Theory and
Treatment Planning
in Counseling and
Psychotherapy
Second Edition
DIANE R. GEHART, Ph.D.
California State University, Northridge
Australia • Brazil • Mexico • Singapore • United Kingdom • United States
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Theory and Treatment Planning in Counseling
and Psychotherapy, Second Edition
Diane R. Gehart
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Brief Contents
Preface
xiii
Acknowledgements
About the Author
Introduction
SECTION I
xvii
xix
xx
Introduction to Theories, Competencies,
and Treatment Planning 1
1
Counseling Theory, Competency, Research, and You:
Connecting the Dots 3
2
Treatment Planning
SECTION II
17
Counseling and Psychotherapy Theories
Analytic Theories
31
33
3
Psychoanalytic and Psychodynamic Counseling and Psychotherapy
4
Jungian Analytic Psychology
5
Adlerian Individual Counseling
33
73
95
Humanistic-Existential Counseling
129
6
Person-Centered Counseling and Psychotherapy
7
Existential Counseling and Psychotherapy
8
Gestalt Counseling and Psychotherapy
Action-Oriented Approaches 203
9
Foundational Cognitive-Behavioral Approaches
10
Evidence-Based Cognitive-Behavioral Approaches: Dialectic Behavior
Therapy and Trauma-Focused Cognitive-Behavioral Therapy 245
11
Systemic Family Counseling and Therapy
Postmodern Approaches 335
12
Solution-Based Approaches
13
Narrative and Collaborative Approaches
14
Feminist and Multicultural Counseling and Psychotherapy
SECTION III
129
163
181
203
293
335
369
413
Theoretical Integration and Case
Conceptualization 433
15
Introduction to Theoretical Integration
16
Integrative Case Conceptualization
Name Index
Subject Index
435
445
488
492
iii
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Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.
Contents
Preface
xiii
Acknowledgements
About the Author
Introduction
SECTION ONE
1
xvii
xix
xx
Introduction to Theories, Competencies,
and Treatment Planning 1
Counseling Theory, Competency, Research, and You:
Connecting the Dots 3
What Distinguishes a Counselor from a Bartender?
3
Why Theory Matters 3
Connecting with Theory: Do I Have to Choose Just One?
Competency in Counseling and Psychotherapy
Competency and (Not) You 5
Common Threads of Competency
Research and the Evidence Base
4
4
5
8
Common Factors Research: Reframing Theory 9
Show Me Proof: Evidence-Based Treatments and Practice
Evidence-Based Practice 14
Research in Perspective 14
13
Rock-Paper-Scissors and Other Strategies for Choosing a Theory
To Be Continued …
Questions for Personal Reflection and Class Discussion
Online Resources 15
References 16
2
Treatment Planning
Treatment Planning
15
15
15
17
17
Creative Planning 18
The Brief History of Mental Health Treatment Planning
Clinical Treatment Plans 19
Theory-Specific Case Conceptualization 19
Treatment Plan Format 20
Writing Useful Treatment Tasks 22
18
Initial Phase Treatment Tasks 22
Working Phase Treatment Task 23
Closing Phase Treatment Tasks 23
Diversity and Treatment Tasks 23
Client Goals
24
Goal Writing Worksheet 24
The Goal Writing Process 26
Initial Phase Client Goals 27
iv
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Contents
Working Phase Client Goals 27
Closing Phase Client Goals 27
Writing Measurable Goals 28
Writing Useful Interventions 28
Do Plans Make a Difference? 29
Questions for Personal Reflection and Class Discussion
Online Resource 29
References 30
29
SECTION TWO
Counseling and Psychotherapy Theories
3
Psychoanalytic and Psychodynamic Counseling
and Psychotherapy 33
Lay of the Land
31
33
Basic Psychodynamic Assumptions
Psychodynamic Theory
34
35
In a Nutshell: The Least You Need to Know 35
The Juice: Significant Contributions to the Field 36
Rumor Has It: The People and Their Stories 38
Big Picture: Overview of Counseling Process 40
Making Connection: Counseling Relationship 41
The Viewing: Case Conceptualization 44
Targeting Change: Goal Setting 53
The Doing: Interventions 55
Putting It All Together: Psychodynamic Case Conceptualization
and Treatment Plan Templates 57
Theory-Specific Case Conceptualization: Psychodynamic
Treatment Plan Template: Psychodynamic 58
57
Research and the Evidence Base 60
Evidence-Based Treatment: Brief Psychodynamic Counseling
61
In a Nutshell: The Least You Need to Know 61
Big Picture: Overview of Counseling Process 61
Making Connection: Counseling Relationship 61
Specific Brief Psychodynamic Approaches 62
Tapestry Weaving: Working with Diverse Populations
Cultural and Ethnic Diversity
Sexual Identity Diversity 64
Psychodynamic Case Study
66
Case Conceptualization: Psychodynamic
Treatment Plan: Psychodynamic 67
66
Questions for Personal Reflection and Class Discussion
Online Resources 69
References 70
4
Jungian Analytic Psychology
Jungian Analytic Psychology
63
63
69
73
73
In a Nutshell: The Least You Need to Know 73
The Juice: Significant Contributions to the Field 73
Rumor Has It: The People and Their Stories 75
Big Picture: Overview of Counseling Process 75
Making Connection: Counseling Relationship 76
The Viewing: Case Conceptualization 76
Targeting Change: Goal Setting 78
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v
vi
Contents
The Doing: Interventions 78
Interventions for Special Populations
81
Putting It All Together: Jungian Case Conceptualization and Treatment
Plan Templates 83
Theory-Specific Case Conceptualization: Jungian Analysis
Treatment Plan Template: Jungian Analysis 84
83
Research and the Evidence Base 85
Tapestry Weaving: Applications with Diverse Populations
Cultural Diversity 86
Sexual Identity Diversity
Jungian Case Study
86
87
88
Case Conceptualization: Jungian 89
Treatment Plan: Jungian 90
Questions for Personal Reflection and Class Discussion
Online Resources 92
References 93
5
Adlerian Individual Counseling
Lay of the Land
92
95
95
In a Nutshell: The Least You Need to Know 96
The Juice: Significant Contributions to the Field 96
Rumor Has It: The People and Their Stories 98
Big Picture: Overview of Counseling Process 99
Making Connection: Counseling Relationship 100
The Viewing: Case Conceptualization 101
Targeting Change: Goal Setting 107
The Doing: Interventions 109
Interventions for Special Populations 113
Putting It All Together: Adlerian Case Conceptualization and Treatment
Plan Templates 114
Theory-Specific Case Conceptualization: Adlerian
Treatment Plan Template: Adlerian 115
114
Tapestry Weaving: Working with Diverse Populations
117
Ethnic and Racial Diversity 117
Sexual Identity Diversity 120
Research and the Evidence Base
121
Evidence-Based Treatment: Systematic Training for Effective Parenting
(STEP) 121
Adlerian Case Study
122
Case Conceptualization: Adlerian 122
Treatment Plan: Adlerian 124
Questions for Personal Reflection and Class Discussion
Online Resources 126
References 127
6
126
Person-Centered Counseling and Psychotherapy
Lay of the Land
129
129
Philosophical Foundations 130
Commonalities Across Humanistic-Existential Theories
Person-Centered Counseling
131
133
In a Nutshell: The Least You Need to Know 133
The Juice: Significant Contributions to the Field 134
Rumor Has It: The People and Their Stories 138
Big Picture: Overview of Counseling Process 139
Making Connection: Therapeutic Relationship 140
The Viewing: Case Conceptualization 140
Targeting Change: Goal Setting 144
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Contents
The Doing: Interventions 145
Interventions for Special Populations
vii
151
Putting It All Together: Person-Centered Case Conceptualization
and Treatment Plan Templates 152
Theory-Specific Case Conceptualization: Person-Centered
Treatment Plan Template: Person-Centered 152
152
Tapestry Weaving: Working with Diverse Populations
154
Cultural, Ethnic, and Gender Diversity
Sexual Identity Diversity 156
154
Research and the Evidence Base 156
Person-Centered Case Study 157
Case Conceptualization: Person-Centered
Treatment Plan: Person-Centered 159
157
Questions for Personal Reflection and Class Discussion
Online Resources 161
References 161
7
Existential Counseling and Psychotherapy
Lay of the Land
160
163
163
In a Nutshell: The Least You Need to Know 163
The Juice: Significant Contributions to the Field 164
Rumor Has It: The People and Their Stories 165
Big Picture: Overview of Counseling Process 166
Making Connection: Counseling Relationship 166
The Viewing: Case Conceptualization 167
Targeting Change: Goal Setting 170
The Doing: Interventions 170
Putting It All Together: Existential Case Conceptualization
and Treatment Plan Templates 172
Theory-Specific Case Conceptualization: Existential
Treatment Plan Template: Existential 172
172
Research and the Evidence Base 174
Tapestry Weaving: Working with Diverse Populations
175
Cultural and Ethnic Diversity 175
Sexual Identity Diversity 175
Existential Case Study
176
Case Conceptualization: Existential
Treatment Plan: Existential 177
176
Questions for Personal Reflection and Class Discussion
Online Resources 179
References 180
8
Gestalt Counseling and Psychotherapy
Lay of the Land
179
181
181
In a Nutshell: The Least You Need to Know 181
