Relationship between rehabilitation counselor efficacy for counseling skills and client outcomes.
Bandura's model of Social Cognitive Theory hypothesizes that cognitive, environmental, and behavioral factors interact to determine human behavior (Bandura, 2001). Cognitive factors are generally thought of as a person's attitudes, knowledge, and expectations. Environmental factors include factors such as social norms and one's ability to change his/her own environment. Finally, behavioral factors are things like skills, practice, and self-efficacy.
Self-efficacy is a major piece of Social Cognitive Theory. The theory of self-efficacy represents one's judgment of one's capability to successful carry out a particular course of action (Bandura, 1977; Bandura, 1982). In essence, if someone believes they are capable of achieving something, they put forth the effort and have the motivation to persevere. For example, if rehabilitation counselors believe they have an ability to successfully execute counseling microskills (i.e., reflecting, paraphrasing, etc.), their thoughts and behaviors are shaped by that belief, and they are likely to actually execute microskills effectively with their client. This process is also thought to be true when the task at hand is difficult; however, the theory suggests that people may avoid situations that they perceive to be beyond their capability. Self-efficacy theory has been used for decades to study performance in various activities such as work (Heppner, Multon, Gysbers, Ellis, & Zook, 1998; Larson et al., 1992).
Self-efficacy is based on an individual's perception of their ability to successfully achieve an outcome (Bandura, 1982). This perception is influenced by outside factors such as the environment or personal factors, and this perception may be accurate or not. Whether accurate or inaccurate, perceived self-efficacy impacts an individual's decision to engage in certain activities, his/her effort towards those activities, as well as how long those efforts will be sustained (Bandura, 1977). For example, if a rehabilitation counselor perceives little or no efficacy for successfully executing counseling skills, then he/she may avoid situations where those skills are required or fail to put forth effort to successful execute those skills in situations when those skills are required.
Given the importance of perceived self-efficacy, it is necessary to understand how perceived self-efficacy can be increased or decreased (Bandura, 1977). Perceived self-efficacy can be increased by mastery experience, vicarious experience, verbal persuasion, and physiological feedback (Bandura, 1977). First, mastery experiences or experiences with success can impact cognitions about tasks (Bandura, 1977). Take the example of a rehabilitation counselor who executes counseling skills with a client and subsequently, the client achieves their goal. The rehabilitation counselor's cognitions about their own counseling skills might change as a result of their perceived success (e.g., 1 tried and succeeded). Additionally, when faced with a related situation in the future, the counselor may feel more confident in their counseling skills than they did before working with this client and having this perceived success (e.g., I tried and succeeded in the past, so I can succeed in the future). In comparison, if a counselor perceives failure with a client as a result of their skills, they may be less confident in the future than before the incident. In this instance, when faced with a related situation in the future, counselors may perceive themselves to lack the needed skills, which may lead to another perceived failure (e.g., I tried and failed before, so I'll fail again). This is also connected to physiological feedback, such as the positive feelings associated with success and the uncomfortable feels associated with failure (Bandura, 1977).
Second, vicarious experience also influences perceived self-efficacy (Bandura, 1977). By watching someone perform a course of action that one has little or no experience with, one's cognitions about that course of action and its related outcome can be modified. For example, motivation for the course of action may be enhanced by seeing and anticipating various rewards associated with the course of action. It is also thought that individuals may increase self-efficacy through vicarious experience because they gain strategies for achieving a successful outcome. In the case of an individual rehabilitation counselor, perhaps watching a supervisor successfully work with a difficult client behavior may allow the rehabilitation to increase perceived self-efficacy for working with that difficult client behavior because the rehabilitation counselor saw the rewards associated with assisting the client and observed strategies they may use with his/her own future clients. Vicarious experience is closely related to modeling (Bandura, 1977).
Finally, verbal persuasion or what is said to us about what others think we can and cannot do, is also considered to impact perceived self-efficacy (Bandura, 1977). The impact of verbal persuasion on perceived self-efficacy varies, but can have tremendous impact if one perceives the person to be trustworthy. For example, if a rehabilitation counselor receives information from a trusted supervisor suggesting the rehabilitation counselor is capable of a specific course of action, then the rehabilitation counselor's perceived self-efficacy on that course of action is thought to increase.
