A graduate student is eligible to take the comprehensive examinations only during the long term semester or summer in which all work is completed. Students must be enrolled in their final course work (last semester of classes) or have all course work completed.

Application for Comprehensive Exam in Counselor Education *

Format of Test *

Written Examination (Sample Test) *

Research Review *

Sample Answers to sample questions *

Beginning summer of 1997, all students taking comprehensive exams in either Professional Counseling or School Counseling will take both a written and (possibly) oral comprehensive examinations. The structure for the exams is as follows:

• Details:
• The date for the spring, 1999 written exam is July 16^th (Friday). Plan on meeting at the Hastings Learning Center (basement of the library) at 12:00 p.m. The Oral Comprehensive Exam will be scheduled as needed.
• Students will have a maximum of 5 hours to take the test. Most students will require at least 4 hours.
• Be sure to limit your answers to 30 minutes. Many students get carried away on their first and second answers; write only what is needed. The best way of taking the test is to write for 30 minutes, go to the next question, and use the extra time at the end to pad your weaker answers. If you adequately prepare for the exam (see preparing for exam), you should be able to predict exactly how much time each question will take. This is a very predictable test.

• Test structure:
• Overview: This test provides a variety of focused, brief questions that will allow you to provide a framework of knowledge that will be further explored in the Oral Exam.
• The test is divided into four sections:

1. theories
2. research,
3. applied theories (e.g., group and techniques/diagnosis), and
4. multidisciplinary (e.g., ethics, human development, techniques with children, psychopharmacology, gender and multicultural issues, etc.)

• From these four categories, 8 questions are created involving the following content areas:

1. Theories 1: Compare and contrast two theories
2. Theories 2: Case conceptualization
3. Research 1: React to a research study
4. Research 2: Analyze a table
5. Applied 1: Group Counseling
6. Applied 2: Techniques of Counseling/Psychopathology
7. Ethics & Professional Orientation
8. Multidisciplinary (see sample questions below)

• Students will have a variety of questions from which to choose, but you must write on a total of 8 questions, 2 from each section (see examples on the following page).
• Each question stands alone. You must answer the question completely without relying on what you might have said in answers to other questions. With up to four people grading your test, the grader is unlikely to have access to many of your other answers.
• You will receive a copy of your written exam within one week after taking it. It will have few very comments made on, so please don’t depend on these to help you study for the written.
• Note: Students may only fail the written and oral exam one time. After receiving a second failing score, students will never reach candidacy in the program.
• Preparing for the test: The best way to prepare is to take the sample test in a timed format. You might be surprised how difficult it is to keep your answers short. In addition to taking a sample exam, meet with your group and design questions you would like to see on the test.

• Find four articles with tables from psychology/counseling journals which you would like to see on the exam (simple correlations will not be accepted – please find t-tests, factorial analyses, regression analyses, or any other non-correlation study). You would be wise to pick tables that you understand or that are well described in the text. You must submit four entire articles (not just the tables). The chosen table will be from one of those articles but will be slightly modified for the test.
• Submit four broad questions for questions #1 and 5. The narrow questions are less likely to be used. Broad topics are almost certain to be used. We will construct a narrower question from the topics you submit.
• The questions asked on the test are likely to reflect the questions you wrote, but they are unlikely to be identical to your questions. Be prepared to answer any question on the four topics you addressed.
• For example, for question #5, you could submit "what are the stages of group counseling?" For the actual test, this may turn into the following, "describe in detail the second stage of a group."
• You will not be able to submit sample questions for questions #2 or #6. These are the case studies. The actual questions will be identical to the ones on the enclosed sample test, but the case will be different. However, you may submit four DSM-IV categories (e.g., Disorders of Infancy, Childhood, mood disorders, psychotic disorders, personality disorders, etc.) which you would like to see on the test. This is to your advantage since you will have to provide a diagnosis for question #6.
• Question #7 is always the same and requires you to interact to a series of ethical dilemmas. You may submit questions but be prepared to answer the questions from the study guide.
• Many of you may have unique areas for question #8. Please submit four questions for each of the category option you wish to write on. For example, if only one person took Multicultural and Gender Issues for Counselors, that person could write four questions for that class. Other students would write questions for the classes they took.
• DO NOT SUBMIT THE STUDY GUIDE QUESTIONS FOR ANY OF THE QUESTIONS. PLEASE MAKE UP YOUR OWN.
• If you are concerned about the appropriateness of your question, please ask. We will help you hone your questions to ones that are likely to be used.
• Note: Submit your questions early in the process. That way you can prepare for specific topic areas and assign jobs.

