Abstract: Counseling is within the reach of anyone in today’s society. The fields of mental health and community counseling allow services to be rendered to anyone that may need these services while in the past these service were only accessible for a person of a higher social standing in essence the rich. Mental health and community counseling had its beginnings several centuries ago.The services received from mental health and community counseling have helped those with personality development and emotional problems that are unable to pay for services in private practice and therefore if not for these services these clients would fall through the cracks. Mental health and community counseling use a blended technique spectrum in order to reach solutions with their clients. While there is mounting evidence of the impact of spirituality on mental well-being many counselors still do not incorporate spirituality as part of their therapy.
Mental Health and Community Counseling Mental health and community counseling has been an important part of the field of psychology since these branches have emerged. Both of these sectors of counseling provided services to people who would otherwise not be able to obtain these services. Both of mental health counseling and community counseling have a rich history that can be traced back to psychology. The following will provide a look at how these branches emerged from humble beginnings in psychology and the avenues of techniques used within both forms of this type of counseling.Psychology did not emerge as a separate discipline until the late 1800’s; this discipline can be traced back to its earliest history of the early Greeks (Kendra). During the 17th century Rene Descartes, a French Philosopher, introduced the idea of dualism, which asserted that the mind and the body were two separate entities that interact to form the human experience and psychology was born (Kendra).
Mental health counseling and community counseling are fields with in the discipline of psychology (Kendra). Mental health counseling and community counseling deal with a wealth of issues.Community counselors work to assist individual, families, and groups with diverse needs through challenges in their lives.
Counselors take a developmental perspective that people grow and change throughout their lives. Professional counselors understand principles of human development, psychology, mental health, and change theories, and develop an effective helping relationship with people from diverse cultures. Counselors are skilled in the assessment of people and situations, diagnosis and treatment of mental disorders, and in the application of cognitive, behavioral and systemic strategies to facilitate change.Community counselors help clients explore their concerns and assist them in creating change. Counselors work with client to implement personal goals and advocate of system wide changes.
Counselors in the mental health field and community counseling use a wide array of techniques to help their patients. This paper will discuss a use of the unstructured clinical interview, existential theory, solution focused strategies, and empathy. Fernando (2007) concluded existential theory is a theory based on obvious parts of human existence: freedom, isolation, meaninglessness, and death.Existential therapy deals with the anxiety the people feel while dealing with the facts of their life that are rooted in existence (Fernando, 2007). The use of existential therapy with client does not stop the suffering that the client feels but instead the counselor helps the client to deal with the suffering in a positive manner (Fernando, 2007). The counselor points out the faulty thinking and behavior patterns that may have cause the suffering in the client’s life (Fernando, 2007).
In the practice of existential approach there is no certain set of techniques but rather the counselor is to relate to the client as a compassionate human being (Fernando, 2007). A philosophical discussion about the client’s life in terms of the issues that are causing the client’s anxiety has been found to be very useful (Fernando, 2007). The first step for the counselor is to help the client assume responsibility for any given situation while also helping the client decide what part they have played in contributing to their particular situation (Fernando, 2007).Fernando (2007) noted in the study that many clients evade responsibility for their situations; therefore, the counselor must establish which ways the client used and convey this to the client. The next step is to get the client to appreciate how they contributed to this situation which has been found in some cases to force change the structure of their own life (Fernando, 2007). Solution-focused therapy (SFT) is widely used in the community counseling field due to the fact that what brought the client to counseling is resolved in a very short period of time (Fernando, 2007).SFT is also widely used because is if very cost effective (Fernando, 2007). SFT deals with the solution to a client’s problem rather than what caused the problem (Fernando, 2007).
Counselors using SFT help the client’s to recognize when something is not working and to discontinue that action but also the recognize what is working in the client’s life and to do more of that action (Fernando, 2007). Use of scaling questions with SFT is a common tool that helps the client to evaluate change and progress in their treatment (Fernando, 2007).Brief solution-focused counseling has become a technique used by many counselors because resource distribution in public mental health has not matched the demand for services, resulting in waiting lists, a problem faced by many counselors working with publicly funded mental health services (Mireau & Inch, 2009). This situation challenges counselors to struggle continuously with how to serve our clients most efficiently (Mireau & Inch, 2009). Wait list have been found to disparaging for clients. Mireau et al.concluded that clients on wait lists experience more problems and experience lower motivation and poorer outcomes as the waiting period lengthens.
