Introduction

Competent and ethical practice requires counselors to base their work in “techniques/procedures/modalities that are grounded in theory and/or have an empirical or scientific foundation” (American Counseling Association 2014, Standard, C.7.a.). Theory acts as a guide for why counselors do what they do and techniques provide the how (Anderson et al. 2011; Rønnestad and Skovholt 2013). Furthermore, research has demonstrated that developing a guiding theory is one piece of overall professional identity development (Moss et al. 2014; Rønnestad and Skovholt 2013).

In 1993, Young evaluated trends of then-practicing counselors in the United States by conducting a survey on theoretical preferences and counseling skills most often used. Participants were also asked to predict which theories would most likely be emphasized in the field in the next five years; the cognitive-behavioral approach was predicted to replace the person-centered approach in popularity among counselors. However, no follow-up research has yet been conducted to explore this prediction or to update trends on theory use among counselors. Furthermore, there is a lack of research regarding theory use specific to the field of counseling, with most research being focused on psychologists and psychotherapists. The purpose of this article was to contribute to and update the current knowledge regarding trends in theory use among professional counselors in the United States.

Literature Review

In the United States, the field of counseling is seen as a separate discipline from psychology and social work with its own unique philosophy and distinguishing educational and licensure requirements. The beginning of the profession of counseling as a distinct discipline can be traced to the formation of the American Personnel and Guidance Association (APGA; now known as the American Counseling Association) in 1952 (Glosoff et al. 2017). A variety of influences comprised the development of the field of counseling including vocational guidance, education, psychology and key figures such as Carl Rogers with his non-directive, client-centered approach. As the counseling profession has grown there has been a focus on developing a distinct identity along with promoting the field, licensure portability, and a research base for the field (Kaplan and Gladding 2011), with little focus on developing our own theories. As a result, the counseling field relies heavily on the field of psychology and other disciples for theory and methodology.

In preparation for this study, we began with a review of the literature, which produced limited research specific to the field of counseling. We augmented this review by the examination of several omnibus textbooks (Theory and practice of counseling and psychotherapy, Corey 2016; and Current Psychotherapies, Corsini and Wedding 2014) often used in counselor education. Additionally, we reviewed literature from the field of psychology and found several studies (Jaimes et al. 2015; Norcross and Prochaska 1983; Norcross et al. 1993; Norcross and Rogan 2013) that surveyed psychologists about theory use across time. Finally, to get a view of the current theoretical landscape, we expanded our review to consider studies that included input from a variety of mental health professionals including psychiatrists, psychologists, social workers, counselors, and family therapists (e.g., Cook et al. 2010; Orlinsky and Rønnestad 2005; Orlinsky et al. 2011; Schofield and Roedel 2012) and also included mental health professions from outside of the United States (e.g., Orlinsky and Rønnestad 2005; Orlinsky et al. 2011; Schofield and Roedel 2012). It should be noted that in such material there exists a lot of variety regarding which theories are listed, how participants were surveyed and how responses were summed.

Theoretical Trends in the Field of Counseling

Young’s 1993 study was the impetus for the current study as the authors wanted to update knowledge on trends regarding theory use among counselors. A review of the Journal of Counseling & Development back to 1952 yielded two additional studies (Calley & Hawley 2008; White 1980) in which participants were surveyed regarding theoretical approaches used. Participants in Young’s study included both mental health counselors and counselor educators who were currently practicing. Young found that 32% of participants reported using an eclectic approach, 22% used a person-centered approach, and 10% practiced a family systems approach (para. 22). Whereas, the participants in the Young study were a mixture of practicing counselors and counselor educators, the participants in both the Calley and Hawley and White studies were counselor educators. Fifty percent of the participants in the White study reported an eclectic approach, 29% humanistic, 11% client-centered, and 9% behavioral (p. 32). In the Calley and Hawley study 41% of participants reported a broad humanistic (including person-centered, existential, and gestalt) theoretical approach, 23% constructivist, 15% cognitive-behavioral, and 6% psychodynamic (p. 11).

