Assessing Individual Needs And Resources: Dynamics And Process Of Psychotherapy

One of the characteristics of all approaches to counseling and psychotherapy is the attempt to understand the client and the client's world. One of the toughest problems faced by a professional counselor is bridging the barriers to understanding, empathizing and constantly intervening with the client's world.

  1. Diagnostic Process in Counseling

Diagnostics is a process that seeks to reach and understand something. In counseling, diagnostics is the process by which the counselor tries to reach and understand the client/counselor.

However, in medical settings attempts to implement a type of illness called "mental illness" have not been particularly successful. The nature of the disease identity suspected in “functional mental illness” has been shown to be different from the types of pathology for which a particular organic cause can be established (Eysenck, 1961).

Diagnostics in Guidance and Counseling relates to the process that seeks to understand and reach clients in managing their effectiveness as humans.

  1. Human Effectiveness Level

The concept of human effectiveness is the ability to gain significant long-term control of the individual's environment both physically, socially, and psychologically. Human effectiveness is not purely an intrapsychic trait, but is a measure of the quality of people's interactions with the environment at certain times and under certain circumstances.

The lowest level of human effectiveness is Panic. From this level of panic, if it cannot be overcome, it will become apathetic. From the apathy of the individual struggling/trying/coping, at this level the individual is able to maintain control over most short-term transactions with his environment and is actively involved in seeking more long-term control,

  1. Panic

Panic is characterized by an intense feeling of being out of control helplessly by the evil forces in the environment. Panic may be accompanied by crying, anger, or with intense physical symptoms, such as hyperventilation, rapid pulse, increased blood pressure, increased urination, fainting, sweating, and shaking.

Panic is a reaction to intense or uncontrollable stress. This is not automatically an indication of intrapsychic deficits or inadequate personality development.

Panic reactions can be prevented by various counseling procedures. This procedure is sometimes called a stress inoculation, or stress-management procedure. These procedures include coping behaviors or anticipations at the beginning of a stressful situation. Counseling with clients who are or have recently been in a state of panic, or who are on the verge of panicking, is often called crisis intervention. Crisis interventions try to help people deal with stressful situations in very short-term by helping them to control their emotions and to deal with problems immediately.

  1. Apathetic

The second level of human effectiveness can be called "apathy." At this level there is some control over the short-term, immediate aspects of the environment. At the level of individuals often try to exercise control over their environment, especially by avoiding stress in threatening interactions, perhaps even leading to greater long-term control.

Individuals in the grip of apathy tend to avoid or ignore demands from the environment. Because of the emphasis on avoiding immediate punishment or preventing obvious failure, individuals have great difficulty in following even the most carefully structured plans and in accepting responsibility for their own behavior and consequences. Others will be blamed and various excuses will be found to rationalize the loss or failure.

  1. Struggle/ Effort

Individual struggles/efforts are often limited in planning and delayed gratification, but are easily discouraged by failure to achieve results quickly. Often these clients tend to set unrealistic goals and objectives with respect to their scope or for the time it will take to achieve them, and then become discouraged when they are not achieved. This individual's life is characterized by a series of crises and emergencies that could have been prevented with more consistent and careful planning.

  1. Countermeasures/Coping

At the "Coping/overcoming" level the client is able to take considerable responsibility for selecting goals and setting direction in the counseling process, and in turn the counselor is able to take advantage of a rather wide variety of approaches to counselling. Once a fairly good relationship has been established, it also "creates a partnership" between the counselor and the client.

  1. Mastery

At this level of mastery people tend to experience feelings of adequacy and self-confidence in most roles and relationships. They experience problems or obstacles as challenges and may show real passion and enthusiasm in setting goals and planning activities.

People at mastery levels may have difficulty when new roles entrusted to them that involve an empathetic role form or nurture with people who are less effective and confident. Sometimes counselors working with client systems in the organizational development or consulting process must help administrators and executives adjust to function in new roles at the mastery level. Interventions, such as human relations training or "sensitivity" training, are sometimes useful in these situations.

  1. Diagnosis as Continuous and Tentative Process.

The diagnostic process in counseling is most effective when it occurs continuously, tentatively, and tested. Because the diagnosis process penetrates and encompasses the entire counseling process, diagnosis is an ongoing process of continual modification of the counselor's services and client perceptions.

As the counselor observes carefully and systematically, these observations are organized and give rise to a set of conclusions, guesses, or "clinical hunches". These conclusions are organized into images or impressions of "hypothetical clients." It is the description of the hypothetical client that provides the true basis for the counselor's response. Counselors usually respond to real clients as if they were hypothetical models that, in fact, exist only in the counselor's mind. 

