We can conceptualize human effectiveness as the ability to obtain long term control over the significant features of an individual’s physical, social, and psychological environment. In this sense human effectiveness is not purely an intrapsychic trait; rather it is a measure of the quality of the person-environment interaction at particular times and in specific circumstances.
We can categorize person-environment transactions within a unitary model that specifies five levels of interaction that include the cognitive, affective, and behavioral components of that interaction.
The lowest level of human effectiveness is aptly described by the term “panic.” This level is characterized by a major loss of the individual’s control over effective responses and by a significant loss of control over even the immediate and short-term environment. In situations of extreme panic the individual may require hospitalization or careful supervision for his or her own protection.
People in the extreme my be suicidal or even violent. Panic is characterized by intense feelings of being helpless, out of control, and at the mercy of random, malevolent forces in the environment. Panic may be accompanied by crying, rage, or by intense physical symptoms, such us hyperventilation, rapid pulse, increased blood pressure, frequency of urination, faintness, sweating, and shaking.
Panic is reaction to intense, uncontrolled, or uncontrollable stress. It is not automatically an indication of an intrapsychic deficit or inadequate personality development. Almost any individual can be reduced to panic is stressful stimuli are intense and prolonged enough and if no control of the situation seems possible.
Panic is the lowest level of human effectiveness precisely because the individual’s affective arousal is so intense that cognitive functioning, including problem-solving and actual coping behaviors, are severely impaired. When panic sets in, an individual may be unable to operate simple safety device, may become disoriented, and may be temporarily unable to accomplish previously learned skills, such as driving a car, using a machine, or operating other kinds of equipment.
Exposure to extreme danger in natural disasters, wars, violent crimes, or accidents frequently triggers panic reactions. Panic can also result from prolonged exposure to moderate stress levels when these levels are perceived as totally uncontrollable. Providing constant care for an emotionally disturbed or acutely ill person, performing very demanding, complex task for long hours under very adverse working conditions, or experiencing chronic pain or discomfort for long periods can all trigger panic.
Panic reactions may be made more likely and heightened when exposure to very demanding or threatening situations is accompanied by noxious environmental conditions, such as oppressive heat, high-noise levels, or intense lighting. Panic is socially contagious in that exposure to a panicked individual may trigger a similar level of arousal in others.
When dealing with panicked individuals in counseling situations, rational and highly introspective counseling approaches will be ineffective until the panic has subsided. Withdrawing the individual from the stressful situation, providing positive reassurance and support in a calm and composed way, and offering direct, structured advice or instruction about how to control the stressful situation may be helpful. In cases of extreme panic, sedation by physician, or even short-term hospitalization, may called for.
Panic reactions may be prevented from occurring by a variety of counseling procedures. These procedures are sometimes termed stress inoculations, or stress-management procedures. Such procedures include behavioral rehearsal, in which the client practices a set of coping responses in advance of the anticipated stressful situation. Learning to analyze identify threatening or emergency situations and having a set of coping procedures available seem effective ways to prevent panic. When stress is prolonged and unavoidable, training in progressive relaxation is also helpful. Good physical condition, including good sleeping habits, nutrition, and exercise help individuals to resist panic in stressful situations.
People in a state of panic seldom approach professional counselors directly and voluntarily. Rather they are often referred to counselors by others. Victims of rape, assault, or other violent crimes are frequently referred for counseling. Sometimes people who are facing surgery or life threatening illnesses, who are suffering from very painful, disabling injuries and illnesses, who are experiencing bereavement, and who have attempted or threatened suicide are also referred to counselors.
Counseling with clients who are or have recently been in a state of panic, or who are on the verge of such states is often called crisis intervention. Crisis intervention tries to help people cope with extremely stressful short-term situations by helping them to control their emotions and too cope with the immediate problem. In many crisis situations “insight-oriented” counseling approaches may be premature, or even counter-productive, until the crisis has been resolved.
The second level of human effectiveness can be called “apathy.” At this level there is some control of the short-term, immediate aspects of the environment. In comparison to panic, the immediate level of affective arousal here is much lower, and there are fewer symptoms of emotional arousal. At this level individuals often try to exert control over their environment largely by avoiding the stress of threatening interactions, even when these might lead to greater long-term control. While the individual may not require institutionalization, he or she is unlike to be economically or socially self-sufficient or independent. The will to make plans and pursue goals is almost totally absent, and even the degree of organization required to hold a low-level job is often missing.
The individual in the grip of apathy tends to avoid or ignore demands from the environment. Because the emphasis is on avoiding immediate punishments or preventing obvious failures, the individual has great difficultly in following through on even the n carefully structured plans and in accepting responsibility for his or her own behavior and its consequences. Others will be blamed and a wide variety of excuses will be found to rationalize lost opportunities or failures. Typically, individuals at this level have very low self-esteem and often feel at the mercy of fate or luck, so that in interpersonal relationships they tend to show distrust and indifference.
Like people at the panic level, these individuals can be very hard to reach. They rarely approach counseling on their own. Often they are referred by relatives or others who simply do not know how to cope with them.
People at the apathy stage often have histories of long-term hospitalization, imprisonment, unemployment, invalidism, or have experienced a long series of tragedies and failures that have led them to abandon efforts to control their environment. They respond to the positive and negative stimuli of their environment in lethargic ways, and at deeper emotional levels there may be feelings of despair, alienation, and abandonment.
This type of client is often referred involuntarily by courts, probation officers, parole service, or welfare agencies. In some ways this client is even more difficult than the panicked individual. Clients at the apathy stage typically require a great deal of counselor-initiated structure, even to the point of setting and reminding the client of specific times and places for appointments. When goals are set and action planned, they must be very explicit and short-term. Often this means breaking down goals into a series of very short-term, readily accomplished objective.