With the backdrop of self-efficacy, it is important to understand how counseling skills are thought of in the rehabilitation counseling profession. The call for rehabilitation counselors to have some level of competency with counseling skills is well defined in the literature. First, the Commission on Rehabilitation Counselor Certification (CRCC) Scope of Practice Statement (2012) has indicated that "individual and group counseling treatment interventions focused on facilitating adjustments to the medical and psychosocial impact of disability" (p.1) as an essential function of a rehabilitation counselor. Second, the need for counseling skills exists in The Council on Rehabilitation Education (CORE) requirement that students engage in practicum experiences that "facilitate the development of basic rehabilitation counseling skills" (CORE, 2008, p. 16). Third, knowledge of individual counseling and career counseling has been reported by practicing certified rehabilitation counselors as important for effective practice (Leahy, Muenzen, Saunders, & Strauser, 2009).
Clients also seem to want and need rehabilitation counselors who employ counseling skills (Lustig, Strauser, Rice, & Rucker, 2002). Lustig et al. (2002) found a positive relationship between working alliance between counselor and client and successful client outcomes. Working alliance can be developed though the counselor expressing warmth for, respect for, and interest in the client (Safron & Muran, 1988). Balancing directive responses with reflective responses is also thought to contribute to the building of a successful working alliance (Safron & Muran, 1988). Regardless of the specific client concern or the specific counseling approach of the rehabilitation counselor, rehabilitation counselors and client can be assisted with the use of such basic counseling skills that facilitate working relationships.
Self-efficacy theory has been used to explore the relationship between counselor efficacy for counseling skills and the outcomes counselors achieve (Heppner et al., 1998; Larson et al., 1992). In one study, counselor responses on a self-efficacy inventory were found to positively relate to counselor performance (Larson et al., 1992). In a sample of psychology students, self-efficacy was found to be positively related to client outcomes, but only in cases where the students received regular feedback from their clients on their clinical skills (Reese et al., 2009).
The relationship between counselor self-efficacy and client outcomes may be complex. Specifically, a non-linear relationship has been found between career counselor self-efficacy and client outcomes. Heppner et al. (1998) found that counselors who reported the highest levels of self-efficacy had clients who felt less empowered and engaged in the counseling process than did clients of counselors who reported slightly lower levels of self-efficacy. One possible explanation for this finding is that counselors who have extremely high levels of perceived ability for their work as counselors may not prepare for sessions, may not work to gain and maintain skills, and may fail to critically evaluate their work with clients. Overall then, results of studies investigating the relationship between client outcomes and counselor self-efficacy have shown mixed results.
Need for Current Study
Self-efficacy seems to play an important role in an individual's engagement in activities (Bandura, 1977). Literature suggests rehabilitation counselors need counseling skills (CRCC, 2012; Lustig et al., 2002). It would be expected that a rehabilitation counselor with high levels of self-efficacy for employing counseling skills would be more likely to employ counseling skills than a rehabilitation counselor with lower levels of self-efficacy (Bandura, 1977). However the impact of rehabilitation counselor efficacy for counseling skills on any type of rehabilitation counseling outcome is relatively unknown. Some literature suggests that counselors with strong working relationships with their clients have clients with better outcomes (Lustig, et al., 2002). However, it is unknown how self-efficacy for counseling skills is related to client outcomes.
One of the problems of not understanding the relationship between self-efficacy for counseling skills and client outcomes in rehabilitation counseling is that it is difficult to mandate the use of a practice like counseling skills without multiple sources of evidence of its effectiveness. Specifically, many rehabilitation counselors in the state vocational rehabilitation counseling system see their role as a case manager and not a counselor who needs to utilize counseling skills (Herbert, 2004). Rehabilitation counselors that hold such beliefs will likely continue to hold such beliefs unless evidence is provided that encourages change.
There are also other benefits that could result from understanding the relationship between counseling skills and client outcomes. First, investigating this relationship may provide guidance to rehabilitation counselors and supervisors on how to incorporate counseling skills for effective practice. If efficacy for a counseling skill is associated with successful client outcomes then supervision can focus on enhancing efficacy for that skill. Alternatively, if efficacy for a specific counseling skill is not related to successful client outcomes, supervisors and counselor can make an informed decision and not focus on enhancing that particular skills.
