Feb 9, 2015 | Article, Volume 5 - Issue 1
Varda Konstam, Amy Cook, Sara Tomek, Esmaeil Mahdavi, Robert Gracia, Alexander H. Bayne
This study examined work engagement and its role in mediating the relationship between organizational support of evidence-based practice (integrating research evidence to inform professional practice) and educational growth and perceived professional expertise. Participants included 78 currently employed counselors, graduates of a master’s program in mental health counseling located in an urban northeastern university. Results revealed that work engagement significantly mediates the relationship between organizational support of evidence-based practice and educational growth and perceived professional expertise. Implications for counseling practice and recommendations for future research are discussed.
Keywords: professional expertise, counselors, evidence-based practice, professional development, work engagement
Although ongoing efforts to maintain and improve clinical competence are intrinsic to ethical practice for counselors (Jennings, Sovereign, Bottorff, Mussell, & Vye, 2005), clinical experience does not appear to guarantee additional skill acquisition among counselors (Goodman & Amatea, 1994; Skovholt & Jennings, 2005). Notably, a meta-analysis conducted by Spengler et al. (2009) revealed that level of education, training and experience had a small effect on clinical judgment (d = .12). Skovholt and Jennings (2005) concluded that “experience alone is not enough” to ensure professional growth and increased professional expertise in counseling practice (p. 15).
Because years of experience only minimally inform professional expertise (defined as the ability to accurately diagnose and implement treatment plans that sensitively incorporate the contexts in which clients are embedded [Meier, 1999]), it is important to isolate both individual and organizational factors that improve professional expertise over time. Individual factors identified in the counseling literature include (a) the importance of self-reflection (Neufeldt, Karno, & Nelson, 1996), (b) exploration of unexamined assumptions about human nature (Auger, 2004), (c) empathy (McLeod, 1999; Pope & Kline, 1999), (d) self-awareness (Richards, Campenni, & Muse-Burke, 2010), (e) mindfulness (Campbell & Christopher, 2012) and (f) cultural competence (Goh, 2005). Organizational factors (defined as organizational systems and processes that are in place to support counselor professional growth linked to organizational and client outcomes) also have been identified (Aarons & Sawitzky, 2006a; Bultsma, 2012, Goh, 2005; Perera-Diltz & Mason, 2012; Truscott et al., 2012). The range of studies, however, has been limited in scope, and research has tended to focus on administrative practices associated with staff turnover, morale, efficiency and productivity (Aarons & Sawitzky, 2006a).
This research focused on how individual counselors and organizations providing counseling services can promote the continuing development and refinement of professional expertise among practicing counselors. Specifically, we focused on individual work engagement and organizational factors—that is, organizational support of evidence-based practice (EBP) and educational growth, and their relationships to perceived counselor professional expertise. Counselor use of EBP involves engaging in critical analysis of professional practice and integrating research evidence to inform interventions (Carey & Dimmitt, 2008). We propose that organizational support of EBP and educational growth are important job resources (Bakker & Demerouti, 2008), and that work engagement mediates the relationship between these resources and perceived counselor professional expertise. First, we present a review of the literature related to organizational support of EBP and work engagement, with a specific focus on linking individual and organizational factors to perceived professional expertise.
Evidence-Based Practice
Efforts put forth by the American Counseling Association (Morkides, 2009) and the American Counseling Association Practice Research Network (Bradley, Sexton, & Smith, 2005) have revealed that evidence-based interventions are critical to the optimal functioning of counselors. Implementation of EBP has been increasingly required across a variety of counseling settings, such as in schools (Carey & Dimmitt, 2008; Dimmitt, Carey, & Hatch, 2007; Forman et al., 2013) and nonprofit human services organizations (McLaughlin, Rothery, Babins-Wagner, & Schleifer, 2010). The Council for Accreditation of Counseling and Related Educational Program standards (2009) also have documented the importance of counselors being trained in using data to inform decision-making, although there are no specific guidelines informing counselors and counselor educators how to engage in EBP effectively. Consequently, implementation of EBP has required that practitioners work in new ways, develop and refine existing clinical skills, and at times reconcile philosophical differences between EBP and their respective disciplines (Tarvydas, Addy, & Fleming, 2010).
The requirement that counselors integrate research findings when working with clients serves to not only sharpen their conceptual understanding of treatment effects, but also aligns conceptual understanding with clinical practice. Such alignment affords the counselor a clearer sense of mastery and aids in developing professional confidence (Beidas & Kendall, 2010). At the organizational and individual practitioner levels, supervisors can work to promote the implementation of more efficacious interventions (Brown, Pryzwansky, & Schulte, 2006; Sears, Rudisill, & Mason-Sears, 2006; Truscott et al., 2012). Thus, understanding individual and organizational factors that influence the use of EBP could help inform counselor development and counseling expertise.
Aarons and Palinkas (2007) surveyed comprehensive home-based services case managers working in child welfare settings specifically with respect to their experiences with EBP. The authors reported that organizational support and willingness to adapt EBP to fit unique settings are the best predictors of successful EBP implementation, including positive attitudes toward EBP. When paired with consistent supportive consultations and supervision, implementation of EBP in child services settings has been associated with greater staff retention (Aarons, Sommerfeld, Hecht, Silovsky, & Chaffin, 2009). Researchers have not yet replicated these results with practitioners working across a range of counseling settings, nor have they expanded their analyses to examine the relationship of EBP training and implementation to professional expertise.
In a qualitative study, Rapp et al. (2008) identified barriers to implementing EBP in five Kansas-based community mental health centers participating in the National Implementing Evidence-Based Practice Project. Rapp et al. (2008) were able to identify critical strategies that produced successful outcomes and positive attitudes toward EBP on behalf of the staff. These strategies included the following: (a) managers setting expectations and front-line staff monitoring EBP use, (b) members of upper management serving as champions of EBP by proactively keeping organizational focus on EBP, (c) educating all staff on the importance of EBP rather than exclusively targeting the staff using EBP as part of their job responsibilities, and (d) creating leadership teams that included representatives from all levels of responsibility within the organization to monitor progress and identify obstacles to implementing EBP. Similarly, in a survey developed to assess EBP implementation in community mental health settings, Carlson, Rapp, and Eichler (2012) found that the key components of successful EBP implementation were team meetings, professional development and skill-building activities, and use of outcome measures to track progress.
Organizational and individual processes by which EBP contributes to optimal counselor functioning over time are relatively unexplored in the literature. One possible variable to consider when addressing issues related to EBP implementation and counselor effectiveness is work engagement, a work-related state of mind associated with feeling connected and fulfilled in relation to one’s work activities (Schaufeli & Bakker, 2004; Schaufeli, Bakker, & Salanova, 2006). Work engagement holds promise in furthering the understanding of how individuals and organizations that support these individuals can promote the continuing development and refinement of professional expertise (Bakker & Demerouti, 2008; Schaufeli et al., 2006).
Work Engagement and Professional Expertise
Schaufeli et al. (2006) defined work engagement as “a positive, fulfilling work-related state of mind that is characterized by vigor, dedication, and absorption” (p. 702). Contrary to those who suffer from burnout, engaged individuals have a sense of connection to their work activities and see themselves as capable of dealing with job responsibilities. It is important to note that the literature related to work engagement is represented by a wide array of contexts including those that are business related. The results of these studies, therefore, cannot be generalized to counselors working across a variety of mental health and school settings (Bakker & Demerouti, 2007, 2008; Salanova, Agut, & Pieró, 2005; Sonnentag, 2003). However, the findings in business-related contexts have revealed interesting associations that warrant further examination. For example, Langelaan, Bakker, van Doornen, and Schaufeli (2006) found that in participants working in diverse business settings (e.g., managers working for Dutch Telecom, blue-collar employees working in food processing companies), specific personality qualities associated with work engagement, such as low levels of neuroticism, high levels of extraversion and the ability to adapt to changing job conditions, were correlated with high levels of work engagement. A number of studies also identified a reciprocal relationship between personal resources (self-esteem and self-efficacy), job resources (effective supervision, social support, autonomy and variety in job tasks) and work engagement (Hakanen, Perhoniemi, & Toppinen-Tanner, 2008; Xanthopoulou, Bakker, Demerouti, & Schaufeli, 2009). The participants in the Hakanen et al. (2008) study were Finnish dentists, whereas the Xanthopoulou et al. (2009) study was based on the responses of employees working in three branches of a fast-food company.
Supportive Organizational Contexts, Work Engagement and Professional Expertise
Colquitt, LePine, and Noe (2000) emphasized the importance of providing organizational support in the workplace when considering job performance and work engagement. However, the focus on “situational characteristics such as support remains surprisingly rare” (p. 700). The authors defined organizational support of educational growth as the extent to which the organization supports ongoing professional learning and development. Research findings have suggested that work engagement is positively correlated with job characteristics identified as resources, such as social support from supervisors and colleagues, performance feedback, coaching, job autonomy, task variety, and training facilities (Bakker & Demerouti, 2007; Demerouti, Bakker, Nachreiner, & Schaufeli, 2001; Salanova et al., 2005; Salanova, Bakker, & Llorens, 2006; Salanova & Schaufeli, 2008; Schaufeli & Bakker, 2003; Schaufeli, Taris, & van Rhenen, 2008). According to Bakker, Giervels, and Van Rijswijk (as cited by Bakker & Demerouti, 2008), engaged employees have been successful in mobilizing their job resources and influencing others to perform better as a team.
In accordance with the model proposed by Bakker and Demerouti (2008), work engagement, in the context of perceived counselor professional expertise, mediates the relationship between job and personal resources and job-related performance. Job resources (e.g., organizational support of EBP, organizational support of educational growth) and personal resources inform work engagement, especially in jobs with high demands (Bakker & Demerouti, 2008; Bakker, Hakanen, Demerouti, & Xanthopoulou, 2007; Salanova et al., 2005). We propose that organizational support of educational growth and organizational support of EBP are important job resources as conceptualized by the Bakker and Demerouti model, and that work engagement mediates the relationship between these resources and counselor professional expertise.
This study addresses a gap in the literature by focusing on understanding the relationships among work engagement, organizational support of EBP and organizational support of educational growth with respect to perceived professional expertise in practicing counselors. To our knowledge, no research to date has linked the systematic organizational implementation of EBP and organizational support of educational growth with the proposed mediating role of work engagement in relationship to counselor perceived professional expertise. See Figure 1 for the proposed mediation model. In addition, the participants of this study function across a variety of counseling settings including schools, hospitals and mental health agencies.
It is important to determine whether a supportive professional context in general, rather than support specific to EBP, accounts for the relationship between EBP and work engagement. We assessed an alternative source of organizational support: support of educational growth, defined as the extent to which the organization supports ongoing professional learning and development. We hypothesized that organizational support of EBP uniquely contributes to work engagement, independent of support of educational growth. We hypothesized the following:
Organizational support of EBP, organizational support of educational growth and professional expertise will all be positively related to each other.
Work engagement will significantly mediate the relationship between organizational support of EBP and educational growth, and in turn will increase perceived professional expertise, as proposed by Bakker and Demerouti (2008).
Methods
Participants
The participants for this study included 78 graduates of a master’s program in mental health counseling located in an urban university in the northeastern part of the United States. The graduates of the counseling program were exposed to coursework that incorporated training and content specific to developing EBP (although they did not complete individual courses devoted specifically to the topic). For example, during the completion of internship coursework and courses foundational to the counseling profession, they were required to complete assignments focusing on using research and data to inform decision-making and practice. As such, prior to being employed in the field as professional counselors, the participants had prior exposure to the theory and practice of employing EBP.
Mailing addresses of 286 mental health counseling graduates were obtained from the alumni office, and a survey was sent to each graduate. A total of 91 mental health counselors located in a variety of settings, including mental health, school and hospital settings, completed the survey and returned it by mail; a response rate of 31.8% was obtained. Five of the questionnaires were excluded due to the participants not working in the field, and eight questionnaires were excluded due to missing data. An a priori power analysis was conducted to ascertain the number of participants required to achieve statistical significance using G*Power (Faul, Erdfelder, Buchner, & Lang, 2009). In using an alpha level of .05 and establishing a minimum power set of .80 and moderate effect size of .30, a minimum of 64 participants was needed to obtain a power of .80 in a hypothesis test using bivariate correlations. A minimum sample size of 58 was needed to achieve a power of .80 for our mediation model analysis (Fritz & MacKinnon, 2007).
The sample consisted of mostly female (n = 67, 86%) respondents. The participants were primarily White (n = 61, 78%), a small percentage Black (n = 4, 5%) and Hispanic (n = 3, 4%), and the rest identified as being “other” or “mixed-race” (n = 10, 13%). Participants averaged 37.4 years old (SD = 9.4), with a median age of 34.5 years. The participants were experienced, with over 90% having 2 or more years of work experience; 35% (n = 27) had 0–4 years of experience, 37% (n = 29) had 5–7 years of experience, while over 28% (n = 22) had 8 or more years of experience. A majority of participants (n = 65, 83%) reported involvement in a national committee within the mental health profession, indicating that the participants were involved within the counseling community and therefore more likely to be engaged at a professional level. Participants came primarily from mental health agencies (n = 33, 42%), followed by school settings (n = 15, 19%) and hospital settings (n = 7, 9%), with the remaining 27% (n = 20) indicating that they worked in more than one type of setting and approximately 4% (n = 3) not identifying their work setting. Data regarding licensure status was not collected.
