International Journal for the Advancement o f Counselling 7." 229-23 7 (1984). © Martinus Ni jho f f Publishers, The Hague. Printed in the Netherlands.

THE CONCEPT OF COUNSELLING AS INTERDISCIPLINARY T E A M W O R K

WARREN J. VALINE and LOUISE M. VALINE

Auburn University and Oglethorpe University

Abstract

This paper presents a rationale for the importance of providing an interdisci- plinary approach to human services. The interdisciplinary concept presented is discussed as based on two descriptive models developed by the authors. The re- mainder of the paper develops the interdisciplinary concept by describing ex- amples of existing models providing services in three areas of human need; children and adolescents, cancer patients and their families, and senior citizens.

Introduction

Counselling as an interdisciplinary concept provides a dimension of expanding roles for the helping professions. In this context the traditional definitions of counselling tend to be somewhat restrictive. However, a recent UNESCO publi- cation edited by Hoxter (1981) provides a definition broad enough to include several helping professions:

Counselling may be described as the interaction developing through the rela- tionship between (a helper) and a person in a temporary state of indecision, confusion or distress, which helps that individual to make his own decisions and choices, to resolve his confusion or cope with his distress in a personally realistic and meaningful way, having consideration for his emotional and practical needs and for the likely consequences of his behavior (p. 1).

Substituting the word 'helper' for 'counsellor' in the above quote makes possi- ble the inclusion of helping professionals that have not traditionally been in- eluded in the definition of counsellor. Each of the helping professions considers itself as a valuable resource to society, but all too often functions as its own enti- ty rather than in mutual support with other helpers. A person may seek out a

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counsellor for psychological/emotional support, a physician for physical heal- ing, a community agency for environmental support while in the home a variety of other issues are successfully or unsuccessfully met, but there frequently is little interaction among the various units.

In their book 'Interdisciplinary Approaches to Human Services', Valletutti and Christoplos (1977) state:

A . . . characteristic of today's profession that supports the need for inter- disciplinary efforts is the ambiguity of professional boundaries. What do psychologists, teachers, nurses, or physicians do that is exclusively within their sphere? Few professionals have escaped asking themselves this ques- tion of domain. When disciplinary overlap leads to defensiveness and pro- fessional exclusivity, clients may be denied needed services, particularly if they are caught in bureaucratic referrals from one agency to another (p. 5).

The concern of ' territory' prevents helpers from crossing over invisible lines. If it could be established that one is not 'better ' than another, but that each one contributes of his/her expertise to the solution or the reduction of anxiety, then there could be a cooperative attitude rather than, as is now often the case, an adversarial relationship among the various helping professions.

The purpose of this paper is to discuss an interdisciplinary approach within and among selected professions that could reduce the concept of territory among professionals and the potential of meeting only segments of a person's needs in the process.

A basic model

The authors became interested in the interdisciplinary approach to human ser- vices as they each worked in their respective fields of teaching and counselling. The model developed from that interest focused on shifting professional respon- sibilities among teachers and counsellors as the needs of the student changed (Valine and Valine, 1981).

Developmental. The teacher provides leadership with the counsellor serving in the role of resource person for the child's development in classroom situations. An example would be career awareness activities such as field trips, resource per- sons, study of specific careers, and other appropriate projects.

Corrective. For specific projects or goals the teacher and counsellor may work on a more equal distribution of responsibilities, each providing part of the ser- vices and each supporting the efforts of the other. Experiences to be dealt with might include moving to a new school, dealing with death or divorce, or develop- ing respect for cultural differences.

ACTIVE

DEVELOPMENIAL

/

, " SUPPORTIVE

CORRECTfVE

ACTWE/SUPPORTIVE ,, ACTIVE/SUPPORTIVE

f f

/

J /

SUPPORTIVE / REMEDIAL ACTIVE z

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Fig. 1.

Remed ia l . For problems requiring greater counselling expertise, the school counsellor provides direct services to the student while the teacher lends'support in the classroom. Examples of this might include school phobias, test anxiety, and problems with interpersonal relationships.

Interdisciplinary model

The teacher/counsellor model is effective in schools and has been developed to varying degrees (Dinkmeyer and Carlson, 1973; Mickelson and Davis, 1977). However, an expansion of the interdisciplinary use of professionals is advocated by Valletutti and Christoplos (1977) whose list of services include dance therapy, music therapy, occupational therapy, law, nutrition and foods, pediatrics, physical medicine and rehabilitation, psychiatry, psychology, social work, speech, hearing, and language pathology.

It is apparent that with greater diversity there must be greater understanding and communication within and among disciplines. Interdisciplinary communica- tion is prerequisite to interdisciplinary cooperation. The fact is that innumerable agencies and many specialties within those agencies offer a variety of services to individuals who need many of the services simultaneously. Without inter- disciplinary cooperation the needs of the individual may be segmented to meet the interests of the agency rather than the best interests of the person.

