Abstract
Key Words
Introduction
Consequently, I designed an evaluation project to learn if these sessions were having a positive impact. I hoped to use this information to adjust my techniques and become a more effective counselor. Moreover, by finding an effective way to evaluate my work, I would be fulfilling an important requirement of the National Association of Social Workers’ Code of Ethics (National Association of Social Workers, 1999, 5.02).
Literature Review
The main externalizing problem my students have is aggression, and their main internalizing problems are anxiety and depression. I primarily use cognitive-behavioral therapy (CBT) and solution-focused brief therapy (SFBT) in my work. Cognitive Behavioral Therapy
CBT has been shown to effectively treat adolescents with aggression-related problems. Litschge, Vaughn, and McCrea (2009) concluded from their meta-analysis that CBT interventions with aggressive children and adolescents tend to be “moderately effective” in general and especially effective with older participants (p. 32). Özabacı (2011) concluded from their meta-analysis that CBT interventions for aggressive adolescents have a “medium [positive] effect” and that “many children who complete CBT report clinically significant reductions in violence” (pp. 1991-1992). Özabacı (2011) further reported that behavioral interventions tend to be more effective than cognitive ones (p. 1992). Hoogsteder (2015) conducted a meta-analysis and found that, compared to control groups (who either receive individual therapy without CBT or group therapy with elements of CBT), “adolescents with severe aggression problems benefit from an intervention with CBT elements and an individual component” (pp. 26, 30).
The counseling I do with my aggressive students is largely based on a CBT model devised by Feindler and Ecton (1994). Feindler, Marriott, and Iwata (1984) compared aggressive junior high school students who had been taught this model to a control group that received no treatment and found that the former group went on to engage in significantly less aggressive behavior and to display greater self-control and problem-solving skills (pp. 299, 309). My work with these students is also guided by a CBT model devised by Larson and Lochman (2010). This model has also yielded impressive results. One study showed that aggressive elementary school boys who completed the program had “had reductions in independently observed disruptive-aggressive off-task behavior, reductions in parents’ ratings of aggression, and improvements in self-esteem” in comparison with boys who received minimal treatment or no treatment at all (Lochman, Curry, Dane, & Ellis, 2001, p. 71). This study was later replicated, and at a three-year follow-up it was found that the boys who completed the program had “better problem-solving skills, self-esteem gains, and lower levels of substance use than an untreated control condition” (Lochman, Curry, Dane, & Ellis, 2001, p. 71).
Considerable research has shown that CBT also effectively treats anxiety disorders and depression in adolescents. James, Soler, and Weatherall (2007) found that adolescents who received CBT saw a reduction in anxiety symptoms that was significantly greater than that experienced by those receiving no treatment (p. 1256). James, James, Cowdrey, Soler, and Choke (2013) confirmed these findings but noted that CBT interventions for anxiety in adolescents was not more effective than other types of therapy (p. 6). Hofmann, Asnaani, Vonk, Sawyer, and Fang (2012) found that the available meta-analyses show that CBT effectively treats depression among adolescents “with maintenance in 6-months follow-up periods” (p. 434).
The counseling I do with students suffering from depression is largely based on a CBT model developed by Munoz and Miranda (2000). Rossello and Bernal (1999) used this model to individually treat depressed adolescents in Puerto Rico and found that it significantly reduced their symptoms when compared to individuals on a wait-list (p. 734). Shrink, Kaplinski, and Gudmundsen (2009) used this model to individually treat depressed adolescents in the United States and found similar results (p. 113).
Solution-Focused Brief Therapy
SFBT has been studied much less than CBT, and therefore our conclusions about it must be more tentative. Bond, Woods, Humphrey, Symes, and Green (2013) conducted a meta-analysis of SFBT studies and found that, “although there are now more studies of SFBT effectiveness, the evidence base itself continues to be relatively weak” (p. 720). Bond et al. (2013) nonetheless found “some preliminary support for the use of SFBT with children presenting with internalizing and externalizing behaviour problems in both school settings and with their families” (p. 720), although they found fewer studies supporting SFBT’s ability to treat internalizing problems (p. 719). Bond et al. (2013) also concluded that “SFBT might be most effective as an early intervention where problems are at a mild-to-moderate level” (p. 720).