Instruments
The Professional Expertise and Work Engagement Survey (PEWES) containing four subscales (Organizational Support of Educational Growth Measure [OSEGM], Organizational Support of Evidence-Based Practice [OSEBP], Utrecht Work Engagement Scale [Utrecht] and Mental Health Counseling Professional Expertise Questionnaire [PES]) was developed to measure professional expertise, organizational support of EBP and educational growth, and work engagement. The survey items were developed through incorporating key literature from counseling and related fields (e.g., business and psychology), since the constructs measured had not been assessed directly in the counseling literature. To ensure that the items were applicable to counseling practices, the survey was developed and piloted by two counselor educators. Items that the counselor educators identified as not applicable to counseling practices were excluded from analysis.
Organizational Support of Educational Growth. This assessment is a 5-item instrument using a 10-point Likert-type scale that evaluates characteristics of work settings. The instrument was designed based on the work of Colquitt et al. (2000) and focuses on attributes that predict motivation to learn and job performance. Cognitive abilities and age (identified as individual factors) along with work environment and trainee feedback from colleagues and supervisors (identified as situational factors) are represented in the model. The scale purports to assess support for educational growth present in the work environment. A few sample items used are the following: (a) To what extent does your work setting provide experiences for professional growth and development? (b) To what extent does your work setting provide time for learning activities to promote your professional growth? (c) To what extent does your organization have a climate that supports learning? A factor analysis was conducted on the items using a principal components extraction method. A single factor solution accounted for 52% of the variance in the items, with an eigenvalue of 2.6, indicating that a single summative scale could be utilized. The scale resulted in a range from 5 (low) to 50 (high). A Cronbach’s alpha of .81, 95% CI [.74, .87], was obtained for this instrument.
Organizational Support of Evidence-Based Practice. This 4-item survey using a 10-point Likert-type scale measures the organization’s culture in terms of supporting employee commitment to EBP. The items were created based on Colquitt and colleagues’ work (2000) and the work of Pfeffer and Sutton (2006). Examples of items used include the following: To what extent do the following statements represent your organizational culture? (a) Committed to evidence-based decision-making, which means being committed to getting the best evidence and using it to guide actions. (b) Looks for the risks and drawbacks in what people recommend—even the best interventions have side effects. A factor analysis with principal components extraction was conducted. Results indicated that a single factor accounted for 66% of the variance in the items, with an eigenvalue of 2.66. The scale resulted in a range of values from 4 (low) to 40 (high). A Cronbach’s alpha of .84, 95% CI [.78, .89], was obtained for this questionnaire.
Utrecht Work Engagement Scale. As originally developed, this is a 9-item assessment using a 10-point Likert-type scale that measures level of connection and enthusiasm related to one’s work (Schaufeli et al., 2006). Individuals are evaluated within three aspects of work engagement: vigor, dedication and absorption. The first five items of the scale are utilized to assess work engagement, as follows: (a) At my work, I feel bursting with energy. (b) At my job, I feel strong and vigorous. (c) When I get up in the morning, I feel like going to work. (d) I am enthusiastic about my job. (e) I am proud of the work that I do. These five items fall within the first two subscales of vigor and dedication. Given that absorption was not assessed due to clerical error, items were examined to determine whether a single summative scale could be utilized that would define both vigor and dedication at work. A factor analysis using a principal components extraction found a single factor to account for 81% of the variance in the items, with an eigenvalue of 4.06. This total sum scale created a range of values from 5 (low) to 50 (high). The Cronbach’s alpha for this subset of questions in our sample was .95, 95% CI [.93, .96], indicating high reliability. Schaufeli and colleagues (2006) found a reliability between .60 and .88 for the full 9-item scale.
Mental Health Counseling Professional Expertise Questionnaire. Professional expertise was measured by the PES. This self-assessment instrument was designed to measure perceived professional expertise and professional skills. It consists of 10-questions on a 10-point Likert-type scale. Those taking the survey are asked to determine how a strict but fair supervisor would rate their counseling and clinical abilities as related to their work setting. Questions focus on two areas of functioning: ability to select and employ appropriate diagnostic methods, including consideration of cultural data, and ability to implement a treatment plan, based on diagnostic considerations. A few sample items include the following: (a) I am able to select and employ appropriate diagnostic methods. (b) I am able to accurately interpret diagnostic material and make an accurate diagnosis. (c) I am able to develop a comprehensive treatment plan based on my diagnosis. A factor analysis with principal component extraction was conducted to determine whether a single summative scale could be utilized. Our results indicated that a single factor accounted for 63% of the variance in the items, with an eigenvalue of 6.3. A total sum scale was then created and had a range of 10 (low) to 100 (high) points. A Cronbach’s alpha of .92, 95% CI [.89, .94], was obtained for the scale.
Data Analysis
Analyses for hypothesis one were performed by calculating a full correlation matrix for the four variables. The second research question evaluated the hypothesized mediation effect proposed by Bakker and Demerouti (2008) using a path analysis. The alpha level was set to .05 for all statistical analyses. Analyses were conducted using SPSS Version 19.0 and SAS Version 9.2.
Results
Hypothesis One
Scores on the OSEGM were positively correlated with the OSEBP Measure, r(76) = .53, p < .001. This positive correlation indicated that high values of organizational support of educational growth were found with high values of organizational support of EBP. In addition, scores on the OSEGM were positively correlated with scores on the Utrecht, r(76) = .55, p < .001. This significant positive relationship indicated that high levels of organizational support of educational growth were found with high scores on the Utrecht. A significant positive correlation also was found between the OSEGM scores and the PES scores, r(76) = .25, p < .03. This positive directional effect indicated that high levels of organizational support of educational growth related to higher scores on professional expertise.
The Utrecht was positively correlated with the OSEBP Measure, r(76) = .58, p < .001. High levels of organizational support of EBP related to higher scores on the Utrecht. The Utrecht was positively correlated with the PES, r(76) = .46, p < .001. The positive relationship indicated that higher scores on the Utrecht found with higher scores on the PES.
Lastly, OSEBP was found to be positively correlated with the PES, r(76) = .33, p = .003. This positive relationship indicated that high levels of organizational support of EBP were found with high scores on the PES. Thus, as hypothesized, organizational support of EBP, organizational support of educational growth and perceived professional expertise were all positively related to each other (see Table 1 for correlations between all major variables.).
Table 1
Correlations Between Study Factors
|
Utrecht
|
OSEBP
|
OSEGM
|
| PESOSEGM |
.46***.55*** |
.33**.53*** |
.25* |
| OSEBP |
.58*** |
|
|
*p < .05, **p < .01, ***p < .001
Hypothesis Two
Bakker and Demerouti (2008) proposed a model with a mediation effect of work engagement on the relationship between job and personal resources and performance. Our interpretation of the model placed the OSEGM and the OSEBP Measure into what Bakker and Demerouti (2008) identified as job and personal resources. Additionally, performance was measured by the PES. Work engagement, a mediating variable as suggested by the model, was measured by the Utrecht. Because we adapted the PEWES in accordance with Bakker and Demerouti’s (2008) model, we assessed the individual items and subscales for content validity and reliability as previously described. Given that preliminary findings suggested strong internal consistency, we hypothesized that the full survey could be utilized to ascertain a potential mediation effect of work engagement on the relationship between organizational support of EBP and educational growth, and consequently, greater perceived professional expertise.
The estimated model, along with the standardized estimates, is shown in Figure 2. The fit of the model was very good, with an RMSEA of 0.00, χ2(2, n = 78) = 0.66, p = .72, GFI = .99, CFI = 1.00. Additionally, 55% of the direct effect between the OSEBP Measure and the PES can be accounted for by the mediation of the Utrecht, and 70% of the direct effect between the OSEGM and the PES can be accounted for by the mediation of the Utrecht. Given the large bivariate relationships between professional expertise and both organizational support of EBP and organizational support of educational growth, it appears that work engagement itself is largely contributing to these positive relationships. This finding is shown by the large percentage of direct effects accounted for by the Utrecht.
Discussion
The purpose of this study was to gain an increased understanding of the relationships between organizational support of EBP and educational growth, work engagement, and perceived counselor professional expertise. In addition, we examined the mediational effect of work engagement on perceived counselor professional expertise. Results revealed a consistent and coherent picture with important implications for organizational support of continued development of counselor professional expertise across a variety of work settings, including mental health agencies, schools and hospital settings.
Significant positive relationships between all variables indicate that counselors who rated themselves higher in professional expertise and perceived their work settings as supportive of EBP and educational growth reported significantly higher work engagement scores. Results affirm the importance of organizational support of EBP and its unique contribution to nurturing and sustaining work engagement levels among counselors. Results also affirm the importance of organizational support of continued counselor educational growth. These findings help to substantiate the research efforts of Bakker and Demerouti (2007, 2008) and Schaufeli and Salanova (2007).
While organizational support of EBP and organizational support of educational growth both were shown to increase professional expertise, it was the amount of work engagement that accounted for a large proportion of the direct relationships between organizational support of EBP and educational growth with professional expertise. This finding suggests that employers can assist in creating environmental conditions that support and promote employee engagement. A commitment to supervision processes that promote the use of EBP and address issues related to the improvement of work engagement can contribute to improvement in counselors’ functioning across a variety of counselor work settings. Supervision that incorporates linkages between and among EBP implementation, work engagement and professional expertise is potentially empowering to respective supervisees.
It is important to note that relying on counselor individual factors exclusively is an insufficient and incomplete path to improving professional expertise outcomes. Results suggest that organizational assessment of work engagement, specifically how it is promoted within the organization, in concert with counselor self-assessments, has the potential to yield meaningful results in terms of creating work environments conducive to professional growth.
Further longitudinal research is needed to corroborate the pathways resulting in increased counselor work engagement and professional expertise. Linkages to client outcomes would have significant implications for the continued assessment and support of professional growth of counselors in the field. Another important contextual consideration, exploration of job demands (e.g., work pressure, emotional demands) and how they inform work engagement, would also be beneficial, with important implications for training, supervision and practice. Because work engagement appears to increase possibilities for influencing positive counselor outcomes across a variety of settings, a promising practice includes increased emphasis on assessment and continued monitoring of counselor work engagement.
Treatment approaches based on evidence-based principles are likely to increase counselors’ confidence levels and expectations for treatment (Beidas & Kendall, 2010). As suggested by the work of Bakker and Demerouti (2008), a positive feedback loop develops between level of work engagement and organizational support of EBP. Our data are incomplete in terms of understanding these critical and complex relationships that suggest mutually reinforcing feedback loops. Future research is needed urgently to understand these linkages, specifically how organizational support of EBP and counselor level of work engagement reinforce each other in the service of improving treatment outcomes. Conducting longitudinal studies would allow more complete understanding of the relationship between organizational support of EBP and counselor work engagement. Such studies would permit careful examination of how these feedback loops unfold and are sustained over time. Furthermore, supervision models that promote systematic understanding of feedback loops can empower supervisees and promote them monitoring and evaluating their professional growth.
In the current study, we did not assess individual attitudes about and commitment to EBP; rather, we assessed participants’ perceptions of organizational commitment to supporting EBP in their respective counseling work settings. We did not explore the unique contributions of supervision models across provider settings and their contributions to perceived professional growth. Consequently, future studies are needed to determine how organizational implementation of EBP, including the use of formal and informal supervision, combined with individual commitment to EBP, is implicated in terms of levels of work engagement and professional expertise.
Organizational support of EBP is likely to thrive in a context in which individuals, as well as the system in which they are embedded, embrace and respect the scientific inquiry process (Aarons & Sawitzky, 2006b). While preliminary factors have been identified (e.g., Rapp et al., 2008), further research is needed to investigate this potentially fruitful area of inquiry across culturally diverse work settings, including mental health agencies, schools and hospital settings.
Limitations
This study is characterized by several limitations, in particular, generalizability. All of the participants were graduates of a Master of Science degree program in mental health counseling at an urban northeastern university with a strong commitment to and focus on social justice and serving vulnerable populations. In addition, participants had completed coursework that incorporated assignments focusing on building knowledge and understanding of EBP. Further limiting the generalizability of our findings is that only a select number (31.8%) of graduates from the master’s degree program chose to respond to the questionnaire. The participants were a self-selected group committed to serving clients in urban contexts, and therefore the findings cannot be generalized to all practicing counselors.
Another limitation in our results is the use of a subset of questions designed to assess vigor and dedication on the Utrecht, but that did not assess absorption. However, the questions that were included to assess vigor and dedication yielded a Cronbach’s alpha of .95, indicating a very high reliability. A factor analysis revealed that a single factor accounted for 81% of the variance in the items.
The use of self-reports is an additional limitation of the study. Professional expertise and counselor work engagement were assessed by the participants themselves. The study would be enhanced if seasoned external evaluators, deemed experts in their fields, evaluated each of the participants’ level of work engagement and professional expertise. Multiple self-report measurements such as the EBP Attitude Scale (Aarons, 2004) would have provided additional useful information.