The Juice: Significant Contributions to the Field 182
Rumor Has It: The People and Their Stories 183
Big Picture: Overview of Counseling Process 184
Making Connection: Therapeutic Relationship 184
The Viewing: Case Conceptualization 185
Targeting Change: Goal Setting 188
The Doing: Interventions 189
Putting It All Together: Gestalt Case Conceptualization and Treatment
Plan Templates 191
Theory-Specific Case Conceptualization: Gestalt
Treatment Plan Template: Gestalt 192
Research and the Evidence Base
191
194
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viii
Contents
Tapestry Weaving: Working with Diverse Populations
194
Cultural and Ethnic Diversity 194
Sexual Identity Diversity 196
Gestalt Case Study
198
Case Conceptualization: Gestalt
Treatment Plan: Gestalt 199
198
Questions for Personal Reflection and Class Discussion
Online Resources 201
References 202
9
200
Foundational Cognitive-Behavioral Approaches
Lay of the Land 203
Cognitive-Behavioral Approaches
203
204
In a Nutshell: The Least You Need to Know 204
The Juice: Significant Contributions to the Field 205
Rumor Has It: The People and Their Stories 207
Big Picture: Overview of Counseling Process 208
Making Connection: Counseling Relationship 208
The Viewing: Case Conceptualization 209
Targeting Change: Goal Setting 214
The Doing: Interventions 214
Putting It All Together: Cognitive-Behavioral Case Conceptualization
and Treatment Plan Templates 224
Theory-Specific Case Conceptualization: Cognitive-Behavioral
Treatment Plan Template: Cognitive-Behavioral 225
Reality Theory
224
226
In a Nutshell: The Least You Need to Know
Choice Theory 227
Reality Theory Behavioral Analysis 227
Mindfulness-Based Approaches
226
228
In a Nutshell: The Least You Need to Know 228
A Brief History of Mindfulness in Mental Health 228
Mindfulness Basics 229
Specific Mindfulness Approaches 230
Tapestry Weaving: Working with Diverse Populations
Ethnic, Racial, and Cultural Diversity
Sexual Identity Diversity 234
232
232
Research and the Evidence Base 235
Cognitive-Behavioral Case Study 236
Case Conceptualization: Cognitive-Behavioral
Treatment Plan: Cognitive-Behavioral 238
237
Questions for Personal Reflection and Class Discussion
Online Resources 240
References 241
10
240
Evidence-Based Cognitive-Behavioral Approaches:
Dialectic Behavior Therapy and Trauma-Focused
Cognitive-Behavioral Therapy 245
Lay of the Land 245
Dialectical Behavior Therapy
246
In a Nutshell: The Least You Need to Know 246
The Juice: Significant Contributions to the Field 246
Big Picture: Overview of Counseling Process 248
Making Connection: Counseling Relationship 249
The Viewing: Case Conceptualization 251
Targeting Change: Goal Setting 254
The Doing: Interventions 255
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Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.
Contents
ix
Putting It All Together: Cognitive-Behavioral Case Conceptualization
and Treatment Plan Templates 262
Theory-Specific Case Conceptualization: Dialectical Behavior Therapy
Treatment Plan Template: Dialectical Behavior Therapy 263
Trauma-Focused Cognitive Behavioral Therapy
262
265
In a Nutshell: The Least You Need to Know 265
The Juice: Significant Contributions to the Field 266
Rumor Has It: The People and Their Stories 266
Big Picture: Overview of Counseling Process 267
Making Connection: Counseling Relationship 268
The Viewing: Case Conceptualization 269
Targeting Change: Goal Setting 273
The Doing: Interventions 273
Putting It All Together: TF-CBT Case Conceptualization and Treatment
Plan Templates 280
Theory-Specific Case Conceptualization: Trauma-Focused CBT 280
Treatment Plan Template: Trauma-Focused CBT 281
Research and the Evidence Base 283
Tapestry Weaving: Working with Diverse Clients
Cultural Diversity 283
Sexual Identity Diversity
DBT Case Study
283
286
286
Case Conceptualization: DBT 287
Treatment Plan: DBT 288
Questions for Personal Reflection and Class Discussion
Online Resources 291
References 291
11
Systemic Family Counseling and Therapy
Lay of the Land
290
293
293
Systems 101: Philosophical Foundations 295
In a Nutshell: The Least You Need to Know 298
The Juice: Significant Contributions to the Field 298
Rumor Has It: The People and Their Stories 300
Big Picture: Overview of Treatment 302
Making Connection: Counseling Relationship 303
The Viewing: Case Conceptualization and Assessment 306
Targeting Change: Goal Setting 311
The Doing: Interventions 313
Interventions for Specific Problems 318
Putting It All Together: Systemic Treatment Plan Case
Conceptualization and Treatment Plan Templates 319
Theory-Specific Case Conceptualization: Systemic
Treatment Plan Template: Systemic 320
319
Snapshot: Bowen’s Intergenerational Family Approach 321
Snapshot: Satir’s Human Growth Model 322
Research and the Evidence Base 323
Evidence-Based Therapy: Emotionally Focused Therapy 323
In a Nutshell: The Least You Need to Know
Attachment and Adult Love 324
EFT Tasks and Stages 324
323
Tapestry Weaving: Diversity Considerations
325
Ethnic, Racial, and Cultural Diversity
Sexual Identity Diversity 326
Systemic Case Study
325
328
Case Conceptualization: Systemic
Treatment Plan: Systemic 330
328
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x
Contents
Questions for Personal Reflection and Class Discussion
Online Resources 332
References 333
12
Solution-Based Approaches
Lay of the Land 335
Solution-Based Counseling
331
335
336
In a Nutshell: The Least You Need to Know 336
The Juice: Significant Contributions to the Field 337
Rumor Has It: The People and Their Stories 339
Big Picture: Overview of Counseling Process 340
Making Connection: Counseling Relationship 341
The Viewing: Case Conceptualization 342
Targeting Change: Goal Setting 348
The Doing: Interventions 349
Interventions for Specific Problems 352
Putting It All Together: Solution-Based Treatment Plan Case
Conceptualization and Treatment Plan Templates 354
Theory-Specific Case Conceptualization: Solution-Based
Treatment Plan Template: Solution-Based 354
354
Solution-Focused School Counseling 356
Tapestry Weaving: Working with Diverse Populations
Ethnic, Racial, and Cultural Diversity
Sexual Identity Diversity 361
359
359
Research and the Evidence Base 361
Solution-Focused Case Study 362
Case Conceptualization: Solution-Focused
Treatment Plan: Solution-Focused 363
362
Questions for Personal Reflection and Class Discussion
Online Resources 365
References 366
13
Narrative and Collaborative Approaches
365
369
Lay of the Land 369
Narrative Approaches 370
In a Nutshell: The Least You Need to Know 370
The Juice: Significant Contributions to the Field 370
Rumor Has It: The People and Their Stories 371
Big Picture: Overview of Counseling Process 371
Making Connection: Counseling Relationship 372
The Viewing: Case Conceptualization 373
Targeting Change: Goal Setting 374
The Doing: Interventions 375
Putting It All Together: Narrative Treatment Plan Case
Conceptualization and Treatment Plan Templates 383
Theory-Specific Case Conceptualization: Narrative
Treatment Plan Template: Narrative 383
383
Collaborative Language Systems and Reflecting Teams
385
In a Nutshell: The Least You Need to Know 385
The Juice: Significant Contributions to the Field 386
Rumor Has It: The People and Their Stories 387
Big Picture: Overview of Counseling Process 388
Making Connection: Counseling Relationship 388
The Viewing: Case Conceptualization 391
Targeting Change: Goal Setting 392
The Doing: Interventions and Ways of Promoting Change 393
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Contents
Putting It All Together: Collaborative Treatment Plan Case
Conceptualization and Treatment Plan Templates 399
Theory-Specific Case Conceptualization: Collaborative
Treatment Plan Template: Collaborative 399
399
Research and the Evidence Base 401
Tapestry Weaving: Working with Diverse Populations
403
Cultural and Ethnic Diversity 403
Sexual Identity Diversity 404
Postmodern Case Study
406
Case Conceptualization: Postmodern
Treatment Plan: Postmodern 407
406
Questions for Personal Reflection and Class Discussion
Online Resources 409
References 410
14
409
Feminist and Multicultural Counseling
and Psychotherapy 413
Lay of the Land 413
Feminist Counseling 414
In a Nutshell: The Least You Need to Know 414
The Juice: Significant Contributions to the Field 414
Rumor Has It: The People and Their Stories 415
Big Picture: Overview of Counseling Process 415
Making Connection: Counseling Relationship 416
The Viewing: Case Conceptualization 417
Targeting Change: Goal Setting 420
The Doing: Interventions 421
Putting It All Together: Feminist Treatment Plan Case
Conceptualization and Treatment Plan Templates 423
Theory-Specific Case Conceptualization: Feminist
Treatment Plan Template: Feminist 423
423
Research and the Evidence Base 425
Tapestry Weaving: Working with Diverse Populations
426
Cultural and Ethnic Diversity 426
Sexual Identity Diversity 427
Feminist Case Study
427
Case Conceptualization: Feminist
Treatment Plan: Feminist 429
428
Questions for Personal Reflection and Class Discussion
Online Resources 431