Kim and Franklin (2009) concluded that SFBT can effectively treat some externalizing problems and adduced a 2008 study showing “that SFBT improved the outcomes” of students who “were having classroom and behavioral problems that could not be resolved by teachers, principals, or school counselors. After receiving the SFBT intervention, teachers and students reported on standardized measures that the children’s behavior problems significantly improved” (p. 468). Kim and Franklin (2009) also cited studies showing that SFBT "demonstrated school outcomes such as credits earned and better grades,” although they noted that SFBT had not been shown to increase attendance or self-esteem (p. 469).
Gingerich and Peterson (2013) found three studies in their meta-analysis showing that SFBT reduced aggression among juvenile delinquents (pp. 275, 279). Gingerich and Peterson (2013) also found studies showing that SFBT had reduced depression and anxiety among adults (pp. 271, 273). Despite these positive results, Gingerich and Peterson (2013) noted that in most cases SFBT did not produce better results than “alternative treatments” (p. 279).
Methodology
Research Design
I performed a single-system design on six of the students I counsel. I used a single-system design since the students have different presenting problems, and therefore I do not use the same therapeutic techniques with all of them. By using a single-system design, I believed I would be able to better determine which of my techniques were effective and which were not. Since I did not measure the students before I started counseling them, this was a B design. In most B designs, the collection of data begins as soon as the intervention begins (Weinbach, 2005, p. 78). The fact that I had been counseling the students for about three months before the study began made this B design different than most. I did not believe that this difference was significant since the students in the study still had significant presenting problems when the study began. Therefore, this study still had the possibility of showing if my counseling mitigated their problems.
Sample
The study consisted of five male students and one female, ranging from ages eleven to fifteen. I began counseling different students for different reasons. The school’s restorative approaches coordinator referred Student A to me because he was having conflict with other students. Student B’s mother referred him because he was having behavioral problems at home. Student C’s mother referred him because he was having behavioral problems in class. Student D referred himself because he was experiencing grief from the death of his father. Student E referred himself for reasons that he could not articulate. Student F referred herself because she felt sad at school.
Measures
I used two objective and two subjective measures for this project. My first objective measure was the number of disciplinary actions staff members recorded in the school database for each student. I refer to these actions as formal disciplinaries. My second objective measure was be the number of Re-focus forms each student had been given. A Re-focus is a minor disciplinary action that is generally not recorded in the school’s database. I refer to these actions as informal disciplinaries.
My first subjective measure was the Individual Therapy Process Questionnaire (ITPQ). Mander et al. (2015) developed the ITPQ to assess the effectiveness of individual psychotherapy. The ITPQ assesses the degree to which a therapy session contains “five empirically derived general mechanisms of [psychotherapeutic] change,” mechanisms of change “that are based on thousands of findings from psychotherapy process research as well as from randomized clinical trials” (Mander et al. 2015, p. 329). These mechanisms of change are mastery/coping, that is, when clients learn coping skills to deal with their problems; clarification of meaning, when clients gain understanding of their unconscious thoughts and desires; problem actuation, when clients experience their problems in therapy sessions; resource activation, when clients use their own strengths to solve their problems; and strong therapeutic alliance, when clients have high quality relationships with their therapists (Grawe, 1997, pp. 4-6; Mander et al., 2013, p. 105).
The ITPQ is an amalgam of two “established change mechanism instruments,” the Scale for the Multiperspective Assessment of General Change Mechanisms in Psychotherapy (SACiP) and the Revised Scale of the Therapeutic Alliance (STA-R) (Mander et al. 2015, p. 328). Mander et al. (2015) had 457 psychosomatic inpatients take the ITPQ and found that “[t]he psychometric properties” of the ITPQ “were generally good to excellent, as demonstrated by (a) exploratory factor analyses,” (b) confirmatory factor analyses “on later measuring times, (c) high internal consistencies and (d) significant outcome predictive effects” (p. 328).