Second, many efforts are underway to support rehabilitation counseling as a specialization of the counseling profession (Maki & Tarvydas, 2012). Leaders in the field are asking for states to include graduates of Council on Rehabilitation Education (CORE) programs in state licensure laws and traditional mental health counseling positions (Maki & Tarvydas, 2012). Investigating the relationship between self-efficacy for counseling skills and client outcomes may help inform such efforts. Third, investigating this relationship in the state vocational rehabilitation counseling setting will provide information specific to that setting, and can guide practice. In sum, results of this study may provide insights to rehabilitation counselors and supervisors as well as leaders in the rehabilitation counseling profession..
As a result of the literature review, three research questions were developed:
1. Is there a linear relationship between rehabilitation counselor self-efficacy and number of successful client outcomes?
2. If the relationship is non-linear, is there an optimum level of rehabilitation counselor self-efficacy in terms of achieving successful client outcomes?
3. What, if any, demographic variables (i.e, year of work experience as a rehabilitation counselor, years employed in current agency, CRC or not, number of clients on caseload, counselor's gender, counselor's race, counselor's highest level of education achieved, and age in years) are associated with counselor self-efficacy for counseling skills?
Demographic information was collected for participants in the study. Participants were currently employed by state vocational rehabilitation counseling programs in Nevada, Arizona, West Virginia, Wisconsin, and Rhode Island (N = 166). Table 1 summarizes the descriptive statistics for participants. The mean age was 46.50 years (SD = 12.24); the majority (84%) were Caucasian. A total of 92% reported having at least a Masters Degree. Mean years employed as a rehabilitation counselor was 10.00 (SD = 8.75) and mean years employed in their current agency was 8.01 (SD = 7.49). Fewer than half (44%) reported being certified as a rehabilitation counselor.
Counselor Self-Efficacy. The Counseling Self-Estimate Inventory (COSE) was used as a measure of the rehabilitation counselors' self-efficacy for counseling skills (Larson et al., 1992; Larson & Daniels, 1998). The COSE is a 37-item instrument that includes five counseling areas judged to be required for effective counseling practice: a) executing microskills (12 items), b) attending to the process (10 items), c) dealing with difficult client behavior (7 items), d) behaving in a culturally competent way (4 items), and e) being aware of one's own values (4 items). Respondents indicate their level of agreement on a scale with Likert type response choices (/strong disagree to 6-strongly agree). This inventory was selected because it is designed for use on a post-academic population versus those enrolled in a graduate program (Larson & Daniels, 1998) is the oldest and most widely used to measure counseling skill self-efficacy within the counseling and related literature. Further, this instrument was reviewed by three doctorate-level professionals with experience in counseling and was determined to be face valid for the target population of the study.
According to Larson et al., (1992) scores on the COSE are highly reliable, predictive of counselor performance, and robust against counselors' theoretical orientation (Larson et al., 1992). Further, and consistent with self-efficacy theory, COSE scores have been found to increase over time as counselors achieve successful client outcomes (Larson et al., 1992). Overall, the COSE has been assessed as a reliable and valid measure of a counselor's efficacy for general counseling skills (Larson et al., 1992). Cronbach's alpha for the composite scale and each subscale were as follows: Composite (.94); Microskills (.89); Process (.86); Difficult Client Behavior (.80); Cultural Competence (.60); Awareness of Own Values (.42). A factor analysis was conducted on responses from the current study to replicat the analysis described in Larson et al. (1992), the original validation study for the COSE. The first five factors in the solution had eigen values ranging from 12.8 to 1.3 and accounted for slightly over 50 percent of the variance in the variables. This was found to be comparable to Larson et al. (1992).
