Once the problem is clarified, decisions must be made about which treatment to select or design for a particular client. Evidence is now accumulating that suggests that the type of treatment may be a factor in the success of the intervention. This is a relatively new field of inquiry that hopes to perfect treatment selection to improve effectiveness. The notion that treatments should vary according to type of client appeared first among developmental theorists (R. A. Myers, 1971). Its application to career counseling treatments was most cogently presented by Fretz (1981), who outlined several domains of client and treatment variables that might interact to affect outcomes.
Although the concept of the attribute-treatment interaction is appealing to counselors and researchers hoping to design more effective career interventions, the influence attributable to client variables in outcome studies is generally less than might be expected. The studies that show that certain treatments affect some people more than others generally consider only a portion of a comprehensive treatment. It is not clear, however, that on the whole specifically tailored treatments would be more effective than comprehensive treatments that included all kinds of interventions and all manner of clients.
Theoretically, it is possible that some career interventions could have detrimental effects on a few individuals. There has, however, been no such evidence, and thus there is little basis for withholding a treatment from any client. The practical application of the attribute-treatment interaction studies may lead to the more liberal use of self-help and self-directing interventions with clients who show minimal presenting problems, thus reserving more expensive counselor-intensive interventions for more serious concerns, or for clients with low self-esteem or minimal social skills (Spokane, in press, a). Presently, there is insufficient evidence for firm conclusions about which clients will benefit from specific interventions. The studies on this issue, while not yet conclusive, are beginning to show certain trends and may eventually lead to advances in the differential use of career interventions.
In Kivlighan, Hageseth, Tipton, and McGovern (1981), a ground-breaking effort to study the differential effects of treatment types, subjects were classified as either people oriented or task oriented using their Holland type and assigned to treatment groups using a stratified random assignment procedure. All subjects received group career interventions, but in half of the groups, member interactions were encouraged, whereas in the other half individual problem solving was emphasized. The outcome measures were career maturity, information seeking, and treatment satisfaction. No treatment effects were found between the group and individual treatments until the Holland type was used to analyze groups separately. Blocking clients according to their sociability (people oriented versus task oriented) unmasked substantial interactions between client type and the use of interaction in the treatment. People-oriented clients fared better in the interactive groups than in individual problem-solving groups. The interaction effects, especially on information seeking, were substantial.
In a similar study, Robbins and Tucker (1986) used level of goal instability as the client attribute, and compared the effectiveness of self-directed or interactional career workshops. The authors employed career maturity and exploration as outcome variables. Subjects with high goal instability fared better in the interactional treatment, whereas those with low goal instability had favorable outcomes regardless of treatment type. Likewise, Krumboltz, Kinnier, Rude, Scherba, and Hamel (1986) used a single, ninety-minute rational decision intervention and classified subjects as rational, intuitive, fatalistic, impulsive, or independent using a decision questionnaire. Results revealed that rational types had higher decision information scores in response to the rational decision training than did intuitive or dependent types. Barak and Friedkes (1981) used the career decision scale to make a differential diagnosis before administering a career intervention. They found that clients who scored higher on lack of structure did better in career counseling than those who scored high on conflicts with others or blocked choices. No interaction was found between the nature of the treatment and the presenting problem, however, which led Barak and Friedkes to conclude that the delivery mode of a career treatment was less likely to result in attribute-treatment interaction than was a dramatic variation in the informational content of the treatment itself.
Fretz and Leong (1982) found that the Self-Directed Search was most effective for subjects with minimal levels of career indecision. Zager (1982) attempted to enhance self-esteem as a career intervention, but inadvertently found that clients with low self-esteem dropped out of group treatment at unusually high rates. Finally, Melhus, Hershenson, and Vermillion (1973) found that low-readiness clients fared better in one-on-one interventions with a trained counselor than with a computer-assisted treatment.
Evidence on the effect of client and treatment variables on outcome is thus slowly accumulating, and reveals that individuals with minimal indecision and stable goals will demonstrate significant gains with a self-directing career intervention, whereas clients with low self-esteem, low readiness, low sociability, or high goal instability should probably receive individual as opposed to group or self-directing career interventions. This is summarized in the below postulate:
Postulate: A few major personality and adjustment styles (e.g.: sociability, self-esteem, and decisive style and type) should guide the choice of career intervention. In general, the stronger the level of client personality integration, the more educative and less therapeutic the treatment need be.
It should be noted, however, that one might also consider other attributes before choosing a treatment strategy (e.g., obsessive or hysterical personality style; see Shapiro, 1965), and that future research may uncover other salient variables as well.