• Grading
• The oral and written tests are graded in the following manner. Each question is graded with either a
• pass-with-excellence (1 point)
• pass (one point),
• partial pass (half point), or
• fail (no points).
• To Pass the test (two options)

• Distinction: Students who receive passes with excellence on three or more questions and receive 7½ or more points on their written exam will graduate with distinction. Distinction awards may be indicated on your vita, announced at the annual Waugh conference and may include a small stipend, depending on available funds.

• Details:
• At the conclusion of the written, you will receive a copy of your test. Very few, if any, comments will be made. You will have to look at other people’s tests to know where yours may have been weak. Please use this to study what you may have missed. You will receive your score within one week of taking the written test.
• Orals are usually scheduled to take place two weeks after the Written Exam. Remember that students receiving perfect or near perfect scores (7 to 8) on the written exam are not required to take the oral. Within the week following the exam, you will receive a grade for you written exam.
• Exams are scheduled in group format for 1½ hour sessions. Please note, this is not a group test. You will be required to demonstrate independent knowledge on the exam. Please come to the Dean’s conference room (Old main 410E) for your exam.
• You will be assigned groups and times for your Oral exam. You may have some input on who you would like to have in your group but we will attempt to separate school counselors from LPC students.

• Preparing for the exam
• Your written answers comprise the heart of the oral exam. You should be prepared to critically explain what you wrote. For example, we could ask, "on question #3, on page 10, you wrote ‘the study lacked any clear focus.’ What did you mean by that? How do you think the study could have been improved?" A good answer would be something other than, "It sounded good," or "I don’t remember what I wrote."
• A good way to prepare would be to meet as a group and pass around your written tests. The group should be able to provide feedback as to the strengths and weaknesses of your answers.
• Review all of your answers, not just the ones you failed. If you passed all of the theories questions, for example, you will still be asked questions about theories. In this phase, we want to know why you wrote what you wrote.
• Most students consider this part of the exam less stressful than the written exam. At least you know what to study J All of the questions asked on the oral will stem from your answers on the written exam. We may go into more depth or provide you another table but at least 85% of the test will be identical to the content of the written exam.
• Remember, all you need is a 5 ½ average (written and oral) or a 7 on the Oral to pass. If you come into the oral with a 6 ½, it is highly unlikely that you will fail.

Please begin each answer at the beginning of a new page. You have 4 hours to complete the exam. You should write for at least 25 minutes on each question. Remember, the test is timed so keep at your answers as concise as possible.

Question #1 (answer one of the following questions):

(LPC CASE) – The Case of Alice

(SCHOOL COUNSELING CASE – The case of Tom)

Question #3 (use the below mentioned description to answer the following questions):

• Include how generalizable would these findings be? (see threats to external-validity for clues to the latter question)

Use the following headings in your answer:

• Independent and dependent variables
• General findings
• Specific findings
• Applications to the field of counseling

Note: * P <.10 ** P < .01

(taken from Foster, E. M., & McLanahan, S. (1996). An illustration of the use of instrumental variables: Do neighborhood conditions affect a young person’s change of finishing high school? Psychological Methods, 1(3), 249-260.

Table 2

(simplified and mutated) Results of Hierarchical Regressions of the Multicultural Counseling Inventory (MCI) Subscales on Demographic Variables, and Educational and Clinical Experience Variables.

Note. N=128.

* p<.05. ** p<.01 *** p<.001

Table 3

(simplified and mutated) Partial Correlations of Session Impacts Scale Indexes to Other Measures of Session Impact

* p< .001

Original Table – Results of Multiple Regression Analysis (Beta Weights)

*p<.05, ** p<.01, *** p<.001

and

Predictors of Session Impacts Scale Indexes

Table 4

* p <.05

(below is mutated and compressed - you will not be asked anything this complicated – it’s just here as a reference)

Hierarchical Multiple Regression Analyses Predicting Working Alliance From Parental Bonds and Social Competencies

Table 5

* p <.05, ** p < .01

Correlations between Counselor Trainees Countertransference Management and Two Countertransference Measures within Client Sexual Orientation Conditions

Table 6

Note. The n=17 in the lesbian condition and n=25 in the heterosexual condition.

