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Research and Evaluation
Counseling Outcome
http://cor.sagepub.com/content/3/1/17
The online version of this article can be found at:
DOI: 10.1177/2150137811435233
2012
2012 3: 17 originally published online 10 FebruaryCounseling Outcome Research and Evaluation
A. Stephen Lenz, Megan Speciale and Jinnelle V. Aguilar
Single-Case Effectiveness Design
Relational-Cultural Therapy Intervention With Incarcerated Adolescents : A
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Counseling Outcome Research
Relational-Cultural Therapy
Intervention With Incarcerated
Adolescents: A Single-Case
Effectiveness Design
A. Stephen Lenz
1
, Megan Speciale
2
, and
Jinnelle V. Aguilar
3
Abstract
The authors implemented a small series (N ¼ 4) single-case research design to assessthe effectivenessof
a nine-session Relational-Cultural Therapy (RCT) intervention with adolescentfemales incarcerated in a
youth detention facility. Analysis of participants’ scores on the Relational Health Inventory using the
Percentage Of Data Points Exceeding the Median procedure yielded treatment effects indicating
that RCT may be effective for promoting relational empowerment and engagement with others;
however, treatment was not associated with a greater amount of relational authenticity with others.
Discussion of systemic variables that limit relational development during incarceration is provided.
Keywords
counseling outcome, relational-cultural therapy, relational health, incarcerated, adolescents,
females, single-case research design, RHI
Submitted 16 September 2011. Revised 12 December 2011. Accepted 13 December 2011.
The National Center for Juvenile Justice has
estimated that approximately 97,000 juveniles
aged 18 and younger were housed in residential
correctional facilities within the United States
(Snyder & Sickmund, 2006). Of these youth,
15% were female juvenile offenders, a popula-
tion that has increased in the frequency and sever-
ity of criminal offences during the past decade
(Snyder, 2004; Snyder & Sickmund, 2006). The
number of female offenders in custody increased
52% from 1991 to 2003, with most female offen-
ders being 15 to 16 years of age (Snyder & Sick-
mund, 2006). With the female adolescent
population increasing within the correctional sys-
tem, researchers have begun examining the
effects of juvenile incarceration. These research-
ers have detected ubiquitous trends for decreased
educational attainment (Holman & Zeidenberg,
2006), restricted occupational opportunities
(Glaser, Calhoun, Bates, & Bradshaw, 2003),
increased mental health symptoms (Corneau &
Lanctoˆt, 2004), and social skills deficits (Gagnon
& Barber, 2010) following release when com-
pared to nonadjudicated peers. Furthermore,
1
College of Education, The University of Memphis, Memphis,
TN, USA
2
The University of New Mexico, Albuquerque, NM, USA
3
Texas A&M University, Corpus Christi, TX, USA
Corresponding Author:
A. Stephen Lenz, College of Education, The University of
Memphis, Ball Hall, Room 303, Memphis, TN 38152, USA
E-mail: aslenz@memphis.edu
Counseling Outcome Research
and Evaluation
3(1) 17-29
ª The Author(s) 2012
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DOI: 10.1177/2150137811435233
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despite the differential experience of females and
males while incarcerated, both groups often
receive similar rehabilitative programming with
little desired effect on recidivism or social adjust-
ment among females (Covington, 2007). Thus, it
is a prudent task for counselors to implement and
evaluate counseling programs that promote the
social and relational development of adolescent
females.
The National Mental Health Association
(2004) has endorsed several therapeutic inter-
vention strategies for use with adolescents
involved with justice systems, each emphasiz-
ing prosocial interactions with peers, family
members, and significant others. Of these, one
widely endorsed counseling intervention is
family-focused therapy, which incorporates
active participation of the family in developing
treatment, educational, and aftercare plans.