Figure 2 shows four environmental influences, impacting on an individual. In- terdisciplinary teams can be formed in several combinations from these four areas. The remainder of this paper describes three models each using a combina- tion of professional services from these four areas to meet the needs of the population served. The models are: (1) services to children and adolescents, (2)

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f ~ / \ ,

> . z . / Fig. 2. Interdisciplinary relationships.

services to medical patients, specifically cancer patients and their families, and (3) examples of effectively meeting the needs of senior citizens.

Services to children and adolescents

Follow-Through (Rath, 1976) is a school program for disadvantaged children in grades one through three. Begun in 1967, it is still in effect and provides an exam- ple of an interdisciplinary approach to meeting the needs of the whole child. This educational program is a comprehensive one and focuses directly on all aspects of child development. The program serves not only the educational needs of the children but their health, social and psychological needs as well. The components of the support services are five fold: health, psychological, social Services, career development and nutrition. Each of the five areas has extensive descriptions of services and expectations. A descriptive statement of the focus of each area

follows. The health component focuses on preventive care and sustained health supervi-

sion, but meets appropriate and immediate remedial needs as well. Resources in- clude the school health services, neighborhood, community, and private health centers and the U.S. Public Health Service. Through the psychological compo- nent specialized and individualized guidance programs are developed as a result of expert observation of children in their classroom relationships with peers, teachers, aides, parents, and other adults. Activities such as individual and group counselling for children and parents, in-service workshops for the staff and case conferences are provided. The social services personnel work with the families

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of the children in the community assisting low-income families to overcome problems preventing the child's development. The career development specialists focus on expanding career expectations and developing marketable skills while the nutrition staff assist parents, children, and the Follow-Through staff to realize the importance of nutrition for physical, mental, and emotional health. These five teams work in a cooperative effort with the expertise of each area pro- viding services to meet the needs of the whole child.

A second example of an interdisciplinary approach to the concerns of children is The Har t ford Day-Care Model (Leach, 1972). The team consists of (1) a psychiatrist, (2) a pediatritian, (3) a nutritionist, (4) an early childhood educator, (5) a social worker, and (6) a nurse. This particular model demonstrates a dis- tinguishing characteristic of interdisciplinary consultation. Through regular 'pool meetings' it was possible to clarify the team's basic philosophy, theory, and goals. This differs from the type of consultation in which a group of specialists 'do' a specific job for the client. Instead, problems were dealt with as a team ef- fort in which the interdisciplinary team consultation was a 'package' so that the whole became greater than the sum of the parts. This effort brought together broad and in-depth expertise to focus on meeting the needs of the whole child.

Services to medical patients

Interdisciplinary teamwork can be illustrated in two examples of programs that provide support for cancer patients and their families. The disease of cancer is the second leading cause of death in the U.S. affecting one out of four Americans and two out of three families. In the 1970s three and one half million persons died of cancer in the U.S. and over ten million persons were under medical care for cancer (Royal, 1982). With this vast number of families and patients affected there is a great need for support services beyond meeting the physical needs of the patient.

An organization that is attempting to meet the psychological needs of cancer victims - both patients and families, is known as TOUCH (Today Our Under- standing Of Cancer Is Hope) (Josof, L., I982). The organization was established in 1976 in the state of Alabama and is co-sponsored by the Alabama Division of the American Cancer Society and the comprehensive Cancer Center at the University of Alabama at Birmingham. It is a support group whose purpose is ' to provide assistance to cancer patients and their families in forming realistic positive attitudes toward cancer and its required treatment' (p. 3). The organiza- tion has three objectives: train a core of volunteer visitors, initiate support groups in other cities, and identify ways to combat unproven methods of cancer treatment. The team for training volunteers includes a willing physician who treats cancer patients and a person qualified in counseling and group process who

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acts as a consultant and assists in implementing the training of the volunteer visitors.

Selection of volunteers is of utmost importance in the program. Those selected must possess self-awareness, openness-willingness to share their feelings and ex- periences, emotional stability and must have coped successfully with cancer and cancer treatment.

The identified patients meet with the physician and the advisor to be informed of the program and are invited to participate. Following this meeting, training takes place for the volunteers. Six sessions are held during which medical cancer terminology is defined, medical and psychosocial aspects of cancer are discussed and the psychological dimensions of cancer are reviewed with the volunteers in- cluding their own attitudes and feelings about cancer. Visits to the patients are carefully monitored by the team to insure effectiveness of the program.

A second model known as The Baptist Medical Center Model is an outgrowth of TOUCH and is being developed in the Baptist Medical Center in Mon- tgomery, Alabama (Royal, P., 1982). This effort involves the cooperative action of the oncology social worker staff and the physicians of the hospital. The team provides counselling for the families of cancer patients during the time these pa- tients come to the hospital for regular treatment. The hospital has established a suite in one wing where there is provision for the family member(s) to be com- fortable and for the social worker to talk with them while the patient is in treatment.

