Integrating life-design counseling and psychotherapy: possibilities and practices.

Author:Cardoso, Paulo
 
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The debate on the relationship between career counseling and psychotherapy revealed the close relationship between psychosocial and career issues. The connection between these 2 approaches paves the way for the integration of career counseling into psychotherapy. In this article, the Systematic Treatment Selection (Beutler & Clarkin, 1990) perspective in psychotherapy is presented as a framework for guiding career counseling integration into psychotherapy. Then, the author describes life-design counseling, underlining its possibilities for integration with psychotherapeutic practices. Finally, the author presents and discusses a case study to illustrate the complexity of this integrative process.

Keywords: career construction counseling, integration, life design, psychotherapy

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The relationship between career counseling and psychotherapy is not a new subject (Mcllveen, 2015). The debate on this relationship (Subich, 1993) allows the affirmation of career counseling as a dimension of personal counseling and recognizes the close relationship between psychosocial and career issues (Blustein & Spengler, 1995; Mcllveen, 2015). The connection between these two approaches paves the way for the integration of career counseling with psychotherapy. Indeed, the inseparability of mental health and career issues frequendy leads psychotherapists to help their clients to deal with work satisfaction, underemployment, or unemployment through psychotherapy. Moreover, when working with specific populations, such as people with intellectual disabilities and people with addiction or mental health problems, psychotherapy calls for integration with career counseling to consolidate and enhance therapeutic gains (Blustein, 1987; Jordan & Kahnweiler, 1995; Leff & Warner, 2006).

Recognizing the links between career counseling and psychotherapy, this article primarily aims to present the Systematic Treatment Selection (STS; Beutler & Clarkin, 1990) perspective as a framework for an effective integration of psychotherapy and career counseling. The perspective of career counseling and psychotherapy integration presented here is grounded in a view of integration that is best described as a process of "informed differentiation" (Vasco, 2001, p. 220), which implies the sequential or complementary use of assessment tools, concepts, and interventions from different theoretical orientations (and worldviews) to capture the complexities and maximize the efficacy of therapeutic interventions (Vasco, 2001). First, I present the STS framework. Then, I describe life design in the form of career construction counseling (Savickas, 2011), underlining its possibilities for integration with psychotherapeutic practices. Finally, I present and discuss a case study to illustrate the complexity of this integrative process.

STS: Fitting Career Counseling to Client Characteristics

The STS framework is a technical eclectic approach designed to tailor treatment to client needs. It allows indicators from identifiable client and environmental characteristics to be used by counselors to guide treatment selection, regardless of their theoretical perspectives (e.g., behavioral, cognitive, or psychodynamic). Individualizing treatment based on the client's needs is regarded as a process that takes into account four classes of temporally related variables: client variables, relationship variables, treatment context, and tailoring strategies and techniques (Beutler & Clarkin, 1990; Beutler, Consoli, & Lane, 2005).

Client Variables

Client variables include the client characteristics brought into treatment and provide indicators for matching the intervention techniques to the client. Research in psychotherapy suggests the relevance of the following client variables: problem severity, problem complexity, coping style, and levels of reactance (Beutler & Consoli, 2003). Problem severity is defined as impairment in the capacity of the client to tackle social, occupational, and interpersonal demands of daily life (Beutler & Consoli, 2003). When career counseling is integrated into psychotherapy, the assessment of problem severity is especially relevant, for example, to favor a client's transition to the labor market. This assessment facilitates the anticipation of barriers and supports career development and, therefore, is fundamental to planning the transition to the labor market.

