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This foundational text offers dynamic and fresh perspectives on theories across the helping professions to help guide client case conceptualization and therapeutic transformation. A diverse group of topical experts providees contemporary insight on the following theories: relational-cultural, psychodynamic, Jungian, Adlerian, existential, person-centered, Gestalt, cognitive behavioral, third-wave cognitive behavioral, rational emotive, reality therapy/choice, family, feminist, constructivist, and emotion-focused theories, as well as creative approaches to counseling used in a variety of theoretical models.
Each theory is discussed in terms of historical backtround; human nature and development; major constructs; applications, including goals, the process of change, traditional and brief interventions, and serious mental health issues, supporting research and limitations; and the case of Clarita. The use of a consistent case study across chapters reinforces the differences between theories and demonstrates how each theory influences the counseling and treatment plan. A complimentary test manual and PowerPoints for instructor use are available by request.
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Veröffentlichungsjahr: 2022
Cover
Title Page
Copyright Page
Preface
FEATURES OF THE BOOK
THE FORMAT FOLLOWED FOR CHAPTERS 2–17
THE CASE OF CLARITA
NEW TO THIS EDITION
Acknowledgments
Meet the Editors
Meet the Contributors
Part 1: Foundations for Individual Counseling and Psychotherapy
Chapter 1: Helping Relationships and Theoretical Foundations for Counseling and Psychotherapy
DEFINITIONS AND DESCRIPTIONS OF THE HELPING RELATIONSHIP
HELPING RELATIONSHIPS: STAGES
HELPING RELATIONSHIPS: CORE CONDITIONS
HELPING RELATIONSHIPS: STRATEGIES
MOVING TOWARD AN INTEGRATIVE APPROACH TO COUNSELING AND PSYCHOTHERAPY
MULTICULTURAL AND SOCIAL/CULTURAL ORIENTATIONS
SUMMARY
REFERENCES
Chapter 2: Multicultural and Social Justice Counseling Through Relational-Cultural Theory
BACKGROUND
HUMAN NATURE: A DEVELOPMENTAL PERSPECTIVE
MAJOR CONSTRUCTS
APPLICATIONS
SUPPORTING RESEARCH AND LIMITATIONS
THE CASE OF CLARITA: AN RCT APPROACH
REFERENCES
Part 2: Theories of Counseling and Psychotherapy
Chapter 3: Psychodynamic Theories: Psychoanalysis and Beyond
BACKGROUND
HUMAN NATURE: A DEVELOPMENTAL PERSPECTIVE
MAJOR CONSTRUCTS
APPLICATIONS
SUPPORTING RESEARCH AND LIMITATIONS
THE CASE OF CLARITA: A BRIEF PSYCHODYNAMIC APPROACH
REFERENCES
Chapter 4: Jungian Analytical Theory
BACKGROUND
HUMAN NATURE: A DEVELOPMENTAL PERSPECTIVE
MAJOR CONSTRUCTS
APPLICATIONS
SUPPORTING RESEARCH AND LIMITATIONS
THE CASE OF CLARITA: A JUNGIAN APPROACH
REFERENCES
Chapter 5: Adlerian Theory
BACKGROUND
HUMAN NATURE: A DEVELOPMENTAL PERSPECTIVE
MAJOR CONSTRUCTS
APPLICATIONS
SUPPORTING RESEARCH AND LIMITATIONS
THE CASE OF CLARITA: AN ADLERIAN APPROACH
REFERENCES
Chapter 6: Existential Theory
BACKGROUND
HUMAN NATURE: A DEVELOPMENTAL PERSPECTIVE
MAJOR CONSTRUCTS
APPLICATIONS
SUPPORTING RESEARCH AND LIMITATIONS
THE CASE OF CLARITA: AN EXISTENTIAL APPROACH
REFERENCES
Chapter 7: Person-Centered Theory
BACKGROUND
HUMAN NATURE: A DEVELOPMENTAL PERSPECTIVE
MAJOR CONSTRUCTS
APPLICATIONS
SUPPORTING RESEARCH AND LIMITATIONS
THE CASE OF CLARITA: A PERSON-CENTERED APPROACH
REFERENCES
Chapter 8: Gestalt Theory
BACKGROUND
HUMAN NATURE: A DEVELOPMENTAL PERSPECTIVE
MAJOR CONSTRUCTS
APPLICATIONS
SUPPORTING RESEARCH AND LIMITATIONS
THE CASE OF CLARITA: A GESTALT APPROACH
REFERENCES
Chapter 9: Cognitive Behavioral Theories
BACKGROUND
HUMAN NATURE: A DEVELOPMENTAL PERSPECTIVE
MAJOR CONSTRUCTS
APPLICATIONS
SUPPORTING RESEARCH AND LIMITATIONS
THE CASE OF CLARITA: A CBT APPROACH
REFERENCES
Chapter 10: Third-Wave Cognitive Behavioral Theories With Mindfulness-Based Interventions
BACKGROUND
HUMAN NATURE: A DEVELOPMENTAL PERSPECTIVE
MAJOR CONSTRUCTS
APPLICATIONS
SUPPORTING RESEARCH AND LIMITATIONS
THE CASE OF CLARITA: A DIALECTICAL APPROACH
REFERENCES
Chapter 11: Rational Emotive Behavior Therapy
BACKGROUND
HUMAN NATURE: A DEVELOPMENTAL PERSPECTIVE
MAJOR CONSTRUCTS
APPLICATIONS
SUPPORTING RESEARCH AND LIMITATIONS
THE CASE OF CLARITA: AN REBT APPROACH
REFERENCES
Chapter 12: Reality Therapy/Choice Theory
BACKGROUND
HUMAN NATURE: A DEVELOPMENTAL PERSPECTIVE
MAJOR CONSTRUCTS
APPLICATIONS
SUPPORTING RESEARCH AND LIMITATIONS
THE CASE OF CLARITA: A REALITY THERAPY APPROACH
REFERENCES
Chapter 13: Family Theory
BACKGROUND
HUMAN NATURE: A DEVELOPMENTAL PERSPECTIVE
MAJOR CONSTRUCTS
APPLICATIONS
SUPPORTING RESEARCH AND LIMITATIONS
THE CASE OF CLARITA: A FAMILY COUNSELING APPROACH
REFERENCES
Chapter 14: Feminist Theory
BACKGROUND
HUMAN NATURE: A DEVELOPMENTAL PERSPECTIVE
MAJOR CONSTRUCTS
APPLICATIONS
SUPPORTING RESEARCH AND LIMITATIONS
THE CASE OF CLARITA: A FEMINIST APPROACH
REFERENCES
Chapter 15: Constructivist Theories: Solution-Focused and Narrative Therapies
BACKGROUND
HUMAN NATURE: A DEVELOPMENTAL PERSPECTIVE
MAJOR CONSTRUCTS
APPLICATIONS
SUPPORTING RESEARCH AND LIMITATIONS
THE CASE OF CLARITA: A CONSTRUCTIVIST APPROACH
REFERENCES
Chapter 16: Integrating Theories: Emotion-Focused Therapy
BACKGROUND
HUMAN NATURE: A DEVELOPMENTAL PERSPECTIVE
MAJOR CONSTRUCTS
APPLICATIONS
SUPPORTING RESEARCH AND LIMITATIONS
THE CASE OF CLARITA: AN EFT FOR INDIVIDUALS APPROACH
REFERENCES
Chapter 17: Using Creative Approaches in the Context of Counseling and Psychotherapy
BACKGROUND
HUMAN NATURE: A DEVELOPMENTAL PERSPECTIVE
MAJOR CONSTRUCTS
APPLICATIONS
SUPPORTING RESEARCH AND LIMITATIONS
THE CASE OF CLARITA: CREATIVE APPROACHES
REFERENCES
Name Index
Subject Index
End User License Agreement
Chapter 5
Table 5.1 Birth Order Characteristics
Chapter 6
Table 6.1 Taking the Existential Journey With the Client: Recognize the Anxi...