Cognitive–behavioral therapies addressing
relational and social skill deficits, coping
skill development, and self-management are
also recommended. Both of the aforementioned
approaches are highly structured, rigorous, and
organized around the development of social
functioning through positive behavioral change
(Altschuler, 1998). In a meta-analysis conducted
by Lipsey, Wilson, and Cothern (2000), interper-
sonal skills and family-oriented programming
consistently yielded statistically significant
declines in recidivism rates for institutionalized
youth offenders. In this review, the most success-
ful programs often included the use of multiple
counseling services from community programs
that offered advocacy, counseling, educational,
vocational supports in conjunction with beha-
vioral programs such as stress management train-
ing, anger management, and cognitive mediation
(Lipsey, Wilson, & Cothern, 2000).
Despite progressive strides reported by these
researchers, little can be found regarding
evidence-based practices that are effective in
other areas of social and relational functioning
such as engaging in growth-fostering relation-
ships. Additionally, although the gender gap
between incarcerated male and female offen-
ders has begun to close, a marked discrepancy
exists in the representation of females in the
juvenile justice system research. As a
consequence, the data available addressing
effective interventions with female adolescents
is ambiguous, resulting from the practice of
grouping female youth within the same standards
for rehabilitation as those of males. Therefore,
more investigations are needed to extend and eval-
uate counseling interventions such as Relational-
Cultural Therapy (RCT; Jordan, 2010) that are
sensitive to the development of women.
RCT Groups
Originally founded on the writings of Jean
Baker Miller in Toward a New Psychology of
Women (1976), RCT adheres to the core beliefs
that all personal growth occurs during and
throughout meaningful relationships. Jordan
(2010) later noted that all people desire connec-
tion and that mutual empathy and empowerment
are needed for relationships to promote growth.
Proponents of RCT posit that growth-fostering
relationships are characterized by increases in
vivacity ability to take action, clarity about rela-
tionships between self and others, a sense of
worth, and the yearning to form more meaning-
ful relationships(Miller, 1986). Miller (1990)
proposed t hat when rela tions hi ps are assoc i-
ated with marginalization, individuals experi-
ence a relational dis connection rec ognizabl e
by diminished e nergy , disemp owerme nt, con -
fusion, decreased sense of self-worth, and
turningawayfromrelationships. Although all
relationships include disconnections, growth-
fostering relationships utilize and transform
disconnections, through mutual effort, into
strengthen ed co nne ctio ns (J or da n, 20 10) .
Group practice of relational-cultural theory
explores and implements the core tenets of
RCT with the goal of promoting growth-
fostering relationships, which increases creativ-
ity, clarity, and relational awareness/intelligence
(Jordan & Dooley, 2001). Comstock, Duffey,
and St. George (2002) presented an RCT frame-
work for approaching group counseling. The
stages of the relational movement throughout
the group are outlined as: (a) est ablishing safety
through s upported vulnerability, (b) flexibilit y
in making relational choices, ( c) experiencin g
empowerment and conflict, and (d) the
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development of relational confidence and
relational resilience. This model has been
proposed as useful for working with men and
women experiencing grief, sexual and physical
trauma, addictions, divorce, and eating disorders
(Comstock, Duffey, & St. George, 2002). Jordan
and Dooley (2001) presented an alternative model
specifically for working with mental health
agency, school, and prison populations. This
approach is highly structured and explicitly pro-
vides an eight session manual for counselors
that includes experiential activities to facilitate
learning. Although these out lines for group
intervention are promising , there is a pauc ity
of research available assessing the utility of this
model with divers e populations such as incar-
cerated female adolescents.
RCT groups may have distinct utility within
the detainment setting given that within the juve-
nile justice system traditional views of indepen-
dence and self-reliance are markedly intensified.
Covington (2007) outlined the harmful impact
of the traditional detainment environment for the
relational development of females by noting:
Tragically, current correctional settings often
recreate women’s relationships of disconnec-
tion and violation on a systemic level. Our
criminal justice system, which is based on
power and control, reflects the dominant/subor-
dinate model of our patriarchal society. It is a
microcosm of the larger social system. Rela-
tionships in correctional setting are based on
ranking people, with women and girls at the
lowest rung of the ladder. (p. 12)
Therefore, it may be conjectured that the
juvenile correctional system does not promote
rehabilitation or development of critical social
and relational skills by virtue of systemic design.