In addition to the counseling literature, two series of omnibus textbooks were reviewed to investigate changes in theories represented over time. Theory and practice of counseling and psychotherapy (1977, 1982, 1986, 1991, 1996, 2001, 2005, 2009, 2012, 2016) by Gerald Corey and Current Psychotherapies initially edited by Corsini (1973, 1979) and later edited by Corsini and Wedding (1984, 1989, 1995, 2000, 2005, 2008, 2011, 2014), were chosen as both series have 10 editions and are often used in counselor education programs. In the Corey text there are five chapters that have been in every edition: psychoanalytic, person-centered, gestalt, behavior, and reality therapy. In the 5th edition (1996) the cognitive behavioral approach was added as a standalone chapter as well as a chapter on family systems. Feminism was added as a chapter in the 6th edition (2001). The postmodern approaches of solution-focused brief therapy and narrative therapy were added in the 7th edition (2005).

Similarly, there are five chapters that have been in every edition of Current psychotherapies: psychoanalytic, Adlerian, person-centered, behavior, and rational-emotive behavior therapy. Other theories that have been in numerous additions include existential, gestalt, and multimodal. A chapter on family therapy was added in the second edition (1979). Unlike the Corey text, which includes a chapter on cognitive-behavioral therapy, this text has separate chapters for behavioral and cognitive approaches. Distinctive from the Corey text, the last several editions (2011 and 2014) have included chapters on the following theories interpersonal, contemplative, integrative, and multicultural.

Theoretical Trends in the Field of Psychology

Several studies will be summarized that examine trends in theory use among psychologists. We begin with a review of a series of studies conducted by Norcross and various colleagues (Norcross and Prochaska 1983; Norcross et al. 1993; Norcross and Rogan 2013) of American psychologists in 1983, 1993, and 2013. In the 1983 study by Norcross and Prochaska, 31% of participants reported using an eclective/integrative approach, 28% a psychodynamic and psychoanalysis approach (combined percentages), 6.2% behavioral, and 7.6% cognitive (p. 874). The results of Norcross et al.'s 1993 study were very similar to the 1983 study with “one-third … endorsing eclecticism, one-third a variant of psychanalytic therapy, and one-third various other approaches” (p. 695). Some differences that were noted included that behaviorism dropped by 3% and the cognitive approach increased by 3% (p. 695). Participants in the 2013 study (Norcross and Rogan, p. 492) reported using the following orientations: psychodynamic/relational (27%), integrative/eclectic (25%), and cognitive (17%). Psychodynamic approaches continued to be one of the top choices for psychologists, with an integrative/eclectic choice still being near the top, but having dropped by 5%. An interesting result to note was the increase in the cognitive approach from 10% in 1993 to 17% in 2013.

Next we examined Jaimes et al.’s (2015) study on trends of theory use among clinical psychologists from Quebec, Canada. Jaimes and colleagues examined the annual psychological board registration forms comparing psychologists’ choice of theoretical orientation from 1993 and 2013. Results demonstrated, “psychologists increasingly chose cognitive-behavioral therapy (CBT) as their primary approach, while identification with other approaches declined” (p. 1044). The percentage of participants choosing CBT as their main theoretical approached grew from 18.4% in 1993, to 38% in 2013. Additionally, declines in other theoretical approaches included the existential-humanistic approach lowering from 28 to 21.7%, psychodynamic-analytic changing from 26.4 to 21.5%, and the systemic-interactional approach falling from 11.2 to 6.9% (p. 1044).

Current Trends in Theory Use

Finally, we reviewed several studies in which the participants included a variety of psychotherapists from the U.S. and other countries. In 1989, the Collaborative Research Network (CRN) of the Society for Psychotherapy Research (SPR) conducted an international study of psychotherapists (Orlinsky and Rønnestad 2005), in which only 2% of participants were counselors while the remaining participants included psychologists (57%), psychiatrists (28%), social workers (6%), nurses (2%), and lay therapists or those who had training in another field (p. 29). Participants were asked to rate their most saliently used theoretical orientation. Results showed, “The type of orientation most commonly rated as salient by the therapists... was analytic-psychodynamic (58%), followed by... humanistic (31%), cognitive (24%), systemic (21%), and behavioral (14%)” (p. 31). Other interesting results included that 8% of therapists reported having no salient orientation and 5% reported having three or more salient orientations.

