therapeutic change from within an individual (Huber & Carlson, 1994; Worden, 1994). A symptom is viewed as expression of a problem and also as an ineffective way to resolve inner conflict (Beavers, 1981). In other words, a trainee employing this orientation conceptualizes an "identified client's" concerns with an idea that resolution falls primarily within the landscape of altering a cognitive, affective, and/or behavioral aspect of a client's personality. An individual perspective does not ignore social interaction and development; indeed, an individually oriented trainee is interested in knowing about a client's life experiences and the quality of his/her relationships. Nonetheless, the conceptual focus remains on exploring the manner in which a person responds to internal demands. Subsequently, treatment plans are designed to promote change within the personality of a presenting client (Corey, 1996; Huber & Carlson, 1994; Smith et al., 1995; Worden, 1994).

Systems dynamics, the theoretical foundation for MFC/T, creates a different lens through which trainees conceptualize clinical concerns and engage in the process of therapeutic change (Sexton, 1994). A symptom is viewed as a reflection of and an attempt to resolve relational conflict. A systemic orientation does not ignore the concept that symptoms also may be a reflection of internal conflict that a person is attempting to






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resolve. However, systemic trainees are "concerned with the interactional effects of symptomatic behaviors rather individual motivations or intentions" (p.250). Thus, a trainee working from a systemic lens does not conceptualize an individual's behavior in isolation, but develops an understanding of a client's concerns as being integrally related to a broader context. Systemic thinking prompts a student/trainee to be concerned with repeated patterns of interpersonal interactions that ultimately organize as rules and roles to establish consistency within a client's relational systems (Hoffman, 1981; Sexton, 1994). Essentially, this perspective is guided by the principle that the whole is greater than the sum of its parts (Worden, 1994). Because of this interdependent view of human behavior, intervention/treatment plans aim to facilitate change in a larger context or in specific interpersonal relationships. Therefore, change applied to any part of an individual's relational systems will impact other parts of the immediate system and beyond, which will consequentially address an individual's symptoms (Beavers, 1981; Corey, 1996; Huber & Carlson, 1994; Smith et al., 1995; Worden, 1994). Linear versus Circular Causality

A shift from an individual to a systems perspective not only changes the nature of a problem but also influences the notion of causality explored in programs specializing in the education and training of MHCs or MFC/Ts. Generally, individual points of view support the notion of linear causality, while a systemic perspective yields a circular notion of causality. Like the sequential fall of dominoes placed in a straight line, linear causality follows that event A causes event B and so on. As such, the focus of counseling is on the "cause" of the problem. Linear causality suggests that a person possesses some psychological trait that is causing the problem. Therefore, treatment is designed to change






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some part of an individual's personality that is creating the problem (Corey, 1996; Huber & Carlson, 1994; Strong & Claiborn, 1982; Worden, 1994). This type of approach also is known as first-order change (Watzlawick, Weakiand, & Fisch, 1974).

In first-order change, a trainee identifies the most logical "cause"~ of a problem and subsequently targets the "cause" in an intervention plan (Watzlawick et al., 1974). Again, this view of causality and approach to treatment is a common element of MHC practice (Corey, 1996; Huber & Carlson, 1994; Strong & Claiborn, 1982; Worden, 1994).

An alternative to linear causality is the notion of circular causality, which is often referred to as second-order change by systemically oriented trainees (Watzlawick et al., 1974; Worden, 1994). Circular causality views a client's behavior as reactionary to other members of a client's system (e.g., family) and a client's behavior simultaneously influences other members' behaviors. In the traditional language of MFCIT, this process of understanding the cause of behavior is often referred to as feedback loops, i.e., naturally occurring processes within all systems. This process guarantees that a particular system maintains a steady state and/or progresses toward a particular goal. Feedback loops may be negative or positive, depending on the degree to which a particular system reduces deviation from the status quo or encourages change (Becvar & Becvar, 1996; Nichols & Schwartz, 1998).

When the concept of circular causality is applied to a client, a trainee will focus on several key features of the client's situation. He/she attempts to discern the "rules" of the client's influencing systems that govern the range of acceptable behavior. Second, the tools that are used within a client's systemic world to enforce the spoken and unspoken rules of behavior are sought. In addition, a circular view of causality is concerned with






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the patterns of interaction surrounding a client's problem. For example, how does a family react to a problem? What is the sequence of a family's reactions? What are the existing feedback loops around a client's concern? This principle, when applied to counseling/therapy, prompts the trainee to evaluate how systems, of which a client is an intimate part, manage challenges to the established rules. Such challenges may be external and/or internal to a client's most familiar and immediate systemic membership (Becvar & Beovar, 1996; Nichols & Schwartz, 1998).

Change in the rules of a client's system is known as second-order change. This level of change is distinguishable from first-order change in that the latter does not change the rules of a client system, only the behavior surrounding a particular problem (Watzlawick et al., 1974). According to Nichols and Schwartz (1998), this distinction represents a pivotal conceptual shift in counseling. In essence, linear causality prepares a trainee to conceptualize a client's problem as something that is caused by past occurrences. Subsequently, MHCs traditionally focus on treatment designed to change a particular personality characteristic (first-order change) that has been identified as the causes" of a problem. Conversely, MFC/Ts trained in the concept of circular causality see a client's problem as something that is part of a continuing, circular feedback loop. A MFCJI' trainee's attention is thereby drawn toward viewing an individual's presenting problem as part of a broader context of recurring, self-perpetuating cycles of interaction. Such cycles may be adaptive and encourage the healthy growth and development of a system and its respective members both within a system (e.g., couple) and in relationship to larger systems (e.g., family-of-origin). Or, interactive cycles may be maladaptive, producing symptoms within one (e.g., client, father, or husband) or more members of a






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particular system (e.g., family). In terms of MIFC/T-oriented practice, the maladaptive patterns of interaction become the focus of treatment, often centered on changing the rules (second-order change) (Becvar & Becvar, 1996; Huber & Carlson, 1994; Nichols & Schwartz, 1998; Resnikoff, 1981; Sexton, 1994; Strong & Claiborne 1982; Worden, 1994).

It is important to note that first and second-order changes are not mutually

exclusive to the work and treatment focus of either MHCs or MFC/Ts. However, the respective levels of therapeutic change are traditionally associated with a particular conceptualization of causality, which is in turn traditionally promoted within a particular specialized program of training. Accordingly, linear causality is usually associated with MI-C and circular causality is usually associated with MFC/T (Becvar & Becvar, 1996; Huber & Carlson, 1994; Nichols & Schwartz, 1998; Strong & Claiborne, 1982; Worden, 1994).

Content versus Process Dynamics

Just as the shift between an individual and a systemic perspective evolved from a shift in the conceptualization of causality, the alternative perspectives draw trainees to different issues occurring in the counseling/therapy process. Worden (1994) referred to this shift as content versus process and defined it as follows. Content refers to the concrete issues being presented in a counseling/therapy session. In other words, the "what" of a counseling/therapeutic discussion is often the focus of individually, linearbased conceptualization. and treatment planning. Process refers to the "systemic series of interactions" (p. 7) lying beneath a counseling/therapeutic discussion. More to the point, process encourages students/trainees to focus on how a particular counseling/therapy






41


topic of discussion is interactionally embodied by the members of a client's system. The content-oriented trainee focuses on resolving and negotiating solutions to presenting issues. The process-oriented trainee is concerned with maladaptive patterns supporting the content issue. Respectively, the conceptualizations of MHCs and MFCITs have been distinguishable by a content versus process focus within a counseling/therapy session.

In summary, MHC and MFC/T are distinguishable by three closely connected concepts. MHC emphasizes an individual perspective of behavior, linear causality, and content resolution. MFC/T emphasizes a systemic perspective of behavior, circular causality, and a focus on process over content. Each point of view offers a unique means of conceptualizing client concerns and intervening in treatment, and neither paradigm diminishes the value of the other. Further, each perspective may be best thought of as a general way of understanding problems, how they occur, and how they may be resolved effectively, as opposed to a standardized theory of counseling (Worden, 1994).

Studies Related to Counselor Trainee's Conceptual Development

Case conceptualization plays a central role in the counseling/therapy process

(Nathan, 1998). In working with a client, a counselor/therapist must come to understand a client's problem and make a tentative plan of action that will best address the client's needs (Strohmer & Newman, 1983). Conceptualization has received attention from all major schools of therapy as well as from the decision-making field (Waddington, 1997). The focus of this attention has been widely dispersed, including experimental studies of clinical judgment (e.g., Friedlander & Phillips, 1984; Herbert, Nelson, & Herbert, 1988; Spengler & Strohmer, 1994); professional commentary on clinical judgment (e.g., Dumont & Leconte, 1987; Rock, Bransford, Maisto, & Morey 1987); theory specific






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models of conceptualization (e.g., Andersen, 1992; Barber & Crits-Christoph, 1993; Haynes & O'Brien, 1990; Persons, 1989); attempts to understand conceptualization as it is influenced by a human's (limited) information-processing capacity (e.g., Garb, 1998); explanations of how heuristics (i.e., decision-rules) influence conceptualization (e.g., Garb, 1998; Tversky & Kahueman, 1973); research on accuracy of practitioners' clinical hypotheses (e.g., Garb, 1998; Schinka & Sines, 1974; Turner, 1966); attempts to understand the relationship of conceptualization to a counselor's/therapist's ability to integrate large quantities of client-related data in multidimensional ways (cognitive complexity) (e.g., Spengler & Strohiner, 1994); and the impact of client characteristics on counselor/therapist conceptualization (e.g., Garb, 1998; Stevens, 1981).

The considerable breadth of research and literature suggests that, in general, conceptualization and treatment recommendations depend on the manner in which a helping professional views the origin of a client's concerns. However, this conclusion is dependent upon a number of factors (Langer & Abelson, 1974; Plous & Zimbardo, 1986; Snyder, 1977). For example, counselor/therapist demographic variables represent one of the factors believed to impact conceptualization (Falvey, 2001; Shueman, 1997; Skovholt & Ronnestad, 1992).

The professional community's interest in conceptual development and practice has been intensified by the changing quality of health care policy (Falvey, 2001). In recent years, the managed care industry has become a powerful force in determining which mental health service providers are allowed to practice and to be reimbursed for their services. As a result, mental health providers have found it necessary to demonstrate their fitness to provide services through presentation of their academic training, level of






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education, experience, and professional credentials (Falvey, 2001; Shueman, 1997). However, relevant research presents conflicting results about how counselor/therapist demographic variables impact counseling, the result of which is little professional consensus (e.g., Dawes, 1989; Garb, 1998; Gil-Adi & Newman, 1984; Skovholt & Ronnestad, 1992).

