Activities and Interventions

The program will consist of implementing an initial one hour individual intake session, scheduled individual sessions with a career counseling professional, and participation in group sessions. During the course, the client will be assessed and evaluated for an accurate formulation of a career plan. Since treatment for this particular population spans from three to four months of intensive outpatient participation, clients will be referred if they are eligible for substance abuse counseling and are required to maintain employment as part of their treatment or are interested in developing skills to expand employment options. The general criterion for eligibility for career services is participation in the IOP treatment at the mid-Bergen Care Plus. Additionally, since typically a client participates in group therapy sessions three types per week, Tuesday through Thursday, group career development sessions will be offered on each of those days, one group session for 45 minutes before their prescribed substance abuse treatment and one session for 45 minutes after the prescribed regimen. This will allow the clients’ flexibility in scheduling participation in group sessions and minimizes schedule conflicts with their IOP. Clients will have the opportunity to attend group sessions recommended by the career counselor or simply attend for knowledge attainment. Group session topics will be recycled every 12 weeks to allow clients to take full advantage of all topics discussed. Individual sessions may be scheduled weekly, biweekly or monthly. The intensity will be based on the primary substance abuse treatment intensity, the nature of the treatment, and individual needs.

Individual career counseling sessions will be available and recommended for the duration of the client’s treatment, depending on individual needs, to assist the client in the various phases of career development. Interventions and activities will be centered on Holland’s RIASEC theory of vocational personalities which has been successfully applied to vocational life in recent decades (Holland, 1997). Some of the themes that will be facilitated throughout the career counseling process include: an increased awareness of career decision-making and vocational self, identification of career alternatives, making conditional and mainstay choices, job security, employment maintenance and the opportunities for expansion of career options.

Awareness of career decision-making and vocational self concept

The initial focus will be centered on the collection of information from the client and the organization of this information in order to understand where the client fits in relation to Holland’s RIASEC personality types. Formal and informal assessments (described below) will be utilized in order to learn about the client’s extent of congruence; the consistency of the client’s interests and abilities in order to understand who they are and how they make effective career decisions; whether or not they are differentiated according to their code; and the discernment of individual life roles. The following activities and interventions will be implemented:

1. A structured intake interview will be employed to learn about the client’s interests, values system, hobbies, previous employment, and life roles including family and support systems, specific multicultural needs, abilities, and/or challenges that may affect career development.
2. Use of an assessment instrument will provide information about the degree of awareness the client has and his or her needs as he or she enters the career planning process. The client will be guided in expanding his or her options according to what was shared during the interview. This will help the client develop sensible career options. The assessment system utilized will be The Self-Directed Search (Holland, 1985) through the use of computer technology in which a comprehensive report will be provided and results and interpretations will be discussed with the counselor. The client will be instructed to take the instrument on site from the internet. Should the client not be experienced in the use of a personal computer and/or the internet, the counselor will assist the client through the systematic process. For those clients with a moderate computer experience, a handout will be supplied as well as a quick walk through to familiarize him or her with the use of the program.
3. Informal assessments will include a values checklist (see appendix) which will be used especially with those clients who have difficulties expressing themselves in the interview. Here, the client will focus on him or herself in finding interests that satisfy the work experience, discover abilities to perform specific occupations, and make choices congruent with his or her personality.
4. The client will be educated on Holland’s typology to provide a structure andvocabulary the client could use to increase his or her self-understanding and sort through prospective occupational options (Niles, pg. 239).

5. Preliminary goals for career counseling will be identified and documented including all contextual factors discussed in # 1.

The SDS is a vocational assessment instrument based on Holland’s personality model in which an individual’s personality and presumed work environment are assessed in an effort to predict a successful work experience. The directions of the manual are clear and include diagrams that allow the users to understand how to maneuver the program. Because the instructions are easy to understand, this makes the system easy to operate and therefore instructions easy to follow by the test-takers. The computerized version (SDS:CV ) (Reardron, 1987) will be used and the administration time for this assessment is approximately 30-40 minutes. This works well because it fits during session times since time is a commodity for most people.