Brief solution-focused counseling has proven to that client with very short wait prior to their first appointments are more likely to show up for their first appointments and are more likely to complete treatment (Mireau & Inch, 2009). The research has shown that counselors who use this method make a conscious use of their time by engaging the client quickly and keeping the client focused on goals and priorities (Mireau & Inch, 2009).There are some drawbacks to BSFC; this method is not a style for beginning counselors (Mireau & Inch, 2009). BSFC relies heavily on the art and intuition of the experienced clinician (Mireau & Inch, 2009). The technique requires that counselors have appropriate training and an eclectic knowledge of and comfort in a variety of other counseling styles to meet the needs of the client (Mireau & Inch, 2009). Another technique used by counselors in the mental health and community counseling field is unstructured clinical interview (Jones, 2010).Jones concluded that the initial interview is the most fundamental area of counselor training because it is the beginning of every counseling relationship. The unstructured interview remains the primary assessment tool for diagnosing disorders based on DSM-IV-TR (Jones, 2010).
This technique was traditionally only used by psychiatrists but the diagnosing of clients has fallen to master’s level counselors (Jones). With more counselors having to diagnose clients diagnostic training in counselor’s education programs has existed for the last 15 to 20 years (Jones, 2010).While the unstructured interview is the most commonly used technique there is little importance placed on this technique in the portion of counselor’s (Jones, 2010).
Information about clinical interviewing is scarce in counseling literature or counseling assessment textbooks this information is mostly found in psychiatry journals and textbooks (Jones, 2010). The unstructured interview consists of questions posed by the counselor with no standardization of questioning (Jones, 2010). The client responses and counselor observations are recorded by the counselor (Jones, 2010).The counselor is entirely responsibly for deciding what questions to ask and how the resulting information is used in arriving at a diagnosis (Jones, 2010). The accuracy of diagnoses using this technique depends greatly on the ability of the counselor to recognize DSM-IV-TR diagnostic symptoms (Jones, 2010). Although unstructured clinical interviews do not have a standardized format or questions, it is useful for counselors to follow a general outline consisting of several content domains (Jones, 2010).The outline format for an unstructured clinical interview consist of the following: indentifying information, presenting problem and chief complaint, history of presenting problem, family history, relationship history, developmental history, educational history, work history, medical history, substance use, legal history, previous counseling, and mental status examination (Jones, 2010). The indentifying information includes the client’s name, sex, age, race/ethnicity, relationship status, and referral source.
This information could provide clues to a potential diagnosis for example a client’s sex can be associated with vulnerability to certain mental illnesses (Jones, 2010). Men have a higher rate of substance abuse and antisocial disorders whereas women are more vulnerable to depression, anxiety disorders, and somatic complaints (Jones). The presenting problem and chief complaint is a statement about the client’s problems or concerns that brought him or her to counseling (Jones, 2010).It is very important for counselors to listen for psychological symptoms, patterns of maladjusted behavior, stressors and interpersonal conflicts in order to pick up clues to diagnosis (Jones, 2010).
During this portion of the interview the client may express he or she has a problem sleeping in this case the counselor my need to explore questions dealing with depression (Jones, 2010). Certain disorders have the same symptoms therefore it is vital to investigate the history of the presenting problem (Jones, 2010). Disorders with the same symptoms only differ in the onset, duration and severity (Jones, 2010).Therefore the portion of the interview about history of presenting problem should elaborate on three main areas: Onset/course, severity, and stressor (Jones, 2010). Family history focuses on the client’s first-degree relatives (parents, siblings, and children) and their mental history, family members age, education and occupation, composition of the family during the client’s childhood and adolescence, a medical history of family members, client’s relationship with family members, and any history of child abuse, substance abuse, domestic violence, suicide, violent behavior, or other traumatic experiences (Jones, 2010).
Information about a client’s family is very important because many mental disorders are often associated with or intensified by the client’s current or past interaction with family members (Jones, 2010). Also mental disorders have a genetic factor (Jones, 2010). From the domains listed previously you can get a general idea of how to structure the interview and what the answers to these questions can be clues to in diagnosis (Jones, 2010).