This study would be enhanced if variables such as provider demographics, job characteristics and in-depth analyses of supervision services provided were assessed. In addition, using a longitudinal design that incorporated client outcomes and linked them to mental health counselor professional expertise and work engagement would address the limitation of the cross-sectional nature of this design. Nevertheless, given the dearth of research in this unfolding area of study, our findings provide an important contribution in terms of building a foundation for developing a relatively unexplored section of literature as it relates to the counseling profession. Examining the impact of organizational support of EBP and educational growth and level of work engagement has the potential for significantly improving counselor professional expertise over time.
Professional Practice and Supervision Implications
The findings of this study suggest important directions for counselors, counseling supervisors and administrators. The mediation model indicates the strength of work engagement as a mediator of the large positive relationship between organizational support of EBP and counselor professional expertise, and provides a potential powerful lens for improving counselor outcomes. Given that work engagement accounts for a majority of the direct relationship between organizational support of EBP and professional expertise, the findings of this study suggest that assessment of work engagement can be a valuable avenue for increasing professional expertise.
Professionals in counseling and related work settings are struggling with how best to situate their organizations in terms of ensuring optimal counselor and client outcomes, particularly in a context of diminishing economic resources. Although, for example, research studies have provided a degree of clarity in terms of identifying strategies that promote positive attitudes on the part of counselors toward implementation of EBP (Rapp et al., 2008), the systematic study of counselor work engagement and its contribution to professional expertise has not received the attention and focus it merits. While traditional models of counselor training have focused on counselor deficiencies, our finding in support of the mediational role of work engagement expands the understanding of professional growth from a positive psychology perspective—the positive aspects of work.
The dynamic nature of the mediational model proposed in this study provides important opportunities for supervision and administrative practices. In accordance with the model proposed by Bakker and Demerouti (2008), relationships between resources, such as organizational support of EBP and continuing organizational support of education; work engagement; and counselor professional expertise are neither static nor unidirectional. These variables mutually reinforce and inform each other. Based on the model suggested by Salanova et al. (2005), organizational support of EBP and organizational support of educational growth serve as job resources that increase work engagement levels among counselors; they also inform counselor professional expertise. Sensitizing counselors and supervisors who function across a variety of settings, including schools, hospitals and mental health agencies, to the significance of work engagement, its linkage to EBP and the opportunities it provides for self-assessment can increase possibilities for improving counselor professional expertise (Crocket, 2007). To date, there is no study that suggests how these important linkages—organizational support of EBP and education, work engagement, and professional expertise—can best be harnessed and translated to a variety of settings and improved outcomes with respect to counselor professional expertise (as well as improved client counseling outcomes). Comparison studies are needed to determine optimal models and how they may be adapted and individualized across a variety of sociocultural settings in order to reinforce the dynamic interplay of these important constructs.
Supervisors of mental health counselors have an important role in helping counselors understand organizational contexts, and how they may influence and support their professional growth. Crocket (2007) found that a counselor’s workplace and professional culture, including what transpires during supervision discussions, influence the counselor’s development. Supervisors also play a role in deciphering organizational contexts and can be instrumental in supporting supervisees’ job satisfaction and work motivation (Sears et al., 2006). It is important to understand one’s work context and the potential impact of organizational and professional values on one’s own professional development, a stance that helps counselors to engage actively in the process of self-assessment (Crocket, 2007). Finally, the linkage of organizational commitment to EBP and counselor engagement to continuing professional expertise offers promising opportunities for reflection and professional growth. There is developing evidence that support for professional growth in general facilitates the successful implementation of EBP (Rapp et al., 2008). When there is consistent supportive supervision for using EBP, and when all staff members are included in the education on EBP and demonstration of its importance, even those personnel who are not targeted for EBP implementation, more successful outcomes of EBP implementation have been reported (Rapp et al., 2008). Further, Carlson et al. (2012) reported that successful implementation of EBP is supported by implementation of professional development and skill building as supervisory activities. Not only does our model provide support for the implementation of EBP in counseling settings, but it also provides support for implementation of interventions that enhance professional growth. In keeping with the findings of Colquitt et al. (2000), our model suggests that organizational support contributes to work engagement, independent of support of EBP. Furthermore, Witteman, Weiss, and Metzmacher (2012), based on the work of Gaines (1988), suggested that the development and refinement of professional expertise depend on consistent positive feedback processes. Organizational support of EBP provides counselors and administrators with data-driven feedback processes that encourage opportunities for focused collaboration with room for reflection, evaluation and refinement.
Conclusion
Our robust findings suggest a potentially fruitful area of inquiry that is relatively unexplored terrain. Given that implementation of EBP requires both well-conceived research and practitioners to interpret that research, it would be helpful to isolate and understand the variables that promote successful implementation of EBP in terms of counselor level of work engagement and counselor professional expertise. In the present study, a mediational model that considered systemic factors yielded fruitful findings that have significant implications for counselors, supervisors and administrators working in mental health, school and hospital settings.
Conflict of Interest and Funding Disclosure
The authors reported no conflict of
interest or funding contributions for
the development of this manuscript.
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Varda Konstam is a professor emerita at the University of Massachusetts-Boston. Sara Tomek is an assistant professor and the director of the Research Assistance Center at the University of Alabama. Amy L. Cook is an assistant professor at the University of Massachusetts-Boston. Esmaeil Mahdavi is a professor at the University of Massachusetts-Boston. Robert Gracia is an instructor at the University of Massachusetts-Boston. Alexander H. Bayne is a graduate student at the University of Massachusetts-Boston. Correspondence can be addressed to Varda Konstam, Department of Counseling and School Psychology, University of Massachusetts, Boston, 2 Avery Street, Boston, MA 02111, vkonstam@gmail.com.
Feb 9, 2015 | Author Videos, Volume 5 - Issue 1
Janeé R. Avent, Craig S. Cashwell
Researchers, scholars and counseling practitioners note the differences in help-seeking behaviors among racial and ethnic minority clients. With African Americans in particular, researchers attribute some of these differences to African Americans’ preference for relying on their spiritual and religious communities (i.e., the Black Church) for support in dealing with mental health issues rather than seeking help from professional mental health counseling resources. However, less articulated in the literature are the rationales behind this preference. Because of the salience of spirituality and religion in the African-American community, it behooves counselors to increase their knowledge of the African-American religious experience. This article provides an overview of the history of the Black Church, its theological foundations, implications for culturally competent counseling and recommendations for counselors in practice.
Keywords: African American, religion, spirituality, Black Church, mental health counseling
Kuczewski (2007) asserted that helping professionals often are charged to care for “vulnerable persons facing difficult situations and tragic choices” (p. 9). Often, within the counseling context, client spirituality is an important part of the healing process. There is substantial evidence that one’s religious life is a critical feature of the developmental process and can serve to improve one’s overall well-being (Cashwell & Young, 2011). Further, researchers have found positive benefits to incorporating spirituality and faith into one’s life, including improved physical (Matthews et al., 1998) and psychological (Joubert, 2010) health. Therefore, counselors are expected to assess the impact of a client’s spirituality and religion on his or her mental health and overall well-being (Cashwell & Watts, 2010). Moreover, attending to the spiritual needs of clients is an essential part of developing culturally sensitive treatment plans and recommendations (Kuczewski, 2007).
Not unlike other racial groups, African-American families rely on spirituality as a source of support as they face various challenges. These challenges include both systemic oppressions (e.g., overt racism) and familial stressors (e.g., parenting). Given these life stressors, perhaps spirituality and religion offer some explanation as to why African Americans are better adjusted and more psychologically well than some experts expect and predict (Bell-Tolliver & Wilkerson, 2011).
Nearly 80% of African Americans identify religion as important compared to only 50% of the general population (Pew Research Center, 2009). Further, a majority of African Americans identify as Christian, and 50% of African Americans attend church services weekly. The majority of African Americans attend a predominantly African-American church (Pew Research Center, 2009). Many African Americans identify God as a core aspect of their coping, and rely on their religion and spirituality during difficult life transitions (Bell-Tolliver & Wilkerson, 2011; Whitley, 2012). Additionally, African Americans assert that attending worship services and Bible study, being involved in their churches, having devotion time, and listening to religious sermons and gospel music allow them to conceptualize their struggles within the larger struggle between good and evil, or God and the devil (Whitley, 2012).
Because of the salience of spirituality and religion in the experience of African Americans, it behooves professional counselors to increase their knowledge and awareness of the African-American religious experience, particularly as it relates to psychological health. Several researchers (Ayalon & Young, 2005; Woodward, 2011) have found that African Americans tend to seek professional counseling at a much lower rate than other racial and ethnic populations. Further, African Americans often choose their spiritual leaders and churches as resources for their mental health needs instead of professional counselors (Ayalon & Young, 2005). Thus, one area of the African-American religious experience that needs further attention from counselors is the Black Church. The Black Church is the term used in popular culture and scholarly literature to refer to the overall institution that encompasses individual, predominantly African-American Christian congregations (Lincoln & Mamiya, 1990).
In order to understand the Black Church and the people who worship therein, counselors must familiarize themselves with the historical context and theological underpinnings that frame the Black Church and likely influence individual parishioners’ help-seeking behaviors. The purpose of this article is to provide a brief overview of the history and development of the Black Church, built upon unique theological foundations. These elements of history and theology have important implications for counselors working with religious African-American clients.
History of the Black Church
Similar to African-American communities, the Black Church has experienced change, progression, challenges, struggle and resilience. Counselors must understand the historical role and relevance of the Black Church in African-American communities in order to better understand African-American mental health help-seeking behaviors. This section will provide an overview of the Black Church’s inception during slavery, its role in the Civil Rights Era and its relevance in the lives of many African Americans in the 21st century. This history will provide counselors with a context for understanding the Church’s salience in the lives of many of their religious African-American clients.
The Black Church and Slavery
During slavery, many plantation owners forbade more than five slaves to gather at a time without supervision by a White overseer. Although slaves possessed a desire for religious and spiritual expression, this rule complicated their ability to assemble for worship services and stifled their sense of community and opportunities for fellowship. Thus, in fear of repercussions for breaking these rules, slaves resorted to informal worship gatherings in secret locations (e.g., swamps and wooded areas; see Frazier, 1963; Lincoln, 1973). Eventually, during the mid-1700s, these informal gatherings became less secretive and more visible (Pinn, 2011), laying the foundation for the institution that would be become known as the Black Church. The churches became the epicenter of the slaves’ community and a place of education and fellowship that slaves lacked elsewhere on the plantation.
During the genesis of the Black Church, plantation owners feared that if slaves were able to read the Bible, their proclivity to defer hopes of freedom until after death would decrease, and a surge of strength and demand for emancipation would emerge. Slave masters feared that slaves would acquire a comprehensive knowledge of Scripture that would illuminate the flaws and Biblical inconsistencies of a despotic slave system. With a comprehensive knowledge of Scripture, slaves would have an increasingly difficult time reconciling a Biblically based system that would capture and enslave innocent people (Taylor, Thornton, & Chatters, 1987). As predicted, slaves became discontented with their situation and used the Church as a means to bring about change. As slaves’ Scriptural knowledge grew, so did their frustration with organized religion, particularly Christianity. Slaves viewed Christianity as another vehicle used by Whites to advance oppression (Lincoln & Mamiya, 1990).
Slave masters and their families treated slaves poorly even though they worshipped together in the same buildings. Instead of church being a sacred haven away from maltreatment, it was another opportunity for Whites to exert their power, which became overwhelming for many Blacks (Lincoln & Mamiya, 1990). Thus, slaves incepted their own churches out of a desire to have their own worship places on Southern plantations and escape discrimination on Sunday mornings (Lincoln, 1973). Richard Allen inaugurated the first Black church of the Methodist denomination in 1807 (Wilmore, 1998). The formation of the Black Methodist churches was considered a visceral response to the Methodist tradition of having segregated churches for Blacks and Whites. This departure of Blacks from the Methodist Church was one of the first major civil rights protests by African Americans (Lincoln & Mamiya, 1990). Subsequently, African Americans formed predominantly African-American congregations of Baptist, Presbyterian and Episcopal denominations (DuBois, 1903), setting the stage for the prominent emergence of the Black Church during the Civil Rights Era. Slaves felt that they could be themselves and their status as slaves did not subsume their identity in these churches. These services provided therapeutic relief and a departure from the pressures and brutality experienced on the plantation (Wilmore, 1998).
In essence, church services and religious and spiritual resources operated much like counseling sessions. Slaves found hope in the Scriptural promises of a future void of oppression. They looked forward to death as a transition from suffering on earth to a promise of reward and deliverance in Heaven (Johnston, 1954; Wilmore, 1998). Slaves especially could relate to the persecution and torment of Jesus Christ, the pivotal figure of Christianity. In fact, slaves even likened the crucifixion experienced by Christ to the popularized practice of lynching Black men (Pinn, 2010; Terrell, 1998). Terrell (1998) further elaborated that the connection between Jesus and slaves also was related to the Bible story of Judas betraying Jesus for economic compensation. Slaves knew that White plantation owners betrayed, captured and brought them to America for others’ economic gain (Pinn, 2011; Terrell, 1998).
Although slaves faced horrendous conditions on plantations, counseling services obviously were not available as a support and therapeutic release. During this time, the Church was the primary resource for support and change during life challenges. It is likely that this proclivity to seek support from the Church began during slavery and continues today. This historical precedent could help explain why African Americans are less likely than many other racial/ethnic groups to seek support from professional counselors (Ayalon & Young, 2005).