Given this supposition, Covington (1998) has
advocated for women to be provided with oppor-
tunities for change, growth, and healing based on
relationships and mutuality while incarcerated.
As such, counselors implementing RCT
programming may be able to support this initia-
tive by providing relational development oppor-
tunities that prepares females to connect with
one another and the community-at-large after
serving their sentences. Based on these two
assumptions, this study examined the following
research questions: Is an RCT group counseling
intervention effective for increasing the rela-
tional health of incarcerated adolescent females
as measured by scores on the Relational Health
Indices? (Liang et al., 2002); and what relational
domains are more resistant to development while
in the correctional setting?
Method
Participants
Five adolescent females were solicited to
participate in group therapy based on the RCT
program developed by Jordan and Dooley
(2001); one declined to participate. The four
participants electing to complete the group were
Hispanic (n ¼ 2; 50%), Caucasian (n ¼ 1;
25%), and African American/Black (n ¼ 1;
25%). Participants were 16 (n ¼ 3; 75%)and
17 (n ¼ 1; 25%) years of age who were incarcer-
ated for offenses including family violence,
drug-related, assault, absconding, and violation
of probation. Three participants resided within
lower socioeconomic status (SES) households
(75%) and one was from a middle SES household
(25%); two reported living with a single parent.
Pseudonyms were self-selected by participants
to protect their identities during data collection,
analyses, and reporting.
Participant 1. Maegan was a 16-year-old
Caucasian female of Scottish-American des-
cent. She is from a traditional nuclear family
with SES in the middle range. Maegan was aca-
demically on track, verbal during interactions
with group, and reported that detainment was
associated with assault and family violence.
Participant 2. Lauren was a 17-year-old
Hispanic female born and raised in a traditional
nuclear family with a lower SES background.
Lauren was academically behind one grade,
participated in groups moderately in the begin-
ning, but became highly engaged within latter
sessions, and reported a history of assault, family
violence, and narcotics-related misdemeanors.
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Participant 3. Crystal was a 16-year-old
African American female raised in a single parent
household with a lower SES background. Crystal
was academically behind one grade, actively
engaged and highly verbal during group meet-
ings, although distracting and encouraging of
group to get off topic at times, and reported a his-
tory of assault charges.
Participant 4. Samantha was a 16-year-old
Hispanic female raised in a single parent house-
hold with a lower SES background. Samantha
was academically on track, did not participate
in group process often, but intermittently con-
veyed understanding of content, and reported
history of absconding from her family home
and repeated violations of probation terms.
Instrumentation
Relational health indices. The Relational
Health Indices (Liang et al., 2002) was devel-
oped to detect the degree to which individuals
are engaging in growth fostering relationships
with peers, mentors, and their community.
Several researchers have used the Relational
Health Inventory (RHI) to investigate the
influence of environmental and interpersonal
variables on the relational health (Frey, Beasley,
& Miller, 2006; LaBrie et al., 2008; Liang &
West, 2011; Liang, Tracy, Kenny, Brogan, &
Gatha, 2010). The RHI (Liang et al., 2002) is a
37-item self-report questionnaire that yields
three composite subscales and can be calculated
to measure the relational quality with Peers,
Mentors, and the Community. The response for-
mat for the RHI is a 5-point Likert-type scale
ranging from 0 (never)to4(always)andrequires
participants to assess variables associated with
relationships. Higher scores on the RHI represent
higher quality of relational health. Three sub-
scales can be calculated to assess relational
domains of authenticity, empowerment, and
engagement within each of the composite
domains. Authenticity was defined as ‘‘the pro-
cess of acquiring knowledge of self and other and
feeling free to be genuine in the context of
the relationship’’ (Liang et al., 2002, p. 26).
Empowerment was defined as ‘‘the experience
of feeling personally strengthened and inspired
to take action,’’ whereas engagement was
described as the ‘‘perceived mutual involvement,
commitment, attunement to the relationship’’
(Liang et al., 2002, p. 26). Frey, Beasley, and
Newman (2005) reported high Cronbach’s a
coefficients for the subscales ranging from .86
to .91 indicating strong reliability of the items.