Successful Client Outcomes. Status 26 was used as a measure of a successful client outcome, which indicates the client has achieved their vocational goal, as outlined in the individualize plan for employment. A pre-test was conducted to validate the collection method for the successful client outcome variable. The client outcome variable used in the study was the counselor self-reported number of successful client outcomes in the most recent one year period. To conduct this pre-test, approval was gained through the author's institutional review board and a state vocational rehabilitation program. Supervisors from the state agency were invited to participate in the pre-test and were asked to report a total of two data points. First, supervisors collected all of their counselors' self-reported number of Status 26s in the past twelve months. Second, supervisors retrieved the actual number of Status 26s each of those counselors achieved in the past twelve months. Those two data points were reported back to the researcher by phone or e-mail.
The association between self-reported number of Status 26s and actual number of Status 26s was high, r = .969; p < .01, N = 39. Based on the pretest, it appeared that having counselors self-report the number of Status 26s achieved in the past twelve months was an accurate measure of their actual number of Status 26s. Therefore, the Status 26 variable was collected using counselor self-report.
Research approval was secured from the Institutional Review Board at the author's academic institution and from each participating agency. Agencies were randomly selected to participate using geographical cluster sampling. All 50 United States were grouped into one of five regions based on their geographical location: Northeast, Northwest, Southeast, Southwest, and Midwest. States in each region were randomly ordered using a random number generator and this was done to ensure geographic diversity in the sample (e.g., counselors, agencies, supervisors, populations served by agencies). Directors of five states at the top of the list in each region were contacted, provided with information about the study (i.e., purpose, design, time commitment of participants, benefits of the study), and invited to have rehabilitation counselors in his/ her state participate in the study. Four of the five first state directors contacted selected to have rehabilitation counselors participate in the study. In one region, the first and second states declined participation and the third state on the list agreed to participate in the study. Most states provided verbal consent and then moved forward with providing the survey to rehabilitation counselors in their state. Several states required the research to submit additional information including evidence of Institutional Review Board approval and a signed researcher agreement. Rehabilitation counselors in participating agencies received a total of five electronic mail contacts during the month of April 2012 (Dillman, 2009). Each contact was forwarded to participants by agency directors or his or her assistant. First, a pre-survey e-mail was sent explaining the purpose of the study and informing counselors they would be receiving an invitation to participate in an electronic survey in three to four days. Second, an e-mail containing a description of the study and a link to the survey, including an informed consent process, was provided to counselors in participating agencies. Third, a reminder e-mail was sent one week after the survey link was sent. Fourth, a second reminder e-mail was sent two weeks after the survey link was sent. Fifth, two to three days after the second reminder was forwarded a message was sent indicating the survey was closed. These data were collected as part of a larger round of data collection where information on counseling skills and clinical supervision practices was collected and only the data relevant to the research questions are included in this manuscript (McCarthy, in press).
A negative binomial regression model was created to answer research one and identify if there was a linear relationship between counselor self-efficacy and the count outcome variable of client outcomes. Negative binomial regression was selected as logistic regression may create bias in a model where the outcome variable is a count or rate data (Coxe, West, & Aiken, 2009) and over dispersion was evident in the Poission regression model (Coxe et al., 2009).
A known predictor of number of successful client outcomes is caseload size (Emener, 1980; Fish et al., 1982) and years of experience as a rehabilitation counselor (Szymanski, 1991). Therefore, caseload size and years of experience were entered in as control variables. COSE composite (mean centered) was entered as the variable of interest. A negative binominal regression model assumes variability in the model between individuals who have the same predicted values; therefore, overdispersion is not a problem in this model (Coxe et al., 2009). The model goodness of fit statistics were calculated (BIC = 1274; Deviance 1.00) and indicate this model is a good fit (Coxe et al., 2009). An examination of the standardized residuals indicated a normal distribution. The same model was used for each subscale (mean centered), replacing COSE composite (mean centered) with each subscale (mean centered).
To answer research question two and test for a non-linear relationship between counselor self-efficacy and client outcomes, the identical negative binominal regression model was utilized, but the quadratic function of self-efficacy (i.e., self-efficacy x self-efficacy) was entered as the final predictor variable. The same model was used for each subscale, replacing COSE composite (mean centered) for each subscale (mean centered).
Finally, to answer research question three and identify the demographic variables associated with counselor self-efficacy, a series of Pearson regressions were conducted.