One of the ITPQ’s founders, Johannes Mander (personal communication, October 21, 2015) recommended that, given my time limitations, I use the short version of the ITPQ, found in Appendix A. Although the ITPQ is generally filled out by both the client and therapist after each session, for this study I did not have the students fill one out. My reason for this was twofold. First, even the short version of the ITPQ contains twenty-one questions, and since the time I have with students is limited, I thought that having them fill out an ITPQ every week or even every other week would take too long. Second, my field supervisor convincingly argued that the ITPQ’s questions were likely too complex for such young students to answer competently.
My second subjective measure varied for each student. I initially intended to ask each student a weekly scaling question that focused on a presenting problem, but as I began the study it quickly became evident that Students A, C, E, and F did not have clearly defined problems. It seemed that each of them had different problems every week, and I had trouble discerning a theme, and so I did not ask them scaling questions. Since Student B was referred by his mother, I used her feedback to measure of our therapeutic progress. I asked Student D a series of questions based on the work of Boelen, Van Den Hout, and Van Den Bout (2006). These authors posit that complicated grief is developed and maintained by at least two of the following cognitive-behavioral dysfunctions working together: (a) failure to accept the permanence of the loss, (b) distorted cognitions, and (c) anxious avoidance and depressive avoidance strategies. And so early in my work with Student D and right before concluding this study, I asked him some questions I had devised meant to assess how severely these different cognitive-behavioral dysfunctions were affecting him.
For this study, the counseling services I provided were the independent variable and the different measures stated above were the dependent variables. It was my hypothesis that the counseling services would mitigate the problems of each student, which would be demonstrated by progressively (1) fewer disciplinary measures recorded, (2) fewer Re-focus forms assigned, (3) higher scores on the ITPQ, (4a) for Student B, positive reports from his mother, and (4b) for Student D lower scores on the scaling questions I asked about his grief.
Data Collection
I obtained the number of disciplinary actions that teachers recorded for each student (formal disciplinaries) from the school’s internal database, which I have been given access to. I obtained the number of Re-focus forms each student had been given (informal disciplinaries) by asking the school’s dean, who keeps a copy of each Re-focus form in a filing cabinet. I filled out an ITPQ after each session.
Analysis
I intended for my data analysis for this study to be fairly simple, as my hypothesis would be supported if the number of disciplinary actions recorded and Re-focus forms given decreased, my ITPQ ratings increased, and the individual ratings for Student B and Student D improved.
Timeline
As soon as this proposal received approval by the Department of Social Work Research and Ethics Committee, I began procuring permission from each student and from each student’s guardian. I completed ITPQs from February through March.
Results
I used the two-standard deviation method to analyze my data. I have presented this data on three Shewart charts, all of which are reprinted below. (The raw data upon which the charts are based are found in Appendix B.) On the first Shewart chart, the x-axis covers weeks and the y-axis shows ITPQ scores for each student. On the second Shewart chart, the x-axis covers months (from August through March) and the y-axix shows the number of formal disciplinaries received by each student. On the third Shewart chart, the x-axis covers months (from August through March) and the y-axix shows the number of informal disciplinaries received by each student.
After charting this data, I “eyeballed” each chart (Weinbach, 2005, 87) to see if I noticed progressively (1) higher scores on the ITPQ, (2) fewer formal disciplinary measures recorded, and (3) fewer informal disciplinary measures record. On the first chart, there does not appear to be an overall trend of ITPQ scores rising. It appears that one student’s scores gradually rose, but most of them remained fairly constant. I do not see any trends on the second and third charts.
Moving on, Student B’s mother reported to me that his behavior at home significantly improved, and she attributed much of this improvement to his counseling sessions with me. I initially asked Student D the scaling questions regarding his grief in January and then again in April, and much to my surprise his scores were essentially identical. To be more specific, his score in Category A (failure to accept the permanence of the loss) was exactly the same (9), his score in Category B (distorted cognitions) increased slightly (rising from 8 to 10), and his score in Category C (anxious avoidance and depressive avoidance strategies) decreased slightly (falling from 6 to 5).