In 2010 Cook et al. conducted a study of psychotherapists from the United States and Canada. Participants included social workers (36%), professional counselors (23%), psychologists (17%), and marriage and family therapists (17%) (p. 261). The results indicated that CBT (79%) was the most popular approach followed by family systems (49%), then mindfulness (41%), psychodynamic/analytic (36%), with Rogerian/client-centered/humanistic (31%) rounding out the top five (p. 262). In addition, only 2% of participants reported using a single-theory approach.

Orlinsky et al. (2011) surveyed psychotherapists from the United States, Canada, United Kingdom, Ireland, Australia, and New Zealand. Thirty-eight percent of participants identified as counselors, 32% as psychologists, and 9% as social workers (p. 832). Participants reported a strong preference for a broadly humanistic approach (48%), followed by analytic/dynamic (38%), cognitive-behavioral (29%), plus another 9% for cognitive (other than cognitive-behavioral), and systemic (25%) (p. 832).

Schofield and Roedel (2012) conducted a study in Australia in which 70% of the participants identified as counselors. Similar to the results of Orlinsky et al.’s (2011) study participants in this study also demonstrated a preference for a humanistic approach (39%). Other saliently preferred theories included interpersonal 38%, family/systems theory 33%, experiential 32%, analytic/psychodynamic 32%, and cognitive 25%. Five percent of participants reported no salient orientation, whereas, 36% reported 3 or more salient orientations (p. 16).

The results of the reviewed studies indicated no one preferred theoretical approach among mental health professionals. American psychologists appeared to continue to prefer a psychodynamic/analytic approach, whereas, psychologists in Canada demonstrated a preference for a cognitive-behavioral approach. Additionally, psychotherapists from North America in the Cook et al. (2010) study also had a strong preference for CBT (79%). In several of the more recent studies (Calley & Hawley 2008; Orlinsky et al. 2011; Schofield and Roedel 2012), a humanistic approach was the most popular. Several studies (Norcross and Prochaska 1983; Norcross et al. 1993; Norcross and Rogan 2013; Young 1993) offered a category of eclectic or integrative that was often chosen by participants. It should be noted that there was never a specific definition provided as to what the authors or participants meant by eclectic or integrative. Several studies (Calley & Hawley 2008; Cook et al. 2010; Jaimes et al. 2015; Orlinsky and Rønnestad 2005; Orlinsky et al. 2011; Schofield and Roedel 2012) went in a different direction; instead of offering an eclectic or integrative option, participants were asked either to check off their primary orientation or to rate how each of the theoretical approaches listed influenced their current practice.

Counseling Skill Use

As a way to examine current trends in counseling practice, several studies (Cook et al. 2010; Schofield and Roedel 2012; Young 1993) explored the counseling skills used by participants. A common pattern found in the results of these studies involved a strong preference for using relational skills and humanistic techniques. Results of Young’s (1993) study demonstrated that techniques most often utilized were empathic understanding, encouragement, and unconditional positive regard. Likewise, in the Cook et al. (2010) survey the top three techniques reported were: convey warmth, caring, and respect, communicate that the client is accepted and prized, and communicate understanding of the client’s experience. Schofield and Roedel (2012) found that over 80% of participants endorsed the following relational skills: being ‘natural’ while working with clients, being effective in engaging clients in a working alliance, and being effective in communicating understanding and concern to clients (p. 41).

Theoretical Integration

Because the technique of integrating theoretical approaches has been suggested in the literature (Cook et al. 2010; Jaimes et al. 2015; Norcross and Rogan 2013; Young 1993), part of our current review of the literature examined theoretical integration. There are various methods of theoretical integration, but the four most popular are technical eclecticism, assimilative integration, theoretical integration, and common factors (Norcross 2005). Technical eclecticism involves the use of different techniques from different theories, where the goal is to find interventions that will work best for each client (Norcross 2005). Similar to technical eclecticism, assimilative integration involves assimilating techniques and practices from other theories into one system of counseling in which the counselor is firmly grounded (Norcross and Beutler 2011). Theoretical integration moves integration to a more sophisticated level by synthesizing the principles and methodologies of two or more theories into a new conceptual framework. The goal of theoretical integration is to “create a conceptual framework that synthesizes the best elements of two or more theories” (Norcross and Beutler 2011, p. 503) in order to enhance therapy.