References 431
SECTION THREE
Theoretical Integration and Case
Conceptualization 433
15
Introduction to Theoretical Integration
And Now for the Exciting Conclusion
Integration Options 436
431
435
435
Common Factors Approach 436
Theoretical Integration 436
Assimilative Integration 436
Technical Eclecticism 436
Systematic Treatment Selection 437
Syncretism and Sloppy Thinking 437
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xi
xii
Contents
Integration with Integrity
438
Modernism 439
Phenomenology: Humanistic-Existential
Systemic 440
Postmodern 441
439
Wrapping Up Integration 443
Questions for Personal Reflection and Class Discussion
Online Resources 443
References 443
16
Integrative Case Conceptualization
445
Case Conceptualization and Great Counseling
Realistic Expectations
443
445
445
Elements of Case Conceptualization 446
Introduction to Client 447
Presenting Concern 448
Background Information 449
Assessment of Strengths and Diversity 450
Client Strengths
450
Theoretical Conceptualizations 454
Psychodynamic and Adlerian Conceptualization
454
Psychodynamic Defense Mechanisms 455
Object Relations and Attachment Patterns 458
Erickson’s Psychosocial Developmental Stages 458
Basic Mistake Perceptions 462
Humanistic-Existential Conceptualization
462
Expression of Authentic Self 462
Existential Analysis 465
Gestalt Contact Boundary Disturbances
466
Cognitive-Behavioral Conceptualization
467
Baseline Assessment 467
A-B-C Analysis of Irrational Beliefs
Beck’s Schema Analysis 469
468
Family Systemic Conceptualization
470
Stage of Family Life Cycle Development 471
Interpersonal Boundaries 471
Triangles/Coalitions: Problem Subsystems and Triangles
Hierarchy Between Child and Parents 473
Complementary Patterns 473
Intergenerational Patterns 474
Postmodern-Feminist Conceptualization
474
Solutions and Unique Outcomes 474
Narrative, Dominant Discourses, and Diversity
476
Case Conceptualization, Diversity, and Sameness 477
This End Is Just the Beginning 478
Questions for Personal Reflection and Class Discussion
Online Resource 479
References 479
Case Conceptualization Form 480
Name Index
Subject Index
473
478
488
492
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Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.
Preface
Purpose of This Book
The second edition of Theory and Treatment Planning in Counseling and Psychotherapy
is designed to be an efficient and highly effective means of introducing contemporary
counseling theories. The text enables readers to skillfully apply theory in real-world settings by introducing theory-specific approaches to case conceptualization and treatment
planning. Furthermore, readers learn about the evidence base for each theory as well as
unique applications for specific culturally and sexually diverse populations. Unlike a typical textbook, this book is also intended to be used as a clinical reference manual to
assist mental health professionals in their practice settings for years to come as a helpful
aid for conceptualizing treatment with a wide range of clients, writing treatment plans,
and preparing for licensing exams.
Overview of the Text
Using state-of-the-art pedagogical methods, the second edition of Theory and Treatment
Planning in Counseling and Psychotherapy is part of a new-generation textbook specifically designed to thoughtfully promote student mastery of the material while enabling
faculty to easily measure student learning outcomes, a task now required by all regional
and professional accrediting bodies. Using a learning- centered, outcome-based pedagogy,
the text engages students in an active learning process rather than deliver content in a traditional narrative style. More specifically, the text introduces counseling and psychotherapy theories using two clinically relevant assignments: a) theory-informed case
conceptualization and b) theory-specific treatment planning. These assignments empower
students to apply theoretical concepts and develop real-world skills as early as possible in
their training, resulting in greater and quicker mastery of the material. Furthermore, the
author uses a friendly and fun style to explain concepts in clear and practical language
that contemporary students appreciate. Instructors will enjoy the simplicity of having the
text and assignments work together seamlessly, thus requiring less time in class preparation and grading. The extensive set of instructor materials—which include syllabi templates, detailed PowerPoints, test banks, online lectures, and scoring rubrics designed for
accreditation assessment—further reduce educators’ workloads. In summary, the book
employs the most efficient and effective pedagogical methods available to teach counseling
and psychotherapy theories, resulting in a win-win for instructors and students alike.
What’s New in the Second Edition
Instructors and students familiar with the first edition will notice a similar style and
format and will also appreciate numerous enhancements:
●
Significantly Expanded and More Practical Diversity Sections: The diversity sections
in each theory chapter have been significantly expanded to include practical
xiii
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xiv
Preface
●
●
●
●
●
●
applications of the theory with specific diverse populations. Each chapter contains
a discussion of both a) ethnic/racial diversity as well as b) sexual identity diversity.
Expanded sections on specific populations provide students with detailed suggestions, adaptations, and cautions for using a given theory with a specific population,
including African Americans, Hispanic/Latinos, Asian Americans, Native Americans/
First Nation/Aboriginals, gay men, lesbians, and gay and transgendered youth.
New Chapter on Trauma-Related Evidence-Based Treatments: The second edition
includes a new chapter on evidence-based cognitive-behavioral treatments: dialectic
behavioral therapy (DBT) and trauma-focused CBT for children. Both approaches
are used extensively with clients who have experienced childhood and complex
trauma.
Theory-Specific Case Conceptualization Templates: Each theory chapter now
includes a theory-specific case conceptualization outline that students and therapists
can use to develop case conceptualizations using a single theory. This conceptualization can be used to create a theory-specific treatment plan. Each chapter has a
sample theory-specific case conceptualization as part of the case study.
Revised Case Conceptualization and Treatment Plan Forms: The cross-theoretical
case conceptualization and treatment plan forms have been revised to be more
succinct and easier to use. Digital forms are available for free download.
Jungian Chapter: Jungian analysis is now covered in a separate chapter with a case
study.
Practice Exercises: Throughout the text, “try it yourself” exercises are provided to
allow the reader to practice using assessment and intervention techniques.
Questions for Reflection and Class Discussion: This is a new section added to each
chapter to promote personal reflection and class discussion and to engage material
more thoughtfully.
Appropriate Courses
A versatile book that serves as a reference across the curriculum, this text is specifically
designed for use as a primary or secondary textbook in the following courses:
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●
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Introductory or advanced counseling and psychotherapy theories courses
Pre-practicum skills classes
Practicum or fieldwork classes
Assessing Student Learning and Competence
The learning assignments in the text are designed to simplify the process of measuring
student learning for regional and national accreditation. The case conceptualization and
treatment plans in the book come with scoring rubrics, which are available on the student and instructor websites for the book at www.cengage.com; select materials are also
available on www.masteringcompetencies.com. Scoring rubrics are available for all
major mental health disciplines using the following sets of competencies:
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Counseling: Council on the Accreditation of Counseling and Related Educational
Programs (CACREP) standards for each of the six areas of specialization
Marriage and Family Therapy: MFT core competencies
Psychology: Psychology competency benchmarks
Social work: Council for Social Work Education (CSWE) accreditation standards
Each scoring rubric is linked to competencies identified in these disciplinary standards,
and discipline-specific sample syllabi on the website include lists of the competencies
covered on the treatment plan and case conceptualization assignments.
Copyright 2016 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).
Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.
Preface
xv
Organization
This book is organized into three parts:
●
●
●
Part I: Introduction to Counseling Theories and Treatment Planning provides an
introduction to counseling, competencies, research, and treatment planning.
