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The Impact of Counselor Self-Disclosure on Client Trust During Early Recovery Research P.

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The Impact of Counselor Self-Disclosure on Client Trust During Early Recovery 

Research Proposal

Alexandra Arpey

Chadron State College 

Counseling Research and Program Evaluation - COUN 641

Dr. Tara Wilson

November 23, 2025

Abstract

The main goal of this quantitative quasi-experimental research study is to explore whether counselor self-disclosures regarding their recovery processes influence client's beliefs regarding trust in the therapeutic process at the beginning of their recovery from substance use. This research will draw upon a combination of research studies documenting both the positive effects (i.e., enhanced relatability and credibility as documented by Corey (2021); Knight (2019)) and potential adverse effects (i.e., violation of professional boundaries; diminished counselor competence as documented by Henretty & Levitt (2010); Audet & Everall (2010)) of counselor self-disclosure. In addition, this research study will attempt to fill an empirical void in the research related to the relationship between counselor self-disclosures and client belief systems related to the development of trust within the therapeutic relationship during the early stages of treatment (the National Institute on Drug Abuse reports that approximately fifty percent of individuals seeking drug or alcohol treatment will stop attending therapy before completion as reported by SAMHSA (2023) which may occur during a time when engagement in the treatment process is likely to be fragile).

A total of 120 participants (ages 18+ years old) who are in the early stages of recovery (i.e., within the first 30 days of outpatient/residential treatment) will be recruited from a variety of urban/suburban treatment programs (i.e., ≥ 40% women, ≥ 30% racial/ethnic minorities) and randomly assigned to one of two existing counselor-client dyad conditions: (1) counselors will provide a standardized scripted disclosure of their recovery experience during the initial session (e.g., discussing their struggles with sobriety), or (2) there will be no counselor disclosure. Client perceived trust in the therapeutic relationship will be measured using the reliable Working Alliance Inventory-Short Revised (WAI-SR) (Hatcher & Gillaspy, 2006; α = .90; also has strong validity with both client retention and treatment outcome measures).

Research Hypothesis: Clients who receive a counselor's self-disclosure will have significantly higher WAI-SR trust scores compared to clients who do not receive a counselor's self-disclosure (H1), rather than having similar trust scores (H0). The manipulation check measures (client self-report: yes/no self-disclosure recall, relevance rating, open-ended content) and counselor logs will confirm counselor adherence to the experimental protocols; however, data collected from non-adherent cases will be excluded. Data analysis will occur using SPSS software and include t-tests for comparing mean scores across groups, ANCOVA for examining covariates (e.g., demographics, type of substance used, culture as documented by Sue & Sue (2022); gender; client readiness), and calculating effect sizes.

Utilizing an action research methodology will facilitate collaborative relationships with practitioners to make iterative refinements and increase the practical applicability of findings. The study's results will inform the development of evidence-based guidelines for both training/supervision of counselors and for practicing counselors concerning ethical self-disclosure, including the balance of authenticity and maintaining professional boundaries. The study's findings may ultimately decrease early dropout rates, improve client-counselor alliances, and empower recovering counselors to practice ethically.

Introduction

Counselor self-disclosure has been widely debated in the field of counseling, especially in the area of substance use treatment (Henretty & Levitt, 2010; Knight, 2019; Audet & Everall, 2010; Henretty et al., 2014). There is a belief that when counselors disclose, it may help foster authenticity and make them more relatable. Still, it may also raise concerns about boundaries and the risk of shifting the treatment focus to the counselor. Henretty and Levitt (2010) conducted a qualitative review of therapist self-disclosure and found that self-disclosure could promote a sense of normalization in clients' experiences, reducing perceived power differences and potentially strengthening the therapeutic relationship. However, they did provide a couple of cautions; they posited through their review that frequent or inaccurately timed self-disclosures may lead to boundary confusion or, in their term, "overfamiliarity", where clients may see the counselor more as peers than as professional helpers. This change can undermine the therapeutic intent, divert attention from the client's needs, and ultimately erode the helping relationship. The gaps identified above serve as a basis for the research contained within this dissertation. The area identified is also one where little research has explored the use of lived experience and credibility as they relate to counselor self-disclosure in the area of addiction counseling and how it impacts clients' confidence in their counselor and the client-counselor relationship.

Counselor Disclosure

Although research on substance use counseling has suggested the positive aspects of counselor disclosure provided some discretion is used — particularly when disclosing about a counselor's personal recovery experience — Knight (2019) reviewed how counselors' self-disclosures regarding their history of recovery influenced substance abuse treatment by noting that counselors who have revealed their personal recovery history are seen as being more credible and relatable than those who did not reveal this information. Knight's findings suggest an alignment with the needs of addiction counselors; shared recovery experiences can reduce the distance between understanding of the client and client openness. This focus on lived experience as a factor in credibility with regard to clients who are in recovery from addiction lends credence to Corey (2021) whose statement that "authenticity and immediacy" increases the strength of the therapeutic alliance when utilized appropriately by counselors.

Qualitative studies of recovering counselors also provide additional evidence supporting the use of selective counselor disclosures. Stauffer & LeMasson (2013) conducted interviews with counselors in recovery, and found that revealing personal sobriety milestones at the right time could help build empathy and model long-term recovery; however, the participants stated that they had to be intentional about the timing of these disclosures so as not to trigger their own sensitivities.

Client Trust in Early Recovery 

Counselor self-disclosure has been shown to increase the initial level of rapport and client engagement for clients beginning their treatment process. The importance of this discovery is significant because early recovery is the highest risk of drop-out for treatment and trust is typically the single largest determining factor for continuing treatment. Additionally, Curtis and Davis (2014) stated that a well-timed disclosure could instill hope or provide a client with an example of someone who is capable of enduring the challenges of recovery thereby demonstrating a model of perseverance and resiliency. However, contrasting perspectives exist in larger meta-analyses. For instance, Henretty et al. (2014) conducted a meta-analysis using 53 studies examining the effects of therapist self-disclosure, indicating a small but positive relationship between therapist self-disclosure and client outcomes (i.e., increased liking of the therapist and increased client disclosure). However, it also identified variability among the findings. Specifically, disclosures of similarity (e.g. shared experiences of recovery-related challenges), had significantly greater benefits than those that were unrelated to the therapeutic relationship or overly negative, which resulted in decreased perceptions of the counselors' competence.

Working Alliance Inventory 

While initial evidence supports that counselor disclosure can produce positive outcomes, systematic research using quantifiable means to assess directly counselor disclosure and trust is currently limited. The majority of literature exists in the form of anecdotal and/or theoretical literature, and lacks empirical data. The Working Alliance Inventory (WAI; Horvath & Greenberg, 1989) is one of the most commonly used standardized assessment tools to evaluate the therapeutic relationship (i.e., trust), and has demonstrated reliability (α = .85 – .93 internal consistency across subscales; r = .83 test/retest reliability over two weeks) while assessing client perception of the alliance along three dimensions: bond, goal, and task, demonstrating a high degree of construct validity, significantly relating to treatment retention (r = .55) and outcome measures across numerous samples, supported through meta-analytic validation. There are however very few studies utilizing the WAI within the domain of counselor self-disclosure in substance use treatment contexts, indicating a large knowledge gap, and therefore, the question remains unanswered regarding whether counselor disclosures of a personal nature enhance or diminish client trust during the early stages of recovery. The emphasis on a research gap based upon existing theory demonstrates the need for empirical studies that provide quantifiable evidence regarding the extent to which counselor disclosure contributes to the formation of the therapeutic bond between the counselor and the client.

