Abstract
Intake summaries and progress notes written by counseling trainees were examined to determine the extent to which work or academically related problems are discussed in counseling sessions when clients present with distress attributed to work or academic problems and personal concerns. Content analysis revealed that work or academically related problems were rarely discussed. The notes were also examined to explore factors or processes that distract counselors from addressing work or academically related problems in counseling sessions when clients indicated problems in work or academic area. Relational problems were found to be the most common topic that was likely to have distracted counselors from addressing work or academic problems. Finally, the data also revealed failure to integrate work and academic areas with discussions of personal concerns.
The ignoring of vocational issues was termed vocational overshadowing by Spengler, Blustein, and Strohmer (1990), as they likened counselors’ reluctance to address career issues to a phenomenon dubbed diagnosis overshadowing. According to Reiss, Levitan, and Szysko (1982), diagnosis overshadowing refers to the possibility of one diagnosis being overshadowed by the importance of another diagnosis. According to Spengler et al. (1990), vocational overshadowing occurs when vocational issues are overlooked by the treating practitioners when they coexist with personal problems and the severity of the socioemotional issues is equal to or less than that of the career concerns. Using case vignettes, Spengler et al. found that when socioemotional and work-related aspects of the client’s presenting concerns were similarly contributing to clients’ distress, counseling psychologists were more likely to address the more personal aspect of the presenting concerns at the expense of the career concerns. They also found that vocational overshadowing was more apparent among practitioners who did not declare an interest in career counseling. In a second study that also used case material, Spengler (2000) found no evidence of vocational overshadowing among clinicians. In another analog study, Magee and Whiston (2010) supported Spengler’s findings and found no evidence of vocational overshadowing when counseling students viewed a video of a counseling session. Due to the small number of analog studies and inconclusive results, Spengler and Magee and Whiston called for further investigation of this phenomenon.
There is some research that vocational overshadowing may happen in actual counseling with client and may affect client care. Both Gelso et al. (1985) and Vargo-Moncier and Jessell (1995) found the quality of counselors’ intake reports to be significantly lower for clients with vocational concerns as compared to those who were seeking treatment for personal problems. Gelso et al. (1985) found that counselors were likely to conduct less thorough assessments and wrote less extensive intake reports. As a follow-up to Gelso et al.’s study, Vargo-Moncier and Jessel (1995) conducted a similar study. Consistent with Gelso et al., Vargo-Moncier and Jessell found that intake reports for vocational clients were shorter, less adequate, and less comprehensive than the intake reports for clients who presented with personal–social issues. Although both Gelso et al. and Vargo-Moncier and Jessell contended that intake reports reflect treatment of clients, they both suggested that future research evaluate counselors’ focus in succeeding sessions after the initial intake.
Another area in which overshadowing may occur that is closely related to vocational issues relates to clients’ academic or educational concerns. Wlazelek and Hartman (2007) urged counselors working with college students to provide well-rounded treatments that included addressing academic issues. They found that struggling with academic achievement was the most common reason college students gave for prematurely leaving an academic program. The need for counseling to address academic issues is further supported by Andrews, Andrews, Long, and Henton (1987), who found that students who were struggling academically voiced a greater need for counseling as compared to academic advising. Benton, Robertson, Tseng, Newton, and Benton (2003) found that the number of students with academic problems who sought counseling at a college counseling center increased significantly over a 13-year period. In their study, Wlazelek and Coulter (1999) also found that students receiving academic counseling at a college counseling center as compared to those who did not received counseling appeared to have higher grade point averages only after one semester of receiving counseling services. Hence, Wlazelek and Coulter asserted that academic counseling interventions are instrumental in helping students. Unfortunately, according to Wlazelek and Hartman (2007), the trend in current practice indicated that counselors who work with college students are often tempted to address other issues than academic performance.
According to Whiston and Oliver (2005), few research studies have been conducted that examined how mental health professionals perceive career counseling and whether career issues are likely to be avoided in counseling sessions in favor of personal issues. A limitation of both Gelso et al. and Vargo-Moncier and Jessell is that they only examined intake reports and did not investigate all sessions to see if career-related concerns continued to be dismissed. Even less than the number of studies on the overshadowing of work-related concerns in counseling sessions are the number of studies that have been conducted to assess whether academically related concerns are also overshadowed by personal problems. Wlazelek and Hartman (2007) called for practitioners working with students who are struggling with academic performance to thoroughly assess during intake the student’s academic standing, as well as factors contributing to the academic struggles. Wlazelek and Hartman also suggested continuous assessment of improvement and deterioration of academic performance throughout the counseling.