Part II: Counseling Theories covers the major schools of counseling and
psychotherapy theory.
○
Analytic Theories
●
Psychoanalytic and Psychodynamic Theories
●
Jungian Analysis
●
Adler’s Individual Psychology
○
Humanistic-Existential Theories
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Person-Centered
●
Existential
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Gestalt
○
Action-Oriented Theories
●
Behavioral and Cognitive-Behavioral
●
Dialectic Behavioral Therapy
●
Trauma-Focused CBT
●
Family Systems
○
Postmodern Theories
●
Solution-Focused
●
Narrative
●
Collaborative
●
Feminist
Part III: Integration and Case Conceptualization describes current trends toward
integration and includes a comprehensive integrative case conceptualization
approach to help solidify student understanding of theories.
The theory chapters in Part II are organized in a user-friendly way to maximize students’
ability to use the book when developing case conceptualizations, writing treatment
plans, and designing interventions with clients. The theory chapters follow this outline
consistently throughout the book:
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●
●
●
●
●
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●
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●
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In a Nutshell: The Least You Need to Know
The Juice: Significant Contributions to the Field: If there is one thing to remember
from this chapter it should be…
Rumor Has It: The People and Their Stories
Big Picture: Overview of Counseling Process
Making Connection: Counseling Relationship
The Viewing: Case Conceptualization
Targeting Change: Goal Setting
The Doing: Interventions
Case Conceptualization and Treatment Plan Templates
Tapestry Weaving: Working with Diverse Clients
○
Cultural Diversity
○
Sexual Identity Diversity
Try It Yourself: Exercises to practice skills in the text
Questions for Personal Reflection and Class Discussion
Case Example: Vignette with
○
Theory-specific Case Conceptualization
○
Theory-specific Treatment Plan
Online Resources
References
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Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.
xvi
Preface
Accompanying This Text
Online Instructor’s Manual The instructor’s manual contains a variety of resources to
aid instructors in preparing and presenting text material in a manner that meets their
personal preferences and course needs. It includes sample syllabi, assignment templates,
and scoring rubrics correlated with national accreditation bodies.
Online Test Bank For assessment support, the test bank includes multiple-choice questions for each chapter with references to the text.
Online PowerPoint® Slides These vibrant lecture slides for each chapter assist you with
your lecture by providing concept coverage using content directly from your textbook.
CourseMate Available with the text, Cengage Learning’s CourseMate brings course concepts to life with interactive learning, study, and exam preparation tools that support the
printed textbook. CourseMate includes an integrated eBook, glossaries, flashcards, quizzes, videos, downloadable forms, assignment templates, scoring rubrics, and more. CourseMate also includes Engagement Tracker—a first-of-its-kind tool that monitors student
engagement in the course.
Helping Professions Learning Center Designed to help you bridge the gap between coursework and practice, the Helping Professions Learning Center offers a centralized online
resource that allows you to build your skills and gain even more confidence and familiarity with the principles that govern the life of the helping professional. The interactive
site includes video activities organized by curriculum area accompanied by critical thinking questions; case studies built around ethics, diversity, and theory; flashcards and practice quizzes; a professional development center; and a research and writing center.
Select resources are also available at www.masteringcompetencies.com.
Copyright 2016 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).
Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.
Acknowledgements
I would like to thank the following content experts who gave their time and energy to
ensure that the information in this textbook was accurate and current:
Rie Rogers Mitchell: Jungian sand play, psychodynamic theories
Luis Rubalcava: psychodynamic theories
Stan Charnofsky: humanistic, person-centered, Gestalt, existential
Wendel Ray and his doctoral students, Todd Gunter and Allison Lux: systemic theories
Marion Lindblad-Goldberg: systemic theories
Scott Woolley: emotionally focused therapy
Bill O’Hanlon: solution-based therapies
Harlene Anderson: collaborative therapy
Gerald Monk: narrative therapy
Ron Chenail: Competencies Assessment System
Thorana Nelson: Competencies Assessment System
William Northey: Competencies Assessment System
Jeremy Dastic: Case studies for Jungian and DBT chapters
Instructor and student materials second edition:
Diana Pantaleo
Rena Jacobs
Kayla Caceres
I would also like to thank the following people for their assistance on the second
edition:
Kayla Caceres: Research assistant for the second edition
Eric Garcia: Librarian extraordinaire
Julie Martinez, Product Manager: My amazing and inspiring editor
Lori Bradshaw (from S4Carlisle), Content Developer: Editorial guidance and overseeing
development of the instructor materials
Jean Smith: Permissions assistance
Anna and Guenther Gehart: For the extra hours taking care of Michael and Alex
Joseph McNicholas: For watching kids when I needed to write and for being my best
friend
Michael McNicholas: For making each day a new adventure, for the best hugs ever, and
for decorating my office with your art
Alexander McNicholas: For melting my heart each day with your “crazy cute” baby
ways
Finally, I would like to thank the following reviewers and survey respondents who provided invaluable feedback on making this book work for faculty:
xvii
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Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.
xviii
Acknowledgements
Reviewers:
Gregg Allinson, Beaufort County Community College
Samantha Anders, University of Minnesota
Kathleen Arveson, Regent University
Nancy Baily, University of West Alabama
Jayne Barnes, Nashua Community College
Eric Burns, Campbellsville University
Tamara Clingerman, Syracuse University
Paul DeSena, Loyola Marymount University
Annmarie Early, Eastner Mennonite University
Bengu Erguner-Tekinalp, Drake University, Des Moines
Yvonne Garza, Sam Houston State University
Helene Halvorson, East Tennessee State University
Glenda Hufnagel, University of Oklahoma, Norman
Donna Huger, South Carolina State University
Nithya Karuppaswamy, University of Illinois, Springfield
Mary Livingston, Louisiana Technical University
Krista Medina, University of Cincinnati
Paula Nelson, Saint Leo University
Jenny Savage, Jacksonville State University
Cheryl Warner, Clemson University
Kelly Wester, University of North Carolina, Greensboro
Stephanie Hall, Monmouth University
Lia Wilson, Hope International University
Teressa Wilcox, Hope International University
Tim Vandergast, William Paterson University
Forrest Kelly, West Texas A&M University
Survey Respondents:
Ernestine C. Brittingham, Delaware State University
Charmaine D. Caldwell, Valdosta State University
Mathilda Catarina, William Paterson University
Dibya Choudhuri, Eastern Michigan University
Nancy DeCesare, Chestnut Hill College
Faith Drew, Pfeiffer University
Kevin R. Galey, Dallas Baptist University
Amy Ginsberg, Long Island University
Nicholas Greco, Adler School of Professional Psychology
Kathleen Hathaway, Clover Park Technical College
James M. Hepburn, Waynesburg University
Mary Kay Houston-Vega, University of Texas at San Antonio
Stuart G. Itzkowitz, Wayne State University
Kelly James, Brigham Young University
Randi Kim, Rhode Island College
Cynthia N. Lepley, Thomas College
David Lutz, Missouri State University
Don Lynch, Unity College
Jeanie McCarville Kerber, Des Moines Area Community College
Polly McMahon, Spokane Falls Community College
Richard McWhorter, Prairie View A&M University
C. Michael Nina, William Paterson University
Gwen Newsom, North Carolina Central University
Kate Pandolpho, Kean University
Lois Pasapane, Palm Beach State College
Kim-Anne Perkins, University of Maine at Presque Isle
David Rentler, Northwestern Connecticut Community College
Barbara Roland, Grayson County College
Allen R. Stata, Judson College
Jenny Warren, Liberty University
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About the Author
DR. DIANE R. GEHART is a professor in the Marriage and Family Therapy and Counseling
Programs at California State University, Northridge. Having practiced, taught, and supervised for over 20 years, she has authored/edited the following:
●
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Photo by Jones Photo Art
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Mastering Competencies in Family Therapy
Theory and Treatment Planning in Family Therapy
Case Documentation in Counseling and Psychotherapy (forthcoming)
Mindfulness and Acceptance in Couple and Family Therapy
Collaborative Therapy: Relationships and Conversations That Make a Difference
(coedited with Harlene Anderson)
The Complete MFT Core Competency Assessment System
The Complete Counseling Assessment System
Theory-Based Treatment Planning for Marriage and Family Therapists (coauthored)
She has also written on postmodern therapies, mindfulness, mental health recovery, sexual abuse treatment, gender
issues, children and adolescents, client advocacy, qualitative research, and counselor and marriage and family therapy
education. She speaks internationally, having given workshops to professional and general audiences in the United
States, Canada, Europe, and Mexico. Her work has been featured in newspapers, radio shows, and television worldwide, including the BBC, National Public Radio, Oprah Winfrey’s O magazine, and Ladies’ Home Journal. She is an
associate faculty member at three international postgraduate training institutes: the Houston Galveston Institute, the
Taos Institute, and the Marburg Institute for Collaborative Studies in Germany. Additionally, she is an active leader
in state and national professional organizations. She maintains a private practice in Agoura Hills, California, specializing in couples, families, women’s issues, trauma, life transitions, and difficult-to-treat cases. For fun, she enjoys
spending time with her family, hiking, swimming, yoga, meditating, and savoring all forms of dark chocolate. You
can learn more about her work at www.dianegehart.com.