There are several examples of quantitative studies that introduce ambiguity into the discussion. Audet and Everall (2010) completed a survey-based analysis of client perception and found that, although some non-immediate disclosures (including the counselor sharing their own recovery experiences) were viewed as supportive by some clients, other clients rated these disclosures as intrusive, which resulted in lower alliance ratings, in some cases, due to the client perceiving the counselor as less expert. These findings contradict those reported by Knight (2019) and highlight how the client's readiness for a particular disclosure can act as a moderator of its effects.

In addition, results of studies on this topic have produced mixed results, contributing to the overall complexity of this issue (Audet & Everall, 2010). While some clients may find disclosure comforting and connecting, other clients may view disclosure as distracting them from the recovery process, creating ambivalence as to whether the counselor was acting professionally. The timing, type, and amount of the disclosure may all have an effect on the client's perception, as well as various demographic characteristics of the client (e.g., age, gender, length of time in recovery). Cultural considerations also add to the complexity of this issue; for example, in culturally diverse populations, disclosures that are not matched to the cultural norms of the client may exacerbate pre-existing mistrust created by systemic inequities (Sue & Sue, 2022). Therefore, demographic and contextual factors should be examined and considered in order to understand better the role of disclosure in practice. Additionally, research designs that examine clients who are in early recovery and utilize valid measures of trust will allow future researchers to move beyond anecdotal research and develop evidence based recommendations for practice.

Therefore, both the potential for benefit and the risks associated with counselor self-disclosure were identified. While Henretty and Levitt (2010) stated that many counselors over-disclose, Knight (2019) pointed out that when utilized appropriately in the substance abuse context, counselor self-disclosure can have beneficial effects on clients. The conflicting results presented in Audet and Everall (2010) and the moderated effects reported in Henretty et al. (2014) further support the need for nuance in discussing counselor self-disclosure. Currently, there is no empirical study examining the extent to which counselors' disclosure of their own recovery experiences increases client trust, especially in the early stage of treatment where the importance of the working alliance is greater than at any point in the treatment. The proposed research question is: To what extent does counselor self-disclosure of personal recovery experiences contribute to client-perceived trust as measured by the Working Alliance Inventory among adult individuals in early recovery from a substance use disorder? Hypothesis: Clients in early recovery will rate themselves as trusting their counselors (using the WAI) to a greater degree when counselors share their personal recovery experiences than when counselors do not.

Purpose Statement

The purpose of this study is to examine the association between counselor self-disclosure of personal recovery experiences and client trust in early recovery. It is important to establish trust early in treatment; approximately 50% of clients in substance abuse treatment programs will drop out of treatment before completing one month of treatment (Substance Abuse and Mental Health Services Administration [SAMHSA], 2023). This quantitative study examines the association between a counselor's self-disclosure of personal recovery experiences and client trust in the counselor-client relationship among adult clients in early recovery from substance use disorders. In particular, it will investigate if clients experience increased levels of trust with their counselor in a counselor-client relationship when they know that their counselor has experienced a similar recovery process compared to those clients whose counselors do not have personal recovery experiences to disclose. A quasi-experimental design will be utilized to assess the effects of the counselors' disclosure of their personal recovery experiences through random assignment of clients into one of two conditions: counselors will either utilize a standardized scripted disclosure during the first session of treatment, or counselors will not utilize any form of disclosure about their recovery. Although this design does allow for some form of causal inference regarding the impact of counselor self-disclosure, it also accounts for many of the constraints of a "real world" clinical setting by allowing existing counselor-client dyads to continue to work together in treatment settings.

Client trust will be assessed using the Working Alliance Inventory (WAI; Horvath & Greenberg, 1989), which is an established empirical measure assessing the strength of the therapeutic alliance. The WAI has 36 items rated on a 7 point Likert scale that yields subscales for bond, goals and tasks and emphasizes the overall degree of trust and cooperation in the therapeutic alliance. As reported in previous validation studies, the WAI consistently demonstrates high internal consistency reliability (Cronbach's α=0.85-0.93) and high test-retest reliability (r=.83 at 2 week intervals). Additionally, the construct validity of the WAI is strong as it has been found to correlate positively with treatment retention (r=0.55) and positive outcome in counseling modalities according to meta-analysis results. Utilizing a pre-established inventory will enhance comparability of the present study to past alliance research and minimize potential development bias.

Participation in the study will be solicited from adult clients (aged 18–65) participating in outpatient and residential addiction treatment programs and who are commencing treatment in the early stages of recovery. By limiting the participant sample to only include clients in this narrowly defined population, the study seeks to determine whether disclosing personal recovery experiences is a viable method for increasing client trust in the counselor-client relationship or whether these disclosures may potentially breach professional boundaries. The ultimate objective of the study is to provide evidence based recommendations for counselors regarding how they can utilize personal recovery experiences within counselor training, supervision and practice.

Hypothesis

Taking into account the mixed but hopeful findings from the literature, I propose the following hypothesis: H1: Clients in early recovery will have higher levels of trust (as measured by the Working Alliance Inventory) when their counselors promote self-disclosure of personal recovery experiences, compared to clients whose counselors do not engage in self-disclosure. H0: There will be no difference in trust (as measured by the Working Alliance Inventory) between clients whose counselors promote self-disclosure of personal recovery experiences and clients whose counselors do not self-disclose.

To establish that counselors engaged in self-disclosure as intended, a Manipulation Check will be used to collect data by way of client self-report immediately after the session. The Manipulation Check will be an anonymous, brief questionnaire including: (a) A binary response ("Was there anything about how you got sober that your counselor shared with you? Yes/No") , (b) A 5-Point Likert Scale assessing perceived relevance ("How much did this relate to you? 1 = Not At All, 5 = Very Much") if yes; and (c) An Open-Ended Section to obtain a brief description to assess content accuracy. If clients do not report adherence (for example, if they disclose something about themselves in the control group unintentionally), those cases will be removed from primary analysis so as to preserve group integrity. Session Logs completed by counselors will serve as a Secondary Verification Method, indicating compliance with protocol without audio taping, to protect client confidentiality. The purpose of this research is to provide an empirical base to determine the impact on trust when a counselor engages in disclosure regarding substance abuse counseling. Results of this study can assist in determining the role of disclosure within the context of clinical practice and assist in developing guidelines for counselor training that allow for a balance between authenticity in interactions with clients and maintaining professional boundaries.

Methodology

The study will be conducted using a quantitative methodology guided by an action research approach. The researcher is also a practitioner, so the method involves working collaboratively with treatment program staff to implement and evaluate disclosure methods in natural settings, making iterative changes in light of emerging data to increase the practical utility of the results. A quasi-experimental comparative design will be employed to examine trust outcomes between groups who were exposed to standardized disclosure versus no disclosure. Such a design will allow for actionable recommendations for use in counseling settings.