Fully investigating the complex nature of conceptualization is beyond the scope of this research. However, one aim of this study is to provide data that will contribute to the overall task. Therefore, this study focuses on the impact of some trainee demographic variables relevant to case conceptualization and treatment planning.

Conceptualization. and treatment planning are widely recognized as essential competencies of counselors (Falvey, 2001; Garb, 1998; Mordock, 1994; O'Donohue, Fisher, Plaud, & Curtis, 1990). Therefore, understanding how ft-ainee demographic variables shape these critical counselor/therapist abilities is important to multiple entities, such as the counseling profession, consumers, counselor educators, and the health care industry. The remainder of this section presents a representative sampling of what has been studied regarding counselor/therapist demographic variables. The Influence of Demographic Variables

The majority of relevant research has investigated samples of the helping professional population outside the focus of this study. That is, trainees enrolled in academically-based counseling programs and being trained within a selected area of specialization have received little attention in regard to understanding their conceptualization and treatment planning and relationships fi-ainee demographic variables have to these tasks (Anderson, 1992). Further, even within the existing research, the






44

findings are conflicting. Some research (e.g., Bishop & Richards, 1984; Falvey & Hebert, 1992; Garb, 1989; Gil-Ali & Newman, 1984; Lambert & Wertheimer, 1988) supports the notion that counselor/therapist demographics (e.g., degree, work setting, experience, professional orientation, or supervisor's/mentor's professional orientation) influence conceptualization and treatment planning. Other research (e.g., Rock et al., 1987; Spengler & Strohmer, 1994; Strohmer & Spengler, 1993; Turner & Kofoed, 1984) concludes that counselor/therapist demographic variables do not significantly influence conceptualization or treatment planning.

Brickman and associates (1982) stated that a helping professional's socialization through a particular professional affiliation is influential to treatment approach. Several studies support this contention. For example, Pious and Zimbardo (1986) investigated the conceptualization and treatment recommendations of professionals in relation to academic training (i.e., psychoanalysts, behavior therapists, and undergraduate students taking their first psychology course), level of education (i.e., no degree, masters, doctorate, or M.D.), and self-selected theoretical orientation (i.e., psychoanalytic, behavioral, or cognitive-behavioral). They suggested that diagnosis and treatment are strongly affected by a practitioner's professional orientation, and regardless of a client's presenting problems. Houts' (1984) study of doctoral-level trainees also supported the idea that a practitioner's orientation impacts conceptualization and treatment planning practices. However, when Kopta, Newman, McGovern, and Sandrock (1986) investigated the level of education, professional affiliation, and years of experience, they found that conceptualization varied significantly in accordance with the subject's professional affiliation.






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Professional affiliation also appeared to stand out as a distinguishing variable in a study conducted by Simmons and Doherty (1998). In their exploratory study of how academic training influences the manner in which clinical members of AAMFT from different training backgrounds (e.g., social work, psychology, counseling, or MFT) engaged in treatment provision, 60.5% of the study's population identified their professional affiliation as marriage and family therapy. As to the impact of academic training, the study offered no relationship between training and practice. It is important to note that these findings can be generalized only to credentialed N4FTs who are members of AAMFT; therefore, nothing can be gleaned about the influence of academic training in relationship to trainees' conceptualization and treatment.

Turner and Kofoed (1984) studied seventy-five mental health practitioners from social work, psychology, nursing, psychiatry, and alcohol/drug counseling. Their findings revealed that only social workers were inclined to shape their conceptualization of a client's problem in relationship to their professional affiliation. Similarly, Falvey's (1992) research on the treatment planning of experts in the fields of psychiatry, psychology, social work, psychiatric nursing, marriage and family therapy, and mental health counseling revealed no substantial differences based on professional affiliation.

Simmons' and Doherty's (1998) analysis found that a counselor's/therapist's gender and level of education (e.g., masters or doctorate obtained) had no substantial relationship to treatment planning and conceptualization. However, other studies found to the contrary regarding level of education. One example was Skovholt and Ronnestad's (1992) investigation of normative counselor/therapist development across the life span. Participants ranged from first year graduate-level trainees to practicing professionals with






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more than forty years in the field. The qualitative analysis was designed to account for both personal and professional sources of influence on development. Their study illustrated that the manner in which counselors/therapists conceptualize client issues progresses from being strongly externally regulated during training to being increasingly congruent with a counselor's/therapist's personality over time. The investigators noted that the nature of graduate education demands that trainees meet the approved competency standards of the profession's gatekeepers (e.g., supervisors and professors). Competency standards come in the form of examinations, structured practica and internships, and professional socialization. "A direct result of this enormous professional pressure is the development of externally imposed rigidity in many areas of professional functioning" (p. 507), such as conceptualization. Other studies suggest that training, level of education, supervisor's/advisor's professional affiliation, and experience are integrally related to one another as it pertains to their influence on conceptualization. and treatment planning.

Another study by Fong, Borders, Ethington, and Pitts (1997) illustrated the

findings of Skovholt and Ronnestad (1992) empirically. Specifically, "small incremental gains in counselor cognitive functioning" (1997, p. 107) were found to occur over time during a master's-level training program. The most prominent change occurred after trainees had completed a counseling skills course. At that point, trainees' conceptualizations were focused more on a client's psychological characteristics rather than on a client's physical characteristics and interactions.

Conceptualization also has been found to be influenced by interaction with

established professionals (e.g., supervisors, mentors, and advisors), peers, and personal






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life experiences While the extent to which these factors impact each person is unique, interpersonal encounters with established professionals and a trainee's age at the start of graduate-level training stood out over learned theories and empirical research results as being the most important developmental factors (Skovholt & Ronnestad, 1992). However, "theory and research is often mediated through [established professionals], and in this way, both people and knowledge are of importance" (p. 509).

Newer members of the field (e.g., start of graduate education and limited

experience) want "to learn from, model, please, and respect" (Skovholt & Ronnestad, 1992, p. 510) their professional elders. However, experienced professionals have moved beyond imitation and are more focused on expanding and clarifying their professional conceptualizations and approaches to treatment planning in a manner congruent with their personal sense of being. Beutler and McNabb (1981) found that the less experienced and the earlier in an education program a trainee was, the more likely he/she was influenced by the professional affiliation and preferred conceptualizations of his/her supervisor/advisor/mentor.

Regarding age at the start of graduate school, Skovholt and Ronnestad found that the older a beginning graduate student was, the more quickly the trainee progressed from a "conventional" stage of conceptualization to an "imitation of experts" stage to an exploration" stage. However, at 10 to 30 years beyond graduate training, age did not play a significant factor in a professional's growth toward highly individualized and personally congruent conceptual ideas.

As with other demographic variables, existing research regarding a relationship between experience and the crucial clinical tasks of conceptualization and treatment






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planning is inconclusive (Falvey, 2001). However, experience is not to be confused with expertise. Cummings, Slemon, and Hallberg (1993) defined expert counselors/therapists as those persons evaluated to be expert by some panel of evaluators, and experienced counselors/therapists as those with a specified number of years of counseling experience.

Dulaney and O'Connell (1963) demonstrated that experience has no relationship to how a person conceptualizes a problem. Instead, they stated that a person must have access, through learning (i.e., academic training), to a particular understanding of an issue before it can be employed. Therefore, from this point of view, experience has no direct relationship to conceptualization. However, the existing counselor development literature appears to support a relationship between experience and conceptualization (e.g., Stringer, Hillerbrand, & Claiborne 1995). Martin, Slemon, Hiebert, Hallberg, and Cummings (1989), for example, illustrated that experienced counselors/therapists were able to conceptualize information more efficiently and abstractly. Similarly, in Kivilighan and Quigley's (1991) study of the relationship between group leadership experience and conceptualization of group process, experienced (i.e., having at least one thousand hours of group therapy experience) counselors/therapists were found to have more complex views of group members, group member interactions, and ability to differentiate between group members more extensively than did novice (i.e., counseling psychology graduate students in their first group counseling course) counselors/therapists.

In general, the research suggests more frequently that experience is essential to the development of effective conceptual ization and problem solving abilities (Martin et al., 1989). Presumably, conceptualization and treatment planning involve complex interactions between acquired knowledge, repeated experience, and cognitive processes






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that promote the connection between knowledge acquired and a counseling/therapy situation (Gick, 1986).

It is important to note that research on the influence of family therapy training has been conducted primarily in postgraduate degree programs rather than academically based programs (Anderson, 1992). For example, Tucker and Pinsof (1984) examined trainees' conceptualization changes after completion of the first year of a two-year, postgraduate, MFT program. They found significant movement toward a family systems conceptualization of clinical problems on one of three scales used. Their findings also revealed that academic training, level of education, and experience prior to training did not result in differences in the trainees' grasp of clinical problems. Perlesz, Stolk, and Firestone (1990) found improvement in trainees' (MFC/T-oriented) conceptualizations; of client problems at the completion of a two-year, postgraduate MFT training program. Unfortunately, no studies were found that evaluated the conceptualization and treatment planning qualities of MFC/Ts trained within an academically based program.

The available research base directed toward clarification of the influence of

counselor/therapist demographics on conceptualization and treatment planning is limited in its direct application to students/trainees. Nonetheless, the literature does suggest that demographics such as educational training level, experience, professional affiliation of both the student/trainee and the supervisor/mentor, and age are important variables to consider in relation to the focus of this study. Challenges- that Relate to Conceptualization of MHCs and MEC/Ts

Trainees entering a counseling program typically have been exposed to numerous theories that include focus on the experience of the individual. Further, the common






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language used to identify a person's problem (i.e., the DSM-IV-R) is based on the medical model, which necessitates that a trainee conceptualizes a client's concerns from an individual orientation (Huber & Carlson, 1994; Worden, 1994). Consideration of individual dynamics also is reinforced by rich resources of individual personality theories (e.g.. Freudian psychodynamic theory), current psychiatric diagnostic system of disorders (e.g., Diagnostic and Statistical Manual IV-R), developmental psychology studies focused on an individual's development across the lifespan, and each person's particular experience of the world (Worden, 1994). The value of the latter is particularly apparent in that a person always has his/her particular viewing lens of the world in operation.