Author’s Introduction
Bridge Across the Grand Canyon
Known for making its visitors audibly gasp in awe, the Grand Canyon is so wide at points that it is hard to see the
other side. Having inspired reverence for generations, this great natural wonder provides many with a palpable
experience of the divine. However, these qualities are not what I believe students over the years were referring to
when they told me that the gap between their university coursework and fieldwork experiences was like the Grand
Canyon. In marked contrast, my students were referring to the canyon’s gaping and seemingly impassable chasms
that appear impossible to traverse, at least not without hiring a personal jet, helicopter, or the starship Enterprise.
Clearly, my students were feeling as though they were not able to connect their classroom experiences to their
internships with the tools they had been given. Thus, I wrote this book to create a bridge across the Grand Canyon
of Counseling—or at least a zip line—to help new counselors and therapists gracefully traverse two worlds that have
been far too distant for too long: the worlds of academic theory and real-world practice.
You might be thinking, “That is a bold claim. How is she going to achieve this lofty goal?” As often happens in life,
the answer lies in the question. In this case, the key is the term goal. As you learn about counseling and psychotherapy theories in this book, you are also going to learn how these theories are used to generate meaningful clinical goals to help clients and their counselors skillfully address the concerns brought to counseling. Thus, you will be introduced to counseling
theories from the perspective of a practitioner more so than an academic. You will get less history and more information
about how these ideas inform action in the counseling room. Furthermore, you will be given two vehicles for translating
theory into practice: case conceptualizations and treatment plans. These tools are what counselors in the field use to help
them do their job—and the versions in this book are specifically designed to integrate theoretical knowledge.
Enjoy the adventure!
Diane R. Gehart, Ph.D., Westlake Village, California
xix
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Introduction
Start Here: Introduction and Instructions
for Using This Book
Similar to most people reading this book, I was one of those students in school who
always worked hard and went the extra mile. Perhaps I was simply a nerd (ironically,
the last four digits of my family’s childhood phone number was 4335, or G-E-E-K). Perhaps it was my immigrant father’s constant reminder that without a good education one
becomes a “ditch digger” or worse. Regardless of the reasons, I have always loved the
whole school experience far more than playing soccer or watching television (confession:
being bad at sports may have also played a role). This love of education may have
started with those kindergarten activity books. Few things are more exciting than filling
out these workbooks—pictures, colors, dots, lines, puzzles, and mazes—much more
engaging than dull, dry, black-and-white textbooks (present text excluded, I hope).
In graduate school, this overdo-it tendency took another form: never leaving the
library. When it came time to write the doctoral dissertation, which some consider the
crowning academic assignment in Western civilization, it only seemed natural that one
had to write an exhaustive literature review. It took me two years to write that review.
Toward the end, my professor offhandedly mentioned that the review did not have to
include every last study related to my topic. After a wave of now-you-tell-me thoughts
washed over me, I returned to my personal brand of in-“sanity” (i.e., overdo-it logic)
and said, “But I want to,” and just kept searching for everything ever written on the
subject (please note: my dissertation was written at a time in history when this was
possible—the library had a “card catalogue” and only the earliest forms of digital
databases).
Given this extreme tendency, it is astounding to look back and realize—and now
confess to you—that I never once read the introduction to any of the hundreds of books
I “read” in graduate school. Professors never listed them as required reading, the publisher never cared enough to give a formal chapter or real page number, and they were
short, seemingly too short to possibly be of value. Now, sitting here writing to you,
I realize that it was foolhardy to skip the introduction. In most cases, authors reveal the
most important information, summarize the really big idea behind the book, and tell you
how to read and learn from it. In short: it’s where the most important information is
(I guess that’s why it goes first).
Thus, although anyone reading this book is likely to lean toward the industrious end
of the spectrum (but not necessarily a geek and failed athlete like me), I am concerned
that they may miss reading the information in the introduction, as I had for decades.
So, to avoid that error—easily made by even the most devout learners—the introduction
has been labeled “start here” in hopes you read those quick-start guides for your electrical gadgets. I hope that you will find that it greatly enhances your ability to get the
most out of this book. Also, you may want to take a glace at introductions for your
future reads.
xx
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Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.
Introduction
xxi
How This Book Is Different and What It Means to You
Theory and Treatment Planning in Counseling and Psychotherapy is a different kind of
textbook. Based on a new pedagogical model, learning-centered teaching (Killen, 2004;
Weimer, 2002), this book is designed to help you actively learn the content rather than
my simply delivering the content and hoping that you’ll memorize it. Thus, learning
activities are woven into the text so that you have opportunities to apply and use the
information in ways that facilitate learning (not unlike my son’s elementary school activity books). The specific learning activities in this book are (a) case conceptualization and
(b) treatment plans that translate the theory learned in each chapter to client situations.
This book teaches real-world skills that you can immediately use to serve your clients
better.
Also, this book is different in another way: it is organized by key concepts rather
than general headings with long narratives sections. This organization—which evolved from my personal study notes for my graduate school and licensing exams back—
facilitates the retention of vocabulary and terms because of the visual layout. Each year,
I receive numerous emails from enthusiastic, newly licensed counselors and therapists
thanking me for helping them pass their licensing exams—they all say that the organization of the book made the difference. So, spending some time with this text should better
prepare you for the big exams in your future (and if you have already passed these, you
should be all the more impressed with yourself for doing it the hard way).
Lay of the Land
This book is organized into three parts:
Part I: Introduction to Counseling Theories and Treatment Planning provides an introduction to counseling, competencies, research, and treatment planning.
Part II: Counseling Theories covers the major schools of counseling and psychotherapy
theory.
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●
●
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Analytic theories
Humanistic-existential theories
Action-oriented theories
Postmodern theories
Part III: Integration and Case Conceptualization describes current trends toward integration and includes a comprehensive integrative case conceptualization approach to help
solidify your understanding of theories.
Anatomy of a Theory
The theory chapters in Part II are organized in a user-friendly way to maximize your
ability to use this book to support you when developing case conceptualizations, writing
treatment plans, and designing interventions with clients. The anatomy of each of the
theory chapters in Part II (Chapters 3–14) follows this outline:
Anatomy of a Theory
In a Nutshell: The Least You Need to Know
The Juice: Significant Contributions to the Field
Rumor Has It: The People and Their Stories
Big Picture: Overview of Counseling Process
Making Connection: Counseling Relationship
(continued)
Copyright 2016 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).
Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.
xxii
Introduction
The Viewing: Case Conceptualization
Targeting Change: Goal Setting
The Doing: Interventions
Putting It All Together: Case Conceptualization and Treatment Plan Template
Snapshot: Research and the Evidence Base
Snapshot: Working with Diverse Populations
Online Resources
References
Case Example: Vignette with Case Conceptualization and Treatment Plan
In a Nutshell: The Least You Need to Know
The chapters begin with a brief summary of the key features of the theory. Although it
may not be the absolute least you need to know to get an A in a theory class or help a
client, it is the basic information you should have memorized and be able to quickly
articulate at any moment to help you keep your theories straight.
The Juice: Significant Contributions to the Field
In the next section, I use the principle of primacy (first information introduced) to help
you remember one of the most significant contributions of the theory to the field of
counseling. In most cases, well-trained clinicians who generally use another approach to
counseling are likely to be skilled and use this particular concept because it has shaped
standard practice in the field. This section is your red flag to remember a seminal concept or practice for the theory. Feedback from students indicates this is often one of
their favorite sections.
Rumor Has It: The People and Their Stories
In this section, you can read about the developers of the theory and how their personal
stories shaped the evolution of the ideas. And, yes, some of the rumors are juicier than
others. Since the focus of this text is how counseling theories are actually used in contemporary settings, I have deemphasized the history and development of the theory, but
you will find brief summaries of such history here.
Big Picture: Overview of Counseling Process
The big picture provides an overview of the flow of the counseling process: what
happens in the beginning, middle, and end, and how change is facilitated across these
phases.
Making Connection: Counseling Relationship
All approaches start by establishing a working relationship with clients, but each
approach does it differently. In this section, you will read about the unique ways that
counselors of various schools build relationships that provide the foundation for
change.
