War on Drugs: A Failed System?

The United States’ War on Drugs, a Failed System

Introduction
In 1968 the United States began an official “War on Drugs.” Since that year, ineffective policies have been created, incarceration rates have risen, and the costs associated with the drug war increase by the year. The United States currently spends over $40 billion a year to fight the “War on Drugs,” and yet it continues to be the world’s largest consumer of illegal drugs (Williams, 2001, p.1541), which implies that, the cost associated with the drug war far from justifies it’s results. In the past 20 years, the number of inmates incarcerated on drug charges has tripled with sixty to seventy percent test positive for drug usage at the time of their arrest. Federal surveys have shown an increase in drug use between 1991 and 1997, with the rate of first time use for 12th grade students nearly doubling. It appears drug use, incarceration rates, and the cost to fight the drug war continues to mount with no avail and because of this, the United States must change its’ tactics. The following will present data, statistics, and information regarding this failure. In addition, it will be shown that the gross expenditures to fight the drug war have failed to result in a decline in drug usage and rather, have caused an increase in black market profits and violence associated with the drug trade. Finally, recommendations for decriminalization, legalization, and government regulation will be presented. To fully understand the issues, the problems must be defined.

America’s fight to abolish drugs is not a new issue; it has always been a lengthy and costly battle. The origins of this fight can be traced back to 1874 when the Women’s Christian Temperance Union formed to prevent the use of drugs and alcohol. Then in 1914 the Harrison Act was passed. It was the first official drug law created to stop drug use by controlling opium trade. The results of this act were immediate. Just six weeks after this bill passed, on May 15, 1915, the New York Medical Journal writes:
As was expected ... the immediate effects of the Harrison antinarcotic law were seen in the flocking of drug habitués to hospitals and sanatoriums. Sporadic crimes of violence were reported too, due usually to desperate efforts by addicts to obtain drugs....The really serious results of this legislation, however, will only appear gradually and will not always be recognized as such. These will be the failures of promising careers, the disrupting of happy families, the commission of crimes that will never be traced to their real cause, (p. 799).

Six months later an editorial in American Medicine wrote:
Abuses in the sale of narcotic drugs are increasing. . . . A particular sinister sequence . . . is the character of the places to which [addicts] are forced to go to get their drugs and the type of people with whom they are obliged to mix….. The moral dangers, as well as the effect on the self-respect of the addict, call for no comment, (p.800).

Then two more federal laws were passed, the Boggs Act of 1952 and the Narcotics Control Act of 1956, which raised the penalties for all drug offenses by setting mandatory sentences. A first-offense marijuana possession carried a minimum sentence of two to ten years with a fine of up to $20,000 and a third-time offense offered life in prison. After these acts were passed, reports once again showed that drug usage increased, proving these Acts ineffective. In 1968, President Nixon initiated the “War on Drugs” after soldiers came home from Vietnam addicted to heroin. Then in 1970, the Comprehensive Drug Abuse Prevention and Control Act passed. This Act established a plan to regulate and control drugs according to classifications, which were determined by the Attorney General. The same year, congress repealed most of the mandatory penalties for drug-related offenses because the mandatory minimum sentences of the 1950s were often unduly harsh and had done nothing to eliminate the drug culture. Next President Ronald Reagan passed the Comprehensive Crime Control Act of 1984, raising the federal penalties for both marijuana possession and dealing. A later amendment to this Act allowed for life sentences for repeat drug offenders, and the death penalty for major suppliers, which reinstated the failed and once abandoned policies of the 1970 Act. Then in 1982, Nancy Reagan created the “Just Say No” campaign and Daryl Gates, Police Chief of the Los Angeles police department, developed the D.A.R.E. program. These programs were designed to teach youths how to avoid pressures to use drugs. In 1989, President George Bush declared that illegal drugs were public enemy number one, again increasing the federal budget for this war. The United States government attempted many times to eradicate illegal drugs, and prevent them from entering and being used within its borders, but has failed. After drastic steps, enacting many new laws, and the increasingly large amounts of money that have been spent for the “War on Drugs”, drug usage steadily increased while crime rates and poverty have risen.

Theory and Research From Prior Research
One reason this drug initiative has failed is the inaccurate system of defining and classifying drugs. In Erich Goode’s (1997) book, “Between Politics and Reason”, he explains that drugs are given many definitions, as; medical substances, either illegal or controlled substances, publicly defined substances, or substances taken for a certain effect, while other drugs are defined by subjective criterion, meaning, a drug is what the members of society say or think is. What becomes apparent is that there is no correct definition for all contexts of its use. Furthermore, many of these definitions actually prevent us from reaching a sound understanding of the drug itself and its possible uses. Hans Van Mastrigt also addressed this issue in his (1990) article, The Abolition of the Drug Policy: Toward Strategic Alternatives, where he evaluates these classifications and gives reasons why people should reject these standards. He focuses on the fact that drugs are currently classified by assessing the harm connected with their use. Under this classification standard “harm” is defined by physical or psychological harm, as well as addiction. Where this definition seems to fail is that it is not used consistently. Alcohol and tobacco should be considered “hard drugs” from a pharmaceutical viewpoint, but they are not regulated. Alternatively, “soft drugs” like cannabis and cocaine have been placed under strict administrations of control (Bean, 1974). Van Mastright further states that the pharmacology of a drug can only provide partial information in regards to the problems associated with drug use and abuse. Many other factors can contribute to the harm drug consumption causes, such as: the amount or quantity used, the route of administration, or the frequency of use. Van Mastright says to fully understand drug abuse it must be understood in a “real world” context because the situation in which the drug is used contributes to its’ physical damage and addiction. The current standards fail to recognize that the risks and dangers associated with drugs are not unique. Serious health risks are related to a wide variety of behavior. Many people die of socially acceptable behavior and the risks associated with them; driving a vehicle, participating in sports, and even work related injuries. It is also ridiculous to classify drugs based on their ability to cause addiction. “The subjective experience of addiction is, for example, not limited to the consumption of substances, but can arise with such "normal" human behaviors as working, eating, playing and loving,” (Peele, 1985, p.13). The ability to become addicted is not caused by the action or substance itself, but by a person’s own unique qualities, beliefs, and convictions. The current definitions of drugs and harm associated with their uses do not make sense, nor are they unique to the drug experience. It is not difficult to understand why the United States is losing this war when years of drug policies were created based on these faulty definitions of what a drug is.

Additionally, the government has “created” facts and distorted the truths about the “War on Drugs”. In fact, these false statements have been so publicized and repeatedly quoted that most Americans and politicians accept them without questioning their merit. The most erroneous distortion is that drug use has actually declined over time. Citizens are often told that America is winning the drug war and regular drug use has been cut in half since 1979. However, federal surveys show the exact opposite. They show increases in use, especially by adolescents, (Monitoring The Future: National Survey Results on Drug Use, 1975-2000). Research conducted by Johnston, O’Malley, & Bachman (2001), found in 1980 marijuana use among American high school seniors dropped for the first time, but then in 1992 it began to rise again. Between 1992 and 1997 the rate of usages nearly doubled, from 22% to 39%, and thirty-day use also rose significantly, doubling from 12% to 24% in 1997. The United States Department of Health and Human Services states that overdose deaths and emergency room visits due to drug usage are at record highs with both consistently escalating since the 1980s. Their data showed that, "from 1990 to 2000, total drug-related episodes increased 62 percent, from 371,208 to 601, 776,” (2001, p. 2). The government often states that America is winning the drug war, but statistics show that drug use is higher than it was ten years ago and the drugs are now more dangerous than ever, causing more overdose deaths and hospitalizations.

The government has created ineffective laws, drugs are improperly classified, misunderstood, and the American people have been improperly informed about the success of the “War on Drugs”, yet they still spend over $40 billion a year fighting a losing, impractical, self-defeating war. The National Drug Control Budget Executive Summary shows that in 1969, The Nixon administration spent $65 million on the drug war; in 1982 the Reagan administration spent $1.65 billion, and in 2002, the Bush administration spent more than $18.822 billion, (these totals do not include state and local budgets). Between 1969 and 2002, the federal budget increased over 292 times, and yet the National Survey Results on Drug Use from 1975-2002, shows that there is little or no change in the frequency and usage of illegal drugs. The monetary costs to Americans for the drug war is enormous and it is apparent that it is doing little or nothing to stop, control, or prevent drug use in America.

Another major issue concerning the United States is number of inmates incarcerated in its’ prison system for drug related charges. Decriminalizing personal possession would also alleviate the overcrowding of American prisons. “In 1997, there were 216,254 drug offenders in state prisons (out of a total State prison population of 1,046,706 that year). Of these, 92,373 were in for possession,” (Mumola, 1999, p.2), and this figure does not include the additional 10,094 prisoners in federal prisons. In 1997 alone, a total of 102,467 people were incarcerated for possession, and the estimated cost to Americans for their incarceration was over $20 million (based on Jones (1999), who showed the average cost to house an inmate is $20,000 a year). Besides the cost to Americans, the impractical use of the judicial system and the loss of freedom to those prosecuted; there is another issue, the children.

Nearly two million young people in the United States have one or both parents incarcerated many for non-violent drug offenses. Many young people have lost their parents due to incarceration and have been put into the foster care system, both which have shown to increase the likelihood of delinquency (Greenfield, Lawrence, & Snell, 1999, p.8). Children are also incarcerated for drug related offenses for drug related offenses under the current system. In fact “the number of offenders under age 18 admitted to prison for drug offenses increased twelve fold between 1985 to 1997. This increase troubles many social scientists. Thorton (2007) concludes, “Policies that stigmatize and imprison drug users may hurt rather than help troubled young people. The abstractions of prohibition or legalization have little to do with troubled people’s behavior or needs” (423). This statement is not an endorsement of policies that fail to police illegal drug markets, but rather made to identify that the drug war has created black markets that are very dangerous yet attractive to troubled youths with limited opportunities and resources and who are at the highest risk of becoming drug users themselves. “The drug war does not cause the family and social problems that put young people at risk, but rather diverts resources and attention from education and treatment programs that might help them, (Cleveland, 433). As an additional detriment to young people, is that under federal law those convicted of a drug offense lose their right to federal college loans - 43,000 students were affected by this provision in 2001 -increasing the likelihood that they will be undereducated and unable to compete for good jobs,” (Storm, 2000, p.4). As consequence, many young Americans have had their lives ruined, not by the drugs themselves, but by drug laws and their enforcement.