The final and most frequent approach to integration is the common factors approach. The essence of this approach focuses on elements that create positive therapeutic outcomes that are common to almost all theories (Hubble et al. 2011; Wampold 2012). Hubble et al. (2011) identified four categories of common factors: client and extratherapeutic factors; therapists as people; models and techniques; and the therapeutic relationship or alliance. It is difficult to determine which of the common factors has greater influence on positive therapeutic outcomes given that every relationship between client and counselor is unique, with certain factors dominating over others at any time during the therapeutic process. This approach does, however, highlight the necessity of each category of factors being present to some degree within the therapeutic relationship in order to achieve client goals (Anderson et al. 2011; Hubble et al. 2011).

From our examination of the most recent literature on the use of theoretical approaches and skill use in mental health professions, we identified several separate inclinations regarding trends in practice. However, the question of relevance of these findings for current counselors was central to the present study. It seemed to be time to extend Young’s (1993) counseling research particularly with today’s counselors to better understand the trends in counseling practice, with a focus on the United States. The research questions for the present study included (1) What theories are currently influencing the practice of professional counselors? and (2) Which counseling skills are most frequently used by counselors in their practice? Following the results of previous studies we also asked three additional questions (3) Are there any significant correlations between theory [preference] and skill usage? (4) Will professional counselors show a strong preference for using a cognitive behavioral approach? and (5) Will professional counselors show a strong preference for an integrative approach? The aim was to enable findings from the current research study to provide the counseling profession with information regarding current trends in counseling practice within the United States.

Method

Research Design and Participants

We utilized a survey protocol (Fowler Jr. 2009; Heppner et al. 2016) to address the research questions. Heppner et al. (2016) described the basic aim of survey research as “documenting the nature or frequency of a particular variable [e.g., the incidence and extent of alcohol use] within a certain population [e.g., U.S. college students]” (p. 288). Our research questions included descriptive and correlational elements lending themselves well to the use of this methodology.

The first step in our process was determining an appropriate sample. Because previous studies (Cook et al. 2010; Jaimes et al. 2015; Norcross and Rogan 2013; Orlinsky et al. 2011) included multiple mental health disciplines or were conducted over 20 years ago (Young 1993), our target population was 'currently practicing professional counselors within the United States'. In particular, we were looking for those working directly in the mental health counseling field. We chose to select participants through random sampling of the membership of the American Mental Health Counselors Association (AMHCA). We also wanted to control our sampling processes in a way where simple random sampling within an organization could occur. Sampling the AMHCA membership allowed us to have access to two thousand names randomly selected from their entire membership, as opposed to requesting participation through listservs or discussion forums.

Survey Design

The survey included a demographic questionnaire and specific questions about theory and counseling skill use. The demographic information was collected to provide a description of the participants sampled and to determine if any differences existed in the results when comparing different demographics. The first question regarding theory use asked the respondents to rate the influence the listed theoretical approaches had on their current practice. Following the trend of more recent studies (Cook et al. 2010; Orlinsky et al. 2011; Schofield and Roedel 2012) we did not offer an option for eclectic or integrative, but rather asked participants to rate the influence of each theoretical approach listed. The list of theories included Psychoanalytic, Adlerian, Existential, Gestalt, Behavioral, Cognitive-Behavioral, Solution-Focused, Narrative, Constructivist, Family Systems, Feminist, Strength-based, and Multicultural. Theories were selected based on previous research (Cook et al. 2010; Jaimes et al. 2015; Norcross and Rogan 2013; Orlinsky and Rønnestad 2005; Young 1993). The responses were arranged in a Likert scale ranging from 1 indicating no influence to 4 indicating a strong influence.

The second question highlighted the frequency of use of a variety of counseling skills drawn from basic counseling skills texts and previous research (Cook et al. 2010; Hill 2014; Ivey et al. 2010; Young 1993), and a pilot study as mentioned below. Focusing, summarizing, paraphrasing, reflection of feeling, early recollections, confrontation, general encouraging and encouraging self-care were some of the active skills listed. Other interventions focused on a way of being in session and included demonstrating empathic understanding, promoting instillation of hope, genuineness, and unconditional positive regard. Again, the response format was presented as a Likert scale with scores ranging from 1 representing no use to 4 where interventions were used frequently. For each of these questions, we provided space for respondents to write in another theory or intervention. Prior to utilizing this survey at the national level, we performed a pilot study to refine our instrument and clarify goals, as described below.