Participants

Adult participants (n = 120; aged 18+) who are in early recovery (defined as within the first 30 days of starting treatment) for substance use disorders will be recruited from four locations: two outpatient and two residential addiction treatment centers located in urban and suburban settings. This time frame coincides with the time frame identified by Meier et al. (2005) as the most unstable period of treatment engagement and alliance development, which occurs within the first thirty days of treatment. Diversity will be ensured by recruiting from various programs serving different demographics (i.e., at least 40% female participants; at least 30% racial/ethnic minority participants; and a range of ages from 18-65). Participants will be included if they can voluntarily enroll, provide informed consent, do not currently exhibit acute psychosis or cognitive impairments that would impede their ability to complete questionnaires. Excluded will be those who have previously had a therapeutic relationship with one of the participating counselors. Recruitment efforts will emphasize programs that serve a variety of populations to obtain diversity in terms of demographics. However, convenience sampling will be used initially and stratified recruitment will occur later to achieve a balanced sample across key demographics. Based on power analysis (conducted using GPower), n = 60 per condition will be required to detect a medium effect size (d = 0.5) at α = .05 and power = .80.

Measures

The primary tool will be the Working Alliance Inventory-Short Revised (WAI-SR; Hatcher & Gillaspy, 2006). The WAI-SR is a 12-item self-report measure of therapeutic alliance that uses a 7-point Likert scale (1 = seldom, 7 = always) with three subscales (task, bond, goal). The WAI-SR has demonstrated high levels of reliability (α = .90) and validity in counseling settings, with correlations between the WAI-SR and outcome measures (e.g., treatment retention). A short manipulation check questionnaire will also be completed after each session by participants in the disclosure condition to assess whether the participant believed the counselor disclosed his/her own recovery experiences (yes/no) and how relevant such a disclosure was to the participant (rating scale: 1-5).

Standardized procedures for administering both the WAI-SR and the manipulation check questionnaire will be implemented to improve reliability. Pilot-testing of both tools will also occur with 10 non-study clients to further refine the language used in the questionnaires to improve clarity and reduce ambiguity. Social desirability bias in self-reporting will be minimized by the anonymity of the responses and the assurance of confidentiality provided to participants. Potential limitations related to measurement tools include recall bias if sessions vary in length and self-selection bias if participants choose to participate in specific programs; however, both issues will be addressed through random assignment of participants to counselors and statistical control for potential baseline differences in demographics (e.g., age, race/ethnicity). Demographic information will be collected from participants at the time of entry into the study to enable the researchers to control for any possible demographic confounds (e.g., substance type, recovery duration).

Research Design and Procedure

A quasi-experimental between-group design will be used to conduct this study. Participants will be randomly assigned to either receive a standardized disclosure statement or receive no disclosure from their counselor during the first session. Randomization to counselors will be used to control for counselor effects (e.g., personality traits). The action research approach will involve initial meetings with program directors and counselors to develop the disclosure statements, followed by subsequent data collection cycles with regular reflection sessions to make any necessary protocol changes.

Specifically, the procedures for the study will be: (1) Obtain Institutional Review Board (IRB) approval and site permission. (2) Train 8-10 licensed counselors (each with at least 2 years of experience) on the study procedures; half of them will be trained to deliver a standardized and genuine disclosure statement in the first session (e.g., "I have experienced recovery from [substance] which enables me to better understand your struggles"), while the remaining half will not share any personal recovery experiences. (3) Screen and consent eligible clients upon admission to treatment. (4) Provide standard individual counseling sessions (approximately 45-60 minutes long) as normally occurs, with the disclosure statement delivered by the counselor in the experimental group. (5) Administer the WAI-SR and manipulation check questionnaire to participants immediately after each session. (6) Debrief participants and provide follow-up support if requested. Data collection will occur over a period of six months, with mid-term review sessions to revise any aspects of the study based on the feedback loops of the action research model. Participants will be randomly assigned using the random assignment function in SPSS to insure equal distribution of participants across all three groups of treatment. The effect of counselors will be controlled statistically by including counselor ID as a nested variable in statistical analysis. Participants will have the ability to withdraw from the study and/or request to change counselors at any point during the study.

Data Analysis

All data will be analyzed using Statistical Package for the Social Sciences (SPSS). Descriptive statistics will be calculated to examine demographics of participants and to ensure that both conditions are equivalent in terms of demographics (t-tests/chi-squares). An independent samples t-test will be calculated to determine if there are significant differences in mean WAI-SR total scores between participants receiving a standardized disclosure statement and those receiving no disclosure statement. Additionally, Analysis of Covariance (ANCOVA) will be used to statistically control for potential covariates (e.g., demographics, baseline mistrust via a pre-measurement if possible). Effect sizes (Cohen's d) and confidence intervals will also be reported. Finally, the manipulation check will help determine the extent to which participants in the disclosure condition received the intended disclosure and will be used to exclude any cases where disclosure was not successful.

Implications for Future Research

The proposed study addresses several important gaps in the counseling literature regarding the role of self-disclosure in substance abuse treatment. Currently, the majority of existing research has relied on qualitative reviews (Henretty & Levitt, 2010; Stauffer & Le Masson, 2013) or small-scale surveys (Knight, 2019) that have not established a clear link to trust using a valid measure (such as the WAI). Thus, this study will address the empirically identified void in the literature related to the unclear findings in previous studies (Audet & Everall, 2010; Henretty et al., 2014) and provide a quasi-experimental design to establish causality regarding the impact of disclosure on alliance. Action research will also facilitate practical application and provide opportunities for iterative collaboration with practitioners to create revised disclosure guidelines, which may inform counselor education programs (e.g., inclusion of the disclosure statements in supervision curriculum). Overall, this study will contribute to the field by establishing testable interventions rather than continuing to debate theories, and may ultimately result in reduced drop-out rates in early recovery, when approximately 50% of clients discontinue treatment within the first month. These results have potential application in supervisory settings for guiding counselor trainees' consideration of the level of transparency to practice appropriately in counselor-client relationships and for guiding supervisor modeling of ethical and client centered counselor behavior during training and evaluation processes.

Diversity and Cultural Considerations

This study will incorporate diversity considerations that are critical for conducting fair and representative mental health research. Historically, individuals from marginalized groups (Black, Indigenous, and People of Color) have been disproportionately affected by substance use disorders and have lower levels of trust in service delivery systems due to systemic oppression and stigma. Therefore, recruitment will occur from a diverse set of treatment programs and covariate analyses for race/ethnicity will be conducted to identify possible moderation effects (e.g., do recovery disclosures resonate more in collectivistic cultures where shared narratives are emphasized vs. in individualistic cultures where boundaries are emphasized?). Sue and Sue (2022) emphasize the significant role that cultural values play in shaping perceptions of counselor authenticity and flexibility of boundaries, and therefore, the degree to which the same counselor disclosure is viewed as empowering or intrusive will depend upon cultural norms. Gender dynamics are also relevant to this study; women in recovery may respond to disclosures differently due to higher levels of trauma histories and thus subgroup analyses will be conducted.

Limitations in generalizability (urban location) suggest future directions for the study (e.g., replication in rural or telehealth settings or tracking alliance longitudinally across multiple sessions). Extensions of the study using mixed-methods designs could include incorporating qualitative interviews with participants to explore why there were differences in quantitative outcomes. More broadly, the study's findings could support advocacy for culturally responsive training and provide policy implications regarding the development of culturally sensitive disclosure protocols that avoid stereotyping (e.g., assume that all BIPOC participants will relate to certain recovery experiences). Overall, positive findings could empower recovering counselors — often underrepresented — to utilize their lived experiences in ethical ways and to promote greater inclusion in the counseling profession, while maintaining professional boundaries. Additionally, future analyses will investigate if gender of the counselor and/or the counselor and client sharing a racial identity will moderate the degree to which clients perceive counselor recovery-related disclosures as authentic and trustworthy.