Programs financed by the government to prevent the usage of drugs among youths, such as D.A.R.E, have shown to be ineffective and counterproductive, even encouraging drug use among certain populations. Still these programs continue to receive large amounts of federal funding (Lynam, Milich, et al., 1999). Furthermore, recent studies have shown that youth are more influenced by their peers and their perception of the prevalence of drug usage, and then are discouraged by such preventative programs. One such study conducted by Hammermeister, Roland & Page (2002), Are high school students accurate or clueless in estimating substance abuse among peers, demonstrated this influence. This study was conducted using qualitative research by obtaining investigative data collected through self-report surveys. The self-report surveys were administered to “223 high school students enrolled in health or physical education courses at three separate high schools in the Pacific Northwest (two in Idaho and one in Washington). Health and physical education classes were selected because these are required for graduation and would provide a representative sample of students in each school” (Hammermeister, Roland & Page, 568). The data collected from this survey found that there was a direct correlation between the students’ perceptions of drug usage and their own self reported usage. Although, student’s often over-estimated the prevalence of their peer’s usage, when compared, the data showed that the estimations and self-reported usage of each school were relative to the other two schools. Demonstrating that in those schools where the perception was greatest (see Table 1), the reported self-usage was also the highest (see Table 2). Studies such as the Hammermeister, Roland & Page (2002) research have shown that although educational and preventative programs have become regular installments in the school system, they are less influential on youth’s behavior than peer pressure.

Americans have been deceived into believing that violence and criminal activity are a direct result of illegal drug consumption. However several recent studies have offered contradictory data to this theory and in fact have found a direct correlation between increased penalties and arrests to an increase in criminal activity. One such finding was produced by Shepard & Blackley (2007) titled, The Impact of marijuana law enforcement in an economic model of crime. This study was conducted using quantitative research whereby investigative data was collected from existing government reports. Data was obtained from 1,200 U.S. counties, which were randomly selected from a national pool for the 1994-2001 time period from; police reports, U.S. Department of Justice Uniform crime reports, U.S. Department of Commerce, Bureau of Economic Analysis, Regional Economic Accounts, U.S. Department of Labor, Bureau of Labor Statistics, Local Area Unemployment Statistics, FBI Uniform crime reports from the University of Michigan, and National Archive of Criminal Justice Data. There was little control over the initial procedures of data collection, but the data can be considered reliable as it was initially gathered from reputable agencies. The results of this provided evidence that “marijuana arrests are positively associated with higher levels of property crime and homicides during the 1994-2001 period. Specifically, possession arrests are found to be related to the commission of property crimes, while sales arrests are found to be associated with burglary and homicide rates” (Shepard and Blackley, p.9), see Tables 3 and 4. Furthermore, it has been found that criminal activity is more associated with the drugs’ illegal classification and its’ governing laws than usage of such substances. The connection between drugs and illegal activity has a greater probability of being caused by: the “effects that involve the manufacture, distribution, and sale of illegal drugs, with no legal mechanisms for dispute resolution” (407), the violent crime directly associated with the attempt to enforce drug prohibition, and because the resources used for drug enforcement cannot be used against other types of crime which in turns reduces the enforcement effectiveness in those areas. Chris Paul (1994), a published economist claims, the
“competition for market control creates negative externalities which take several forms. First, violence increases as sellers attempt to monopolize markets, enforce contracts and protect property risking harm or harming non-participants. Second, as a consequence often-higher 'monopoly' price, the number and severity of crimes increase as buyers attempt to support their use. Third, some of the revenue is used to corrupt police, politicians and otherwise legitimate businesses. Fourth, as illustrated by the current 'war on drugs,' non-participants' civil liberties are eroded as law enforcement agencies attempt to identify voluntary market participants. Finally, steps taken by the public to insulate themselves from these crimes and civil disruptions constitute additional social costs" (114).

With all this information, it is clear that the current policies failing to eliminate the criminal activity associated with the illegal drug trade in the United States, because the main cause of this activity, the underground market, are left intact. Therefore, “the only way to truly eliminate those problems is to legalize the sale of drugs” (Thorton, 430).

Recommendations
Americans must accept the “War on Drugs” is not working and a society without drugs is impossible, if not intolerable. The question then is, “How does America implement policies that will regulate the production, distribution, and consumption of currently illegal drugs in order to create a safer atmosphere for its people?” The first thing United States governments must do is decriminalize personal possession of drugs as other countries already have. In 1976, the Netherlands decriminalized the possession of marijuana and almost immediately discovered a decline in usage from 13% to 6% (Heather, Wodak, Nadelmann, & O'Hare, 1993), proving that sometimes the forbidden fruit really is the sweetest.
The United States’ government has decriminalized personal possession; it must take responsibility for distribution of safer forms of currently illegal drugs. According to a United Nations report, "US authorities reported the mean purity level of heroin to be around 6% in 1987 but about 37% in 1997, in which year levels were even reaching 60% in New York," (1999, p.86). The United States’ government should regulate these drugs, just as they do with tobacco and alcohol. Regulation would ensure there are of safe levels of certain ingredients, while omitting the lethal chemicals often added to street drugs to increase quantity and weight for higher profits. The current policies of prohibition have caused deregulation. “Anarchy now rules the distribution and sale of drugs” (Trebach, 523). By taking control of the distribution of these drugs, the government would then be able regulate the sale of these drugs just as they do with tobacco and alcohol. Once decriminalized, the Controlled Substances Authority (CSA) would be able to issue licenses to competent sellers and be able to establish conditions for sale, such as age requirements. This governmental control of the production, sale, and distribution would eliminate the black market (as well as the violence, crime, and illegal profits) that prohibition of drugs has caused and that society has thus far been unable to control. It is obvious that the only real way to win the “War on Drugs,” is to decriminalize, regulate, and distribute these drugs to the American people, just as it has with tobacco and alcohol.

The United Nations Office for Drug Control and Crime Prevention (1998) states “the international illicit drug business generates as much as $400 billion in trade annually… That amounts to 8% of all international trade and is comparable to the annual turnover in textiles,” (p. 3). The United States government has attempted to stop drugs from being produced abroad, by creating crop substitution programs, which grow legal crops, but these efforts have also failed. They have failed because profits from the cultivation and sale of drugs are enormous due to prohibition so as that profits from legal crops cannot compare monetarily. According to a report prepared for ONDCP by Abt Associates in 2000, "Between 1989 and 1998, American users spent $69 billion to $77 billion yearly on cocaine and $19 billion to $22 billion yearly on heroin," (2000, p.5). But if the United States’ government became the supplier of these currently illegal drugs, it would receive the profits from every sale by way of taxes. In addition, billions of dollars would be saved, no longer needed to fight the drug war in such an aggressive manner. This revenue could be used to reduce the actual consumption through better education and treatment facilities.

Treatment facilities and harm reduction programs are necessary and could be effective if governmentally funded. The funds required for these programs could be made available by reallocating a portion of the current drug war monies. Previously, monies had been dispersed for addictive treatment, but Reagan’s administration had discontinued this allocation, even though it encountered opposition from many members of congress. It is important that treatment be available, inexpensively and repeatedly on demand, as it is understood that relapse is often part of the process of recovery. It must be understood that treatment is an essential step in getting one off drugs, and that “it is very difficult to rehabilitate a dead addict” (Trebach, 522). The United Kingdom has already implemented such programs in which they dispense maintenance medications of oral and injectable drugs, free needle exchanges, provide instruction regarding the correct use of needles, free condoms and safe sex education all in an effort to stop the spread of AIDS, detoxication, abstinence, and mental health therapy, in addition to general health care. And although crime remains in this county, there has been a reduction in criminal activity, an example that could prove to be valuable to the United States.

“There is persuasive evidence from experience with other drugs that the most effective way to reduce consumption is through education,” (Chambliss, 1995, p.102). Chambliss has found that education programs for addicts have significantly impacted tobacco and alcohol use and that these individuals have found benefits from self-help groups. Americans would be more likely to seek the help they need to overcome their addiction, if drugs were legalized and the stigma of criminality was not attached to them. Contrary to popular beliefs, addiction is not a major problem. The fact is that most people who report using cocaine and marijuana are occasional users and most claim they have no trouble stopping if they decide to. Additionally only three percent of the people who tried cocaine say they had difficulty stopping, (Chambliss, 1995). These statistics contradict previous information given by the United States government, and shed an entirely different light on the subject of addiction. The most important factor in reducing the consumption of drugs will be education. Education has been proven time and time again as the most powerful tool available, and therefore stands to reason, that those fully educated on the risks associated with drug use are less likely to try it in the first place.

Conclusion
In conclusion, it is imperative that the United States change its current policies to gain control over drug use within its borders. “The United States has been conducting a drug war for seven decades, during which time there have been steady increases in the seizures of illegal drugs, the numbers of people using drugs, and the health and social costs of drug taking,” (Smith, 1995, p.1655). Economists have argued that the drug war has been destined to fail due to the financial gains one has to receive through illegal sales. “Any success in reducing the supply will raise the price of illegal drugs. Addicts must then commit more crime to feed their habit; and a rise in the profit margins of drug smugglers urges them on to greater efforts,” (Smith, 1995, p.1655). The United States government has created illogical, unfounded, counterproductive drug policies, based on inaccurate drug definition, moral beliefs and distortions of fact. Americans have been led to believe that the drug war is imperative to their safety, and drugs themselves are responsible for the increase in crime and poverty. The fact is that most drug related crime is not derived from the use of drugs, but by the black market, which has been created by the drug war. Many Americans and prominent legislative supporters such as; Superior Judge James Gray of Orange County as well as Judge Robert Sweet of the Manhattan Federal Court, believe that the only way to win this war is to decriminalize personal possession. Additionally, fifty senior federal judges have refused to hear drug cases, and recently, former United States Surgeon General, Dr. Joycelyn Elders, publicly supported decriminalization. The United States’ “” is doomed to fail, and while other countries that have decriminalized or legalized drugs have shown promising results, the drug problem in the United States seems increase. The United States government must create new policies that allow decriminalization and legalization, which would be more likely than prohibition, to succeed in achieving everybody’s aim of minimizing the harm from drug abuse.

