Domain V: Collaborate with Clients to Apply a Contextualized, Systemic Lens to Case Conceptualization
Collins, S. (2018). Collaborative case conceptualization: Applying a contextualized, systemic lens. In S. Collins (Ed.), Embracing cultural responsivity and social justice: Re-shaping professional identity in counselling psychology (pp. 556–572). Counselling Concepts. https://counsellingconcepts.ca/
The 13th CRSJ counselling competency (Collins, 2018) focuses specifically on the nature of professional practice in light of the evidence for social injustice and inequity in society and within the professions of counselling and psychology. Re-shaping professional identity requires a stepping back to consider the metatheoretical lenses that support cultural responsivity and social justice in scholarship, practice, advocacy, and leadership. For example, a positivist position that purports a single reality or truth is less conducive to the kind of cognitive flexibility that embraces diverse cultural meanings and understandings of self, health, and healing. Instead, I point to postmodern, constructivist, and critical lenses (Audet, 2016; Gergen, 2015), which foster deconstruction of underlying and potentially oppressive assumptions, both within the counselling discipline and in society more generally, as well as ecological systems theory (McMahon, 2017), which broadens our lens to the multilayered contexts of clients lived experiences. Learners are invited to reflect critically on knowledge sources, including culture-bound models of counselling. Some theoretical approaches have contributed to a paradigm shift that supports CRSJ counselling; however, rigid adherence to any one model risks cultural hegemony and misses evidence that points to common factors in counselling outcomes unrelated to theoretical orientation, including the counselling relationship (Duncan, 2014; Feinstein et al., 2015) which forms the focus of the next domain in the CRSJ counselling model.
The activities in this chapter are designed to support competency development related to the key concepts listed below. Click on the concepts in the table and you will be taken to the related activities, exercises, learning resources, or discussion prompts.
A central premise of postmodernism holds that it is impossible to situate knowledge claims outside of their cultural contexts. This is the point that Gergen et al. (1996) made long ago when they wrote: “Rather than working toward abstract theoretical formulations, the culturally engaged psychologist might help to appraise various problems of health, environment, industrial development, and the like in terms of the values, beliefs, and motives that are particular to the culture at hand” (p. 496).
Your task for this activity is to assume the role of the “culturally engaged psychologist” (Gergen et al., 1996, p. 496). Pick a chapter on a counselling model (one that you are unfamiliar with) from a counselling theories or model textbook.
As you read your chosen chapter, identify and takes notes on culturally embedded assumptions regarding
- what it means to be psychologically healthy,
- how personal problems develop and are resolved,
- who should attend counselling sessions,
- what should be talked about in counselling sessions,
- the role of the counsellor, and
- who is responsible for change.
From from the notes you take, paste your ideas into Wordclouds.com (or a similar resource) to create a wordle or word cloud of key ideas that reflect your critical evaluation of cultural assumptions.
[Permanent link: https://crsjguide.pressbooks.com/chapter/cc13/#culturalassumptions]
Feminist writers often play on the word, history, to emphasize the gender bias in most accounts of historical events, labelling their restorying of events, herstory. History has been constructed and recorded to reflect white eurowestern perspectives, characters, and significant events.
Recall what you have learned about the historical and contextual factors influencing the development of various counselling theories, including their white, male, and christian roots. Then discuss the following:
- What are the implications for counselling theory of the omission of other cultural perspectives from historical and current theory and practice?
- How might the exclusion of other worldviews, including Indigenous views of health and healing, limit the relevance counselling theory and practices?
- Give some specific examples of the ways these omissions have, or continue to, play out in our field.
- What might counselling practice look like if it was truly based on ourstory?
- Finally, consider how the exclusion of other worldviews, for example Indigenous views of health and healing, limit the relevance counselling theory and practices?