Liang, Tracy, Kenny, Brogan, and Gatha (2010)
detected similarly robust reliability and retention
of the factor structure of the RHI with a sample of
adolescents students (N ¼ 188).
Setting
During the present study, each of the partici-
pants was incarcerated in a military-style deten-
tion center for a period ranging from 8 to 10
months. The facility, located in a central south-
ern state of the United States is based on disci-
pline, education, and counseling. Participants
and their peers complete regular physical train-
ing activities, go to school with the encourage-
ment to complete their General Education
Diploma, and attend regular programming asso-
ciated with life skills development and problem
solving. Counseling services for adolescents
detained at this facility are contracted through
community partners such as the mental health
agency that provided the RCT groups in this
study. In this particular facility, males and
females are separated and under 24-hr observa-
tion by same sex staff that implement facility
rules and standards for behavior including pro-
tocols for interpersonal communication, aca-
demic task completion, and completing
scheduled activities. Noncompliance with facil-
ity policies is associated with noncorporal pun-
ishments including physical training, increased
cleaning duties, and isolation.
Treatment
Participants received nine sessions of group
RCT using the manual presented by Jordan and
Dooley (2001). The RCT treatment manual
consists of eight structured sessions completed
in approximately one and a half to two hours.
Each group session is led by two cocounselors
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and composed of a relational check-in, creative
moments, clarity in connections, and closing
connections/relational impact. During the rela-
tional check-in each group member, including
the counselors, makes a statement about their
current status emotionally, cognitively, or spiri-
tually and what impact their state-of-being may
have on the group process. Next, the creative
moments portion of the session educates group
members about relational concepts (e.g., rela-
tional images, mutual empathy, experiencing
disconnection, etc.) and how one is shaped by
personal experiences. Group members are sup-
ported and guided to contribute to the groups
understanding of these concepts and how they
are expressed in their lives. Following, the
clarity in connections section, the group pro-
vides concept-related experiential activities to
facilitate participants’ deeper understanding of
the content through personal expression, mutual
sharing, and collaborative discussion. Finally,
the closing connections/relational impact com-
ponent provides group members an opportunity
to discuss their emotional, cognitive, and
spiritual status following the education and
experiential activities, how the group has
affected them, and whether any new questions
or perspectives have emerged.
Prior to providing treatment, the authors
reviewed the content of the RCT treatment man-
ual and made revisions to content if necessary to
promote developmental and cultural fit for the
population being served. The counselors (sec-
ond and third authors) made an initial round of
accommodations to the content independently
and collaborated with their supervisor (first
author) to assure that the interventions were
within the intended scope of the sessions’ pur-
pose. Additionally, one session was added to the
curriculum addressing the expression of empathy
to individuals from different backgrounds. The
activity was based on a participatory visual anal-
ysis task developed by Lenz and Sangganajana-
vanich (in press) which has been demonstrated
to promote empathic responses among students
in one study. This additional session followed the
format of all previous and subsequent sessions and
was integrated into a discussion regarding mutual
empathy.
Procedure
As part of an agreement with a local juvenile jus-
tice detention facility in a central southern state
of the United States, a community mental health
agency provided pro bono group counseling ser-
vices as part of the facility’s enrichment program-
ming. We implemented an A-B single-case
research design to assess the effectiveness of an
RCT group therapy intervention for improving
three domains of relational health (i.e., authenti-
city, empowerment, and engagement) among
adolescent females that were incarcerated. This
design was selected to accommodate the limited
time frame (12 weeks) to complete the group
intervention and was regarded as a reasonable
strategy for evaluating the RCT program among
individual participants. Participants were edu-
cated about group structure, content, process, and
rationale during an orientation provided by two
masters-level counselors completing their final
internship experience through a counseling-
oriented fellowship program (second and third
authors) and were provided the choice to partici-
pate in RCT weekly groups. As an alternative to
RCT programming, all participants were pro-
vided the choice to use group time to complete
school work or have leisure time to assure volun-
tary participation. After electing to participate in
RCT groups, participants chose a pseudonym to
be used when completing the RHI protocols and
completed an initial RHI to establish a baseline
for relational health.