References
Abt Associates, (2000). What America's Users Spend on Illegal Drugs 1988-1998. Washington, DC: ONDCP. Retrieved November 25, 2007 from http://www.whitehousedrugpolicy.gov/publications/pdf/spending_drugs_1988_1998.pdf

American Medicine, (November 1915), 21, 10, 799-800.

Bean, P. (1974) The Social Control of Drugs. London: Martin Robertson

Brecher, E. M. (1972). The consumers union report on licit and illicit drugs. Consumer Reports Magazine. Retrieved on November, 12, 2007, from http://www.druglibrary.org/schaffer/Library/studies/cu/cu8.html.

Chepesiuk, R. (1999). The war on drugs: An international encyclopedia. Santa Barbara, CA: ABC-CLIO, Inc.

Ferraiolo, K. (2007, April). From killer weed to popular medicine: The evolution of american drug control policy, 1937-2000. Journal of Policy History, 19(2), 147-179.

France, S. (1990). Should we fight or switch? The ABA Journal, 76. 42-46.

Goode, E. (1997). Between politics and reason: The drug legalization debate. New York, NY: St. Martin’s Press.

Greenfield, Lawrence, A., & Snell, T.L. (1999), US Department of Justice, Bureau of Justice Statistics, Women Offenders. Washington, DC: US Department of Justice. Retrieved on November 27, 2007, from http://www.ojp.usdoj.gov/bjs/crimoff.htm

Hammermeister, J., Roland, M., & Page, R. (2002). Are high school students accurate or clueless in estimating substance abuse among peers? Adolescence, 37(147), 567-573.

Heather N, Wodak A, Nadelmann E, & O'Hare P, (Eds.). (1993). Psychoactive drugs and harm reduction: From faith to science. London: Whurr. Retrieved on November 6, 2007, from http://www.drugtext.org/library/articles/rosenbaum01.htm

Johnston, L. D., O’Malley, P.M., & Bachman, J.G. (2001). Monitoring the future: National survey results on drug use, 1975-2000, Volume 1: Secondary school students. Washington, DC: National Institute on Drug Abuse.

Johnston, L. D., O’Malley, P.M., & Bachman, J.G. (2003). Monitoring the future: National survey results on drug use, 1975-2002, Volume 2: College students and adults ages 19-40. Bethesda, MD: National Institute on Drug Abuse.

Jones, S. (1999, June, 24). What does the drug war cost. New Times, CA. Retrieved on November 17, 2007, from http://www.mapinc.org/drugnews/v99/n667/a01.html

Lynam, D.R., Milich, R., et al. (1999). Project D.A.R.E.: No effects at 10-year follow-up, Journal of Consulting and Clinical Psychology, 67(4). 590-593.

Mental Sequelae of the Harrison Law (May 15, 1915). New York Medical Journal, 102, 1014.

Mumola, C. J. (1999). Substance abuse and treatment, state and federal prisoners, 1997. Washington, DC: US Dept. of Justice, 3.

Office of Applied Studies, Substance Abuse and Mental Health Services Administration, & US Dept. of Health and Human Services. (2001). Year-end 2000 emergency room data from the drug abuse warning network. Washington, DC: DHHS.

Peele, S. (1985). The Meaning of Addiction. Compulsive Experience and its Interpretation. Lexington, Massachusetts: Lexington Books.

Shepard, E., Blackley, P. (2007). The Impact of marijuana law enforcement in an economic model of crime. Journal of Drug Issues. 37 (2). 403-424.

Smith, R. (1995). The war on drugs: Prohibition isn’t working – some legalization will help. British Medical Journal, 311. 1655-1656.

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Terry-McElrath, Y.M. & McBride, D.C. (2004). Local implementation of drug policy and access to treatment services for juveniles. Crime & Delinquency, 50, 60-87.

Thornton, M. (2007, Winter). Prohibition versus legalization: Do economists reach a conclusion on drug policy?. Independent Review, 11(3), 417-433.

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Van Mastright, H. (1990) The abolition of drug policy: Toward strategic alternatives. Journal of Drug Issues, 20(4). 647-657.

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Stephanie Lowrance-Henckel

The SORT approach in family therapy

In the United States, prevalence rates for drug use and abuse has consistently risen, thus causing this phenomenon to be considered a great public health and social concern. “Lifetime incidence of alcohol and drug abuse is nearly 20%,” (Liddle & Dakof, 511) while “epidemiological data revealed that 9% of adolescent females and 20% of adolescent males meet adult diagnostic criteria for an alcohol use disorder,” (American Academy of Pediatrics, 1026). Furthermore, while studies have shown that substance abuse has increased over the past decade, it is also occurring at younger ages. This increase in use and abuse is cause for great concern, as usage during adolescence is “associated with a more rapid progression into addiction, delayed entry into adult roles (that is, adult relationships, employment, and so forth), and high societal costs,” (Smith & Hall, 185). Due to the over-whelming prevalence of drug use and abuse amongst adolescents, the likelihood of addiction, future predictions of impaired social functioning, and societal costs of this disorder, it is imperative that treatment options for adolescents with substance abuse problems be expanded, (Smith & Hall, 2008).

In their article, Strengths-oriented family therapy for adolescence abuse problems, Smith & Hall (2008) explore a “treatment program, developed by social workers, called Strengths-Oriented Family Therapy (SORT),” (p.185). The SOFT approach utilizing many aspects from previous, established approaches, but have developed three aspects which are unique to it’s approach; (1) a pretreatment family motivational enhancement session called the Strengths-Oriented Referral for Teens (SORT), (2) a foundation in solution-focused language and treatment techniques, and (3) a formal strengths and resources assessment in the early stages of treatment. Overall, this approach, while aimed to help the adolescent client suffering from addiction, largely incorporates the entire family unit. The authors’ belief in the effectiveness of this approach lies in their position that the family unit and relationships and parenting style can predict adolescent drug use. The basis of this approach is founded in the principles of motivational interviewing, ex. discussing the adolescents' strengths and weaknesses, and solution-focused counseling thereby increasing one’s ability to employ positive coping techniques.

The SOFT program usually lasts 12 weeks, during which the family participates in a cumulative of 30 hours of therapy, in a combination of individual, family, and multifamily group sessions. The program itself is divided into 3 main parts, stages 1,2, and 3. In the first stage, the family is asked to evaluate the strengths of their child and their family as a whole. This process allows for therapy to begin on a good note and provides reference and reminders to the positive attributes of each family member. This aspect is an important component to the SORT therapy, so that as the family discusses the difficult aspects of the family functioning and weaknesses of each individual, that they do not “lose sight” of the strengths. Of course, if there are immediate or life and death concerns that need to be addressed during this stage, the therapist will work on these as well, however the focus will be on building a positive relationship between the family members themselves as well as the therapist.

Stage 2 of the SORT approach implements aspects of solution-focused therapy whereas each client will develop a set of goals that they intend to achieve throughout the course of their treatment. During this phase, the clients will be asked to reflect on coping methods, behaviors and approaches that have successfully worked in the past that they could explore and apply to current situations. Then individually, the clients will outline the steps that they specifically can take to achieve their treatment goals. The counselor will assist the client in making attainable goals and focusing on small tasks that added together will result in the outcomes that they hope to gain.

Once the clients have been able to identify their goals and complete some of the tasks they had set forth, they will move on to Stage 3. In stage 3, the counselor and family will reflect on their original goals and evaluate their progress. If necessary the client’s plans can be modified, however, it is important to recognize and praise the success, regardless of how minuet, that the clients have made thus far. Once the family has achieved their desired goals, therapy will be concluded.

As a future therapist and one who currently works with children in an educational and counseling setting, she finds that the SORT approach provides numerous benefits and could easily be employed in her practice. In the domestic abuse shelter in which she works, she often finds that the clients struggle with issues of self-esteem, dependency, and often their previous environment has denoted that their focus be on survival more than on their own mental health concerns. Mothers, often over-whelmed, fail to acknowledge the positive attributes of their children, and even as adults feel that they have very little to offer to others. Furthermore, in abusive relationships, where the abuser uses methods to maintain power and control over their victims, the victim finds themselves “put down,” degraded and often feels worthless. With these characteristics in mind, one could see how, especially stage 1, focusing on the strengths of each individual, could benefit all members of the family and aid in the rebuilding of their relationship. Additionally, prior to the clients’ arrival at the shelter, they had been in a situation where they were powerless, unable to make there own decisions, be in control, and see out a plan for success. In using the SORT approach, the counselor could teach the client this process, with constant reassurance, thereby allowing the client to take control of their destiny.

In the future, this writer intends to work with individuals struggling with substance abuse issues, and while she finds that this approach could work well with domestic abuse clients, she also believes that it would be applicable those who have issues with addiction. She maintains that these two areas are quite similar to each other, in that both sets of clients struggle with issues of addiction, the first set are addicted to the abuser and their situation and the latter to substances. Similarly, both sets of clients struggle with issues of self-esteem, acceptance, goal-oriented behaviors and have relinquished their power either to the drug or to the abuser, furthermore, the clients in both scenarios struggle with guilt and embarrassment over their decision to remain in their situation. With these thoughts in mind, it would seem that the SORT approach could easily be implemented with both sets and provide positive results.

References
American Academy of Pediatrics. (2001). Improving substance abuse prevention, assessment, and treatment financing for children and adolescents. Pediatrics 108(4), 1025–1029.
Liddle, H.A. & Dakof, G.A. (1995). Efficacy of family therapy for drug abuse: Promising but not definitive. Journal of Marital and Family Therapy, 21(4), 511.
Smith, D.C. & Hall, J.A. (2008). Strengths-oriented family therapy for adolescents with substance abuse problems. Social Work, 53(2), 185-188.