* p < .05

Question #5 – Group Counseling:

Question #7 – Ethics and Professional Orientation

Person centered therapy rests on the belief that the private world of the individual (experience) modifies individual perceptions (reality). This phenomenological perspective emphasizes the internal experience of the individual over the shaping forces of the environment. Our families, society, workplace, and other social forces color the way we see the world, but our perception of reality has more to do with our interpretation of these forces. In general, the world is a constrictive force limiting or using us. It teaches us to pursue actions that are socially gratifying (e.g., praise) rather than actions that result in growth (e.g., standing up for our values).

In order to break away for the negative influences of society, Rogerian counselors emphasize a redefining of the Self. The is often described as helping the client recognize incongruence between the person she is and who she wants to become. All people will have faced environments that limited their inherent inclination to develop all of their capacities, to differentiate, to expand, and to become more autonomous. Many clients expect the counselor to do the same thing. An effective counselor will move the client toward their innate actualizing tendency or the wisdom of their organism and will help to eliminate the psychic tension that comes when people can’t figure out who or what they want to be.

When people successfully tap into their actualizing tendency, they will choose health over sickness and pleasure over discomfort. The trick in reaching this self-actualization is in learning to integrate interpretations of experiences into our experience of self. For example, if a woman was raped, the event will inevitably change her perception of self. If she hides in her room with the lights off and refuses to leave her house, she is likely to become conflicted between her current behavior and who she believes herself to be. She may begin to doubt that she is strong, autonomous, self sufficient, and valuable. In therapy, the process of helping her identify these feelings will eventually lead to a recognition that one experience hasn’t robed her of these qualities. Her innate tendency toward growth will reappear when she begins to feel safe and free to self-examine.

Counselors can assist clients in reaching their potential in two ways: (a) fostering their own actualizing tendency and (b) developing better clinical and listening skills. Rogers often wrote about doing his best when was closest to his "inner, intuitive self." These were moments when he was touch with the unknown in himself. When these moments occur, he believed that his very presence was healing.

In addition to the therapist modeling self-actualization, PCT advocates that counselors and therapists learn to listen. This includes skills such as empathy, demonstrating unconditional positive regard, congruence, paraphrasing verbalizations, paraphrasing nonverbal messages, and engaging in active listening. The assumption is that the better counselors listen to their clients, the better able the client will be in listening to him or herself.

Not all theorists agree with the position advocated by Rogers. Lazarus has long been a vocal opponent to PCT, and he considers it a polar opposite to his Multimodal therapy. His chief complaint is with the notion that therapists are most helpful when they approach all clients in the same manner. Rather than handle every client the same way, he argues, we should explore the techniques and skills that are empirically validated for specific problem areas. We must conduct multimodal assessments to discover areas of concern that may lay beyond the client’s conscious reach (nonconscious thinking). Their behavior, affect, sensation, imagery, cognition, interpersonal relationships, and biological thresholds all play important roles in the formation of the self. Counselors act unprofessionally when they either focus on one of these areas or expect the client to recognize how they all fit together.

This technical eclecticism obviously depends more on a behavioral than a humanistic philosophy. Lazarus is basically saying that people can’t heal themselves, or maybe we they don’t have a actualizing tendency. At this point in my career, it is hard to say who is correct. I would like to believe that Rogers is right; that we are striving for goodness and health. With the amount of harm and destruction in the world, however, it seems that therapists will need to have a more directive presence. The answer seems to lie somewhere between the two.

(Time taken to type this sample answer: 32 minutes)

According to Reality therapy, Alice is at the latter stages of a failure identity that is likely to manifest itself through her drug use. She has passed stage 1 (giving up). She views herself as unable to fulfill her needs effectively. This is clearly the case with her belonging needs. She has distanced herself from her mother, she is likely to view all men as hostile, and she is having hallucinations that probably interfere with her relationships from school. She has also passed through stage 2 (choosing negative symptoms). She is engaging in anti-social actions (heroin use), negative thinking (she is a "looser"), and negative feelings (e.g., depression and anxiety). Although Glasser believed few clients actually make it to stage 3 (negative addictions), Alice apparently has. Her drug addiction is her way of providing herself with a momentary sense of power, fun, and possibly freedom. It will be important for her realize that these behaviors are moving her in an ineffective life direction.