Conclusion

The study will provide additional benefits to those already listed as well as provide the necessary information to begin resolving a number of longstanding debates among researchers and practitioners concerning the role of counselor self-disclosure in substance abuse treatment by establishing an empirical link between counselor self-disclosure and client trust at the beginning of the recovery process when clients are most vulnerable. Action Research Methods using a quasi-experimental research design is utilized in the proposed study to compare two standardized conditions of counselor disclosures (i.e. a disclosure condition in which counselors share their own recovery experiences with the client and a non-disclosure condition in which counselors do not share their own recovery experiences with the client). The WAI-SR (Hatcher & Gillispy, 2006), a widely recognized measure of the working alliance, which has demonstrated both reliability and validity, will be utilized to assess the level of the working alliance established between the counselor and the client. 

The proposed study will address several major limitations of the current literature on counselor self-disclosure, specifically, the lack of empirically-supported relationships between counselor self-disclosure and client trust, the mixed results associated with the impact of counselor self-disclosure on the development of a working alliance (Audet & Everall, 2010; Knight, 2019) and the failure to consider how contextual moderators (e.g., timing, demographic characteristics (age, sex), and culture) may influence these relationships. Together, the proposed study is expected to provide empirical support for the establishment of best practice guidelines for counselors seeking to find an appropriate balance between the importance of being authentic and transparent while maintaining professional boundaries. Recommendations for counselor education and supervision based upon the findings of the proposed study should provide practical ways for reducing high dropout rates (approximately 50% within the first month of initiating treatment; Substance Abuse and Mental Health Services Administration, 2023) of clients in substance abuse treatment settings. Finally, through its focus on diversity issues and the assessment of the potential moderating effects of the client's culture (Sue & Sue, 2022) and the gender-related dynamics between the counselor and the client, the proposed study establishes a basis for developing culturally responsive, equitable treatments. Ultimately, the proposed study will enable counselors who are in recovery to use their lived experience in an ethical manner, enhance the development of strong working alliances with their clients, increase the likelihood that their clients remain in treatment and improve treatment outcomes in addiction counseling.

References

Audet, C. T., & Everall, R. D. (2010). Therapist self-disclosure and the therapeutic alliance: Client perceptions. Counselling Psychology Quarterly, 23(4), 375–387. https://doi.org/10.1080/09515070.2010.530484

Corey, G. (2021). Theory and practice of counseling and psychotherapy (10th ed.). Cengage Learning.

Curtis, R., & Davis, P. (2014). Counselor self-disclosure in addiction treatment: Perceptions of recovering counselors. Journal of Addictions & Offender Counseling, 35(2), 78–92. https://doi.org/10.1002/jaoc.12013

Hatcher, R. L., & Gillaspy, J. A. (2006). Development and validation of a revised short version of the Working Alliance Inventory. Psychotherapy Research, 16(1), 12–25. https://doi.org/10.1080/10503300500352500

Henretty, J. R., & Levitt, H. M. (2010). The role of therapist self-disclosure in psychotherapy: A qualitative review. Clinical Psychology Review, 30(1), 63–77. https://doi.org/10.1016/j.cpr.2009.09.004

Henretty, J. R., Levitt, H. M., & Mathews, S. S. (2014). Clients’ and therapists’ views of therapist self-disclosure: A meta-analysis. Psychotherapy, 51(3), 351–366. https://doi.org/10.1037/a0036939

Horvath, A. O., & Greenberg, L. S. (1989). Development and validation of the Working Alliance Inventory. Journal of Counseling Psychology, 36(2), 223–233. https://doi.org/10.1037/0022-0167.36.2.223

Knight, D. (2019). Therapeutic alliance in substance use treatment: Implications of counselor self-disclosure. Journal of Substance Abuse Treatment, 106, 45–52. https://doi.org/10.1016/j.jsat.2019.08.004

Meier, P. S., Donmall, M. C., McElduff, P., Barrowclough, C., & Heller, R. F. (2005). The role of the therapeutic alliance in the treatment of substance misuse: A critical review of the literature. Addiction, 100(3), 304–316. https://doi.org/10.1111/j.1360-0443.2004.00935.x

Sheperis, C. J. (2024). Counseling research: Quantitative, qualitative, and mixed methods (3rd ed.). Pearson.

Stauffer, M. D., & LeMasson, A. (2013). Counselor self-disclosure in substance abuse treatment: A qualitative study of recovering counselors. Journal of Addictions & Offender Counseling, 34(1), 3–16. https://doi.org/10.1002/j.2161-1874.2013.00009.x

Substance Abuse and Mental Health Services Administration. (2023). National Survey on Drug Use and Health: Detailed tables. Author. https://www.samhsa.gov/data

Sue, D. W., & Sue, D. (2022). Counseling the culturally diverse: Theory and practice (9th ed.). Wiley.

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Program Evaluation Project

Alexandra Arpey

Chadron State College

Counseling Research – COUN 641

Dr. Tara Wilson

December 7, 2025

Agency Overview

The Hazelden Betty Ford Foundation (HBFF) is a national organization that specializes in providing treatment, prevention, and recovery support services to those struggling with substance use disorders as well as other mental health issues. The organization was founded in 1949 and utilizes both the evidence based models of treatment and the 12-step model of recovery to provide long term support and wellness for its patients (Hazelden Betty Ford Foundation, 2024). The mission of the Hazelden Betty Ford Foundation (HBFF) is to provide lifelong recovery to individuals and their families who are suffering from substance use disorders through an evidence based treatment model and a variety of educational and support programs (Hazelden Betty Ford Foundation, 2024). HBFF provides treatment services to adults and adolescents that have a substance use disorder and/or a co-occurring mental health condition. HBFF addresses all aspects of addiction including the biological, psychological, social, and spiritual aspects.

HBFF offers residential and outpatient treatment throughout multiple states so that individuals can receive a continuum of care as they transition from detoxification to aftercare. Core Services: HBFF has the following core services: (1) individual and group therapy sessions (2) family counseling and psychoeducation (3) relapse prevention and aftercare programming (4) alumni support and recovery community engagement (5) virtual and telehealth treatment options Clinical Approach: HBFF uses a combination of Cognitive Behavioral Therapy (CBT), Motivational Interviewing (MI), and 12-step facilitation as part of its clinical approach. These methods are consistent with the recommendations for treating substance use disorders listed in the book Counseling Research: Quantitative, Qualitative, and Mixed-Methods (Sheperis, 2024).

HBFF focuses on using a client centered approach to teach individuals how to make behavioral changes, build self-efficacy, and develop motivation to recover from substance use disorders. HBFF's model of treatment is consistent with research published in the Journal of Addictions and Offender Counseling (2023), which stated that the integration of evidence based treatments with peer and community support systems will lead to improved recovery outcomes for individuals struggling with substance use disorders.

Selected Program Evaluation Model

CIPP — Context, Input, Process, and Product — is a full-featured, systematic approach developed by Daniel Stufflebeam (2007), used to evaluate the performance of programs through both formative and summative evaluation. the focus of CIPP is to gather systematic information for the purpose of informing decision-making and providing opportunities for continued development and improvement, as opposed to merely identifying if a program was successful or unsuccessful. within the realm of clinical mental health counseling, CIPP offers an ideal framework for evaluating the Hazelden Betty Ford Foundation (HBFF) due to its ability to provide a broad scope of assessment relative to client needs, treatment design, service delivery, and quantifiable outcomes.

