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Commentary on freedom, or, maybe integration is not just for counseling anymore.

In this commentary the author identifies her estimation of the most salient points of Hanna's (2011) seminal article. While in agreement that movement toward a unified model is timely, the author suggests alternative conceptualizations to the freedom paradigm, such as Wilber's (1995, 1996) Integral Model. for disciplinary unification.

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I am honored by this opportunity to respond to Hanna's (2011) article for a proposed integrative paradigm. My comments are offered with the utmost respect for Hanna as well as the other cited scholars, in the spirit of pushing the envelope and contributing to a generation of energy, inquiry, and exploration of this timely topic. I have structured my commentary to follow some of the main headings and discussion topics presented in Hanna's article.

Hanna (2011) calls for a new paradigm to generate new models, research avenues, approaches, and techniques that enhance the profession. He also notes, "The purpose of virtually all counseling endeavors, at some level and to some degree, is to set people free" (p. 363). The semantics of that stated purpose subsequently gives rise to the basis of his proposed paradigm of freedom, which considers freedom in four dimensions. A simplified paraphrase of those dimensions would be freedom from suffering, freedom to move toward new options, freedom with others who are similarly able to act in their own best interests, and freedom for others, an altruistic drive first identified by Adler (1938/1964) as social interest.

One of the most significant contributions of Hanna's (2011) article is elucidation of the need for increased integration and collaboration across specialties. Hanna suggests the need for a "rigorous analysis, synthesis, and steady extension and expansion of the profession as an integrated whole" (p. 362). I am in complete agreement with his observation. If we are going to talk about integration, it could be helpful to first briefly consider how the proliferation of specialties and fragmented groups began and evolved.

The same fragmentation observed in counseling has also been apparent in related professions. For example, Bower (1993) stated that fragmentation in the field of psychology occurred in part because many different ways to apply psychological principles had become evident, and also in part because in any discipline, as the science develops and the knowledge base expands, multiple branches and avenues of knowledge and skill become increasingly evident. If the word counseling was substituted for psychology in Bower's description, the same process appears to have manifested in counseling.

The lack of unification in the field of counseling may arise, in part, because of the various emphases of numerous interest groups. Multiculturalism emphasizes societal and cultural aspects of functioning and wellness, marriage and family counseling emphasizes relational aspects of development and wellness, and so on. "Special interest groups" in my context refers to particular groups of counselor educators, researchers, and practitioners who have developed a sophisticated set of skills in researching, teaching, or providing services related to particular topic areas in the overall domain in counseling. The topic of specialties was the focus of a special issue of the Journal of Counseling & Development (JCD) 17 years ago. J. E. Myers (1995) observed that "specialties may play a vital and perhaps complicating role [italics added] in the professionalization of counseling" (p. 115). A related statement by Herr (1984, cited in Sweeney, 1995, p. 124) was that "the challenge is to nurture both the interests and advantages of the specialties while forging a common vision and plan for the practice of professional counseling as a unified discipline."

In that same JCD issue, Smith and Robinson (1995) wrote, "We anticipate that practicing mental health counselors will have basic knowledge and skills in diagnosing and treating mental and emotional disorders as well as preventive, developmental, holistic, multidisciplinary emphasis in counseling" (p. 161). Indeed, a perusal of the Council for Accreditation of Counseling and Related Educational Programs (CACREP) 2009 Standards (CACREP, 2009) for the clinical mental health counseling track verifies that Smith and Robinson's anticipation was completely accurate.

There seem to now be core principles in the counseling profession. Douthit (2006) identified a "rich tradition of prevention, developmentalism, multiculturalism, contextualism, and social activism" (p. 17) among professional counselors. Mellin, Hunt, and Lindsey (2011) cited multiple scholars who have identified the primary characteristics of counselors as professionals who emphasize developmental, preventive, and wellness issues, and Hansen (2007) stated, "[The counseling profession] places emphasis on client strengths, potential for growth, and developmental transitions" (p. 289). The American Counseling Association (ACA) Code of Ethics preamble states,

ACA members are dedicated to the enhancement of human development throughout the life span. Association members recognize diversity and embrace a cross-cultural approach in support of the worth, dignity, potential, and uniqueness of people within their social and cultural contexts. (American Counseling Association. 2005. p. 2)