Results of research question one indicate that the omnibus test for the model was statistically significant, [chi square](3) = 13.21, p = .004; however, only years of experience as a rehabilitation counselor significantly predicted the outcome variable ([beta] = .02, SE = .01, [chi square](1)= 5.25, p = .022). No significant relationship between COSE and number of successful case closures existed ([beta] = .12, SE = .13, [chi square](1) = -87, p = .352). The relationship between COSE Composite (and each subscale, see Table 2) and number of successful client outcomes was not statistically significant. Therefore, it appears there is not a linear relationship between counselor self-efficacy and number of successful case closures.
The results of the test for a non-linear relationship between counseling self-efficacy and client outcomes indicate that a significant non-linear relationship does not exist (see Table 3). COSE composite and each of the subscales do not appear to have a significant U-shape relationship or inverse U-shape relationship with client outcomes.
A series of correlation analyses were conducted to identify the relationship between COSE Composite and subscales with the following demographic variables: year of work experience as a rehabilitation counselor, years employed in current agency, CRC or not, number of clients on caseload, counselor's gender, counselor's race, counselor's highest level of education achieved, and age in years. Only age in years was significantly related to counselor self-efficacy (see table 4).
Several limitations should be taken into consideration when interpreting the findings of this study. First, participants in this study were not selected at random, instead agencies were selected at random. The nature of this design poses threats to external validity and results of this study cannot be generalized to rehabilitation counselors not employed in a state vocational rehabilitation counseling agency. The second limitation of this study is that the relationships between predictor and outcome variables are based on statistical associations and causality cannot be determined. For example, the significant relationship between dealing with difficult clients subscale and successful client outcomes could either be due to the efficacy for dealing with difficult clients improving client outcomes, a counselor that has successful outcomes is already good at dealing with difficult clients, or some unmeasured third variable. Finally, all of the variables in this study were collected using self-report methods. It is possible that response bias occurred and results need to be interpreted with that possibility in mind. In sum, when interpreting results of this study, these limitations need to be considered.
When the regression analysis indicated no relationship between counselor self-efficacy and the Status 26 outcome, post-hoc correlation analyses were conducted to identify the correlational relationships between these two variables. Although efficacy for counseling skills does not predict a rehabilitation counselors' successful case closures above and beyond covariates (caseload size and years of experience), efficacy for executing microskills and efficacy for dealing with difficult client behavior were significantly correlated to successful client outcomes. This correlational finding may be supported by literature on client outcomes in rehabilitation counseling (see Saunders et al., 2006). Specifically, predictors of successful client outcomes are client attitudes towards work and willingness to engage in rehabilitation counseling services. Clients with efficacy for obtaining work and those who are actively engaged in the rehabilitation counseling process are more likely to meet their goals than clients with low levels of self-efficacy for obtaining employment and those not invested in the process. A counselor's perceived ability to use microskills (e.g., build rapport) and negotiate with difficult client behavior (e.g., lack of motivation) may be important for helping a client change their beliefs about their abilities and counseling skills associated with successfully negotiating difficult client behavior may be important for actively engaging a client in the rehabilitation counseling process.
The positive relationship between microskills and successful client outcomes is also supported by Lustig et al. (2002) with the significant finding between working alliance and client outcomes. It is thought that being warm, interested, and making reflective statements enhances the working relationship between a counselor and client (Safron & Muran, 1988). Microskills such as paraphrasing, reflection of feeling, and attending behaviors would therefore seem to enhace the relationship between the counselor and client and work to facilitate a positive outcome.
The positive relationship between a rehabilitation counselor's efficacy for dealing with difficult client behavior and the number of successful client outcomes is also supported by literature. Saunders et al. (2006) found that clients who were not investigated in the rehabilitation process were less likely to achieve a successful outcome versus clients who were actively involved. A rehabilitation counselor's ability to assist a client to become motivated to engage in the rehabilitation counseling process would therefore be important. Even the ability to recognize when a client is ready to engage in the process versus not ready could be important. In sum, correlations indicate positive relationships between successful client outcomes, efficacy for microskills, and difficult client behavior.