I hypothesized that this study would show that my counseling with these six students was effective at mitigating their presenting problems as demonstrated by progressively (1) higher scores on the ITPQ, (2) fewer formal disciplinary measures recorded, (3) fewer informal disciplinary measures recorded, (4) more positive reports by Student B’s mother, and (5) lowered scores on the scaling questions I asked Student D. Given the raw data I collected, one might conclude that my counseling was not generally effective, as ITPQ scores and the number of formal and informal disciplinary measures students received remained mostly stagnant. Student B’s mother reported that his behavior improved, but his ITPQ scores remained relatively low. And Student D’s answers to my scaling questions about his grief remained unchanged. Upon closer inspection, however, I do not think it is fair to conclude that my counseling was ineffective.
ITPQ
Given the way I framed my hypothesis, I was forced to conclude that the ITPQ was ineffective at measuring the effectiveness of my counseling. I stated that, if my counseling were effective, then IPTQ scores would progressively increase, but in retrospect I can see that this assumption was unfounded. It seems likely that students who enter counseling in what Prochaska and DiClemente termed the Determination Stage or Action Stage (Miller & Rollnick, 1991, p. 18) would have high ITPQ scores right away—for example, such students would likely enter counseling emotionally involved, eager to talk about their problems, open to advice, etc.—and that these scores would remain at approximately the same level as time progressed. They would remain at the same level because there is a ceiling on how high ITPQ scores can rise. Two of my students fell into this category, and if we assume that the ITPQ is an accurate measure of therapeutic success, it makes sense to conclude that my counseling with them was effective.
The ITPQ scores for two students remained fairly low during the study, but I do not think this indicates that my counseling with them was ineffective. The ITPQ, I can see in retrospect, was not an accurate measure for either of these two young men. The ITPQ is a good measure when counseling focuses on a specific problem or set of problems. Notice how a great many of the questionnaire’s statements focus on the client’s problems: e.g., “Today, I enabled the patient to view his/her problems in new contexts,” “Today, the patient and I worked toward mutually agreed upon goals,” “Today, we really made progress in therapy in overcoming the patient’s problems.” But my counseling with these two students was not problem-focused at all and in fact was more like mentoring than counseling. I do not believe that these young men needed a counselor. What they needed was a compassionate older man who validated their sense of worth by simply spending time with them and taking an interest in their lives. I think my time with at least one of these men was successful, as corroborated by statements made by his mother.
Disciplinaries
Tracking formal and informal disciplinaries also proved to be ineffective at assessing the effectiveness of my counseling. In theory it would stand to reason that effective counseling would result in fewer disciplinaries given to students. But I learned during the course of this study that teachers and administrators at the school do not regularly record in the school’s computer system the formal disciplinaries students receive, and they do not keep most of the informal disciplinaries students receive.
I am aware of several serious incidents involve students in this study that were not recorded in the school’s computer system. Two months ago, for instance, Student A slapped a female student’s behind and as a result spent the afternoon in the principal’s office, and yet this incident was never recorded in the school’s computer system. I can provide several similar examples. Although teachers and administrators are encouraged to record such incidents, some of them often fail to do so, and some teachers, I have noticed, seem to never record such incidents.
Similar things can be said about informal disciplinaries. I am aware that a certain student has received several informal disciplinaries throughout the school year; my conservative estimate would be 15-20. And yet when I looked in his file in the dean’s office I found a mere four informal disciplinaries. I asked the restorative approaches coordinator about this, and she said that the file cabinet only contains a small number of informal disciplinaries because most teachers do not pass on these disciplinaries to the dean.
If formal and informal disciplinaries were accurately recorded, then the data drawn from them would undoubtedly be a valuable resource. But given that the disciplinary actions students receive are not consistently recorded, it is impossible to draw any conclusions from this data.