The format for interpretation utilized by the SDS is detailed, perhaps too detailed and overwhelming for some of our clients who are facing multiple challenges. However, if the client chooses to interpret results on his or her own, a precaution is reported in the manual that offers clients no guarantee that any of the occupations would be satisfying, nor does it guarantee the person has the necessary abilities, skills, or educational background necessary for a particular occupation (McKee & Levinson, 1990). For this reason, the program will be used to identify preliminary occupational options as a starting point in the process with assistance from a career professional.

This program was chosen because of its intensive research supporting the system. The system has different forms (R, E, CP) and can be used with clients with diverse educational and racial backgrounds with various needs. A strong range for reliability (correlational coefficients were .90 – .94) was demonstrated in the summary scales in the norm-referenced sample of 2,602 students and working adults. Different individual scales ranges were on a lower less acceptable range starting at .72 although based on Brown’s review (1994) it is not clear which scales resulted in lower internal reliability. The stronger reliability was demonstrated for form R which is directed toward working adults and students. However, comparability is somewhat limited to the population intended because the sample size consisted of mostly women with a mean age of 23.5. Therefore, this allows for an assumption that a good portion of the sample size consisted of mostly students, which is not comparable to the population proposed for in this request. Additionally, the sample size for the other two forms E and CP are smaller, thus leaving more room for reporting biases. Another drawback (Brown, 2004) is the limited evidence demonstrated in predictive validity by following up with the test takers and establishing how accurate the results matched the person’s ultimate occupational choice and satisfactions.

The proliferation of computer technology has allowed for the SDS to become available in computer format. When comparing the paper and pencil and computer version, evidence demonstrates that there are no statistically significant differences between the formats (Reardon & Loughead, 1988). Since it is assumed Form R will be the most in use, with the assistance of a career professional, the SDS will be made available for our clients as a starting point in the exploration of occupations. Although it does have reported limitations, overall, the SDS system is dependable, consistent, and stable Moreover, because of the inclusive good reviews and a great deal of utility for a variety of career development application reported, including the long history of its use of (Brown, 2004) this instrument is considered helpful for our population.

Identifying occupational alternatives

Here the client’s goals are explored and refined and the client will be encouraged to clarify his or her life-role saliency thus, polishing occupational options in order to develop a specific plan. The client will work with a counselor in identifying those occupations in which he or she can implement his or her vocational identity. The following will be used and implemented to proceed through this process:

1. The Occupational Outlook Handbook (OOH) will be used so that the clients have access to information of over 250 occupations (185) to help them in identifying their choices.
2. The database, O*Net (U. S. Department of Labor, 2000) will allow the client to relate information about themselves in many different ways, focusing on single characteristics or a combination of characteristics (Niles, 2005). Since this database provides instruments such as the, O *Net Interest Profiler, (see Appendix for a demonstration) designed to measure interests by Holland’s six personality types (Niles, 2005), clients will have the opportunity with the counselor’s assistance, to identify occupations with which they match, what their interests are and how they relate to the world of work (U.S. Department of Labor, 2000).
3. The client with the counselor will formulate a list of occupations guided through the use of the SDS, OOH and the O*Net database.

O*Net is also a self-assessment of career exploration and because clients will have access to the O*Net Interest Profiler (U. S. Department of Labor, 2000) through the database, it will be used as a tool in early identification of interests in an effort to narrow down or expand on career possibilities for our clients. This tool is developed by the U.S. Department of Labor and requires approximately 20- 60 minutes to complete. This instrument was chosen because of its compatibility with Holland’s personality typology. Another attractive feature about this system is its usability in a group administration format, where the use of the Interest Profiler by several clients is guided by a professional counselor (Brown, 2004). It is also applicable for persons with a variety of cultural backgrounds.