As we all engage in relationships with other people, counselors must constantly remember that our impressions are forever tentative and must remain open to revision and additions born of new, more credible observations and conclusions. As new observations are made and new conclusions and hunches are formulated, the "hypothetical client" grows richer, more detailed, more complex, in a more complete sense.

  1. Use of Psychological Testing and Other Assessment Techniques

The use of tests in counseling should be considered as part of the overall diagnostic process. The use of tests in counseling is a total effort of the counselor to understand the client, and from that understanding it is used to help the client.

Like a questionnaire or a structured interview, a test is really just a device designed to make observations under conditions that would allow us to make comparisons between one person and another or about the same person at two or more different times. That is why standardization of instructions, time limits, and other aspects of the test procedure is required.

  1. Observation and Inference

To understand the use of tests and to fully understand both their advantages and their potential dangers and limitations, we must understand the basic processes of observation and inference.

  • Observation.

If we want to understand any phenomenon, we try to make arrangements to observe it. Generally we want to ensure their accuracy by comparing the perceptions of two or more observers or by making more than one observation. We do it in situations where accuracy is important. Of course, any intervention in the life of another human must be based on careful, accurate observations.

  • inference.

The extension of understanding is a process of inference, and one that is fraught with many dangers. As an extension of meaning beyond a specific set of observations, conclusions are essentially guesswork and can be fully supported by data. As we pointed out earlier, that should always be seen as a tentative approximation.

When we see a student "burning the midnight oil" in preparation for a big test, we tend to explain that behavior by saying that he or she is "highly motivated." Motivation is the construct that we create to explain goal, goal directed behavior. Similarly, we create constructs such as "anxiety" or "defensive" or "intelligent" to explain other behavioral patterns. Some constructs such as intelligence are also called traits.

Traits are tendencies in an individual to behave in a certain way in different situations. When we discover traits, we make assumptions about human behavior in terms of consistency and resistance to change. For this reason the concept is essentially an intrapsychic nature.

The nature of environmental demands and the ways in which these demands are interpreted by a given culture tend to determine the type of behavior that will be termed intelligent.

Hunt (1961) concludes based on extensive research that the assumption of intelligence, keeping it simple, is simply genetically determined is not compatible with the evidence. Instead, he concludes that intellectual development and constructing explanations of intelligence are something that grows out of the interaction between child development and the environment. When we measure intelligence, therefore, we get a picture of a person that is relevant to a point in his book or his development.

  1. Validity (Validity)

The concept of "validity" involves the degree to which a given test instrument actually measures what it measures. A number of closely related concepts in psychological measurement relate to various aspects of validity. These include predictive validity, concurrent validity and construct validity.

Validity relates to the usefulness of psychological test information for a particular purpose. As we noted earlier, test users typically seek to draw inferences from their results about various aspects of an individual's present or future behavior. The validity of this information is important because it informs the user about the types of conclusions about the individual that can be attempted, given the nature of the tests involved. Even when a test or instrument is deemed valid for a particular purpose, as noted, another complex set of assumptions may be involved (Messick, 1980).

Another aspect of validity is predictive validity. In this situation the scores are obtained before the criteria data. In our example, a test might be administered to a group of bound high school seniors and the information gathered by the criteria earned them a point average at the end of their first year in college.

Usually validity is expressed in the correlation coefficient between test scores and criteria scores. A high correlation or relationship between test scores and external criteria is meaningful only in so far as we believe the criterion is concerned with establishing the basis for which it is intended to be predicted. In other words, a measure of validity must relate to our assumptions about how the trait or construct relates to performance on the criterion.

Construct validity, can be considered the most comprehensive and most important aspect of the overall validity question (Messick, 1980). Construct validity is concerned with the total pattern of relationships that exist between scores on a particular test or instrument and all logically related variables. Validation is the process of studying a network of empirical relationships that relate results to other measures and methods of observation. Relationships can be studied either by looking for converging patterns of results from tests intended to measure the same construct, or by looking for different patterns of tests assumed to measure different constructs. It can be concluded that the test administered measures of "creativity" noting that the test had a high correlation with other tests of creative thinking and a low correlation with measures of general intelligence.

  1. Reliability

Another major concept in using tests is reliability. Reliability relates to the consistency of measurement. The two main aspects of reliability are

  1. consistency over time, which is usually measured by "retest-retest reliability".
  2. consistency between two similar sets of items, which is sometimes called "parallel form," or "half-sided reliability."

The two aspects of reliability are not the same, and one cannot replace the other because they hold very different types of consistency.