Given the common threads that are already indicative of a unified thought process about the emphasis of counseling, I am not convinced that the freedom paradigm is necessarily the most parsimonious or advisable avenue for ideological integration and collaboration. I believe that, as counselors, we are already collaborating in cross-disciplinary ways with other mental health professions, without completely recognizing that is what we are doing. I would like to broaden the scope of discussion beyond counseling to look more broadly at the mental health helping professions as a whole. Returning briefly to Bower's (1993) metaphor of science being like a tree with increasing complexity of branches, he went on to "carry the metaphor to an unflattering extreme, an individual scientist is like a small bug feeding on a succulent leaf at one end of a tiny branch and perhaps talking to other bugs on the same leaf' (p. 905).

I humbly submit that perhaps what we should be calling for is the courage to consider ourselves as Bower's (1993) "small bugs," and not only to ponder the need for departure from our individual leaves and branches but also to fly far enough up and away that we can see the whole tree, and even more broadly, the entire forest. We ask our clients to boldly self-examine and imagine more ideal ways of being; it seems only fitting that we also are willing to hold ourselves as a profession to that same standard of unflinching self-assessment.

Therapeutic Change

Hanna (2011) presents an excellent overview of the processes and precursors of change. Notably, the studies he cites that support those change models are highly integrative with regard to the manner in which they draw from empirically derived knowledge in both counseling and psychology literature. Additionally, the terms counseling and psychotherapy seem to be used interchangeably.

A quick explanation of Prochaska and DiClemente's (1982) stages of readiness for change is warranted as we move toward additional considerations of disciplinary integration. When people are in the precontemplation stage, they are unaware or underaware of the need for change and are experiencing benefits from a given behavior that is meeting basic needs. The strength of the need, and the behavior's ability to meet that need, overshadow any recognition of how that need-meeting behavior might be problematic. The costs incurred by that behavior are far outweighed by the needs that must be met. As people move into the contemplation phase of readiness for change, they start to become more aware that those needs are being met at a cost. The cost becomes more of a concern, and they begin to consider other ways to meet the need that do not come at such a price. In the preparation stage, people begin to envision what their behavior would look like, and how they would feel, if they were using a different set of behaviors and skills to meet their needs. They plan out in detail what they will need to do to make behavioral changes, and what environmental features will also need to change to support their efforts to use new behaviors. In the action phase, new behaviors are initiated, and there is also an assessment of the need and inventory of the extent to which the need is being met. Finally, in maintenance, attention is given to possible antecedents of a relapse, using anticipatory problem solving to manage the internal and external variables that might increase the likelihood of reverting to old ways of meeting the need.

In addition to those stages and processes of change being applicable in conceptualizing work with clients, I suggest that there may be applicability to the entire realm of counseling and Hanna's (2011) posed problem of lack of progressive thinking. That is to say, perhaps the proliferation of special interest groups in counseling has endured and expanded in part because the benefits of doing so have thus far outweighed the costs, the same way that a client in the precontemplation stage of readiness for change is using problematic behavior to meet needs that are of greater salience than the inherent disadvantages of said behavior. As counselors, we may now have reached a developmental juncture in which increasingly complex, holistic, integrative approaches to thinking and growth offer greater promise because a more comprehensive conceptualization gives us a means of applying new knowledge and research findings that are being generated across diverse areas of inquiry.

Scholarly Attempts at Integrating the Theories

I move now to Hanna's (2011) section on scholarly attempts to integrate theories. His presentation incorporates thoughts and perspectives that have emanated in large part from the meta-analytic literature on common therapeutic factors. At the outset, I make the disclaimer that I am heavily biased; the common factors approach holds great appeal to me. In my own experiences of studying about and practicing helping, the common factors stance seems to make the most intuitive sense, despite the fact that "intuition" has proved less reliable than statistics in clinical judgment (e.g., D. Myers, 2008).