Reliability and validity data were gathered with a sample of 1,061 from a variety of settings including schools and agencies. Internal reliability was strong with coefficients ranges from .93 to .96 for the scales in the system and test-retest reliability coefficients of .81 to .92 with 1 month retest, which are also acceptable. Limitations are apparent with the O*Net Interest Profiler including the inconsistencies amongst the RIASEC scales. For example, the Enterprising scale correlates too highly with the Artistic scale but not enough with the Social scale (Brown, 2004) which might pose challenges in the identification of degree of consistency within personality types which are supposed to have higher degrees of consistency according to Holland’s (Niles, 2006) Hexagon model. Although is known that no instrument is completely valid, it is important to know the extent of systematic error because of the possible invalid inferences that can be made from the scores.

An O*Net database advantage is the availability of its system through the O*Net website free of charge, which is attractive to many people. Also, clients may be given homework assignments which may include a search through the system of which instructions are easy to follow. This system also adds a nice supplement to our assessment procedures.

Making provisional choices

Clients will be assisted in narrowing down choices through the use of structured interviews and career fantasy (Niles, 2005) activities through individual sessions in which the individual will be stimulated by a set of instructions in an effort to visualize employment and lifestyle fantasies and determine those with the highest priorities from the identified options list. In an effort to identify codes and their matching occupations, The Occupations Finder (Niles, second source) and the The Dictionary of Occupational Titles, will also be utilized in an effort to provide finer choices for our clients.

Guest speakers will be invited to participate in group experiences to expose the clients to diverse occupations in which they will talk about work life in specific skilled and non-skilled occupations. The clients will also have the opportunity to ask questions. This will ease an understanding of a clearer vocational identity and increase the degree of differentiation since the face-to-face contact may help some clients identify more with certain jobs.

Follow-up activities such as group and/or individual sessions will be offered, before the phase of making a choice, so that the clients will have the opportunity to share and analyze what they’ve learned, further explore options, and implement the process of decision making.

Implementing a choice

To ensure the continuation of the career counseling process, clients will be educated through the use of videos, interactive computer programs, discussions (individual and group), and literature. However, maintaining a good attitude is a crucial first step in the job search course and therefore feelings and attitudes should be managed in order to begin the transition. Employing these skills may be challenging for some clients because of the nature of their substance abuse history. Although all of our clients will be involved in substance abuse group and individual counseling through Care Plus, clients will be encouraged to expand on what was learned during those sessions and apply them to the work situation. Special needs for ex-offenders will be outlined and empathically discussed and opportunities to learn methods during the job search will become available. Concrete job searching skills taught through means already discussed are within the areas of:

1. Locating job openings
2. Resume writing
3. Filling out job applications
4. Interviewing techniques
5. Dressing for success
6. Job and salary negotiation
7. Making the decision

Clients will be educated on how to formulate an individualized written job plan with specific goals and objectives that are attainable according individual needs and skills. To increase self-responsibility and sense of autonomy, independent assignments will be given to clients. Examples of such assignments include choosing jobs in help wanted ads, surfing the internet, networking about job opportunities and discussing those during the next session.

Maintaining employment

All activities and intervention strategies used will help clients understand what is needed in order to preserve a stable career. Through individual and group sessions with the utilization of bibliotherapy (the use of reading materials to increase client awareness of their own and others problems to develop new insights), videos, discussions, role-playing, and demonstrations, strategies on personal development such as stress management, anger management, time management, and others will be implemented. Interventions will be geared towards pscyhoeducational reinforcement from regular substance abuse treatment centered on career related issues. These include:

1. Anger management skills training. Through the use of behavioral rehearsal in hypothetical diverse situations encountered at work, clients learn how to resolve work related discords while managing anger feelings appropriately. All the techniques will be practiced during group to help clients consolidate the use of new anger management skills in the real world of work. Clients will also be educated on how to identify ways he or she handles anger and the negative consequences that may result in the work environment if actions are not healthy.
2. Stress Management skills training. Client will be taught relaxation techniques such as paced breathing and calming imagery for responding to stress. Role rehearsal will be utilized to reduce anxiety during the job search and increase chances of a more positive experience in the employment situation. Clients will also be guided to explore the effect of work stress on interpersonal dynamics with family and friends.
3. Assertiveness training. The use educational techniques on the determinants of successful verbal communication will be employed which includes instruction, modeling and role playing in assertive communication. Included topics will include the right things to say and not to say to an employer or coworker in diverse hypothetical situations.
4. Exploration of the client’s transfer of personal problems to the employment

situation. Client’s will be asked to identify and rehearse possible situations and circumstances that may occur in various life roles which lapses to anger may occur and how these may influence the role as an employee. Clients will be guided to explore behavioral patterns of interpersonal conflict that may be repeated in a work setting even if they haven’t occurred there yet.

5. Conflict Resolution. Through the use of handouts and videos followed by discussions, clients will be educated on how to comply with supervisor directedness, coworker’s employment habits and violation of work spaces, and how to find alternatives to coworker and/or supervisor conflict.
6. Time Management. Clients will be educated on new approaches to manage

self and time. The formulation of timelines and “to do” lists will be introduced and demonstrated.

7. Leisure Education. Group sessions will be facilitated about the importance of leisure time, management of leisure, and social interaction skills through group activities. Leisure lifestyle awareness will help clients’ self-knowledge in terms of leisure values, beliefs, and attitudes, particularly as they relate to difficulties surrounding career development.

Pursuing expanded employment

The federal “Second Chance Act of 2005” calls for expanding reentry services for people leaving prison, yet existing policies restrict access to needed services for those with criminal records (Pogorzelski et al, 2005). In order to reduce recidivism, people with criminal records should have a positive experience in society by having access to resources and opportunities that encourages positive participation. Our clients, many of which have criminal records, may be interested in pursuing expanded employment and part of that may alert them of the need for more education. Many have already experienced the stigmas attached to their lifestyle choices and unfortunately engaging in certain jobs or more education, may continue to solidify these experiences through the public policies in New Jersey that restrict educational and employment opportunities. Such restrictions are as follows (Pogorzelkis et al, 2005):

Employment lifetime restrictions:

• Potential for employers to ask about arrests and convictions
• Denying of applications for certain types of professional licenses
• The mandatory reporting of convictions on employment and license applications
• Banning of 22 categories of employment, depending on type of conviction, including public sector, public schools, housing authorities, New Jersey Turnpike Authority, airports, banks, and places where liquor is served or sold
• The requirement of criminal background checks for jobs in substance abuse counseling, nursing home staff, social workers, hazardous waste workers, work with mentally ill clients or home health care (conditionally)

Education restrictions:

• Admission to colleges and universities is at the institution’s discretion for any conviction
• Provisional restriction: persons with drug convictions may be ineligible for aid until a treatment program has been completed. For a conviction for possession or sale of drugs during the school year, any aid received after conviction must be repaid
• Persons with drug convictions may be ineligible for financial aid for 1 to 2 years after first or second offense, and permanently ineligible after third offense

The career program proposed will acknowledge these restrictions but will also facilitate reentry by educating the clients on what to expect when attempting to make employment and educational transitions and how to prepare a plan for successful career reestablishment. Strategies will be discussed primarily in group sessions geared toward the career life of an ex-offender.

Since many of our clients have criminal records for drug related convictions but are willing to rehabilitate, an effort is placed on the expansion of options for people with this type of background. This eases their apprehension and through group sessions, will be exposed to the unique challenges, both obstacles and opportunities and how to manage these. The positive learning atmosphere will increase their motivation to resume or begin a productive career establishment. Written activities and group processing will provide an outlet for solutions through their own ideas and feedback. The handouts will provide tangible information in facilitating the learning experience beyond the program.

1. Cognitive-behavioral therapy

Cognitive-behavioral theories (CBT) are best conceptualized as a general category of theories, or set of related theories, that have evolved from the theoretical writings, clinical experiences, and empirical studies of behavioral and cognitive oriented psychologists and other mental health workers (Capuzzi & Gross, 2003). Cognitive-behavioral therapies evolved from the workings of Albert Ellis’s Rational-Emotive Therapy in 1962, Cognitive Therapy associated with Aaron Beck 1962, and Self Instructional Training developed by Donald Meichenbaum in 1969.