Avis and Sprenkle (1990) evaluated fifteen empirical studies focused on training in MFC/T. Of the fifteen studies, nine were concerned with training methods and formats and six addressed the development of instrumentation. Training, in these studies, ranged in duration (e.g., intensive, year long training to brief or three-day workshops), population (e.g., students in medical school, MSWs, counseling graduate students, practicing MFC/Ts, and graduate-level students in MFCIT), and participants' experience level (e.g., students to licensed practitioners). Specific to this investigation, Avis and Sprenkle (1990) concluded that empirical research in MFC/T is limited, many studies lack replication, and evidence exists that training can improve a trainee's ability to systemically conceptualize the causal components of clients' presenting problems. However, of the fifteen studies reviewed, most did not control for important trainee variables such as gender, experience level, and professional orientation of a primary supervisor/advisor.






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As a general rule, education in the field of psychology/counseling introduces trainees to the many individual personality theories significant to the development of MHC and MFC/T. With such powerful supporting resources, Huber and Carlson (1994) noted that shifting from an individual (e.g., MHC) to a systems (e.g., MFC/T) perspective can be a difficult task. In essence, systemic thinking is not the psychosocial norm of modem western culture (Sexton, 1994). As a result, systemically oriented trainees may face additional practice, legal, and ethical considerations in implementing their views. For example, a systemically oriented trainee must be able to understand and communicate a client's individually oriented experiences in a manner that validates the client's view yet allows the trainee to maintain a broader interactional perspective (Sexton, 1994; Sluzki, 1978). The purpose here is not to debate the merits of either approach or determine the treatment of choice. Rather, the point is that a trainee's level of education, professional orientation, experience, and/or the professional orientation of his/her supervisor/advisor may indeed impact his/her conceptual tendencies.

Support for Methodology and Instrumentation

This section is focused on the method by which conceptualization and treatment planning characteristics will be determined. Attention is given first to theory and then to appropriate methodology.

Schema Theory

Schema theory is rooted in constructivist metatheory and emerged from

contemporary cognitive psychology. Constructivist theory holds that human perception results from a person's mediation and transformation of external experiences through internally constructed cognitive structures or schemata (Pace, 1988). Many influential






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theorists have proposed types of constructivist theory for inquiry into human problems, change, and processes of counseling (e.g., Bartlett, 1932; Beck, 1976; Frank, 1973; Kelly, 1955; Piaget, 1977).

There exists within constructivist metatheory three basic schools of thought: the traditional, social constructivism, and integrated constructivist views. These perspectives differ by the roles given to nature, cognitive factors, and social factors as explanations of knowledge development. The integrated constructivist approach to understanding conceptual development is of primary interest here. It encompasses social and cognitive factors as well as nature (Chinn, 1998). Chinn argued that integrated constructivism is frequently the approach of choice for addressing questions about conceptual development adequately. As with other theoretical approaches, integrated constructivism encompasses different schools of thought. One particular application of integrated constructivism is schema theory (Chinn, 1998; Pace, 1988; Popper & Eccles, 1977).

Schema theory allows taking into account variables and characteristics within the complex nature of conceptual development. Additionally, because nature and society play a strong role in determining cognitive structures and applications thereof, questions can be posed that are not addressable within other theories (Chinn, 1998). For example, how does a trainee's identification with a particular professional organization relate to conceptualization of client concerns and treatment planning? Or, what influence does culture have on a trainee's conceptualizations? Thus, Chinn (1998) and Pace (1988) present a compelling argument for the use of schema theory in the study of conceptual development related to counseling processes.






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Schema theory holds that individuals develop knowledge configurations through interaction with their surroundings and conceptual antecedents. Such knowledge configurations are generally known as schemata. Schemata are defined as "unconscious mental structures and processes that underlie the molar aspects of human knowledge and skill" (Brewer & Nakamura, 1984, p. 140), "the medium by which the past affects the future" (Neisser, 1976, p. 22), and as the mechanism by which effective thinking and action are possible because schemata allow a person to select, limit, and organize information in a meaningful manner (Mandler, 1984). According to Taylor and Crocker (1981), schemata are domain specific cognitive structures consisting of hypotheses about incoming information. These hypotheses mediate the plan for gathering, interpreting, and utilizing information. Further, schemata, by attending to how the complex integration of social and natural factors influences cognition, also can account for distortions in information processing.

In part, knowledge is embedded in and gained from social interaction. Meaning thus is "socially negotiated" and has value within the context of the community in which a person exists (Chinn, 1998; Thagard, 1994). The process of learning MHC and MFT/C concepts thus involves social interaction (e.g., structured learning activities or supervision). Similarly, a trainee's individual and cultural characteristic interact with the process of training in MHC and MFT/C to shape conceptual development (Mandler, 1984).

Nature also plays a key role in understanding the influence of MFT/C and MHC training on conceptualization and treatment planning. Chinn (1998) found that, in most cases, conceptualization is limited to the explanation that best fits the data for the






54

situation. Therefore, conceptualization is strongly shaped by the elements of the natural environment.

In sum, social factors and nature are integrally connected to understanding

cognition/conceptual development and how people approach problems (Chinn, 1998). The development and application of alternative explanations/concepts is bounded by an individual's depth and breadth of knowledge, data from the physical world (nature), and social factors (e.g., situational or personal relational experience). According to Pace (1988), the constructivist schema theory perspective is relevant and applicable to the characteristically complex nature of conceptual development and treatment planning. A major strength of this perspective is a framework that accounts for differences in information processing based on events that are inconsistent with a trainee's conceptual schema and/or current level of training, and/or are emotionally charged or highly ambiguous.

Assessment Instrumentation

Several factors guide data collection methodology, including the nature of the

information sought and the research questions. Also to be considered are the geographical location of participants, extent of researcher-participant interaction, monetary resources, and time (Alreck & Settle, 1995). Given that this study does not attempt "to do anything to [trainees], apart from asking them to provide information in response" (Jaeger, 1997, p.53) to particular case vignettes, survey research is an appropriate methodology.

Internet and web-based survey research

Traditional survey research is beset with methodological problems. For example, a traditional pen-and-paper, mailed survey may prove to be cost and time prohibitive.






55


Also, surveys personally administered by a researcher may increase a subject's potential to please the researcher, thereby yielding only socially desirable responses. Selfadministered, pen-and-paper surveys also have relatively low response rates and relatively high item completion errors (Issac & Michael, 1995; Kiesler & Sproull, 1986). Technological advances have created new means to conduct survey research (Pealer, 1999); the Internet is such a technology.

Between the end of 2000 and June 2001, 8.4 million new Internet users went

online. Currently, over 65 million U.S. households actively use the Internet and MWW (Thorsberg, 2002). The Pew Internet and American Life Project reports that Internet use for many residents of the U.S. is now "indispensable" (Well, 2002). Further, institutions of higher learning now commonly require students to have access to the Internet to complete their degree programs successfully (e.g., University of Florida Admissions, 2002; University of Nevada, Las Vegas, 2002).

These resources allow researchers to address some of the problems inherent in traditional survey research. For example, Parker (1992) found a 68%6 response rate with an electronic mail (i.e., via e-mail) survey versus a 38% return rate for a traditional, mailed, pen-and-paper, self-administered format. Web-based surveys also are less expensive or time consuming to design and distribute (Gaddis, 1998). Participants also may be more likely to respond to Web-based surveys outside the socially desirable response realm due to the anonymity of the medium (Houston & Fiore, 1998). Webbased surveys also have been found to have fewer item completion errors (Kiesler & Sproull, 1986). Finally, participants reported finding web-based surveys more interesting






56


and to have a sense of scientific value, privacy, and legitimacy (Tourangeau & Smith, 1996).

Web-based surveys present still other advantages, including being able to respond in an "intuitive, non-labor intensive manner" (Pitkow & Recker, 1995, p.809). Ease of survey completion, along with interest, in turn has been found to be influential to response rate (Pealer, 1999). Within Web-based surveys, participants' responses can be recorded automatically, thereby eliminating transcription errors (1995). Furthermore, participants reasonably can be ensured that their responses will be kept confidential and/or anonymous due to encryption techniques (Kurland, 1996). Pealer's study (1999) stands as a good example that Web-based survey research is a viable method for collecting data from a university population.

Although Web-based surveys have distinct advantages, they also have limitations. Some are the same as for traditional surveys and others are unique to the medium. For example, both methods suffer from a not easily resolved problem of incomplete survey submissions (Schmidt, 1997). Also, incentives may influence response rates. Denton, Tsai, and Chevrette (1988) recommended use of tangible incentives (e.g., online coupons or request for results of study) for participants to receive upon completion of the survey. Computer hardware, survey software, and Internet access factors present researchers and participants with substantial costs. Fortunately, these costs may be avoided when researchers and participants are affiliated with an institution which has unlimited access to the Internet (Gaddis, 1998; Schmidt, 1997).

The use of Web-based surveys for data collection is frequently used for marketing and business purposes. However, academic researchers have learned quickly and applied






57


the technology to their research. Indeed, as of mid-2002, the American Psychological Society was conducting well over 100 Internet and/or Web-based studies, ranging from causal reasoning surveys to those concerned with organizational decision making (Krantz, 2002). In 2001, Chi Sigma Iota, an international honor society of counseling academicians and practitioners, devoted a series of articles in their newsletter to the use of computer technology in counselor education. In it, Leech and Greene (2001) wrote that use of computer technology and the Internet in counselor education is not a question of "if, but how" (p.8). The technology thus has been recognized as an important medium for education, conducting meaningful research (Bell & Kahn, 1996; Birnbaum, 2000), and providing access to a growing and widespread population of research participants (Houston & Fiore, 1998).

Use of case vignettes

When faced with the task of assessing trainee conceptualization and treatment planning characteristics, numerous techniques have been developed. For example, a trainee's conceptualization and treatment planning has been evaluated through the use of "real" client counseling/therapy video and audiotapes, live supervision of "real" client counseling/therapy sessions, paper-and-pencil examinations, role-playing clinical situations, and student/trainee personal journaling. Each of these methods has its strengths and limitations. However, use of case vignettes seems to be the most advantageous (McLeod, 1992). Therefore, this study employs case vignettes.