The Viewing: Case Conceptualization
The case conceptualization section will identify the signature theory concepts that counselors from each approach use to identify and assess clients and their problems. This
really is the heart of the theory and where the real differences emerge. I encourage you
to pay particularly close attention to these. You can also read more about case conceptualization in Chapters 15 and 16.
Targeting Change: Goal Setting
Based on the areas assessed in the case conceptualization and the overall counseling process, each approach has a unique strategy for identifying client goals that become the
foundation for the treatment plan.
Copyright 2016 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).
Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.
Introduction
xxiii
The Doing: Interventions
Probably the most exciting part for most new counselors, this section outlines the common techniques and interventions for each theory. In some cases, a section for techniques used with special populations is included, if these are notably different from those
in standard practice.
Putting It All Together: Case Conceptualization and Treatment Plan
Template
After graduation, you will probably thank me most for this section, which provides a
template for a treatment plan that can be used for addressing depression, anxiety, and
similar concerns. This plan ties everything in the chapter together.
Tapestry Weaving: Working with Diverse Populations
This section provides a review of using the approach with a) ethnic and racial diversity
and b) sexual identity diversity. In addition, unique applications for specific populations
are also covered.
Research and the Evidence Base
This section reviews the research and evidence base for each theory, and this review is
provided to offer a general sense of empirical foundations for the theory. In some cases,
influential evidence-based treatments (see Chapter 1 for a definition) are highlighted.
Online Resources
A list of Web pages and Web documents are included for those who want to pursue
specialized training or conduct further research on the theory.
References
Many students pass right over reference lists and forget all about them. But if you need
to do an academic paper or literature review on any of these theories, the references
should be your first stop. You might remember my historical difficulty with leaving
the library. In this case, I had several hundred books go through my 12-by-12-foot office
while writing this book over a two-year period, in addition to having PsychInfo set as
my home page for faster lit searches (I discovered the joy of library eBooks). Thus,
you can shorten the time it takes to locate key resources by pursuing these before
you hit the library yourself (oh, I forgot, no one steps foot in these places any more;
I meant “surf” the library’s Web page while still in your bunny slippers—one of the
joys of modern technology).
Case Example with Case Conceptualization and Treatment Plan
Finally, each chapter ends with a case vignette, case conceptualization, and treatment
plan to give you a sense of how the theory looks in action and how to put it down on
paper. I use examples of adults presenting for individual counseling in this text; see my
other text Mastering Competencies in Family Therapy (Gehart, 2010) for examples with
couples, families, and children. Again, I think you will find this most useful once your
instructor or supervisor asks you to write one yourself.
Theoretical Friends and Families
Although each theory presented is wholly unique and independent, like the rest of us,
each has friends and families with whom they associate. These are generally referred to
as “schools” of counseling or therapy, and these are increasingly important as more and
more counselors move toward integrated approaches (see Chapters 15 and 16). Unfortunately, like virtually all systems of grouping individuals, these groupings do not capture
the full complexity of their characters. For example, in this book, Adlerian individual
psychology is in the “analytic approach” section because it includes analytic elements;
Copyright 2016 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).
Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.
xxiv
Introduction
however, it also has humanistic, cognitive-behavioral, and even systemic elements. Obviously, reprinting the chapter four times would not help you, so you will have to read
each chapter to learn about the similarities and differences between approaches in the
same school. The rough and imperfect classifications of theories in this book are as
follows:
Analytic approaches
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Psychodynamic
Jungian analytic
Adlerian individual psychology
Humanistic-existential approaches
●
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Person-centered
Existential
Gestalt
Action-based approaches
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Behavioral
Cognitive-behavioral
Systemic/family
Postmodern and multicultural approaches
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Solution-based
Narrative
Collaborative
Feminist
Reflecting teams
Voice and Tone
Finally, I should mention that the voice and tone of this textbook is a bit different from
your average college read. I hope you have noticed by now that I am talking “right at
ya.” I also like to add some humor and have some fun while I write. Why? Well, first,
I have more fun writing this way. But, more important, I want to engage you as if you
were one of my students or supervisees learning how to apply these ideas for the first
time. Counseling and psychotherapy are relationship-based practices, where both parties
are fully present in their humanity (at least in most approaches). Thus, it is hard for me
to write about how to be genuine and present to clients as a detached, faceless author.
So, as I write, I am imagining you as a full and real person eager to learn about how to
use these ideas to help others. I am going to try to reach out to you, answer questions
I imagine you have, and periodically tap you on the shoulder to make sure you are
still awake.
Suggested Uses
Suggestions for Thinking About Counseling Theories
As you read the chapters in this book, you are going to be tempted to identify which
ones you like the best and deemphasize the ones you’re less attracted to. This may seem
like a great idea at first, but here are some points to consider:
Favorite versus Useful: The theories that the average counselor finds personally useful are probably not the same ones that the average client of new counselors is likely to
find useful. Many counselors are psychologically minded, meaning that they enjoy thinking about the inner world and how it works. However, most new counselors begin
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Introduction
xxv
working with diverse, multi-problem clients and families, many (but not all) of whom
are not psychologically minded because they are often struggling with issues of survival
and/or they come from cultural traditions that place less value on analysis and understanding of the inner world. So the theory you find most useful to you personally may
not be a good fit for your first client.
Appreciation: The theories in this book are not casually chosen. They have become
part of the standard canon of theories because generations of counselors and therapists
have found them helpful. Each has wisdom worthy of study. The one lesson I have
learned over the years is that the more theories counselors understand, the better able
they are to serve their clients because their understanding of the human condition and
its concomitant problems is broader. Thus, I recommend approaching each theory with
an attitude of searching for its essential and useful parts. I facilitate this for you in the
“Juice” section of each chapter that identifies the one thing you should work hardest to
remember from the chapter.
Common Threads: Counseling theories are ironic: in one sense, they are very different and inform distinct and mutually exclusive behaviors and attitudes. However, the better you understand one, the better you understand them all. In fact, some counselors, the
common factors proponents, argue that theories are generally equally effective because
they are simply different modes for delivering the same factors (Miller, Duncan, &
Hubble, 1997; you will read more in Chapter 1). So, it is quite possible that commonalities across theories are more important than their differences.
Suggestions for Using This Book to Learn Theories
First, I recommend that you set aside an hour or two to read about a single theory from
beginning to end (from “In a Nutshell” to “Putting It All Together”) to help get the full
sense of the theory. Some chapters have a couple of theories in one, so for these it is fine
to read the chapter in chunks. Additionally, some learners may find it helpful to scan
the treatment plan (either the template or the example at the end of the chapter) or
some other section first, to provide a practical overview; that said, I have tried to organize the ideas in the way most people seem to prefer. But I encourage you to discover
what works best for you, since different learners have different strategies that work best
for them. When you are done with a chapter, you might want to try completing a case
conceptualization and treatment plan for yourself (you may have to make up a problem
if you are nearly perfect) or for someone else, to get a sense of how this would work.
Finally, I strongly recommend that either after reading the chapter or after going to
class, you take good old-fashioned notes. Yes, I mean it. I recommend that you type up
(or, if you prefer, handwrite) a complete outline of the key concepts in your own words.
Why do I advocate for such painful torture? All of us, myself included, when we read
long, dense books such as this one, fade in and out of alert attentiveness to what we are
reading—often lapsing into more interesting fantasies or less interesting to-do lists—
and—gasp!—sometimes even skim large sections of the text (no, I am not surprised or
offended). The only way to make sure that you really understand the concepts you read
about is to put them in your own words and organize them in a way that makes sense
to you. If you need to take culminating exams or plan to pursue licensure, you will
have to log the concepts in this book into your long-term memory, which requires more
than cramming for a final exam. Being a mental health professional requires that you
master and build on what you learn, and you will be expected to know what is in this
book for the entire time you are active in the profession (seriously—and if you think
that is bad, just wait until you get to a class on diagnosis—you’ll have to memorize
an even longer book). Thus, if your former study habits included all-night cramming,
gallons of espresso (or other favorite caffeine delivery system), and little recall after
the exam, you might want to try my note-taking tip or some other strategy as you
move forward.
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xxvi
Introduction
Suggestions for Using This Book to Write Treatment Plans
Because I know some of you might be tempted to skip ahead to the examples and
avoid the boring theory, I feel it necessary to recommend taking a few minutes to read
Chapter 2 on treatment planning before trying to quickly write one for class or your
supervisor. There are some basic “rules” of good treatment planning that all counselors
use and that are clearly spelled out in Chapter 2, and in the end, if you need to get a signature or grade on your treatment plan, it will save you lots of time to read the “howtos” in Chapter 2 first.