Pilot Testing

A pilot study provided an initial evaluation of the research questions and developed a final list of items to include. The pilot study included 74 professional counselors from a state in the U.S. mid-west. The authors designed the survey to allow participants to delineate what theories and skills informed their counseling practice. Results regarding theoretical approach, showed CBT (58.1%) as the most frequently cited theory being used by participants, followed by person-centered (51.4%), family-systems (44.6%), and solution-focused and strengths-based, both with 40.5%. Additionally, participants were asked if they used a single theory approach or an integrative approach. Results demonstrated an inclination towards an integrative approach, with 85.1% of participants reporting using an integrative approach and only 13.5% reporting using a single theory approach. Results regarding counseling skills used were based on frequency. Participants were provided a list of counseling skills and asked to rate the frequency with which they used each skill. Demonstrating empathic understanding was the most frequently used skill, followed by general encouraging, encouraging self-care, conveying genuineness, and demonstrating unconditional positive regard, rounding out the top five most frequently used skills.

The pilot study allowed us to receive feedback regarding the questions contained in our survey as well as providing the opportunity to determine if correlational statistics were well suited to the findings. Following the pilot study, we moved forward with conducting the survey on a national sample of professional counselors.

Procedures

In the study, two thousand professional counselors were randomly selected from the membership of the American Mental Health Counselors Association (AMHCA). AMHCA is a national organization within the United States that maintains a membership of between 6000 and 6400 members. An introductory letter with consent to participate was sent out to these members, with a link to the on-line survey. If the member agreed to participate, they would be directed to the on-line Qualtrics survey. Of the two thousand e-mails sent out, 163 responded to the request for participation with 140 completing the survey such that data could be used. This constitutes a low response rate of 7 % of usable surveys from this initial call. Due to the limited funds for this project and the overall cost of solicitation through the organization, we were only able to complete a single call for participation through the on-line survey software provider. We left the survey open for just over two weeks as response rates fell off dramatically with only 1.8% of the 163 total surveys completed in the final three days. We then exported our data to JMP Pro 12® for analysis.

Data Analysis

The first two research questions focused on percentages related to theory and skill use. Next, we explored the relationship between theory and skills usage. The final two questions focused on use of cognitive-behavioral theory specifically, and the integrative nature of the counselors’ practice. Descriptive statistics including mean and standard deviations were used for the first two questions. Correlational statistics were used to explore relationships between specific theories and skills. Additionally, determining the z score for cognitive-behavioral therapy provided a simple indicator of preference for this theory. For the question investigating the preference for integrative practice, Pearson r correlations were run to determine what theories were often used together.

Results

Statistical analyses from the national sample (n = 140) were conducted based on the five research questions. Thirty-six states were represented in the data. Of the individuals completing the survey, 89 identified as female and 51 identified as male. The mean age for participants was 57.2 years old and ranged from 24 to 81. The majority of the respondents identified as white/Caucasian (91%, n = 128). Other identified ethnicities included Latino/a (n = 4), African American (n = 3), Asian (n = 1), Native American (n = 1), Native Hawaiian or other Pacific Islander (n = 1). Fifteen participants identified as biracial or “other”.

Although the majority of those completing the survey identified as licensed counselors (n = 129), training, service longevity, and work settings varied. Ninety-seven participants had completed a master’s degree, six a PsyD, nine an EdD, and 27 a PhD. Eighty-five graduated from a program accredited by the Council for Accreditation of Counseling & Related Educational Programs (CACREP). Those completing the survey had extensive experience, with an average of 21.5 years and a range of one to 47 years. Private practice (n = 85) was the primary work setting. Community mental health centers (n = 17), hospitals (n = 6), and educational settings (n = 12) rounded out the majority of work settings. Results for the completed surveys are summarized below. Each research question was addressed individually and pertinent data are provided. The majority of respondents completed major portions of the survey. Missing data are reported in the findings as content areas are discussed.

The survey allowed space for respondents to add in theories and skills that were not overtly listed. Although various different theories and interventions were listed, a consistent theme across participants was not determined. Several theories mentioned several times included rational emotive behavior therapy (REBT), dialectical behavior therapy (DBT), acceptance and commitment therapy (ACT), logotherapy, and attachment theory. Skills included relaxation, eye movement desensitization and reprocessing (EMDR), trauma-informed care, and mindfulness exercises.