This study seeks to explore whether the trend of ignoring work-related issues in counseling has been reversed in the decade after Vargo-Moncier and Jessell’s (1995) study. At the same time, this study seeks to shed light on whether counselors who work with college students, whose major obligation is often to study and perform well academically, address academically related issues. Through available documentation (i.e., intake summaries and progress notes), this study addressed the following questions: (a) To what extent do counseling trainees address career and/or academically related concerns with clients who report career and/or academic problems? (b) Are there factors or processes that may encourage or distract counselors from addressing work and/or academically related problems in counseling sessions when clients report work and/or academic issues?
Method
Participants
The participants in this study were 12 clients who had sought individual counseling services at a departmental training clinic in a large, Midwestern university and the trainees who provided them with counseling services. Five of the clients were male and the other seven clients were female. At the time of the initial intake interview, the ages of the clients ranged from 20 to 42 years old (M = 25.5, standard deviation [SD] = 6.94). Nine of these clients identified as Caucasian, two as African American, and one as Asian/Asian American. Seven of the clients reported being full-time students. Two of the clients had full-time employment and one client was unemployed. Two clients reported being both employed and being full-time students. The participants were reflective of the training clinic who typically serves around 35% community members and 65% college students with an average age of 27.9 years old. The training clinic also serves as a research facility and all clients signed an informed consent indicating that they agreed to have their records and file content used in future research.
In order to identify clients with career or academic concerns, this study utilized 6 items from the Outcome Questionnaire–45.2 (OQ-45.2). The OQ-45.2 is a 45-item self-report measure often administered to assess clients’ perception of their current state of well-being (Lambert et al., 2004). The 6 items were included in the selection process (i.e., “I feel stressed at work/school,” “I find my work/school satisfying,” “I work/study too much,” “I am not working/studying as well as I used to,” “I feel that I am not doing well at work/school,” and “I have too many disagreements at work/school”). The responses ranged from “0” to “4,” and a higher numerical response indicates perception of increased severity of the problem (Lambert et al., 2004). The average work/school difficulties score (M = 11.44; SD = 3.28) was then calculated for this variable using OQ-45.2 data from 533 clients that were seen at the counseling center for a 4-year period. Only files from clients whose work difficulties mean scores were two SDs above the means for work/school-related difficulties (i.e., work-related or academic-related difficulties score of 18 or above) were identified (n = 21) for further analysis. In order to capture an approximation of what might have been addressed during a comparable number of counseling sessions, only files belonging to clients who were seen for at least four counseling sessions but not more than 16 were included in further data collection, which resulted in a final sample 12 client files. For the 12 clients who were selected, the mean score on the 6 items of the OQ-45.was 19.0 (SD = .95), with a median and mode score of 19.
Of the counselors who provided counseling to these 12 clients, 2 were master’s students in counseling and 10 were doctoral students in counseling psychology. Of the 12 counselors, 1 identified as a male and 11 reported being female. One of the counselors identified as African American, five as Asian, and six reported being Caucasian. Of the 12 counselors, two individuals had declared a research interest in career counseling issues, although all therapists had taken coursework related to career counseling.
Data Selection
Intake summaries and progress notes written by counseling students regarding the counseling they provided for the 12 clients were selected for data analyses for this study. According to Gelso et al. (1985), an intake note should convey a description of the client’s problem situation. In addition, counseling progress notes written were expected to include pertinent information relevant to clients’ presenting concerns, interventions, and treatment-related details (Chenail, Somers, & Benjamin, 2009). Therefore, intake summaries and progress notes written for the clients included in this study were deemed to be an appropriate type of data for this study. The same type of data has also been used in at least one grounded theory study conducted in the mental health field (i.e., Lucas, Skokowski, & Ancis, 2000). In health care, treatment notes frequently have been used as data in content analysis studies. The principal investigator de-identified the intake summaries and progress notes, so that the identity of the counselors was not known during the data analysis processes.