One of the most compelling, culturally sensitive descriptions I have seen describing helping relationships and positive outcomes was offered by Frank and Frank (1991). They identified the following four conditions for successful treatment: (a) an emotionally charged relationship, meaning an interaction with a helper who is both caring and hopeful; (b) a therapeutic setting, meaning an environment that conveys that the helper has successfully helped others; (c) a therapeutic myth, meaning that the helper must use some coherent model that he or she can both explain and subscribe to, explaining the presence of symptoms; and (d) a therapeutic ritual, meaning a rationale and method defining the techniques to eliminate the symptoms. These conditions aptly describe any helping relationship endemic across not only counseling but also psychology, psychiatry, social work, and healing rituals that are successfully used in indigenous cultures.

In recognition of those common factors, and as a logical step toward inclusive integration, I offer an alternative model for organizing the conceptualization of all the counseling disciplines. This is a model that is also readily applicable to the allied mental health professions, and it has the potential to provide a vehicle for conceptualizing deficits, strengths, and wellness; the individual and inner subjective experience (Hansen, 2007); and the cultural, relational, semantic, and behavioral aspects of individuals and groups.

My suggestion for an alternative way to consider a unifying paradigm is Wilber's (1995, 1996) four-quadrant Integral Model (Figure 1). The Integral Model evolved from Wilber's contemplation of massive amounts of literature across many disciplines, including anthropology, sociology, religion, psychology, and human development. The ensuing two-axis, four-quadrant framework provides a comprehensive conceptual structure from which one may simultaneously perceive and understand multiple perspectives on whatever subject one is attempting to understand. (For more explanation, see MacCluskie & Ingersoll, 2001; Wilber, 1995, 1996.)

[FIGURE 1 OMITTED]

A brief explanation of the four quadrants will clarify Wilber's deceptively simple paradigm. The left column "Inside" consists of the observer's subjective experiences that require dialogue and interpretation in order for the information to be known to others, including thoughts, feelings, sensations, self-expectations, inner subjective experiences, and perceptions of the expectations of others. The right column "Outside" is made up of those aspects of a phenomenon that can be measured objectively, without any disclosure necessary from the person or group being observed.

The quadrants of Wilber's Integral Model can be applied to categorizing the emphases of various specialties in counseling; many of the specialties' purposes and topics of study occupy more than one domain, although there may be emphasis on one in particular. For example, school counseling involves expertise in providing services in all four of the quadrants. School counselors provide individual counseling (upper left, individual-inside), group counseling (lower left, group-inside; and lower right, group-outside), and classroom instruction on job-seeking skills (lower left, group-inside; and lower right, group-outside).

One could also use the quadrants of the Integral Model as a means of understanding a particular client's presentation, from the standpoints of needs that should be addressed, as well as assets and resources. For example, imagine an individual adult presenting for counseling due to stress and fear about the pending results of a recent biopsy to diagnose cancer. An integral conceptualization of this client's assets might be self-efficacy and positive self-talk (upper left, individual-inside), healthy and adaptive coping behaviors such as exercise for stress relief (upper right, individual-outside), perceived family support (lower left, group-inside), and family members offering to accompany the client to get the biopsy results (lower right, group-outside).

From a wider vantage point of all the counseling specialty areas, the Integral Model offers a simple means of framing the ideas, techniques, and services each specialty offers. Even more broadly, the Integral Model may offer a means of inclusively framing what each of the allied helping professions offers, successfully avoiding subtle or overt implications of any one profession being superior or inferior to the others. Douthit (2006) articulated what many readers might have observed; in the recent past, the medical model (namely psychiatry) in Western mental health service reigned economically and politically dominant. From a more balanced, egalitarian viewpoint, a less hierarchical conceptualization of the mental health field is that the allied mental health professions each have a somewhat different emphasis while all simultaneously intend to promote human health, development, empowerment, and justice.

Before examining my diagram of the Integral Model as applied to mental health professions, consider a comparison between the ACA Code of Ethics preamble presented earlier in this article and the following preambles across the related professions' codes of ethics (italics added by this author). The preamble of the National Association of Social Workers (2008) code of ethics states,
   The primary mission of the social work profession is to enhance
   human wellbeing and help meet the basic human needs of all people,
   with particular attention to the needs and empowerment of people
   who are vulnerable, oppressed, and living in poverty. A historic
   and defining feature of social work is the profession's focus on
   individual wellbeing in a social context and the wellbeing of
   society. Fundamental to social work is attention to the
   environmental forces that create, contribute to, and address
   problems in living.