Student D
I remained befuddled that Student D’s answers to my scaling questions did not improve during the course of this study. I followed the cognitive-behavioral approach outlined by Boelen, Van Den Hout, and Van Den Bout (2006), and this student consistently received high ITPQ scores. I think that one of the following conclusions is likely. First, although Student D’s complicated grief is gradually lessening, the process will take more time than allotted by this study. Second, I did not use an empirically validated grief assessment measure. Had I used an assessment such as the Inventory of Prolonged Grief for Adolescents (Spuij et al., 2012), I might have seen some results.
Implications for Future Practice
I began this evaluation project in hopes of finding effective ways to evaluate my counseling with middle school students. I believe now that the ITPQ is a good resource for students who are committed to the counseling process and working towards specific therapeutic goals. I erred in using it in my work with students who do not fit these criteria. I also remain convinced that tracking the number of disciplinaries student receive can be an effective way for measuring counseling effectiveness. Needless to say, it is essentially that student disciplinaries be accurately and consistently reported.
In my future work, I plan to continue using the ITPQ for appropriate students, and I plan to encourage teachers and administrators to more faithfully keep records of the disciplinaries students receive. When a student has a specific presenting problem, I will try to use a psychometrically-sound tool to assess them, e.g., the Inventory of Prolonged Grief for Adolescents or Beck’s Depression Inventory. Finally, I plan to have better communication with other adults in the lives of students and, for example, to regularly ask teachers and parents how they rate the progress of the students.
Boelen, P. A., Van Den Hout, M. A., & Van Den Bout, J. (2006). A Cognitive-behavioral conceptualization of complicated grief. Clinical Psychology: Science and Practice, 13(2), 109-128.
Bond, C., Woods, K., Humphrey, N., Symes, W., & Green, L. (2013). Practitioner review: The effectiveness of solution focused brief therapy with children and families: A systematic and critical evaluation of the literature from 1990–2010. Journal of Child Psychology and Psychiatry, 54(7), 707-723.
Forster, C., Berthollier, N., & Rawlinson, D. (2014). A Systematic Review of Potential Mechanisms of Change in Psychotherapeutic Interventions for Personality Disorder. Journal of Psychology and Psychotherapy, 4(133), 2161-0487.
Feindler, E.L, & Ecton, R.B. (1994). Adolescent anger control: Cognitive-behavioral techniques. Boston: Allyn and Baker.
Feindler, E. L., Marriott, S. A., & Iwata, M. (1984). Group anger control training for junior high school delinquents. Cognitive Therapy and Research, 8(3), 299-311.
Gingerich, W. J., & Peterson, L. T. (2013). Effectiveness of Solution-Focused Brief Therapy A Systematic Qualitative Review of Controlled Outcome Studies.Research on Social Work Practice, 23(3), 266-283.
Grawe, K. (1997). Research-informed psychotherapy. Psychotherapy research,7(1), 1-19.
Hofmann, S. G., Asnaani, A., Vonk, I. J., Sawyer, A. T., & Fang, A. (2012). The efficacy of cognitive behavioral therapy: a review of meta-analyses.Cognitive therapy and research, 36(5), 427-440.
Hoogsteder, L. M., Stams, G. J. J., Figge, M. A., Changoe, K., van Horn, J. E., Hendriks, J., & Wissink, I. B. (2015). A meta-analysis of the effectiveness of individually oriented Cognitive Behavioral Treatment (CBT) for severe aggressive behavior in adolescents. The Journal of Forensic Psychiatry & Psychology, 26(1), 22-37.
James, A. C., James, G., Cowdrey, F. A., Soler, A., & Choke, A. (2013). Cognitive behavioural therapy for anxiety disorders in children and adolescents.Cochrane Database of Systematic Reviews, 3, 6.
James, A. A., Soler, A., & Weatherall, R. R. (2007). Cognitive behavioural therapy for anxiety disorders in children and adolescents. Evidence-Based Child Health: A Cochrane Review Journal, 2, 1248-1275.
Kazdin, A. E. (2007). Mediators and mechanisms of change in psychotherapy research. Annual Review of Clinical Psychology, 3, 1-27.