Three baseline measurements of the RHI (A)
were completed during a 2-week period prior to
starting the RCT groups. During the treatment
phase (B), participants met weekly for nine ses-
sions on Friday afternoons for one and a half
hours and participated in an RCT group inter-
vention; participants had no contact with the
group leaders outside of group time. During
RCT group meetings, the group leaders main-
tained several controls presented by Jordan and
Dooley (2001) including group structure and
process (i.e., relational check-in, creative
moments, clarity in connections, and closing
connections/relational impact), consistency of
group facilitators, and time. At the conclusion
of each group meeting, participants completed
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the RHI including their pseudonym. Inventories
were collected, sealed in an envelope, labeled by
date and session number, and stored in a secure
location until the conclusion of data collection.
Data Analysis
The effectiveness of an RCT group intervention
was evaluated for each participant using the
Percentage of Data Exceeding the Median
procedure (PEM; Ma, 2006). This procedure
was implemented in favor of other nonoverlap
methods such as the Percentage of Nonoverlap-
ping Data procedure (Scruggs, Mastropieri, &
Casto, 1987) due to the existence of baseline
data covering a considerable range of scores
without becoming stable in some instances.
Additionally, PEM has been demonstrated as
a robust measure of treatment effect for
within-subjects research designs (e.g., AB),
especially when the number of data points in
treatment phases is less than 10 (Ma, 2009).
To calculate PEM, the intended change was
identified, in this case it was hoped that partici-
pant scores on the RHI would increase during
the 9 weeks of RCT group involvement. Next,
all data points were graphed on a semilogarith-
mic chart and the median data point in the base-
line condition was identified. Following this, a
trend line was drawn extending from the med-
ian datum point in the baseline phase through the
treatment phase. The baseline and treatment
measurements within each figure are denoted
on the abscissa of each graph as B1 through
B3 and T1 through T9, respectively. The num-
ber of data points above the median line in the
treatment phase were counted and divided by
total number of data points in the treatment con-
dition. The resultant effect size coefficient was
interpreted using the guidelines presented by
Scruggs and Mastropieri (2001) for evaluating
treatment effectiveness in single-case research
designs. According to these guidelines, treat-
ments that yield an effect size coefficient in the
range of .90–1 are regarded as very effective,
.70–.89 as effective, .50–.69 as debatable, and
scores less than .50 are indicative of ineffective
interventions. In addition to interpreting the
PEM statistic, each participant’s graphical data
were analyzed using visual trend analysis.
Results
Participant 1
Figure 1 presents the subscale ratings for
Maegan on the RHI illustrating that an RCT
intervention was effective for promoting rela-
tional empowerment, but ineffective for pro-
moting relational authenticity and engagement
during the 9-week intervention. Evaluation of
the PEM statistic for authenticity (.22) indicated
that only two scores recorded during the treat-
ment condition were above the baseline median
(31) demonstrating treatment ineffectiveness
for this domain. A trend analysis of Maegan’s
authenticity subscale scores demonstrated that
both these data points were recorded shortly after
the treatment phase began, with a deep recess
during the middle sessions, and an upward trend
toward the baseline during the second half of
the RCT group. Maegan’s PEM statistic for the
empowerment subscale (1) represents all data
points in the treatment phase exceeding the base-
line median (25) and that RCT was very effective
for promoting relational empowerment. Trend
analysis of this subscale revealed that all but
one score was within 5 points of the baseline
median indicating sustained improvement
throughout the RCT group sessions. Finally, the
PEM statistic for the engagement subscale (.22)
demonstrated that 2 points in the treatment phase
exceeded the baseline median (25); thus, the RCT
group was ineffective for improving relational
engagement for Maegan. The trend analysis for
this subscale illustrates four data points at the
baseline median with the final two observations
exceeding the value.
Participant 2
Figure 2 presents the subscale ratings for
Lauren on the RHI illustrating that an RCT
intervention was effective for promoting
relational empowerment, debatable for promot-
ing engagement, and ineffective for promoting
authenticity during the 9-week intervention.