Re-testing the reliability of the test is the most frequently used aspect of reliability by counselors. The underlying point is that if a given test or instrument it is intended to measure is considered stable over a sufficiently long period, we would expect that two successive measurements on the same individual would produce very similar results. Of course, the difference between the two measurements can be attributed to error. Such errors can be caused by various factors, such as illness or interference on the part of the subject during a test administration, guessing answers, misunderstanding of instructions, or lack of clarity in some items, thereby reducing reliability.

  1. Norms and Criteria Referenced Score

When we select a norm group for a type of interpretation, we make judgments about the appropriateness and meaning of the comparison. If the group of norms used is disproportionate to factors affecting the individual such as previous educational opportunity, cultural and linguistic background, or other factors that affect test performance, the comparison may be quite misleading.

The second type of reference base is called score-based criteria. Sometimes we really want to know how an individual's performance compares to some independent absolute criterion "about how others do it." For example, experience may show that to succeed in a particular job a worker must be able to read two hundred words per minute at least 80%. This reading level then becomes a criterion for the performance indicated by the individual test scores to be compared.

  1. Result Interpretation

In interpreting the client's score or results, the counselor should keep in mind:

  1. Test scores must be interpreted in the context of all available information about the client. Information regarding the cultural background, health, motivation, and educational and linguistic skills of the client, among other variables, are important factors in constructing the meaning of test scores.
  2. Predictions of test scores obtained are always based on groups rather than specific individuals, so such predictions should always be made in the third person plural.
  3. Success in any endeavor is determined by a complex set of factors including motivation and self-control, as well as talent. Behavior is also needed here.
  1. Behavioral Assessment

Behaviorism is an approach to the study of human behavior that attempts to limit the use of inferences about people in an attempt to reduce some of the possibility of error.

Behavioral assessment procedures that aim to find the fundamental functional relationship between individual behavior and environmental factors and stimuli, so that behavioral assessment involves functional analysis of individual transactions with the environment.

The behavioral assessment approach emphasizes two important principles. The first is the principle of direct observation. By direct observation or sampling we can look at the specific symptoms of the behavior that is considered problematic and focus on it directly.

The second important principle is that all terms or concepts used in the assessment must be operationalized. The terms used to describe the client should always be expressed as observable behavior. Every effort should be made to avoid or eliminate conclusions about events or processes that are internal and unobservable.

Behavioral assessment is an integral and ongoing part of treatment. The total process involves five specific phases (Keefe, Kopel, & Gordon, 1978): 1) problem definition, 2) functional analysis, 3) treatment procedures, 4) information sharing sessions with clients, and 5) treatment evaluation.

Problem definition is carried out first by determining the problem posed in terms of the actual behavior involved. Redefined client complaints and problems in terms of actual response. Each relevant problem response pattern was assessed in terms of frequency, duration, intensity, and appropriateness, as well as with common situational factors associated with the same time. drug or alcohol use, or illness.

The purpose of this phase of the assessment process is to identify the targets of all behavior and environmental events that can be modified through treatment

The second stage in the behavior assessment process involves carrying out a functional analysis of the relationship between behavior and events and the potential for environmental controls.

The result of the functional analysis is to make a final selection of the target behavior, establish the frequency of occurrence, and conceptualize the functional relationship or contingency between the target behavior and the modified event in the environment.

The third step in the assessment process is the design of a series of treatment procedures. As part of this phase, an assessment is made of the client's motivation and willingness to cooperate in the treatment and resources available to the client in the environment. This includes the willingness of a partner, roommate, supervisor, or co-worker to assist in the treatment process, or the degree of flexibility possible in the client's schedule.

The next stage of the assessment process involves an information sharing session with the client. In this session the counselor reviews and discusses the problem description obtained in the initial phase of the assessment and listens to the client's perception. Then, a treatment plan is proposed and mutually accepted. This type of collaborative exchange can be repeated several times during the treatment. The counselor and client discuss progress in terms of changes in the frequency and duration of the target behavior compared to baseline or baseline frequency. Progress in terms of target behavior change is generally charted by clients, counselors, and assisting others in a careful and formal manner.

The final stage of the overall behavioral assessment process involves careful evaluation. This is generally done in terms of specific changes to the target behavior from the ground level. Attention is also given to sustaining post-treatment changes and ensuring that changes transfer from the treatment situation to other relevant situations in the client's life.

Behavioral assessments, then, are based on seeking the client's ways of influencing specific target behaviors in the environment. This involves generating sufficient information about the client and the environment to allow the design of a treatment plan to be modified or a functional relationship between the state of the environment and the client's behavior.