Case vignettes/simulations of clinical practice situations have many potential applications (Berven, 1985; Falvey & Hebert, 1992). For example, in the field of medicine, vignettes referred to as patient management problems have long been used as a






58


general clinical problem-solving assessment tool. A medical student is given a brief written or audiovisual description of a patient's relevant history and presenting problem. Students then select from a list of potential interventions (e.g., medication or hospitalization). Intervention selection continues until no further action is deemed necessary. From this information, medical students' conceptualization and treatment abilities are evaluated (Berven, 1985). In 1961, the National Board of Medical Examiners began using this method in its examinations. Smith (1983) reported that at least eight medical specialties utilize the vignette technique in their certification examinations. Computerized formats also have been used in medical education and certification processes (e.g., Friedman, Korst, Schultz, Beatty, & Entine, 1978; Schumacher, Burg, & Taylor, 1975; Taylor, Grace, Taylor, Fincham, & Skakun, 1976).

The use of clinical vignettes/simulations also can be found in the fields of psychology and business. For example, Berven and Scofield (1980) employed simulations, in computerized form, to assess the clinical problem-solving abilities of graduate students in rehabilitation counseling. Smith (1983) also described the potential credentialing applications of this methodology for the practice of psychology. Pegorsch (1998) noted that business employers have used case simulations successfully to select personnel, finding the method to have strong validity and to be a reasonable predictor of a potential employee's job performance.

In recent years, the counseling field has embraced this methodology. For example, Berven and Scofield (1980) demonstrated that this method is useful to study decisionmaking styles as related to the clinical judgments of rehabilitation and mental health counselors. Case vignettes also have been used effectively to study a trainee's ability to






59


cope with ambiguity and develop a clear rationale for professional and ethical decisions (Frame, Flanagan, Frederick, Gold, & Harris, 1997). The American Mental Health Counselors Association (AMHCA) investigated the psychometric properties of case simulations and found that clinical treatment planning simulations were highly reliable and demonstrated adequate content, discriminant, and predictive validity (Falvey & Hebert, 1992).

Clinical vignettes also have been found to be effective in terms of cost, time and ease of administration (Peabody, Luck, Glassman, Dresselhaus, & Lee, 2000). Van Zuuren, de Groot, Mulder, and Muris (1995) suggested the advantage that persons being assessed have roughly the same situation in mind when responding to a given scenario. Furthermore, investigators are able to control effectively for case mix (Peabody et al., 2000).

Case vignettes also have been shown to be sensitive to change in knowledge and skills (e.g., Sriram et al., 1990), and to differentiate a participant's grasp of concepts and information (e.g., Carroll, 1993), and are correlated positively to clinical skills (e.g., Mortowildo, Dunnette, & Carter, 1990; Sriram et al., 1990). Skaner, Bring, Ullman, and Strender (2000) concluded use of vignettes is acceptable for making group comparisons, a finding previously illustrated by Sandvik (1996). And, finally, Peabody and associates (2000) concluded that clinical simulations provide a valuable way of assessing the quality of care among different providers in different systems of care and with different populations.






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SUMMM

In Lindvall's (1959) article concerning the purpose of the review of related

research, he contended that the researcher should be concerned primarily with relating his/her investigation to the findings of others, so that when combined, they help to complete an integrated pattern of research results. In this review of related research, an attempt has been made to select those studies most directly related to this investigation and to create a framework of thought that produces an important problem and documents its significance.














CHAPTER 3
METHODOLOGY


The solution of a problem requires a plan of action by which to study as

efficiently as possible the problem and to arrive at valid conclusions with respect to it. The soundness of this design, and its workability when put into operation, are important to the success of the study. This chapter deals with the planning and execution of the design for this study. Included are descriptions of the population, sample, methodological procedures, research variables, data analyses, and methodological limitations.

General Design

This study employed an internet-based, survey research to examine how trainees currently enrolled in master's and doctoral-level CACREP-approved MHC or MFC/T preparation programs select different conceptualizations of clients' concerns. Surveys (e.g., pen-and-paper, computer-based, and interviews) are used extensively in educational research to collect information that is not readily and/or directly observable (Gall, Borg, & Gall, 1996). Surveys also are used to examine a respondent's status with respect to a particular variable of interest (e.g., conceptualization), but not to determine how subjects respond to a particular action taken by the researcher (Jaeger, 1997). Surveys thus allow researchers to investigate a wide range of educational problems (Gall et al., 1996).

Gall, Borg, and Gall (1996) wrote that surveys intended to measure skills such as conceptualization generally must be constructed using a scale that allows for indication of the extent of agreement with a particular item. These types of survey assessments must 61






62


use a relatively large number of items, "at least 19' (p.297), to obtain a reliable assessment of what is being measured. This study presented respondents with three case vignettes and six responses for each vignette. Respondents were asked to select how likely they were to conceptualize or plan treatment according to each response following a particular vignette. A ten-point response scale ranging from "extremely unlikely" to "extremely likely" that represents how a respondent might conceptualize and/or plan treatment according to a given response was included. A total of 18 responses for each participant were to be obtained.

The survey was distributed via the Internet. This distribution method was selected because of the advantages the Internet provides with regard to considerations of cost, administration, and geographical location of the population (Albert, Cluxton, & Miller, 1997; Pitkow & Recker, 1995). Participants were reasonably ensured that their responses were kept confidential and/or anonymous due to encryption techniques (Kurland, 1996).

Prior to formal distribution of a survey, it was tested to eliminate weaknesses and address issues of validity (Albert et al., 1997; Gall et al., 1996). A panel of experts reviewed and evaluated the survey instrument. This process allowed the survey to be adjusted to establish an evidentiary basis for content relevance and representativeness, technical quality, and construct validity (Albert et al., 1997; Messick, 1980).

Population

The respondents for this study had completed an undergraduate degree program and were currently enrolled in college or university-based, graduate-level preparation program to become a counselor/therapist. This study was confined to programs accredited by CACREP in the areas of MHC, MFC/T, and Counselor Education and Supervision.






63


Programs fitting eligibility criteria were housed in more than one administrative unit (e.g., department, division, or college) of universities or colleges. Thus, administrative units were used to determine the population (Hollis, 1997). Administrative units housing eligible programs were identified through ACA's Directory of Accredited Programs 2002 (available on-line) and institutions listed in Counselor Preparation 19961998: Programs, Faculty, Trends, Ninth Edition (Hollis, 1997). As of May 2002,73 universities/colleges housed 84 administrative units that offered 96 programs appropriate to this study. At the master's-level, CACREP reported 27 MHC-accredited programs and 26 MHC/T-accredited programs nationally. At the doctoral level, 43 CACREP-accredited programs were identified.

Based on responses supplied for Hollis' (1997) review of counselor preparation and the 2002-03 online version of the Occupational Outlook Handbook (OOH), several factors can be noted about this population. At the master's-level of education and training in MHC and MFC/T, trainees' undergraduate G.P.A.s ranged from 2.5 to 3.5. Their eligibility for enrollment in master's-level MHC and MFC/T programs commonly required meeting a cutoff score on the GRE and/or MAT, submitting letters of reference, providing evidence of work experience, and participating in a personal interview. An average of fifty trainees were enrolled per program/per year. Some programs had as few as four students and others had as many as 200. Master's-level MHC and MFC/T programs graduated approximately equal amounts of trainees annually, with a 3:1 ratio of female to male graduates (1997). Master of Arts (M.A) and Master of Science (M.S.) are the two major degrees granted to trainees completing these programs. The next highest degree frequency in MHC and MFCIT was an Education Specialist (Ed.S).






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At the doctoral level of training, trainees are typically granted admission upon completion of a master's degree in a compatible program as well as meeting admission requirements similar to those applied at the master's level. The range of students per doctoral program was 2 to 90 in 1996. On average, programs graduate nine doctoral-level trainees per year. Female doctoral-level graduates outnumbered males by a ratio of 2: 1. The Ph.D. and the Ed.D. were the degrees commonly granted upon completion of a doctoral-level program (Hollis, 1997).

A precise trainee enrollment count was unknown. However, estimations were

obtained by extrapolation of data from several resources (e.g., Hollis, 19917; OOH, 2002). Where information was available, the basis for extrapolating enrollment data was formed from administrative units identified as providing CACREP-approved programs terminating in a MA., M.S., U.S., Ph.D., and/or Ed.D. degree. As of 1998, an estimate of more than 3200 trainees were enrolled in one of the CACREP-approved programs of interest. It may be noted that Hollis's finding that enrollment appears to be on an upward trend is consistent with the job market overview provided by the OOH (2002).

Counselors/therapists were estimated to hold 465,000 jobs in 2000. Of these,

67,000 specifically were mental health counselors and 21,000 were marriage and fwnily counselors/therapists. Settings in which masters and doctoral-level graduates were employed were varied and included work in private and public healthcare organizations, health maintenance organizations, and educational institutions. The Occupational Outlook Handbook 2002-2003 estimated that employment for counselors/therapists was expected to grow faster than the average for all other occupations through 2010.






65

Additionally, with many counselors reaching retirement age, many new job opportunities were predicted to become available (2002).

Sample

It usually is not practical to study an entire population of interest (Sarvela & McDermott, 1993). Therefore, sampling allows researchers to examine a portion of a population and "to make valid generalizations after careful measurement of the variables of interest in a relatively small segment of the population" (p.221). Soliciting newsgroups or listservs related to a research topic has proven an effective method by which to recruit subjects on the Internet (Birnbaum, 1999, 2000; Mehta & Sivadas, 1995). Several listservs were identified as being related to or developed for this study's eligible population. Counsgrads was a listserv developed specifically to help graduate students across the country communicate with one another (listserver@lists.acs.ohio-state.edu) and had approximately 800 members. The American Mental Health Counselors Association hosts a national graduate student listserv (join-students@lyris.amhca.org). The listserv Diversegrad-L provided a medium by which students, counselors, educators, among others may communicate about issues of diversity in the counseling profession (Diversegrad-L@listserv.american.edu). ACA hosted a listserv designed to enhance global communication among counselors (ACA-INT-SUBSCRIBEREOUEST@home.ease.lsoft.com). Another counseling listserv that reported members, including graduate students, from every state in the U.S. and several countries was the International Counselor Network (listserv@utkvml.utk.edu). GROUPSTUFF, at maiordomo@indiana.edu, targeted students and professionals interested in group counseling. Relevant information about this study also was distributed on a listserv






66

specifically for Counselor Educators (CESNET-L at maiordomo@www2.colstate.edu), a listserv for the discussion of counseling theory, research, and practice with couples and families from a family systems perspective (IAMFCNET-L@baylor.edu, and a listserv for mental health students and professionals (PsychNews: Mental health newsletter at listserv@vml .nodak.edu).