CBT involves an amalgamation of techniques from different treatment approaches, cognitive and behavioral modification, which reflect the importance of understanding and helping clients. Such a marriage between two approaches results from a deficiency in one or both of the methods in bringing about the desired counseling outcome (Thompson & Henderson, 2007). CBT is based on an idea that cognitions lead to behavioral change with the goals being best viewed in terms of developing insight into current thoughts, how these are manifested in behavior, what contingencies are preserving these behaviors and which interventions are more likely to encourage the process of change.

In terms of children and their families, Cognitive-Behavioral approaches reinforce the idea that mediating cognitions can greatly affect the interactions between caregivers and children and therefore, is more effective when both parties are included in treatment. For instance, when parents continually put their children down, these children may begin making negative self-statements toward their self-worth. For this reason, in addition to the children’s autonomic thoughts being addressed, so are the parental behaviors toward their children.

1. Developmental perspective

CBT is not based on the idea that human development takes its course in stages like other theories imply. It is based on the assumption that behavior is learned and it is maintained by environmental reinforcers and internal processes such as thinking patterns. Hence, an individual’s learning experience and the way he or she understands the world is the basis for that person’s human nature.

III. Major constructs CBT

Cognitive-behavioral interventions target both cognitive and behavior deficiencies and excesses (Capuzzi & Gross, 2003). It also places focus on dysfunctional cognitions, learning theory, interpretations, external contingencies, and the therapeutic relationship.

1. CBT interventions

Cognitive Interventions focus on targeting cognitive schemas, or assumptions people have about other people, events, and/or environment that may be distorted. Becoming aware of these negative schemas and replacing them with healthier thinking patterns will allow the client to achieve his or her goals. The following are some cognitive distortions:

• All-or-nothing thinking: Something has to be exactly what one wants or it is considered a failure.
• Catastrophizing: The exaggeration of a negative event so that it has much more impact that it deserves.
• Mind reading: Believing that we know what other people are thinking about us.
• Overgeneralization: Making it a rule that when a few bad events occur, every single similar event after that will be negative as well.
• Magnification or minimization: When individuals expand on imperfections and reduce good points.

Behavioral interventions focus on changing exclusive behaviors. The following are some behavioral interventions:

• Reinforcement: The utilization of a positive reinforcer that is followed by a reward for good behavior. Negative reinforcement is the removal of something aversive to increase behavior. Extinction involves withdrawing something that encourages the individual to stop the behavior.
• Shaping: Gradually moving from negative behavior to a more positive behavior and reinforcing the behavior that brings a person closer to the desired outcome.

Stress-inoculation training (SIT) involves the idea that individuals deal with stressful behaviors by changing their beliefs about the behaviors. It can be used with role-playing, relaxation techniques, self-talk and reframing exercises that help children replace their anxiety with relaxation.

1. Working with caregivers

Parents should increase awareness of how they may be contributing to unhealthy behaviors displayed by their children. For example, parental intrusiveness can manifest in a least 3 domains: unnecessary assistance with children’s daily routines, infantilizing behavior, and invasions of privacy (Wood, 2006). Sessions with the child in addition to educational sessions with parents may emphasize: awareness of child-rearing styles; allowing children autonomy in making decisions for the development of increased problem-solving skills; and acknowledging appropriate behaviors through an incentive system.

1. Multicultural Issues

When applying principles of CBT, one should always remain aware of cultural influences amongst children who come from families with diverse belief systems, some which may be misconstrued as distorted schemas. In addition, some cultures rely heavily on their families, or a figure in the family to make decisions. CBT techniques should be presented in a way that will allow for true schemas to be modified while respecting individual cultural values. Often children who are first generation Americans are torn between their cultural values and American values. Issues of acculturation should be addressed as conflicts arise between children and their families.