The Black Church and Civil Rights
During the 1950s and 1960s, the Black Church became increasingly more autonomous as it began expanding doctrinal beliefs, electing leaders and even creating seminary institutions to educate its leaders (Lincoln, 1973). Further, the Black Church offered a platform for activists to promote messages of equal rights for African Americans (Chandler, 2010). The Black Church worked at both the macro and micro levels of society. For example, on the macro level, large institutions such as the NAACP garnered support (e.g., financial, emotional) from the Black Church (Chandler, 2010). At a more micro level, individuals with difficulty fulfilling financial obligations received economic assistance. The Black Church’s growing financial independence initiated the self-help doctrine, as African Americans could not rely on support from outside sources. African Americans learned that in order to survive they had to support themselves financially, mentally, emotionally and socially (Littlefield, 2005). It is possible that African Americans may still maintain this perspective, and therefore may be less likely to seek support from resources such as professional counselors.
Particularly during the Civil Rights Era, the Black Church was a place that Blacks could experience prestige, rank and authority otherwise denied them by outside institutions, which were typically dominated by the majority culture (Douglas & Hopson, 2001). Thus, many African Americans may be distrustful of the counseling relationship, as it may reflect the larger dominant culture from which they have experienced exclusion and oppression (Sue & Sue, 2013).
The Black Church in the 21st Century
While the Black Church of past decades struggled with achieving equal rights in the community, the contemporary Black Church faces its own set of unique challenges. These challenges are related to health (e.g., HIV/AIDS) and social issues (e.g., welfare reform, disproportionately high unemployment rates for African Americans; Billingsley & Caldwell, 1994). Nonetheless, African Americans have certainly made considerable strides in advancement compared to previous decades, notably in the areas of education. Many argue that these strides should be attributed, at least in large part, to the efforts of the Black Church (Byrd, 2001). These strides are particularly important as the African-American community faces issues such as disproportionate rates of physical illness, financial strains, anxiety, depression and familial concerns (U.S. Department of Health and Human Services, 2001; 2011). Although these challenges may seem daunting for African-American communities and the Black Church in particular, scholars encourage the Black Church to draw on the strength that brought it through turbulent times such as slavery and the Civil Rights Era (Billingsley & Caldwell, 1994). Given the historical involvement of the Black Church in all aspects of the individual lives of African Americans, it is understandable that many African Americans may view their local churches as a viable alternative resource to professional counselors. Therefore, counselors should involve themselves in African-American communities and familiarize themselves with local churches. Counselors have a unique opportunity to partner with Black churches in their communities to build trust, decrease stigma around help seeking, assist in combating concerns facing many African Americans and learning about the impact of Black Church theology.
Black Church Theology
Just as it is important to understand the historical context of the Black Church, it is imperative to understand the Black Church’s foundational belief systems in order to thoroughly understand its roles and functions. Theology unites the collective Black Church, but also differentiates between local congregations. Often, individual churches and denominations vary in theological principles, and therefore differ in how they execute beliefs about their purpose, roles and responsibilities (Barber, 2011; Lincoln, 1974). Often, the Black Church is mistaken as a homogenous grouping of individual churches. However, theological differences make this a false pretense (Barber, 2011). These theological positions can serve as overarching guiding principles and influences for parishioners’ individual lives and their choices, including decisions about seeking help from professional counselors.
Although theological differences exist, most Black churches unite in the theological belief that during worship services their members experience a personal visitation from Jesus. Typically, this theological notion guides the way services are conducted. This visitation could be manifested through rituals and practices such as shouting, singing gospel songs and hymns, or speaking in tongues. To that end, Moore (2003) noted these behaviors as examples of the liberal and animated worship that often is indicative of the Black Church. Other practices that are common to the Black Church and reflective of its theology may befuddle those unfamiliar with the structure of the Black Church service. For example, members of the Black Church may be more likely to reference God and Jesus interchangeably in spiritual practices, such as prayer, which could be confusing to some outside observers (Johnson, 2010).
These complexities could confuse counselors not immersed in Black Church culture. Moreover, many observers question the variations in theology and the often ambivalent character of an institution that can be so progressive on one hand, yet quite rooted in traditional theology on the other hand. This apparent ambiguity gives many observers pause (Douglas & Hopson, 2001). The religious theology that guides the Black Church can provide helpful insight for counselors interested in increasing their multicultural competence and understanding of African-American clients. Often, this theology can influence individual congregation members’ personal lives, including how they make choices regarding whether to seek professional counseling. The following section elaborates on various theologies and how they may manifest in African-American clients.
Liberation Theology
James Cone’s liberation theology is one of the most prevailing schools of thought in the Black Church (McBeth, 1981). According to liberation theology, African Americans took Christianity, traditionally perceived as a White man’s religion, and adapted it to the plights and triumphs of African Americans. Compared to other theologies, liberation theology is seen as a comprehensive theology because it considers how individuals view God and how they interact with one another. According to liberation theology, the Black Church offered oppressed Blacks a sense of freedom rarely experienced in their day-to-day lives. The Black Church was a place where African Americans had the opportunity to gather and vent about their problems as a community. Additionally, the Black Church was a place where change could be created and enacted (McBeth, 1981). While other theologies focus on Caucasians as oppressors, churches whose members ascribe to liberation theology tend to focus less on the oppression and more on the freedom that is felt when congregation members experience fellowship with one another (Burrow, 1994). Because slaves viewed the master–slave relationship as the epitome of evil, African Americans placed a significant emphasis on forming and preserving healthy relationships (Burrow, 1994; Douglas & Hopson, 2001). Liberation theology values addressing people holistically, emphasizing the connection of the body and the mind (Burrow, 1994).
Alternate Society Theology
Frazier’s idea of the alternate society is somewhat similar to liberation theology, in that he proposed that the Black Church should operate as a sovereign society where African Americans would be able to fully express their authentic selves (see McBeth, 1981). Frazier founded this theology upon the belief that Caucasians did not understand African Americans, and therefore could not adequately meet their needs (Frazier, 1963). Frazier endorsed the idea that the Black Church would be a separate nation within the United States and would meet the needs of African-American communities in ways beyond just the spiritual. Optimally, the Black Church would be able to produce education centers, financial institutions, housing and a social outlet (Lincoln & Mamiya, 1990). Ironically, Frazier acknowledged that this alternate society would further inhibit Blacks from successfully acculturating in the majority culture in which they were expected to live and function (Frazier, 1963). It is likely that churches ascribing to this theology believe they will be able to meet both the psychological and spiritual needs of congregation members. In fact, in churches where this philosophy is predominant, it is possible that members who seek guidance from church leaders may be discouraged from seeking services such as professional counseling outside the Black Church.
Other-Worldly and This-Worldly Theology
Other-worldly churches are those whose members believe in deferring freedom and reward until after death. In other words, these churches’ members are more accepting of present pain and suffering since they believe they will experience relief posthumously in Heaven. Spiritual songs birthed to comfort, direct and relieve Black slaves became a critical part of other-worldly theology. These songs have served as a reminder that earthly suffering is temporary and an eternal promise of heavenly peace awaits upon death (Cashwell & Young, 2011). Also, pastors serve as an important mouthpiece for other-worldly theology. During slavery, preachers often delivered sermons reminding listeners of life after death, a life that contrasted with the current reality of enslavement. Today, although some of the challenges facing African Americans may be different, some pastors continue to uphold messages of enduring present suffering and awaiting the promises that accompany death (Wilmore, 1998). Attendees of other-worldly churches may be less likely to present in counseling, but when they do, it is critical for the counselor to understand that the client may be less oriented to solving his or her problem and more oriented to focusing on life after death. Failing to understand and embrace this perspective might lead some counselors to focus prematurely on problem-solving tasks that might damage the therapeutic relationship.
Conversely, this-worldly churches typically advocate explicitly for Blacks to experience earthly freedom and happiness. For example, whereas a member of an other-worldly church may be satisfied with receiving physical healing through death, a member of a this-worldly church may pursue other avenues to minimize pain and suffering and delay death as much as possible (Lincoln & Mamiya, 1990). These ideas about suffering also could manifest in one’s attitudes about psychological health and needs for counseling. Clients from this-worldly churches may possess a greater sense of urgency to seek counseling during times of psychological discomfort compared to clients from other-worldly churches, who may be less inclined to alleviate emotional distress.
Recommendations for Counselors
Sue and Sue (2013) challenged culturally competent counselors to appreciate and incorporate clients’ history, worldviews and life experiences into the counseling relationship. One critical dimension of those considerations is clients’ religious and spiritual backgrounds (Cashwell & Young, 2011). Specifically, for religious African-American clients, this process involves examining the intersection of at least two social identities (i.e., what it means to the client to be religious and what it means to be African American; Roccas & Brewer, 2002). One essential aspect of many African Americans’ identity is the Black Church and the expression of its various theological perspectives. Thus, it is important that counseling practitioners, counselor educators and clinical supervisors are aware of the nuances of the Black Church and African-American religion and spirituality. Additionally, counseling professionals should be aware of the theology of each individual client’s local church, which could influence communal beliefs about symptomology and counseling. Counselors should use this information to increase understanding and inform accurate diagnoses, as well as competent treatment plans and recommendations (Association for Spiritual, Ethical, and Religious Values in Counseling [ASERVC], 2009; Cashwell & Watts, 2010). To that end, counselors can incorporate the following strategies in recruiting and retaining African-American clients who identify as religious and as members of the Black Church.
African-American clients active in churches with particular theologies (e.g., alternate society theology and other-worldly theology) may be disinclined to seek counseling services outside the church. Congregants may receive messages that the church can take care of all of their concerns, including mental health issues. Moreover, many churches (particularly within the alternate society theological tradition) may offer programs (e.g., financial seminars to address income-related stress) that attend to many of the needs of church members. In these cases, members may not feel a need to go outside to professional counselors. These clients may not voluntarily seek services from professional counselors even when their presenting concerns may warrant intervention. Thus, it is important for counselors to contact local Black Church congregations to establish relationships, form trust and increase visibility. Rather than depending on African Americans to initiate communication with mental health professionals, counselors can volunteer outreach services and host programs at local churches in an effort to increase access to African Americans. Counselors are expected to operate as advocates and proponents of change for their clients (Sue & Sue, 2013); often the Black Church is a hub of social justice advocacy efforts within African-American communities (Lincoln & Mamiya, 1990). Traditionally, programs in the Black Church have provided clothing, substance abuse services, tutoring, mentoring and nonreligious education services (Tsitsos, 2003). Counselors can partner with the advocacy efforts of the Black Church to help church members in need. These needs range from issues within the family to more systemic issues that affect a large number of African Americans (e.g., unemployment, poverty, AIDS/HIV, incarceration, anxiety, depression). These efforts may increase church members’ comfort level with counseling and decrease stigma associated with seeking help.
Specifically, counselors can connect with local pastors, since pastors are very influential in the Black Church and African-American communities in general (Billingsley & Caldwell, 1994; Lincoln & Mamiya, 1990; Mattis et al., 2007; Roberts, 1994). Often, the pastoral role extends beyond spiritual responsibilities, as the majority of African Americans prefer to seek psychological help from their pastors rather than professional counselors (Ayalon & Young, 2005; Chatters et al., 2011). Pastors may be more likely to refer congregation members to trusted counselors who are visible in their community. Counselors likewise have the opportunity to learn more about the pastors’ approaches to responding to mental health needs in their congregations.
In addition, theology is important for counselors in formulating client conceptualizations and treatment recommendations. In particular, counselors should be aware of when the client’s beliefs about healing juxtapose with the professional’s knowledge of science (Kuczeweski, 2007), and where counselor biases might be imposed on the client. For example, it is important that counselors are cautious in labeling presenting concerns as problematic when working with a client from a church that focuses on liberation theology. Such clients may choose to focus less on the presenting concern and instead take a more strength-based, optimistic perspective. Clients who attend churches that emphasize liberation theology may be open to more holistic treatment recommendations and reluctant to rely on psychotropic medications to alleviate symptoms. Thus, counselors should be aware of this preference when referring clients to a psychiatrist and suggesting medication as a part of the treatment plan.
Counselors are encouraged to work from theoretical orientations that are sensitive and inclusive of clients’ religious and spiritual identities (ASERVC, 2009). Since theology is an important part of many religious African Americans’ identities, the counselor should be careful not to approach the counseling relationship from a theoretical orientation that contradicts the client’s theological orientation. The biopsychosocial-spiritual model (Cairns, 2011: Engel, 1977) is a culturally sensitive theoretical framework that allows for a client to be holistically assessed from a biological, psychological, social and spiritual perspective. With the addition of the spirituality component to the traditional biopsychosocial model, the religious coping strategies of many African-American clients have been considered, addressed and appreciated (Clark, Anderson, Clark, & Williams, 1999). Further, the importance of addressing people holistically, emphasizing the connection of the body and the mind, is rooted in liberation theology (Burrow, 1994). In this regard, it appears that the spiritually founded liberation theology of the Church and the biopsychosocial-spiritual model may complement one another well. Leaders of the Black Church may not automatically articulate views using the language of the biopsychosocial-spiritual, but are likely to be able to do so using the language of liberation theology. Thus, it is incumbent upon counseling professionals to probe deeper into the intersections of Black Church theology and counseling models.