Chapter 8
Table 8.1 Gestalt Therapy Intervention Strategies
Chapter 9
Table 9.1 Types of Reinforcement and Punishment
Table 9.2 Common Cognitive Distortions
Table 9.3 Self-Monitoring Thought Record Example
Table 9.4 Cognitive Behavior Therapy Interventions
Chapter 8
Figure 8.1 The Cycle of Awareness
Chapter 9
Figure 9.1 Classical Conditioning of Social Anxiety Example
Figure 9.2 Cognitive Conceptualization Example
Chapter 10
Figure 10.1 Third-Wave Therapies
Figure 10.2 Third-Wave Cognitive Behavioral Theories Holistic Framework
Figure 10.3 Dialectical Behavior Therapy Stages of Treatment
Chapter 12
Figure 12.1 Cycle of Counseling, Coaching, Managing, Supervising, and Parent...
Cover Page
Title Page
Copyright Page
Preface
Acknowledgments
Meet the Editors
Meet the Contributors
Table of Contents
Begin Reading
Name Index
Subject Index
Wiley End User License Agreement
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edited by
David CapuzziMark D. Stauffer
American Counseling Association2461 Eisenhower Avenue, Suite 300Alexandria, VA 22331www.counseling.org
Copyright © 2022 by the American Counseling Association. All rights reserved. Printed in the United States of America. Except as permitted under the United States Copyright Act of 1976, no part of this publication may be reproduced or distributed in any form or by any means, or stored in a database or retrieval system, without the written permission of the publisher.
American Counseling Association
2461 Eisenhower Avenue, Suite 300 ■ Alexandria, VA 22331
Associate Publisher ■ Carolyn C. Baker
Digital and Print Development Editor ■ Nancy Driver
Senior Production Manager ■ Bonny E. Gaston
Copy Editor ■ Elaine G. Dunn
Cover and text design by Bonny E. Gaston.
Library of Congress Cataloging-in-Publication Data
Names: Capuzzi, Dave, editor. | Stauffer, Mark D., editor.Title: Counseling and psychotherapy : theories and interventions / edited by David Capuzzi and Mark D. Stauffer.Description: Seventh edition. | Alexandria, VA : American Counseling Association, [2022] | Includes bibliographical references and index. |Identifiers: LCCN 2021052713 | ISBN 9781556204104 (paperback)Subjects: LCSH: Counseling. | Psychotherapy. | Counseling—Case studies. | Psychotherapy—Case studies.Classification: LCC BF637.C6 C634 2022 | DDC 158/.3—dc23/eng/20220103LC record available at https://lccn.loc.gov/2021052713
This seventh edition of Counseling and Psychotherapy: Theories and Interventions presents a representative variety of theories and conceptual frameworks that are used across helping professions to organize client case conceptualization and guide the path for therapeutic transformation. Although there are hundreds of discrete therapies, they are offshoots of greater branches of the therapeutic tradition tree. This book has been created by a diverse group of experts, who share their theoretical knowledge of different branches of theory as well as the intersectionality of their lived experience and culture. The book covers not only traditional counseling and psychotherapeutic theories but also theories that have emerged in response to multicultural and social justice work with clients. The greater a counselor’s or therapist’s awareness of the strengths and possibilities inherent in numerous theoretical frames of reference, the greater the potential for understanding the uniqueness of a particular client and for developing the most effective treatment plan.
This edition presents dynamic and fresh perspectives and includes critical material not addressed in other counseling and psychotherapy textbooks, such as a chapter that focuses on multicultural and social justice counseling through relational-cultural theory, a chapter that addresses psychodynamic models used by today’s practitioners rather than only classic psychoanalytic theory, a chapter that examines third-wave cognitive behavioral theories with mindfulness-based interventions, a chapter on feminist theory, a chapter on integrating theories via emotion-focused therapy, and a chapter on using creative approaches in the context of counseling and psychotherapy. The book’s unique approach and expanded perspectives enhance its contemporary relevance and should increase reader interest in the material.
This book is unique in both format and content. All the contributing authors are experts who provide state-of-the-art information about theories of counseling and psychotherapy (see the “Meet the Contributors” section for their backgrounds). In addition, each chapter discusses applications of the theory as it relates to one particular case study of a hypothetical client named Clarita, who is introduced here in this Preface.
This book is designed for students who are beginning their study of individual counseling and psychotherapy. It presents a comprehensive overview of relational-cultural, psychodynamic, Jungian, Adlerian, existential, person-centered, Gestalt, cognitive behavioral, third-wave cognitive behavioral, rational emotive, reality therapy/choice, family, feminist, constructivist, and emotion-focused theories, along with a discussion of how to use creative approaches in the context of those theories.