One area of intervention is that of clarifying for patients and their families in- formation given by the physician. At the time of the initial cancer information, the people frequently do not hear or understand because of shock or lack of com- prehending what is taking place. At a later time these matters can be heard more objectively and accepted in a less traumatic climate.

The oncology social worker functions in a variety of roles including patient ad- vocate, counsellor, financial advisor, treatment coordinator, and communica- tion liaison. This contact is a continuous one throughout the course of the disease, and in a special relationship if the disease is terminal. To be effective there must be close cooperation among the attending physician, the social worker, "the family, and the identified patient.

Services to senior citizens

The field of gerontology continues to demand more and more attention as an area to be addressed by the helping professions. Government bodies at all levels are concerning themselves with how to more adequately meet the needs and the demands of the older citizen. The American Personnel and Guidance Association has recently held a series of regional conferences on aging. These resulted in the

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publication of three training manuals to assist both professionals and volunteers in providing services to senior citizens (Meyers, 1981; Meyers and Ganikos, 1981; Meyers et al., 1981). The number of persons over 65 continues to grow. This seg- ment of the population has increased in the period from 1900 to 1980 from just over three million to approximately twentyfive and a half million (Riker, 1981). Riker states:

Some elements of our s o c i e t y . . , are aware in only general terms of the im- pact of aging on people and factors involved in helping older persons to adopt to aging and to create new and productive life styles. The education and medical professions, for example, are just beginning to define their roles and responsibilities for this expanding segment of our population. Conver- sant with human needs, counselors can serve as consultants to assist public and private agencies to meet the needs of older persons more effectively (p.7).

The potential for interdisciplinary teams is great in this area and should include leaders in area mental health centers, housing projects for older citizens, retire- ment communities, day care centers, churches, nursing homes, and colleges and universities. The potential is just being tapped and much education is needed to develop effective teams using cooperative efforts to meet the needs of this popu- lation. The needs are far ahead of the provisions. A recent check of available places for elderly for residential care showed that in Atlanta, Georgia, there is generally a two year waiting period at the present time.

The standard of services provided for senior citizens ranges from inadequate to a full staff of professionally trained personnel. An example of a comprehen- sive community is located in St. Paul, Minnesota. This facility provides for the care of the older citizen who is ambulatory and can travel from the facility at will to the bedfast person needing constant medical attention. The staff includes the administrators, social workers, pastoral care and worship opportunities, physical therapy, physicians and nurses, dietitians, and a recreational director. One member of this kind of team needs the awareness of the potential for loneliness, feelings of rejection on the part of some residents and of guilt on the part of family members. There is a need for understanding and support for both the parent(s) and the children as the time comes for new living arrangements and a break-up of long standing patterns of relationships.

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Becker, W.C. (1977). Teaching reading and language to the disadvantaged - what we have learned from field research, Harvard Educational Review, 47(4): 518-543.

Dinkmeyer, D., and Carlson, J. (1973). Consulting. Columbus, Ohio: Merrill Publ. Freeman, H.A. (1967). Counseling in the United States. Oceana Publ.

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Holden, A. (1971). Counseling in secondary schools. Constable, London. Hoxter, H.A. (Ed.) (1981). The forms, methods and techniques o f vocational and educational

guidance: International ease studies. UNESCO, Paris. Josof, L. (1982). Guidelines for organizing TOUCH Today Our Understanding of Cancer is Hope,

(Revised) American Cancer Society. Alabama Division, Inc. Leach, L.B, (1972). Interdisciplinary team consultation in day care, community council o f the capitol

region. West Hartford, Conn. Meyers, J. et al, (Eds.) (1981). Counseling older persons. Vol. I: Guidelines for a team approach to

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Baltimore: University Park Press.

AUTHORS' ADDRESSES

C.E. Ahia and R.W. Bradley Southern Illinois University Dept. of Guidance and

Educational Psychology Carbondale, IL 62901 U.S.A.

M. Barry and L. Wilgosh School of Education Dept. of Educational Psychology University of Alberta Edmonton, Alberta CANADA

E.T. Buckner Director Counselling Center 149 SWKT Brigham Young

University Provo, Utah U.S.A.

S. Chavez University of California School of Education Dept. of Counselor Education Berkeley, Calif. U.S.A.

F.A. Ibrahim Box U-64 University of Connecticut Storrs, CT 06268 U.S.A.

M. Karayanni and A. Spitzer School of Education Counseling Department Haifa University Haifa ISRAEL

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H. McCarthy Human Resources Center Albertson, NY 11507 U.S.A.

F.J. Rechnic and E. Scherzer AUVA RZ Meidling Kundratstrasse 37 1120 Wien XII AUSTRIA

W.J. Valine and L.M. Valine School of Education Dept. of Counselor Education Auburn University Auburn, AL 36830 U.S.A.

J.W. Vargo Dept. of Occupational Therapy Faculty of Rehabilitation Medicine University of Alberta Edmonton, Alberta CANADA

S.B. Wetstein-Kroft Dept. of Counselling Psychology Faculty of Education University of British Columbia Vancouver, British Columbia CANADA