The Context component assesses the unique needs of the target population and their environment which will assist in determining if HBFF's treatment goals, including relapse prevention, recovery maintenance, and family involvement, appropriately meet the client and community needs (Stufflebeam & Coryn, 2014). The Input component reviews the availability of all necessary resources, including personnel qualification, various treatment modalities, and the organizational design of HBFF. This will include the review of evidence based practices such as Cognitive Behavioral Therapy (CBT) and Motivational Interviewing (MI), and how these practices are being implemented to assure that treatment is consistent with contemporary clinical standards and research supported approaches (Sheperis, 2024).

The Process component identifies and reviews how services are delivered to determine if the program is operating as designed. With a large, multi-site organization such as HBFF, this component is critical in assuring that treatment programs are maintained across the different sites where services are offered, and that client engagement and quality of care are consistently delivered. The Product component is concerned with reviewing outcome measures such as, but not limited to, sobriety rates, client satisfaction, and long term recovery stability. These outcomes will be used to identify areas for program modification and as a basis for future strategic planning in order to continue the process of continuous improvement and maintain ethical accountability (Stufflebeam, 2007).

CIPP is especially well-suited to evaluating a clinical counseling agency since it facilitates a continuing cycle of reflection, data driven decision-making and quality improvement, all of which are fundamental to ethical and effective counseling practice. As stated in the American Counseling Association Code of Ethics (ACA, 2014), counselors have an ethical obligation to conduct program evaluations in order to ensure the effectiveness of services they deliver and to protect the welfare of their clients. Therefore, the CIPP model is aligned with both the structural and ethical standards of counseling agencies such as HBFF; thus, it is an excellent choice for evaluating clinical effectiveness and for building trust between the counselor/client relationship during the recovery process.

Formation of Evaluation Team

In order to have a fair, unbiased and structured evaluation process, it is important to have a well-organized evaluation team. In conducting the Hazelden Betty Ford Foundation (HBFF) program evaluation, the team would include various professionals with different types of knowledge about the different aspects of addiction treatment and recovery services. The proposed evaluation team includes a lead evaluator, two to three staff members from the programs, an external evaluation consultant, and a data analyst. Having this combination of inside knowledge and outside perspective will give you the best of both worlds, which is the way most professionals suggest that evaluations should be conducted (Sheperis, 2024).

The lead evaluator, who would be a licensed professional counselor (LPC) or clinical supervisor, would oversee every aspect of the evaluation process. The lead evaluator's responsibility would be to make sure that the evaluation is done in accordance with clinical standards, ethical guidelines, and the goal of the CIPP model (Stufflebeam & Coryn, 2014).

The lead evaluator would also be responsible for scheduling meetings, establishing time lines, making sure that the research being conducted is being done ethically (i.e. maintaining confidentiality and obtaining informed consent) and making sure that all data that is being collected and analyzed is accurate. The staff member(s) from the programs (therapists, case managers, etc.) would help provide the lead evaluator with an insiders view of how the programs operate on a day-to-day basis. They would assist the lead evaluator in helping identify the practical problems and challenges, client engagement patterns and the strengths and weaknesses of the organization during the Context and Process phases of the CIPP model (Sheperis, 2024). By having the staff members involved in the evaluation process, it would allow the results to be immediately applicable to improve clinical practice (Sheperis, 2024).

The external evaluation consultant would be a neutral third party who would help evaluate the evaluation and keep it unbiased. The consultant would have expertise in evaluating programs, research designs and theory and would enhance the validity and credibility of the evaluation results by reducing potential bias (Stufflebeam, 2007). When using results to secure funding or to obtain accreditation, the inclusion of an independent evaluation consultant adds to transparency and accountability (Stufflebeam, 2007).

The data analyst would be responsible for managing the data that was collected through the evaluation. This would include collecting and organizing the data (both quantitative and qualitative), entering the data into a database, cleaning the data, analyzing the data statistically and presenting the results to the evaluation team. The data analyst would work with the lead evaluator and consultant to ensure that the results of the evaluation were reliable, valid and easy to understand for the stakeholders.

It would take the evaluation team at least one month to organize before they could start the actual evaluation. Prior to beginning the evaluation, the evaluation team would undergo training on the CIPP model, ethical principles of evaluation and relevant data protection policies based on the American Counseling Association (ACA) Code of Ethics (ACA, 2014). The training would focus on issues related to confidentiality, informed consent and the responsible use of data, to assure that the evaluation team complies with the professional standards of their profession while assuring the safety and welfare of clients. With this collaboration of clinical expertise, methodological expertise and ethical oversight, the evaluation process will provide the Hazelden Betty Ford Foundation (HBFF) with an evidence-based framework for program improvement and accountability.

Identification of Key Stakeholders

Evaluation of Program(s) will require involvement of a wide range of stakeholders in the evaluation process. Stakeholders are individuals/organizations who are either impacted directly or indirectly by the operational activities of the program, or the outcomes of the program. Involvement of stakeholders in the evaluation of the HBFF Programs will ensure that the evaluation of the programs is carried out in a way that reflects diverse viewpoints, while being carried out in accordance with the standards of professional and ethical behavior of researchers conducting counseling research (Sheperis, 2024). All levels of HBFF will be engaged with stakeholders (clients, staff, families, community partners, and funders), to provide transparency of the evaluation process; relevance of the evaluation process to stakeholders; and to provide shared ownership of the results of the evaluation process (Stufflebeam & Coryn, 2014).

Primary stakeholders for the evaluation of the HBFF Programs are the clients. The clients are those individuals in early recovery from a substance use disorder, and receive residential or outpatient treatment from HBFF. Evaluations of the programs will be completed using various survey techniques (surveys, interviews, focus groups etc.), which allows for client anonymity in assessing program accessibility, cultural responsiveness, therapeutic relationship, and client perceptions of the effectiveness of the program interventions. Engagement of clients in the evaluation of the programs provides a method of demonstrating ethical practice, by providing evidence-based solutions to program improvement based on the experience of the client (ACA, 2014); and supports the empowerment of the client, which is central to both recovery-oriented care and person-centered counseling models.

Staff members of HBFF (counselors, therapists, case managers, and administrators) are key stakeholders for the implementation and delivery of the program. Staff members have first-hand knowledge of the treatment process, barriers to the delivery of services, and internal communication structure. HBFF will use the Process and Input stages of the CIPP model when involving staff members in the evaluation of the programs, to ensure that the results of the evaluation are both accurate and applicable to the specific needs of HBFF. Collaboration between staff members and the evaluation process also promotes their sense of engagement and professionalism, thus increasing their desire to implement program improvements (Sheperis, 2024).

Community/family members are additional stakeholders for HBFF. This includes referring agencies, family members, and recovery support networks. Recovery outcomes are highly influenced by the system of support outside of the recovery services provided by HBFF. To determine if HBFF's services are a part of an overall system of community based support services for families, it is very important to gather as much data as possible from the HBFF. The families with whom you work will be able to share their experiences regarding the communication process, success of family therapy, and post-treatment follow up care. Community-based organizations such as referring agencies and/or outpatient treatment centers that are in partnership with HBFF can provide valuable information about what occurs following discharge from HBFF, and the level of cooperation between HBFF and other service providers (Journal of Addictions and Offender Counseling, 2023).