Data Preparation and Coding
Content Analysis
The data for this study were made suitable for the coding process for content analysis by following the suggestions of Neuendorf (2002) and Weber (1990). They suggested that researchers make a decision as to the most appropriate recording unit for coding. Using each collected session note as a recording unit could cause significant difficulties and potential inaccuracy during the coding process as each note consists of multiple topics. At the same time, using a word as a recording unit was also deemed inappropriate for the purpose of this study as a word may not adequately explain the phenomenon being investigated or the context in which the words had been written. Therefore, the researchers decided that each of the sentences in the notes was to be considered a recording unit. The principal investigator eliminated sentences that did not indicate information being discussed during the session (e.g., the time and date of the next counseling session, the number of sessions that client had attended thus far), which eliminated 216 sentences.
In the data set, there were some complex sentences that addressed more than one topic. The principal investigator followed Weber’s (1990) suggestion and divided those sentences into multiple units to enable more accurate classification. Upon reviewing the recording units, the principal investigator decided that a total of 76 sentences should be split into multiple sentences, as these sentences contained multiple topics. This process yielded an additional 98 sentences, bringing the total number of recording units eligible to be categorized to 691 sentences.
The following definitions were used to categorize each sentence. For the purpose of this study, sentences were considered work related, if the sentences were related to the definitions of work, career, occupation, employment, or vocation taken from the Merriam-Webster dictionary. Work was the labor, task, or duty that is one’s accustomed means of livelihood. Career was defined as a field for or pursuit of consecutive progressive achievement especially in public, professional, or business life or a profession for which one trains and which is undertaken as a permanent calling. Occupation was defined as work in which one engages regularly as a result of training. Merriam-Webster further defined employment as work for which one has been engaged and is being paid by an employer. Vocation refers to the work in which a person is employed. Additional criteria and examples can be obtained from the first author.
The variable academic was also defined using the definition provided by Merriam-Webster, which is relating to, or associated with an academy or school, especially of higher learning or relating to performance in academic courses. The word school was defined as the process of teaching or learning especially at school or attendance at a school, or the student attending a school. Education was defined as the action or process of educating or of being educated, whereas higher education was defined as education beyond the secondary level. For the purpose of this study, the sentences included that are related to client’s experience as a student of a school or higher education institution should be categorized as academically related content. Additional criteria and examples are available from the first author.
Sentences were coded other if the content of the sentence could not be coded as either work-related or academic-related content.
The principal investigator and another coder conducted a trial run of classifying the recording units under one of these categories. According to Neuendorf (2002), interrater reliability coefficient should be calculated and suggested computing Pearson correlation coefficients. Upon completion of this process, an initial Pearson correlation coefficient was computed to be .84. This indicated that the definitions in the coding manual were reliable in accordance with Krippendorff (1980) and Riffe, Lacy, and Fico (1998) who stated that a reliability score of .80 or above indicates high reliability. Once these categories were deemed appropriate, the principal investigator began to classify all of the remaining recording units into the most appropriate category, based on the definitions. Per the suggestion of Neuendorf (2002), the categories included in content analytic studies should be both exhaustive and mutually exclusive. Therefore, each recording unit can only belong in one category. A second coder also independently reviewed the sentences and classified each of them into the most appropriate category. Prior to beginning the initial coding process, the second coder received instructions from the principal investigator. Pearson correlation coefficient was calculated as a means to determine the interrater reliability (r = .94). After the computation of the reliability coefficient, where the two coders did not agree, the coders consulted with each other in order to reach a consensus. The recording units in question were then classified under the agreed upon category.
Grounded Theory
To examine the question of whether there are factors or processes that may encourage or distract counselors from addressing work and/or academically related problems in counseling sessions, grounded theory was utilized. The data analysis process in the grounded theory portion of the study occurred in two stages, which were open coding and axial coding (Strauss & Corbin, 1990). After the first author gained familiarity with the data, the open coding process began. During open coding, initial themes were identified by means of reviewing the available data. The data were reorganized based on a scheme (i.e., categories and subcategories) that emerged. The second step of this process, axial coding, consisted of the researchers examining the relationships among the categories and subcategories. The axial coding process yielded central themes.
