Client Advocacy Client Advocacy and Social Justiceand Social Justice

By Jill Kiely and Jonathan OhrtBy Jill Kiely and Jonathan Ohrt

Advocacy = Changes are driven by an Advocacy = Changes are driven by an awareness of inequities with an intent to awareness of inequities with an intent to

move humanity toward an move humanity toward an “enlightened world society”.“enlightened world society”.

AdvocateAdvocatea person who acts on someone else’s behalf

CounselorFamily

MemberNeighbor

Purpose’s of AdvocacyPurpose’s of Advocacy

Promoting equity for clients:Promoting equity for clients: Teaching clients assertiveness skillsTeaching clients assertiveness skills Coaching clients on writing letters to Coaching clients on writing letters to

newspapers or politiciansnewspapers or politicians Intervening with clients on their own Intervening with clients on their own

behalf with members of the behalf with members of the community such as landlords or community such as landlords or employersemployers

Empowering the ClientEmpowering the ClientAs counselors we know the point of counseling is to help As counselors we know the point of counseling is to help the client to acquire coping skills and resources to not the client to acquire coping skills and resources to not

need us. The same principle is applied to advocacy.need us. The same principle is applied to advocacy.

An Old Fable:An Old Fable:““When a man is hungry, you can catch When a man is hungry, you can catch him a fish to feed to his family, but, if him a fish to feed to his family, but, if

you teach him how to fish, he can feed you teach him how to fish, he can feed the whole village”.the whole village”.

Developmental Phases of Developmental Phases of Advocacy Advocacy (Kieffer, 1983)(Kieffer, 1983)

Entry: The person first begins to get Entry: The person first begins to get involved and become aware of the need for involved and become aware of the need for advocacy efforts.advocacy efforts.

Advancement: A person becomes Advancement: A person becomes increasingly involved in organizational increasingly involved in organizational activity.activity.

Incorporation: The person develops a sense Incorporation: The person develops a sense of mastery over and competence in the of mastery over and competence in the advocacy activities.advocacy activities.

Commitment: The person develops a further Commitment: The person develops a further sense of mastery and participatory sense of mastery and participatory competence.competence.

Multisystems PerspectiveMultisystems PerspectiveCounselors must advocate for clients at the Counselors must advocate for clients at the

individual, group, and organizational levelindividual, group, and organizational level

Individual (educating and empowering the Individual (educating and empowering the client)client)

Group (educate groups that effect the clients, Group (educate groups that effect the clients, e.g. family)e.g. family)

Organizational (serve as a mediator between Organizational (serve as a mediator between a client and institutions, negotiate with a client and institutions, negotiate with agencies to provide better services)agencies to provide better services)

(Kiselica & Robinson, 2001)(Kiselica & Robinson, 2001)

Necessary Counselor Skills and Necessary Counselor Skills and Attributes for AdvocacyAttributes for Advocacy

Commitment (willingness to address the issues)Commitment (willingness to address the issues) Appreciation for human suffering (empathy)Appreciation for human suffering (empathy) Nonverbal and Verbal communication skills (with Nonverbal and Verbal communication skills (with

clients, those in power)clients, those in power) Multisystems perspective Multisystems perspective Knowledge and Use of the media and technologyKnowledge and Use of the media and technology Research SkillsResearch Skills(Kiselica & Robinson, 2001)(Kiselica & Robinson, 2001)

Knowledge of current laws and rights of clientsKnowledge of current laws and rights of clients Ability to access resourcesAbility to access resources

Purpose’s of AdvocacyPurpose’s of Advocacy

Gaining recognition among the Gaining recognition among the general public for the profession of general public for the profession of counseling:counseling:

Public service messages Public service messages Speaking at local PTA meetingsSpeaking at local PTA meetings

Purpose’s of AdvocacyPurpose’s of Advocacy

Gaining recognition of counseling as a Gaining recognition of counseling as a discipline among other therapeutic discipline among other therapeutic professionals:professionals:

Becoming involved in professional Becoming involved in professional organizations to develop standards of organizations to develop standards of carecare

Attempting to exert influence over who is Attempting to exert influence over who is assigned to state board for counselorsassigned to state board for counselors

Advocating for Counselor’sAdvocating for Counselor’s

• Membership in state and national Membership in state and national counseling associations: ACA, ASCA, counseling associations: ACA, ASCA, FCA, FSCA, etc.FCA, FSCA, etc.