We know that one book cannot adequately address all the factors connected with a given theory; entire texts have been written discussing each of the theories in this book. We have, however, attempted to provide readers with a consistent approach to analyzing and studying each theory and have included examples of how to apply the theory to the case of Clarita.
The format for the book is designed so that readers can compare how adherence to a theory influences the counseling and treatment plan. Each chapter contains theoretical and applied content. The theories presented are bookended by an opening chapter on the helping relationship and an ending chapter on using creative approaches in the context of counseling and psychotherapy.
As noted earlier, we wanted the reader to be able to make comparisons between and among the theories by having all the contributors follow the same outline and develop a treatment plan, focused on goals, for one hypothetical client named Clarita. The authors of Chapters 2 through 17 followed the outline below as they discuss each theory in relation to the case study of Clarita.
Background
This section includes historical information related to the development of the theoretical system and the individual(s) responsible for its development.
Human Nature: A Developmental Perspective
(primary)
This section discusses how the theory defines an individual’s developmental process over time.
Major Constructs
This section includes the structural components of the theory.
Applications
This section includes the following secondary areas:
Overview
: An introduction to the five areas that follow.
Goals of counseling and psychotherapy
: A description of desired client outcomes based on the tenets of the theory.
The process of change
: The factors within the theory that address what brings about change in the individual.
Techniques and interventions
: Techniques for implementing the process of change. The chapter authors name and describe five to six specific traditional and current techniques and interventions.
Brief intervention strategies
: Techniques and interventions for implementing the process of change using a brief approach.
Clients with serious mental health issues
: A discussion of how the theory applies to counseling clients with mental disorders. The chapter authors delineate and discuss what types of mental disorders can be successfully “treated” using this theoretical approach.
Supporting Research and Limitations
This section includes the following secondary areas:
Overview
: An introduction to the two areas that follow.
Supporting research
: Current research studies that form the bases for continued use of this theoretical system.
Limitations
: A description of the factors that limit the use of this theoretical system with clients and types of presenting problems.
The Case of Clarita: Approach
This section includes a case study writeup consistent with the theory and emphasizes the goals and interventions/techniques that will be used when counseling Clarita. The goals and interventions/techniques should be directly connected to the theory being used for the case study.
The client, Clarita, is a 32-year-old Latinx woman. She is the oldest of five children and was raised in a predominantly Latinx neighborhood in Puerto Rico. She attended Catholic schools, and her religion is a very significant part of her life. She is a single parent raising two children, a 6-year-old son and an 8-year-old daughter. She is bilingual, graduated from college with honors, has a degree in education, and for the past 4 years has taught middle school math and science. She and her husband of 5 years divorced 3 years ago. Recently, Clarita was forced to move from Puerto Rico to Florida as a result of a Category 5 hurricane, which devastated the island. Although she jokes about being a “climate refugee,” she believes it is true and is not sure whether she will be able to move back home anytime soon. She receives no financial assistance from her ex-husband, and the only knowledge the children have of their father is through communication with their paternal grandparents.
Clarita arrived 15 minutes early for her initial appointment. She related easily and expressed herself well, but her body appeared tense and her voice was strained. She expressed appreciation for getting an early appointment because she felt that she could not have waited much longer. She had been referred to the mental health agency by her physician because of insomnia and frequent unexplained crying spells. During the intake process, Clarita stated that she is depressed, unable to sleep because of reoccurring nightmares, not eating, losing control of her two children, and having difficulty missing and dealing with distant family members, who are now scattered as a result of the hurricane destruction. She said that she has thought about suicide but stops because of the guilt she feels about abandoning her children and the tenets of her religion. She has difficulty concentrating, and this is affecting her teaching. Clarita has been absent frequently from work, and her principal is recommending that she takes a leave of absence, which is causing her great stress because she needs the income to support her children. Luckily, she found a new teaching position to apply for, but if she leaves her teaching position, she would be forced to uproot to yet another place. Clarita is unable to maintain meaningful relationships and, when asked to describe herself, she used terms such as insecure, frightened, distrustful of self and others, lonely, and lacking hope.
From information gathered during the intake process, Clarita described her family of origin as very close knit, held together by both cultural and religious values. She was raised to be proud of her Latinx heritage, her language, and her culture’s traditions. She has three younger brothers and one younger sister, all of whom looked to her for advice and support. Education was emphasized in her home, and her academic success was the center of much family pride. She was touted as a model to her siblings and was expected to perform in an exemplary way not only in school but also in other aspects of her life.
Clarita’s parents were self-educated and operated a small business near their home. Because the business demanded a large time commitment from both parents, Clarita often found herself, during adolescence, taking care of both the house and her younger siblings. Most of the family activities centered around their local parish and the activities generated in the community. Clarita’s social life was very much tied to her immediate family and contacts she made at either the Catholic school or the church youth groups. She was encouraged to bring her friends to her home and to date young men within the community. Cultural pride, religion, and the parameters of the local community had an impact on much of her formative development.
Clarita’s first true exposure to other cultures came after she left home to attend a university in the U.S. mainland. She had received scholarship offers from three universities, and although her parents wanted her to stay at home and attend the local university, she decided to attend a university located away from Puerto Rico. Her decision caused conflict within her family, and she reported that it placed a good deal of strain on her relationships with both parents. Her sister supported her actions, but her brothers felt that she was abandoning the family.
Clarita was very successful at the university, and it was there that she met and later married the first person she had dated outside of her religion and culture. Mark was a European American engineering student and seemed to have no specific religious affiliation. It was not until their graduation that Clarita introduced Mark to her family and at the same time announced their plans to be married.
Clarita’s family, with the exception of her sister, was very opposed to the marriage and made their opposition known to both Clarita and Mark. And they also faced opposition from his parents. To avoid further confrontations, Clarita and Mark eloped and were married by a justice of the peace in Florida.
After their marriage, they settled in Puerto Rico, secured jobs, and began to build a life together, even though Mark wanted to live near his family in southern Georgia and had a hard time fitting in. It was not until after their first child was born that they tried to improve relationships with both families. By the time their second child was born, Clarita’s family members were much more involved with their children; they were less close to Mark’s family because of the distance, but they still called his parents monthly.
The second child put a strain on the marriage, and within 2 years, Clarita and Mark separated and later divorced. Mark left Puerto Rico and has had no contact with Clarita or his children. Shortly thereafter, the devastation left by the hurricane uprooted Clarita from her home and family. Mark’s parents do continue to have contact with their grandchildren.