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Evaluation of the PEM statistic for authenticity
(.22) indicated that only two scores recorded dur-
ing the treatment condition were above the base-
line median (29) supporting the conclusion that
treatment was ineffective for improving this
domain. A trend analysis of Lauren’s authenticity
subscale scores demonstrated that data points
were decreased as far as 6 points from the base-
line median and abruptly increased above the
PEM line following the final two group sessions.
Lauren’s PEM statistic for the empowerment
subscale (.88) represents all but one data points
in the treatment phase exceeding the baseline
median (31) and that RCT was effective to very
effective for promoting relational empowerment.
Trend analysis of this subscale revealed that
all s cores above the PEM line were within a
5-point range indicating a sustained level
of improvement throughout the RCT group
sessions. Finally, the PEM statistic for the
engagement subscale (.55) resulted from 5 points
in the treatment phase exceeding the baseline
median (32) indicating a debatable effect of the
RCT group for improving relational engagement
for Lauren. The trend analysis for this subscale
illustrates an 11-point range separating the
5
10
15
20
25
30
35
40
45
B1 B2 B3 T1 T2 T3 T4 T5 T6 T7 T8 T9
Authenticity
5
10
15
20
25
30
35
40
45
B1 B2 B3 T1 T2 T3 T4 T5 T6 T7 T8 T9
Empowerment
5
10
15
20
25
30
35
40
45
B1 B2 B3 T1 T2 T3 T4 T5 T6 T7 T8 T9
Engagement
Figure 1. Ratings for Maegan on the authenticity, empowerment, and engagement subscales.
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lowest and highest scores for this subscale with
the final 2 points notably above the PEM line con-
noting considerable change following the RCT
intervention.
Participant 3
Figure 3 presents the subscale ratings for
Crystal on the RHI illustrating that an
RCT intervention was ineffective for promoting
relational authenticity, empowerment, or
engagement during the 9-week intervention.
Evaluation of the PEM statistic for authenticity
(.22) indicated that only two scores recorded dur-
ing the treatment condition were above the
baseline median (32) indicating that treatment
was ineffective for improving this domain. A
trend analysis of Crystal’s authenticity subscale
scores demonstrated that data points were predo-
minately decreased by 6 points and as much as 13
points from the baseline median with no points
above the median following the fourth session.
Crystal’s PEM statistic for the empowerment
subscale (.22) represents all but only two data
points in the treatment phase exceeding the
baseline median (34) and that RCT was ineffec-
tive for promoting relational empowerment.
Trend analysis of this subscale revealed that the
scores above the PEM line were marginal eleva-
tions, whereas decreases in this domain deviated
5
10
15
20
25
30
35
40
45
B1 B2 B3 T1 T2 T3 T4 T5 T6 T7 T8 T9
Authenticity
5
10
15
20
25
30
35
40
45
B1 B2 B3 T1 T2 T3 T4 T5 T6 T7 T8 T9
Empowerment
5
10
15
20
25
30
35
40
45
B1 B2 B3 T1 T2 T3 T4 T5 T6 T7 T8 T9
Engagement
Figure 2. Ratings for Lauren on the authenticity, empowerment, and engagement subscales.
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from the baseline median by as much as 8 points.
Finally, the PEM statistic for the engagement
subscale (.11) resulted from one elevated point
in the treatment phase that exceeding the baseline
median (28) indicating that participation in the
RCT group was ineffective for improving rela-
tional engagement for Crystal. The trend
analysis for this subscale illustrates only moder-
ate variability in the data with the majority of data
points residing within a 6-point range under the
PEM line indicating little change in this domain
associated with the RCT intervention.
Participant 4
Figure 4 presents the subscale ratings for
Samantha on the RHI illustrating that an RCT
intervention was ineffective for promoting rela-
tional authenticity and empowerment, but
effective for promoting engagement during the
9-week intervention. Evaluation of the PEM
statistic for authenticity (.42) indicated that
four scores recorded during the treatment con-
dition were above the baseline median (32)
supporting the conclusion that treatment was
5
10
15
20
25
30
35
40
45
B1 B2 B3 T1 T2 T3 T4 T5 T6 T7 T8 T9
Authenticity
5
10
15
20
25
30
35
40
45
B1 B2 B3 T1 T2 T3 T4 T5 T6 T7 T8 T9
Empowerment
5
10
15
20
25
30
35
40
45
B1 B2 B3 T1 T2 T3 T4 T5 T6 T7 T8 T9
Engagement
Figure 3. Ratings for Crystal on the authenticity, empowerment, and engagement subscales.