In order to be better conceptualize the case, I will use Wubbolding’s WDEP system. In the WDEP system, planning for the future would entail first asking what the client wants (W). Alice is likely to focus on the drugs and relationships problems, but rather than assume these, it is important to investigate the client’s perceptions. Over what components of her life does she feel that she has some control. Does she perceive herself as a victim (external locus of control) or someone who has gone through some hard times but able to change (internal locus of control)? Alice seems to have components of both, but her poor self-image and depression stem from an internal locus of control. She views herself as a "looser," which, in some ways, is positive. At least she is willing to take responsibility for her actions. Her weakness lies in taking responsibility for actions outside of her control.

After establishing what the client’s desires for therapy, I would ask Alice what she doing and her overall direction (D). She does not appear to believe she has the ability to overcome her drug addiction. She stated that she cannot "control" her impulses and fears that she is setting herself up.

Her self-evaluation (E) is obviously poor, but from her monologue, we don’t have a clear indication of what she things would be realistic change. She is able to evaluate some specific actions, such as the dangers of taking drugs, but she feels incapable of stopping. It would be important to ask questions such as , "do you really have no control over the situation?" It may also help to focus on her perception of her relationship with her mother. The "loss" of her mother’s respect does not appear to be based on a conversation. It would help for her to at least see the possibility that her mother still respects and loves her.

The final stage of the process of Reality-based psychotherapy is to co-construct a plan with the client. Alice’s failure identity is likely to impair her ability to make effective plans. In order to foster this skill, it would important to teach her that (1) behavior is purposeful, (2) behavior is a choice, and (3) the past is behind her – we only have the present. If we can make progress in these areas, we can help her make a SAMIC plan. This is a plan that is simple, attainable, measurable, immediate, and one she is able to commit to. One option would be to explore the possibility of taking to her mother. We could role play the possible outcome of this and help her to view that relationship as a possible means of obtaining a sense of belonging.

For any drug addict, however, no plan could be successful without addressing the addiction itself. It is be important for Alice to start developing a Positive addiction; i.e., a route of gaining psychological strength. She hasn’t provided much insight into her preferred positive activities, but we could explore the possibly of developing a daily routine involving running, meditation, or some other method of gaining strength. Of course, she has to desire change for change to occur. Once she expresses a desire to grow, we can work on developing a more effective life direction (success identity). We would work on developing (a) altruistic actions, (b) demonstrating effective thinking (e.g., "I am a valuable person – even if I don’t succeed in school), (c) developing positive feelings such as self-confidence and trust, and finally creating effective behaviors such as healthy diet and exercise.

Whether we ever get to the creation of a positive addiction is beyond the scope of the immediate issues. Alice is in crisis, and may even be suicidal (an issue which must be addressed from any theoretical perception). However, the elements specific to reality therapy involve helping Alice to choose to act differently in order to achieve greater need satisfaction. It requires self-searching, self-evaluation, and the realization that one’s current way of life is not effective. She already sees herself as a "looser," now we just have to help her see herself as a potential daily winner.

(Time taken to type to this sample answer: 33 minutes)

Alice wanted to test the effectiveness of Eusteak (an artificial beef product) on children’s intelligence levels. The principal at Beefareus Elementary (grades 3-5) agreed to allow her students to be involved in the project if Alice obtained parental consent from the student’s parents. Alice randomly selected 50 of the 200 students at the school to be involved. She tested all the student’s IQs with the K-BIT (mean score = 100), waited a week, then started the children on a daily diet of Eusteak. At the end of the week, she tested the children again (mean score = 107). The children then returned to their normal diet and were told not to eat Eusteak for the next month. One month later, she tested the children again to see if the effects were still present (mean score = 102).