It was 3 years after the divorce that Clarita was finally able to discuss the physical and psychological abuse that she received from Mark. During their marriage, he became physically abusive whenever he drank and constantly demeaned her profession, culture, and religion. This was particularly true when he was not adjusting and felt isolated in Puerto Rico. He withdrew from both Clarita and the children and spent more and more time away “on business trips.” When Clarita turned to her family for support, she was confronted with indifference and reminders of their opposition to the marriage. Her sister, once supportive, now blames Clarita for a great deal of the disunity within the family. They all grieve the challenges facing their community ever since the hurricane. The children’s paternal grandparents refuse to believe that their son was abusive and are very critical of the way in which Clarita is raising their grandchildren and of how she does not visit enough.
With the lack of support from family, Clarita turned to newly made friends in Florida for help and one Puerto Rican friend who had also moved nearby. A friend suggested that Clarita needed to meet and start dating other men. She found that she had difficulty relating to men, was afraid to trust, and felt that all they wanted was sex. She felt that the relationships cooled rapidly when they found out she had two children.
Clarita turned to her work and poured all her energy into her students. This resulted in very little energy left for her own children, and their relationship grew very strained. It was at this time that she began to have disturbing dreams that kept her from sleeping. The dreams, according to Clarita, generally entailed the following:
I am always running, and there are shadowy figures behind me. I am in a large warehouse-type structure with lots of boxes and crates. The boxes and crates are all marked with arrows reading “Exit.” The only problem is that the arrows are all going in different directions. Therefore, I never find the exit, and the figures keep getting closer and closer. I wake up in a cold sweat, breathing rapidly, heart pounding, and a scream stuck in my throat. I lie there trying to calm down, knowing that I am too afraid to go back to sleep. In a little while, I get up and spend the rest of the long night sitting at the kitchen table drinking coffee.
The more often the dreams occurred, the more depressed Clarita became. She fought sleep because of her fear of dreaming, and at times she found herself crying uncontrollably. Her eating habits have also changed drastically, and she finds herself buying fast food for the children so that she does not have to cook. She seldom eats and has lost 15 pounds, weight she really cannot afford to lose.
Her depression has kept her away from work and away from people. She has been spending more and more time alone ruminating. In Clarita’s words, “I have nothing to live for. No one cares about me. I have ruined my life and the lives of two families, and I am currently hurting my children.” On the advice of her priest, she sought the help of her physician, who recommended that she seek psychological help.
An update of
Chapter 1
on the helping relationship, with an emphasis on the impact that diverse cultural intersectionalities have on every client who comes to a counselor
A new chapter on how multicultural and social justice issues can be addressed through relational-cultural theory
A chapter on the psychodynamic theories derived from classical psychoanalysis
An updated explanation of Jungian analytical theory
New versions of the chapters on Adlerian, existential, person-centered, Gestalt, rational emotive, and reality theories
A reconceptualized chapter on cognitive behavioral theories
A new chapter describing third-wave cognitive behavioral theories with mindfulness-based interventions
Updated versions of family, feminist, and constructivist theories
A new chapter on emotion-focused therapy
A chapter describing how creative approaches to counseling can be used in the context of a variety of theoretical models
We, the coeditors, and the contributors have made every effort to give the reader current information and content focused on both theory and application. It is our hope that the seventh edition of Counseling and Psychotherapy: Theories and Interventions will provide the foundation that students need to make decisions about follow-up study of specific theories as well as the development of their own personal theory of counseling and psychotherapy.
We would like to thank the authors who contributed their time and expertise to the development of this textbook for professionals interested in individual counseling and psychotherapy. We also thank our families who supported and encouraged our writing and editing efforts. Thanks go out to Carolyn Baker and other staff members of the Publications Department of the American Counseling Association for their collaborative and thorough approach to the editing and production of this textbook.
David Capuzzi, PhD, NCC, LPC, is a counselor educator and professor emeritus at Portland State University. Previously, he served as an affiliate professor in the Department of Counselor Education, Counseling Psychology, and Rehabilitation Services at Pennsylvania State University and Scholar in Residence in Counselor Education at Johns Hopkins University. He is past president of the American Counseling Association (ACA), formerly the American Association for Counseling and Development, and past chair of both the ACA Foundation and the ACA Insurance Trust.
From 1980 to 1984, Dr. Capuzzi was editor of The School Counselor. He has authored several textbook chapters and monographs on the topic of preventing adolescent suicide and is coeditor and author with Dr. Larry Golden of Helping Families Help Children: Family Interventions With School Related Problems (1986) and Preventing Adolescent Suicide (1988). He coauthored and edited with Douglas R. Gross Youth at Risk: A Prevention Resource for Counselors, Teachers, and Parents (1989, 1996, 2000, 2004, 2008, 2014, 2019); Introduction to the Counseling Profession (1991, 1995,1997, 2001, 2005, 2009, 2013, 2017); Introduction to Group Work (1992, 1998, 2002, 2006, 2010); and Counseling and Psychotherapy: Theories and Interventions (1995, 1999, 2003, 2007, 2011).
In addition to Foundations of Addictions Counseling (2008, 2012, 2016, 2020) and Foundations of Group Counseling (2019), published by Pearson with Dr. Mark D. Stauffer, he and Dr. Stauffer have published Career Counseling: Foundations, Perspectives, and Applications (2006, 2012, 2019); Foundations of Couples, Marriage, and Family Counseling (2015, 2021); Human Growth and Development Across the Life Span: Applications for Counselors (2016); and Counseling and Psychotherapy: Theories and Interventions (2016, 2022). Other books include Approaches to Group Work: A Handbook for Practitioners (2003), Suicide Across the Life Span (2006), and Sexuality Issues in Counseling, the last coauthored and edited with Larry D. Burlew. He has authored or coauthored articles in several ACA-related journals.
A frequent speaker and keynoter at professional conferences and institutes, Dr. Capuzzi has also consulted with a variety of school districts and community agencies interested in initiating prevention and intervention strategies for adolescents at risk for suicide. He has facilitated the development of suicide prevention, crisis management, and postvention programs in communities throughout the United States; provides training on the topics of youth at risk and grief and loss; and serves as an invited adjunct faculty member at other universities as time permits.