The preamble of the American Psychological Association's (2010) code of ethics states,
   Psychologists are committed to increasing scientific and
   professional knowledge of behavior and people's understanding of
   themselves and others and to the use of such knowledge to improve
   the condition of individuals, organizations, and society.
   Psychologists respect and protect civil and human rights and the
   central importance of freedom of inquiry and expression in
   research, teaching, and publication. They strive to help the public
   in developing informed judgments and choices concerning human
   behavior.


The preamble of the American Psychiatric Association's (2010) code of ethics states,
   The medical profession has long subscribed to a body of ethical
   statements developed primarily for the benefit of the patient. As a
   member of this profession, a physician must recognize
   responsibility to patients first and foremost. as well as to
   society, to other health professionals, and to self.


I contend that all of these codes of ethics are variations on the same theme. The thematic variations can be readily understood through application of the Integral Model; an application of the model to the helping professions is presented in Figure 2. Hansen (2007) noted that there is ample evidence of cross-disciplinary movement; his discussion was in the context of counseling being considered as a health care profession. I have also noted that there are frequently citations in articles in counseling journals that come from the fields of psychology, sociology, psychiatry, law, and anthropology. Through the lens of the Integral Model for conceptualizing comparative emphases in each discipline, it becomes evident that each branch of this proverbial tree affords a different vantage point of the same phenomena, and that all the branches have the same aspirations to exert efforts that will benefit others. It is unnecessary to spend any more time debating about distinct professional identity. Rather than succumb to the old argument about whether it makes more sense to look at deficits (the medical model) or self-actualization (the counseling model), inner subjective experience, or behavior, let us look instead at how each profession represents one note of a complex musical chord.

[FIGURE 2 OMITTED]

Adoption of a paradigm that allows for multiple perspectives, in which all offer a complementary perspective of some phenomena--in this case, alleviation of human suffering, recovery, benefit, health, and empowerment--seems like a more sustainable venue. I believe the Integral Model fits that bill. It provides a platform from which all the allied helping professions can move forward collaboratively, with a conscious, mindful acknowledgment of what Hanna (2011) is advocating. This multidimensionality has actually already been happening in our thought processes for a long time, yet it has not been fully in our sphere of awareness. This fits with Hanna's caveat that a new paradigm explicates thinking and practices that have been hiding in plain view. Freedom certainly has been hiding in plain view; I submit that cross-disciplinary collaboration and integration has been peeking right around the corner of our awareness too.

Finally, although I am probably preaching to the choir, I cannot in good conscience forgo this opportunity to offer my most heartfelt thoughts about the primacy of this call for collaboration. We all entered helping professions because we aspired to help. As we gaze backward upon the sweep of all recorded human history, the contemporary level of sophistication in health care, technology, and access to resources available to some people in the world is more advanced now than ever before. Concurrently, however, the world population is at an all-time high and is continuing to grow exponentially. On a daily basis we are witnessing diminishment of natural resources such as fresh water, ecosystems, and biodiversity. Injustice, oppression, maltreatment, and attempts to exclude people who do not belong to the dominant group continue to evidence themselves.

This is heartbreaking and tragic to witness; it can also be perceived as an emergent, critical window of opportunity for helping professionals to rise to the occasion. Julia Butterfly Hill is an environmental activist whose work inspires for me a tremendous respect. Her website features the following quote:

The question we need to ask ourselves is not, "Can one person make a difference?" Each and every one of us does make a difference. It is actually impossible to not make a difference. So the question we need to ask ourselves is, "What kind of a difference do I want to make?"

We are the ancestors of the future. What do you want your legacy to be? (Hill, n.d.).

As counselors, we might ask ourselves, then, if we were to move toward a more holistic, collaborative way of offering our skills, our abilities, ourselves, to the world, what might that look like? How might lives be better as a result of those changes? How might our students, clients, and communities be better for our efforts to intentionally and mindfully collaborate and integrate? These questions might stir some anxiety about the realities of mundane details like job security or being discounted by our peers in related professions. However, having courage does not mean one does not feel fear; it means one feels fear but takes risks anyway.