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ineffective f or improving this domain. A
trend analysis of Samantha’s authenticity
subscale scores demonstrat ed that data points
steadily increased from below the baseli ne
median to above it throughout participation
in the group. Samantha’s PEM statistic for
the empowerment subsca le (.22) reflects two
data points in the treatment phase exceeding
the baseline median (43) and that RCT was
ineffective for promoting relational empow-
erment. Trend analysis of this subscale illus-
trates that all score s were grouped very close
to the PEM line and di d not exceed a 6-point
range indicat ing very little magnitude of
change during the treatment phase. Finally,
the PEM statistic for the engagement sub-
scale (.77) resulted from 7 points in the treat-
ment phase exceeding the baseline median
(37) i ndicating effectiveness of the RCT
group for improving relational engagement
for Samantha. The trend analysis for this
subscale illustrates a progressive increase is
subscale scores above the baseline median
within a 6-point range.
5
10
15
20
25
30
35
40
45
B1 B2 B3 T1 T2 T3 T4 T5 T6 T7 T8 T9
Authenticity
5
10
15
20
25
30
35
40
45
B1 B2 B3 T1 T2 T3 T4 T5 T6 T7 T8 T9
Empowerment
5
10
15
20
25
30
35
40
45
B1 B2 B3 T1 T2 T3 T4 T5 T6 T7 T8 T9
Engagement
Figure 4. Ratings for Samantha on the authenticity, empowerment, and engagement subscales.
26 Counseling Outcome Research and Evaluation 3(1)
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Discussion
The results of this study found that three of the
four participants reported a noteworthy amount
of change in at least one domain of relational
health as measured by the RHI. Maegan’s level
of relational empowerment increased during
the treatment phase; similar results were noted
for Lauren as indicated by consistent increase of
scores on the empowerment subscale. In both
cases, an RCT group intervention was within the
range of effective to very effective for increas-
ing participant feelings of being personally
strengthened and inspired to take action within
relationships. This change is especially poignant
when considering the supposition by Covington
(2007) that correctional facility milieu com-
monly represses the development of social and
relational skills needed for growth fostering
relationships. It is reasonable to surmise that if
counselors are able to inculcate adolescent
females to desire meaningful engagement with
others while detained, the trends of social inter-
action may be positively influenced when
released. Liang, Tracy, Taylor, Williams, and
Jordan (2002) suggested that developing the
energy for involvement with others was requi-
site for creating a sense of belonging with peers,
mentors, and the community at-large.
While these two participants’ ratings on the
empowerment subscale improved, two partici-
pants reported scores on the RHI engagement
subscale that indicate that an RCT group
demonstrated debatable to effective results dur-
ing treatment. For Samantha, the PEM scores
indicate that her scores maintained sustained
improvement over time. For Lauren, increases
in activities associated with meaningful
engagement behaviors with others were inter-
mittently reported for several weeks at a time
without consistent or sustained development.
Liang et al. (2002) suggested that when individ-
uals are mutually engaged with others, associ-
ated closeness and empathy with others may
mediate self-esteem, self-actualization, and
satisfactions with relationships. This increase
in relations with others based in mutuality is a
hopeful indication of the effectiveness of coun-
selors within the correctional setting purported
by Covington (1998, 2007) as characterized by
disproportionate power hierarchies, ubiquitous
control, and compliance with subordination.
Finally, our results did not yield any treat-
ment effect in perceived authenticity among
any of the participants. This finding may be
attributed to the participants’ developmental
experiences with important others that have
resulted in the reported acts of drug abuse,
running away from home and family violence.