Stephanie Lowrance-Henckel

Are we disordered? Should we subscribe to the medical model of counseling?

Debating the legitimacy of mental health counseling and disorders... I feel that it is important to be knowledgeable of both sides of this debate, is psychology just a bunch of assumptions or is it "science?"
In a post that I wrote, which positioned that disorders do not exist, someone responded by saying… “It is obvious through your writings that you are against the medical model of counseling. However, I wonder how you will then base your research of symptoms, settle on an approach, or bill an insurance company”. While, I myself believe that there is biological and physiological causes for mental disorders, it is important to understand that the positions of the other camp. Here is my response...
The question itself is circular. If I do not believe that existential human problems are illnesses, then I will not “research symptoms” at all, since a symptom is, by definition, the outward sign of an illness. It is like asking an atheist “Well, if you do not believe in God, how, then, are you going to pray?” In terms of settling on an approach, surely this will follow from talking and listening to the client and his/her description of the problem(s). A person has come for help of a certain kind and for a certain problem, and I will do my best to understand the problem from the client’s perspective and offer what is asked for. For this, it is certainly not necessary to believe that psychological conflicts are diseases or follow any sort of “medical model”. Perhaps an example will serve to clarify what I mean by this.

Carl Jung tells the story of a woman who had been incarcerated in his hospital, and with whom he worked for quite a long time. After trying every treatment approach he knew to try and seeing no appreciable progress, the famous Swiss psychiatrist finally ran out of options. Feeling completely stumped and having no idea what to do next, Jung actually went to the woman and said: “I’m sorry, but we’ve been at this a long time, we’re obviously not getting anywhere, and quite frankly, I don’t know what else to do for you. What would YOU like me to do?” The woman responded with elegant simplicity: “Read to me,” she said, “from the Bible.”

Now, Jung had grown up under the cold, authoritarian hand of a fundamentalist Christian minister, and he had no use whatsoever for the Christian scriptures. If anything, he resented them and wished to have nothing to do with them ever again. But, in a show of genuine humility and openness that seems all but completely absent from modern psychiatry and would probably scandalize his colleagues today, Jung consented to do as his patient requested, got himself a Bible, and began reading to her from it. A few weeks later, she had improved so dramatically that she was discharged from the hospital as “cured”.

This story, to me, offers a powerful insight into the real nature of counseling. Carl Jung read to his patient from the Bible. Was this a radical new “treatment” for the woman’s “illness”? Should we now send researchers off with fists full of grant money to find out why the words in the Bible are “therapeutic”, and if so, for which DSM disorders they are “indicated”? Of course not. The woman had no illness, and Jung gave her no treatment. What the woman wanted was help on her own terms, that is, in a form that she could recognize and accept. She did not want to be the object of some expert’s “treatments”; she wanted to be heard, understood, accepted, and given the help SHE wanted. And once she got it, she no longer needed help. Strip away all the pseudo-scientific mumbo-jumbo and medical-sounding hokum in which the mental health professions are awash today, and this is what remains: a simple human exchange in which one asks to be heard, and the other truly listens.

Of course, insurance companies, as you indicate, are not interested in paying for people to sit and talk to each other, nor should they be. As noble as it may appear to “help” the poor by classifying counseling as a form of medical treatment and making it insurable, in the end it merely places the insurance bureaucracy in charge of counseling, where it most definitely does not belong. What is my answer to this conundrum? As things stand now, I have none, except to suggest that those who can go into private practice and refuse all third-party payers, substituting a sliding scale fee schedule instead. For those not licensed for private practice, however, it is a real problem with no easy answers. I certainly do not have a magic solution.

What the whole thing comes down to in the end is this: people who are in psychological pain, who behave in bizarre ways, and whose lives are a shambles either have diseases or they do not. Since medicine is a branch of science, the burden of proof falls on those who advocate the disease theory to prove their case. Yet despite the endless repetitions in the literature that (mis)behaviors and destructive thoughts are illnesses just like heart disease or cancer, not one shred of credible empirical evidence has been produced to back up this claim in over a century of looking.

Ironically, that this is true is demonstrable even in the very literature that argues for the medical model. Take the text you quote in your reply to me: “The DSM-IV does follow a medical model--if you are a medical practitioner. If you are a counselor, the DSM may not be a manual of diseases, but simply a description of harmful behaviors, dysfunctions, mental disorders, developmental roadblocks, or whatever one chooses to call them. The DSM does not recommend the prescription of medication or hooking clients up to electrodes, or any other treatment method for that matter” (Hinkle, 1998). Now I ask you, in simple honesty, is the absurdity of this statement not obvious to anyone who is willing to look at it objectively? Can you imagine, say, the American Medical Association making such a statement about its own publications? Can you envision them coming out and saying “Our medical reference is a medical book, if you look at it from perspective X. If you look at it from perspective Y, it is something else”? A medical reference is always a medical reference, no matter who happens to be reading it, and real diseases are always diseases, not “whatever one chooses to call them”. In stating that what the DSM is depends on how one looks at it, Hinkle is merely admitting that it can, in fact, mean whatever the reader wants it to mean. And this is the very opposite of legitimate science.

Hinkle’s concluding statement that the DSM “does not recommend” any treatment methods is irrelevant at best, and disingenuous at worst. Whether it recommends specific “treatments” for its “illnesses” or not, it is most certainly the foundational justification for all mental health diagnoses, and therefore, for all treatments as well. Indeed, it really cannot recommend specific treatment modalities for the “mental disorders”, since the number of these so-called treatments is growing steadily year by year, and the effectiveness of each depends on whom you talk to. To recommend one treatment approach for disorder X over the other dozen or so available for it would put half the counselors (and, if the recommended treatment did not include drugs, almost all psychiatrists) out of business overnight.

If you are wondering how such obvious medical fraud on such a grand scale is possible, simply do what any good investigator would do: follow the money. Like it or not, medicine and counseling are both businesses, and the marriage of the two has made a small consortium of people extremely wealthy. Consider: if depression, for example, is an illness (i.e., a brain chemical imbalance) and not the result of, say, an interpretation of the self and its circumstances, then the answer is not to deal with the person or his life, but rather simply to correct the chemical imbalance. This, of course, requires not human empathy, communication and understanding, but pharmaceuticals, and these, in turn, are synthesized mostly from petroleum. Hence, by convincing both counselors and the public that anger, sadness, confusion, despondency, “inappropriate” euphoria, hallucinations, “dysfunctional” relationships, employment instability, and other concomitants of the contemporary human condition are really problems of brain chemistry, the drug and oil companies have made profits that you and I (and most other industries outside of banking) could scarcely conceive of. This is why these industries have spent such inordinate sums of money on public advertising (“Sex with your wife of 36 years isn’t so exciting anymore? Ask your doctor!”), impressive-sounding (and often ghostwritten) studies and media reports that upon analysis offer no substantive evidence, political lobbying, and even direct marketing to physicians. Repeated over and over ad nauseam from every corner, sooner or later the message was bound to be accepted as gospel, and the baldly obvious lack of proof and breathtakingly illogical argumentation behind it overlooked. And so it has been.

And let us not forget that we counselors receive a few “benefits” of our own. Accepted now as quasi-medical “mental health professionals”, we are guaranteed payment by insurance companies and/or the government and are accorded a social status (and, in many cases, income) that would be impossible for a profession in which it was openly admitted that the only activities in which its practitioners engaged were talking and listening.

And so today we have the “medical model of counseling”, despite the fact that the concept is no more logical than, say, the “theological model of fly-fishing”. Fishing has nothing to do with theology, and counseling has nothing to do with medicine, but no one wants to see that the emperor has no clothes, because everyone benefits so richly from praising his lavish new garments.

Everyone, that is, except the client.

Intentions or Aspirations of Getting Published, Advice?

So as you may notice, I have spent a considerable amount of my time researching and writing papers on psychtherapy topics. At times, I feel that my time has been wasted, as this process fails to provide me with any concrete evidence of my efforts (other than completing course requirements). In an attempt to satisify my own needs, I would like to explore the option of submitting my articles for publication in professional journals. Any advice for me?

Assessment of the Stanford-Binet Intelligence Scale

Overview of the Stanford-Binet

In the United States, between the years of 1890 and 1915, laws were changed regarding child labor and an emphasis was placed on education, this transition caused a significant increase of students enrolled in primary education (Chapman, 1988). Educators were faced with the difficult task of teaching students at varying educational levels, at a time when there was no way to access their learning abilities. During the same period, in an effort to assist educators, the French government employed Psychologist, Alfred Binet, to create an assessment tool for intelligence that could then be administered to school age children to calculate their individual intellect. The creation of Binet’s test was intended to assist school officials in identifying children with learning deficients and facilitate their placement in special education programs. Binet’s original assessment of 1896 failed and provided minimal data due to the author’s lack of research and quantity of available participants.

Binet continued his research of intelligence assessments and partnered with physician, Theodore Simone. Together they focused their attentions to assessing children with mental retardation within a population of male students. Based on their findings, they created the Binet-Simon test in 1905. The Binet-Simon scale contained 20 questions, graded either by a pass or fail score, and encompassed topics such as; word problems, repeating sentences and digits, paper-cutting tasks, and comparing blocks by placing them in order by weight (Wolf, 1969). The questions increased in difficulty and were able to measure the client’s attention, verbal skills, and memory. The authors also established age-graded norms and this, in combination with the increasingly difficult questions, was able to decipher between individuals functioning at a “normal” level and those with mental deficiencies. The creation of this test was a breakthrough in the psychology field. Prior to this, all measures of intelligence were calculated with laboratory equipment and “included visual perception, reaction time, hearing acuity, and other physical measurements” (Roid & Barram, 5). This test was also the first to employ detailed instructions for administration and scoring. Binet and Simon revised their test two more times, once in 1908 and again 1911, to include scales that could score adults as well as children. The final revision of this test allowed for assessment of: language, auditory and visual processing, learning, memory, judgment, and problem solving.