Eligible trainees were contacted via e-mail (Appendix A) regarding the purpose

and method of this investigation. They were asked to click on the direct link provided and to complete the survey before Friday, October 04, 2002. They also were asked to distribute this information to other trainees in their department.

Program chairpersons also were to be contacted via email regarding the purpose and method of this investigation and asked to distribute relevant investigation information to faculty, and/or students/trainees in their respective departments. However, the University of Florida Institutional Review Board was concerned about the recruitment method, stating "students may feel pressured to participate." As a result, the original study plan was revised to address these concerns. Appendix L details this process.

The sample sought for this study was approximately 200 trainees currently enrolled in masters-level MHC, masters-level MFC/T, or doctoral-level Counselor Education programs. Demographic information was collected to allow complete description of the resultant sample._To obtain an adequate sample, the survey deadline was extended to Sunday, October 27, 2002.

Methodological Procedures

Following are descriptions of the major elements of procedures and resources actually used in this study.






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Instrumentation

A four-task process for participants to complete was developed. Three tasks (i.e., obtaining informed consent and demographic information and responses to case vignette options) were essential to the collection of complete data. The fourth task (i.e., request for results) was optional.

Three case vignettes/simulations of situations that trainees were likely to

encounter in professional practice and six selected conceptual responses for each of the three vignettes respectively were developed. The vignettes were selected to be standard stimuli to assess clinical judgment in case conceptualization and treatment planning (Falvey, 2001). Acknowledged experts in the field of counseling/therapy originally developed the three vignettes selected for this study. Permission to reprint each vignette was requested and granted by the respective publishers (Appendix F). Vignette one is from the DSM-IV-TR Case Book by Spitzer, Gibbon, Skodol, Williams, and First (2002). Vignette two is from Family Therapy Basics by Worden (1994). Vignette three is from DSM-IV Made Easy: The Clinician's Guide To Diagnosis by Morrison (1995).

The purpose of the instrument was to examine the likelihood with which trainees would select different conceptualizations of clients' concerns. There were six conceptualization responses for each vignette. Each response was intended to reflect a different conceptual dimension: individual dynamics, systemic dynamics, linear causality, circular causality, content focus, or process focus.

In order to establish that data generated from this instrument would provide reasonable answers to the research questions posed and would fit existing theory and research, the instrument was reviewed and evaluated to validate response choice type






68


prior to conducting the study (Bordens, & Abbott, 1991). A panel of reviewers was assembled on the basis of standards commonly used to qualify experts in the field of counseling (Falvey, 1992; Hogan, 1979). Panelists were qualified to participate in the construct validation process if they met three of the following five criteria: (a) membership in a major professional organization (i.e., ACA, AAMFT, or APA) of his/her discipline, (b) possession of highest degree awarded by his/her profession, (c) hold an active license (i.e., LMFT, LMHC, CPC, and LPC) to practice counseling/therapy and/or National Board Counselor Certification (NBCC) (e.g., NCC),

(d) at least five years of experience in research, practice, and/or educational settings, and/or (e) published in referred journal s and/or presented at regional and/or national level professional meetings within the last five years. Verification of a panelist's eligibility was established through review of individual vitae and/or a potential panelist's completion of a brief data form.

Chapters I and 2 of this study presented a foundation for several of the generally accepted practices for establishing construct validity (Sax, 1990), including demonstrating that conceptualization and treatment planning have important educational, psychological, or practice implications, and illustrating that varying manners of conceptualization can be distinguished. The remainder of this section describes how construct validity was further established.

Qualified panelists who agreed to participate in this process were given a brief description of the purpose of the study, a list of seven possible response types, and a definition of each (Appendix 1). They also were provided with the three case simulations and eighteen response choices (Appendix J). They were asked to select which of the






69

seven response choices/conceptual dimensions best described each clinical vignette response. Panelists made their selections by putting a check mark next to their selected response type. The seven response types included the six types (e.g., individual dynamics, systemic dynamics, linear causality, circular causality, content focus, and process focus) used in this study and one response type (e.g., equilibrium focus) not used in this study. Construct validity was determined to have been satisfied when the panel of experts reached at least an 80% agreement for each of the eighteen responses. Until this rate of agreement was obtained, the responses were rewritten and redistributed for evaluation. Appendix K presents this process in greater detail.

Based on the expert panel selection criteria, the panel (across all rounds) represented three nationally recognized health professions, a variety of counseling specializations (e.g., MFC/T, MHC, substance abuse, gerontology, and career), and five states. The panel was 40% male and 60% female, which is reflective of Hollis' (1997) reported gender composition of MHC and MFC/T graduates. All panelists were credentialed professionals, with 4010/c holding more than one license in MHC, MFC, LPC, CPC, or psychology. The NBCC had certified 80% of the panel. Panelists' work settings and years of experience reflected between five and twenty-five years as a practitioner, educator, researcher, or some combination thereof. Sixty percent of the panel had completed the highest degree offered in his/her profession and the remaining panelists had been awarded a minimum of an Ed.S. and/or were near completion of his/her terminal degree (e.g., Ph.D. or Ed.D.).






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Human Subiects

Prior to initiation of this study, an application was submitted to the University of Florida Institutional Review Board (UFIRB). The duty of UFIRB is to ensure that the rights, dignity, and welfare of human participants are protected and that participation is voluntary, privacy protected, and safety assured (University of Florida, 2002a). This study, project #2002-624, was approved for August 2002 to August 2003 (Appendix Q. Data Collection

Subsequent to addressing issues central to construct validation, trainees were

contacted regarding the investigation. Relevant information was distributed on listservs directly related to or designed for this study's population. These initial contacts were made on Monday, September 23, 2002. Trainees who were members of these listservs were informed of the purpose and survey methodology. They also were asked to click on the direct link provided and to complete the survey before Friday, October 04, 2002. They also were asked to distribute this information to other trainees in their department.

Having accessed the survey via direct link, participants were informed of the purpose, methodology, risks of participation, and persons to whom they could direct questions. They were then asked to select electronically the "go to survey" link, which indicated that the trainee had read and understood the procedure described and agreed to participate voluntarily (Appendix B).

Trainees responded to a demographic questionnaire, eighteen conceptual

responses based on three different case simulations/vignettes, and the opportunity to request results of the survey. For ease of use, participants selected their responses via point-and-click of the computer mouse. Demographic information (Appendix Q was






71


collected to ensure that participants fit the eligibility criteria. Participants were instructed to click the "go to vignettes" button. Participants will be reminded to click the button only once, thereby reducing duplication error. This reminder was carefully highlighted throughout the process.

Having clicked "go to vignettes," the vignettes and corresponding response options appeared on a participant's computer monitor (Appendix D). Following each simulation, six possible responses were provided. They were asked to select the likelihood with which each might conceptualize and/or plan therapeutic intervention in the manner described in the respective responses.

Each response had a scale of extremely unlikely to extremely likely (weighted I to 10). Upon completion, participants were instructed to (electronically) "submit now" their responses. At this point, participants were immediately directed to a "request for results" page (Appendix E). There, appreciation for their participation was conveyed and they had the opportunity to request the results of this study. The "request for results" information was not related in any manner to the person's responses.

Approximately one week after the initial request for participants was posted to appropriate listservs, a follow up e-mail was posted (Appendix G). On or about one day after the date requested for participants to have completed the survey, a computation of the initial response rate was calculated. The researcher extended the deadline for survey completion and another follow up e-mail (Appendix H) was sent to appropriate listservs.

This process of data collection was possible through the use of the computer software specifically designed to allow researchers to design or modify a survey/questionnaire in a word processing interface. The software converted the






72

survey/questionnaire into a publishable format for the Web, collected and stored survey responses, and calculated summary statistics and frequencies. Data also were exported in an ASCII format to be used by the Statistical Analysis System (SAS) (Truppin, Benson, Nelson, Washburn, & Henning, 1997).

Research Variables

This study had eight independent variables, including the trainee's:

1. Gender (e.g., male or female)

2. Age category in years (i.e., 20-29,30-39,40-49, and 50+)

3. Current Program enrollment (i.e., MHC-masters, MFCIT-masters, CES-doctorate
with emphasis in MHC, or CES-doctorate with emphasis in MFC/T)

4. Program's Accreditation (i.e., CACREP, COAMFTE, and/or APA)

5. Level of Experience (i.e., Practicum 1 = up to 150 contact hours/40 hours face-toface, Practicum 2 = 150-400 contact hours/40-60 hours face-to-face, Internship in
Counseling & Development = 400-1000 contact hours/100-350 hours face-toface, Completed ALL M.A./Ed.S. level clinical experiences, Internship in
Counseling & Development = advanced clinical experience at doctoral-level,
Internship in Counselor Education = Doctoral level, Completed ALL masters and
doctoral-level internships

6. Primary Type of Practicum/lnternship Experience (i.e., MHC or MFC/T setting)

7. Professional Affiliation, if any (i.e., AMHCA, IAMFC, ACES or none)

8. Primary Professional Affiliation of Supervisor/Educator (i.e., AMHCA, IAMFC,
ACES with a specialization in MHC, ACES with a specialization in MFC/T, or
none).

The dependent variables were the trainees' indications (i.e., ratings) of likelihood of conceptualizing each of the three vignettes in accordance with the each of the six response possibilities.






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Data Anal yses

The response rating means, standard deviations, and frequency distributions were

computed for the total sample and by program type. Next, correlations were computed

between each of the 18 ratings and age. t-tests for independent means were calculated to

determine if there were differences in the ratings based on gender. Factorial analyses of

variance were computed to determine if there were significant differences among the

means based on various factors. For example, a 4 x 4 (age category x academic major)

factorial ANOVA, a 2 x 4 (gender x academic major) factorial ANO VA, and an 8 x 2

(experience level x type of experience) factorial analysis were calculated.