The use of empathy will be the last technique we will discusses.Empathy has offered a way for mental health counselors to grasp the feeling and meaning of a client and convey this understanding to the client (Clark, 2010). The use of empathy with varying degrees is endorsed and practiced in counseling across a diverse range of contemporary theoretical orientation (Clark, 2010). Empathy is subject to misuse when a counselor semantically confuses empathy and sympathy (Clark, 2010). Clark stated that empathy emphasizes an active sharing by the counselor of what a client is experiencing while maintaining some level of emotional detachment.While a counselor’s sympathetic response is more circumscribed function of expressing compassion for an individual’s distressful situation (Clark, 2010). It has been found not to be the best avenue to use in a therapeutic relationship (Clark, 2010).
Sympathy employs the use of self-disclosure of a counselor and could contribute to therapeutic gain, the technique may prove to be ineffective when a counselor assumes that their own experience matches or equates that of the client (Clark, 2010).A counselor’s accurate and appropriate use of empathy involves expressing an empathic understanding without implying agreement with the client (Clark, 2010). Clark concludes that while expressing compassion and commiseration, it is possible for a counselor to sympathetically convey agreement with the views and perspective of a client. While the intent of alleviating distress a counselor may side with the client and support the person’s point of view (Clark, 2010). As an unintended consequence, however the counselor’s perceived agreement with a client may subsequently hinder the exploration of alternative perspectives (Clark, 2010).When a mental health counselor equates empathy and sympathy this confusion may contribute to misdirection in counseling (Clark, 2010).
Empathy is a prominent factor in promoting positive treatment outcomes; sympathy has an essential role in human relationships (Clark, 2010). It is a possible to clarify distinction between empathy and sympathy through the dimensions of aim, appropriate use of empathy and sympathy has potential to foster therapeutic gain (Clark, 2010). Spirituality has become an increasing part of the counseling process. And many community and mental health counselors use spirituality as a part of therapy.Curry (2009) concluded that spirituality may be defined as an awareness of being or force that transcends the material universe (Curry, 2009). Spirituality has been correlated with greater job satisfaction, promotion of existential meaning construction, moral development, coping with life stress and difficulties, life adjustment, fostering forgiveness cultural identity, and physical health (Curry, 2009). Curry also stated that spirituality has been associated with positive mental well-being, life transformation, empowerment for change and overall holistic wellness.
Counselors need to consider how religious attitudes and beliefs affect clients’ lives whether negatively or positively and how their beliefs about religion, especially when they differ from those of a client affect the therapeutic process (Curry, 2009). However, in spite of these strides to integrate spirituality in counseling process, it appears that counseling students and counselors may still hesitate to address client’s spiritual issues, possibly due to a lack of efficacy for how to effectively deal with spirituality in the counseling process.Spiritual timeline are being used in counseling to address the spirituality needs of some clients (Curry, 2009). A timeline is a sequence of related events arranged in chronological order and displayed along a line (Curry, 2009). Curry (2009) concluded in order to effectively use timeline in counseling, it is important to explain what a timeline is and to ask the client’s permission to use it as an activity in the counseling process.
It is also helpful to make a physical representation because the client and counselor can have a common visual prompt that provides a conversation medium (Curry, 2009).Though many counselors perceive spirituality as import for client growth and well-being, but many still do not have the proper training to deliver these counseling services (Curry, 2009). The training in both areas of spirituality (belief systems) and the specific aspects (spiritual practices and activities) are important for counselors wishing to learn more about integrating client spirituality into counseling practice (Curry, 2009). Curry (2009) stated when using timeline to facilitate spiritual discourse with a client, it is critical that counselors be comfortable with, and aware of, their own spiritual beliefs.
It is also critical that counselors not force their personal beliefs or theology on the client (Curry, 2009). Another aspect of dealing with spirituality in counseling is Christian counseling. In Christian counseling, the client is the agent of change and is responsible for turning away from the contemporaneous caused of the problem (Strong, 1980). But the client receives special help because God, through the grace of the Holy Spirit, helps to facilitate change (Strong, 1980).
In Christian counseling counselors believe that God heals past injuries, gives wisdom and insight into problems, and strengthens clients for change (Strong, 1980).Strong article presents the concept that Christian counselors view people in two different ways. Basically, because people are God’s creatures and creation, they are viewed as good created with free will, intelligence, and capacity for loving and a need for a close relationship with God (Strong, 1980). The other side is that people are indeed free to choose our fate and are inclined to misuse this gift (Strong, 1980). Strong concluded that people wanted to set themselves up as all-knowing so as not to be dependent on God.Therefore people are prone to pridefully make ourselves the center of our existence and cut themselves off from God, these prideful and selfish attitudes and actions that carry out this tendency are the root of much psychological disturbance (Strong, 1980).