At this level of human effectiveness the individual is able to maintain control over most of the short-term transactions with his or her environment and is actively engaged in seeking more long-term control. The individual has some control over affective responses, but may vacillate between feelings of hope and confidence and feelings of resignation and despair.
The “striving” individual is capable of a limited amount of planning and gratification deferral, but is easily discouraged by failure to attain results quickly. Often this kind of client tends to set goals and objectives that are unrealistic with regard to their scope or to the time that would be required to accomplish them, and then becomes discouraged when they are not attained. This individual’s life is likely to be characterized by a series of crisis and emergencies that are preventable with more consistent, careful planning.
At this stage clients may self-refer, but they may also have unrealistic and grandiose expectations of immediate results. They are frequently referred by teachers or supervisors because of inconsistent performances or underachievement in school or on the job, but they also tend to withdraw from counseling prematurely.
Although clients at the striving level may wan considerable counselor initiated structure, they are usually able to accept a gradual increase in responsibility for the counseling process. They may be able to profit from insight-oriented approaches that move very slowly and are accompanied by considerable support. Sudden attempts at confrontation with these clients can result in premature termination of counseling.
At this level of human effectiveness the individual has control over large segments of long-term transactions with the environment. Behavioral is purposeful and largely goal-oriented. The individual reacts to life’s problems more as challenges than as treats. Problems and difficulties tend to be readily identifiable in terms of specific roles or relationships, or particular developmental tasks.
Clients at this level tend self-refer and to articulate their concerns and problems fairly well. Yet they tend to have considerable anxiety about the outcome of ego-involving problems and situations. However, their anxiety is not crippling, but rather provides motivation for them to work actively in behalf of their goals. At this level clients generally have fairly realistic perceptions of themselves and their life situations. However, they may have “blind spots” about certain relationships or situations.
At this “coping” level clients are able to take considerable responsibility for choosing goals and setting directions in the counseling process, and in turn the counselor is able to utilize a rather wide range of counseling approaches. Once a reasonably good relationship has been established, a “working partnership” between counselor and client often result.
This level of person-environment transactions represents the highest category of human effectiveness. The individual is in active control large and important segments of the environment on both a short-term and long-term basis. Such people typically enter into active interaction with the environment, anticipating rather than merely reacting to events. At the mastery level people tend to experience feelings of adequacy and self confidence in most of their roles and relationships. They experience problems or obstacles as challenges and may show real zest and enthusiasm in setting goals and planning activities.
At the mastery level clients my self-refer or be referred by others, often for very specific information or assistance. They may seek assistance to do educational and vocational planning prior to graduation from college, or later in midlife at the point of a major career change. They may contact counselors for assistance in planning for retirement, or in seeking to prepare for some other major life change. Difficult life transitions, occasioned by death or divorce, or by disabling illnesses, or injuries, may move an individual back temporarily into the coping level.
People at mastery level may experience difficulty when new roles are thrust upon them that involve forming empathic or nurturing roles with less effective and self-confidence people. Sometimes the counselor who works with client systems in organizational development or process consultation must help administrators and executives adjust to functioning in new roles at a mastery level. Interventions, such us human relations training or “sensitivity” training, are sometimes useful in this kind of situation.
In working with clients who function at the mastery level the counselor has the problem of establishing his or her credibility. This kind of client usually extends credibility primarily on the basis of perceived expertness.
This kind of client is usually also active in communicating expectations about both the counseling process and the outcome. Such clients may resist or resent what they perceive as “spoon-feeding” or “talking down.” In order to obtain cooperation the rationale and purpose of an approach or technique often must be explained in advance. Failure to be direct and open with such clients can lead to abrupt termination. However when mastery level clients are fully informed an committed, they often involve themselves enthusiastically in such task as homework assignments, information searches, vocational information, and bibliotherapy.
In a sense, the human effectiveness framework we have considered constitutes both a unitary diagnostic system and a goal structure for counseling. Obviously, we would like to see our clients eventually functioning at the coping and mastery levels.
The framework also provides a useful basis on which counselor can begin to shape his or her own initial approach to the client. The degree of client responsibility that can be expected, the amount of counselor-intiated structure that is appropriate, the degree of counselor attention to emotional factors, and even the ways in which appointments are scheduled and task assigned may all vary in terms of the clients’ level of effectiveness and functioning.
For example, it may be inappropriate to begin a contact with a client at the apathy level by asking him or her to free associate or give detailed information. Similarly, a client verging upon panic may not be expected to give a detailed history or to engage in logical problem-solving exercises.
A unitary system of diagnosis, then, seems a more useful tool for the counselor than is the intrapsychic, disease entity approach. When such a system is rooted in observations about the quality of the client’s transactions with the environment, such systems are especially germane. After all, the counselor is a part of the environment, so that beginning, at least, the client will interact with the counselor in a similar fashion to his or her other transactions.
However, even a unitary system of diagnosis is not without its limitations and disadvantages. Like other diagnostic frameworks, the human effectiveness model is a system of categories. That is, it assigns clients to boxes and categories based on a set of previously defined characteristics. Whenever we assign a complex, ever-changing, and essentially unique individual to a single category, we run the risk of ignoring other vital factors. We may oversimplify in the face of complexity, or prematurely close ourselves of from new information.
In counseling, then, diagnosis is much more than an event or stage in the counseling process that is completed before moving on. As we said earlier, diagnosis involves the entire process by which the counselor seeks to understand a client and that client’s world.
For this reason the question of whether to diagnose or not has little meaning so longs as the counselor is engaged in a serious effort to understand his or her client.
Donald H. Blocher. (1987). The Professional Counselor. New York: Macmillan Publishing