“Researchers in the United States, such as Goddard and Terman, quickly saw the theoretical and practical value of Binet’s work and began to adapt the work to American context,” (Roid & Barram, 4) in an attempt to deal with the influx of children with varying learning abilities into the school system. Terman conducted his own research based on the Simon-Binet test, gathering normative data on more than 2,300 children and adolescents, and altered the Binet’s “normal” age levels of functioning. In 1916, Terman’s revision of the Binet-Simon test was published and his intelligence quotient (IQ), the ratio between chronological age and mental age, became the new standard for the assessment of intelligence, (Roid & Barram, 2004). Additionally, Terman’s version included ninety tests and sixteen alternatives, whereby the previous Binet-Simon test only consisted of fifty-four. Terman’s revision was more appropriate for use within the United States, where unlike its predecessors who had been focused on diagnosing mental deficients, Terman’s test was more “concerned with generating test scores that would be normally distributed. With a normal distribution of IQ scores, it would be feasible to make specific educational placements based on where in the distribution a child's score was located,” (Milton, 1998). The IQ tests and their normative data were then available for use in placing children in appropriate grade levels as well as facilitating decisions regarding advancement or school transfers of the tested child. Terman’s revision was renamed the Stanford-Binet test and emerged as the most widely used individually-administered test of intelligence ability until the 1940’s, when the Wechsler Intelligence scales were published.

Terman died in 1956, but had continued to test and revise his assessment since it’s original publishing date. Since that time, one revision was made, but by the 1950’s the items on the test had become out-of-date and after World War II the toys used for testing were difficult to obtain. Terman realizing this, had formulated the 3rd revision, which was published after his death. This 3rd edition was also tested on a normative sample and appropriate for use with clients aged 2 – adult, and now included items appropriate for testing African Americans and Hispanics.

The test then underwent two more revisions before reaching its current state. In 1986, Thorndike, Hagen, and Sattler revised the Stanford-Binet and the look of the test changed. The Stanford-Binet 4th edition (SB4) “was based on a four-factor, hierarchical model with general ability (g) as the overarching summary score. The most significant change from the previous editions was the use of point scales for all subtests rather than the developmental age levels used in previous forms” (Roid & Barram, 9). Although the SB4 appeared comprehensive, continuing research was performed and the fifth edition was published in 2003.

The Stanford-Binet 5th edition, SB5, incorporated aspects of the earlier additions while making improvements in the artwork, content, and psychometric design. Further, it added another factor, for a total of five (Fluid Reasoning, Knowledge, Quantitative Reasoning, Visual-Spatial Processing, and Working Memory). This revision sought to incorporate modern intelligence theories such as the Cattell-Horn-Carroll theory. Thereby providing practitioners with “more than 60 years of accumulated research and clinical experience in the assessment and interpretation of intellectual abilities” (Roid, p.8). The SB5 is a standardized test, “ meaning that norms were established during the design phase of the test by administering the test to a large representative sample of the test population. Both tests follow a uniform testing protocol, or procedure (i.e., test instructions, test conditions, and scoring procedures) and their scores can be interpreted in relation to established norms” (Ford-Martin, 2006). The normative sample for the SB5 was a group of individuals aged 2-85+ years of age, a group that closely resembled the 2000 U.S. Census. In addition to the normative, 3,000 participants were screened from special populations (e.g. gifted, MR, developmental delay, LD, ADHA, Speech/Language problems, Deaf). “Bias reviews were conducted on all items for the following variables: gender, ethnicity, cultural, religion, region, and socio-economic status” (Roid, p.10). In addition, the SB5 scored high is reliability, ranging from .90 to .98, as well as in concurrent and criterion validity when correlated to other intelligence tests, such as: Woodcock-Johnson III, Universal Nonverbal Intelligence Test, and the Wechsler tests. The SB5 now contains a nonverbal mode of testing, which encompasses all five of the assessment factors. Point-scales format each of the subtests which allow for measurement of behavior at every age, including elderly clients, and the range of scales were extended in order to better measure both higher and lower areas of performance. Additionally, two routing subtests identify the developmental starting points of the examinee, and the items can be tailored to cognitive level, resulting in greater precision in measurement. The SB5 has been found appropriate for use with individuals aged two through late adulthood, and is designed to measure a range of intelligence, from “individuals at the highest level of gifted performance and individuals who are younger, low-functioning, or adults with mental impairment” (Ward, n.d.). Additionally, the SB5 is useful in neuropsychological assessment, early childhood assessment, psycho-educational evaluations, and adult social security and worker’s compensation evaluations (Roid, 2003). And although, the original purpose of the Binet test was to identify children with mental retardation, the SB5 is “the best single tool available to measure the full extent of giftedness in the very highest ranges, in children under thirteen years of age” (Kearney, 2006).

Assessment Procedure

The Binet Assessment was the first test to employ detailed instructions for administration and scoring, and has since maintained an extensive training manual for the presentation, interpretation and scoring of each item on the test. Roid & Barram (2004) warn, “the most important considerations in testing with the SB5 is to follow the standardized directions exactly,” (p.19). The counselor should be aware that the assessment procedure begins even prior to presenting the client the test itself. The technical manual advises for physical arrangements and rapport building with the client before beginning a test, both factors that are claimed to have a significant impact on score potential. A client’s background information, including known or perceived disabilities, language barriers, and/or significant cultural influences should be known to the counselor prior to administration, so as that special accommodations (set forth in the SB5 technical manual can be made). “Testing is begun with two routing subtests (Object Series-Matrices and Vocabulary) to determine the starting point for the remaining subtests” (Hood & Johnson, 60). Then based on the results of these initial subtests, the client is given one of five developmental levels on each of the remaining eight tests. The testing process then continues until the client has missed at least three out of four items. The results of the test can then be interpreted and scored by the counselor, either by hand, or through use of Windows-based Scoring Pro, a computer based program which then calculates the client’s score.

Stanford Binet in comparison to other Intelligence Assessments

Binet’s original assessment remained the main intelligence measure, until the creation of the Wechsler Scales of Intelligence. David Wechsler, noting that the Stanford-Binet tests were intended mainly for use with children, found a need for a tool designed to assess intelligence assessment in adults, therefore with the adult population in mind, he created the Wechsler Bellevue Intelligence Scale in 1939. The Wechsler tests were designed to have similar scores to the Stanford-Binet but to test a wider range of skills and abilities. Wechsler was also concerned that the Stanford-Binet relied too heavily on verbal aptitude and therefore created nonverbal measures of intelligence. The Wechsler assessments of intelligence (WAIS) is an incorporation of several subtests designed specifically for age appropriate use, whereas the SB5 is one test, appropriate for use amongst all age groups, which increases difficulty gradually to allow for increased intelligence. Normative data for the WAIS was gathered from 2,450 individuals, representative of the population of those aged 16-89 years of age. “A stratified, census-based sampling plan ensured that the standardization samples included representative proportions of adults according to each selected demographic variable. The variables used for stratification were age, sex, race/ethnicity, education level, and geographic region” (Zohrab, 2007). Furthermore, the WAIS-III, WMS-III Technical Manual (1997), finds that the interscorer agreement is high, averaging in the upper .90s, is high in test-rest reliability, as well as receiving high scores in both concurrent criterion-related and content validity, whereby the WAIS-III correlates with the SB5 with a score of .88 (Hess & Rogers, 1997). Furthermore, criterion-related validity was confirmed through moderate to high correlations, ranging between .40 to .90, observed between examiner’s scores on the WAID and their scores on other measures of cognitive ability, such as; Stanford-Binet VI and Woodcock-Johnson III Tests of Cognitive Ability, (Sink, Eppler & Vacca, 2005). Both the SB5 and the Wechsler Scale for children (WISC- IV) are frequently used for assessment of children aged 6-16 years, and provided correlation results. Hood and Johnson (2007) find that the WISC-IV is a useful instrument in diagnosing children with mental and learning disabilities, and retardation. One major benefit of the Wechsler tests is that they do not rely wholly upon verbal problems and many of the sub-tests on the WAIS and WISC tests are based on non-verbal, or performance skills. The WISC provides a measure of general intellectual functioning, as well as four index scores of: perceptual reasoning, verbal comprehension, working memory, and processing speed. It is comprised of 14 subtests, seven of which are verbal and the other seven which measure performance, or nonverbal scales. Similar to the SB5, the Wechsler tests use factors, such as; vocabulary, similarities, picture completion, block design, matrix reasoning, letter-number sequencing, digit span, digit symbol-coding, and symbol search, in obtaining one’s IQ score. Additionally, like the SB5, the WAIS produces an overall IQ and area IQs, which have a mean of 100 and a standard deviation of 15. Furthermore, the SB5 and the WAIS are both standardized and produce IQ scores, which are compared to a normative group. Numerous studies have been conducted comparing the results, validity and reliability of both the SB5 and the WAIS and it has been found both are suitable measures for the identification of giftedness as well as those with low intellectual ability (Simpson, et. all, 2002). It has been suggested that the Wechsler scales may be most appropriate for use with adults while, the Stanford- Binet may present itself as a more accurate tool for assessing children. This may be due to the fact that “the Stanford-Binet has a higher ceiling than any of the other tests currently on the market, and gives more opportunity than the Wechsler Intelligence Scale for Children (WISC-R) for gifted children to display their fluency, imagination, unusual or advanced concepts, and complex linguistic usage" (Vernon, 256). The Wechsler scales are reportedly the most frequently used assessments by school counselors (Hood & Johnson, 2007) and other professionals, because each of the Wechsler tests cover a narrow age range and is therefore easier to use.