It is possible that although some participants
reported being inspired to move toward
(empowerment) and take meaningful action
within relationships (engagement), interperso-
nal histories may have inhibited willingness
to be freely genuine and open with others. Con-
versely, while working within the system as
mental health professionals, we frequently
questioned how effective this RCT intervention
would be based upon the supposition that the
interpersonal environment of a correctional
does not promote honest, authentic expression
of feelings, thoughts, and values; instead, pre-
mium behaviors include nondisclosure, compli-
ance with authority, and uniform values. This
observation is commensurate with Covington’s
(1998, 2007) description of correctional facili-
ties as being interpersonally austere and dis-
paraging environments for meaningful,
positive self-expression. It may be possible that
within other contexts, through long-term inter-
ventions, or in the absence of a correctional
staff member that a safe disposition regarding
self-disclosure and relational exploration with
others can be promoted.
Limitations
Several caveats are noted regarding the results
of our investigation related to design, partici-
pant selection, and data analysis. Foremost,
although the AB approach to single-case
research designs is an accepted evaluation
method, time constraints to complete therapeutic
programming did not provide opportunity to
implement an ABA design that would have
allowed provided stronger internal validity for
the RCT intervention and reliable determinations
of lasting change. Next, our number of baseline
Lenz et al. 27
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measurements (N ¼ 3) is regarded as sufficient
when implementing a single-case research
design, however, more data collections may have
allowed for the data to stabilize prior to the RCT
intervention. Furthermore, our results would
have been regarded as more robust if participants
had been randomly assigned to the RCT group
and another group completed measures while
receiving alternative treatment. As noted, by
Parker and Hagan-Burke (2007), despite their
usefulness, effect sizes reflect amount of change,
not cause of change; the latter is contingent upon
strong research designs with considerable inter-
nal validity. Future studies implementing an
alternative treatment group will also be capable
of applying more rigorous data analysis proce-
dures such as the Success Rate Difference, Rela-
tive Success Rate, and Relative Success Rate
Improvement procedures (see Parker and
Hagan-Burke) used in medical trials.
Conclusions
There has been considerable discussion
concerning the differential experiences of
female offenders within correctional institu-
tions. Most prominently, the rehabilitative struc-
ture of detainment facilities is generally
characterized by a system that promotes subordi-
nation, individualism, and isolation as a means
of thriving. Covington (1998, 2007) has sug-
gested that this system is not conducive to pro-
moting the social and relational rehabilitation
that may be beneficial for females. We have pro-
vided some initial support for the use of RCT
groups for promoting relational development
empowerment and engagement among incarcer-
ated adolescent females; similar findings were
not noted for relational authenticity. Given the
interpersonal austerity of many correctional sys-
tems, we regard RCT as a promising interven-
tion for creating positive relational movement
between adolescent females; however, it is
undeniable that this burgeoning approach to
counseling needs to be investigated further.
We are hopeful that scientist–practitioners will
evaluate similar practices in other correctional
facilities to ascertain the relevancy for this
approach and substantiate RCT as an evidence-
supported treatment.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of
interest with respect to the research, authorship,
and/or publication of this article.
Funding
The author(s) received no financial support for
the research, authorship, and/or publication of
this article.
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Bios
A. Stephen Lenz is an Assistant Professor in the
Department of Counseling, Educational Psychology,
and Research at The University of Memphis and a
Licensed Professional Counselor. His research
interests include holistic approaches to counselor
development, evidence-supported counseling inter-
ventions, community program evaluation, and rela-
tional approaches to increasing college student
adjustment.
Megan Speciale is a doctoral candidate in Counselor
Education in the Department of Individual, Family,
and Community Education at The University of New
Mexico. Her research interests include the integra-
tion of a wellness perspective in counselor training
and supervision, LGBTQQIA issues in professional
counseling and counselor education, and intimacy
and sexuality issues in couples counseling.
Jinnelle V. Aguilar recently graduated from Texas
A&M University–Corpus Christi with a Master of
Science in Counseling. She is presently the Program
Coordinator for the Veterans Incentive Program at
MHMR of Nueces County in Corpus Christi, Texas.
Lenz et al. 29
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