Theories Influencing Current Practice

Current theory use in counseling was determined by asking participants to rate the influence each theoretical approach listed had on their current practice on a Likert scale from no influence (1) to strong influence (4). The top four influential theories reported were cognitive-behavioral (mean = 3.5, n = 140), person-centered/interpersonal (mean = 3.3, n = 135), strength-based (mean = 3.1, n = 133), and solution-focused (mean = 3.0, n = 136). A mean score of 3.0 indicated a moderate influence. Theories that were slightly below this moderate influence included behavioral (mean = 2.9, n = 136), reality/choice (mean = 2.7, n = 135), family/systemic (mean = 2.8, n = 137), and multicultural (mean = 2.7, n = 132). The two lowest ranking theories were constructivist (mean = 1.8, n = 131) and feminist (mean = 2.0, n = 131). Other theories such as existential, Adlerian, psychoanalytic, and gestalt ranged from 2.3 to 2.5.

Counseling Skill Use

Participants reported using a majority of the counseling skills listed at a frequency of at least sometimes. This was evidenced by the tallied scores for the 21 skills presented. The mean score was 3.54 with a standard deviation of 0.34. The scores ranged from 2.65 to 3.98. A score of three indicated a skill was used sometimes and a score of four represented a skill being used frequently. The most frequently used counseling skills were demonstrating empathic understanding (mean = 3.98, n = 138), general encouraging (mean = 3.86, n = 138), encouraging self-care (mean = 3.86, n = 136), conveying genuineness (mean = 3.85, n = 138), and demonstrating unconditional positive regard (mean = 3.79, n = 138). Other skills ranking high in frequency of use included exploration of healthy coping skills, open questions, reflection of feeling and meaning, and reframing (ranging from 3.67-3.78). Self-disclosure and early recollections were the only two with mean scores below 3.0. They were 2.65 and 2.74, respectively.

Relationship between Counseling Skills and Theory

Relationships between preferred counseling theories and interventions traditionally associated with theories generally corresponded. Table 1 displays the significant correlations between counseling skills and theories that were moderately correlated. Several significant correlations were found, but were weak (r < .30). Of particular interest, skills often associated with the core conditions in person-centered theory for the counseling relationship scored highly across all theories. Interestingly the relationships between person-centered theory and demonstrating empathic understanding, genuineness/congruence, and showing unconditional positive regard were all weak, with one not being significant. Demonstrating empathic understanding (r = 0.06, p = .5) had no significant relationship, genuineness/congruence (r = 0.22, p = .0095) had a significant yet weak relationship, and showing unconditional positive regard (r = 0.22, p = 0.012) also had a significant yet weak relationship.

Table 1 Significant Correlations between Counseling Skills and Influential Theories
Full size table

Use of Cognitive-Behavioral Approach

All participants completing the survey responded to the question pertaining to the influence of cognitive-behavioral theory. As reported above, the mean score for influence of cognitive-behavioral theory was 3.5 (indicating a moderate to strong influence). When compared to the mean scores of all 15 theories (mean influence of all theories = 2.65, SD = .47) presented to the participants, the corresponding z score for cognitive-behavioral theory was 1.8. Of the 140 responses, 83 identified cognitive-behavioral as having a strong influence on his or her practice. Rounding out the rest of the responses for cognitive-behavioral theory, 45 participants reported a moderate influence and 12 reported a weak influence. Of the 140 participants, none reported cognitive-behavioral theory as having no influence on their current practice. We found no significant differences in CBT influencing practice depending on CACREP schooling, sex, or ethnicities. Additionally, there was not a significant correlation involving CBT and age.

Preference towards an Integrative Approach

The majority of respondents reported being influenced in their current practice by multiple theories. Only one participant reported a clear theoretical preference. This individual reported being strongly influenced by both behavioral and cognitive-behavioral theories and left all other theories blank. Four other individuals only rated four to six theories, and of these respondents, theoretical influences extended across paradigms. A correlation matrix was developed to determine if there were any significant relationships between influential theories using JMP Pro 12® software. As mentioned earlier, some participants did not rate all theories and, therefore, there were 20 missing values. We found multiple significant relationships ranging from weak to moderate strength based on a correlational pairwise method. To help inform the phenomenon of an integrative approach, only moderate relationships with a Pearson r of .39 or greater are presented in Table 2. The only significant negative correlations were associated with Psychoanalytic theory. Psychoanalytic theory was negatively correlated with Behavioral theory (r = −0.26, p = 0.004), CBT (r = −0.24, p = 0.008), Reality/Choice (r = −0.25, p = 0.007), Solution-focused (r = −0.35, p < 0.0001), and Strength-based theory (r = −0.30, p = .001).