In accordance with the suggestions of Creswell (1998), the coding was accomplished with sensitivity to reflexivity and verification. One of the verification processes suggested by Creswell involves having an auditor. This auditor does not participate in the coding process; rather, the auditor should have familiarity with the process of this study and assist the researcher by verifying the accuracy of the coding process. The auditor for this study was a professor in counseling who had conducted a number of research studies related to career counseling.
Results
Results of content analytic review of intake summaries and progress notes are presented to examine the extent to which work or academically related concerns were discussed in counseling sessions with clients who had work or academic issues based on their OQ-45.2 scores. Second, findings of the qualitative review generated themes related to factors or processes that might encourage or distract counselors from addressing clients’ work or academically related problems during counseling sessions.
Content Analysis Results
As described in the Method section, each sentence of all intake summaries was coded. Table 1 contains the number of intake summary sentences that were coded under each of the categories (i.e., work, academic, and other). Of the 131 eligible sentences taken from the 12 intake summaries, 16 (12.2%) of those sentences were categorized as work-related sentences, 18 (13.7%) were categorized as academically related sentences, and 97 (74.1%) sentences were other related. This means, 25.6% of the eligible sentences derived from these summaries were about clients’ work-related or academic-related concerns. Table 1 also contains the frequency of sentences that were coded as work related, academically related, or other related from the progress notes. In total, there were 92 progress notes included in this portion of the analyses, with a total number of sentences of 560. Of the 560 sentences, a total of 78 (13.9%) sentences from 35 different counseling sessions were included in the work-related category. In addition, 76 (13.6%) sentences from 26 different counseling sessions were included in the academically related category. The remainder of the sentences (n = 406; 72.5%) were other related. It should be noted that all of the clients whose files were included in this analysis scored two SDs above the mean on items on the OQ-45 items that indicate difficulties in work or academic life; however, only 27.5% of the progress note sentences were work or academically related.
Observation of Work and Academically Related Sentences in Intake Summaries and Progress Notes.
Table 2 contains information about the number and percentages of work or academically related sentences found in both intake summaries and progress notes written by counselors working with clients who identified either as being students, employed or unemployed, or student and employed. As indicated, 23.23% of the sentences written by counselors who worked with clients who were employed or unemployed were work related. Counselors who worked with clients who identified as employed or unemployed did not write any academically related sentences in the intake summaries. In addition, 76.77% of sentences written by counselors working with clients who identified as being employed or unemployed were other related. Of the sentences written by counselors who worked with clients who identified as students, 19.40% were academic related. The counselors working with students wrote a total of 331 sentences (70.58%) that were other related. Table 2 also shows that counselors working with clients who identified as both student and employee included 12 sentences (8.28%) that were coded as work related and 14 sentences (9.65%) that were coded as academically related. These counselors wrote 119 (82.07%) other-related sentences.
Content of Notes Based on Client’s Stated Occupation.
Qualitative Examination of Intake Summaries and Progress Notes
The available data were organized, so that all of the sentences written for each of the clients were combined. In addition, these sentences were listed in chronological order. The initial stage of the coding process, which was the open coding process, was intended as a means to thoroughly examine the data to uncover categories and subcategories that might emerge during extensive evaluation of the available text. Axial coding was the second stage of the coding process. The purpose of the axial coding process was to examine the relationships among the categories and subcategories that were uncovered during the open coding process. In doing so, the principal investigator continued to connect the data with the research question. During the axial coding process, the principal investigator generated themes that appeared to have emerged through analyzing the data. Just as during the open coding process, the principal investigator continued to work with the auditor. The principal investigator consulted with the auditor in order to ensure that the auditor also observed similar central themes.
Themes
At the conclusion of the axial coding process, the principal investigator and the auditor agreed on three themes.
Limited discussion of work and academic issues
A theme that emerged through the qualitative analysis was limited discussion of work or academic issues. As previously noted, work-related sentences were observed in five intake summaries, while academically related sentences were observed in seven intake summaries. Nevertheless, examination of progress notes indicated that such articulation of work or academic issues did not always yield follow-up during subsequent counseling sessions. At the same time, when notation of work or academically related concerns in intake summaries yielded some follow-up, such follow-up often seemed to end prematurely.
