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Article Excerpt
This study assessed mental health experts' comparative evaluations of the two existing published idiographic intake instruments, the Adlerian-based Life-Style Introductory Interview (LI) and the Multimodal Life History Inventory (MI), along with Marquis' (2002; in press) newly developed Integral Intake (II), grounded in Ken Wilber's (1999d) integral theory. Fifty-eight counseling/psychotherapy educators and experienced mental health practitioners perused the three instruments and then used the author-developed Evaluation Form to respond to open-ended questions, as well as to rate and rank them on 11 dimensions: the instrument's overall helpfulness, comprehensiveness, and efficiency, and 8 fundamental dimensions of clients (thoughts, emotions, behaviors, physical aspects, culture, environmental systems, spirituality, and what is most meaningful to them). Respondents evaluated the LI consistently worst, and the II better than the MI on all three instrument dimensions and four of the eight client dimensions. We discuss the II's potential to become a standard in the field of mental health counseling.
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Most counseling theorists and practitioners agree that comprehensive assessment, in which information encompassing as many aspects of the client as is reasonable to obtain, is essential and crucial to successful counseling (Cavanagh, 1982; Eckstein, Baruth, & Mahrer, 1992; Hood & Johnson, 1991; Lazarus, 1997, 2004; Marquis, in press; Mosak, 2004; Shertzer & Linden, 1979; Wilber, 1999d). Moreover, "the ability to assess an individual is a basic skill required of all counselors regardless of the setting in which they practice" (Shertzer & Linden, 1979, p. 3).
Client intake represents one crucial point for assessment in the counseling process. Our collective experience and a thorough review of the professional counseling literature revealed that initial assessment instruments in the field of counseling are both ubiquitous and lacking in uniformity. Regarding idiographic intake instruments in particular--through which the counselor elicits unique, subjective information from the client through interview and/or questionnaire--the diversity was striking.
Our experience indicated that one reason for this diversity is the unique informational needs of each counseling setting, to which mental health counselors in many settings have responded by developing their own unique client history and data forms. Another possible reason is variations in counselors' theoretical orientations. To varying degrees of conscious awareness, every counselor operates from a guiding theory of counseling (Fall, Holden, & Marquis, 2004); thus, each counselor both seeks and interprets initial client assessment data through the filter of assumptions about clients' innate endowment, sociocultural factors, developmental dynamics, means of change, and so forth. Yet a thorough review of the literature revealed only two published, theory-based initial assessment instruments--the Adlerian-based Life-Style Introductory Interview (LI) (Eckstein, Baruth, & Mahrer, 1992) and the Multimodal Life History Inventory (MI) (Lazarus, 1997; Lazarus & Lazarus, 1991)--and an absence of research on either.
The LI begins by inquiring into the client's subjective "way of being in the world" and then has the client rate herself on the life task dimensions of work/school, friendship, love, self-esteem, and spirituality/existentialia. The majority of the inventory is devoted to exploring the atmosphere of the client's family of origin with questions such as "Who was most different from you? How?"; If you are an only child, in your peer group who was most different from you? How?"; "Who was most like you?"; and "Who took care of whom?" Next, the client is presented with 23 characteristics such as intelligence, conforming, and idealistic, and the client is asked to rate which sibling is most and least characterized by each adjective. The client then describes her parents, including who was each parent's favorite child and why. The inventory ends with inquiry into the client's early recollections and any recurring dreams.
The MI is an extensive initial assessment instrument. It begins with general information and a personal and social history. Next, it asks for a description of the client's presenting problems and expectations of therapy. After that is the modality assessment. Following Lazarus' acronym "BASIC I.D.," the modality assessment thoroughly inquires into the client's behaviors, feelings/affect, physical sensations, images, thoughts/cognitions, interpersonal relationships, and biological factors/drugs with open-ended questions, checklists, and Likert-scaled questions.
Advancement of the counseling profession depends in part on research, and research related to initial client assessment would be potentiated by the development of a single, widely used intake questionnaire. Because of pressure by managed care and other work setting factors to maximize the efficiency of client contact time (Glosoff, Garcia, Herlihy, & Remley, 1999), an instrument that clients could complete on their own time and at their own pace would likely appeal to many mental health counselors. In addition, because of counselors' diversity in guiding theories, an instrument based on a metatheory that overtly acknowledges and integrates all the major counseling approaches into an overarching system of thought would likely have the greatest universal appeal to practitioners. Moreover, an intake instrument that assesses clients' strengths and resources as much as their struggles and deficits in a culturally sensitive, nonpathologizing manner should hold tremendous appeal to mental health counselors.