Problem complexity is characterized by enduring repetitive patterns of behaviors that are intended to solve a problem, but often result in suffering. In a narrative framework, problem complexity is expressed by a redundant self-narrative and, consequently, rigidity in coping or adjusting to new experiences. That is, individuals are prisoners of redundant constructions of their experiences and, therefore, are incapable of using alternative ways of coping and adjusting to novelty (Cardoso, 2012). Research on career counseling processes suggests that intervention is less effective when addressing complex problems (Stauffer, Perdrix, Masdonati, Massoudi, & Rossier, 2013), should be conducted for a longer period of time (Heppner & Hendricks, 1995; Janeiro, Mota, & Ribas, 2014), and should be performed using the most supportive style of career counseling (Anderson & Niles, 2000; Rochlen, Milburn, & Hill, 2004). In these cases, it is imperative to help clients integrate career difficulties in the matrix of the core themes that organize their experiences. This support facilitates problem comprehension by reconsidering the roots of the problem and understanding the role of career plans in addressing psychosocial problems.

Closely related to problem complexity, coping style refers to patterns of defenses used to preserve a sense of self and maintain internal consistency (Beutler & Clarkin, 1990). The assessment of the role of coping styles in career difficulties is critical to fitting career counseling tasks to client needs (Janeiro et al., 2014). As far as career counseling is concerned, the difficulties in recognizing interests, aptitudes, or values could be related to an internalizing coping style, in which the client limits contact with internal experiences. In these cases, research in psychotherapy suggests the importance of using career counseling procedures that foster emotional arousal to facilitate vocational self-concept clarification (Beutler & Consoli, 2003). These procedures are also regarded as complementing psychotherapeutic support to overcome the limitations of an internalizing coping style.

Reactance is conceptualized as client noncompliance resulting from the failure to fit the intervention to client characteristics (Beutler, Harwood, Michaelson, Song, & Holman, 2011). A feature of reactant clients is their sensitivity to being controlled by others and, consequently, their resistance to directive practices (Beutler & Harwood, 2000). Reactant clients are more likely to resist career counseling to avoid the responsibilities of career decision making (Gysbers, Heppner, & Johnston, 2009) or directive practices, such as educational tasks (e.g., giving information) and recommendations for career exploration between sessions.

Relationship Variables

Relationship variables contribute the most to enhancing the working alliance. Among these variables, client and counselor demographic characteristics (e.g., age, gender, ethnicity, social and cultural background), interpersonal response patterns, expectations, and beliefs are regarded as key because of their importance in promoting client-counselor compatibility (Beutler & Clarkin, 1990). Psychotherapy research suggests that demographic similarities between the client and counselor strengthen the working alliance--an effect particularly relevant among disadvantaged populations (Beutler & Consoli, 2003). These findings are consistent with the vocational psychology literature suggesting that counselors should be culturally competent to adapt their practices to the clients' experiences and develop the proximity needed for a successful counseling relationship (Fouad & Kantamneni, 2013). Among demographic client characteristics, age has proven to be an important variable in career counseling effectiveness. In fact, research has revealed that intervention is more effective with younger clients (Perdrix, Stauffer, Masdonati, Massoudi, & Rossier, 2012; Stauffer et ah, 2013).

Interpersonal response patterns express the client's needs for attachment and affiliation, which range in a continuum from the individuals who desire affiliation, dependency, relatedness, and recognition to the individuals striving for distinction and autonomy from others (Beutler & Consoli, 2003). When career counseling is integrated into psychotherapy, the counselor must be attentive to the clients' interpersonal patterns to ensure the continuity of psychotherapeutic work in the career counseling tasks. For example, with a dependent client, it is important to encourage autonomy in solving career problems and resist subtle client requests to be told what to do or what to decide.

The compatibility between counselor and client beliefs and expectations is also crucial to strengthening the working alliance. Research in psychotherapy (Bordin, 1979; Horvath, 2005) and career counseling (Masdonati, Perdrix, Massoudi, & Rossier, 2013; Tinsley, Tokar, & Helwig, 1994) has suggested that the counselor and client should agree on intervention goals and tasks to increase the level of involvement and counseling effectiveness. Typically, clients expect the use of psychological tests in career counseling and the counselor's advice on the right career (Cardoso, Taveira, Biscaia, & Santos, 2012). These expectations do not fit practices emphasizing meaning making, such as career construction counseling. Therefore, it is appropriate to educate the client about career counseling goals and tasks to strengthen the working alliance, as well as integrate career counseling within the context...

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