Lack of follow-up
This theme was observed in multiple sets of client notes. Clients 2, 3, 5, 9, 10, and 11 all reported issues with one or more work or academically related problems during the counseling process. An example was observed in the notes written by the counselor who worked with Client 3, a female Caucasian client, who presented with difficulties adjusting to changes that were taking place at her workplace that had “left her with less responsibilities.” The counselor noted that the client had considered her career to be “the most important aspect of her life,” which makes “dealing with the change more difficult.” The counselor recorded client’s intention to adjust her career direction by “applying to other positions and to graduate schools.” Even though this counselor–client pair worked together for an additional four counseling sessions, the progress notes did not indicate any follow-up on this particular career-related matter. For example, there was no notation of the counselors having made attempts to assist the client in the job search process, such as helping the client clarify her career interests, values, or providing the client with assistance in information gathering. Also, there was no notation of follow-up on the steps that the client might have taken to search for new employment or apply to graduate school.
The notes that were written for Client 5, a female Caucasian client, also included an example that fits this theme. In the intake summary, the counselor indicated that the client was experiencing anxiety that was partly attributed to the atmosphere at the client’s place of employment. According to the intake summary, the client had reported that “a customer at her work has been harassing her for the past 6 months.” The intake summary also indicated that Client 5 had attributed her anxiety to personal factors as well. Examination of progress notes revealed that the counselor did not include any notation of discussions or further assessment of the workplace harassment. The intake summary also indicated that Client 5 was struggling with her ability to “(concentrate) on school work” as a result of her distress. Just as the counselor did not note follow-up of the work-related concern presented by the client at intake, progress notes also did not include sentences that indicated discussions or interventions to help the client manage her difficulties with academic concentration.
Limited or premature end to discussions of work and academic issues
Qualitative analysis also indicated that when a work or academically related problem was discussed in counseling sessions, the discussion of such issue often appeared limited or ended prematurely. This theme was observed in the notes that were written by the counselors who worked with Clients 1, 3, 4, 5, and 6.
The counselor who worked with Client 1, a female Caucasian client, appeared to have prematurely ended discussions about client’s academically related problems as focus was given to another problem (i.e., symptom management). In the intake summary, the counselor wrote that this client had been experiencing “a significant amount of school-related stress.” In the progress notes that were written for Sessions 2 and 3, sentences were observed that indicated further assessment of the client’s academically related problem. In these notes, the counselor indicated discussions of the client’s educational backgrounds and cognitive interventions (e.g., discussing “client’s ways of thinking about her studies”) to gain better understanding of the academic stress experienced by the client. In the notes for Sessions 4 through 10, however, sentences were observed that indicated a change in focus as the counselor noted discussions of client’s self-confidence and struggles with anxiety, without relating these issues back to the client’s academic stress.
A second example of this theme was observed in the notes for Client 4, a client who identified as a Caucasian male. The counselor who worked with Client 4 noted in the intake summary that the client was struggling with a relationship problem and a career-related problem (i.e., lack of work) that contributed to depressed moods, feelings of “hopelessness, helplessness, and worthlessness,” which was followed by a suicide attempt. Examination of progress notes indicated a clear emphasis on client’s safety. However, examination of progress notes also revealed that the counselor minimally addressed some factors contributing to the client’s distress. Based on the sentences written in the progress notes, the client’s work-related problem was discussed in only one of the total six progress notes. In the note for Session 2, the counselor noted that the client had received financial assistance from a family member, resulting in temporary resolution of his financial issues and a reduction in depression. This temporary resolution was the last discussion of client’s unemployment despite the fact that his employment situation had not changed.
Relational concerns as the most commonly observed distracting factor
Examination of progress notes indicated at the minimum, one type of relational concerns (i.e., romantic, family, or social). Examination of progress notes tended to show that when work- or academically related problems were presented along with relational concerns, the relationship problems are more likely to have been discussed first and/or to a fuller extent.
