Counselor-client agreement on session impact.

Abstract

We propose a new framework for understanding studies of counselor-client agreement about their counseling. The framework includes five factors: the scope of counseling being studied (process, impact, or outcome), the dimension (index) being rated (in this study, session Depth, Smoothness, Positivity, or Arousal), the measure used to assess agreement (correlations or absolute differences), the level at which the analysis is conducted (session, client, or counselor), and the type of agreement--(a) consensus, the similarity of counselors' own ratings to clients' own ratings; (b) counselor awareness, the similarity of counselors' perceptions of their clients to clients' own ratings; (c) client awareness, the similarity of counselors' own ratings to clients' perceptions of their counselors; and (d) matched awareness, the similarity of counselors' perceptions of their clients to clients' perceptions of their counselors. In a study of session impact (scope), degree of agreement was found to vary substantially with each of the other factors--type of agreement, dimension rated, measure of agreement, and level of analysis. The answer to the question Do counselors and clients agree about their counseling? is another question, What do you mean by agree? Studies comparing counselors' and clients' ratings of their counseling and psychotherapy sessions have returned correlations that range from negligible to moderate (Berzins, Bednar, & Severy, 1975; Carkhuff & Burstein, 1970; Caskey, Barker, & Elliott, 1985; Garfield, Prager, & Bergin, 1971; LaCrosse, 1977; Mintz, Auerbach, Luborsky, & Johnson, 1973; Mintz, Luborsky, & Christoph, 1979; Orlinsky & Howard, 1975; Schwartz & Bernard, 1981; Shapiro, Struening, Shapiro, & Barten, 1976; Stiles, 1980; Stiles, Shapiro, & Firth, 1987; Stiles & Snow, 1984a). These studies were divergent, however, with respect to the aspect of counseling rated and how agreement was defined and assessed, as well as with respect to settings, samples, and measures. In this article, we propose a framework for classifying and thus better understanding the variability in these studies, and we report a study of counselor-client agreement that uses the new framework. Knowing how well counselors and clients agree is important because the strategies and goals that participants adopt in counseling may depend on their understanding of each other's views. In studying this understanding, it is important to distinguish consensus, the degree to which counselors' and clients' views coincide, from awareness, the degree to which each knows the other's views. Participants may evaluate their counseling differently (low consensus) and know this (high awareness), or they may evaluate their counseling similarly (high consensus) but not realize it (low awareness). Because counseling focuses primarily on the client, counselors may know how clients feel (high counselor awareness) even though clients have little understanding of their counselors (low client