In the early 1980s, the Kaufmans developed an alternative to the WISC and Stanford-Binet. The Kaufman tests were designed in an attempt to reduce cultural bias and to separately assess crystallized and fluid intelligence. This grouping included several tests, two of which are the Kaufman Assessment Battery for Children (K-ABC), used with clients aged 3-18 and the Kaufman Adolescent and Adult Intelligence Test (KAIT). The KAIT normative information was based on the United States standardization samples and included 2000 individuals, in 13 age groups, ranging in age from 11–75+. These groups were then divided according to geographical area, race ethnic group, and examinee or parental education level (Dumont & Hagberg, 1994). Findings found that “reliabilities for the KAIT are generally outstanding. Each of the 3 IQ scales has an internal consistency reliability that averages .95. The six core subtests have an average reliability of .90. Test-retest reliability for the Crystallized, Fluid, and Composite IQs were .94, .87, and .94, respectively” (p. 191). The KAIT also received high scores in construct validity and correlational validity when compared to other intelligence tests. “In general the KAIT was found to have high correlations, and thus, substantial variance overlap with the Wechsler tests and the Stanford Binet” (p.192) obtaining correlational scores in the high .80s within this comparison, (Ackerman, Ford & Turk, 1993). In comparing these with other assessment tools, the Kaufman test instructions, state that “the WISC-R focuses on the content of intelligence (i.e. verbal and performance), whereas the K-ABC is primarily directed at mental processes involved in problem-solving activities (i.e. sequential and simultaneous operations)” (Meesters, et. all, 1054). Unlike, the Wechsler tests and the Stanford-Binet, The K-ABC does not provide for use of part score analysis, but does allow for some a priori decision-making on the part of the evaluator.

It has been shown that all three measures of intellect, the Stanford-Binet, Wechsler, and Kaufman assessments all receive scores high in reliability, validity, and cultural sensitivity. Additionally, studies have shown that all three tests are appropriate for use with individuals regardless of age, education, language abilities, culture, ethnicity, race, and/or gender. The Stanford-Binet, however, remains to be touted as the still best tool available to measure the full extent of giftedness in the very highest ranges, in children under thirteen years of age (Kearney, 2006) because it allows for higher potentials in scoring than any of the other tests currently on the market, and gives more opportunity than the Wechsler Intelligence Scale for Children (WISC-R) "for gifted children to display their fluency, imagination, unusual or advanced concepts, and complex linguistic usage" (Vernon, 256).

Appropriate Use of the Stanford-Binet – 5

The fifth edition of the Stanford-Binet Intelligence Scales were “designed to meet the needs of educators and psychologists working with special education, preschool assessment, evaluation of individuals with mental retardation, gifted assessment, and other applications of previous editions of the Stanford-Binet tests” further “a new emphasis was placed on assessment for adults and the elderly by extending the normative age range above 85 years,” (Roid & Barram, 98). In addition this tool shows great strength in that it includes factors that will allow for testing under both verbal and nonverbal categories, has one of the largest standardization samples amongst all intelligence tests, with its’ normative sample demonstrating an exact match to the socioeconomic and ethnic characteristics of the United States population (U.S. Census Bureau, 2001, as reported in Roid, 2004), and “was one of the first tests to undergo extensive fairness reviews by experts from various religious perspectives as well as those from representative ethnic, gender, and disability groups” (Roid & Barram, 99). Furthermore, the SB5 used a method of item classification, graduating difficulty levels, and routing subtests in order to present the examiner with initial estimates of the examinee’s verbal ability, all which are used to progress him or her to the appropriate testing level for the remainder of the assessment, “e.g. into the level in Item Books 2 and 3 that matched the estimated ability score and the difficulty of the items located in that level” (Roid & Barram 101). In addition, the SB5 has scored high in reliability, as well as in concurrent and criterion validity when correlated to other intelligence and achievement tests. Therefore with this recent revision, the SB5 would appear to be an all-encompassing measure of intellect, and suitable for use in a variety of settings. It is important to note however, that this form of assessment appears to be most appropriate for use with youths in determining their current level of intellect and diagnosing possible deficits and learning disabilities, allowing for proper placement in special education programs.

As with any tool, regardless of it’s strength, there are always weaknesses and availability for improvement, in this the Stanford-Binet is no exception. The problem with intelligence assessments, in general, lies in its method. Currently, the only way to assess intelligence is through the test itself, additionally, the only correlation construct for intelligence is also tests. Furthermore, intellectual assessments are only able to measure verbal ability and abstract reasoning, both of which are important for success in school, but are less predictive of success in the real world (Kail & Cavanaugh, 212). While the Stanford-Binet test does focus on areas of linguistic, logical-mathematical, and spatial intelligence, it fails to consider other areas of intelligence related to creativity, emotional, or bodily intelligence. And although, extensive bias reviews have been conducted on the SB5 and corrections made regarding these findings, it has been argued that all intelligence tests are to some extent culturally bound, and are reflective of Western views of intelligence. Furthermore, administration of the Standford-Binet is expensive and requires extensive training and credentials for processing and interpreting the results. As result, counselors often refer their client’s to other, more qualified and specialized professionals, but in this process, it can be assumed that much information about the client and their results can be lost.

Even in light of its’ weaknesses, the Stanford-Binet remains one of the most popular intelligence tests in the world, one to which all other intelligence assessments are validated against (Hood & Johnson, 2007). Studies have found the SB5 is appropriate for use with individuals aged two through late adulthood, and is designed to measure a range of intelligence, from “individuals at the highest level of gifted performance and individuals who are younger, low-functioning, or adults with mental impairment” (Ward, n.d.). Additionally, the SB5 is useful in neuropsychological assessment, psycho-educational evaluations, adult social security, and worker’s compensation evaluations (Roid, 2003). A common use of intelligence testing is to evaluate and provide early predictions of learning disabilities (LD) in children. “Research by Roid (2003) and Roid and Pomplum (2004) showed that the SB5 Working Memory and Knowledge were predictive of reading achievement, while Working Memory and Quantitative Reasoning were predictive of mathematics achievement. This research promises to provide a method of predicting risk for LD with the SB5 alone, instead of waiting for reading skills to develop,” (Roid & Barram, 116) thus allowing for an early IEP or a special education plan to be developed for the client, advantageous because this knowledge will be gained prior to these deficiencies developing and presenting themselves in elementary school. And although, the original purpose of the Binet test was to identify children with mental retardation, the SB5 is “the best single tool available to measure the full extent of giftedness in the very highest ranges, in children under thirteen years of age” (Kearney, 2006).

Applying ACA Ethical Standards to the Use of the Stanford-Binet 5

It is essential that ethical standards set forth by the American Counseling Association (ACA) be considered and strategically followed when considering a course of treatment or assessment of a client. When employing the use of the SB5, or any other assessment, a counselor must consider these factors, listed below relevant to sections “E” of the code.

ACA section, E.1. General, finds that assessment tools are imperative in diagnosing individuals with disorders, while aiding counselors’ understanding of their client, their psychological needs, and course of treatment, it is essential however that counselors use these tools in a safe and ethical manner for their clients. They must also consider their clients’ welfare and right to have this information protected from misuse. In addition, they must respect and provide to the client, at his or her request, access to data, interpretations, conclusions, and any recommendations (E.1.b Client Welfare).

Section, E.2.Competence to Use and Interpret Assessment Instruments, states that prior to administering any assessment tool, a counselor must have knowledge of and been properly trained in the use of such a tool. The Stanford-Binet requires that it be administered, by an individual, who has obtained graduate or professional-level training in psychological assessment. It would, therefore, be highly unethical for this test to be administered or interpreted without first receiving the proper credentials and training.

Section E.3. Informed Consent in Assessment – The ACA reminds that it is essential that the client have full knowledge and understanding of the process, purpose, and intended usage of results obtained by any assessment tool they may be administered. This complete understanding is necessary to ensure that the client feels comfortable with the process, thereby providing data and/or answers that are true and accurate representations of their intellectual abilities.

Section E.4. Release of Data to Qualified Professionals, warns that clients should have a full understanding of the issues related to confidentially and be informed that their data can only be released to parties of which they have consented to. This is especially important when employing the use of the SB5, as the client is often referred to an outside professional for the administration of the test, interpretation, and scoring. Once the results are calculated, they are then shared with interested parties, such as; school officials, physicians, courts, and employers.

Regarding section E.6. Instrument Selection, the ACA advises that, when considering any assessment tool, the counselor should evaluate it for validity, reliability, and also consider its’ limitations. This is important to ensure the results will be applicable and are representative of the client and their needs (E.6.a.). It is the counselor’s responsibility to ensure that the SB5 is the appropriate test for use with their client based on his or her overall situation. Thus one must consider any and all factors that could adversely affect the results of the test, such as: age, culture, language, and disability and if possible, make the appropriate accommodations.

In section E.7. Conditions of Assessment Administration, the ACA states that it is important for the counselor to understand and administer assessments under the same conditions in which they were established under their standardization. The SB5 examiner’s manual, offers a detailed outline of the settings, layout, process, and method by which the test should be administered. In addition, it allows for and suggests accommodations that should be made for individuals with disabilities. While, it is important to retain the basic construct validity of test by using it in accordance to the standardization process, one must remember that ethical guidelines require that professionals respond to the unique needs of their client.

ACA section E.8. Multicultural Issues/ Diversity in Assessment, finds that a counselor must evaluate the appropriateness of any instrument based on their cultural reliably, as all populations are not equal. An assessment that may be deemed reliable and suitable for a client of Caucasian decent, may not be appropriate for one who is of Latino decent and vise versa. This must be always be considered, as intelligence has been shown to vary by cultural or environmental differences. This will be discussed further in the following section.
Stanford-Binet’s appropriateness for use with Special Populations

“The typical intelligence test administered in the United States assumes a relatively common cultural background found in contemporary society and English as the native language” (Hood & Johnson, 67). This has subsequently caused many to question whether intelligence tests can provide unbiased results, particularly with individuals from lower socioeconomic status, ESL (English as a second language), and those of differing cultural or ethnic backgrounds. Hood & Johnson (2007) state that there are three ways in which intelligence tests may be culturally biased; (1) they may include items, illustrations, or vocabulary which favor one group over another, (2) they may produce test related factors of bias, such as the anxiety or motivational issues, and (3) a bias may come from the usage of test results in the selection of employees or college admissions, whereas one group score scores higher than another, thus obtaining the desired position. With this is mind, the SB5 has undergone “extensive fairness reviews by experts from various religious perspectives as well as those from representative ethnic, gender, and disability groups” (Roid & Barram, 99) These reviews considered the items, illustrations, and procedures of the SB5 and were conducted by assessment professionals representing religions, to include: Buddhism, Christianity (both conservative and liberal denominations), Hinduism, Islam, and Judaism. “Ethnic perspectives were addressed by reviewers representing African American, Asian American or Pacific Islander, Hispanic American, and Native American or Alaskan Native populations” (Roid & Barram, 99). However, even with all attempts at removing biased materials, it has been shown that, “as a group, African Americans score approximately 1 standard deviation below White Americans on most standardized tests of cognitive ability” (Hood & Johnson, 213), results which are not unlike those of other cultural or ethnic groups. With this data in mind, it is imperative that a counselor understands section E.8. Multicultural Issues/ Diversity in Assessment, of the ACA ethical standards when considering and interpreting the results of the SB5. While it remains that there are cultural and ethnic differences in the scores derived from the SB5, the biases have been drastically reduced, and are minimal. In some cases, counselors have chosen to remove items that can be considered potentially biased, but “studies show that the removal of biased items does not affect the overall test scores and that many cognitive tests continue to provide mostly accurate predictions for most minority clients” (Hood & Johnson, 217). As result, the SB5 should be considered a valid and reliable measure of intelligence among individuals of varying cultures, ethnicity, and/or gender.