An ACA fellow, he was the first recipient of ACA’s Kitty Cole Human Rights Award and was also a recipient of the Leona Tyler Award in Oregon. In 2010, he received ACA’s Gilbert and Kathleen Wrenn Award for a Humanitarian and Caring Person. In 2011, he was named a distinguished alumni of the College of Education at Florida State University, and in 2016, he received the Locke/Paisley Mentorship award from the Association for Counselor Education and Supervision (ACES). In 2018, he received the Mary Smith Arnold Anti-Oppression Award from the Counselors for Social Justice, a division of ACA, as well as the U.S. President’s Lifetime Achievement Award. He was the 2019 recipient of the Lifetime Achievement Award from ACES.
One of Dr. Capuzzi’s most recent contributions to the profession was a webinar series titled Leading Lights in Counseling developed for Walden University in 2021. This series featured prominent scholars and practitioners who addressed pertinent issues and topics that impact the role of the counselor and other helping professionals.
Mark D. Stauffer, PhD, NCC, is a core faculty member in the clinical mental health counseling program at Walden University. He specialized in couples, marriage, and family counseling during his graduate work in the counselor education program at Portland State University, where he received his master’s degree. He received his doctoral degree from Oregon State University, Department of Teacher and Counselor Education.
Dr. Stauffer is the past president of the Association for Humanistic Counseling (AHC) and past cochair of the ACA International Committee, and he recently served on ACA’s Climate Change Task Force. He was a Chi Sigma Iota International Fellow and was awarded ACA’s Emerging Leaders Grant and the AHC Humanistic Leadership and Past President’s awards.
As a clinician, Dr. Stauffer has worked in crisis centers and other nonprofit organizations working with low-income individuals, couples, and families in the Portland metropolitan area in Oregon. Along with an existential-humanistic and systems theoretical orientation, he has studied and trained in the Zen tradition for 25 years and presents locally and nationally on meditation as well as mindfulness-based therapies in counseling. He also leads nature-connection community mentoring programs for youth. His current research projects focus on climate change and mental health as well as antiracism in counselor education.
In addition to Counseling and Psychotherapy: Theories and Interventions (2016), he has copublished with Dr. Capuzzi Foundations of Couples, Marriage, and Family Counseling (2015, 2021); Foundations of Addictions Counseling (2008, 2012, 2016, 2020); Foundations of Group Counseling (2019); Career Counseling: Foundations, Perspectives, and Applications (2006, 2012, 2019); and Human Growth and Development Across the Life Span: Applications for Counselors (2016).
Talana Butler is a second-year student in the master’s counseling program at Xavier University of Louisiana, where she serves as coordinator of the university’s Center for Traumatic Stress Research, working under the direction of Dr. Cirecie West-Olatunji. Ms. Butler’s research interests focus on clinical interventions for adjudicated youth. She is a graduate of the psychology program at Southern University (Baton Rouge, LA).
Julia Champe, PhD, core faculty at Walden University, teaches counseling theory, practicum, and research coursework in the clinical mental health and counselor education and supervision programs. A former co-owner of a rural private practice specializing in low-cost couple and family counseling, Dr. Champe has taught in counselor education programs in Wisconsin and Illinois. An avid group worker, Dr. Champe has written several articles on group work theory and practice and taught group work across the United States and in Japan. She currently serves as chair of the Product Development Committee for the Association for Specialists in Group Work and as an editorial reviewer for The Journal for Specialists in Group Work. She has cowritten extensively on counselor education and diversity, cultural competence, and inter-cultural communication. Dr. Champe’s additional areas of scholarly interest include supervision, counselor development, sexuality, multicultural issues, and qualitative research.
Lauren B. Clark, MS, LPC, NCC, is a current doctoral candidate in the counselor education program at the University of New Orleans. She serves as Doctoral Member-at-Large for Chi Sigma Iota-Alpha Eta chapter at the University of New Orleans and has published the journal article, “Utilizing Mindfulness Based CBT to Address Anger and Aggression in Middle Schools.”
Tatiana Cruz, MS, LMHC, is a licensed mental health counselor in New York state and current doctoral student at the University of Texas at San Antonio studying counselor education and supervision. She received her master’s degree in clinical mental health counseling at Canisius College in Buffalo, New York.
Thelma Duffey, PhD, is professor and chair in the Department of Counseling at the University of Texas at San Antonio (UTSA) and past president of the American Counseling Association (ACA). An ACA Fellow, Dr. Duffey was a longtime member of the ACA Governing Council and a two-term ACA treasurer. Dr. Duffey was the founding president of the Association for Creativity in Counseling, a division within ACA, and she is editor of the Journal of Creativity in Mental Health. Dr. Duffey has received numerous leadership and research awards from professional organizations, including ACA, the Association for Counselor Education and Supervision (ACES), the Southern Association for Counselor Education and Supervision, the Texas Counseling Association, the Texas Association for Counselor Education and Supervision, and the Association for Assessment and Research in Counseling. The Association for Creativity in Counseling established an award in her name. Dr. Duffey has over 60 peer-reviewed publications and four edited and coedited books. Her research interests include relational-cultural theory, developmental relational counseling, creativity in counseling, crisis and trauma counseling, and strengths-based leadership. She is currently spearheading a leadership academy initiative for faculty and doctoral students within her college. Dr. Duffey provided support and consultation in the Newtown, Connecticut, community following the shootings at Sandy Hook Elementary School and co-led efforts to provide crisis and trauma services to Sutherland Springs, Texas, and neighboring communities after the church shooting in 2017. Dr. Duffey codirects the Academy for Crisis and Trauma Counseling within the Department of Counseling at UTSA. During her tenure as ACA president, Dr. Duffey led a national antibullying and interpersonal violence initiative, and she currently leads efforts within the UTSA Department of Counseling to support the works of the David’s Legacy Foundation.
Roxane L. Dufrene, PhD, LPC-S, LMFT, NCC, is an associate professor of counseling in the Department of Educational Leadership, Counseling, and Foundations at The University of New Orleans. She holds a doctorate in counselor education from Mississippi State University and a master’s in counseling psychology from Nicholls State University. Dr. Dufrene has clinical experience in outpatient and inpatient state mental health treatment, college counseling, crisis intervention, training clinics, and collaboration in schools and private practice. She is a Louisiana licensed marriage and family therapist, a licensed professional counselor, a licensed professional counselor approved supervisor, and a national certified counselor. Dr. Dufrene is also certified in critical incident stress management and psychological first aid, has Louisiana appraisal privilege, and is an American Red Cross mental health counselor. Her research and teaching interests include disaster mental health, crisis counseling, student remediation, counseling ethics, qualitative and quantitative research in counseling, and supervision.