Kim, J. S., & Franklin, C. (2009). Solution-focused brief therapy in schools: A review of the outcome literature. Children and Youth Services Review, 31(4), 464-470.
Litschge, C. M., Vaughn, M. G., & McCrea, C. (2009). The empirical status of treatments for children and youth with conduct problems: An overview of meta-analytic studies. Research on Social Work Practice, 20(1), 21-35.
Larson, J., & Lochman, J. E. (2010). Helping schoolchildren cope with anger: A cognitive-behavioral intervention. Guilford Press.
Lochman, J. E., Curry, J. F., Dane, H., & Ellis, M. (2001). The Anger Coping Program: An empirically-supported treatment for aggressive children. Residential Treatment for Children & Youth, 18(3), 63-73.
Mander, J., Schlarb, A., Teufel, M., Keller, F., Hautzinger, M., Zipfel, S., ... & Sammet,I. (2015). The individual therapy process questionnaire: Development and validation of a revised measure to evaluate general change mechanisms in psychotherapy. Clinical psychology & psychotherapy, 22, 328-345.
Mander, J. V., Wittorf, A., Schlarb, A., Hautzinger, M., Zipfel, S., & Sammet, I. (2013). Change mechanisms in psychotherapy: Multiperspective assessment and relation to outcome. Psychotherapy Research, 23(1), 105-116.
Miller, W.R. & Rollnick, S. (1991). Motivational interviewing: Preparing people to change addictive behavior. New York: Guilford Press.
Munoz, R.F., & Miranda, J. (2000). Cognitive therapy manual for cognitive-behavioral treatment of depression. Santa Monica, CA: RAND.
National Association of Social Workers. (1999). Code of ethics of the National Association of Social Workers. Washington, DC: NASW Press.
Özabacı, N. (2011). Cognitive behavioural therapy for violent behaviour in children and adolescents: A meta-analysis. Children and Youth Services Review, 33(10), 1989-1993.
Rossello, J., & Bernal, G. (1999). The efficacy of cognitive-behavioral and interpersonal treatments for depression in Puerto Rican adolescents. Journal of Consulting and Clinical Psychology, 67(5), 734-745.
Shrink, S.R., Kaplinski, H., & Gudmundsen, G. (2009). School-based cognitive-behavioral therapy for adolescent depression. Journal of Emotional and Behavioral Disorders, 17(2), 106-117.
Spuij, M., Prinzie, P., Zijderlaan, J., Stikkelbroek, Y., Dillen, L., Roos, C., & Boelen, P. A. (2012). Psychometric properties of the Dutch inventories of prolonged grief for children and adolescents. Clinical psychology & psychotherapy, 19(6), 540-551.
Weinbach, R. W. (2005). Evaluating social work services and programs. Boston: Pearson.
Instruction: How did you experience today's therapy session?