Alice investigated the effects of Eusteak (independent variable) on children’s K-Bit scores (dependent variable). She started off well, seeking permission from the principal and obtaining parental permission (though this is only implied from the principal’s request). The students were randomly selected, which strengthened internal validity, but after this stage some difficulties arose. There was no control group, and all students received the same (a) pretest, (b) treatment (Eusteak), (c) post-test, and (d) follow-up test. Alice fell prey to a post hoc error. She argued that changes in IQ scores was a result of Eusteak and failed to consider that increased exposure to a testing measurement (i.e., the K-BIT) might also increase test scores. Students may have increased their scores by learning the questions to the test. Alice attempted to control for this by providing a follow-up test after the treatment had ended. However, the time between the pre-test and post-test was only one week, while the time between the post-test and follow-up test was a full month. It is certainly possible that students may have increased their scores after the first test and then forgotten some of that material over the course of the month.

Given the design flaws and limited validity (see below), it seems unlikely that this study would be published. It only warrants further study into the area; i.e., more rigorous studies should be conducted to test the effectiveness of Eusteak on childhood intelligence. If the results are valid, which I don’t believe them to be, this study implies that the effects of Eusteak are temporary. Children would have to eat this product continuously to maintain their increased scores.

The study appears to be reliable. The changes from pre to post tests scores indicate that some form of the treatment had a sustaining effect over a brief period of time. The follow-up test indicates that the changes were attenuated over longer periods of time. However, there are significant threats to internal and external validity. Internal validity was strengthened when she randomly selected her participants, but it was weakened by her failure to control for testing effects. Threats to external validity are discussed below.

Given the weak internal validity of the study, the generalizability of the study must also be weak. However, even when overlooking the flaws related to internal validity there are other factors to consider. Alice did not attend to possible Hawthorne effects, Novelty effects, or Experimenter effects. Her students knew they were part of a study, and may have become excited about the possible effects of the treatment (Hawthorne effect). If she communicated the purpose of the study to the participants, a placebo effect may also have occurred. Additionally, there is no way to test for a Novelty effect. The treatment was only provided for a week. It would have been better to test the students weekly for at least a month to control for the novelty of the treatment. Finally, there may have been experimenter effects. Maybe the students did better simply because Alice motivated them to do better. Without additional experimenters, it is difficult to know what effect her presence had on the participant’s performance. This was not a good study.

Correlations between Counselor Trainees Countertransference Management and Two Countertransference Measures within Client Sexual Orientation Conditions

Note. The n=17 in the lesbian condition and n=25 in the heterosexual condition.

* p < .05

Of course, tables with different types of measurements or statistical analysis will all be interpreted a little differently. However, once you learn how to interpret one table, the next one should be easier. It is recommended that you look up the sources for the other practice articles to see how the authors described the tables.

In this case, the independent and dependent variables are described in the title (as they are in most well written tables). The independent variables are the Countertransference Management techniques (empathy, anxiety management, self-insight, self-integration, and conceptualization ability) and the dependent variables are the two Countertransference Measures within client sexual orientation conditions (meaning counselor avoidance and counselor state anxiety as related to gay or lesbian clients).

One of the first steps in interpreting a table is to find out what the table is attempting to communicate. In this case, the study appears to be investigating whether learning management skills related to Countertransference affect Countertransference measures of state anxiety or avoidance when dealing with homosexual clients. If there is a relationship, it appears that the authors hope to argue that teaching these management skills will reduce Countertransference when working with these clients.

After determining the point of the study, the next step is to investigate what the table conveys. This is best accomplished by looking at significant levels. In this case, the p value (or significant level indicated) is .05, which means there is a 95% likelihood that the relationship between the independent and dependent variables is not due to chance. Interactions or correlations meeting this criteria are indicated with an asterisks (*).

Scanning the columns, you will note that the only variable reaching the .05 significant level is the lesbian variable within the counselor’s state anxiety, which means that the only impact the countertransference management skills had on the countertransference measures examined related to the counselor’s anxiety when dealing with lesbian clients. Specifically, anxiety management skills and self-integration skills were negatively correlated with state anxiety levels when dealing with lesbian clients.

From this interpretation of the table, this study conveys the following: when counselors’ anxiety management skills and self-integration skills increased, the counselors state anxiety with lesbian clients decreased. The assumption being that counselors with these skills would work better with lesbian clients.