Over the past three decades, Ken Wilber has been developing just such a metatheory, which he has termed integral theory (1999a, 1999b, 1999c, 1999d, 2000a, 2000b). The theories upon which the LI and MI are based, Adlerian and Multimodal, respectively, are well-documented in numerous primary and secondary counseling publications (Fall et al., 2004; Lazarus, 2004; Mosak, 2004). In addition to Wilber's work, the primary literature on Integral Counseling also is vast (Marquis, in press; Marquis, 2007; Marquis & Wilber, in press; Holden, 2004; Marquis & Warren, 2004; Mahoney & Marquis, 2002; Ingersoll & Cook-Greuter, 2007; Cook-Greuter & Soulen, 2007; Pearson, 2007; Foster & Black, 2007). However, to our knowledge, only one recent counseling theory text includes a chapter on integral theory and its specific application to counseling (Fall et al., 2004). Because readers may not be as familiar with integral theory as they are with Adlerian and Multimodal theories, we will summarize a few of the key points of integral theory and its application to counseling.
KEY POINTS OF INTEGRAL THEORY AND PRACTICE
Integral theory is an integration of many diverse disciplines, including spiritual traditions, philosophy, and psychology, as well as anthropology, sociology, neuroscience, and consciousness studies. The result is a system of thought that coherently honors both ancient wisdom and modern knowledge from both the East and the West, and also incorporates both individual and collective--as well as subjective and objective--perspectives within an overarching developmental framework. The most succinct definition of "integral" that Wilber has offered is "all quadrants, all levels" (AQAL) (2006, p. 26), the meaning of which we address below. One of the key strengths of such a metatheoretical approach is its explicit attention to, and honoring of, diversity and the unique values and perspectives held by those who are underprivileged or otherwise marginalized.
All Quadrants
Wilber's (1999d, 2000a) theory begins with the tenet that any and all phenomena have internal (relatively subjective) and external (relatively objective), as well as individual and collective, dimensions. Intersecting the internal/external perspectives (vertical axis) with the individual/collective perspectives (horizontal axis) yields four quadrants (see Figure 1). In other words, an integral approach to any discipline--in our case, mental health counseling--requires that inquiry and practice take into account internal and external perspectives of both the individual and the collective, as well as how all levels of developmental complexity may be implicated in the issue at hand. Such an AQAL approach is not merely pluralistic and comprehensive; it also
honors the validity of each discipline/counseling theory and its associated set of methodologies and techniques while simultaneously recognizing the incompleteness and blind spots of each discipline/counseling theory ... [An integral approach] then takes a step beyond most multicultural, pluralistic stances by revealing precisely how the diversity can be unified in a more encompassing and compassionate framework (AQAL) that salvages the validity of each by relieving each of its absolutisms. When the various disciplines are genuinely integrated, we have ... a correlative transformation from a partial pluralism to an integral holism. (Marquis, 2007, p. 176; brackets added)
The four quadrants involve unique dimension-perspectives that are related to each other; that cannot be reduced to each other; that, therefore, complement, rather than contradict, each other; and that together provide a holistic understanding of any phenomenon. For example, when seeking to understand the phenomenon of a person, each of these four perspectives yields different meanings and information necessary for a more complete conceptualization. A veteran of the war in Iraq provides an example of how such a client could be understood using the four-quadrant model.
The upper left quadrant includes the subjective, phenomenal dimension of individual consciousness: one's experience "from the inside." Wilber termed this quadrant "Intentional"--although Marquis (2007) has found it more useful to refer to it as "Experiential"--and included in it sensations, perceptions, feelings, and thoughts that can be subjectively described in "I" language. A veteran's report of traumatic flashbacks of battle experiences would fall within this perspective, reflecting the client's inner, subjective phenomenology.
The upper right quadrant includes the objective perspective of individual structure-function as viewed "from the outside." Wilber termed this quadrant "Behavioral" and included in it structures and processes that can be externally observed and described in "it" language. Clinically, the behavioral quadrant involves inquiry into clients' sensory, physical, or mental impairments; medical conditions and any medications clients are taking; objective or nomothetic assessments or evaluations; clients' diet, drug and alcohol use; clients' patterns of exercise, sleep, and rest; and any specific behaviors for which clients are seeking counseling. From this perspective, a counselor would consider the veteran's diagnosis of PTSD,...
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