Rating scale: 0 = does not apply; 1 = somewhat applies; 2 = half-applies; 3 = predominantly applies; 4 = fully applies
Emotional bond
Today, I felt comfortable in the relationship with the patient. ____
The patient and I understood each other today. ____
Today, I felt that the patient appreciates me. ____
Problem actuation
In today’s session, the patient was highly emotionally involved. ____
Today, I touched the patient’s sore spots. ____
What we did today affected the patient very deeply. ____
Resource activation
In today’s session, the patient felt where his/her strengths lie. ____
By means of today’s session, the patient felt enhanced in his/her self-concept. ____
Today, I intentionally used the patient’s abilities for therapy. ____
Clarification of meaning
Today, I enabled the patient to view his/her problems in new contexts. ____
The patient has (have) a better understanding of himself/herself and his/her difficulties after today’s session. ____
Today, the patient became more aware of the motives for his/her behavior. ____
Agreement on collaboration
Today, the patient and I worked toward mutually agreed upon goals. ____
Today, the patient and I agreed about the steps to be made in therapy. ____
Today, the patient and I had a good understanding of what changes are good for him/her. ____
The patient and I agreed on the usefulness of the activities in today’s session. ____
Today, the patient and I had a shared view on what his/her real problems are. ____
Today, the patient agreed with me on how therapy was conducted. ____
Mastery
After today’s session, I assume that the patient can cope better with situations which are difficult for him/her. ____
Today, we really made progress in therapy in overcoming the patient’s problems. ____
I have the impression that the patient’s capacity to act improved by today’s session. ____
Discussion and Implications
ITPQ
Given the way I framed my hypothesis, I was forced to conclude that the ITPQ was ineffective at measuring the effectiveness of my counseling. I stated that, if my counseling were effective, then IPTQ scores would progressively increase, but in retrospect I can see that this assumption was unfounded. It seems likely that students who enter counseling in what Prochaska and DiClemente termed the Determination Stage or Action Stage (Miller & Rollnick, 1991, p. 18) would have high ITPQ scores right away—for example, such students would likely enter counseling emotionally involved, eager to talk about their problems, open to advice, etc.—and that these scores would remain at approximately the same level as time progressed. They would remain at the same level because there is a ceiling on how high ITPQ scores can rise. Two of my students fell into this category, and if we assume that the ITPQ is an accurate measure of therapeutic success, it makes sense to conclude that my counseling with them was effective.
The ITPQ scores for two students remained fairly low during the study, but I do not think this indicates that my counseling with them was ineffective. The ITPQ, I can see in retrospect, was not an accurate measure for either of these two young men. The ITPQ is a good measure when counseling focuses on a specific problem or set of problems. Notice how a great many of the questionnaire’s statements focus on the client’s problems: e.g., “Today, I enabled the patient to view his/her problems in new contexts,” “Today, the patient and I worked toward mutually agreed upon goals,” “Today, we really made progress in therapy in overcoming the patient’s problems.” But my counseling with these two students was not problem-focused at all and in fact was more like mentoring than counseling. I do not believe that these young men needed a counselor. What they needed was a compassionate older man who validated their sense of worth by simply spending time with them and taking an interest in their lives. I think my time with at least one of these men was successful, as corroborated by statements made by his mother.
Disciplinaries
Tracking formal and informal disciplinaries also proved to be ineffective at assessing the effectiveness of my counseling. In theory it would stand to reason that effective counseling would result in fewer disciplinaries given to students. But I learned during the course of this study that teachers and administrators at the school do not regularly record in the school’s computer system the formal disciplinaries students receive, and they do not keep most of the informal disciplinaries students receive.
I am aware of several serious incidents involve students in this study that were not recorded in the school’s computer system. Two months ago, for instance, Student A slapped a female student’s behind and as a result spent the afternoon in the principal’s office, and yet this incident was never recorded in the school’s computer system. I can provide several similar examples. Although teachers and administrators are encouraged to record such incidents, some of them often fail to do so, and some teachers, I have noticed, seem to never record such incidents.
Similar things can be said about informal disciplinaries. I am aware that a certain student has received several informal disciplinaries throughout the school year; my conservative estimate would be 15-20. And yet when I looked in his file in the dean’s office I found a mere four informal disciplinaries. I asked the restorative approaches coordinator about this, and she said that the file cabinet only contains a small number of informal disciplinaries because most teachers do not pass on these disciplinaries to the dean.
If formal and informal disciplinaries were accurately recorded, then the data drawn from them would undoubtedly be a valuable resource. But given that the disciplinary actions students receive are not consistently recorded, it is impossible to draw any conclusions from this data.
Student D
I remained befuddled that Student D’s answers to my scaling questions did not improve during the course of this study. I followed the cognitive-behavioral approach outlined by Boelen, Van Den Hout, and Van Den Bout (2006), and this student consistently received high ITPQ scores. I think that one of the following conclusions is likely. First, although Student D’s complicated grief is gradually lessening, the process will take more time than allotted by this study. Second, I did not use an empirically validated grief assessment measure. Had I used an assessment such as the Inventory of Prolonged Grief for Adolescents (Spuij et al., 2012), I might have seen some results.