Methodological Limitations

The following limitations are applicable to the conduct of this study:

1. Not all trainees eligible to participate were notified of the opportunity to
participate. Notification was dependent upon membership on one of the identified
listservs and/or the transfer of relevant information from listserv subscribers. Email messages may have been purged after a certain period of time, may have
been forgotten if not completed immediately, or misplaced (Goree & Marsalek,
1995; Kittleson, 1997). However, requests for participants in this study were
designed in accordance with Kittleson's (1997) study that determined that 1, 2, or 4 reminder messages was the optimal number to receive the highest response rate among professionals in the field of Health Education. Good (1997) concluded that
response rate was influenced most by use of follow-up messages.

2. Some participants may not have had access to a computer and the Internet, be
computer illiterate, or be unable to comply with instructions for the study (Goree & Marsalek, 1995; Kittleson, 1997). However, while this limitation was inherent
in computer, internet-based research, institutions of higher learning commonly
required students to be computer literate and to have access to the Internet.
Furthermore, survey participants can "complete forms that are visually and
functionally identical to conventional questionnaires" (Houston & Fiore, 1998, p.
17). Consequently, this limitation was not likely to be of significance among the
respondents for this study.

3. Variations in the participants' computer hardware and operating systems software
may have affected the trainees' participation in the study. However, new






74

developments in computer software programs make this concern of unlikely
significance to this study.

4. Intemet-based surveys may suffer from multiple submissions and/or incomplete
surveys (Schmidt, 1997). However, the problem of multiple submissions was
resolved by using a well-written common gateway program. It also was helpful to
post a reminder to only click once to responses. Many computer users have been
conditioned to double click in programs, but the Web's hypertext does not require double clicking. Consequently, the use of these methods made this concern of less
significance. Unfortunately, incomplete form submission, like that for pen-andpaper surveys, was not easily resolved. Programs could have been written to
return participants to the survey when not completed; however, this raised ethical considerations given that participation was voluntary and could terminated at any
time.

5. Validity of research using case vignettes is contingent upon the extent to which
respondents can envision themselves in the situations portrayed. Vignettes were
selected on the basis that each provided standard stimuli for assessing clinical judgment in case conceptualization, treatment planning, and diagnostic tasks
(Falvey, 2001). The three vignettes selected for this study were originally
developed by acknowledged experts in the field of counseling/therapy are readily
available in published counselor education resources, are likely to be situations discussed in learning environments, and/or situations participants have already
encountered. Therefore, this limitation was not likely to be significant among the
respondents.

6. Trainees had different levels of identification with the 18 response choices
presented in this study. In fact, participants may have preferred a response not
illustrated in any of the given response choices. However, like the previous limitation, response choices were carefully developed and evaluated for the
purposes of this study. Therefore, again, this limitation was unlikely to be of
significance to the study's findings.

Summary

The methods and materials used to conduct this study were presented in this

chapter and included descriptions of the population, sample, research design, data

collection, research variables, data analysis, and methodological limitations.














CHAPTER 4
RESULTS


Presented in this chapter are the results of an internet-based survey study to

examine how trainees currently enrolled in master's-level and doctoral-level CACREPaccredited MHC or MFC/T preparation programs select different conceptualizations of clients' concerns. The data were analyzed and are presented as follows: demographics of participants by total sample and by current program enrollment, and response rating means and standard deviations provided by program type. Also, an 18 x 18 intercorrelation matrix is presented to examine relationships among responses of participants in like preparation programs. Finally, hypotheses for each of three vignettes and the six response types are analyzed. Post hoc analyses for significant differences among participant subgroup responses are reported where appropriate.

Participant Demographics

Two hundred and four trainees in the program areas of MHC, MFC/T, or

Counselor Education and Supervision with an emphasis in MHC or MFC/T participated. The sample included 157 females (76.96%) and 47 males (23.04%). Seventy-seven (37.75%) of the participants were between the ages of 20 and 29, 54 (26.47%) were between ages 30 and 39,48 (23.53%) were between ages 40 and 49, and 25 (12.25%) were 50 years of age or older. Of these participants, 169 (83.25%) were currently enrolled in a CACREP-accredited program, 18 (8.87%) in CACREP and APA-accredited programs, 14 (7.00%) in CACREP and COAMFTE-accredited programs, and one (.49%)


75






76


was reported to be currently enrolled in either a program with COAMIFTE accreditation only or APA accreditation only. The latter respondents' data were not included in response rating analyses by program accreditation type because one person does not constitute a sufficient basis for evaluation by that type.

At the time of this study, 109 (53.70%) participants indicated not having a preferred professional affiliation, 40 (19.70%) preferred an ACES association, 31 (15.27%) indicated a preference for AMHCA, 23 (11.33%) selected IAMFC as their preferred professional affiliation, and one participant did not respond to this question. Participants indicated the following distribution as the primary professional organizational affiliation of the person (e.g., supervisor, instructor, or advisor) considered most influential to their education and training: 24 (11.82%) had a primary ACES affiliation and specialized in MFCIT, 49 (24.14%) primarily affiliated with ACES and specialized in MHC, 37 (18.23%) had an AMHCA primary affiliation, 17 (8.37%) had an IAMFC primary affiliation, and 76 (37.44%) were reported as not having a primary professional affiliation.

Among the 204 respondents, 159 (77.94%) had clinical experience primarily in a MHFC setting and 45 (22.06%) had experienced their clinical work primarily in a MFCIT setting. The number of participants having no supervised clinical experience was 53 (26.50%). Twenty-one (10.50%) had completed or were currently enrolled in their first Practicum, 17 (8.5%) were at the Practicumn 2 level, 32 (16.00%) were at the Internship, 60 (30.00%) had completed all M.A./Ed.S. level clinical experiences, and 2 (1.00%) were at the post master's-level of clinical experience. At the doctoral-level of clinical experience, 12 (6.00%) indicated having completed all masters and doctoral-level clinical






77

experiences and three (1.50%) reported being at the internship level. Program

enrollments were represented by 19 (9.31%) in CES with an emphasis in MFC/T, 6

(2.94%) in CES with an emphasis in MHC, 33 (16.18%) in master's-level MFC/T, and

146 (71.57%) in master's-level MHC. Descriptive information about participants by

current program enrollment is presented in Table 1.

Table 1

Demographic Data by Academic Program Subgroup

Factor CES-MFC/T CES-MHC MFC/T-Masters MHC-Masters
Frequency/% Frequency/% Frequency/% Frequency/%

Age
20-29 4 21.05 1 16.67 17 51.52 55 37.67
30-39 7 36.84 1 16.67 9 27.27 37 25.34
40-49 5 26.32 1 16.67 4 12.12 38 26.03
50-50+ 3 15.79 3 50.00 3 9.09 16 10.96
Gender
Female 13 68.42 4 66.67 26 78.79 114 78.08
Male 6 31.58 2 33.33 7 21.21 32 21.92

Program Accreditation
CACREP 12 63.16 6 100.00 24 72.73 127 87.59
CACREP,
APA 1 5.26 3 9.09 14 9.66
CACREP,
COAMF'E 6 31.58 5 15.15 3 2.07
COAMFTE 1 3.03
APA 1 0.68
Missing

Clinical Experience Level
None 1 5.56 12 38.71 40 27.59
Practicum 1 5 16.13 16 11.03
Practicum2 2 11.11 2 33.33 5 16.13 8 5.52
Masters-level
Internship ------ 1 16.67 5 16.13 26 17.93
Completed all
Masters-level 1 5.56 ------ -4 12.90 55 37.93
Post-masters
Clinical 1 5.56 1 16.67 ------ --






78


Table 1 Continued


Factor CES-MFC/T CES-MHC MFC/T-Masters MHC-Masters
Frequency/% Frequency/% Frequency/% Frequency/%

Doctoral-level
Internship 3 16.67
Completed all
Masters &
Doctoral-level 10 55.56 2 33.33
Missing 1 2 1

Primary Clinical
Experience Setting
MFC/T 17 89.47 20 60.61 8 5.48
MHC 2 10.53 6 100.00 13 39.39 138 94.52

Trainees' Primary
Organizational Affiliation
AMHCA ----- 2 33.33 29 20.00
ACES 6 31.58 3 50.00 31 2138
IAMFC 8 42.11 .....- 11 33.33 4 2.76
None 5 26.32 1 16.67 22 66.67 81 55.86
Missing 1

Supervisor/Advisor/Instructor's
Primary Professional Affiliation
ACES with
specialization
in MFC/T 4 21.05 1 16.67 7 21.21 12 8.28
ACES with
specialization
in MHC 3 15.79 3 50.00 2 6.06 41 28.28
AMHCA 1 5.26 3 9.09 33 22.76
IAMFC 4 21.05 7 21.21 6 4.13
None 7 36.84 2 33.33 14 42.42 53 36.55
Missing 1

Total N 19 9.31 6 2.94 33 16.18 146 71.57






79

Response Rating Frequencies, Means and Standard Deviations by Academic Program TylLe

As noted, program enrollment representation in this study was widely dispersed. Given the wide variability in the number of students who responded from the four possible programs, no participant responses were eliminated from the data analyses due to incomplete ratings on all 18 responses. Instead, response ratings were excluded from data analyses on a response-by-response evaluation of the data necessary to conduct any particular analysis related to the questions posed. The response means and standard deviations by type of academic program are summarized in Tables 2a 2d. Response frequencies were computed for each of the 18 responses and for each of the four academic programs, and are presented in Table 3. Table 2a

Means and Standard Deviations for Each Response by Program: CES Ph.DJH.D., MFC/T emphasis Vignette/Response Type N Mean Standard Deviation

Vignette I Systemic Dynamics 17 6.06 331

Vignette I Content Focus 17 4.00 2.12

Vignette I Linear Causality 17 5.41 2.87

Vignette I Process Focus 16 6.81 2.71

Vignette I Individual Dynamics 17 2.29 1.83

Vignette I Circular Causality 18 7.56 2.67


Vignette 2 Individual Dynamics 17 2.00 1.41

Vignette 2 Linear Causality 17 3.94 2.22

Vignette 2 Content Focus 17 5.76 2.44






80


Table 2a CES MFC/T emphasis continued Vignette/Response Type N Mean Standard Deviation

Vignette 2 Circular Causality 17 7.88 1.76

Vignette 2 Systemic Dynamics 17 7.88 1.96

Vignette 2 Process Focus 18 7.89 2.47


Vignette 3 Individual Dynamics 16 6.06 2.41

Vignette 3 Process Focus 16 6.44 2.22

Vignette 3 Linear Causality 16 5.06 2.26

Vignette 3 Circular Causality 16 6.31 2.89

Vignette 3 Content Focus 16 5.19 2.43

Vignette 3 Systemic Dynamics 17 8.06 2.19


The mean age of the 19 CES- emphasis MFC/T participants in this study was

approximately 36 years. The range of experience level was from no clinical experience to completion of all master's- and doctoral-level experiences. The mean experience level was 6.61 years. Thus, the mean experience level reported was at the entry-level, doctoral experience in counseling (i.e., advanced clinical experience, post master's-level). Table 2b