Based on the results of this study, it appears that there is not a linear relationship between the perceived self-efficacy a rehabilitation counselor has for performing counseling skills and the number of successful client outcomes they achieve. Essentially, knowing the efficacy a state rehabilitation counselor has for performing counseling skills does not seem to be helpful in predicting the number of successful case closures that rehabilitation counselor achieves. There are several possible reasons for this non-significant finding. One possibility is that self-efficacy may not be a large enough influence on an individual's behavior. According to Social Cognitive Theory, cognitive, environmental, and behavioral factor influence behavior (Bandura, 2001). Perhaps environmental factors such as office culture or personal attributes such as attitudes toward counseling skills are having more influence on the behaviors such as counseling skills leading to client outcomes.
Another possibility is that the self-efficacy a counselor has for performing counseling skills such as executing microskills, facilitating the counseling process, handling difficult clients, being culturally aware, and being aware of one's own values are not actually related to the outcomes a rehabilitation counselor achieves. Saunders, Leahy, McGlynn and Estrada-Hernandez (2003) suggested that among multiple client, counselor, and service variables that contributed to a successful client outcome, clients receiving job development and job placement services were more likely to achieve a successful outcome than clients who did not receive that service. It is reasonable to conclude that receiving a specific service may be more important for achieving a successful outcome than a counselor's ability to perform basic counseling skills.
Another possibility for the non-significant finding is that counselors are not accurate in their assessment of their counseling skills. Reese et al (2009) found a significant relationship between practitioner self-efficacy and client outcomes only when practitioners received feedback from their clients on their skills. Perhaps, feedback on skills assists in the accurate assessment of self-efficacy skills and that rehabilitation counselors in this study were not able to accurately assess their skills.
The non-significant finding may also provide insight into the culture of state vocational rehabilitation agencies. It is possible that efficacy for counseling skills may be more important for quality of a case closure instead of quantity of case closure, which was measured in this study. Although self-efficacy for counseling skills does not seem to predict the quantitative outcome a client achieves (gains employment or does not gain employment) perhaps there are additional outcome measures of the state vocational rehabilitation counseling process that would be related to a rehabilitation counselor's efficacy for basic counseling skills. For example, state vocational rehabilitation clients have complained about the general counseling skills of their rehabilitation counselor citing that feeling listed to and respected as important to them (Hein, Lustig, & Uruk, 2005). Quantitative outcomes may not be related to counseling skills, but other outcomes important to clients may be related to counseling skills.
Results of this study suggest that a non-liner relationship does not exist between a rehabilitation counselor's self-efficacy and the client outcomes they achieve. Authors of a previous study suggested that a non-linear relationship may exist between these two variables (Heppner et al., 1998); however, the outcome variables used were related to clients' attitudes towards the career counseling process and skills development outcomes (i.e., decisiveness, information utilization). Perhaps execution of general counseling skills assist the client to feel more equipped to engage in the job search process (i.e., I can find a job), but that is separate from actually obtaining a successful employment outcome (i.e., I obtained a job). Essentially, the lack of finding a non-linear relationship in this study may be due to the outcome variable used.
Age of the counselor (in years) was the only demographic variable found to be significantly correlated with COSE responses. A counselor's perceived ability to execute microskills, facilitate the counseling process, and handle difficult client behaviors seem to be positively associated with a counselor's age. This finding is consistent with self-efficacy theory in that efficacy for a particular activity tends to increase with successful in that activity (Bandura 1977, 1982). Counselor's age was not significantly related to cultural competence or being aware of one's own values. It is possible that rehabilitation counselors trained before the importance of multicultural competence was emphasized do not feel competent in the area of multicultural competence or the importance of being aware of one's own values.
Implications for Practice
Results of this study suggest that a rehabilitation counselor's efficacy for successfully performing basic counseling skills do not seem to impact the number of successful client outcomes a public vocational rehabilitation counselor achieves. However, successful client outcomes were found to be correlated with a rehabilitation counselor's efficacy for executing microskills and efficacy for dealing with complex client behavior. Further, execution of counseling skills with clients could be associated with other relevant outcomes not measured in this study. Rehabilitation counselors employed in the state vocational rehabilitation counseling program are encouraged to gain and/or maintain basic counseling microskills (e.g., paraphrasing, confrontation) and enhance their ability to work with challenging client behavior (e.g., clients in crisis, indecisive clients) as those seem to be correlated with positive rehabilitation outcomes. Rehabilitation counselors could work to gain and/or maintain these skills through counseling supervision. This may include receiving direct observation from supervisors on these skills or using counselor self-report to discuss these skills during supervision sessions. Rehabilitation counselors are encouraged to work with their supervisors in order to assess their counseling skills and identify a plan for addressing any deficiencies.