Implications for Future Practice
I began this evaluation project in hopes of finding effective ways to evaluate my counseling with middle school students. I believe now that the ITPQ is a good resource for students who are committed to the counseling process and working towards specific therapeutic goals. I erred in using it in my work with students who do not fit these criteria. I also remain convinced that tracking the number of disciplinaries student receive can be an effective way for measuring counseling effectiveness. Needless to say, it is essentially that student disciplinaries be accurately and consistently reported.
In my future work, I plan to continue using the ITPQ for appropriate students, and I plan to encourage teachers and administrators to more faithfully keep records of the disciplinaries students receive. When a student has a specific presenting problem, I will try to use a psychometrically-sound tool to assess them, e.g., the Inventory of Prolonged Grief for Adolescents or Beck’s Depression Inventory. Finally, I plan to have better communication with other adults in the lives of students and, for example, to regularly ask teachers and parents how they rate the progress of the students.
References
Bond, C., Woods, K., Humphrey, N., Symes, W., & Green, L. (2013). Practitioner review: The effectiveness of solution focused brief therapy with children and families: A systematic and critical evaluation of the literature from 1990–2010. Journal of Child Psychology and Psychiatry, 54(7), 707-723.
Forster, C., Berthollier, N., & Rawlinson, D. (2014). A Systematic Review of Potential Mechanisms of Change in Psychotherapeutic Interventions for Personality Disorder. Journal of Psychology and Psychotherapy, 4(133), 2161-0487.
Feindler, E.L, & Ecton, R.B. (1994). Adolescent anger control: Cognitive-behavioral techniques. Boston: Allyn and Baker.
Feindler, E. L., Marriott, S. A., & Iwata, M. (1984). Group anger control training for junior high school delinquents. Cognitive Therapy and Research, 8(3), 299-311.
Gingerich, W. J., & Peterson, L. T. (2013). Effectiveness of Solution-Focused Brief Therapy A Systematic Qualitative Review of Controlled Outcome Studies.Research on Social Work Practice, 23(3), 266-283.
Grawe, K. (1997). Research-informed psychotherapy. Psychotherapy research,7(1), 1-19.
Hofmann, S. G., Asnaani, A., Vonk, I. J., Sawyer, A. T., & Fang, A. (2012). The efficacy of cognitive behavioral therapy: a review of meta-analyses.Cognitive therapy and research, 36(5), 427-440.
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Appendix: ITPQ (Mander et al., 2013)
Rating scale: 0 = does not apply; 1 = somewhat applies; 2 = half-applies; 3 = predominantly applies; 4 = fully applies
Emotional bond
Today, I felt comfortable in the relationship with the patient. ____
The patient and I understood each other today. ____
Today, I felt that the patient appreciates me. ____
Problem actuation
In today’s session, the patient was highly emotionally involved. ____
Today, I touched the patient’s sore spots. ____
What we did today affected the patient very deeply. ____
Resource activation
In today’s session, the patient felt where his/her strengths lie. ____
By means of today’s session, the patient felt enhanced in his/her self-concept. ____
Today, I intentionally used the patient’s abilities for therapy. ____
Clarification of meaning
Today, I enabled the patient to view his/her problems in new contexts. ____
The patient has (have) a better understanding of himself/herself and his/her difficulties after today’s session. ____
Today, the patient became more aware of the motives for his/her behavior. ____
Agreement on collaboration
Today, the patient and I worked toward mutually agreed upon goals. ____
Today, the patient and I agreed about the steps to be made in therapy. ____
Today, the patient and I had a good understanding of what changes are good for him/her. ____
The patient and I agreed on the usefulness of the activities in today’s session. ____
Today, the patient and I had a shared view on what his/her real problems are. ____
Today, the patient agreed with me on how therapy was conducted. ____
Mastery
After today’s session, I assume that the patient can cope better with situations which are difficult for him/her. ____
Today, we really made progress in therapy in overcoming the patient’s problems. ____
I have the impression that the patient’s capacity to act improved by today’s session. ____
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