Means and Standard Deviations for Each Response by Program: CES Ph.D./Ed.D., MEC emphasis Vignette/Response Type N Mean Standard Deviation

Vignette I Systemic Dynamics 4 3.25 1.26

Vignette I Content Focus 6 6.83 2.56






81

Table 2b CES MHC emphasis continued Vignette/Response Type N Mean Standard Deviation

Vignette I Linear Causality 5 7.40 0.89

Vignette I Process Focus 5 7.20 1.92

Vignette I Individual Dynamics 5 3.40 1.67

Vignette I Circular Causality 6 7.83 1.33


Vignette 2 Individual Dynamics 6 3.50 3.15

Vignette 2 Linear Causality 6 4.50 2.35

Vignette 2 Content Focus 5 7.20 2.17

Vignette 2 Circular Causality 6 7.00 2.97

Vignette 2 Systemic Dynamics 6 4.67 3.39

Vignette 2 Process Focus 6 6.50 1.22


Vignette 3 Individual Dynamics 6 7.83 1.17

Vignette 3 Process Focus 5 5.80 1.79

Vignette 3 Linear Causality 6 7.17 1.72

Vignette 3 Circular Causality 5 4.60 1.52

Vignette 3 Content Focus 6 8.00 1.10

Vignette 3 Systemic Dynamics 5 5.60 2.88


The mean age of the six CES-emphasis MHC participants in this study was approximately 41.67 years. The range of experience level was from Practicurn 2 to completion of all master's- and doctoral-level experiences. The mean experience level






82

was 5.33 years. Thus, the mean experience level reported was at completion of all master's-level clinical experiences.

Table 2c

Means and Standard Deviations for Each Response by Program: MFC/T Masters Level

Vignette/Response Type N Mean Standard Deviation

Vignette I Systemic Dynamics 32 5.59 1.95

Vignette I Content Focus 32 6.56 2.17

Vignette I Linear Causality 32 6.69 2.22

Vignette 1 Process Focus 32 6.28 2.19

Vignette I Individual Dynamics 32 4.19 2.63

Vignette I Circular Causality 32 6.72 2.07


Vignette 2 Individual Dynamics 32 3.75 2.50

Vignette 2 Linear Causality 32 4.88 2.80

Vignette 2 Content Focus 32 7.06 2.37

Vignette 2 Circular Causality 32 7.50 2.06

Vignette 2 Systemic Dynamics 32 6.59 2.17

Vignette 2 Process Focus 32 6.88 2.12


Vignette 3 Individual Dynamics 32 6.41 231

Vignette 3 Process Focus 32 6.63 2.39

Vignette 3 Linear Causality 32 6.53 2.05

Vignette 3 Circular Causality 32 5.47 2.18

Vignette 3 Content Focus 32 6.63 2.11






83


Table 2c MFC/T Masters Level continued Vignette/Response Type N Mean Standard Deviation

Vignette 3 Systemic Dynamics 32 7.47 1.87



The mean age of the 33 MFC/T masters-level participants in this study was approximately 30.17 years. All experience level responses corresponded with the indicated academic degree of this subgroup. The mean experience level was 2.48 years. Thus, the mean experience level reported was at the Practicum. 1 level. Table 2d

Means and Standard Deviations for Each Response by Program: MHC Masters Level

Vignette/Response Type N Mean Standard Deviation

Vignette I Systernic Dynamics 145 5.10 2.23

Vignette I Content Focus 143 5.89 2.26

Vignette I Linear Causality 140 6.87 2.11

Vignette I Process Focus 141 6.42 2.03

Vignette I Individual Dynamics 141 4.47 2.42

Vignette I Circular Causality 142 6.43 2.04


Vignette 2 Individual Dynamics 139 3.85 2.37

Vignette 2 Linear Causality 139 4.60 2.30

Vignette 2 Content Focus 140 7.09 1.62

Vignette 2 Circular Causality 140 7.56 1.93

Vignette 2 Systemic Dynamics 142 6.37 2.40






84


Table 2d MHC Masters Level continued Vignette/Response Type N Mean Standard Deviation

Vignette 2 Process Focus 142 6.57 2.37


Vignette 3 Individual Dynamics 140 6.86 1.96

Vignette 3 Process Focus 140 5.29 2.05

Vignette 3 Linear Causality 140 6.31 2.11

Vignette 3 Circular Causality 137 4.39 2.09

Vignette 3 Content Focus 140 6.15 2.34

Vignette 3 Systemic Dynamics 139 6.58 2.45



The mean age of the 146 MHC master's-level participants in this study was 33.67 years. The range of experience level was from Practicum 2 to completion of all master'slevel clinical experiences. The mean experience level was 3.27 years. Thus, the mean experience level reported was at the Practicum 2 level. Table 3

Response Frequencies by Academic Program Extremely Extremely
Unlikely 4 0 Likely
Viaetteespnse Type 1 2 3 4 5 6 7 8 9 10
Academic Frequency/
Program Percent

V1 Systemic Dynamics
CES-MFC/T 2 2 2 1 1 3 5 1
11.7 11.76 11.76 5.88 5.88 17.65 29.41 5.88
CES-MIHC 1 2 1
25.00 50.00 25.00
MFC/T-Masters 3 4 2 3 7 8 5
938 12.50 6.25 9.38 21.88 25.00 15.63 1 1 MHC-Masters 5 12 27 24 10 18 23 21 3 2
3.45 8.28 18.62 16.55 6.90 12.41 15.86 14.48 2.07 138






85







Table 3 Response Frequencies by Academic Program continued

V I Content Focus
CES-MFC/T 2 3 1 6 1 2 2
11.76 17.65 5.88 35.29 5.88 11.76 1.76
CES-MHC 1 1 3 1
16.67 16.67 50.00 16.67
MFCTff-Masters 1 2 5 3 2 4 8 7
3.13 6.25 15.63 9.38 6.25 12.50 25.00 21.88 MHC-Masters 4 7 14 21 12 17 26 28 10 4
2.80 4.90 9.79 14.69 8.39 11.89 18.18 19.58 6.99 2.80

V1 Linear Causality
CES-MFC/T 1 2 3 2 1 5 1 2
5.88 11.76 17.65 11.76 5.88 29.4 5.88 11.76
CES-MHC 1 1 3
20.00 20.00 60.00
MFCf/T-Masters 2 1 4 3 2 3 11 5 1
6.25 3.13 12.50 9.38 6.25 938 3438 15.63 3.13 MHC-Masters 8 10 4 7 14 30 38 23 6
5.71 7.14 2.86 5.00 10.00 21.43 27.14 16.43 4.29

V1 Process Focus
CES-MFCTff 1 1 1 1 4 1 2 1 4
6.25 6.25 6.25 6.25 25.00 6.25 12.50 6.25 25.00
CES-MHC 1 1 2 1.
20.00 20.00 40.00 20.00
MFC/T-Masters 1 3 5 4 1 5 9 3 1
3.13 9.38 15.63 12.50 3.13 15.63 28.13 938 3.13 MHC-Masters 2 4 6 16 16 21 23 34 16 3
1.42 2.84 4.26 11.35 11.35 14.89 16.31 21.11 1135 2.13

V1 Individual Dynamics
CES-MFCIT 9 2 3 2 1
52.94 11.76 17.65 11.76 5.88
CES-MHC 2 1 1 1
40.00 20.00 20.00 20.00
MFCIT-Masters 3 8 7 2 3 2 4 3
9.38 25.00 21.88 6.25 9.38 6.25 12.50 938
MHC-Masters 14 22 23 20 14 12 17 11 6 2
9.93 15.60 1631 14.18 9.93 8.51 12.06 7.80 4.26 1.42

VI Circular Causality
CES-MFC/T 1 1 -1 3 3 3 5
5.56 5.56 5.56 5. 16.67 16.67 16.67 27.78






86







Table 3 Response Frequencies by Academic Program continued

CES-MHC 4 1 1
____ ____66.67 16.67 16.67
MFC/T-Masters 1 5 4 1 7 8 5 1
3.13 15.63 12.50 3.13 21.88 25.00 15.63 3.13
MHC-Masters 5 12 12 12 22 31 28 14 6
3.52 8.45 8.45 8.45 15.49 21.83 19.72 9.86 4.23

V2 Individual Dynamics
CES-MFC/T 9 3 3 1 18
52.94 17.65 17.65 5.88
CES-MHC 2 2 1 1
3333 33.33 16.67 16.67
MFC/T-Masters 6 6 9 1 1 2 3 3 1
18.75 18.75 28.13 3.13 3.13 6.25 938 9.38 3.13 MHC-Masters 23 26 30 12 9 16 11 5 6 1
16.55 18.71 21.58 8.63 6.47 11.51 7.91 3.60 4.32 0.72

V2 Linear Causality
CES-MFC/T 1 5 3 2 2 1 1 2
5.88 29.41 17.65 11.76 11.76 5.88 5.88 1.76 CES-MHC 1 1 1 1 2
16.67 16.67 16.67 16.67 3333
MFCTff-Masters 2 6 7 2 2 2 2 5 3 1
6.25 18.75 21.88 6.25 6.25 6.25 6.25 15.63 938 3.13 MHC-Masters 10 18 28 18 14 16 15 15 4 1
7.19 12.95 20.14 12.95 10.07 11.51 10.79 10.79 2.88 0.72

V2 Content Focus
CES-MFC/T 1 4 1 2 1 3 2 3
5.88 25.53 5.88 11.76 5.8 17.65 11.76 17.65 CES-MHC 1 1 1 2
20.00 20.00 20.00 40.00
MFCfT-Masters 1 1 4 2 5 1 8 5 5
3.13 3.13 12.50 6.25 15.63 3.13 25.00 15.63 15.63
MHC-Masters 1 5 4 10 22 39 30 26 3
0.71 3.57 2.86 7.14 15.71 27.86 21.43 18.57 2.14