Table 2 Significant correlations between influential theories
Full size table

Discussion

The results of the present study contribute to the counseling field literature by updating information on current trends in counseling practice of professional counselors within the United States. Several similarities and differences between the results of this study and previously reviewed studies exist. CBT was found to have a strong influence not only in the current study, but also in the surveys by both Cook et al. (2010) and Jaimes et al. (2015). These results support the prediction from Young’s (1993) study regarding the increased popularity of CBT among counseling professionals. Given the popularity of CBT and its demonstrated efficacy, it should be noted that in several studies (Norcross and Rogan 2013; Orlinsky and Rønnestad 2005; Schofield and Roedel 2012) CBT was not listed as a theoretical choice for participants; cognitive and behavioral being listed as separate choices.

Participants in the Young (1993) study predicted a significant decline in the person-centered approach. This prediction was not supported by the current study in which the person-centered theory ranked 2nd in influence. Cook et al.’s (2010) study also demonstrated high rates of person-centered theory. Even though the broader term humanism was used in the studies by Orlinsky and Rønnestad (2005), Orlinsky et al. (2011), Schofield and Roedel (2012), and Jaimes et al. (2015), participants here, likewise, rated a humanistic approach as having a strong influence. Humanism, or specifically the person-centered theory, ranked within the top five theoretical choices in all the studies except the Norcross and Rogan (2013) study of psychologists in which only two-percent of participants endorsed a humanistic theoretical approach.

Furthermore, several notable differences exist. The strengths-based and solution-focused approaches were rated to have a strong influence in the current study and not in any of the previous studies reviewed. The high ranking of the strengths-based approach is not surprising considering the philosophical similarities evident in the counseling field and this approach. The counseling profession is based on professional relationships that promote empowerment, wellness, and an understanding of development (American Counseling Association 2014). Correspondingly, the strengths-based perspective emphasizes clients’ strengths and resiliency and that people develop across the life span (Smith 2016). Additionally, the high ranking of the solution-focused approach demonstrates that postmodern philosophy is beginning to have an influence in the field of counseling.

Another notable difference was regarding the influence of psychodynamic theories. Both the Orlinsky and Rønnestad (2005) and the Norcross and Rogan (2013) studies, in which either the entire body of participants or a majority of the participants were psychologists, demonstrated high rates of influence from psychodynamic theories. The current study and other studies, where the participants were professional counselors or a variety of psychotherapists, demonstrated both less influence and less reliance on psychodynamic theories. This discrepancy may speak to the differences in underlying philosophies and training between the fields of counseling and psychology.

The counseling skills that participants reported they used most often aligned with the theoretical approaches that they noted were most influential on their current counseling practice. An interesting finding in this study was regarding the skills traditionally aligned with the person-centered approach, including demonstrating empathic understanding, genuineness, and unconditional positive regard. Participants ranked the person-centered approach as the second most influential theory, yet there was only weak correlations found with each of the traditional skills. Without having asked participants the reasoning behind their choices, we can only speculate on why this might be. One reason might be that from a person-centered lens the concepts of demonstrating empathic understanding, genuineness, and unconditional positive regard are seen as attitudes that a counselor holds versus skills that they use with clients (Cain 2002). Additionally, given that the counseling relationship is one of the factors common to almost all theories that leads to positive therapeutic outcomes and that the elements of empathy, positive regard, and genuineness have been demonstrated to be an effective components of that relationship (Norcross 2011), these concepts are no longer seen as strictly person-centered concepts. Therefore, it makes sense that these three skills would rank high across theories.

These results are comparable with the results from the Young (1993), Cook et al. (2010), and Schofield and Roedel (2012) studies. There were several skills that were aligned with specific theories. Pairings such as early recollections with psychoanalytic and here and now awareness with existential and gestalt were anticipated. Additionally, the skills of exploration of healthy coping skills and reframing align with the CBT approach. Finally, encouragement is one of the main principles of the strengths-based approach.