[Permanent link: https://crsjguide.pressbooks.com/chapter/cc13/#fromhistory]
A number of metatheoretical models have been proposed as organizational frameworks for a transdisciplinary and transtheoretical approach to case conceptualization. Engel (1977) proposed the bio-psycho-social model as an alternative to the medical or disease model, which dominated the health disciplines at that time. Sulmasy (2002) then introduced the modification, bio-psycho-social-spiritual, to emphasize the importance of spirituality to health and well-being. The CRSJ counselling model positions cultural and systemic as two additional elements of a broad metatheoretical framework for case conceptualization. Spirituality included in the broad definition of culture (i.e., ethnicity, ability, gender, gender identity, social class, age, religion/spirituality, sexual orientation) advocated in CRSJ counselling. Hilty (2015) proposed repositioning Engel’s original model as bio-psycho-social-cultural in recognition of the influence of culture, broadly defined, on health care. The video below proposes a bio-psycho-social-cultural-systemic lens to ensure application of a contextualized/systemic lens to counselling practice.
Choose a presenting concern that you might anticipate encountering in counselling, or reflect on conversations with a current client. Apply the bio-psycho-social-cultural-systemic framework, imagining possible influences on case conceptualization from within each of these dimensions.
[Permanent link: https://crsjguide.pressbooks.com/chapter/cc13/#bpscs]
Many now consider multicultural counselling as the fourth force in counselling and psychology and social justice as a fifth force. The first three forces were psychoanalytic, behavioural, and cognitive. Each of these reflected a paradigm shift: a substantive change in the conceptualization of human experience and the change process. Consider the following short vignette:
Anacaona dreams of being an astronaut or an archaeologist or maybe a pipe welder like her uncle Agwe. Even when they were still in Haiti, she felt out of place with the other girls who all dreamed of being mothers, and if they had to work for a little to find a husband, wanted to be teachers or nurses. Anacaona works hard at school, but she doesn’t have time to do homework, because she is either looking after her younger sisters and brothers, or she is participating in activities at the church. She loves her mother, but her mother looks at her with disappointment when she discovers Anacaona sneaking off to finish up her homework or to read the book her uncle gave her about the solar system. Her mother and her aunt are very busy with leading women’s activities at the church, and she is expected to follow in their footsteps. She is not looking forward to seeing the school counsellor today. She knows that she hasn’t been able to show how much she loves being at school, because she is so tired and so distracted. She didn’t have time to study for her last math test, and it was her worst grade ever. She is very proud of, and thankful to, her parents for bringing her to Canada and giving her a chance to get an education. Maybe she just needs to get up a little earlier in the morning. She tries to stay up at night but finds herself asleep with her book in the morning.
Begin by reflecting on this story from the lens of psychoanalytic, behavioural, and cognitive paradigms. Then identify specific principles of multicultural counselling and social justice lenses that might be useful in informing school counselling with Anacaona? If your last name starts with A‒M, focus on the multicultural paradigm, and if N‒Z, focus on social justice approaches.
- Be specific in giving examples of principles or practices that you see as potentially relevant to work with Anacaona.
- Engage in a dialogue with your peers about the similarities and differences in all five approaches.
- Consider, using each approach, what might be missed in both the story and the conceptualization of Anacaona’s presenting concerns and avenues for change.
[Permanent link: https://crsjguide.pressbooks.com/chapter/cc13/#paradigms]
Take a moment to look at the image below, and write down what you see. Make your assessment before you read further.
|An audio file is provided to the right for individuals who are visually challenged.|
Then, take a poll in the class to see how many people saw (a) an elderly woman, (b) a young woman, or (c) both an older and a younger woman. What are the implications of the results for your appreciation of multiple realities? How might the lenses you apply to viewing the world around you, influence what you do, or don’t, see?
[Permanent link: https://crsjguide.pressbooks.com/chapter/cc13/#whatdoyousee]
Consider carefully the role of metatheoretical and theoretical lenses in your practice. These lenses have an influence on how you conceptualize client presenting concerns, and they also influence the range of options available to you (and therefore to your clients) to support change. It is important for all counsellors to be able to articulate a clear rationale for what they are doing, in the moment with each individual client. As you consider the techniques and strategies available to you from various models of counselling and learn to prioritize client views of health and healing, you may want to consider how you position the role of theory in your own practice. Consider the following options that for the weight you place on counselling theory. Some practitioners rely more heavily on a collection of techniques drawn from various theoretical perspectives. You will notice, moving from left to right, a stronger and stronger influence of counselling theory. Explanation for each term are provided below.