Funders and regulatory agencies, including grant providers, accreditation bodies, and state licensing boards, represent another group of stakeholders for HBFF. Funders and regulatory agencies provide an oversight role for HBFF regarding compliance with regulations, measurement of outcomes, and effective use of funds. HBFF will collaborate with these stakeholders during the Product Stage of the CIPP Model, to enhance the credibility and sustainability of the program, by aligning the changes made to the program with the expectations of funders and regulatory agencies (Stufflebeam, 2007).

HBFF will employ a combination of stakeholder engagement strategies (surveys, focus groups, collaborative review sessions), to promote higher levels of participation and engagement among stakeholders. A participatory approach to evaluating programs is congruent with the standards of ethics in evaluation, and is aligned with the ACA's principles of transparency and respect for all participants (ACA, 2014). Higher levels of stakeholder engagement throughout the evaluation process, as opposed to only at the time of reporting outcomes, will provide HBFF with a better chance of achieving its goals of improving the quality of the programs, protecting the integrity of recovery, and enhancing client wellness.

Determination of Evaluation Focus

One of the main objectives of this evaluation is to measure the extent to which counselors employing Self-Disclosure (CSD) enhance client engagement and trust with counselors during the early stages of recovery treatment at the Hazelden Betty Ford Foundation (HBFF). When employed appropriately by the counselor and in a clinical setting, CSD has been found to promote an atmosphere of mutual respect and understanding between the counselor and client, increase the client's perception of the counselor's credibility, and foster motivation for positive behavioral change (Knight, 2019; Henretty & Levitt, 2010). However, if CSD is either poorly employed or timed inappropriately, it may detract from the client's issue(s) or create unprofessional boundaries (ACA, 2014).

Thus, this assessment will be beneficial for providing a basis for enhancing counselor education/ training, for improving the supervision given by counselors' supervisors, and for identifying ways to effectively engage clients in treatment. The focus of this assessment will be on the first 3-5 counseling sessions of the recovery process; it is documented in literature that the quality of the therapeutic alliance developed through the first 3-5 counseling sessions is most predictive of the degree of client involvement in treatment, and eventually the successful achievement of long-term recovery (Doumas et al., 2019). Limiting the evaluation timeframe to the first 3-5 counseling sessions provides sufficient time to collect quantifiable and manageable data regarding client outcomes, and places the data collected into alignment with both the Process and Product stages of the CIPP Model (Stufflebeam & Coryn, 2014).

Ultimately, the primary goal of this evaluation is to identify whether the intentional and systematic employment of CSD increases the clients' perception of trust, openness and participation in the therapeutic process. In order to increase the reliability of the data collected, and to facilitate the data collection process, the evaluation will utilize measurable tools including client trust scales, engagement rating scales and client satisfaction surveys administered to the client after each session. In addition, the Working Alliance Inventory – Short Form (WAI-SF) may be used to assess the quality of the therapeutic relationship and to gauge the degree to which the client trusts and engages with the counselor (Horvath & Greenberg, 1989).

In order to prevent subjectivity and to minimize the potential for bias in the results, the evaluation will rely solely upon the utilization of quantitative measures to assess client trust and engagement. Follow up qualitative interviews will be conducted to obtain the client's subjective interpretation of the counselor's authenticity, empathy and professionalism. By triangulating these two data collections, a comprehensive understanding of the effect of the counselor's behaviors on the client's outcome during the early stages of recovery treatment will be achieved.

This evaluation will demonstrate HBFF's commitment to providing substance abuse counseling services using both relational and evidence-based approaches and provide documentation that HBFF is in compliance with the ACA Code of Ethics which requires ongoing review and development of the treatment techniques used to promote the best interest of clients (ACA, 2014). Ultimately, the findings from this evaluation will provide the basis for revising counselor training programs, supervisory practices, and program design to maximize the use of CSD in creating trust between the counselor and client, strengthening the counselor-client relationship, and increasing client engagement during the early stages of recovery treatment.

Evaluation Design

This study's evaluation design will have formative and summative components to understand how Counselor Self-Disclosure (CSD) affects client trust and engagement in early recovery sessions at Hazelden Betty Ford Foundation (HBFF). The formative component will focus on improving ongoing practice – specifically, how and when counselors use self-disclosure to improve rapport and engagement. The summative component will evaluate measurable outcomes regarding client trust, therapeutic alliance, and treatment participation. It will help evaluate whether CSD results in statistically significant improvements in these areas over time (Sheperis, 2024; Stufflebeam & Coryn, 2014).

The central evaluation question(s) guiding this design are: Does counselor self-disclosure enhance client trust and therapeutic alliance in early recovery sessions? What are the different forms and frequencies of CSD that can increase client engagement while protecting ethics? Do clients believe that counselor self-disclosure relates to their feelings of comfort, motivation, and trust in the counseling process? These questions are aligned to the Process and Product components of the CIPP model to analyze both program implementation and outcomes (Stufflebeam, 2007).

A mixed-methods evaluation will be used to address these questions using quantitative and qualitative data collection methods to capture both the measurable aspects of the relationship and the individual’s subjective experience. Quantitative data will be collected through pre- and post-session surveys measuring client trust and engagement via standardized measures including the Working Alliance Inventory–Short Form (WAI-SF) and Likert-scaled items evaluating perceived counselor authenticity (Horvath & Greenberg, 1989). Data will be collected after the first and fifth session to demonstrate short-term increases in trust and alliance development. Semi-structured client interviews will be used to collect qualitative data to provide insight into client experience and perception of counselor self-disclosure. The interviews will investigate if CSD helped clients to feel more connected, understood, or motivated to participate in treatment. The insights from these interviews will provide depth and context to the quantitative findings, enabling the evaluator to better understand the nuances of how CSD impacts therapeutic relationships (Henretty & Levitt, 2010). Session observers will conduct observational evaluations to document the frequency and context of CSD, utilizing CSD frequency logs to categorize the type of CSD (i.e., recovery-related, personal anecdote, professional experience) and its relevance to the therapeutic goal. Structured observational data will support evaluator reliability and consistency across evaluators, while identifying patterns between CSD types and client response (Knight, 2019).

Ethical integrity will be ensured by obtaining voluntary and informed consent from all participating clients, and maintaining confidentiality through anonymization of all data and utilization of participant codes rather than names. Evaluators and staff will receive training on maintaining objectivity, avoiding dual relationships, and documenting observational data appropriately. The use of both formative and summative evaluation, with triangulated data collection, will enable HBFF to assess not only if CSD is effective but also how and why it impacts client trust and engagement. The findings will inform counselor supervision, training modules, and best-practice protocols for the intentional use of self-disclosure in addiction counseling. 

Evidence Gathering Methods

The process for collecting data to support the research question will be systematic and follow an ethical framework to collect data about counselor self-disclosure (CSD) and its effects on client trust and engagement at Hazelden Betty Ford Foundation (HBFF) in a way that is accurate and representative of client experiences. This part of the study fits into the Process and Product dimensions of the CIPP Evaluation Model, as it includes the observation of counselor behavior (Process) and the measurement of the outcome of this behavior (Product), (Stufflebeam & Coryn, 2014). A variety of data collection strategies will be used to increase the validity of the findings through the use of Triangulation, which will allow the researcher to compare the results found from each data source to validate the findings, (Sheperis, 2024). Multiple types of data will be collected including; quantitative, qualitative and archival data, to get a full picture of how the actions of the counselor affect the therapeutic relationship throughout early recovery.