• Before a state law is passed there Before a state law is passed there are usually opportunities for public are usually opportunities for public hearing.hearing.

• Maintain a visible profile in the Maintain a visible profile in the community, ex.: find an area of community, ex.: find an area of expertise to speak onexpertise to speak on

OrganizationsOrganizations

Chi Sigma Iota: advocacy projects Chi Sigma Iota: advocacy projects www.csi-net.orgwww.csi-net.org

American Counseling Association: links to American Counseling Association: links to state lawmakers and current issues state lawmakers and current issues www.counseling.orgwww.counseling.org

Florida Counseling Association: legislative Florida Counseling Association: legislative days, information on current issues days, information on current issues www.fla-counseling.orgwww.fla-counseling.org

American Mental Health Counselors American Mental Health Counselors Association: links to legislators Association: links to legislators www.amhca.org www.amhca.org

Other Ways to AdvocateOther Ways to Advocate

Speaking publicly about an issueSpeaking publicly about an issue

Writing newspaper or journal articles both Writing newspaper or journal articles both professional and publicprofessional and public

Writing to legislatureWriting to legislature

Recruiting powerful voices to help advocateRecruiting powerful voices to help advocate

Joining or creating an organization that Joining or creating an organization that advocates for specific populationsadvocates for specific populations

The principles of advocacy The principles of advocacy remain the same regardless of remain the same regardless of

the specific’s of the persons the specific’s of the persons disability.disability.

Well known examples of Well known examples of people advocating for a cause:people advocating for a cause:

Helen Keller: Helped found the Civil Liberties Helen Keller: Helped found the Civil Liberties Union to advocate free speech, member of Union to advocate free speech, member of Industrial Workers of the World, & social Industrial Workers of the World, & social advocate for American Foundation for the advocate for American Foundation for the BlindBlind

Mothers Against Drunk Driving: Established by Mothers Against Drunk Driving: Established by the mother of a child killed by a drunk driverthe mother of a child killed by a drunk driver

Magic Johnson: Contracted HIV and now Magic Johnson: Contracted HIV and now advocates for safe sexadvocates for safe sex

The National Alliance for the Mentally Ill: The National Alliance for the Mentally Ill: Established by consumers and families of Established by consumers and families of consumers.consumers.

ActivityActivity

Think of a group that may be oppressed, Think of a group that may be oppressed, underserved, or may lack the ability to underserved, or may lack the ability to advocate for themselves. Devise an activity advocate for themselves. Devise an activity to raise social awareness regarding the to raise social awareness regarding the groups’ hardships and what can be done to groups’ hardships and what can be done to help alleviate the problems.help alleviate the problems.

Realistic Perception of Realistic Perception of Advocacy: ObstaclesAdvocacy: Obstacles

Perception of job descriptionPerception of job description: “It’s the case : “It’s the case managers job to advocate, my job is to provide managers job to advocate, my job is to provide therapeutic services.”therapeutic services.”

TimeTime: “Advocating is a full time job, often unpaid, : “Advocating is a full time job, often unpaid, and I can only do volunteer work after all my and I can only do volunteer work after all my other responsibilities are met.”other responsibilities are met.”

ExpensesExpenses: “To provide testimony at a state : “To provide testimony at a state hearing requires traveling and lodging costs, plus hearing requires traveling and lodging costs, plus missed time at work.”missed time at work.”

EmotionEmotion: “When I did start talking about the issue : “When I did start talking about the issue at hand my efforts were met with anger from at hand my efforts were met with anger from those around me and it was very intimidating and those around me and it was very intimidating and challenging.”challenging.”