Relational problems discussed more extensively and/or immediately
This theme was observed in the notes for Clients 4, 5, 6, 8, 9, and 10. The notes for Client 6 provided an example of how a relational problem was given priority over work- or academically related matters. The intake summary written for Client 6 indicated that the client had presented with depressive symptoms that was attributed to a turbulent romantic relationship. In addition, the intake summary stated that the client was struggling with financial problems that resulted in the client’s questioning his ability to enroll in his academic program in the subsequent semester. Sentences related to the client’s romantic relationship problems were observed in the progress note written for Session 2, which implied that this client–counselor pair had discussed the romantic relationship struggles in the session immediately following intake. Sentences related to the client’s work-related concerns were not included in the progress notes until Session 5, when the client reported that he had independently begun to search for employment opportunities in an effort to resolve his financial concerns. In addition, examination of progress notes written for Client 6 showed that the client’s work-related problem was discussed in five different counseling sessions while notations of discussions of client’s romantic relationship struggles were observed in 10 of the 12 counseling progress notes.
Another example of this theme was also observed in the progress notes for Client 10, an African American female. In the intake summary, the counselor noted that the client had presented with depressive symptoms that were attributed to her inability to accomplish a previously established career goal. As a result of her depressed moods, the client reported also struggling with academic motivation, which had also negatively influenced her academic performance. In the intake summary, the counselor also noted that the client’s mother had tragically passed away. Examination of progress notes indicated that while the client’s career-related concerns were discussed, the counselor appeared to have addressed the client’s family struggles first in the session immediately following intake. In the note for Session 2, the counselor noted that they had “spent most of (the) session talking about client’s family of origin.” The progress notes indicated that the client’s career-related concerns were mainly addressed in Session 3, as the client reported a deadline to submit an application to a professional academic program. For instance, in the note for Session 3, the counselor noted that they had “spent majority of (this) session discussing client’s application to master’s program in (academic program information removed)” as the “program wants application turned in by (date removed)” and the client was facing difficulties “trying to find recommendations on relatively short notice.” Progress notes indicated that the client and counselor then returned to discussing the client’s family dynamics concern in Session 4. It should be noted that progress notes did not include any sentence that indicated further discussions of the client’s academically related problems (e.g., motivation and academic achievement) in counseling sessions following Session 3.
Failure to integrate
The last major theme that emerged through this qualitative analysis was the counselors’ struggle with integrating work or academic problems in discussions about issues in the personal area. This failure to integrate was observed in most of the cases included in this analysis and was particularly evident in the notes written by the counselors who worked with Clients 1, 2, 3, 6, 7, and 11. In the first example, the counselor who worked with Client 1 noted in the intake summary that this client presented with academic-related stress. In the beginning of the counseling, as observed in the notes for Sessions 2 and 3, the counselor appeared to have addressed the client’s academic concerns. After Session 3, however, the progress notes indicated that the counselor focused on addressing client’s anxiety, as the counselor noted that they “began to go over breathing and relaxation exercises” and “talked about how breathing/relaxation has gone.” Even though the client indicated experience of anxiety in some academic situations, the counselor did not note integration between the client’s academic concerns and the client’s anxiety. For example, it did not appear that the counselor assessed for academically related situations in which the client might have felt more pressure, which in turn might have induced anxiety. In addition, the counselor did not note examples of how to use the relaxation strategy to manage academic-related anxiety.
Another example was found in the notes for Client 2 who according to the intake summary had been struggling with lack of sense of agency, self-confidence, and decision making. The counselor noted discussions of these struggles across progress notes. The progress notes, however, did not include any sentences that indicated that counselor had made attempts to integrate these personal concerns with the client’s career or academic area. For example, the counselor did not note any assessment of how the client’s struggles with decision making might have impacted his ability to make educational or career decisions.
What Encouraged Counselors to Address Work/Academic Concerns?
Examination of progress notes indicated that one counselor was able to discuss academic, career, and personal issues. With Client 12, the counselor documented efforts to integrate all areas in order to understand how the personal aspect of life might affect client’s academic and career aspects, and vice versa. In addition, the counselor did not appear to be distracted by relational concerns and seemed to address the client’s academically related problems extensively. The counselor who worked with Client 12 indicated in the intake summary that the client had presented with depressive and anxiety symptoms that were attributed to a life change that occurred due to a physical injury. Due to the depression and anxiety, the client reported disturbance in daily function (i.e., sleep and eating pattern) and academic difficulties (i.e., motivation and achievement). The client attributed his anxiety to financial concerns and his academic achievement.