Anonymous Client Survey: After completing their third and fifth sessions with a counselor, clients will participate in anonymous surveys using the Working Alliance Inventory – Short Form (WAI-SF). This measure assesses the working alliance between the therapist and client which is made up of three components that are commonly associated with building trust and engagement in therapy (Horvath & Greenberg, 1989). These components include: Bond; Goal Alignment; Task Collaboration. Additionally, the survey will include Likert scale questions assessing client ratings of the counselors’ authenticity, empathy and ability to create a safe and collaborative therapeutic environment. Using an anonymous format will help to reduce social desirability bias improve client honesty and protect the integrity of client feedback.

Trained observers will directly observe select sessions and record the frequency, type and context of CSD using standardized CSD coding sheets. The observer will record the occurrence of self-disclosures (i.e., the counselor discloses personal information to the client); categorize the type of self-disclosure (i.e., recovery related, experiential, etc.); and describe the client's response to the self-disclosure. This will enable the researchers to determine if specific types of self-disclosures result in increased openness, participation and/or emotional responsiveness. In addition to providing a summative function (i.e., determining the relationship between self-disclosure and client response), direct observation will serve a formative function by providing supervisors with the opportunity to give constructive feedback to counselors regarding their use of self-disclosure and to encourage counselors to adhere to ethical standards for self-disclosure (Knight, 2019).

Review of the client’s clinical records that have been de-identified by removing all identifiable information (i.e. Session Notes, Progress Summaries, Discharge Plans): In order to identify the frequency of interactions between the counselor and client as well as to monitor sobriety milestones/progress indicators for the client, the researchers will review the de-identified clinical documentation of each client. The reviewing of clinical documentation will allow the researchers to collect aggregate quantitative data (e.g. number of times attended, relapse incidents, number of sessions completed) in order to determine whether or not counselor self disclosure is related to increased attendance/retention and recovery outcomes (Journal of Addictions and Offender Counseling, 2023). Family members and clients will provide input as to how counselor openness affects trust, motivation and communication. Counselors and supervisors will provide input as to why they utilize self-disclosure and their perceptions of the effect of self-disclosure.

By using these qualitative research methods, researchers will be able to "capture" the human experience of counseling interactions and find commonality or differences between the groups of stakeholders (Henretty & Levitt, 2010). Ethical and procedural considerations for each method of collecting data are to be in compliance with the American Counseling Association (ACA) Code of Ethics (ACA, 2014). Researchers will obtain informed consent from participants before collecting any data. In addition, they will inform participants that their decision to participate in this study is a voluntary one; also, that their responses to questions will be kept confidential. All data collected for this study will follow IRB-approved procedures. Any identifiable information from the data will be removed in order to protect participant identity.

The researchers will take special care to protect vulnerable populations in early recovery and ensure that participating in the study does not disrupt their treatment. Counselors will be encouraged to share aggregated test results (i.e., drug screen results, relapse prevention assessment results) and non-identifiable patterns in client progress with family consultants and other staff during supervision meetings. This will enable the researchers to interpret the findings in a larger context of client progress toward recovery rather than as isolated behaviors.

Timeframe and Duration: Data collection will occur over a three-month time period, and will target clients who have completed between 3-5 sessions with a consistent counselor. Collecting data during this time frame will enable the researchers to collect enough data to determine trends in multiple clients and staff members and will capture the critical time frame of developing trust. Scheduled regular review of the research's progress will allow the researchers to assess whether or not the methods used for collecting data are meeting the goals of both the research and the objectives of the program. The multiple methods of collecting data (behavioral, outcome, compliance) will give the Hazelden Betty Ford Foundation a balanced view of counselors' behavior, clients' outcomes, and adherence to the ethical guidelines, so that it may use the information collected to improve its counselor training, supervision and long-term engagement of clients.

Data Organization and Analysis

The organization and analysis phase provides the foundation for an organized, fair, and based-on-data evaluation. In the case of the Hazelden Betty Ford Foundation (HBFF), the organizational and analytical phases will transform the information regarding how counselor self-disclosure (CSD) impacts client trust and client engagement into usable knowledge to improve the practice of clinical professionals. All data collected will be saved in a HIPPA-compliant database, such as REDCap; this database will provide encryption of all entries, anonymity, and the ability to establish restrictions on who has access to the data. Each participant will receive a unique number so their identity can remain confidential throughout the study while each participant's progress may be followed longitudinally throughout their participation in the study. The categories used to organize the quantitative, qualitative, and archival data will be based on the four categories of the CIPP evaluation model – context, input, process, and product, to help keep the conceptual relationship between the data organization and the CIPP evaluation model (Stufflebeam & Coryn, 2014). By doing this, researchers can link specific counseling techniques, such as the amount of self-disclosure counselors make to clients, to measurable changes in client outcomes, including trust, engagement, and retention.

Using descriptive and inferential statistical analysis techniques, the working alliance inventory-short form (WAI-SF) qualitative data, trust rating scales and counselor observation log qualitative data will be analyzed. Using descriptive statistics; i.e., mean, standard deviation, and distribution of the scores, will provide a general description of what the typical results were for the sample. Inferential statistical tests, including correlation and multiple regression analyses, will be used to examine the strength and direction of the relationship between CSD frequency and client trust scores while controlling for possible confounders such as client demographics, prior treatment experience, and counselor tenure (Sheperis, 2024). In addition, an analysis using a one-way ANOVA can be done to find differences in outcomes based on the level of counselor experience, or CSD style, so as to determine areas of interest for future training and supervising of counselors. All data analyses will be conducted by SPSS or R to ensure that results are valid, replicable, and have the quality expected of professional research (Pew Research Center, 2021).

Qualitative data gathered through methods such as interviews, open-ended surveys, and observational notes will be recorded verbatim. These data will then be placed in qualitative data analysis software programs, i.e., NVivo or Dedoose. Following this, the qualitative data will undergo a six-stage thematic analysis process, developed by Braun and Clark (2006): familiarization of the data; generation of initial codes based on the data; identification of theme; review of identified themes; definition and naming of themes; and finalizing of the synthesized results. This process will highlight recurring patterns in participants' views of counselor authenticity, emotional connections, and comfort with disclosure. Key emergent themes, such as trust development, boundary awareness, and perceived counselor genuineness will be identified and compared among participants to identify commonalities of experience. To ensure accuracy, two independent evaluators will code the data and resolve discrepancies through consensus to increase inter-rater reliability and reduce researcher bias (Henretty & Levitt, 2010; Knight, 2019).

After the analysis is complete, the results from both the quantitative and qualitative assessments will be triangulated to create a comprehensive understanding of the effect of CSD on trust and engagement in early recovery. Each quarter, an evaluation team consisting of the Lead Evaluator, Data Analyst, and Clinical Supervisors will evaluate the quarterly findings to determine whether trends exist that show whether the interventions being implemented produce the intended outcome and will make changes to the training or supervision programs based on the results. The aggregate data will be used to create benchmark goals for improvement (such as a 20% increase in the average client trust score and a decrease in early treatment drop out rates).The data collected will be displayed graphically and presented to the HBFF's staff internally on a regular basis as well as suggestions for the modification of the counselors' training program and ethical disclosure guidelines based on empirical evidence.