I want to emphasize that the treatment plan format, templates, and examples in this
book are just that: formats, templates, and examples. They do not represent the only
approach or the only right approach but simply a solid approach based on the common
standards and expectations. You most likely will work at a counseling agency or institution that uses another format, but the same general rules (the ones in Chapter 2) will
still apply. That is why understanding the principles of how to write good goals and
interventions is more important than memorizing the format.
Furthermore, don’t use the templates and examples too rigidly. Feel free to modify
the goal statements and techniques to fit the unique needs of your client. I have provided
some relatively specific goals as an example of what might work, and I encourage you to
tailor these for each client’s unique needs.
Suggestions for Use in Internships and Clinical Practice
When working as an intern or licensed mental health professional, this book can be useful for teaching yourself theories and techniques in addition to learning how to write
treatment plans. You will likely find that when you work with new populations and
problems, you may be interested in considering how other therapy models might
approach these situations. This book is designed to be a prime resource for quickly scanning to identify other possibilities. Alternatively, you might have a colleague or supervisor who uses a theory with which you are not familiar. You can use this book to
quickly review that theory and avoid looking uneducated. In addition, this book is written to help you appreciate and find common ground across theories, which can be of
particular benefit when working in a “mixed-theory” context. However, to actually
learn to practice any of these theories well, I strongly urge you to take advanced training
from experts in that approach.
Suggestions for Studying for Licensing Exams
Licensing exams are designed not to be unnecessarily tricky or scary but simply to
ensure that you have knowledge necessary to practice counseling and psychotherapy
without supervision and to not harm anybody. And it is a vocabulary test. If you have
honestly engaged your classes, done your homework, avoided cramming for tests and
papers, and made it a priority to get decent supervision, you should have a strong foundation for taking your licensing exam. You should already have in your possession
books (such as this) that cover all the content to be studied for the exam. If your exam
is to be taken on finishing a lengthy post-master’s internship, you should use the entire
two- to four-year period to read as many books as possible on the theories and materials
covered by the exam (no novels for a few years).
I do not recommend that all my students take long, expensive “review courses,”
because such courses are not necessary for those who are proactive in mastering the
material on the exam long before they sign up to take it. If you start studying only after
you are approved to take the test, you are starting about two to four years too late—and
then, yes, you will need to take a crash course. My basic suggestion for studying for
mental health licensing exams is this: read an original text on each major theory during
your post-degree internship, use the Diagnostic and Statistical Manual of Mental Disorders (DSM), keep up with laws and ethics, then buy the practice exams (without the
study guides) and take them until you consistently get 5% above the required passing
score (e.g., 75% if the passing score is 70%). If you find that you are weak in a particular area, such as theory or DSM, use a text such as this, which is designed with the
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Introduction
xxvii
license review in mind. Once you consistently get 75%, you are ready to take the test
with the most learning and the least expense.
Suggestions for Faculty to Measure Competencies and Student Learning
This book is designed specifically to help faculty and supervisors simplify and streamline
the onerous task of measuring student competencies as required by the various accreditation bodies. The forms and scoring rubrics for assessing student learning using counseling,
psychology, social work, and family therapy competencies are available on this book’s
Web page for instructors (see www.cengage.com or www.masteringcompetencies.com).
On this website, instructors will also find free online lectures, PowerPoints, sample syllabi,
and a test bank (test banks are available only from your Cengage sales representative,
in order to maintain security of the questions). This text may be used as the primary or
secondary text in a counseling theories class or as the primary text in a pre-practicum or
practicum/fieldwork class. Because of its combination of solid theory and practical
skills, it can easily be used across more than one class to develop students’ abilities to conceptualize theory and write treatment plans, skills that are not likely to be mastered in a
single class.
When designing a class to measure competencies and student learning using these
treatment plans and case conceptualizations, I recommend initially going over the scoring rubrics with students so that they understand how these are used, to clearly define
what needs to be done and the expectations for the final product. I have found that it is
most helpful to provide two or three opportunities to practice case conceptualization
and treatment planning over a semester, in order to provide feedback and enable students to improve and build on these skills in a systematic fashion. The online instructor
resources include several example syllabi for the various mental health disciplines. Specifically, I have a small group present a case conceptualization and treatment plan with
each theory studied, based on a video the class watches on the theory; that way, students
have enough information to actually conceptualize the client dynamics and treatment.
Then, the entire class can see an example and discuss the thought process of developing
the plan. A later or final assignment for the class can be to independently develop a
treatment plan for a case (either one assigned by the instructor or one from a popular
movie, personal life, or actual client). By the end of a semester with these activities, students will have developed not only competence but also confidence in their case conceptualization and treatment planning abilities.
Student Resources
Students will find numerous useful resources for this text on the Cengage website (www
.cengagebrain.com), with select resources on the text’s website (www.mastering
competencies.com). These include the following:
●
●
●
●
●
●
Online lectures: mp4 recordings of yours truly discussing content of the various
chapters
Digital forms for the treatment plan and integrative case conceptualization
Scoring rubrics
Links to related websites and readings
Glossary of key concepts and terms
Web quizzes
Instructor Resources
Instructors will find numerous resources for the book online on the Cengage website
(www.cengage.com) and select resources on the text’s websites (www.masteringcompetencies.com):
●
●
Online lectures by the author
Sample syllabi for how to use this book in a theory class or practicum class in
counseling, family therapy, psychology, or social work. These syllabi include
detailed lists of the competencies covered for each discipline—to meet accreditation
requirements.
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xxviii
Introduction
●
●
●
Detailed PowerPoints for all of the chapters
Downloadable versions of the integrative case conceptualization, treatment plan,
and scoring rubrics (rubrics are correlated to competencies for each of the CACREP
specialities as well as the core competencies/benchmarks for family therapy, psychology, and social work)
Test bank and Web quizzes
Next Steps
Now that you are acquainted with the lay of the land, it is time to get down to business.
In the chapters that follow, you will learn more about competencies in the field of
counseling and psychotherapy and what they mean for you and your future as a professional. Part of this tour includes a review of what it means to be a professional and the
ethical duties that come with the job. We will also explore the purpose of counseling
theories and consider two streams of research that inform the use and development of
these theories: the common factors research and evidence-based treatment studies. Then
you will learn about the nuts and bolts of treatment planning in Chapter 2. This one
may be a bit dry, but I promise that once you are assigned to write your first treatment
plan, you will find it to be one of the most exciting in this book—nothing like the pressure of having to write your first plan to alter your perspective of what is fascinating.
The remainder of this book will take you on a grand tour of some of the most exciting
ideas from the 20th and 21st centuries. I have confidence that it will be the trip of a
lifetime.
Bon voyage!
And congratulations on reading this book’s introduction! I hope you can see the
value now.
Online Resources
Webpage for this book: www.cengagebrain.com
With select resources also on www.masteringcompetencies.com
Student Resource Page:
●
●
●
●
Treatment plan and case conceptualization forms
Scoring rubrics
Online lectures
Glossary of key concepts and terms
Instructor Resource Page:
●
●
●
●
●
Sample syllabi with detailed list of competencies covered in the class
PowerPoints for each chapter
Treatment plan and case conceptualization forms
Scoring rubrics correlated to accreditation competencies for counseling, family
therapy, psychology, and social work
Test bank and Web quizzes
Author’s page: www.dianegehart.com
References
Gehart, D. (2010). Mastering competencies in family therapy:
A practical approach to theory and clinical case documentation. Pacific Grove, CA: Brooks/Cole.
Killen, R. (2004). Teaching strategies for outcome-based education. Cape Town: Juta Academic.
Miller, S. D., Duncan, B. L., & Hubble, M. (1997). Escape
from Babel: Toward a unifying language for psychotherapy practice. New York: Norton.
Weimer, M. (2002). Learner-centered teaching: Five key
changes to practice. New York: Jossey-Bass.
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Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.
Section I
Introduction to Theories,
Competencies, and
Treatment Planning
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CHAPTER
1
Counseling Theory,
Competency, Research,
and You: Connecting the Dots
What Distinguishes a Counselor from a Bartender?
What makes a counselor or therapist different from a good bartender, hairdresser, or
friend? In many cases, the latter are excellent listeners, can be empathetic, and help
solve problems. Aside from the obvious fact that bartenders and friends typically charge
less for their services—not always true for hairdressers—counselors go beyond these
basic helping skills and do something more. Counselors use theory to (a) develop a specific form of helping relationship, (b) articulate more useful understandings of clients’
situations, and (c) identify effective means to resolve clients’ presenting problems. In the
end, it is the ability to skillfully translate theory into action that makes counselors different from those helpful others. Counseling theories provide powerful lenses through
which to view clients’ situations and identify the most expedient means to resolve their
concerns. This book will show you how counselors do it—and perhaps one day you
will use this skill set to justify your fee, which might rival that of one of the better stylists in town.
