Prevention in Career Practice
The field of preventive psychology presumes that many predictable psychological disorders can be averted by "developing interventions designed to short-circuit negative psychological sequelae for those who have experienced risk-augmenting life situations or stressful life events" (Cowen, 1984, p. 485). Psychologists began to define prevention as one of their professional goals when the demand for psychological services increased and the negative effects of mental disorders became clearer. Rather than treat each individual with a full-blown disorder (tertiary treatment), prevention psychologists insist that many disorders can be entirely prevented (primary prevention) or at least minimized by early identification and intervention (secondary prevention) (Klein 8c Goldston, 1976).
Primary prevention involves the following steps:
- "reducing new instances of the disorder";
- "reducing irritants to dysfunction before they exact their toll"; and
- "building psychological health" (Cowen, 1978a, p. 8). G. Caplan (1964) has written that primary prevention ... involves lowering the rate of new cases of mental disorder in a population over a certain period by counteracting harmful circumstances before they have had a chance to produce illness. It does not seek to prevent a specific person from becoming sick. Instead it seeks to reduce the risk for a whole population so that, although some may become ill, their numbers will be reduced" (p. 26).
Promoting Career Competence
One emphasis in the prevention literature is on the promotion of healthy behaviors that, although not designed to prevent any specific psychological disorder, might ward off problems among large segments of the population. Albee's (1982) definition of primary prevention as "the reduction of unnecessary stress, including powerlessness, and the enhancement of social competence, self-esteem and support networks" (p. 1043) highlights the role of the promotion of competence in reducing psychopathology. More to the point, Albee argued that although the loss of one's job is stressful, even the threat of losing one's job is equally stressful. Competence-building approaches to social and community intervention typically teach a specific set of personal and/or social skills, and relate the acquisition of those skills to important mental health outcomes (Gesten & Jason, 1987). To qualify as a preventive intervention, a competence-building strategy must show that the development of a specific skill will lower the levels of a subsequent disorder in at-risk populations. Bloom (1977) wrote that competency building is the most compelling construct for integrating mental health and community interventions. This emphasis on competence has recently been carefully extended to career problems (Herr, in press; Herr & Cramer, 1988).
Applying Prevention to Career Problems
Suppose that 10 percent of the 30,000 employees in a large company or students in a major university decided to pursue career assistance in one year. Could any career center accommodate 3,000 clients with traditional individual, group, or workshop interventions? If each client required the average 3.74 individual sessions assistance with a trained counselor (Oliver & Spokane, 1988), over 9,000 sessions would be required. These figures probably underestimate the service delivery problem in the field of career development. A recent poll commissioned by the National Career Development Association (NCDA, 1988) revealed that 9.7 percent of adults, or nearly 11 million individuals, needed assistance with job selection and changing in the year surveyed. These numbers are consistent with previous studies that revealed that career assistance is usually the most highly subscribed need in surveys conducted in higher education settings. The NCDA poll further suggests that the problem is substantially worse among non-college and minority populations.
Obviously, we can no longer meet the need for career services with traditional one-on-one and group interventions alone, or even with consultation approaches that attempt to treat groups. Huebner and Corazzini (1984) have noted that counseling psychologists have slowly but steadily moved toward preventive intervention among the various alternatives that are being pursued. The case can be made that the more convincing demonstration of cure or mastery is made by preventing rather than treating a specific disorder (Long, 1986).
A Philosophy of Career Development versus a Model for Preventing Career Accidents
Developmental theories of careers typically describe how careers evolve and change over longer time spans (Herr & Cramer, 1988), and evoke specific career-related constructs (e.g., career maturity) to account for successful progression through desired stages.
In contrast, primary prevention has as its goal the prevention of the development of a specific disorder through more general psychological means. Whereas developmental career intervention would provide a curriculum to ensure completion of the developmental tasks of a given stage (Healy, 1982), a preventive intervention might identify the devastating effects of unemployment on self-esteem and promote early coping skills in the face of adversity.
Using logic similar to that cleverly employed by L. S. Gottfredson (1986), it is possible to use career development and counseling studies to estimate the incidence rates of several of these disorders. Whereas Gottfredson argued that membership in certain minority groups generally increased problems of career choice, the model estimates population incidence rates of more specific career disorders as the bases of the design and evaluation of primary prevention efforts designed to lessen the probability and severity of those disorders. Of course, as Gottfredson has carefully documented, membership in a minority group would increase the probability of many of these disorders.
As an example of the more specific epidemiology approach required to conduct truly preventive studies, it is possible to consult studies of person-environment fit (Spokane, 1985) that suggest that 50 percent of respondents will have incongruent first-letter person and environment Holland codes .
Evaluating Preventive Interventions
The evidence on the effectiveness of preventive interventions is somewhat uneven. The true test of such an intervention, of course, is its impact on the incidence and severity of specific, predictable disorders in the treated versus the control group. A study by Lind-quist and Lowe (1978), for example, drew on the campus ecology model (Huebner and Corazzini, 1984) and applied preventive methods in a college student population. Although the fact that participation in the study was voluntary badly confounded motivation with intervention outcome, neither a written interactive program nor a peer-led group was effective in reducing the dropout rate. The weak outcomes that Lindquist and Lowe found starkly contrast with the substantial effect sizes uncovered by Baker, Swisher, Nadenichek, and Popowicz (1984) in a meta-analysis of primary prevention strategies. Their reanalysis of forty preventive counseling studies resulted in an effect size even higher than that found in individual psychotherapy (M. L. Smith, Glass & Miller, 1980). It is debatable, however, how many of Baker et al.'s set of studies would have been considered primary or even secondary prevention if strict inclusion rules had been used. Few of the studies used base-line rates of disorder, and most were secondary or tertiary treatment studies conducted after a disorder had been identified (e.g., Yates, Johnson, & Johnson, 1979). The content of the studies was also quite broad, whereas a review of career prevention studies in particular would have been more germane to this discussion; however, such a review (and the studies) do not exist. Thus we have little empirical evidence for the effectiveness of career prevention efforts.
In sum, the identification of base rates for specific career disorders opens the possibility that these disorders might be addressed through primary prevention rather than after-the-fact intervention. Once a base rate has been calculated for any sample, an intervention can be evaluated with respect to its effect on the prevalence and severity of that disorder in that population.