Besides working on a plan for professional development in relation to counseling skills, rehabilitation counselors are encouraged to consider how their counseling skills may impact their clients. Overall, findings from this study suggest that efficacy for counseling skills does not directly impact client outcomes in terms of a successful case closure or not. However, the impact counseling skills have on other client outcomes is unknown (Hein, Lustig, & Uruk, 2005). For example, perhaps a rehabilitation counselor that infuses counseling skills into their practice has a positive impact on a client's ability to self-advocate, which adds benefit to the client overall. Even though this study did not demonstrate counseling skills to be significantly associated with the number of successful client outcomes a counselor achieved, rehabilitation counselors in the state vocational rehabilitation counseling system may positively impact rehabilitation clients by utilizing counseling skills in their practice.
Consumers of rehabilitation counseling services are encouraged to communicate his or her needs to their vocational rehabilitation counselor in terms of the counseling skills they would find helpful. Results of this study suggest that counselors' efficacy was not related to the quantity of successful case closures the counselor achieved, but this study did not explore how counseling skills are related to quality of client outcomes. Satisfaction with vocational rehabilitation counseling services could be one example of such an outcome, and level of satisfaction can be impacted by the involvement a rehabilitation counseling consumer feels in their own services (Kosciulek, Vessell, Rosenthal, Accardo, & Merz (1997). If counselors are not receiving satisfactory marks from their clients in terms of satisfaction with services, an evaluation of rehabilitation counselor counseling skills could be necessary. This issue is especially important as issues with general counseling skills of rehabilitation counselors has cited by employed and unemployed vocational rehabilitation counseling consumers (Hein, Lustig, & Uruk, 2005). If consumers are feeling disrespected or uninvolved in their own rehabilitation and would like more counseling skills utilized, consumers are encouraged to communicate with their counselor or appropriate supervisor
Several areas of future research may help clarify for rehabilitation counselors and rehabilitation supervisors the impact counseling skills have on rehabilitation counseling clients. One possibility for the non-significant finding between rehabilitation counselor self-efficacy for counseling skills and client outcomes may be attributed to the state vocational rehabilitation counseling setting and the specific practices of that setting (e.g., focus on Status 26). Therefore, an investigation of the relationship between rehabilitation counselor counseling self-efficacy and client outcome may be warranted in other settings such as for-profit settings and non-profit. Exploring this relationship in other settings may provide rehabilitation counselors employed specific setting with the direction they need to utilize counseling skills effectively.
This study utilized perceived self-efficacy as an independent variable. According to theory, perceived self-efficacy influences a rehabilitation counselors decisions to utilize counseling skills with clients, as well impacts the effort a rehabilitation counselor might put forth to learn and enhance counseling skills (Bandura, 2001). Future research could focus on this variable so that we can better understand the influences on it. For example, how does supervision impact rehabilitation counselor perceived self-efficacy for successfully carrying out counseling skills? How does client feedback impact perceived self-efficacy for counseling skills? If a rehabilitation counselor perceives low levels of efficacy for particular skills, do they tend to use those skills less often regardless of the needs of the client? Are high levels of efficacy for counseling skills associated with skills in other areas of rehabilitation counseling such as job placement and development, evaluation, or case management?
The outcome used in this study was one that measured whether or not a client became employed. Although this outcome is one that is utilized in state vocational rehabilitation counseling programs, perhaps other client outcomes are also important (Kosciulek et al., 1997). Examples may include client self-awareness, client self-efficacy for engaging in the world of work, a measure of client life satisfaction, satisfaction with services, or a measure of rapport between counselor and client. Such outcomes are arguably equally as important as a measure of employed or not employed and may be worthy of investigation (Kosciulek et al., 1997). Studies investigating the relationship between efficacies for counseling skills and other client would provide insights to rehabilitation counselors on how counseling skills may impact their client in ways outside of gaining employment or not gaining employment.