Cass Dykeman, PhD, is a professor of counseling at Oregon State University. He is the author of two books, 33 book chapters, and 46 peer-reviewed articles. His expertise includes the use of corpus linguistics, Bayesian statistics, and artificial intelligence in counseling research. Prior to working in higher education, he was an elementary and high school counselor in Seattle, Washington. Dr. Dykeman is past president of both the Washington State Association for Counselor Education and Supervision and the Western Association for Counselor Education and Supervision. His current research focus is on the use of natural language processing with counseling transcripts.
Mary Lou Bryant Frank, PhD, MS, MEd, is Fellow at the Institute for Higher Education at the University of Georgia and adjunct faculty at Middle Georgia State University and Brenau University. She is a licensed psychologist, court-approved mediator, consultant, and speaker. She served as vice president for academic affairs at Middle Georgia College, dean of undergraduate and university studies at Kennesaw State University, department head of psychology and sociology at North Georgia College and State University, head of the eating disorders treatment program at Arizona State University, and cofounder of the consulting group Transforming Mediation. Her book, The Mind of a Peacemaker: The Psychology of Mediation, is in its second edition. She has published in national and international journals on peacemaking, compassion, eating disorders, existentialism, and diversity. She served as the president of the International Academy of Dispute Resolution, president of Georgia Association for Women in Higher Education, and currently serves on the International Association of Dispute Resolution board of directors, the International Women’s Think Tank, and several international research counsels. She received the Distinguished Provider Award in Counseling and has been the recipient of grants, national leadership awards, teaching awards, diversity leadership awards, and awards for community service.
Judy W. Green, PhD, LPCC, NCC, NCSC, is a core faculty member in the clinical mental health master’s degree program at Walden University. Prior to joining Walden in 2008, Dr. Green was a tenured associate professor in counseling and human development at Walsh University, North Canton, Ohio, where she was also the school counseling coordinator. She is a licensed professional clinical counselor with supervisory status. She earned a PhD in counseling and human development services from Kent State University as well as two master’s degrees, one in early childhood development and the other in school counseling. Dr. Green has extensive experience working as a teacher, school counselor, and private mental health counselor. She has been serving as a counselor educator since 1995. Her specialty interests include group counseling, grief and trauma counseling, women’s issues, and child and adolescent counseling. She has worked as a volunteer mental health counselor for the Red Cross and trained both school and mental health counselors. She has presented widely at local, state, national, and international conferences. Her current research has taken her to Tanzania, one of the poorest countries in the world, every summer since 2009. Because counseling is not yet a profession there, Dr. Green conducts training seminars for local professional people to become mental health facilitators and is conducting research regarding the perceived self-efficacy of those who have received the training and are currently using their newly acquired skills.
Grace Greenan, MA, LPC, has been a counselor for 22 years. She received her bachelor’s degree in psychology from the University of Massachusetts and her master’s in professional counseling from Liberty University. She currently works as an associate vice president for people and experience in a hospital setting and maintains a private counseling practice. She is a student in the PhD program in counselor education and supervision with a concentration on leadership and program development at Walden University. Ms. Greenan’s research interests include the counselor-supervisor relationship, existential and positive psychology, and using mental health principles to improve work environments. She is a member of ACA, the American Psychological Association, and ACES.
Shane Haberstroh, EdD, is a professor of counseling in the Department of Educational Psychology at Northern Arizona University. Prior to that, he served as an associate professor, assistant department chair, founding codirector of the Academy for Crisis and Trauma Counseling, and doctoral program chair in counselor education and supervision at the University of Texas at San Antonio. Dr. Haberstroh completed two 3-year terms on the ACA Governing Council and chaired the 2018–2019 national ACA taskforce on licensure portability. He served on the 2020 national interstate compact advisory board for counselor licensure that developed the national interstate compact for professional counselors.
Laura R. Haddock, PhD, has been a counseling professional for over 25 years in both clinical and academic settings. She received her PhD in counselor education and supervision from the University of Mississippi and currently serves as a clinical faculty member at Southern New Hampshire University. Her clinical practice includes work with a variety of populations, with focus on identity issues and women experiencing significant life transitions. She is a licensed professional counselor-supervisor, national certified counselor, and approved clinical supervisor. Dr. Haddock is an active counseling professional and has served on the Mississippi Licensed Professional Counselors Board of Examiners and the executive boards for Mississippi Counseling Association and Mississippi Licensed Professional Counselors Association. She maintains an active research agenda and was the 2017 recipient of the ACES Distinguished Service Award–Counselor Educator. Her research interests include counselor wellness and secondary trauma, spirituality, sexuality, cultural diversity, and supervision.
Melinda Haley, PhD, received her master’s in counselor education at Portland State University and her doctorate in counseling psychology from New Mexico State University and was an assistant professor at the University of Texas at El Paso in the counseling and guidance program for 5 years. Dr. Haley currently works as a core faculty member in the counselor education and supervision doctoral program at Walden University. She has written numerous book chapters and journal articles on diverse topics related to counseling. She has extensive applied experience working with adults, adolescents, children, inmates, domestic violence offenders, and culturally diverse populations in the areas of assessment, diagnosis, treatment planning, crisis management, and intervention. Dr. Haley’s research interests include multicultural issues in teaching and counseling, personality development over the life span, personality disorders, the psychology of criminal and serial offenders, trauma and posttraumatic stress disorder, bias and racism, and social justice issues.
Richard J. Hazler, PhD, LPC, is professor of counselor education at The Pennsylvania State University. He is known for work in the areas of peer-on-peer abuse, youth violence, humanistic approaches to counseling, and counselor education. Professional work with youth began as an elementary school teacher and later as a school counselor and counselor in a university, the Army, a prison, and private practice. During 34 years as a counselor educator, Dr. Hazler’s research and experience have resulted in a wealth of journal articles, book chapters, and books. Some recent books on counseling youth include Breaking the Cycle of Violence: Interventions for Bullying and Victimization and Helping in the Hallways: Expanding Your Influence Potential (2nd ed.). A sample of books for counseling students and professionals includes The Therapeutic Environment, The Emerging Professional Counselor: Student Dreams to Professional Realities (2nd ed.), and Everything You Never Learned in Graduate School: A Survival Guide for Therapists. Dr. Hazler has a long history of serving the profession as president of state and national and professional organizations, including Chi Sigma Iota, the Association for Humanistic Education and Development, the Kentucky Counseling Association, and the Ohio Counseling Association.