Any conclusions need to be drawn cautiously regarding use of an eclectic or integrative approach from the results of this study and future research, as described below, is needed. In line with previous research studies (Cook et al. 2010; Orlinsky and Rønnestad 2005; Orlinsky et al. 2011; Schofield and Roedel 2012), we chose not to ask specifically about eclectic or integrative approaches, as multiple definitions of what it means to use an eclectic or integrative approach exist, but rather to look at this phenomenon in terms of how counselors’ current practice was being influenced by multiple theoretical approaches. Even though we did not ask participants specifically about an eclectic or integrative approach, all participants in the current study reported multiple theories influencing their current counseling practice. The results of this study indicate that the counselors were no longer being influenced by a single theoretical approach and appeared to show an inclination towards integrating approaches together in some way in their practice.

Limitations

The study was developed to explore the practices of counselors within the United States and several limitations should be noted. Although the participants for this study were randomly selected, the participant responses demographically favored older, Caucasian individuals who had extensive experience and currently worked in private practice. Furthermore this study only involved professional counselors from the United States. Suggested future research survey designs include striving for a sample of counselors that comprises a broader scope of counselors across all counseling specializations and consists of increased diversity of participants, not only of ethnic and cultural factors, but also countries of practice.

Finally, even though our results reflect those of earlier studies (Cook et al. 2010; Jaimes et al. 2015), the findings should be used with caution based upon the overall low response rate. We attempted to control participation through random sampling of AMHCA members to minimize sampling bias. However, this reduced our participant pool to approximately 7% of those contacted. This, in turn, may indicate that only a subpopulation of mental health counselors is being represented in this study. Potential reasons for non-completion may be overloaded schedules, lack of interest, or low technological proficiency in completing on-line surveys. Additionally, limited resources prevented multiple reminders that may have provided more responses. Evaluating electronic dissemination of research requests may be an important consideration given the changing culture of on-line usage and reliance on electronic means for communication. This limitation should be of particular interest when looking to do further research in this area.

Implications and Future Research

The purpose of this research study was to increase the knowledge-base of the counseling field regarding current trends in counseling practice. Implications of this research study include a better understanding of which theories are influencing current practice of counselors and which skills are most often used. While this study adds to the literature, several new questions that may inform future research were also brought to the forefront for the field of counseling, including how does the strong influence of CBT impact the field of counseling that has its foundations in humanistic principles. The results regarding the strong influence of CBT are similar to other studies reviewed that included a variety of mental health professionals, imploring the question what does this mean for the field of counseling as a distinct profession from other mental health professions? Hence, it seems that research that focuses on the factors influencing counselors’ use of theory and how counselors are developing a personal guiding theory of counseling is needed.

The results of this study were based on participants from the United States and participants in many of the reviewed studies were from Western countries with a strong European influence. As the globalization of counseling continues, another question that arose was, would the same trends in counseling practice be found in countries with different ethnic and cultural traditions. Consequently, it seems that additional research is warranted that would continue to explore the trends of theory use and counseling skill use of professional counselors globally.

The final question involves the use of an integrative approach. The findings demonstrate that the current practice of the participants was influenced by more than one theoretical approach. This trend is consistent with previous research and, considering the large number of theories and interventions available, it appears this trend will continue. Even though it is clear that most counselors integrate more than one approach together and several forms of integration exist, it is unclear how counselors are actually integrating approaches. According to Norcross and Beutler (2011), “It is integration by design, not default; that is, clinicians competent in several therapeutic systems systematically select interventions and concepts on the basis of comparative research and patient need” (p. 504). Therefore, understanding how counselors are making decisions about which theories and when to integrate will assist in understanding the dynamics of developing an integrative approach to counseling.

Conclusion

This study provides an increased understanding of trends in counseling practice within the United States including which theories are influencing the practice of counselors and which counseling skills are most often used. The majority of participants in this study reported being influenced by more than one theoretical approach, with cognitive-behavioral, person-centered, strengths-based, and solution-focused being reported as the top four influential theories. The most frequently used counseling skills were demonstrating empathic understanding, general encouraging, encouraging self-care, conveying genuineness, and demonstrating unconditional positive regard. Further research is recommended to gain a broader sample of counselors and to explore how counselors integrate more than one theoretical framework together in their counseling practice.