Advocacy ~ ResearchAdvocacy ~ ResearchInterdependentInterdependent

Research is funded by Research is funded by external sources (private external sources (private foundations or state and foundations or state and federal funding)federal funding)

Projects funded based on Projects funded based on pressing or relevant issuespressing or relevant issues

When it is decided that an When it is decided that an issue is “pressing” issue is “pressing” researchers and researchers and practitioners are practitioners are advocating for a causeadvocating for a cause

Advocates depend on data Advocates depend on data generated by researchgenerated by research

Funding

Advocacy

Research

The Role of ResearchThe Role of Research

Therapists are being increasingly asked to demonstrate Therapists are being increasingly asked to demonstrate that treatment results in positive outcomes.that treatment results in positive outcomes.

There is lack of agreement as to what “treatment There is lack of agreement as to what “treatment outcome” is, however Kazdin (1994) stated the goals of outcome” is, however Kazdin (1994) stated the goals of psychotherapy research as being: psychotherapy research as being:

1.1. Understanding the alternative forms of treatment for a Understanding the alternative forms of treatment for a particular disorder.particular disorder.

2.2. Understanding the mechanisms and processes through Understanding the mechanisms and processes through which treatment operates.which treatment operates.

3.3. Understanding the impact of treatment and other Understanding the impact of treatment and other moderating influences on adaptive and maladaptive moderating influences on adaptive and maladaptive behaviorbehavior

Problems in Conducting Problems in Conducting ResearchResearch

Counseling is a soft science.Counseling is a soft science. The types of variables are rarely concrete, The types of variables are rarely concrete,

observable or measurable.observable or measurable. When dealing with variables related to When dealing with variables related to

human behavior, it is not possible to human behavior, it is not possible to control every variable.control every variable.

Ethical problems are created when Ethical problems are created when controlling variables results in negative controlling variables results in negative outcomes for the client.outcomes for the client.

Being a good consumer of Being a good consumer of researchresearch

When evaluating quantitative research: When evaluating quantitative research:

1.1. How generalizable are the results?How generalizable are the results?

2.2. Can the results be replicated by another, Can the results be replicated by another, uninvolved researcher?uninvolved researcher?

3.3. Are the key variables operationally defined?Are the key variables operationally defined?

4.4. Are there ways to explain the results?Are there ways to explain the results?

5.5. How much do the studies contribute to the How much do the studies contribute to the body of knowledge about theory and body of knowledge about theory and research?research?

Being a good consumer of Being a good consumer of researchresearch

When evaluating a qualitative study:When evaluating a qualitative study:

1.1. How clear are the research How clear are the research procedures?procedures?

2.2. Does the study generate knowledge Does the study generate knowledge that is specific to time and place?that is specific to time and place?

3.3. Does the research help to develop Does the research help to develop theory and interpretive frameworks theory and interpretive frameworks for organizing knowledge?for organizing knowledge?

Outcome measuresOutcome measures

Self report inventoriesSelf report inventories Client satisfaction questionnairesClient satisfaction questionnaires Ratings of target symptoms, either by Ratings of target symptoms, either by

client or clinicianclient or clinician Behavioral measuresBehavioral measures Structured interviews by expert cliniciansStructured interviews by expert clinicians Ratings by significant othersRatings by significant others Ratings by therapistsRatings by therapists Cost –benefit analysisCost –benefit analysis

Research Informs PracticeResearch Informs Practice

In the past a therapists choice of how to In the past a therapists choice of how to proceed with a client may have been based proceed with a client may have been based mainly on their theoretical orientation. mainly on their theoretical orientation. However, with managed care there is emphasis However, with managed care there is emphasis on the maximum therapeutic gain within the on the maximum therapeutic gain within the least amount of time.least amount of time.

1.1. Be well versed in the treatment strategies that Be well versed in the treatment strategies that are indicated for particular disorders.are indicated for particular disorders.

2.2. Be able to cite references that justify your Be able to cite references that justify your treatment approach.treatment approach.

3.3. This increases the likelihood that you are This increases the likelihood that you are providing the best possible treatment you can.providing the best possible treatment you can.