Conclusion

The Stanford-Binet has proven that it can be a useful tool in many areas concerned with assessing intellect. Over the course of the last 100 years, this tool has undergone multiple revisions each increasing its generalizabilty and usefulness in the clinical setting. The current version, the SB5, has obtained high scores in validity and reliability, while extensive studies have shown that it remains appropriate for use with individuals regardless of age, education, language abilities, culture or ethnicity, race, and/or gender. It has been said that the Stanford-Binet, however, remains to be one of the best tools available in assessing school age children, as well as the school’s overall performance. However, as previously shown, the Stanford-Binet test scores of these children are directly correlated to their school performance and so she wonders about the validity of this test. As Hood & Johnson (2007) state, in all measures of validity, the real question is: does this test contribute more than we already know or could predict without them, and she feels the answer to this would be no. The intent of this test is to determine which children are in need of special education programs, but couldn’t this realization be made without the test itself, and instead determined by on the child’s performance in school? Furthermore, the Stanford-Binet test is only useful is predicting school achievement, but fails to be applicable once the child graduates and enters the “real world.” Lastly, this test fails to consider some important aspects of intelligence related to creativity, emotional, or bodily intellect, all worthy of notation, as not all individuals are created equal, and shouldn’t we harness these abilities? This learner feels that it is important to take all of these facts into consideration before labeling or classifying a child based on an irrelevant IQ score, which could stigmatize them throughout their lifetime.




References
ACA Code of Ethics (2005). American Counseling Association. Retrieved on February 14, 2008 from http://ibol.idaho.gov/COU/Documents/2005_ACA_Code_of_Ethics.pdf

Ackerman, P.L., Ford, L. & Turk, K. (1993). Kaufman Survey of Early Academic and Language Skills. Mental Measures Yearbook, 12. Retrieved on March 3, 2008 from http://ezproxy.library.capella.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=loh&AN=12011448&site=ehost-live

American Psychiatric Association. (2002). Ethical principals of psychologists and code of conduct. American Psychologist, 57, 1060-1073.

Chapman, P.D. (1988). Schools as sorters: Lewis M. Terman, applied psychology, and the intelligence movement, 1890-1930. New York: New York. University Press.

Dumont, R. & Hagberg, C. (1994) Kaufman Adolescent and Adult Intelligence Test (KAIT): Test Review Journal of Psychoeducational Assessment, 12, 2, 190-196. Retrieved on March 1, 2008 from http://alpha.fdu.edu/psychology/kait.htm

Ford-Martin, P.A. (2006). Stanford-Binet intelligence scales. Gale encyclopedia of medicine. Retrieved on February 1, 2008 from http://www.healthatoz.com/healthatoz/Atoz/common/standard/transform.jsp?requestURI=/healthatoz/Atoz/ency/stanford-binet_intelligence_scales.jsp

Hess, A.K & Rogers, B.G. (1997). Wechsler Asult Intelligence Scale- Third Edition. Mental Measures Yearbook, 14. Retrieved on March 3, 2008 from http://ezproxy.library.capella.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=loh&AN=14072125&site=ehost-live

Hood, A. B., & Johnson, R. W. (2007). Assessment in counseling: A guide to the use of psychological assessment procedures (4th ed.). Alexandria, VA: American Counseling Association

Kaufman, A. S. & Lichtenberger, E. O. (1999). Essentials of WAIS-III Assessment. New York:Wiley.

Kearney, K. (2006) The 10 most commonly asked questions about highly gifted children. Hoagies’ Gifted Education Page. Retrieved on February 29, 2008 from http://www.hoagiesgifted.org/10_highly_gifted.htm

Meesters, C., Van Gastel, N., Ghys, A. & Merckelbach, H. (1998). Factor analyses of WISC-R and K-ABC in a Dutch sample of children referred for learning disabilities. Journal of Clinical Psychology, 54 (8), 1053-1061. Retrieved on March 1, 2008 from http://web.ebscohost.com.library.capella.edu/ehost/detail?vid=33&hid=116&sid=fd9881e2-49ad-49c3-86a5-bb74f4a50a57%40sessionmgr109

Milton, H.L. (1998). Introduction to; “The uses of intelligence tests” Lewis M. Terman (1916). Classics in the History of Psychology. Retrieved on February 6, 2008 from http://psychclassics.yorku.ca/Terman/intro.htm

Roid, G.H. (2003). Stanford-Binet Intelligence Scales, Fifth Edition, Technical Manual. Itasca, IL: Riverside Publishing.

Roid, G.H. & Barram, R.A. (2004). Essentials of stanford-binet intelligence scales (SB5) assessment. Hoboken, NJ. John Wiley & Sons, Inc.

Simpson, M., Carone, D.A., Burns, W.J., Seidman, T., Montgomery, D. & Sellers, A. (2002). Assessing giftedness with the WISC-III and the SB-IV. Psychology in the Schools, 39(5), 515-524. Retrieved on February 29, 2008 from http://web.ebscohost.com.library.capella.edu/ehost/pdf?vid=27&hid=116&sid=fd9881e2-49ad-49c3-86a5-bb74f4a50a57%40sessionmgr109

Sink, C.A., Eppler, C. & Vacca, J.J. (2005). Stanford-Binet Intelligance Scales for Early Childhood, Fifth edition. Mental Measures Yearbook. 17. Retrieved on March 3, 2008 from http://ezproxy.library.capella.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=loh&AN=17073217&site=ehost-live

Vernon, P. E. (1987). The demise of the Stanford-Binet scale. Canadian Psychology, 28 (3), 251-258.

Ward, K. (n.d.). Stanford-Binet intelligence scales and the perceptions of school psychologists. Retrieved on February 17, 2008 from http://www.bsu.edu/web/keward2/edpsy600-sb%20and%20perceptions.htm

WAIS-III WMS-III Technical Manual. Retrieved on March 1, 2008 from http://harcourtassessment.com/

Wolf, T.H. (1973). Alfred Binet. Chicago: University of Chicago Press.

Zohrab, P. (2007). The Invalidity of the Wechsler adult intelligence scale –III. New Zealand Equality Education Foundation. Retrieved on March 2, 2008 from http://nzmera.orcon.net.nz/waisinvl.html

Stephanie Lowrance-Henckel

Medical or Developmental Approach to Psychotherapy

With proper training, the DSM-IV-TR can and will be a useful tool in diagnosing and treating patients. When utilized by a professional focused in family and marital counseling, an area where concentration of one individual is uncommon, the professional must also be prepared to make individual diagnoses as the psychological health of one is likely to affect his or her relationships, with the greatest impact felt within the nuclear family. When choosing to use the DSM-IV-TR to diagnosis an individual suspected of having a psychiatric disorder, it is best to start with the information provided on an intake form. From there, one should utilize a screening inventory, such as the Inventory of Common Problems (ICP). Through the use of the ICP, the professional could obtain a greater understanding of the individual client’s issues that may or may not relate or influence their interpersonal problems within the family and may or may not contribute to or be as result of a psychiatric disorder. Additionally, suspecting the presence of a disorder, the counselor should employ the use of an inventory of assessing mental disorders, such as the Psychiatric Diagnostic Screening Questionnaire (PDSQ). “The PDSQ contains 13 scales, each of which is related to a mental disorder as defined by the DSM-IV-TR” (Hood & Johnson, 45), and whereby the results of this assessment, could indicate and substantiate the counselor’s concerns regarding the presence of such disorder. Information should then be compiled as needed for the axis IV and V, whereby gaining a holistic overview of the client’s environment and outside stressors. Special considerations should be made regarding information provided in axis IV, as it may be pertinent to the client’s relationships within the family and may correlate with the family unit’s course of treatment. Once all information has been gathered, and if a disorder presents itself, the counselor should, privately sit down with the individual to explain the disorder and then together they would share this information with the rest of the nuclear family, being careful, not to label the individual, but rather identifying the disorder they are suffering from. Additional factors should be considered, those that the DSM fails to incorporate, i.e. cultural and environmental influences. Once the complete analysis has been done, the counselor would formulate a treatment program, either through medication or developmental counseling or a combination of both, (noting that the DSM does not contain any information of suggestions for treatment), but most surely creating a program that would incorporate the family unit as a whole.

“Sara Brown, age 11, white, female, is has been presented by her foster/adoptive parents for a consultation. She has been placed with the foster parents for 3 years, and although they have spent considerable (to their account) of time and energy in teaching her appropriate behaviors, she has failed to comply. Prior to her placement with her foster parents, she experienced many traumatic life experiences. Her biological father and older brother both died of a drug overdose, her mother continues to abuse illegal drugs as well as several of her older siblings. As result of the drug abuse issues within the family, Faye was often left to care for herself, exposed to many illegal and inappropriate activities to include: drug abuse, criminal activities, police contact with members of the family, and sexual activity. Since placed with her foster parents, she has struggled academically and socially, has low self-esteem, demonstrates inability to act rationally, acts in sexually inappropriate manners, is easily distracted, and experiences sleeplessness, phantom pains, occasional bed-wetting, emotional outbursts, and the inability to sit still or follow directions. Recently, her biological mother’s parental rights were terminated, allowing for her foster parents to formally adopt her, but her symptoms have escalated. Her foster parents are concerned that she may be struggling with ADHD and depression and/or grief issues.”