V2 Circular Causality
CES-MFC/T 1 1 5 3 4 3
5.88 5.88 29.71 17.65 23.53 17.65
CES-MHC 2 1 1 2
33.33 16.67 16.67 3333
MFCT-Masters 1 2 3 4 3 5 10 4
3.13 6.25 938 12.50 938 15.63 31.25 12.50






87








Table 3 Response Frequencies by Academic Program continued

MHC-Masters 1 3 3 6 7 11 19 37141 12
0.71 2.14 2.14 4.29 5.00 7.86 13.57 26.43129.291 8.57

V2 Systemic Dynamics
CES-MFCff 1 2 2 5 4 3
5.88 11.76 11.76 29.41 25.53 17.65
CES-MHC 2 1 1 2
33.33 16.67 16.67 33.33
MFCIT-Masters 1 1 1 2 3 5 8 5 4 2
3.13 3.13 3.13 6.25 9.38 15.63 25.00 15.63 12.50 6.25 MHC-Masters 4 9 7 15 14 13 23 31 16 10
2.82 634 4.93 10.56 9.86 9.15 16.20 21.83 18.57 7.04

V2 Process Focus
CES-MFC/T 2 1 2 5 2 6
11.11 5.56 11.1 27.78 11.11 3333
CES-MHC 1 5
16.67 83.33
MFC/T-Masters 3 3 2 3 8 6 3 4
9.38 9.38 6.25 15.63 25,00 18.75 938 12.50 MHC-Masters 2 5 13 16 8 12 29 22 23 12
1.41 3.52 9.15 11.27 5.63 8.45 20.42 15.49 16.20 8.45


V3 Individual Dynamics
CES-MFC/T 2 2 1 1 4 5 1
12.50 12.50 6.25 6.25 25.00 31.25 6.25
CES-MHC 3 2 1
50.00 3333 16.67
MFC/T-Masters 1 5 1 4 4 5 5 5 2
3.13 15.63 3.13 12.50 12.50 15.63 15.63 15.63 6.25 MHC-Masters 1 3 7 8 10 23 28 29 26 5
0.71 2.14 5.00 5.71 7.14 16.43 20.00 20.71 18.57 3.57

V3 Process Focus
CES-MFCiT 2 3 2 2 5 1 1
1 12.50 18.75 12.50 12.50 31.25 6.25 6.25
CES-MHC 2 1 1 1
40.00 20.00 20.00 20.00
MFCIT-Masters 1 1 6 3 5 2 4 7 3
3.13 3.13 18.75 9.38 15.63 6.25 12.50 21.88 938
MHC-Masters 2 14 12 26 20 22 20 17 7
1.43 10.00 8.57 18.57 14.29 15.71 14.29 12.14 5.00







88










Table 3 Response Frequencies by Academic Program continued

V3 Linear Causality
CES-MFCIT 1 5 2 1 5 2
6.25 31.25 12.50 6. 3 12.50
CES-MHC 1 2 2 1
...._.. 16.67 33.33 3333 16.67
MFC/T-Masters 3 4 3 4 7 4 6 1
938 12.50 12.50 12.50 21.88 12.50 18.75 3.13 MHC-Masters 1 2 17 16 10 20 22 31 19 2
0.71 1.43 12.14 11.43 7.14 14.29 15.71 22.14 13.57 1.43

V3 Circular Causality
CES-MFCff 1 3 1 2 6 3
6.25 18.75 6.25 12. 37.50 18.75
CES-MHC 1 2 1 1
20.00 40.00 20.00 20.00
MFC/T-Masters 3 5 4 3 5 6 3 3
938 15.63 12.50 938 15.63 18.75 938 9.38 MHC-Masters 8 21 25 23 18 14 15 11 2
5.84 1533 18.25 16.79 13.14 10.22 10.95 8.03 1.46

V3 Content Focus
CES-MFCT 4 2 3 2 2 1 2
25.00 12.50 18.75 12.50 12.50 6.25 12.50 CES-MHC 2 3 1
33.33 50.00 16.67
MFC/T-Masters 1 2 5 1 3 5 9 6
3.13 6.25 15.63 3.13 938 15.63 28.13 18.75 MHiC-Masters 6 6 13 13 7 19 30 23 21 2
4.29 4.29 9.29 9.29 5.00 13.57 21.43 16.43 15.00 1.43

V3 Systemic Dynamics
CES-MFCIT 2 1 1 2 2 2 7
11.76 5.88 5.88 11.76 11.7 11.76 41.18 CES-MHC 1 1 1 1 1
20.00 20.00 20.00 20.00 20.00
MFCfT-Masters 1 2 2 4 5 6 9 3
3.13 6.25 6.25 12.50 15.63 18.75 28.13 9.38 MHC-Masters 3 4 14 13 12 11 23 23 21 15
2.16 2.88 10.07 9.35 8.63 7.91 16.55 16.55 15.11 10.79






89

Intercorrelations

Patterns of responding within each academic subgroup (i.e., CES-MFC/T

emphasis, CES-MHC emphasis, MFC/T master's-level, and MHC master's-level) were examined by use of an 18-item intercorrelation matrix. Tables 4a 4d present the statistically significant correlations for each of six possible response types for vignettes one to three. Each table presents data for a different academic subgroup. The response type (i.e., conceptual dimension) is indicated by the corresponding vignette and response.

Table 4a presents the statistically significant correlations of Vignette 1, 2,3 and VI, V2, and V3 for students currently enrolled in a CES MFC/T emphasis program. Across the three vignettes, some significant positive correlations between the same response types and response types associated with a particular specialization (i.e., MFC/T or MHC) were found. However, several significant positive correlations between different specializations also were found between Vignette I and 2 (i.e., Systemic-MFC/T and Individual-MHC), Vignette 1 and 3 (i.e., Content-MHC and Process-MFC/T), Vignette 2 and 3 (i.e., Linear-MHC and Process-MFCiT), and between response types in Vignette 3 (i.e., Content-MHC and Systemic-MFCT). The latter two of these findings across area of specialization (i.e., MFC/T or MHC) represent positive, statistically significant correlations across one of the three previously defined key conceptual disciplinary dimensions (i.e., Individual vs. systemic dynamics, Linear vs. Circular causality, and Content vs. Process focus).













Table 4a. Intercorrelations Among Dependent Variables for Vignettes 1, 2 and 3, and V1, V2, and V3 by Program: CBS Ph.D./Ed.D. MFCJ emphasis *.p< .05 ________VARIABLES VI-Sys Vl-Cnt Vi-LinjVR-Prc Vt-mnd VI-CrI V2-Indv V2-UnIV2-Cnt V2-Crl JV2-Sys V2-Prc V3-Indv V3-PrcjV3-Un V3-Crl IV3-Cnt V3-Sysl
Vignette I 0.7o'7* o.5oe* 0.590* -o.51o*-0 49-.56
Systemic I__ I__ I__ __ __
Vignette 1 -0.644** 0.521* 051
Content I___I
Vignette 1 -0.563* 0.514* .4*
Linear0.4* Vignette 1 -0.614* .9*
Process 062
Vignette 1 064
Individual __Vignette 1 0.595*
Circular 055

Vignette 2 054
Individual 0.34
Vignette 2 0.76* 0.32
Linear- 0.3*052
Vignette 2 0.830** O.765**
Content ___ _____Vignette 2 0.862*
Circular ___ _____Vignette 2 0.484* 0.597*
Systemic ___ ______ _____V ignette 2 -0.652*' 0.612**
Process

Vignette 3 -0.770*
Individual __Vignette 3
Process___________________Vignette 3
Linear__ __ __ __ __ ___ __ __ ___ __ __ __
Vignette 3 .68'
Circular ___ ___ ___ ___ ___ ___ __Vignette 3 0.509*
Content ___ ___ __Vignette 3 T___Systemic






91

Presented in Table 4b are the statistically significant correlations of Vignette 1, 2,

3 and V 1, V2, and V3 for CES MHC emphasis students. Statistically significant, positive correlations among like response types were found between Vignette 1-Process and V2-Process, Vignette 2-Individual and V3-Individual, Vignette 2-Linear and V3Linear. Several statistically significant, negative correlations also were found between responses within a vignette (i.e., Vignette I-Linear and Vl-Individual, Vignette 2Individual and V2-Content, and Vignette 3-Linear and V3-Content). These negative correlations indicate that the six participating CES-MHC emphasis students' responses tended to increase and decrease within the MHC specialization, based on different conceptual dimensions. The same type of relationship (i.e., negative correlation between conceptual dimensions within a single area of specialization) occurred between Vignette 2-Linear and V3-Content.

Table 4c presents the correlations between dependent variables for students currently pursuing a master's-level degree in MFC/T. In addition to statistically significant, positive correlations between same response types and between response types within a particular specialization, there were statistically significant, negative correlations between conceptual dimensions for different specializations. For example, Vignette 2-Individual was significantly, negatively correlated to V2-Systemic while Vignette 2-Process was significantly, negatively correlated with the Individual and Content responses of V3. Statistically significant correlations between unlike responses from different academic specializations also were found. The systemic response and the individual response in Vignette 1 were positively correlated. The individual response in Vignette 1 was positively correlated with the circular response in Vignette 3.












Table 4b. Intercorrelations Among Dependent Variables for Vignette 1, 2 and 3, and V I, V2, and V3 by
Program: CES Ph.D.IEd.D. MHC emphasis *.p < .05 **.p < .01
VARIABLES Vi-Sys V1-Cntj Vi-Un'V1-Prc JVI-mnd VI-CrIijV2-IndA V2-U-nj V2-Cnt V2-CrI IV2-Sysj V2- rV3.Indv V3-PrcjV3- Un jV3-Cr1 V3-Cntj V3-Sysl
Vignette 1I
Systemic_______ ______Vignette 1I__Content
Vignette 1 0.969*1
Linear_____Vignette 1 0.930*___ __Process _ __
Vignette 1
Individual____ __Vignette 1 0.824*
Circular

Vignette 2 0925* 08943*
Individual______Vignette 2 0.817* -0.934*1
Linear__Vignette 2
Content __Vignette 2
Circular __Vignette 2
Systemic,________________ ___ ___ __Vignette 2 Q908*
Process

Vignette 3
Individual____ __Vignette 3
Process
Vignette 3 0,848*
Linear _ __ _ _ _
Vignette 3
Circular____ ___ ____ _______ ___ ____ ___ ____ ___ ____ ___ ____ __Vignette 3
Content____ __Vignette 3
Systemic