The counseling progress notes included academically related sentences (i.e., client reports and interventions) in four of the five post-intake counseling sessions. This counselor also noted sentences indicating integration between academic problems and personal concerns. For example, in one note, the counselor noted that the client’s academic achievement had influenced his self-confidence as the client reported no longer feeling “proud of himself.” The counselor also noted that the client “reported that he has not told his parents that he failed his courses,” which indicated that the counselor and client had discussed ways in which the academically related concern was affecting his relationship with his parents. In addition, progress notes noted discussion of how the client’s social life might have “made it impossible to pass school,” indicating integration between the client’s social relationships and academic struggles.
This counselor also wrote sentences in the progress notes that indicated integration of career issues into counseling sessions. For example, the counselor wrote a sentence indicating how the client’s career direction, as reflected in a change in majors, had been influenced by his academic struggles. The counselor indicated that the client “had taken some classes (in an academic concentration) but did not do very well and switched to (another academic concentration).” One progress note indicated discussion of the client’s identity development (i.e., values clarification) as part of a discussion about the client’s career aspiration/direction.
Discussion
This study sought to answer two central research questions, which were (a) to what extent were work and academically related problems addressed in counseling sessions when clients who indicated distress due to work and/or academically related problems also present with personal concerns and (b) what were the factors or themes that encourage or distracted the counselors from addressing these work or academically related problems to a greater degree. Results of this study indicated limited assessment of work and academically related problems at intake, which was evidenced by the high percentage (i.e., 74.10%) of other-related sentences included in the intake summaries. This same trend of ignoring work and academically related problems continued in subsequent sessions with only 14.29% of the sentences addressing work issues and 13.57% addressing academic problems. It should be remembered that these clients reported on the OQ-45 significant work and/or academic problems (i.e., more than two SDs above the average client at intake).
The results of this study concerning that lack of attention to work issues is consistent with the findings of Gelso et al. (1985) and Vargo-Moncier and Jessell (1995) who found that at intake, career-related concerns were perceived as being less important than those that are more personal in nature. In addition, this finding is consistent with the finding of Spengler et al. (1990), who found that work-related concerns were likely overshadowed by client’s personal concerns, which was shown by the apparent large portion of intake summary and progress note sentences that were deemed other related (i.e., 74.1% and 72.5%, respectively). Findings from this qualitative analysis also indicated that even when clients presented with work-related problems, these concerns were often not addressed or only followed up to a limited extent, even when the clients indicated that they were experiencing distress due to these particular concerns. For instance, findings from this study indicated that counselors frequently failed to follow up on work-related issues, which include issues regarding career directions/aspiration and harassment at the work place. Further findings from this study also showed that when work-related sentences were included in the notes, those sentences were likely of clients’ report of their work-related problems rather than counselor interventions. This is dissimilar to the other-related sentences included in the notes, which often included counselors’ interventions directed at personal issues.
Similarly, content analytic review of intake summaries also indicated that the importance of assessment of academically related problems was likely to have been overshadowed by assessment of personal concerns as only a low percentage of intake summary sentences was classified as academically related (i.e., 13.7%). Content analysis of progress notes also showed that the importance of extensive discussions of academically related problems was likely to have been overshadowed by discussions of personal related concerns as only 13.6% of sentences in the progress notes were marked as being academically related. This finding was also a cause for concern as the seven student clients whose files were included in this study had indicated high distress due to academically related issues at intake.
The lack of discussion of academically related problems was also observed during qualitative review of the data. Qualitative analysis of the intake summaries and progress notes also yielded results that indicated some academically related problems (e.g., educational decision making, academic self-confidence) had been addressed to a limited extent in sessions (i.e., in a small number of counseling sessions). Moreover, the analysis of progress notes also reflected that even when academic concerns were identified, these counselors rarely responded with interventions to address issues such as procrastination, motivation, difficulties in maintaining focus, or time management. This was evidenced by the lack of sentences indicating execution of academic-specific interventions during counseling sessions as the majority of the notes written for clients who identified as students were of clients’ report. This finding is discouraging as Wlazelek and Coulter (1999) found academic counseling interventions directed at students’ academically related struggles to be quite potent in helping students reverse academic failure. Only one counselor (i.e., the counselor who worked with Client 12) readily used academic counseling interventions in counseling sessions as evidenced by the notes.