|Syncretism||Uncritical mishmash of techniques and strategies with no conceptual grounding in theory(ies) of change|
|Technical eclecticism||Best technique or strategy for this client with this specific problem; no clear connection between technique or strategy and specific theory(ies) of change|
|Theoretical integration||Personalized conceptual framework that links therapeutic practices and techniques and strategies; coherent theory of change, draws on theoretical ideas and techniques and strategies from various models|
|Assimilative integration||Firm grounding in one theoretical model as foundational with selective integration of techniques and strategies from other models, based on client worldviews, needs, and goals|
|Single theory or model adherence||Preferred theoretical orientation that drives case conceptualization, goal-setting, and intervention planning|
Drawing on what you have learned from the CRSJ counselling model, consider how you might best position yourself in a way that is both accountable to professional research, ethics, and practice guidelines and responsive to the cultural identities, views of health and healing, and social locations of each client.
[Permanent link: https://crsjguide.pressbooks.com/chapter/cc13/#theoreticalflexibility]
Most counselling practitioners develop a professional practice statement as a way of communicating their professional identity to potential clients and include this statement on their professional website. Such practice positions often included reflections on professional values, beliefs, and theoretical lenses. Take a few moments on your own to consider how adopting a culturally-responsive and socially just approach to counselling might influence the positions you adopt, drawing on the following elements.
- The personal values, beliefs, and experiences that influence your approach to counselling.
- Evidence of how your preferred counselling model(s) can accommodate diversity of client needs, preferences, worldviews, views of health and healing, contexts, and social locations.
- Your underlying assumptions about human nature, consistent with the model(s) on which your practice is based.
- An explanation of how human problems develop that is consistent with the model(s) on which your practice is based and that takes into account social determinants of health.
- A theory of change that is consistent with the model(s) on which your practice is based and the role of views of health and healing and client theories of change in the counselling process.
- Incorporation of findings from psychotherapy outcome research, including common factors and responsive practice research, that inform your approach to counselling.
- The way(s) in which psychotherapy integration and the call for responsivity to client culture and social location influence your approach to counselling.
Then connect with your partner or small group to share your perspectives and invite feedback on areas you struggle to articulate. Draw on your critical thinking skills to ask informed and thought-provoking questions of your peer(s) as they work to refine and support their positions.
[Permanent link: https://crsjguide.pressbooks.com/chapter/cc13/#practicestatement]
Audet, C. (2016). Social justice and advocacy in a Canadian context. In N. Gazzola, M. Buchanan, O. Sutherland, & S. Nuttgens (Eds.), Handbook of counselling and psychotherapy in Canada (pp. 95-122). Canadian Counselling and Psychotherapy Association.
Collins, S. (2018). Embracing cultural responsivity and social justice: Re-shaping professional identity in counselling psychology. Counselling Concepts. https://counsellingconcepts.ca/
Duncan, B. L. (2014). So you want to be a better therapist. In On becoming a better therapist: Evidence-based practice one client at a time (2nd ed., pp. 3-33). American Psychological Association. https://doi.org/10.1037/14392-001
Engel, G. L. (1977). The need for a new medical model: A challenge for biomedicine. Science, 196(4286), 129-136. https://doi.org/10.1126/science.847460
Feinstein, R., Heiman, N., & Yager, J. (2015). Common factors affecting psychotherapy outcomes: some implications for teaching psychotherapy. Journal of Psychiatric Practice, 21(3), 180–189. https://doi.org/10.1097/PRA.0000000000000064
Gergen, K. J., Gulerce, A., Lock, A., & Misra, G. (1996). Psychological Science In Cultural Context. American Psychologist, 51(5), 496–503. https://doi.org/10.1037/0003-066X.51.5.496
Gergen, K. J. (2015). An Invitation to Social Construction (3rd ed.). Sage.
Hilty, D.M. (2015). Advancing science, clinical care and education: Shall we update Engel’s biopsychosocial model to a bio-psycho-socio-cultural model? Psychology and Cognitive Sciences Open Journal, 1(1), 1-6. https://doi.org/10.17140/PCSOJ-1-e001
McMahon, M. (2017). Work and why we do it: A systems theory framework perspective. Career Planning & Adult Development Journal, 33(2), 9-15. http://www.careernetwork.org/Journals.cfm
Sulmasy, D. P. (2002). A biopsychosocial-spiritual model for the care of patients at the end of life. Gerontologist, 42(3), 24-33.