Why Theory Matters
Although much has changed over recent decades in mental health care—better research
to guide us, new knowledge about the brain, more details about mental health disorders,
and increased use of psychotropic medication—the primary tool that counselors and
psychotherapists use to help people has not: theory. Counseling theory provides a
means for quickly sifting through the tremendous amount of information clients bring;
then, targeting specific thoughts, behaviors, or emotional processes for change; and
finally, helping clients to effectively make these changes to resolve their initial concerns.
Even with fancy functional magnetic resonance imaging, neurofeedback machines, and
hundreds of available medications, no other technology has taken the place of theory.
However, the changing landscape of mental health care has changed how counseling
theories are understood and used.
3
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4
CHAPTER 1 • Counseling Theory, Competency, Research, and You: Connecting the Dots
Connecting with Theory: Do I Have to Choose Just One?
Over the years, the role of theory in counseling and psychotherapy has become less
rather than more clear. Initially, the general recommendation was to select and train in
one theory, which became a counselor’s primary identity and style of working; it was a
personal choice, and the story ended there. Textbooks such as this one are grounded
around this honorable tradition, a tradition in which I was “raised.” However, many
counselors like to “mix it up,” integrating theories, which has been an increasingly popular and justified practice in the field (see the “Common Factors Research: Reframing
Theory” section; Miller, Duncan, & Hubble, 2004).
Similarly, many of my students, on reading their first theory textbook, enthusiastically exclaim, “I like them all; do I have to choose?” It’s one of those questions that
they quickly regret asking. Because rather than give a simple yes-or-no answer (anyone
who asks is hoping for “no”), I must instead go into a long lecture on epistemological
foundations, developmental stages of becoming a counselor, research on outcomes,
evidence-based treatment, and so on. Within 15 minutes, the class gets very quiet. After
half an hour, most are scrunching their faces with stress. By the end of the first hour, all
have given up hope for a simple answer to their question. So now it’s your turn to listen
to the answer to this question, and out of compassion, I will provide you with a quick
overview and road map.
Counseling theory and how it is being used and understood has been recontextualized by two major movements in recent years: (a) the competency movement, which
includes multicultural competency, and (b) the expanding research base and the
evidence-based treatment movement. These movements have not ended the need for theory but have instead changed how we conceptualize, adapt, and apply theory. The
remainder of this chapter will address these two major movements and discuss their relationship to competency, theory, and you.
●
●
Competency: Common Threads in Competent Use of Theory
○
Diversity and multicultural competence
○
Research competence
○
Law and ethics
○
Person-of-the-counselor
Research and the Evidence Base: Reframing and Redesigning Theory
○
Common factors (across theories) research
○
Evidence-based practice and treatments
○
Evidence-based practice principles
Competency in Counseling and Psychotherapy
Stereotypes are dangerous and typically inaccurate. Nonetheless, I am going to risk stating such a generalization, namely, that counselors and therapists care about others.
Most counselors feel called to the profession to help others and to make a difference in
the world. Few report being motivated by fame and riches, as there are easier and more
expedient means to these ends (you may need to chat with a career counselor if this
comes as a surprise). Many find inspiration from the work of Carl Rogers (1951,
1961), who radically claimed that accurate empathy, unconditional positive regard, and
genuineness are not only necessary but also sufficient conditions for promoting change
in clients. At the grassroots level, clients often describe effective counselors as “nice,”
good-hearted people. Research indicates that this human connection is one of the strongest predictors of change in the counseling process (Miller, Duncan, & Hubble, 1997).
But the counseling relationship does not account for all the change; in fact, many argue
that it is not enough.
Regardless of whether you side with Rogers or those who claim that more is needed,
competent counseling in the 21st century demands that counselors do more than care,
that they are more than nice, and that they demonstrate more than the core conditions
that Rogers advocated. The standard of practice in today’s treatment environments
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Competency in Counseling and Psychotherapy
5
involves several key elements that counselors must master to be considered competent:
having the necessary skills for the job. All mental health professionals who provide
counseling and psychotherapy services—including counselors, family therapists, clinical and counseling psychologists, clinical social workers, psychiatric nurses, and
psychiatrists—must master a core set of competencies. The core elements of competent
counseling are consistent across disciplines, but the specifics of how they are enacted
can vary by training and discipline.
Competency and (Not) You
Although at first it may seem insensitive, the vernacular expression commonly used by
my teen clients sums up the mind-set of competency best: “It’s not about you.” It’s not
about your theoretical preference, what worked for you in your personal counseling,
what you are good at, what you find interesting, or even what you believe will be most
helpful. Competent counseling requires that you get outside your comfort zone, stretch,
and learn how to interact with clients in a way that works for them. In short, you need
to be competent in a wide range of theories and techniques to be helpful to all the clients
with whom you work. If you allow me to go on, you might even begin to see how this
makes some sense and might even be in your best interest.
Perhaps it is best to explain with an example: you will likely either have a natural
propensity for generating a broad-view case conceptualization using counseling theories,
or you will have a disposition that favors a detail-focused mental health assessment and
diagnosis; humans tend to be good either with the big picture or with details. However,
to be competent, a counselor needs to get good at doing both, even if one is easier, preferred, and philosophically favored. Similarly, you may prefer theories that promote
insight and personal reflection; after all, that may be what works for you in your life.
However, that may not work for your client, and/or research may indicate that such an
approach is not the most effective approach for your client’s situation or background.
Thus, you will need to master theories of counseling that may not particularly interest
you or even fit with your theory of counseling. Although at first you may not like this
idea, I think that by the time you are done with this book, you might just warm up to it.
I first learned this competency lesson when working with families in which the parents had difficulty managing the behaviors of their young children. I was never a huge
fan of behaviorism, but it did not take too many hysterically screaming, clawing, and
biting two-year-olds before I was preaching the value of reinforcement schedules and
consistency. Given my strong—admittedly zealous—attachment to my postmodern
approach at the time, I have every faith that you will be driven either by principle (ideally) or by desperation (more likely) to move beyond your comfort zone to become a
well-rounded, competent counselor.
Common Threads of Competency
Although each major mental health profession—such as counseling, marriage and family
therapy, psychology, psychiatry, psychiatric nursing, and chemical dependency counseling—
uses a different set of competencies, there are many similarities across them. They agree that
competent use of theory entails attending four key areas:
●
●
●
Diversity and multicultural competence: The use of counseling theory is always
contextualized by diversity issues, which means that the application and
applicability varies—sometimes dramatically—on the basis of diversity issues such as
age, ethnicity, sexual orientation, ability, socioeconomic status, immigration status,
and so on.
Research and the evidence base: To be competent, counselors must be aware of the
research and the evidence base related to their theory, client populations, and
presenting problem.
Ethics: Perhaps the most obvious commonality across sets of competencies is law and
ethics; without a firm grasp of the laws and ethical standards that relate to professional
mental health practice, well, let’s just say you won’t be practicing very long.
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6
CHAPTER 1 • Counseling Theory, Competency, Research, and You: Connecting the Dots
●
A solid understanding of ethical principles such as confidentiality is a prerequisite for
applying theory well.
Person-of-the-counselor/person-of-the-therapist: Finally, unlike most other
professions, specific personal qualities are identified as competencies for mental
health professionals.
Diversity and Competency
Over the past couple of decades, counselors have begun to take seriously the role of
diversity in the counseling process, including factors such as age, gender, ethnicity, race,
socioeconomic status, immigration, sexual orientation, ability, language, and religion.
These factors inform the selection of theory, development of the counseling relationship,
assessment and diagnosis process, and choice of interventions (Monk, Winslade, &
Sinclair, 2008). In short, everything you think, do, or say as a professional is contextualized and should be informed by diversity issues. If you think that effectively responding
to diversity is easy or can be easily learned, or that perhaps your instructors, supervisors,
or some famous author has magic answers to make it easy, you are going to be in for an
unpleasant surprise. Rather than a black-and-white still life, dealing with diversity issues
is more like finger painting: there are few lines to follow, it is messy for everyone
involved, and it requires enthusiasm and openheartedness to make it fun.
I have often heard new and experienced counselors alike claim that because they are
from a diverse or marginalized group, they don’t need to worry about diversity issues.
Conversely, I have heard counselors from majority groups say things such as “I don’t
have any culture.” Both parties have much to learn on the diversity front. First of all,
we are all part of numerous sociological groups that exert cultural norms on us, with
the more common and powerful ones stemming from gender, ethnicity,...
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