In conclusion, rehabilitation counselors are unique from other human service professions because they not only have specialized knowledge of disability and the world of world, but are also trained to utilize counseling skills (Tarvydas & Maki, 2012). This specialized set of knowledge make rehabilitation counselors essential to providing quality services to people with disabilities; however, the impact of counseling skills on client outcomes needs to be considered especially in the context of the current discussions around counseling licensure and how rehabilitation counseling fits into the larger counseling profession. This study investigated this relationship and draws attention to the idea that the efficacy a rehabilitation counselor has for executing general counseling skills is correlated to the number of successful outcomes achieve. Rehabilitation counselors, supervisors, and consumers of vocational rehabilitation services are encouraged to consider their experience with counseling skills and the importance placed on such skills within his/her agency.
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Amanda K. McCarthy
Northern Illinois University
Amanda K. McCarthy, School of Allied Health and Communicative Disorders, Northern Illinois University, DeKalb, IL 60115.
Table 1. Sample Descriptive Statistics (N = 166) % M SD Age in years 46.50 12.24 Gender Female 74 Male 26 Race African American 5 Asian/Pacific Islander 4 Caucasian 84 Hispanic/Latino/Latina 5 Other/Multiracial 2 Education Some College 1 Bachelors Degree 6 Masters Degree 86 Some Doctoral Work 4 Doctoral Degree 2 Other Professional Degree 1 Years as a rehabilitation counselor 10.00 8.75 Years at current agency 8.01 7.49 Caseload Size 110.11 83.00 Certified Rehabilitation Counselor No 56 Yes 44 Table 2: COSE Predicting Client Outcomes (N = 166) B SE X P Omnibus (p) Microskills .45 1.08 14.23 .679 .164 Process -.10 1.06 20.54 .929 .048 * Difficult Client Behavior -.01 1.06 14.23 .993 .049 * Cultural Competence .97 1.03 4.90 .348 .022 * Awareness of Values .29 1.09 3.98 .790 .040 * Note: COSE = Counseling Self-Estimate Inventory. Negative Binominal Regression Model of COSE responses predicting successful client outcomes with size of counselor caseload and years of experience as a rehabilitation counselor as covariates. The Omnibus test assesses whether all of the variables in the model significantly predict client outcomes. B is the coefficient for the COSE and this assesses whether COSE uniquely predicts client outcomes above and beyond other variables in the model. * p < .05; ** p < .01 Table 3: Test for U-Shape between COSE and Client Outcomes (N = 166) B SE [X.sup.2] P Omnibus (p) Composite 0.10 0.14 0.51 0.476 <.001 ** Microskills 0.11 0.14 0.66 0.416 <.001 ** Process 0.09 0.08 1.35 0.245 <.001 ** Difficult Client Behavior 0.02 0.08 0.07 0.794 <.001 ** Cultural Competence -0.01 0.13 0.00 0.972 <.001 ** Awareness of Values 0.03 0.09 0.09 0.760 <.001 ** Note: COSE = Counseling Self-Estimate Inventory. Negative Binominal Regression Model of COSE responses with Quadratic function predicting successful client outcomes with size of counselor caseload and years of experience as a rehabilitation counselor as covariates. The Omnibus test assesses whether all of the variables in the model significantly predict client outcomes. B is the coefficient for the COSE and this assesses whether COSE uniquely predicts client outcomes above and beyond other variables in the model. Wald Chi-square df = 1 Table 4: Correlation Between COSE Subscales and Counselor Age (N = 166) COSE Subscale Pearson p value Microskills .254 .001 ** Process .171 .028 * Difficult Client Behavior .208 .007 ** Cultural Competence .127 .103 Awareness of Values .078 .320 Composite .228 .003 ** Note: Relationship between Counseling Self-Estimate Inventory responses and age in years. COSE = Counseling Self-Estimate Inventory. * p < .05; ** p < .01
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|Author:||McCarthy, Amanda K.|
|Publication:||The Journal of Rehabilitation|
|Date:||Apr 1, 2014|
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