The results of this study also indicated that relational problems are the most commonly observed factor that may have distracted therapists from focusing on work and academic issues. The results indicated that every counselor had included discussions of at least one type of relational problems in their notes (i.e., romantic relationships, family dynamics, and social relationships). In addition, this review of the intake summaries and progress notes indicated that relational concerns were very likely to have been immediately addressed in the counseling session following intake. Results also indicated that when clients attributed their emotional distress to a work/academic concern and relational problems simultaneously, the counselors appeared to have been more likely to address relational problems. This tendency was apparent even when the client had indicated that the work- or academically related problems were contributing to high level of distress. Unfortunately, this theme was observed in more than half of the files, which indicated the commonality of this particular tendency.
Another important theme that emerged through the review of the intake summaries and progress notes was counselors’ failure to integrate discussions about work and/or academic areas into conversations about the client’s personal struggles. This finding was also consistent with that of Gelso et al. (1985), who found that when clients presented with vocationally related problems, counselors were less likely to note in the intake notes how these concerns might have influenced the client’s personal areas of life (e.g., family relationships). This failure to integrate appeared to be a major contributor to the counselor’s failure to explore or address work or academic problems during counseling sessions and was observed in all but one case (i.e., Client 12). The counselor who worked with Client 12 noted sentences that indicated integration of the client’s academic struggles, career-related concerns, and personal issues. This finding was also noteworthy, given the existing literature indicating interrelation between client’s work/academic life and personal life.
In conclusion, the findings of this study indicated that work- or academically related concerns were likely to have been perceived as less worthy of attention in counseling sessions as compared to other issues. This was reflected in the extent to which client’s work or academically related problems were noted in intake and progress notes. Results also indicated that counselors appeared to have preferred to focus on client’s relational problems in their work in their clients, which appeared to have contributed to the limited descriptions of work or academically related problems in counseling. In addition, despite the fact that the field calls for psychologists to integrate work, academic, and personal concerns in counseling, results of this study indicated that counselors often do not adhere to the holistic treatment model that encourages attention given to all aspects of clients’ lives.
Limitations and Future Research
One of the limitations of this study is the fact that the data used in this analysis were collected from the same training facility and the notes that were included in this study were from trainees. As such, the clinicians had limited training and exposure to clients and range of presenting concerns when compared to more professionally mature practitioners. Future research may profit from using more experienced counselors. Second, the data included in this study were in the form of intake summaries and progress notes. Whereas intake summaries and progress notes should include major themes and other information pertinent to what had taken place during the counseling sessions (e.g., client reports, counselor interventions, observations, and assessment of progress), they might not capture all that occurred during the counseling sessions. Hence, there is a possibility that certain matters had been discussed in counseling sessions; yet, the discussions of these issues were not recorded in the progress notes or intake summaries. In addition, due to the nature of the data, the conclusions made in regard to the distracting factors and themes were based solely on the content of these notes. Therefore, there could be noncontent factors or mechanisms that might have influenced the counselor’s decision on whether to address client’s work- or academically related problems. Future research that involves analyses of actual counseling sessions may provide a finer-grained analysis of whether vocational and academic overshadowing does occur. As the findings of studies that examined vocational overshadowing tend to be inconclusive, more studies should be conducted to further examine this phenomenon. Similarly, more studies need to be conducted that examine counseling psychologists’ perception of academically related issues, and whether the importance of these issues is indeed often overshadowed by that of the personal concerns.
Conclusion
In summary, examination of intake summaries and progress notes suggested that the importance of work and academically related problems was likely to have been overshadowed by other concerns. This was evidenced by the lack of or limited description of work or academically related problems presented by clients in the counseling notes. Examination of intake summaries and progress notes indicated counselors’ preference for addressing clients’ relational concerns at the expense of more integrated or holistic assessment and treatment of client’s concerns. While the findings of this study observed the overshadowing of vocational issues, more studies should be conducted to further examine this phenomenon. In addition, more studies to examine counseling psychologists’ treatment of academically related problems need to be conducted.
Footnotes
Authors’ Note
This article is based on data from Daryn Rogers’ dissertation at Indiana University.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.