Counselors should educate themselves on current events and issues that may be affecting the African-American community in general (e.g., recent events in Ferguson, Missouri) and their clients in particular. Although many of these issues could be disheartening (e.g., disproportionate representation of African Americans in many vulnerable populations), counselors also should be aware of advancements made within the African-American community and work from a strength-based developmental approach that honors the uniqueness of the African-American community in general, and in particular, the Black Church. This perspective is vital, as many references to African Americans are negative, given their disproportionate representation in many vulnerable populations. It could be tempting for counselors to focus on the negative; however, focusing on the positive and acknowledging advancements could serve as a corrective experience for many African Americans.
Because of the centrality of relationships within the Black community, counselors should consider social supports, such as church members, who could serve as great resources for clients during and after the counseling process. For example, counselors should be open to consulting with spiritual advisors and referring clients to their pastors if deemed appropriate. Historically, church members have served as an extended family for many African Americans (Ellison, Musick, & Henderson, 2008; Lincoln & Mamiya, 1990). Therefore, fellow church members also could be included in the counseling process, both within and outside counseling sessions as resources and support systems.
Counselors should invite clients to talk about recent worship services and spiritual experiences in counseling sessions. It is important that this encouragement is made from a curious stance that is noncritical and nonjudgmental. This invitation not only allows the client to integrate his or her spirituality into counseling, but also allows the counselor to learn more about the client’s religious background and preferences, as well as his or her specific church culture.
A counselor also can incorporate creative interventions that integrate a client’s religious and spiritual influences. For example, the counselor could invite the client to compile a list of his or her favorite gospel songs as a musical chronology and emerging life song. This process allows client and counselor to extrapolate themes and values that are important to the client (Cashwell & Young, 2011; Duffey, 2005). Given the historical importance of spirituals, the client could write songs or use existing songs to help articulate presenting concerns to his or her counselor. Additionally, the counselor becomes privy to the client’s spiritual values and theological beliefs by listening to song lyrics. Similar interventions might include asking the client to create a list of favorite Biblical stories or specific scriptures. Additionally, the counselor can ask the client to construct a spirituality genogram, which can provide invaluable information about the role of the Church in the client’s family and its influence on their individual lives (Cashwell & Young, 2011).
Conclusion
Researchers, scholars and counseling practitioners have noted the differences in help-seeking behaviors among racial and ethnic minority clients. With African Americans in particular, researchers have attributed some of these differences to African Americans’ preference for seeking help from spiritual resources rather than professional counseling resources. When exploring the mental health help-seeking behaviors of African Americans, it is imperative to pay particularly close attention to the role of religion, the Black Church and theology in the counseling experiences of many African-American clients. Learning more about various theological traditions and working from a culture-centered framework can substantively increase the quality of counseling services.
Conflict of Interest and Funding Disclosure
The authors reported no conflict of
interest or funding contributions for
the development of this manuscript.
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Janeé R. Avent, NCC, is an Assistant Professor at the University of Texas-San Antonio. Craig S. Cashwell, NCC, is a Professor at the University of North Carolina-Greensboro. Correspondence can be addressed to Janeé R. Avent, 501 César E. Chávez Blvd. DB 4.344, San Antonio, TX 78207, janee.avent@utsa.edu.
Feb 9, 2015 | Author Videos, Volume 5 - Issue 1
Rose Anelyn Visaya-Ceniza
This study aimed to determine the psychosocial health status of women artisanal miners in the Philippines. Their socio-demographic characteristics and psychosocial health status are described to formulate a self-efficacy enhancement program to respond to their needs. This study utilized a descriptive multiple case study design. Primary data were gathered via a simple questionnaire regarding the respondents’ socio-demographic profile and psychosocial health status. Other primary data sources included key informant interviews, respondents’ journal entries, observations and outputs during the structured learning exercises, focus group discussion transcripts, and a researcher’s log. Documentary reviews also were utilized to obtain additional facts. The respondents were selected through a fishbowl method. Results show that the participants’ coping process, attitude of perseverance and stress management have a moderate impact on their ability to manage life experiences. The study resulted in a proposal for a self-efficacy enhancement program to improve the psychosocial health of women artisanal miners.
Keywords: women miners, psychosocial health, coping process, stress management, self-efficacy
In March 2008, the theme “Babae, Yaman Ka Ng Bayan” [Woman, You Are a Treasure of the Nation], emphasizing the worth of women in nation building, was bannered to celebrate Women’s Month in the Philippines. In Barangay Puntalinao, Banaybanay, Davao Oriental, Philippines, active artisanal and small-scale magnesite mining activities are visible to the community and visitors. Banaybanay is the last municipality of Davao Oriental, bordering the municipality of the Pantukan, Compostela Valley Province. Women join men at tilling and extracting minerals from steep mountains. This site was visited in October 2007 for an environmental scanning and initial investigation. The idea of conducting a study was discussed with the artisanal miners and they showed interest in the benefits of the study.
The southern part of Mindanao is rich in mineral resources. Nickel reserves are worth $215 billion (USD), copper reserves are worth $6.49 billion and gold reserves are worth $2.01 billion. Mindanao accounts for 48% of the country’s gold and 83% of the nickel reserves. According to Ambassador Li Jinjun, investors believe that the mining industry is the “ace” of Mindanao. In agreement, former resident of the Republic and current congresswoman of the province of Pampanga, the Honorable Gloria Macapagal Arroyo has made the revival of the mining industry one of her key tools in sustaining the country’s economic growth (Bautista, 2005).
According to the United Nations Development Program (1999), women involved in mining are more likely to be family-centered than men and spend their earnings on food, clothing, education and agriculture. In the Philippines, women artisanal miners’ daily routine involves direct exposure to sunlight, climbing difficult mountains, tilling and extracting minerals, and carrying heavy sacks of rocks, in addition to household chores and family obligations after work. Moreover, some women are undergoing the physiological discomforts of menopause.
In a focus group discussion (FGD) on perseverance, the women artisanal miners reported that they can bear the heat of the sun, the hazards at work and the workload at home in order to preserve their families and provide what is needed. Their husbands’ incomes are not enough for their families’ basic needs, typical of the life conditions of the rural poor in the Philippines. According to the Barangay Captain [Puntalinao community leader], these women persist at low-paying quarrying activities to subsist. Women artisanal miners manifest the spirit to persevere in life through their backbreaking work hours. This labor includes quarrying the rocks with a hammer and wedge, hitting the rocks in succession to break them into small pieces, packing them in a sack (which generally weighs no less than 110 pounds), and carrying the sacks to the buyer’s loading area. Workers aim to fill 25 sacks per day on average, which are sold to a local buyer for 10 pesos each in order to sustain daily family needs.
According to Greenspan (1992), households ideally spend up to 10% of total income to raise one child, 18% for two children and 26% for four children. Since many families lack the resources to raise children, the per-child share drops dramatically with each child. A household with four children spends 25% less per child than a household with two children. This information suggests that the sufficiency of the family economy depends on the number of children in the household, and thus establishes the need to work harder to ensure family survival as the number of children in the family increases. It is not surprising to find an extended family system among Filipino families (Mercado, 1974) and to see children helping their parents at income-generating endeavors.
The miners’ common statement, “Maayo na lang ning pagpamato, bisan ginagmay kaysa wala jud sapi” [Even if mining gives us insufficient income, it is better than having nothing at all], reveals the working poor perspective that is important in considering ways to improve the miners’ psychosocial well-being. These women, ranging from young adults to elders, are vulnerable to stress; their self-efficacy is a powerful personal resource in the coping process (see Lazarus & Folkman, 1987).
While studies have explored the experiences of miners, these studies have failed to grasp fully the psychosocial health situation of women artisanal miners in Philippine rural communities. Since mining is a major contributor to the country’s economy, artisanal mining is expected to spread soon to other rural communities. Therefore, the experiences of community women require attention in order to better anticipate their emerging psychosocial health issues. The theoretical frameworks utilized in developing this study included Erikson’s (1963) psychosocial development theory, which posits that each person experiences psychosocial crises or internal conflicts linked to life’s key stages, which define growth and personality. Social-cognitive and self-efficacy theory (Bandura, 1992, 1997), defined as beliefs about one’s capabilities to produce levels of performance that influence one’s life, also was utilized to formulate this study.
Method
The author utilized a descriptive multiple case study design. Primary data were gathered using a researcher-constructed questionnaire that investigated each respondent’s socio-economic profile and psychosocial health status. Other primary data sources included key informant interviews, respondents’ journal entries, observations and outputs during the structured learning exercises (SLEs), FGD transcripts, and the researcher’s log. Documents provided by the barangay [community] secretary also were reviewed.
Participants
Twenty-six women ages 26–70 volunteered. Eight were between 35 and 43 years old and eight were within the ages of 53–61. Five of the respondents were between ages 44 and 52 and two respondents were 26–34 years old. The artisanal miners participating in the study were identified from the barangay list and via the assistance of the barangay secretary. Based on the socio-demographic data drawn from the selected women miners of Barangay Puntalinao, Banaybanay, Davao Oriental, the respondents generally belonged among the rural poor migrant settlers and had low levels of educational attainment. Most participants were mothers responsible for large families and obliged to participate in mining to sustain daily family needs. Most participants owned their homes; however, the houses were located on rental lots, causing some degree of insecurity in terms of permanence of residence.
Data Sources
A 21-item survey, translated from English to Cebuano, provided a socio-demographic profile and psychosocial health status of each respondent, covering perseverance, stress management and coping processes. It was clustered into three areas: personal data, family structure and housing arrangement. Items 1–6 aimed to determine level of perseverance. Items 7–16 covered the impact of stress management styles, and items 17–21 determined the impact of coping processes on managing life circumstances. Responses were tallied using the following scale: 1.00–1.99 indicating that the given life experience had a high impact on psychosocial health status over the past month, 2.00–2.99 indicating moderate impact on psychosocial health and 3.00–4.00 indicating low impact.
Other primary sources of data included key informant interviews, respondents’ journal entries, observations and outputs during SLEs, transcripts from the FGD, and the researcher’s observation logs from her 3-day community immersion. The key informants included the Barangay Captain, the Barangay Health Worker and a sari-sari [small grocery] store owner, all of whom were interviewed during the researcher’s community immersion. A formal approval to conduct a study in the area was requested from the Barangay Captain. The Barangay Health Worker was interviewed about health conditions among the women miners and the barangay’s health programs for women. An interview also was conducted with a sari-sari store owner who had firsthand knowledge of the women residents’ consumer behavior and lived in a house located at the mining compound. Daily logs recorded what was witnessed and experienced during the immersion. The Barangay Puntalinao Development Plan (2000) also was used to gather basic community information such as the history, demography and topography of the barangay.
SLEs were conducted after the baseline data on psychosocial health status were obtained. The SLEs focused on coping processes, perseverance and stress management. During each SLE, a lecture was conducted and an assignment given for follow-up discussion with the group before the activity concluded. Outputs from the SLEs formed part of the data for the multiple case studies. A FGD with 14 randomly selected miners was conducted after the last SLE, focusing on coping processes, stress management and perseverance. Outputs from the FGD were utilized to validate and expand on the data extracted from the survey questionnaires and SLEs. The psychosocial health status of the respondents was monitored three months after the conclusion of the last SLEs. It provided feedback on the sessions’ lasting effects on the psychosocial health management of the respondents, despite the assessment of medium-term effectiveness, not included in the objectives of the study.
Results
Socio-Demographic Profile and Psychosocial Health Status
The general conditions of poverty resulted in multiple burdens, including reproduction. The high numbers of respondents’ children may have indicated that respondents spent much of their childbearing years within marriage. Six of the artisanal miners had four offspring. One of the respondents had nine and another had 14 children. Eighteen miners had children aged at least 22 years old. Three respondents had children 1 year old or younger, which suggests that more time and effort were needed to exert in mining to provide the needs of these children in the early stages of human development. Aside from economic needs, data implied that the women miners lived with their husbands and managed time for child care, despite long days at the mines.
Coping processes. The results showed that Filipino women artisanal miners’ coping processes had a moderate impact on recent life experiences for which they employed these coping strategies. The respondents had the ability to handle different trials in life, but the ability to use common coping strategies had a fair influence on being able to manage life circumstances well. It was evident from the women’s disclosures that multiple workloads consumed their being. However, the coping processes they employed had a low impact on solving family problems.
“Lisod kaayo ang among kahimtang labi na og mag-abot ang mga problema sa pamilya” [Our situation is very difficult most especially when the entire family encounters problems at the same time]. Because the women miners were responsible and accountable for problems encountered by the entire family, they became concerned when the family experienced difficulty. This finding was similar to findings from the United Nations Development Program (1999), which reported that women were more likely than men to devote resources for family upkeep, food and children’s education. Furthermore, prioritizing the needs of the family demonstrates adherence to the traditional Filipino value of kagandahang loob [compassion] (Miranda, 1992).
Among the 14 respondents who participated in the SLEs, coping behavior was utilized regarding problematic circumstances with their husbands’ vices and behaviors such as drinking, infidelity, physical abuse and financial neglect. Marital cases brought to the barangay office are usually reconciled through forgiveness and for economic reasons. Problems related to their children included participants’ daily absence from home, no contact while away from their children, early marriage and inability to support their children. According to the key informant, mining is considered a survival strategy despite its health risks, low compensation and daily starting time, as early as 5:00 a.m. (see Table 1).