The relationship of anxiety management skills to state anxiety with lesbian clients seems clear. You would expect that when counselors learn how to manage their anxiety, that they would have less anxiety when working with certain clients. The relationship of self-integration skills with state anxiety, however, is less clear. Maybe counselors who are better able to tie together the variance components of the personality, including their sexual orientation issues, are less likely to feel anxious working with clients who are different from them.

It is interesting to note, that countertransference management skills were unrelated to male homosexual clients, and did not significantly impact the counselors’ avoidance with lesbian clients. The study doesn’t tell us if counselors lacking countertransference management skills were highly adept at controlling their avoidance and anxiety tendencies, or if counselors with countertransference skills fell into the same traps as though who didn’t have such skills. Nevertheless, this study provides reasonable evidence to support teaching anxiety management and self-integration skills to counselors who are likely to work with lesbian clients.

Try going back and reading the other tables in the practice exam again and see if you can do the following:

1. Name the independent and dependent variables
2. Identify what the study, in general supports
3. Identify the specific findings of the study
4. Discuss the findings and identify any possible applications of the study to the field of counseling

(This table is more complicated than anything you will be asked. If you can do this one, you can do anything. The table you are most likely to see is something like the one mentioned above.)

(mutated and compressed) Hierarchical Multiple Regression Analyses Predicting Working Alliance From Parental Bonds and Social Competencies

* p <.05, ** p < .01

In a regression analysis, there are two steps to the interpretation. First, we have to investigate whether the variables passed the omnibus F-test. After testing this, we can look at what appears to post hoc t-tests.

Here’s an example essay using the five ideas expressed above.

In this hierarchical multiple regression analyses (don’t freak out; I’m just quoting the title of the table), the researchers investigated the length of treatment, effects of parental bonds, and social competencies (independent variables) on working alliance (dependent variable).

Social competencies (F = 4.46, p < .01) and parental bonds (F = 7.25, p < .01) were both significant, positively-loaded predictors of working alliance. With both of these variables there was at least a 99% likelihood that their relationship to increased working alliance was not due to chance. Social competencies explained 14% of the variance and parental bonds explained 23% of the variance in working alliance. Together, these two variables provide key insight into the formation of working alliance explaining 37% of the variance. The duration of treatment was not a significant variable and explained 0% of the variance in working alliance.

Both social competencies and parental bonds passed the omnibus F-test. Within social competencies, two of the variables were significant: Closeness to others (r = .22, t = 2.44, p < .05) and anxiety in social settings (r = -.32, t = 3.66, p < .01). Within parental bonds, three of the variables were significant: father care (r = -.13, t = 3.12, p < .01), mother overprotection (r = .28, t = 2.80, p < .05), and father overprotection (r = -.35, t = 3.62, p < .05).

The highly significant findings of this study clearly warrant attention. Many psychological theories (e.g., Person Centered, Reality, Cognitive, etc.) argue that the working alliance is one of the most important factors in predicting effective therapy. From this study, there is reason for counselors to investigate the client’s social competencies and parental bonds toward the beginning of therapy. It may be helpful to use a parental bonds and social competencies assessment device to provide the counselor with critical information about the client’s working alliance potential.

It is unclear, however, how to use the specific findings of this study because some of them lack face validity. It was interesting that care provided by mothers was the least significant variable and that the father’s care the most significant variable within parental bonds. Without knowing how "care" was operationally defined, it is difficult to speculate about this relationship. The negative correlation between father care and working alliance implies that clients are less likely to form positive relationships with their counselors if they had strong fatherly care. This is difficult to accept and contradicts commonsense.

Similarly, a mother’s overprotectiveness was positively correlated and a father’s overprotectiveness was negatively correlated with working alliance. This implies that the more overprotective a mother is, the better the alliance, but the more overprotective a father is the worse the alliance. Maybe this would have something to do with the gender of the therapist. From the table, we are unaware of either the clients’ of therapists’ gender. It could be that some sort of transference takes place when male clients had over protective fathers and are working with male counselors. If, however, this finding was unrelated to the therapist’s or client’s gender, perhaps overprotective fathers leave their children fearful and distanced, while overprotective mothers are regarded as thoughtful and caring.