Data from the collection, storage, and analysis of the data will be interpreted in accordance with the ACA's Code of Ethics (ACA, 2014). This ensures that participant rights are protected; the evaluation process is transparent; and that the evaluations are conducted by professionals who are objective. Ultimately, this process will allow the HBFF to develop intervention strategies that are grounded in empirical research. These intervention strategies can enhance the quality of care provided by the HBFF. They also create increased accountability among counselors and promote the ethical delivery of the HBFF's treatment model. Ultimately, the data analysis component will provide statistical validation of the influence of CSD on client outcomes, and serve as a platform for long-term, data-driven decision making to improve counselor development and client recovery outcomes.

Presentation of Findings and Implementation

This stage of the presentation of findings and implementation, evaluates the results of the evaluation to ensure they are communicated clearly, ethically and effectively to both internal and external stakeholders and supports data-driven improvement across the Hazelden Betty Ford Foundation (HBFF), the product dimension of the CIPP Evaluation Model (Stufflebeam & Coryn, 2014). Additionally to validate the effectiveness of the evaluation, the effective dissemination of the findings of the evaluation will aid in developing a culture of accountability, transparency and continuous quality improvement. All three of these items are stressed in the American Counseling Association (ACA) Code of Ethics (ACA, 2014).

The findings of the evaluation will be modified to fit the specific requirements of each of the two different types of stakeholder groups at HBFF, internal and external. Internal findings will be disseminated to staff members by means of employee/staff meetings, clinical supervision and administrative personnel. Program Directors, Counselors and Administrative Personnel will be provided with comprehensive reports of the data trends, statistics and qualitative findings related to the use of Counselor Self-Disclosure (CSD). Discussion of the findings internally will focus on how the findings relate to the day-to-day operation of counseling practices, identifying potential areas of improvement and developing strategies to educate and evaluate staff. Supervisors will function as a liaison between the evaluation team and the staff and will convert the findings into practice by integrating the findings into the counselor training, goals and ongoing supervision (Sheperis, 2024).

External findings will be presented to stakeholders through stakeholder forums, community meetings and funding reports. Funders, accreditors and recovery community partners require clear, concise and outcome-based information to understand the accountability and program impact of the organization. Based on the information gathered by the Evaluation Team as part of this Evaluation, the team will develop an Executive Summary that summarizes the data and statistics collected. The executive summary will include Quantitative Increases in Client Trust/Engagement Scores; qualitative feedback regarding client perceptions of Counselor Authenticity; quantifiable changes in counselor practices as a result of training interventions; and evidence-based improvements and how those were consistent with HBFF’s mission to provide high quality ethical addiction treatment and support (Journal of Addictions and Offender Counseling, 2023).

In order to present the results of the evaluation to stakeholders, multiple formats will be used to present the results, including visual dashboards, infographics and interactive workshops. Aggregate results from the dashboard using tools for Data Visualization (e.g., PowerBI/ Tableau) will include visual representations of the mean increase in Trust Score, frequency trends in CSD use, and Client Satisfaction Rates. A series of interactive workshops will also provide an opportunity for counselors and staff to evaluate and examine case studies based on the findings of this evaluation and apply the findings into their respective clinical settings. By providing a collaborative environment, counselors and staff will become active agents in implementing evidence-based improvements rather than passive recipients of information.

As part of the evaluation process, an Action Plan will be developed to guide the implementation of the findings of the evaluation and will link evaluation outcomes directly to program modification. The data will be used to refine the CSD training modules and to emphasize ethical timing, appropriate depth and clinical relevance of CSD in future counselor education. HBFF’s Supervision Protocols will be revised to include specific monitoring of CSD use by counselors as well as on-going review of session recordings or progress notes to monitor compliance with best practices. Such revisions will correspond with the ACA’s Ethical Guidelines which emphasize counselor self-awareness, reflective practice and client-centered intervention techniques (ACA, 2014). To assure Accountability and Sustainability, follow-up assessments will occur approximately six months post-implementation to determine if the changes made to training, supervision and counselor behaviors contributed to measurable increases in client trust, engagement and retention.

The long term tracking of WAI-SF scores as well as client feedback will indicate whether the positive outcomes achieved through the original assessment are sustained over time.

In addition to evaluating the quantitative data collected through the follow-up assessments, additional qualitative interviews will be administered to assess how the perception and practice of staff members has changed since the initial evaluation. The findings of the follow-up assessments will provide input into HBFF’s continuing Quality Assurance processes thereby completing the cycle of evaluation, implementation and continuous program development (Stufflebeam, 2007). By providing open and honest communication, facilitating collaborative workshops and establishing an organized implementation strategy, HBFF assures that the outcome of the evaluation will be utilized to increase the clinical effectiveness, counselor competence and client outcomes of HBFF clients in early recovery. This cyclic process of feedback exemplifies the utilization of evidence-based practice and demonstrates HBFF’s long-standing commitment to ethical excellence and sustained recovery success.

Conclusion

A CIPP model evaluation of Hazelden Betty Ford Foundation (HBFF) illustrates how an evidenced based, structure evaluation enhances both the quality and ethics of substance abuse treatment services and the effectiveness of these services. HBFF is a nationally recognized authority in substance abuse recovery. HBFF's mission of incorporating research supported practice into client centered, compassionate care offers a strong base for program evaluation. Utilizing the CIPP model—context, input, process and product—assures that all dimensions of service delivery are captured from the client's needs and the development of the program through the client's experience with the program including the fidelity of program implementation and the measurable results of the client's recovery (Stufflebeam & Coryn, 2014).

This evaluation focuses upon the effectiveness of counselor self disclosure (CSD) in building client trust and engagement. These findings are expected to provide clarity regarding how intentional and ethical CSD builds the therapeutic relationship during the initial stages of recovery which have been demonstrated to be predictive of long term recovery outcomes (Doumas et al., 2019; Henretty & Levitt, 2010). A mixed-methods approach was used for the evaluation, using both quantitative data collected through client and counselor surveys, and qualitative information from those populations as well to produce a complete understanding of the interpersonal dynamics that are related to successful recovery outcomes.

Through the evaluation process, ethical standards and methodological consistency were applied in accordance with the professional ethics code of the American Counseling Association (ACA), specifically, the Code of Ethics (ACA, 2014) which emphasizes confidentiality, informed consent and transparency in all phases of an evaluation process to ensure adherence to the professional standards and protect the dignity and safety of every participant involved. The use of both formative and summative evaluation methods allows HBFF to identify areas for immediate programmatic changes while evaluating the long-term effectiveness of their treatment programs at multiple locations across the country.

Findings will directly result in the implementation of positive organizational change. HBFF will revise counselor training, supervisor training and self disclosure guidelines and protocols based on the evaluation findings to insure that counselor practice is consistent with the ACA Code of Ethics and will establish best practice. Evaluation findings will continue to be evaluated and compared to established benchmarks to insure continued improvement in HBFF's treatment programs and to meet emerging research and client needs. The evaluation will therefore provide accountability for the organization but will also be designed to create a culture of ongoing development through continuing education and continuous quality improvement (Sheperis, 2024). Ultimately, this evaluation will clearly illustrate that there is an overwhelming need to integrate empirical evidence, ethical standards, and reflective practice into clinical mental health counseling.

The evaluation will assess the systematic relationship between counselor behaviors and client levels of trust and engagement with HBFF providing a model for excellence in addiction recovery. The process of collecting data, analyzing that data, implementing changes, and then evaluating those changes will continue to demonstrate the organizations commitment to providing compassionate, effective, and ethically based treatment options to help clients and their family members achieve long term transformation as they recover from addictions.

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