According to one informant, a Barangay Health Worker who happened to be a neighbor of the miners, the miners often channeled time and effort into their mining in order to regain a sense of self-worth and focus on caring for their families, despite health risks and low compensation. During the FGD, the women miners mentioned using prayer as a coping strategy. Some Filipino women miners join religious organizations in order to express their feelings with fellow members. Miners’ journal entries indicated that they believed their present situation was their destiny.
Table 1
Psychosocial Health of Women Artisanal Miners at Barangay Puntalinao, Davao Oriental in Terms of Coping Processes
| Coping Processes Indicator |
M
|
SD
|
Description
|
| Coping strategies employed |
2.71
|
.65
|
MI
|
| Conflicts with in-laws or household members |
1.84
|
1.01
|
HI
|
| Conflicts with immediate family members |
2.23
|
1.03
|
MI
|
| Conflicts with friends |
1.42
|
.58
|
HI
|
| Being taken advantage of |
2.58
|
1.27
|
MI
|
| Lots of responsibilities |
3.69
|
.62
|
LI
|
Note. LI = low impact, MI = moderate impact, HI = high impact.
Perseverance. The women miners’ attitude of perseverance had a high impact on their effective socializing with their neighbors. During FGDs, participants shared that the community had not encountered cultural problems because of respect for one another; in addition, most participants belonged to the Cebuano tribe. Based on the observation log, the women artisanal miners cared for each other and showed respect to everyone by treating each other without bias. Jocano (1999) wrote that the Filipino value delicadeza [being proper], is manifested, for instance, when one does not abuse a friendship by doing something that would be hurtful or embarrassing to a friend. This value is apparent in the practice of sabot that allows women to express and meet their needs for help without sacrificing their pride and dignity. Enriquez (1978) discussed kapwa as a mode of Filipino social interaction which he defined as “recognition of shared identities as well as the compassionate generosity to others in need.”
Based on the statement of the sari-sari store owner who was a neighbor of the respondents, the women miners usually incurred credit for food to be paid the following day. This practice of sabot [agreement] maintains social relations based on asal [consideration] as discussed by Jocano (1999) and kagandahang loob [compassion] as depicted by Miranda (1992). The moral undertone of these terms is best expressed by the Filipino concept of pakikiramay, or going out of one’s way in order to share the sorrow of others in times of crisis (Miranda, 1992). The practice of sabot, therefore, addresses the survival needs of the women in a manner that does not compromise their self-esteem, kindness and generosity.
It is evident that the women artisanal miners are insecure in terms of their housing, because most of their homes are built on property owned by other people. The participants’ attitude of perseverance had a moderate impact on dealing with the knowledge that the lot their houses were on could be revoked at any time. At the time the study was conducted, most of the houses had to be relocated to accommodate a road-widening project by the provincial government. Houses were uprooted and moved at least 10 meters from the road, causing the miners uncertainty about where to locate, or how far a potential relocation might be from the workplace.
Individual case studies showed that the women artisanal miners performed multiple roles including mother, wife, grandmother and household manager, as well as miner. Since these women were willing to sacrifice for their family, it was important for them to nurture their attitude to persist. Though they had the determination to continue with their various roles, they also needed to recharge from time to time. Their ability to manage the toll of their physical and psychological loads led them to a greater sense of self-efficacy. Such a sense allowed them to select challenging settings, explore their environments or create new ones (see Table 2).
Table 2
Psychosocial Health of Women Artisanal Miners at Barangay Puntalinao, Davao Oriental in Terms of Perseverance
|
Perseverance Indicator
|
M
|
SD
|
Description
|
| Perseverance |
2.88
|
.46
|
MI
|
| Having your contributions overlooked |
2.62
|
.85
|
MI
|
| Hard work to look after and maintain house |
3.70
|
.55
|
LI
|
| Gossip about yourself |
2.42
|
1.14
|
MI
|
| Findings your work too demanding |
3.88
|
.59
|
LI
|
| Financial conflicts with family members |
2.31
|
1.29
|
MI
|
| Feeling alone |
2.85
|
.97
|
MI
|
| Experiencing high levels of heat |
3.85
|
.61
|
LI
|
| Ethnic or tribal conflict |
1.62
|
.70
|
HI
|
| Dissatisfaction with your physical fitness |
1.85
|
1.12
|
HI
|
| Dissatisfaction with your physical appearance |
1.81
|
.81
|
HI
|
| Disqualifying positives |
2.00
|
1.06
|
MI
|
| Disliking your daily activities |
2.85
|
1.05
|
MI
|
Note. LI = low impact, MI = moderate impact, HI = high impact.
Stress management. The women miners’ stress management styles had a moderate impact on their management of the stressors they encountered. Thus, there was room for improvement in their repertoire of stress management techniques to help prevent exhaustion or burnout. The data, moreover, showed that the miners did not harbor insecurities regarding their physical appearance and fitness. In addition, because of the forgiving attitude of the participants, violent family conflicts were avoided and rarely compounded their difficulties. Instead of borrowing trouble, the women generally opted to forgive.
Data showed that the stress management styles of the women miners had high impact with regard to viewing the future and remaining optimistic and hopeful. As for techniques employed, one participant stated that watching teleseryes, or television series, was a common means of relaxation among the women in the community. Women often finished doing household chores in the evening and watched television. Based on the study log, the miners and their children and grandchildren typically gathered inside the house around 7:30 p.m. to watch television. Teleseryes provided a medium for sympathetic catharsis. For instance, when the women witnessed someone’s misfortune, they compared it with their own and felt better afterward. When they viewed someone being oppressed on television, they tended to feel better about their own situation. When the oppressed character fought back, the viewer identified with the character’s desire to oppose malevolent forces. More importantly, sympathetic catharsis brought stress to a manageable level (see Table 3).
Table 3
Psychosocial Health of Women Artisanal Miners at Barangay Puntalinao, Davao Oriental in Terms of Stress Management
|
Stress Management Indicator
|
M
|
SD
|
Description
|
| Stress management techniques |
2.54
|
.45
|
MI
|
| Unsatisfactory housing and conditions |
2.35
|
.85
|
MI
|
| Trying to secure loans |
3.08
|
1.16
|
LI
|
| Too many things to do at once |
3.52
|
.64
|
LI
|
| Take on the burdens of the entire family |
3.70
|
.79
|
LI
|
Note. LI = low impact, MI = moderate impact, HI = high impact.
The Barangay Health Worker who was interviewed for the study happened to own a karaoke machine and stated that the women miners sometimes came over and sang whenever they had extra money (each song costs one peso on the videoke machine).These were occasions for the miners to bond and socialize as they sang, danced and laughed. During the FGD on stress management, it was mentioned that playing bingo also was one of the miners’ common pastimes, providing another social activity and an opportunity to connect with others and meet a very basic human need for the women.
Based on the survey of psychosocial health status, stress management strategies had a low impact on addressing stressful daily activities. According to one participant, “Usahay kapuyon ko og makabati og sakit sa lawas tungod kay dili lalim ang akong trabaho” [I get tired sometimes and do not feel good physically because my work is not that easy].
Discussion
The participants in this study indicated a need to enhance their coping strategies to cope with adversities in their lives. While they have the fighting spirit, their coping strategies could be improved further. A sense of self-worth must be further developed for the participants to be aware of their respective capabilities to exercise control over stressful situations. If this need was met further and more positive self-efficacy achieved, the miners would be better able to enhance their psychosocial health status.
Most of the women artisanal miners married at an early age and were financially unable to finish school. They were driven to engage in mining for many years to sustain the basic needs of their families. Most of the respondents have husbands and children who mine as well. More often than not, children are forced to discontinue school and begin work to help support the family. Despite being poor, the women have not surrendered to the trials of life, holding on to aspirations and possessing the following self-related cognition: “I can do it.” This attitude allows them to overcome the lack of opportunities by mining as a way to earn income and sustain the needs of their families.
Mining is perceived as God-sent and affords the women an opportunity to be self-reliant and gain a measure of control over their daily experience. Most of the respondents have persevered for the sake of their children and grandchildren. In addition to their labor, physical and emotional abuse from their husbands increases their suffering; yet they tend to be forgiving. Coleman (1998) advocated the therapeutic value of forgiveness as follows: “Forgiveness is a must in any family problem where there has been deep hurt, betrayal, or disloyalty” (p. 78). If there can be no reconciliation, forgiveness is the process that enables the forgiver to move on with life unencumbered with the pain of betrayal. Madanes (1991) further asserted, “The only way we can survive from day to day without emotional breakdown is by forgiving and forgetting” (p. 416). This study did not explore why the women miners forgive the wrongs done to them. It was found, however, that the women tend to forgive their husbands, although some still nurse hurts and resentment.
For the women, mining plays a major role in survival. The activity is described as a means of livelihood, a family bonding activity and source of hope for life. Furthermore, it also is seen as a chance to establish good relationships with colleagues, or pakikipagkapwa, and to enjoy work despite discomfort and hard work.
Most participants aim to build a semi-concrete house with comfortable rooms in a lot that they would own. In addition, the security of their residence is questionable when affected by the road-widening project of the provincial government. Still, the respondents expressed optimism as symbolized by the blooming flowers and abundant trees in their drawings (their output during their SLE), depicting joy and love in their households (see Appendix for an example).
Women artisanal miners in the Philippines would benefit from learning strategies to effectively address problems they encounter. They need to develop a sense of personal efficacy for approaching threatening situations with assurance that they can exercise control over these threats. The miners are hopeful and optimistic; therefore, it would be worthwhile to engage them cognitively and affectively and to facilitate decision-making that would allow them to gain insight into how to better manage resources and improve psychosocial health.
Implications
Given the socio-demographic characteristics, as well as the presentation of different life experiences, aspirations and psychosocial health status of the women artisanal miners, this study discovered that the miners would benefit from an intervention that revitalizes them, despite day-to-day stressors. Although the women are able to cope with various life difficulties, there is a need to enhance their coping strategies for managing stress. The miners should be more aware of their capabilities to exercise control over their own functioning and over the events that affect their lives, and thereby develop a stronger sense of personal efficacy. If these needs are met and self-efficacy achieved, the women miners will be able to enhance their psychosocial health status.
Optimism is commonly manifested in the stories told by the women artisanal miners. According to Bandura (1992), people with high assurance of their own capabilities approach difficult tasks as challenges to be mastered rather than threats to be avoided. Such an efficacious outlook fosters interest and engrossment in activities. A person who believes in being able to cause events can conduct a more active and self-determined life course. This can-do cognition mirrors a sense of control over one’s environment, and reflects the belief of being able to master challenging demands by means of adaptive action. This attitude also can be regarded as an optimistic view of one’s capacity to deal with stress (Bandura, 1992; Maddux, 1995; Wallston, 1994). This study reveals the importance of helping women miners enhance self-efficacy to maintain psychosocial health.
After the exploration of the women miners’ psychosocial health status, the researcher discovered that the miners need an intervention in order to be revitalized despite the various obstacles they encounter from day to day. They need training on how to maintain a positive outlook on life and how to believe in their potential to endure as a mother, wife, grandmother and daughter, as well as person. Considering the lifestyle and psychosocial health status of the women miners in terms of perseverance, coping processes and stress management, the self-efficacy enhancement program focuses on effective ways of creating a strong sense of efficacy among the miners in order to sustain the perseverance needed to succeed.
Conclusion
The stories of the women artisanal miners suggest that their coping processes, attitude of perseverance and stress management strategies have a moderate impact on their ability to manage their respective life experiences. As the 14 individual case studies were examined further for their psychosocial health status, the author found that most of the women artisanal miners face economic crises as well as maternal and marital problems. Despite these challenges, they manifest a forgiving attitude, which reflects the notion that such sacrifice is necessary for the sake of the family’s survival.
The miners also are optimistic about the future, an attitude that was manifested during the sharing of their aspirations in life through drawings. All participants mentioned positive life visions and goals. Flowers and trees were commonly drawn, which symbolized the participants’ desires to have happy and harmonious families. Children wearing togas and parents pinning ribbons on a graduation day also depict the participants’ yearning for the education and advancement of the next generation. Semi-concrete houses with comfortable rooms are illustrated to show longing for comfort and security in living conditions. All these aspects of the drawings (see Appendix) demonstrate that the women artisanal miners have plans and hopes in life that give them the determination to persist. Optimistic processes are an essential key to gaining a sense of self-efficacy.
The women miners possess the optimistic attitude to carry on, but there is room for them to discover more about how to control their functioning and manage their psychosocial health status more effectively. Therefore, it is necessary to help them enhance their coping strategies and stress management techniques.
Conflict of Interest and Funding Disclosure
The authors reported no conflict of interest or funding contributions for the development of this manuscript.
References
Bandura, A. (1992). Self-efficacy mechanism in psychobiologic functioning. In R. Schwarzer (Ed.), Self-Efficacy: Thought control of action (pp. 355–394). Washington, DC: Hemisphere.
Bandura, A. (1997). Self-efficacy and health behaviour. In A. Baum, S. Newman, J. Weinman, R. West, & C. McManus (Eds.), Cambridge handbook of psychology, health and medicine (pp. 160–162). Cambridge, England: Cambridge University Press.
