An Integration of Theories of Child and Adolescent Counseling

Dr. Purushothaman
November 29, 2013

An integration of learned material in theories of child and adolescent counseling discusses counselor accountability in treating children and adolescents, roles of counselors in including parents, siblings and school personnel in the child's or adolescents treatment, balancing ethical and legal issues such as confidentiality and specific treatment approaches. Today the issue of accountability is in the forefront of professional dialogue (Dahir & Stone, (2003). School counselors, working within the framework of comprehensive guidance and counseling programs, increasingly are being asked to demonstrate that their work contributes to student success, particularly student academic achievement. Not only are school counselors being asked to tell what they do, they also are being asked to demonstrate how what they do makes a difference in the lives of students.

Is the focus on accountability a new phenomenon or has our profession always been concerned about assessing the effects of the work of school counselors? The purpose of this essay is to answer this question by tracing the evolution of accountability as documented in professional literature. The aim of making counselors accountable is to promote the psychological wellness of children and adolescents. The three arenas where children live most of their meaningful experiences--home, school, and community--have become unsafe places for some of them. Emotional support is often missing in these arenas, and children often suffer from criticism, rejection, and emotional and social abuse. Children and adolescents are alone in coping with their developmental or situational difficulties. In contrast to adults, who may look for professional support and assistance when facing a difficulty, children and most adolescents would not initiate such a move, and they often resist it when offered. Although they expect significant adults in their lives to support them, for various objective or subjective reasons they are often let down. This is not necessarily true only of children and adolescents with identified problems. Many normative children remain alone in their struggle with life events and stressors. There is more than one way to assist children and adolescents.

Group counseling and psychotherapy using cognitive behavioral therapy are a viable means of addressing many of these issues. School seems to be a natural place to offer children effective assistance without labeling them, although there are other settings in which group counseling and therapy may be viable as well, such as community centers, corrective institutions, and in private practice. What is important is to bring counseling to clients who are not capable of seeking it for themselves, thus reducing their sense of distress. All children, normative children and children with special needs alike are more likely to grow in process-oriented groups in which emotional experiencing is allowed and encouraged, interpersonal support is constantly present, and instrumental assistance with practical issues is offered. I suggest that change in behavior and skills acquisition will be more efficiently achieved through reexperiencing positive relationships than through training. The uniqueness of this focus on affect--lies in its research base. It is extremely important to demonstrate accountability of counseling and psychotherapy.

The counseling literature attests to the broad conceptualization of advocacy. The recent literature reveals the broad scope of advocacy, but it provides only minimal direction toward a coherent conceptualization (see Myers et al., 2002). Several authors have provided definitions and descriptions of advocacy; and although authors vary in conceptualization, a common theme is that advocacy involves identifying unmet needs and taking actions to change the circumstances that contribute to the problem or inequity. Authors also agree that advocacy requires an altruistic disposition. The ASCA National Model (2003) provides much information about the goals of advocacy. Because advocacy cuts across multiple school counseling roles, occurs on multiple levels, and is conceptualized broadly, it is logical to conclude that everything school counselors do is advocacy. But if advocacy is inherent to everything that school counselors do, how can advocacy be adequately delineated and understood? How can it be differentiated from other school counseling roles? How are other school counseling roles complementary to advocacy? How can we--as school counselors, counselor-trainees, and counselor educators and supervisors--become more effective advocates? A model of activism encourages counselors to function as leaders, change agents, and as people willing to take risks. I believe that if counselors adopt an advocacy role they help students become prepared to work in today's world and move toward becoming active, involved citizens. School counselors working from this model stand for social, economic, and political justice and advocate for students not being served well by school systems.

Through diverse educational reform efforts, many schools are working toward greater equity and improved achievement for all students. Supporters of standards-based education have been working diligently to transform many K-12 functions including curriculum, teacher preparation, and continuing professional development for teachers. To date, major school reform efforts have focused on setting more rigorous academic standards, building new assessment strategies and restructuring pre-service and in-service experiences for teachers and administrators. But, reform leaders have paid little or no attention to school counselors' roles in these initiatives. Failure to address what counselors do and how they do it could well undermine even the best efforts of reformers, and risks leaving several million of our young people marooned in low-level classes. A disproportionately high number of them will be low-income students and students of color. School counselors are in key positions to be at the vanguard of educational reform. Issues of equity, access and lack of supporting conditions for academic success come to rest at counselors' desks in the form of data, files and reports of school failure. Thus, school counselors are in a position to influence academic placement and the educational futures of all children and adolescents.

Guidelines regarding counselor's responsibility, confidentiality, and informed consent sometimes become ambiguous with individual clients, but they are even more complicated when multiple family members are seen together in therapy. Questions about confidentiality, refusal of treatment, and value of conflicts between the family members and the counselor may arise. Consideration of these questions in terms of their ethical implications is complex and controversial. Yet answers to these questions must also take into account clinical and legal considerations, which sometimes run a collision course with what is desirable from a strictly ethical standpoint. Examples and preliminary recommendations with respect to these issues are examined; further clarification of professional conduct in marital and family therapy is urged. Treating adolescents in psychotherapy presents a number of unique ethical challenges. Because many adolescents who enter treatment have not yet attained the age of majority, reside in families that include other people with emotional difficulties, attend school, become involved with community agencies (e.g., the courts), and must generally take direction from adult authority figures, the role of the therapist becomes particularly complex.

The unique dilemmas include developing specialized clinical competence, treatment contracting, choice of treatment modality, direction of the therapeutic process, and confidentiality. This range of ethical concerns involved in treating adolescents and suggests strategies for optimal ethical care. Issues dealing with ethics examine children's rights under the Charter, the law of consent, and the ethics associated with the consent to treatment issue. Consistent with the Charter, the common law recognizes the right of competent minors to consent on their own behalf. Decisions regarding competence to consent are made on the basis of cognitive capacity, and not age. In contrast, consent legislation is largely silent on the question of capacity and instead specifies arbitrary ages at which minors may consent. Variation exists across provinces both in the legal age of consent and in the extent to which common law principles are reflected in consent legislation. In the absence of relevant consent legislation, psychologists have both a legal and an ethical responsibility to determine their minor clients' capacity to consent.

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