Barbara Herlihy, PhD, NCC, is professor in practice and counselor education and supervision doctoral program director at the University of Texas at San Antonio. She is also professor emeritus in the College of Education and Human Development at the University of New Orleans. She is an ACA Fellow. A prolific writer, she is coauthor (with Gerald Corey and with Theodore Remley) of three current books on counselor ethics and coeditor (with Cassie Storlie) of a fourth book. She has authored or coauthored approximately 100 journal articles and book chapters, primarily on ethics, social justice, and feminist therapy. She currently serves as associate editor for ethics for the journal Counseling and Values. She has served twice as chair of the ACA Ethics Committee. She is a past recipient of the Southern Association for Counselor Education and Supervision Courtland Lee Social Justice Award and the ACES Distinguished Mentor Award. In recent years, she has become passionate about furthering the globalization of the counseling profession and has presented seminars and workshops across the United States and in other countries.
Adrianne L. Johnson, PhD, is an associate professor in the clinical mental health counseling program at Wright State University. Dr. Johnson is the executive editor for the Journal of Counseling Practice and has served as the president of the Ohio Counseling Association. She was awarded the National Advocacy Award by ACA in 2019 for her work with mental health legislation and counselor parity.
Kirsten W. Murray, PhD, is professor and chair of the Department of Counseling at the University of Montana. Her areas of interest and specialty include couple and family counseling, clinical supervision, and qualitative research. She has practiced clinically for 17 years, taught for 14, and is the author of the 2019 book Strong Couples: Basic Skills that Elicit Connection and Transform Relationships.
Kimberly Nelson, PhD, LPC, ACC, RYT, is core faculty in the clinical mental health counseling program at Walden University and is the lead faculty for couples and family counseling. Dr. Nelson received her master’s degree in psychology from Eastern Washington University and her PhD in counselor education and supervision from the University of Northern Colorado. Dr. Nelson is a licensed professional counselor; approved clinical supervisor; chartered psychologist in Alberta, Canada; and a disaster mental health volunteer for the American Red Cross. Her 25 years of experience in higher education are varied, including several years of teaching at traditional universities, with the last 17 years spent teaching exclusively in online graduate programs accredited by the Council for the Accreditation of Counseling and Related Education Programs. Her clinical work is diverse and includes community mental health, private practice, and assessment and counseling in schools from K–12. Her teaching and research interests include counselor wellness, mindfulness, therapeutic yoga, couples, and supervision. In addition to her teaching, she maintains a small private practice in Austin, Texas.
Rhemma D. Payne, MA, LMHC, NCC, ACS, is a doctoral candidate and contributing faculty at Walden University in the School of Counseling. Ms. Payne serves in a clinical capacity as therapist and owner in private practice, in leadership capacity as cocurator of Tapestry: Sister Circle mentorship group, and in service capacity as membership coordinator of Chi Sigma Iota–Omega Zeta chapter and secretary of the Monroe County women’s commission. Ms. Payne is a 2020 recipient of the National Board for Certified Counselors Foundation’s doctoral fellowship, awarded $20,000 for her service and commitment to serving underrepresented populations through research, practice, and advocacy.
Pamela G. Riley, PhD, NCC, LBS, LPC, received her master’s degree in clinical mental health counseling from Edinboro University of Pennsylvania, where she also completed her undergraduate degree with a major in sociology and a double minor in criminal justice and history. She completed her PhD in counselor education and supervision at Walden University. She is a licensed behavior specialist and licensed professional counselor in the state of Pennsylvania. She also has a certification in trauma-focused cognitive behavioral therapy. Dr. Riley has previous experience with children’s mental health service delivery in homes, schools, and the community. She works with others in a private practice and does outpatient therapy as well as medical-necessity psychological evaluations and psychological assessments. She also supervises master’s-level clinicians working toward licensure in Pennsylvania. Dr. Riley is just starting her own counseling practice, Empowerment With Grace, LLC. She has a passion for advocacy and for coaching and empowering others to self-advocate. She has presented at national and regional counseling conferences, and she has published in scholarly journals. Her research interests include Asperger’s syndrome, autism, trauma, and social justice issues.
Sidney L. Shaw, EdD, is a clinical professional counselor and core faculty at Walden University in the School of Counseling. He has been a mental health counselor since 2002, working with adults, adolescents, and families. His clinical experience includes working in rural community mental health in Alaska, school counseling, adventure-based counseling, medical clinic settings for Native peoples, private practice, and as a mental health consultant for Job Corps. He has conducted trainings and presentations at national, regional, state, and local levels. His research interests include feedback-informed counseling, common factors, multicultural counseling, suicide assessment, and counselor self-efficacy and self-assessment. He is a published author in peer-reviewed journals, including The Family Journal, Journal of Mental Health Counseling, Professional Psychology: Research and Practice, and Journal of Multicultural Counseling and Development. He has also published several articles in Counseling Today and codeveloped a professional training video on the topic of multicultural orientation in counseling.
Ann Vernon, PhD, is a professor emerita at the University of Northern Iowa, where she served as coordinator of the school and mental health counseling programs for many years. She also had a private practice, specializing in counseling children and adolescents. Dr. Vernon has published 23 books, as well as numerous chapters and articles. She is past president of the Albert Ellis Institute and is considered a leading expert on applications of rational emotive behavior therapy with youth. Currently, she is an international consultant, offering rational emotive behavior therapy trainings in various parts of the world. Dr. Vernon received the Distinguished Professional Service Award from ACES in 2019.
Cirecie A. West-Olatunji, PhD, is the Melba Fortuné Martinez Endowed Professor in the counselor education program and director of the Center for Traumatic Stress Research at Xavier University of Louisiana. She has received numerous awards from national organizations and has been recognized as an ACA Fellow. Nationally, Dr. West-Olatunji has initiated several clinical research projects that focus on traumatic stress and systemic oppression. Her publications include three coauthored books, numerous book chapters, and over 50 articles in peer-reviewed journals. Dr. West-Olatunji has delivered research papers throughout Asia, Africa, Europe, and the Americas.