Sweeney (1995) opined that there is a great deal more potential power available in a collectivistic approach. I heartily concur with all those who have advocated such a stance, especially Hanna (2011). I am eager for the opportunity for colleagues to continue this examination and dialogue as we strive to enhance the quality of life for people. Hanna's call needs to go out not just to counselors but to other mental health professionals who are already awake or in the process of waking up. Sustainability not only for the human race, but for all other sentient beings, must be our ultimate collective goal, and we certainly have a huge task ahead of us.

References

Adler, A. (1964). Social interest: A challenge to mankind. New York, NY: Capricorn. (Original work published 1938)

American Counseling Association. (2005). ACA code of ethics. Retrieved from http:// www.counseling.org/Resources/CodeOfEthies/TP/Home/CT2.aspx

American Psychiatric Association. (2010). The principles of medical ethics with annotations especially applicable to psychiatry. Arlington, VA: Author.

American Psychological Association. (2010). Ethical principles of psychologists and code of conduct 2010 amendments. Retrieved from http://www.apa.org/ ethics/code/index.aspx

Bower, G. H. (1993). The fragmentation of psychology? American Psychologist, 48, 905-907.

Council for Accreditation of Counseling and Related Educational Programs. (2009). 2009 standards. Retrieved from http://www.cacrep.org/doc/2009%20Standards.pdf

Douthit, K. Z. (2006). The convergence of counseling and psychiatric genetics: An essential role for counselors. Journal of Counseling & Development, 84, 16-28.

Frank, J. D., & Frank, J. B. (1991). Persuasion and healing: A comparative study of psychotherapy (3rd ed.). Baltimore, MD: Johns Hopkins University Press.

Hanna, F. J. (2011). Freedom: Toward an integration of the counseling profession. Counselor Education and Supervision, 50, 362-385.

Hansen, J. T. (2007). Should counseling be considered a health care profession? Critical thoughts on the transition to a health care ideology. Journal of Counseling & Development, 85, 286-293.

Hill, J. B. (n.d.). Julia Butterfly Hill. Retrieved from http://www.juliabutterfly.com/en/

MacCluskie, K. C., & Ingersoll, R. E. (2001). Becoming a 21st century agency counselor: Personal and professional explorations. Belmont, CA: Wadsworth/ Thomson Learning.

Mellin, E. A., Hunt, B., & Lindsey, M. N. (2011). Counselor professional identity: Findings and implications for counseling and interprofessional collaboration. Journal of Counseling & Development, 89, 140-147.

Myers, D. (2008). Clinical intuition. In S. O. Lillienfeld, J. Ruscio, & S. J. Lynn (Eds.), Navigating the mindfield: A user's guide to distinguishing science from pseudoscience in mental health (pp. 159-174). Amherst, NY: Prometheus Books.

Myers, J. E. (1995) Specialties in counseling: Rich heritage or force for fragmentation? Journal of Counseling & Development, 74, 115-116.

National Association of Social Workers. (2008). Code of ethics of the National Association of Social Workers. Retrieved from http://www.socialworkers.org/ pubs/code/code.asp

Prochaska, J. O., & DiClemente, C. C. (1982). Transtheoretical therapy: Toward a more integrative model of change. Psychotherapy: Theory, Research and Practice, 19, 276-288.

Smith, H. B., & Robinson, G. P. (1995). Mental health counseling: Past, present. and future. Journal of Counseling & Development, 74. 158-161.

Sweeney, T. J. (1995). Accreditation, credentialing, professionalization: The role of specialties. Journal of Counseling & Development. 74, 117-125.

Wilber, K. (1995). Sex, ecology, spirituality: The spirit of evolution. Boston, MA: Shambhala.

Wilber, K. (1996). A brief history of everything. Boston, MA: Shambhala.

Kathryn C. MacCluskie, Department of Counseling, Administration, Supervision, and Adult Learning, Cleveland State University. Correspondence concerning this article should be addressed to Kathryn C. MacCluskie, Department of Counseling, Administration, Supervision, and Adult Learning, Cleveland State University, 2121 Euclid Avenue, JH 272, Cleveland, OH 44115 (e-mail: k. maccluskie@csuohio.edu).
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Author:MacCluskie, Kathryn C.
Publication:Counselor Education and Supervision
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Geographic Code:1USA
Date:Dec 1, 2011
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