Strong stated to be whole we need to be in a close relationship with God. Our relationship with God defines our self-worth and our eternal existence, and without it we lose self-identity. Christian counselors seek to offer a religious and ethical dimension to the client’s thinking and behavior, using the vast legacy of scripture and other sources (Strong, 1980).Christian counseling involves interpretation, confrontation, and instruction. Considerable use is made of scripture (Strong, 1980). Prayer is also an abundant as counselors turn to the Lord for insight and wisdom (Strong, 1980).
Throughout Christian counseling prayer is a key process (Strong, 1980). The counselor using the Christian synthesis may begin and end counseling session with prayer, and pray during session as appropriate (Strong, 1980). The prayers may be for thanksgiving, wisdom, insight, confession, forgiveness, absolution, healing, and strengthening (Strong, 1980).Prayer thus keeps both the counselor and client mindful that God is the real agent of change and the healer at work in Christian counseling (Strong, 1980).
The Bible provides several scripture references that are related to mental health and community counseling. Romans 12:2 states,” And be not conformed to this world : but be ye transformed by the renewing of your mind, that ye may prove what is that good , and acceptable, and perfect, will of God”. This scripture gives reference to the heal powers of God through the Holy Spirit (Bible).
The next verse we will look at is 1 Peter 5: 7 which states, “Castin all you cares upon him for he careth for you” (Bible). This is yet another scripture that exemplifies the use of God as the ultimate counselor. While these are just a few scriptures that give reference to how God along with the Holy Spirit work in the counseling process. The identity of a mental health and or community counselor has many facisades and covers many directions. Counseling researchers have tried to develop a set battery of measurements that could show both the need and the success of psychotherapy (Leibert, 2006).Knowing about treatment course would conceivably be helpful to athe counselor the client and the payer (Leibert). All parties could anticipate their respective levels of investment (Leibert, 2006).
The skills a counselor should possess include the recognition of interpersonal dynamics, adaptability of such techniques as modeling, role-playing, feedback, reinforcement, individualized goal-setting, evaluation, collaborative goal setting, monitoring, and the use of cognitive strategies for increasing counselors awareness of their own thought processes that they bring to their therapeutic work with clients (Pearson, 2006).Uhlemann (1994) findings give confirmation to the importance of the client’s phenomenological perspective in determining what contributes positively to the counseling process. Regardless of how we were trained as counselors, we cannot assume that clients will automatically view our responses in the manner we theoretically might predict (Uhlemann, Lee, & Martin, 1994).It is important to realize that our theories of counseling interaction are perhaps more often based on belief systems that have developed within the counseling community rather than on empirical analyses of the counseling process that have considered clients’ perspectives (Uhlemann, Lee, & Martin, 1994). Ibrahim et al. concluded that many assume the role of a counselor for the most part performs clerical and record-keeping functions.
Counselor’s use of interpretation was perceived as more expert that a use of restatement (Uhlemann, Lee, & Hett, 1984).Theoretically derived counseling approaches are not influenced by their personal preference for existing major counseling orientations (Uhlemann, Lee, & Hett, 1984). Another role or identity that counselors assume is the role of advocate; counselors work as advocates when they plead on behalf of a client or some social cause (Kiselica & Robinson, 2001). There are several mandates that are intended to ensure that counselors know when they have the competency necessary to help a client and when and where they need to work to improve their own abilities (Lepkowski, Packman, Smaby, & Maddux).Although mental health counselors had existed for many years, they had no distinct professional identity and were forced to accept other professional identities (Cannon & Cooper, 2010).
But in 1976 Virginia became the first state to enact a low allowing professional counselors to practice independently with a license, as social worker and psychologist did (Cannon & Cooper, 2010). Although large numbers of programs sprouted in the 1970’s and 1980’s and continue today, no division of community counseling has ever been formed within the ACA (Cannon & Cooper, 2010).Ethics play a major role in any profession and counseling is no different. Each division of counseling has a set guide of ethics (Ponton & Duba, 2009).