Standards of care: professional Standards of care: professional conduct practiced by reasonable conduct practiced by reasonable

and prudent professionals.and prudent professionals.Empirical evidence versus Intuitive KnowledgeEmpirical evidence versus Intuitive Knowledge

Clinical or Intuitive Knowledge Of What Works With Client’s

Using Empirical EvidenceFor Best Possible Treatment

The Process and Outcome of The Process and Outcome of TherapyTherapy

Process: The mechanisms and conditions Process: The mechanisms and conditions under which clients make emotional, under which clients make emotional, behavioral, and cognitive changes through behavioral, and cognitive changes through the course of therapy.the course of therapy.

Outcome: What happens at the conclusion Outcome: What happens at the conclusion of treatment. This includes clients whose of treatment. This includes clients whose concerns were successfully addressed, as concerns were successfully addressed, as well as those who drop out of counseling, or well as those who drop out of counseling, or decide counseling is not meeting their decide counseling is not meeting their needs.needs.

Studying the Process of Studying the Process of TherapyTherapy

A large number of client variables that can A large number of client variables that can potentially influence outcomepotentially influence outcome

Variability in level of therapist expertiseVariability in level of therapist expertise Variability in severity of the disorders Variability in severity of the disorders

being treatedbeing treated Participant and observer biasParticipant and observer bias Questionable ethics of establishing true Questionable ethics of establishing true

treatment and placebo groupstreatment and placebo groups Difficulty in assessing how much progress Difficulty in assessing how much progress

has been madehas been made

Common denominators among Common denominators among the multitude of theories the multitude of theories

(Perry, Francis, and Clarkin, 1985)(Perry, Francis, and Clarkin, 1985) Establishing and maintaining a therapeutic Establishing and maintaining a therapeutic

relationship; unconditional positive regard with relationship; unconditional positive regard with the clients best interest in mindthe clients best interest in mind

Providing support through reality testing, Providing support through reality testing, suggestions, confirmation, and acceptancesuggestions, confirmation, and acceptance

Providing education and informationProviding education and information Decreasing or eliminating painful feelings and/or Decreasing or eliminating painful feelings and/or

maladaptive behaviorsmaladaptive behaviors Modifying specific misinterpretations of stimuliModifying specific misinterpretations of stimuli Helping clients put concerns in meaningful contextHelping clients put concerns in meaningful context Expanding emotional awarenessExpanding emotional awareness Enhancing interpersonal effectivenessEnhancing interpersonal effectiveness

Aspects found in all forms of Aspects found in all forms of therapy therapy

according to Orlinksy, Grawe, & Parks (1994)according to Orlinksy, Grawe, & Parks (1994) The therapeutic contract: goals and conditions The therapeutic contract: goals and conditions

under which the client and counselor work under which the client and counselor work togethertogether

Therapeutic operations: specific, technical, Therapeutic operations: specific, technical, clinical procedures that counselors and client’s clinical procedures that counselors and client’s perform within the parameters of the contractperform within the parameters of the contract

Self-relatedness: self-awarenessSelf-relatedness: self-awareness In session impact: client’s experience during the In session impact: client’s experience during the

sessionsession Sequential flow: the sequence of counseling, both Sequential flow: the sequence of counseling, both

within a session and across the whole processwithin a session and across the whole process

Model of Client ReadinessModel of Client ReadinessProchaska & Di Clemente (1982)Prochaska & Di Clemente (1982)

PrecontemplationPrecontemplation: Unaware or underaware a problem : Unaware or underaware a problem exists and no plans for changeexists and no plans for change

ContemplationContemplation: Beginning to be aware a problem : Beginning to be aware a problem exists, but minimal commitment to take action to exists, but minimal commitment to take action to change “I’ll quit tomorrow, so give me a double today.”change “I’ll quit tomorrow, so give me a double today.”