Barangay Puntalinao Development Plan. (2000). Davao City, Philippines
Bautista, R. (2005, February 2). Revival of the mining industry. Philippine Daily Inquirer.
Coleman, P. W. (1998). The process of forgiveness in marriage and the family. In R. D. Enright & J. North (Eds.), Exploring forgiveness (pp. 75–94). Madison, WI: University of Wisconsin Press.
Enriquez, V. G. (1978). Kapwa: A core concept of Filipino social psychology. Philippine Social Sciences and Hummanities Review, 42,100–108
Erikson, E. H. (1963). Childhood and society (2nd ed.). New York, NY: Norton.
Greenspan, A. (1992). Poverty in the Philippines: The impact on family size. Asia-Pacific Population & Policy, 21, 1-4
Jocano, F. L. (1999). Filipino value system: A cultural definition. Quezon City, Philippines: Punlad Research House.
Madanes, C. (1991). Sex, love, and violence: Strategies for transformation. New York, NY: W. W. Norton.
Maddux, J. E. (Ed.). (1995). Self-efficacy, adaptation, and adjustment: Theory, research, and application. New York, NY: Plenum.
Mercado, L. N. (1974). Elements of Filipino philosophy. Tacloban City: Divine Word.
Miranda, D. M. (1992). Buting pinoy: Probe essays on value as Filipino. Manila, Philippines: Divine Word..
United Nations Development Program. (1999). Human development report. Retrieved from http://hdr.undp.org/sites/default/files/reports/260/hdr_1999_en_nostats.pdf
Wallston, K. A. (1994). Theoretically based strategies for health behavior change. In M. P. O’Donnell & J. S. Harris (Eds.), Health promotion in the workplace (2nd ed., pp. 185–203). Albany, NY: Delmar.
Appendix
A Miner’s Drawing of Life Aspirations
Rose Anelyn Visaya-Ceniza is the Head of the Guidance Counseling and Testing Center of the Davao Oriental State College of Science and Technology, Guang-Guang, Dahican, and a practicing psychologist at St. Camillus Hospital of Mati, Inc. Correspondence can be addressed to Rose Anelyn Visaya-Ceniza, DOSCST, Dahican, 8200 Mati City, Davao Oriental, Philippines, roseanelyn@yahoo.com.
The author previously published portions of this article: “An Exploration of the Psychosocial Health Status of Women Artisanal Miners in Mindanao, Philippines” in Procedia: Social and Behavioral Sciences, 91, 505–514.
Feb 9, 2015 | Article, Volume 5 - Issue 1
Ashley J. Blount, Patrick R. Mullen
Supervision is an integral component of counselor development with the objective of ensuring safe and effective counseling for clients. Wellness also is an important element of counseling and often labeled as the cornerstone of the counseling profession. Literature on supervision contains few models that have a wellness focus or component; however, wellness is fundamental to counseling and the training of counselors, and is primary in developmental, strengths-based counseling. The purpose of this article is to introduce an integrative wellness model for counseling supervision that incorporates existing models of supervision, matching the developmental needs of counselors-in-training and theoretical tenets of wellness.
Keywords: supervision, wellness, counselors-in-training, integrative wellness model, developmental
The practice of counseling is rich with challenges that impact counselor wellness (Kottler, 2010; Maslach, 2003). Consequently, counselors with poor wellness may not produce optimal services for the clients they serve (Lawson, 2007). Furthermore, wellness is regarded as a cornerstone in developmental, strengths-based approaches to counseling (Lawson, 2007; Lawson & Myers, 2011; Myers & Sweeney, 2005, 2008; Witmer, 1985; Witmer & Young, 1996) and is an important consideration when training counselors (Lenz & Smith, 2010; Roach & Young, 2007). Therefore, a focus on methods by which counselor educators can prepare counseling trainees to obtain and maintain wellness is necessary.
Clinical supervision is an integral component of counselor training and involves a relationship in which an expert (e.g., supervisor) facilitates the development of counseling competence in a trainee (Loganbill, Hardy, & Delworth, 1982). Supervision is a requirement of master’s-level counseling training programs and is a part of developing and evaluating counseling students’ skills (Borders, 1992), level of wellness (Lenz, Sangganjanavanich, Balkin, Oliver, & Smith, 2012), readiness for change (Aten, Strain, & Gillespie, 2008; Prochaska & DiClemente, 1982) and overall development into effective counselors (Bernard & Goodyear, 2014). Supervisors use pedagogical methods and theories of supervision to assess and evaluate trainees with the goal of enhancing their counseling competence (American Counseling Association [ACA], 2014; Bernard & Goodyear, 2014). The method or theory of supervision relates to the interaction between counselor educators and counseling trainees and is isomorphic to a counselor using a theory with a client.
The number of supervision theories and methods has increased over recent years. In addition, integrated supervision models have been established with a focus on specific trainee groups (e.g., Carlson & Lambie, 2012; Lambie & Sias, 2009) or specific purposes (e.g., Luke & Bernard, 2006; Ober, Granello, & Henfield, 2009). These integrated models combine the theoretical tenets of key models with the goal of formulating a new perspective for clinical training that adapts to the needs of the supervisee or context. Lenz and Smith (2010) and Roscoe (2009) suggested that the construct of wellness needs further clarification and articulation as a method of supervision. Currently, a single model of supervision with a wellness perspective is available (see Lenz & Smith, 2010). However, it does not specifically apply to master’s-level counselors-in-training (CITs) or focus on the wellness constructs highlighted in the proposed integrative wellness model (IWM). Therefore, this manuscript serves to review relevant literature on supervision and wellness, introduce the IWM, and present implications regarding its implementation and evaluation.
Supervision
ACA (2014), the Council for Accreditation of Counseling and Related Educational Programs (CACREP; 2009), and the Association for Counselor Education and Supervision (ACES; 2011) have articulated standards for best practices in supervision. For example, ACES’ (2011) Standards for Best Practices Guidelines highlights 12 categories as integral components of the supervision process. The categories include responsibilities of supervisors and suggestions for actions to be taken in order to ensure best practices in supervision. The ACA Code of Ethics (2014) states that supervision involves a process of monitoring “client welfare and supervisee performance and professional development” (Standard F.1.a). Furthermore, supervision can be used as a tool to provide supervisees with necessary knowledge, skills and ethical guidelines to provide safe and effective counseling services (Bernard & Goodyear, 2014).
Supervision has two central purposes: to foster supervisees’ personal and professional development and to protect clients (Vespia, Heckman-Stone, & Delworth, 2002). Supervisors work to ensure client welfare by monitoring and evaluating supervisee behavior, which serves as a gatekeeping tool for the counseling profession (Robiner, Fuhrman, Ristvedt, Bobbit, & Schirvar, 1994). Thus, supervisors protect the counseling profession and clients receiving counseling services by providing psychoeducation, modeling appropriate counselor behavior, and evaluating supervisees’ counseling skills and other professional behaviors. In order to do this, supervisors and supervisees must have a strong supervisory relationship that supports positive supervision outcomes (Rønnestad & Skovholt, 2003).
Supervision is a distinct intervention (Borders, 1992) that is separate from teaching, counseling and consultation. Supervision is unique in that it is comprised of multifaceted (e.g., teacher, counselor and consultant) roles that occur at different times throughout the supervision process (Bernard, 1997). Bernard’s (1979, 1997) discrimination model (DM) of supervision is an educational perspective positing that supervisors can match the needs of supervisees with a supervisor role and supervision focus. The DM is situation specific, meaning that supervisors can change roles throughout the supervision session based on their goal for supervisee interaction (Bernard, 1997). Therefore, supervisees require different roles and levels of support from their supervisors at different times throughout the supervision process, which can be determined by a process of assessment and matching of supervisee needs.
According to Worthen and McNeill (1996), supervision varies according to the developmental level of trainees. Beginning supervisees need more support and structure than intermediate or advanced supervisees (Borders, 1990). Additionally, supervisors working with beginning supervisees must pay more attention to student skills and aid in the development of self-awareness. With intermediate supervisees, supervision may focus on personal development, more advanced case conceptualizations of clients and operating within a specific counseling theory (McNeill, Stoltenberg, & Pierce, 1985). Advanced supervisees work on more complex issues of personal development, parallel processes or a replication of the therapeutic relationship in a variety of settings (e.g., counseling, supervision; Ekstein & Wallerstein, 1972), and advanced responses and reactions to clients (Williams, Judge, Hill, & Hoffman, 1997). Consequently, supervision progresses from beginning stages to advanced stages for supervisees, with a developmental framework central to the process. Supervision is tailored to the specific developmental level of a supervisee, and tasks are personalized for needs at specific times throughout the supervision process. Developmental stages in supervision have been identified as key processes that counselor trainees undergo (e.g., Rønnestad & Skovholt, 2003; Stoltenberg & McNeill, 2012), a conceptualization that necessitates a supervision model that aids supervisees in a developmental fashion.
Recent models of supervision represent trends toward integrative and empirically based supervision modalities (e.g., Bernard & Goodyear, 2014; Lambie & Sias, 2009). The current integrated model of supervision draws from the theoretical tenets of the DM (Bernard, 1979, 1997), matching supervisee developmental needs (Lambie & Sias, 2009; Loganbill et al., 1982; Stoltenberg, 1981) and wellness constructs (Lenz et al., 2012; Myers, Sweeney, & Witmer, 1998). Wellness is a conscious, thoughtful process that requires increased awareness of choices that are being made toward optimal human functioning and a more satisfying lifestyle (Johnson, 1986; Swarbrick, 1997). As such, the IWM includes wellness undertones in order to support optimal supervisee functioning. This article presents the IWM’s theoretical tenets, implementation and methods for supervisee evaluation. In addition, a case study is presented to demonstrate the IWM’s application in clinical supervision.
Theoretical Tenets Integrated Into the IWM of Supervision
The DM (Bernard, 1979, 1997) is considered “one of the most accessible models of clinical supervision” (Bernard & Goodyear, 2014, p. 52) and includes the following three supervisor roles: teacher, counselor and consultant. In the teacher role, the supervisor imparts knowledge to the supervisee and serves an educational function. The counselor role involves the supervisor aiding the supervisee in increasing self-awareness, enhancing reflectivity, and working through interpersonal and intrapersonal conflicts. Lastly, the consultant role provides opportunities for supervisors and supervisees to have discussions on a balanced level (Bernard, 1979). The three roles are used throughout the supervision process to promote supervisee learning, growth and development.
The DM of supervision is situation specific in that supervisors enact different roles throughout the supervision session based on the observed need of the supervisee (Bernard & Goodyear, 2014). As needs arise in supervision, the supervisor decides which role is best suited for the issue or concern. This process requires the supervisor to identify or assess a need and to make a decision regarding the appropriate role (i.e., teacher, counselor or consultant) to facilitate appropriate supervision. Furthermore, the use of supervisory roles is fluid, with its ebb and flow contingent upon the supervisee needs or issues. For example, if a supervisee is struggling with how to review informed consent, a supervisor can use the teacher role to educate the student on how to proceed, and then address the supervisee’s anxiety about seeing his or her first client using the counseling role. The DM roles are integrated into the IWM, and supervisors alternate between roles to match supervisee needs throughout the supervision process.
Developmental Tenets
The authors of developmental models have suggested that counseling trainees progress in a structured and sequential fashion through stages of development that increase in complexity and integration (e.g., Blocher, 1983; Loganbill et al., 1982; Stoltenberg, 1981; Stoltenberg & McNeill, 2010). In early experiences, supervisees engage in rigid thinking, have high anxiety and dependence on the supervisor, and express low confidence in their abilities (Borders & Brown, 2005; Rønnestad, & Skovholt, 2003; Stoltenberg & McNeill, 2012). Moreover, supervisees have limited understanding of their own abilities and view their supervisor as an expert (Borders & Brown, 2005; Stoltenberg & McNeill, 2010). Struggles between independency and autonomy, as well as bouts of self-doubt, occur during the middle stages of counselor development (Borders & Brown, 2005; Stoltenberg & McNeill, 2010). In addition, counselors experience decreased anxiety paired with an increase in case conceptualization, skill development and crystallization of theoretical orientation (Stoltenberg & McNeill, 2010). Thinking becomes more flexible and there is an increased understanding of unique client qualities and traits (Borders & Brown, 2005). The later stages of counselor development are marked by increased stability and focus on clinical skill development and professional growth, which promotes a flexibility and adaptability that allows for trainees to overcome setbacks with minimal discouragement (Stoltenberg & McNeill, 1997). Furthermore, supervisees focus on more complex information and diverse perspectives as they learn to conceptualize clients more effectively (Borders & Brown, 2005).
In summary, supervisees’ movement through the developmental stages is marked by individualized supervision needs. Structured, concrete feedback and information are desired in early supervision experiences (Bernard, 1997; Stoltenberg & McNeill, 2010). The middle stages have a general focus on processing the interpersonal reactions in which supervisees engage, and supervisors provide support to help supervisees increase their awareness of transference and countertransference (Borders & Brown, 2005; Stoltenberg, 1981). Toward the later stages of supervision, supervisees seek collaborative relationships with supervisors. This collaboration provides supervisees with more freedom and autonomy, which allows them to progress through the stages as they begin to self-identify the focus of their supervision (Borders & Brown, 2005).