Modern professions have adopted the model of specified code of ethics to ensure common standards, minimized interpersonal strife, and guide professionals through the most common pitfalls in practice (Ponton & Duba, 2009). Codes of ethics are always a work in progress (Ponton & Duba, 2009). One ethical dilemma that is faced by many counselors is the use of biased terminology (Dorre & Kinnier, 2006).
Biased terminology is rooted in the within the various ideologies of philosophies, theories, beliefs, power struggles, and value that are a part of a counselors formal training (Dorre & Kinnier, 2006). It is imperative that counselors pay sensitive attention to the language they use with their clients (Dorre & Kinnier, 2006). Counselors must use new ways to communicate with clients (Dorre & Kinnier, 2006). The use of bias terms cannot be eliminated altogether due to the requirement of insurance claims but counselors must not let these labels hinder the therapy sessions (Dorre & Kinnier, 2006).Although ethic codes provide a guideline for how counselors should behave with clients they do not furnish all the answers (Ponton & Duba, 2009).
Professional counselors are to act ethically, with fidelity and honor while exercising their training and education to serve society and clients to their benefit (Ponton & Duba, 2009). References: Cannon, E. , & Cooper, J. (2010). Clinical mental health counseling: a national survey of counselor educators. Journal of Mental Health Counseling , 32 (3), 236-246.
Clark, A. J. (2010). Empathy and Sympathy: Therapeutic distinctions in counseling.Journal of Mental Health Counseling , 32 (2), 95-101. Curry, J.
R. (2009). Examining client spiritual histor and the construction fo meaning: the use of spiritual timelines in counseling.
Journal of Creativity in Mental Health , 113-123. Dorre, A. , & Kinnier, R. T. (2006).
The ethics of bias in counselor terminology. Counseling and Values , 51, 66-80. Fernando, D. M. (2007).
Existential theory and solution-focused strategies: integration and application. Journal of Mental Health Counseling , 29 (3), 226-241. Ibrahim, F. A. , Helms, B. J.
, & Thompson, D. L. (1986).Counselor role and function: an apraisal by consumers and counselors. The Personnel and Guidance Journal , 597-601. Jones, K. D.
(2010). The unstructured clinical interview. Journal of counseling & Development , 88, 220-226. Kendra, C. (n.
d. ). About. com. Retrieved October 12, 2010, from Origins of Psychology: http://psychology. about. com/od/historyofpsychology/a/psychistory.
htm Kiselica, M. S. , & Robinson, M. (2001).
Bringing advocacy counseling to life: the history, issues, and human dramas of social justice work in counseling. Journal of Counseling & Development , 79, 387-397. Leibert, T. W.
(2006).Making change Visible: the possibilities in assessing mental health counseling outcomes. Journal of Counseling & Development , 84, 108-113.
Lepkowski, W. J. , Packman, J. , Smaby, M.
H. , & Maddux, C. Comparing self and expert assessments of counseling skills before and after skills training, and upon graduation.
Education , 129 (3), 363-371. Lewis & Clark Graduate School of Education and Counseling. (n. d. ). What is Community Counseling? – Counseling Psychology -Departments- Graduate School. Retrieved October 12, 2010, from Lewis & Clark Graduate School of Education and Counseling: http://graduate. 1clark.
edu/departments/counseling_psychology/community_counseling Mireau, R. , & Inch, R. (2009). Brief Solution-focused counseling: a practical effective strategy for dealing with wait lists in community-based mental health services. National Association of Social Workers , 54 (1), 63-70. Pearson, Q.
M. (2006). Psychotherapy-driven supervision: integrating counseling theories into role based supervision. Journal of Mental Health Counseling , 28, 241-252. Ponton, R. F.
, & Duba, J. D. (2009).
The ACA code of ethics: articulating counseling’s professional covenant. Journal of Counceling ; Development , 87, 117-121.Strong, S.
R. (1980). Christian Counseling: A synthesis of Psychological and Christian Concepts.
The personel and Guidance Journal , 589-592. Uhlemann, M. R. , Lee, D. Y. , ; Hett, G. G. (1984).
Perception of theoretically derived counseling approaches as a function of preference for counseling orientation. Journal of Clinical Psychology , 40 (4), 1111-1116. Uhlemann, M. R. , Lee, D. Y.