PreparationPreparation: Intending to make the behavior change: Intending to make the behavior change ActionAction: The person modifies their behavior, : The person modifies their behavior,

experiences or environment to overcome their problem experiences or environment to overcome their problem (joining AA, completely abstaining from alcohol)(joining AA, completely abstaining from alcohol)

MaintenanceMaintenance: The person works to maintain the : The person works to maintain the behavioral changes achieved in the action stagebehavioral changes achieved in the action stage

Treatment Strategy Treatment Strategy SelectionSelection

PrecontemplationPrecontemplation1.1. Consciousness Raising: Develop awareness Consciousness Raising: Develop awareness

of the problem and how it affects oneselfof the problem and how it affects oneself2.2. Dramatic Relief: Experiencing and Dramatic Relief: Experiencing and

expressing feelings about one’s problems expressing feelings about one’s problems and solutions; psychodrama, grieving and solutions; psychodrama, grieving losses, role-playinglosses, role-playing

3.3. Environmental reevaluation: Evaluating Environmental reevaluation: Evaluating how one’s problems have an impact oh the how one’s problems have an impact oh the physical environment physical environment

Treatment Strategy Treatment Strategy SelectionSelection

ContemplationContemplation

1.1. Self-reevaluation: Assessing one’s Self-reevaluation: Assessing one’s feelings and thoughts about oneself in feelings and thoughts about oneself in the context of the problem; value the context of the problem; value clarification, imageryclarification, imagery

PreparationPreparation

1.1. Self-liberation: Accepting responsibility Self-liberation: Accepting responsibility for making changes; decision making for making changes; decision making therapytherapy

Treatment Strategy Treatment Strategy SelectionSelection

MaintenanceMaintenance1.1. Reinforcement Management: Rewarding oneself Reinforcement Management: Rewarding oneself

or having others administer a reward for making or having others administer a reward for making and sustaining changes; contingency contractsand sustaining changes; contingency contracts

2.2. Helping Relationships: developing a warm Helping Relationships: developing a warm supportive interpersonal relationshipsupportive interpersonal relationship

3.3. Counterconditioning: Replacing maladaptive Counterconditioning: Replacing maladaptive behaviors with adaptive ones; relaxation, behaviors with adaptive ones; relaxation, desensitization, assertiveness trainingdesensitization, assertiveness training

4.4. Stimulus Control: Removing or avoiding stimuli Stimulus Control: Removing or avoiding stimuli that stimulate maladaptive behaviors; removing that stimulate maladaptive behaviors; removing alcohol or fattening food, avoiding high-risk alcohol or fattening food, avoiding high-risk cuescues

OverviewOverview

Advocacy and research are central to Advocacy and research are central to delivering competent servicesdelivering competent services

The importance of teaching client’s The importance of teaching client’s to advocate for themselvesto advocate for themselves

Knowing how to identify effective Knowing how to identify effective treatment techniquestreatment techniques

The need to cite relevant data that The need to cite relevant data that support the course of action chosensupport the course of action chosen

ReferencesReferencesAmerican Counseling Association website American Counseling Association website www.aca.orgwww.aca.org viewed on 7/5/06 viewed on 7/5/06

Arredondo, P., & Perez, P. (2003). Expanding multicultural competence Arredondo, P., & Perez, P. (2003). Expanding multicultural competence through social justice leadership. through social justice leadership. The Counseling Psychologist, 31 (3), The Counseling Psychologist, 31 (3), 282-289282-289..

Chi Sigma Iota Website Chi Sigma Iota Website www.csi-net.orgwww.csi-net.org documents retrieved on 7/5/2006 documents retrieved on 7/5/2006

Florida Counseling Association website Florida Counseling Association website www.flacounseling.orgwww.flacounseling.org viewed on viewed on 7/5/20067/5/2006

Kiselica, M. S., & Robinson, M. (2001). Bringing advocacy counseling to Kiselica, M. S., & Robinson, M. (2001). Bringing advocacy counseling to life: The history, issues, and human dramas of social justice work in life: The history, issues, and human dramas of social justice work in counseling. counseling. Journal of Counseling and Development, 79, Journal of Counseling and Development, 79, 387-397387-397

MacCluskie, K. C., & Ingersoll, R. E. (2001) MacCluskie, K. C., & Ingersoll, R. E. (2001) Becoming a 21Becoming a 21stst Century Agency Century Agency Counselor.Counselor. Belmont, CA: Wadsworth/Thomson (ISBN: 0534356052) Belmont, CA: Wadsworth/Thomson (ISBN: 0534356052)