At the initial meeting, an intake form should be compiled, obtaining any and all available medical and family history, obviously made more difficult as the client is currently in foster care. This should be followed by a thorough interview of the foster parents, current teachers, social worker (as deemed appropriate), and finally with the client. During the interview with the client, an Inventory of Common Problems (ICP) would be administered, whereby the counselor could gain a better understanding of the mental, emotional, and physical issues the client believes she is experiencing. In addition, it would be beneficial to have the client answer the Psychiatric Diagnostic Screen Questionnaire (PDSQ), making sure to focus on self-destructive or harmful thoughts or behaviors that may require immediate attention and/or intervention. Also, appropriate in this case would be intelligence testing, utilizing the Stanford Binet IV, as the foster parents are currently considered with the client poor performance in school. Once all pertinent information has been compiled, a treatment plan should be devised. In the case of Faye, it would seem appropriate that both the medical and developmental models be employed during her diagnosis and treatment, as both, as her symptoms would appear to be inter-related within both models.

If she presents with the qualifying symptoms for ADHD, the developmental model should be utilized first. The counselor should work with the parents to teach and devise plans for working with the client to better stay on task, such as: daily scheduling, positive behavioral reinforcement, presenting one task or step of the task at a time, reducing outside stimuli (such as televisions, music, or environmental noise), and requiring eye contact when speaking. However, if after sometime, this developmental approach fail to work, it would be appropriate to employ the use of the medical model and begin medication for these symptoms.
Additionally, it could be possible that the client could be diagnosed with other DSM disorders, such as: Conduct Disorder, Oppositional Defiant Disorder, Anxiety, Depression, and/or Learning Disabilities, all which are co-occurring disorders with ADHD (Jaffe-Gill, De Benedictis, et al., 2007). An evaluation should be made regarding the severity of these disorders and whether immediate medical attention should be provided to the client, to ensure her safety. If the she appears to be in no immediate danger, it would seem appropriate to employ the use of the developmental model to help the client resolve past and present issues that may be causing her emotional and behavioral state. Hinkle (1998) finds that “Counselors are different from other helping professionals because we focus on the art and science of connecting and bonding with individuals, families, and groups and "sharing the reality of their human experience," whatever that reality may be, and help them find ways to change.” There are many issues that this client may be struggling with that she has been unable to resolve or has been fearful to express, and it would seem that utilizing the medical approach may provide little more than a band-aid to this child’s issues.

When considering a course of treatment, it would seem that the developmental model be utilized with patients who are experiencing disorders related to past or presents stressors, whereas the medical model be employed with clients who present with neurological or psychiatric disorders, unrelated to unresolved emotional issues. Hinkle (1998) presents that “It is important to remember that no single approach is superior to another, but neither are all treatments equally effective or equally ineffective (Hester & Miller, 1985),” but rather a delicate balance between the two must be considered. Counselors, who rely to heavily on the medical model, may fail to “treat” the client, but instead only offer a temporary fix while being medicated. Conversely, those who deny the medical model and chose to only utilize the developmental approach may commit a disservice to those clients whose disorder cannot be treated through counseling process. Regardless of which method one chooses to employ, the DSM-IV-TR will prove to be a valuable tool in providing a diagnosis when the criteria for such a disorder has been met, and will offer the counselor a starting point for treatment. “The DSM-IV does follow a medical model--if you are a medical practitioner If you are a counselor, the DSM may not be a manual of diseases, but simply a description of harmful behaviors, dysfunctions, mental disorders, developmental roadblocks, or whatever one chooses to call them. The DSM does not recommend the prescription of medication or hooking clients up to electrodes, or any other treatment method for that matter” (Hinkle, 1998), and therefore should be used regardless of which model one chooses to employ.

References
Hinkle, S.J. (1998). A Voice from the Trenches: A Reaction to ivey and ivey. Journal of Counseling & Development. 77 (4). Retrieved on April 8, 2008 from Academic Search Premier at http://web.ebscohost.com.library.capella.edu/ehost/detail?vid=1&hid=15&sid=49c7ac45-83cf-4afd-a6ba-7767fb2d5968%40SRCSM1

Hood, A. B., & Johnson, R. W. (2007). Assessment in counseling: A guide to the use of psychological assessment procedures (4th ed.). Alexandria, VA: American Counseling Association.
Jaffe-Gill, E., De Benedictis, T, Smith, M. & Segal, J. (2007). Getting help for children with ADD / ADHD: A Guide to diagnosis and treatment. Retrieved on April 8, 2008 from http://www.helpguide.org/mental/adhd_add_diagnosis.htm

Stephanie Lowrance-Henckel

Can we really ever gain complete "insight" of the client?

I am struggling to determine my theorectical approach and philosophy. At times I find that I am aligned with directive, action based theories, while at other times I am heavily slanted in the direction of insight and non-direction by the counselor. This is because the word "insight" actualy means "seeing into", and I do not believe real human happiness is possible without quite literally seeing into oneself. Yet who is the counselor to assume that he or she knows how this is to be done? Even if we assume that the counselor has achieved tremendous self-insight to offer to the client by way of example (and for how many of us is this truly the case?), this still in no way implies that the counselor is privy to some sort of universal method of self-discovery which can be directly taught to clients. This, then, is why I fit squarely into the "non-directive" camp: I do not see myself, or counselors in general, as being in possession of exclusive knowledge or expertise that would give us the right to be in charge of the client's process of reflection and growth.

Perhaps the article I read will make my meaning clearer. Entitled Counseling without Truth: Toward a Neopragmatic Foundation for Counseling Practice, its author, James T. Hansen, makes a compelling case for abandoning entirely the pursuit of any sort of ultimate truth in counseling and focusing instead exclusively on relationship building (which Hansen, I believe with demonstrable correctness, asserts is the only variable in counseling that can be shown to significantly affect outcome), and for doing this by means of the one aspect of counseling which Hansen further asserts can be shown to play an essential – perhaps even THE essential – role in psychological healing across literally all cultures and demographic groups: the cooperative (de-/re-)construction of narratives or stories through which we give meaning to our experience.

It would take far too much space to explain fully the philosophical grounding for Hansen’s argument; however, a few passages from the article may be helpful:

“[T]he factor that seems to be most associated with positive treatment outcomes is the quality of the helping relationship (Wampold, 1991). By emphasizing technique, then, the best practices movement is focused on a variable that contributes very little to outcomes. Therefore, this movement is not consistent with neopragmatism, because the weight of the evidence suggests that a focus on technique has little utility in counseling practice.

"If guided by a neopragmatic paradigm, then, a fundamental aim of counseling practice would be to optimize the quality of the counseling relationship. Clearly, the trial and error introduction of various techniques does not promote intimate relating in counseling practice anymore than it would in noncounseling relationships. If not specific techniques, then, what should determine the content of the counseling relationship if neopragmatic concerns for utility are used as a guide?...[T]he content that a counselor and client discuss or enact during a counseling relationship is highly connected to the quality of the relationship that evolves…

"Consideration of one's own intimate relationships also illustrates the importance of cohesive narratives to human relating. That is, ordinarily, over time, participants in intimate relationships develop shared relational autobiographies that are negotiated between the partners to give meaning to events that happened during the history of the relationship…

"Therefore, the basic paradigm for healing that is effective across cultures, and the progressive enhancement of the quality of a relationship, which is the factor most associated with positive outcomes in counseling, are both highly dependent upon the introduction, and gradual coconstruction, of cohesive, internally consistent narratives. Note that this is the precise opposite of the disconnected implementation of techniques that is advocated by current mental health culture and its emphasis on so-called best practices…

"Within this neopragmatic vision of counseling processes, then, counselors are not experts because they possess transcendent truths about human nature. Rather, counseling expertise is a function of the narrative possibilities, in the form of counseling theories, that counselors bring to the helping situation to facilitate the coconstruction of new narratives (Hansen, 2006)."

One very important thing to note here is that Hansen does not claim counselors should abandon the search for absolute truth (such as that inherent in the act of “diagnosing” so-called “mental disorders”) because absolute truth does not exist, but rather because it is unknowable to the symbolically-construed, conceptual mind. Counselors should therefore, he asserts, forget about trying to know what is ultimately true and instead worry about what works (as defined by the client in collaboration with the counselor). I like this approach very much, not because it denies the existence of absolute truth (it does not do this, in fact), but because it requires the counselor to abandon the role of expert technician and join the client in a mutual and mutually beneficial conversation in which relationship is first established and then deepened via an unlimited and completely uncoerced discussion of what is meaningful to both partners in the conversation.

I am well aware that this position is extremely threatening to established practice, and especially to those who adhere to the medical/diagnostic model of counseling, but this does not constitute an argument against it. Is ultimate truth knowable? Well, there certainly have been individuals throughout the ages who claim that it is indeed knowable by direct experience, and who themselves claim to have had such experience. If this is true, then let me be clear that the help such persons might provide others would far exceed anything a typical counselor might be able, in his present state, to offer, regardless of his previous training and "clinical" experience. I do not suggest that truth is genuinely unknowable. I only assert that, at this point in my life, I do not know what it is, and that neither, I am certain, do the vast majority of those whose profession is to counsel others. Given where we are, then, it makes perfect sense from my perspective to let truth take care of itself and focus our efforts instead on the immediately achievable. Let us help, in other words, humbly and in the best way we currently know how, by setting aside our ego-driven desire to be technical “experts” and instead choosing simply to sit with our clients and join with them in a mutual attempt to arrive at an interpretation of our common experience which, although it won’t be the final truth about everything, may still be helpful and may even remove a few of the blocks which those who claim to have discovered the truth tell us are all that stand in the way of our having the same experience ourselves.


References

Okun, B.F. & Kantrowitz, R.E. (2008). Effective helping: Interviewing and counseling techniques (7th ed). Belmont, CA: Thomson Brooks/Cole

Hansen, J.T. (2007). Counseling without truth: Toward a neopragmatic foundation for counseling practice. Journal of Counseling and Development, 85(4), 423+