, ; Martin, J. (1994). Client cognitive responses as a function of quality of counselor verbal responses. Journal of Counseling ; Development , 73, 198- 203. Cannon, E. , ; Cooper, J.
(2010).Clinical mental health counseling: a national survey of counselor educators. Journal of Mental Health Counseling , 32 (3), 236-246. The authors conducted a study on the criteria for counselor education in community counseling and mental health counseling. This study concluded that the attitudes of which criteria to follow as to how many hours a student completes in order to obtain a license has no set guidelines established nationally but are set by each state. This study has limitations due to the fact that the research was only conducted on CACREP accredited community counseling programs. Clark, A. J.
(2010).Empathy and Sympathy: Therapeutic distinctions in counseling. Journal of Mental Health Counseling , 32 (2), 95-101.
The authors of this article distinguish the difference between empathy and sympathy. Clark stated how important empathy and sympathy are in the therapy process. But often times these terms are interchanged at inappropriate time when the other should be used in its place. Clark reports that one reason for this often misuse of expressions is the fact that these expressions are semantically confused. Clark r if a counselor has awareness of the appropriate use of empathy and sympathy has the potential to foster therapeutic gain.Curry, J.
R. (2009). Examining client spiritual histor and the construction fo meaning: the use of spiritual timelines in counseling. Journal of Creativity in Mental Health , 113-123.
Curry explored the use of Spiritual timelines in counseling and the positive aspects that it offers to a client. Curry concluded that spirituality may be defined as an awareness of being or force that transcends the material aspects of live and gives a deep sense of wholeness or connectedness to the universe. The study demonstrated a how the use of a spiritual timelines helped a client with issues of depression andfatigue. The use of spiritual timelines need to be a graphic in order to prompt the counselor and client to a common visual to promote conversation of the events on the timeline.
Dorre, A. , ; Kinnier, R. T. (2006). The ethics of bias in counselor terminology. Counseling and Values , 51, 66-80.
The author stated that in this article tells us about the traditional image of the mental health counselor. Dorre also concluded that we address the incongruity that seems to exist between the ideal images.The primary responsibly of the mental health counselor as reported by Dorre et al.is to treat the client with respect, dignity, and integrity. The author also eludes that the labels that a counselor may apply to a client can cause bias.
The informal and formal language of a counselor is full of bias terms.The author also examined the root of counselor bias in language which seems to stem from within the ideologies of various philosophies, theories, beliefs, and values. Fernando, D. M.
(2007). Existential theory and solution-focused strategies: integration and application. Journal of Mental Health Counseling , 29 (3), 226-241.The author depicts the function of solution focused brief therapy in mental health counseling. The author also provided the cost effectiveness of using this solution focused brief therapy verses using existential theory and the application of existential theory as it pertains to solution-focused brief therapy. Fernando concluded the counselor must focus the client on the here and now and also direct the client on how to move past the problem at hand. Solution focused brief therapy has become known as the practical approach in the treatment of psychological problems.The counselor must also be able to listen for strengths from the clients in order to help move the client from problems to goals while changing the previous way that the client handled problems.
Ibrahim, F. A. , Helms, B.
J. , ; Thompson, D. L. (1986).
Counselor role and function: an apraisal by consumers and counselors. The Personnel and Guidance Journal , 597-601. Ibrahim et al. concluded how the role and function of a counselor has been scrutinized over the last two decades. And demands are that all counselors are accountable for all doing will with clients.
The authors also stated that it is based on wells and Ritter’s concern on the matter that the crisis is not to be acknowledged by practitioners. Many people don’t know the of the role and function of secondary school counselors. While the authors reported major results of a study to assess the role and function of the secondary school counselor. Ibrahim et al article stated at counselors and their professional associations has finally been accepted by the administrators, school systems, parents, and the business community.
Jones, K. D. (2010). The unstructured clinical interview. Journal of counseling ; Development , 88, 220-226.
Jones explained that the initial interview is the most fundamental area of counselor training. The counselor may use structured, unstructured, or semi structured approaches for their interview purpose. Counselors have to know what information is needed to obtain during the unstructured clinical interview and how that information is relevant to making a diagnosis. It is also stated that any counselor with a master’s degree can make a diagnosis on the client that the counselors are working with in therapy. Clinical interviews are unpredictable at times but they can be structured at times also.
Each interview has its benefits and its drawbac.