The specific findings within social competencies are more readily applicable to counseling than those of parental bonds. The client’s report of feeling close to other and being anxious in social settings are both highly significant and have strong face validity. This study provides a clear mandate for counselors to investigate both of this issues early in the counseling relationship. Clients who are uncomfortable in social settings may require additional guidance, nurturance and support. Clients who feel anxious in social settings may need reassurance and therapists unconditional positive regard.

Overall, this study demonstrates that a client’s parental bonds and social competencies are significant predictors of working alliance, and that parental bonds account for more variance in client’ working-alliance ratings than do the social competencies. A client’s capacity to form a productive alliance appears fixed, to some degree, by childhood experiences (parental bonds) as well as by later social influences (social competencies). This champions psychoanalytic theory and its emphasis on transference relationships to overcome early modes of failed attachment. However, the limited effect of the length of treatment implies that the standard method of psychoanalysis would prove ineffective in actually creating a transference relationship. If transference is reached, it appears is established quickly.

Counselors have a difficult job ahead of them when dealing with clients who failed to form close relationships with either social groups or their parents. Hopefully, future studies will provide techniques for forging new ways to build effective working relationships with poorly skilled clients.

(Don’t waste time typing the words Counselor or Client – you might just put T: and C: for therapist and counselor).

Diagnoses:

Axis I: Post Traumatic Stress Disorder (provisional, need more information)

Rule out Hallucinogen Abuse

Parent-Child Relational Problem

Axis II: No diagnosis on Axis II

Counselor: It’s hard for me to hear you say that you have set yourself "up for failure." I keep picturing a tree that has grown up in the middle of the road just waiting to get hit.

Client: (tears forming) Yeah, (deep sigh) I am a tree, but I’ve already been hit.

Counselor: (leans forward and says softly) Life is very cruel sometimes.

Client: I feel like I’m still laying there; waiting for the traffic to come and finish me off.

Counselor: (sigh) What’s going through your mind as you wait there?

Client: Who will be in the first car.

Counselor: (pause)

Client: I think it will be my mother.

Counselor: (softly) Wow. What a powerful image! (pause) Can you describe your mother’s face?

Client: Her face?

Counselor: What emotions can you see on her face as she drives toward you?

Client: (sigh) (gulps) Anger (pause) sadness (sigh) disappointment – loss.

Counselor: As you went through those emotions, they became more and more powerful: anger (pause), sadness (pause), disappointment (pause), loss. Loss was the one that really stuck in my mind. What’s she going to lose?

Client: She’s going to lose a daughter.

Counselor: (sigh) What I’m about to say is going to be hard for you to hear but I think it might help. Are you ready?

Client: I’m not sure.

Counselor: When you described your mother’s facial expressions and said she was going to lose a daughter, (pause) I got the impression that you feel these things have already happened – that you feel that she no longer considers you her daughter.

Client: (tears form) (in tears) I wanted so much to impress her. I want her to be proud.

Counselor: (pause)

Client: (crying continues)

Counselor: It’s amazing how important a parent’s love is to a child.

Client: uh huh

Counselor: Parents can help us feel valuable and powerful.

Client: uh huh

Counselor: (pause)

Client: I’m not sure what you want me to do.

Counselor: Alice, (pause) I don’t think you’re a tree.

Client: What?

Counselor: A few minutes ago, we were talking about you feeling like a tree in the middle of the road waiting to get hit again. I don’t think you’re a tree.

Client: Why not?

Counselor: Trees don’t cry.

Client: (Crying continues)

Counselor: And if you have a tender enough heart to cry, I’ll bet you have a strong enough heart to move – to escape those cars and find safety.

Client: I’m afraid.

Counselor: Afraid of what?

Client: That you’re wrong – that I’m not strong.

Counselor: Being afraid is okay. You’ve come through some hard times. You have reason to doubt. And I’m not saying it will be easy or that you won’t have some failures along the way. But I believe you will uncover powerful strengths as we continue to work together. You are strong enough to move and grow. You are not a tree.

Client: I still feel like a tree. I want to move – I really do. I just don’t know what will happen. I want everything just be the way it was. I want to feel whole again (sigh).

Counselor: Let’s take things one at a time. Where would you like to start?