  1. Cognitive Assessment

In this view, individuals are not only passive recipients of external information, but, rather, are active and dynamic. From the constructivist view of human behavior, the individual's interaction with his environment depends on the way the individual describes and interprets the information available from the environment.

In studying information processing, cognitive psychology has focused on the two functions of cognitive differentiation and integration. Differentiation refers to the way in which people draw out and categorize information. Individuals who attract a lot of information and have provided a number of categories that can be used to organize them and generate complex thoughts. Integration refers to an individual's ability to combine seemingly unrelated and disparate information from information into a common concept or principle that can reconcile and link various parts. Again, these good integrators are called complex thinkers.

Cognitive developmental psychology has attempted to describe and explain the growth process by which individuals acquire higher levels of cognitive function over the course of their life span. In the process a number of cognitive developmental frameworks have been articulated to describe the sequence of cognitive growth. It presupposes the existence of a framework of certain cognitive stages, each of which is characterized by certain tendencies and styles of reasoning, judgment, decision making, and even interpersonal relations. Each stage of specific cognitive style is viewed as qualitatively different from the previous stage and is then structured.

One of the first cognitive development schemes was proposed by the pioneering Swiss child psychologist Piaget (1929). Furthermore, cognitive development schemas have been articulated to describe moral development (Kohlberg, (1968), general intellectual growth (Perry, 1970), and conceptual development (Harvey, Hunt, & Schroder, 1961. However, perhaps the most comprehensive of cognitive developmental schemas is the The model of ego development was devised by Jane Loevinger (1976).She views the concept of ego development to be the most comprehensive of all developmental periods and maintains other schemas.

  1. Stages of Ego Development By Loevinger

The ego functions in cognitive processes in general, and is very important for the total personality. Each stage in the ego has important implications for various behaviors. Thus, understanding the stages that individuals have is an important key to understanding both the nature and meaning of client behavior.

  1. Pre Social Stage

In young children, infants do not have the ability to fully distinguish themselves from their environment. As infants begin to develop a level of self-awareness and to differentiate themselves from their environment, they tend at first to see others as mere service providers who exist only to meet their own immediate needs. As a child begins to develop language, the processes of self-awareness and social differentiation rapidly accelerate.

  1. Impulsive Stage

As babies develop, they begin to separate themselves from their sense of the rest of the world. Along with self-awareness and awareness of impulses and tendencies to act on the environment. Because of the relative immobility and helplessness of this young child, impulses are limited and regulated almost entirely by parents or other caregivers. The inevitable result is that children are highly dependent on adults both for physical needs and for control of their impulses.

  1. Self Protection Stage

The learning and internalization of social rules still occurs in social contexts where arbitrary punishments are experienced in return. However, in terms of children's thinking and experiences, the self-protection stage is far from normal adult models and reasoning. Children may tend to blame circumstances and others when in trouble.

  1. Conformist Stage

The conformist stage begins with the development of real socialization, that is, the child's consciousness grows out of the fundamental congruence between one's own well-being and that of the group. Identification, which starts in the family, can gradually be extended to other important groups. A sense of group identification is based on trust and the capacity to predict and understand the behavior of others. Children obey these trust-enhancing social rules because they come from groups.

  1. Self-Awareness Stage

This phase is characterized by an increase in self-awareness. and the ability to consider multiple possibilities and perspectives in making moral and social judgments at this level, one can see some exceptions to the group rule: conformity, although those exceptions may be both limited and somewhat arbitrary.

  1. Conscience Stage

This stage of ego development marks the emergence of a fully mature conscience and ability to engage in self-criticism, establish long-term goals, and evaluate them in terms of individual personal values ​​rather than on the basis of general social approval. At this stage individuals can accept responsibility for helping others and are more concerned with the consequences of actions on the welfare of others than they are with observing or ignoring rules.

  1. Autonomy Stage

At this stage of development individuals acquire the ability to recognize and overcome conflicting and competing values ​​and needs within themselves and among themselves and others. Much of the ability results from capacity building to take multiple perspectives. As autonomous individuals become more comfortable with their own intellectual and emotional independence and come to recognize and respect others' need for autonomy, they become less controlling and manipulative. Autonomous individuals have a greater tolerance for ambiguity and complexity and are able to set long-term goals based on self-fulfillment rather than seeking immediate achievement or recognition.

  1. Integrated Stage

This stage is the stage of building self-actualization and is the culmination of the developmental pyramid. In this integrative/integrated stage the individual not only masters, reconciles and problems but gains complete mastery over them. Therefore, this stage is the highest in intellectual achievement, emotional control and environmental mastery. 

Sumber : 

Donald H.Blocher ( 2007).The Professional Counselor. New York : Macmilan Publishing Company.Page 73-202)

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