Robert E. Wubbolding, EdD, presents workshops of practical demonstrations on how to counsel a wide variety of clients. He is director of the Center for Reality Therapy in Cincinnati, Ohio; professor emeritus at Xavier University; and director of training for the William Glasser Institute (1987–2011). Dr. Wubbolding has taught reality therapy in Asia, the Middle East, Europe, and North America. A counselor and psychologist, he has been a high school counselor, elementary school counselor, a halfway house counselor for ex-offenders, and a consultant to the drug and alcohol abuse programs of the U.S. Army and Air Force. He is a qualified trauma therapist. Dr. Wubbolding is author of 18 books, including Reality Therapy and Self-Evaluation, published by ACA in 2017, as well as author of 40 chapters in textbooks. In October 2005, he was awarded Outstanding Graduate for the 1970s decade by the University of Cincinnati Counseling Department. He received the “Legend of Counseling” award at the ACA Annual Conference in Hawaii in 2014, and the “Friend of Singapore” award in 2016. He has introduced reality therapy in Romania, Malta, and South Korea, among other countries.
Mark Young, PhD, is an associate professor at Gonzaga University, where he serves as director of the marriage and family counseling program in the Department of Counselor Education. His research interests are healthy couple relationships and live supervision. He has written several articles and book chapters in the areas of couples counseling and supervision.
Anthony Zazzarino, PhD, is an assistant professor at Rutgers University in the Department of Psychiatric Rehabilitation and Counseling Professions, where he is core faculty in the master’s program in rehabilitation counseling and the doctoral program in psychiatric rehabilitation. Dr. Zazzarino is the field experience coordinator for the counselor education and supervision track. Dr. Zazzarino is actively presenting at local, state, national, and international conferences related to sexual, affectional, and gender identity; multiculturalism; psychiatric rehabilitation methods; counseling services; substance use disorders; housing; and supervision practices. Furthermore, he has an extensive clinical history providing supportive services to adults with a serious mental illness living in supported housing agencies and continues to conduct clinical work today. Dr. Zazzarino provides group therapy for adolescents and adults at an intensive outpatient program, outpatient counseling services at his private practice, and clinical supervision for counselors who need supervised clinical hours in New Jersey.
David Capuzzi, Mark D. Stauffer, and Rhemma D. Payne
Studying theories of individual counseling and psychotherapy is simultaneously challenging and enlightening and usually marks the beginning of a long-term journey to develop one’s personal theory of counseling. The process is challenging as there are so many options from which to choose to guide one’s practice because theories, though different conceptually, all have one thing in common—the importance of developing a therapeutic alliance with a client. Through the counseling relationship and the therapeutic alliance that develops, client change occurs. Although the creation of this relationship is not the end goal of the process, it certainly is the means by which goals are met. It serves as the framework within which effective helping takes place. In addition, even though use of each theory is dependent on the helping relationship, each theory presents a different model for case conceptualization and treatment planning and uses a variation of aligned techniques and interventions.
Most beginning counselors experience doubts and insecurities about how theories help counselors navigate their work with clients, and more specifically, how they will use theories in their own practice. What are they nervous about in their study and application of counseling theories? Some counselors have an overwhelming sense that they must quickly or eventually choose one theory to work from and then faithfully hold to it (in a limited and an uncreative way). Others worry that working from any theory will box in or limit their view of the client. How can one theory capture a person’s lived experience? How can one theory be used across multiple clients with diverse cultural intersectionalities? Intersectionality means that “different aspects of one’s identity are not exclusive of each other, but rather inform the construction of each other in reciprocal ways” (Brinkman & Donahue, 2020, p. 109). These questions and others like them must be kept alive by counselors in their living practice. At the same time, use of theory is intended not to limit who a client is but rather to help a client change through a specific path or lens. This is one path among possible helpful paths.
Rather than thinking that there is only one theory that can help a client, consider that therapy from multiple theories may help the same client. The first question may be, are certain theories more or less appropriate given the circumstances and the client’s cultural intersectionalities? Second, how do those relate to how you, as a counselor, are able to work with clients? Examine the mechanism for how a theory creates change in a client’s life (e.g., through insight, behaviors, emotion, catharsis, or cognitions) and realize that success through one mechanism leads to changes in other aspects because growth is systemically interdependent. Thus, a transformative existential insight in therapy will likely cause secondary behavioral, relational, emotional, and systemic changes. Can you think of how you created a change in your life in one area, such as your thoughts, behaviors, relations, or in your bonding with others, that then created a ripple of secondary changes, and then tertiary changes? Adept counselors clearly understand the range of theories, mechanisms of change, and advantages to different systems of therapy even if they have a theoretical focus. Additionally, students of counseling often think that they are coming to the helping profession without personal, cultural, and familial notions of helping. Without thorough examination of different theories and techniques of helping, they may develop a therapeutic relationship and simply default to the ideas of helping from their family of origin. These are not necessarily wrong; however, mastery as well as helping diverse clients goes beyond a counselor’s default as a professional.
Some counselors-in-training initially try to apply attending, building rapport, and helping skills without a helping theory and find themselves lost in medium-and long-term work with clients. The study of theories will often be at the beginning of coursework for necessary growth and understanding throughout the program, but often it is taught before one works with clients, which makes the application of theory harder to understand. As a suggestion, they should review this book during their program as well as to guide their practicum and internship; in the meantime, they should examine how individuals, families, and groups change in their lives, and, of course, watch counseling videos from different theoretical lenses with current and culturally relevant scenarios. In this book, we have tried to make it as easy as possible to learn about available options to guide counselors’ and therapists’ preparation and actual work with clients. Because this is a foundations text for broad synthesis and introduction to various theories, we encourage counselors and therapists to find landmark resources, current adaptations, and new research to deepen their work in the theories they pursue.
Notice that each chapter from Chapters 2 through 17 addresses the theory under consideration using the same headings and subheadings; this enables the reader to compare concepts, areas of focus for follow-up when developing treatment plans, and the goals and techniques used to achieve preferred outcomes for clients. More important, all stages of work with a client must be theoretically aligned, even if there are core dimensions to a helping relationship. For example, viewing a case from a psychodynamic lens and then using a cognitive behavioral strategy or intervention will not work, let alone make sense. We will introduce how theories are integrated, because many are harmonious and the way that the case is conceptualized may allow for various theoretical strategies.
Before we turn attention to integration, much of this chapter will focus on factors that affect the helping relationship: definitions and descriptions, stages, core conditions, and strategies. In addition, we discuss multicultural and social/cultural orientations as a necessary element of counseling and psychotherapy from theoretical conceptualization to intervention.