Similar to the IWM, models of supervision that are development-focused derive from Hunt’s (1971) matching model that suggests a person–environment fit (Stoltenberg, McNeill, & Crethar, 1994). The matching model advocates that the developmental level of supervisees should be matched with environmental or contextual structures to enhance the opportunity for learning (Lambie & Sias, 2009). Specifically, the developmental models account for trainees’ needs specific to their experience level and contextual environment, with the goal of matching interventions to support movement into more advanced developmental levels (Bernard & Goodyear, 2014; Stoltenberg & McNeill, 2012). The IWM derives its developmental perspective from the unique levels trainees experience during supervision and the cycling and recycling of stages that occurs (Loganbill et al., 1982).
Wellness and Unwellness
Wellness is a topic that has received much attention in counseling literature (Hattie, Myers, & Sweeney, 2004), including several perspectives on how to define wellness (Keyes, 1998). Dunn (1967) is considered the architect of the wellness crusade and described wellness as an integration of spirit, body and mind. The World Health Organization (1968) defined health as more than the absence of disease and emphasized a wellness quality, which includes mental, social and physical well-being. Cohen (1991) described wellness as an idealistic state that individuals strive to attain, and as something that is situated along a continuum (i.e., people experience bouts of wellness and unwellness). Witmer and Sweeney (1992) depicted wellness as interconnectedness between health characteristics, life tasks (spirituality, love, work, friendship, self), and life forces (family, community, religion, education). Additionally, Roscoe (2009) depicted wellness as a holistic paradigm that includes physical, emotional, social, occupational, spiritual, intellectual and environmental components. Witmer and Granello (2005) stated that the counseling profession is distinctively suited to promoting health and wellness with a developmental approach and, coincidentally, supervision could serve as a tool to promote wellness in supervisees as well as in clients receiving counseling services.
Smith, Robinson, and Young (2007) found that counselor wellness is negatively influenced by increased exposure to psychological distress. Furthermore, research has shown that counselors face stress because of the nature of their job (Cummins, Massey, & Jones, 2007). Increased stress and anxiety associated with counseling may have deleterious effects on counselor wellness, and supervisors and supervisees who are unwell may adversely impact their clients. In addition, Lawson and Myers (2011) suggested that increasing counselors’ wellness could lead to increased compassion satisfaction and aid counselors in avoiding compassion fatigue and burnout. Thus, supervisee and supervisor wellness should be an important component of counselor training and supervision. The IWM makes counselor wellness a focus of the supervision process.
Supervision literature contains few supervision models that include wellness components and/or focus on wellness as a key aspect of the supervision experience (e.g., Lenz et al., 2012; Lenz & Smith, 2010). Nevertheless, the paradigm of wellness has emerged in the field of counseling and is primary in developmental, strengths-based counseling (Lenz & Smith, 2010; Myers & Sweeney, 2005). The CACREP 2009 Standards note the importance of wellness for counseling students and counselor educators by promoting human functioning, wellness and health through advocacy, prevention and education. To illustrate, the CACREP 2009 Standards include suggestions of facilitating optimal development and wellness, incorporating orientations to wellness in counseling goals, and using wellness approaches to work with a plethora of populations. The overall goal of wellness counseling is to support wellness in clients (Granello & Witmer, 2013). However, if supervisees seeing clients are unwell, how efficient are they in promoting wellness in others? In order to support development of wellness in supervisees, the IWM incorporates the five wellness domains of creative, coping, physical, essential and social (Myers, Luecht, & Sweeney, 2004) by implementing the use of the Five Factor Wellness Evaluation of Lifestyle (5F-Wel; Myers et al., 2004). In addition, supervisees can use a starfish template (Echterling et al., 2002) to gauge their own wellness and prioritize the constructs that influence their personal and professional levels of wellness and unwellness, as well as create plans to increase their overall wellness.
Implementing the IWM
The IWM was created to offer an integrative method of supervision that is concise and easy to facilitate. Specifically, the IWM consists of several processes, including supervisory relationship development, evaluation of developmental phase, allocation of supervision need, and assessment and matching of wellness intervention. The following section outlines each process.
Supervisory Relationship Development
Rapport building and relationship development between supervisor and supervisee constitute a critical step in supervision (Hird, Cavalieri, Dulko, Felice, & Ho, 2001). Similar to counseling, establishing a strong, trusting supervisory relationship is essential because the relationship is an integral component of the supervision experience (Borders & Brown, 2005; Rønnestad & Skovholt, 1993). During initial sessions, supervisors describe the process of the IWM to supervisees in order to maintain open, transparent communication and to promote a safe environment for supervisees to learn, share emotions and feelings, and develop counseling skills. It is hoped that modeling appropriate professional behaviors and setting up supervision sessions to promote a trusting environment will aid in the overall development of counseling supervisees and matriculate into their normal routines as professional counselors. As with counseling, supervisors can promote a strong relationship with supervisees by focusing on the core conditions of empathy, genuineness and unconditional positive regard (Rogers, 1957). Open communication and supervisor authenticity are just two examples of processes that help develop a sound supervisor–supervisee relationship.
Evaluation of Developmental Phase
Supervisee development is an important consideration in the IWM. The IWM divides supervisee development into three phases that consist of distinct developmental characteristics. Similar to Stoltenberg and McNeill’s (2010) suggestion and other integrative models (e.g., Carlson & Lambie, 2012; Young, Lambie, Hutchinson, & Thurston-Dyer, 2011), the phases in the IWM are hierarchical in nature, with the highest phase (phase three) being ideal for developed supervisees. In addition, the IWM acknowledges the preclinical experiences (e.g., lay helper; Rønnestad, & Skovholt, 2003) of supervisees as valuable and relevant to their development. In the IWM, it is important to acknowledge and address the experiences that supervisees have had prior to their work as counselors because they may impact perceptions and expectations.
For example, supervisors can facilitate activities to promote awareness of how supervisees influence counseling sessions. To illustrate, supervisees may participate in activities highlighting culture, family-of-origin, character strengths and bias, and evaluate how those factors may influence their counseling skills, views of clients and interactions with clients, peers and supervisors. One example of a technique that can generate conversation on the aforementioned areas is the genogram (Lim & Nakamoto, 2008). Supervisees can use the genogram to map out their family history, life influences and path to becoming a counselor during a supervision session. Ultimately, the genogram can be used as a tool to assess where supervisees are developmentally and what might have contributed to their worldview and presence as counselors. With any technique used during the supervision process, the goal of increasing awareness is emphasized. Furthermore, supervisees can implement these activities for use with their own clients. Ultimately, supervisors work to facilitate supervisee progression toward being more self-actualized, self-aware counselors. Table 1 provides descriptions of awareness of well-being, developmental characteristics, supervisory descriptors and supervision considerations for each developmental phase.
Table 1
IWM Phases of Supervisee Development
|
Awareness of Well-being
|
Developmental Characteristics
|
Supervisory Descriptors
|
Supervision Considerations
|
|
|
|
|
|
|
| Phase 1 |
|
Low awareness |
Low independenceIncreased anxietyFollows the lead of others
Low self-efficacy |
SupportiveEducationalStructured |
Live supervisionFeedbackPsychoeducation
Modeling |
| Phase 2 |
|
Pursuit of awareness |
Seeking independenceModerate anxietyMakes attempts to lead
Modest self-efficacy |
Generating awarenessCelebrating successesChallenging |
Advanced skill feedbackChallenge awareness |
| Phase 3 |
|
Increased awareness |
Mostly independentNominal anxietyLeads others
Moderate–high self-efficacy |
Increased mutualityCollaborative |
Active listeningConsultation |
One way supervisors seek to assess supervisees’ developmental phase is through active inquiry. Similar to Young and colleagues’ (2011) recommendations, the assessment of supervisees’ developmental phase is achieved through the use of questioning, reflecting, active listening and challenging incongruences. In addition, direct and intentional questions are used to target specific topics. For example, a supervisor seeking to assess the wellness of a supervisee might ask, “How are you feeling?” and then if there is incongruence, the supervisor might state, “You’re saying that you feel ‘fine,’ but you appear to be anxious tonight.” Based on supervisee reaction, the supervisor can judge the level of awareness the trainee has into his or her own well-being. Additionally, supervisors might want to ask about specific issues such as planned interventions, diagnostic interpretations or theoretical orientation. For example, a supervisor might ask, “How do you plan to assess for suicide?” Then, based on the trainee’s reaction (e.g., asking for help, giving a tentative answer or giving a confident answer) the supervisor can determine his or her developmental phase.
Supervisors also can assess supervisee developmental phase through evaluation. By observing a supervisee in a number of settings (e.g., counseling, triadic supervision, group supervision), supervisors can gauge where he or she is developmentally. Furthermore, observing the supervisee’s counseling skills, professional behaviors and dispositions (Swank, Lambie, & Witta, 2012) can provide increased insight into what phase the supervisee is experiencing at that particular point in time.
Allocation of Supervision Need
The allocation of supervision need is the next process in the IWM of supervision. The supervisor assesses the developmental phase of the supervisee and then provides a supervision intervention (contextual or educational) with the goal of supporting and/or challenging the supervisee (Lambie & Sias, 2009). Phase one of supervisee development is marked by high anxiety, low self-efficacy, decreased awareness of wellness and poor initiative. The supervision environment is one of structure with prescribed activities. Activities to support growth in phase one include live supervision, critical feedback, education on relevant issues, and modeling of behavior and skill.
Gaining insight into trainee wellness also is critical. Supervisors can use insight-oriented activities such as scrapbook journaling, which allows supervisees to gain awareness through the use of multiple media such as photos, music, quotes and poems in the journaling process (Bradley, Whisenhunt, Adamson, & Kress, 2013), or openly discussing the supervisee’s current state of wellness to help foster an increased awareness of it. Supervisees in this developmental phase can be encouraged to explore the five wellness domains (creative self, coping self, social self, essential self, physical self) and begin increasing awareness of their current level of wellness. An example of an activity for assessing supervisee wellness is the starfish technique, which is adapted from Echterling and colleagues’ (2002) sea star balancing exercise. Within this technique, supervisees receive a picture of a five-armed starfish marked with the five wellness constructs (creative, coping, physical, essential, social; Hattie et al., 2004; Myers et al., 2004) and are asked to evaluate the areas that influence or contribute to their overall wellness. Following this, supervisors and supervisees can pursue a discussion regarding the constructs. After the discussion, supervisees redraw the starfish with arm lengths representing the amount of influence that each construct has on their overall wellness or change the constructs into things that they feel better represent their personal wellness. Figure 1 is an example of a supervisee’s initial starfish. Figure 2 is the redrawn wellness starfish based on prioritizing or changing the wellness constructs; this supervisee’s redrawn starfish prioritizes social, physical and creative aspects. In contrast, nutritional and emotional constructs are depicted as smaller arms, indicating areas for growth or a potential imbalance.
Supervisees’ progression to higher levels of development is facilitated through educational and reflective interventions that their supervisors deliver. Phase two of supervisee development is marked by increased autonomy and self-efficacy, decreased anxiety, and attempts to lead or take initiatives. The context of supervision is less concrete and structured but still supportive and encouraging. Supervisees may seek independence, as well as reassurance that they are correct when working through challenges (Borders & Brown, 2005). Supervisors can provide feedback on advanced skills, challenge supervisee awareness and foster opportunities for supervisees to take risks (i.e., challenge, support; Lambie & Sias, 2009). Supervisees in phase two have an increased awareness of their well-being but may be reluctant to integrate support strategies. Therefore, supervisors may integrate activities, assignments or challenges to enhance supervisees’ wellness. For example, supervisors can have supervisees create wellness plans or discuss current wellness plans. Thus, the supervisor can hold the supervisee accountable for personal well-being.
Supervisees in phase three exhibit high autonomy and self-efficacy, low anxiety, and greater efforts to lead (Borders & Brown, 2005). The supervision environment is less structured and the supervisor assumes a consultative role. In addition, the supervisee may serve as a leader by supporting less developed peers. Interventions at this level take the form of consulting on tough cases, working through unresolved issues and providing guidance on advanced skills. Furthermore, supervisees have higher awareness of their wellness and its implications on their work with clients. Finally, supervisees in this phase seek to minimize negative well-being and may need encouragement to overcome this challenge.
Assessment and Matching of Wellness Interventions
Evaluation is a key component of the supervision process (Borders & Brown, 2005) and therefore, wellness, supervisee skill level and supervisor role are assessed in the IWM. A key feature of the IWM is the emphasis on promoting supervisee wellness. Therefore, the IWM emphasizes the evaluation of supervisees and matching of wellness interventions. Furthermore, it is important to assess supervisees’ counseling skills throughout the supervision process to provide formative and summative feedback.
The IWM utilizes the five factors of the indivisible self model (Myers & Sweeney, 2004, 2005) as points of assessment. Furthermore, the development of personal well-being is dependent upon education of wellness, self-assessment, goal planning and progress evaluation (Granello, 2000; Myers, Sweeney, & Witmer, 2000). Therefore, the IWM utilizes these aspects of wellness development as a modality for enhancing supervisee well-being. Supervisees are viewed from a positive, strengths-based perspective in the IWM and thus, activities in supervision should highlight positive attributes, increase understanding of supervisees’ level of wellness and promote knowledge of holistic wellness. Wellness plans (WPs) and the starfish activity are used to assess supervisee wellness by promoting communication and self-awareness in the supervision session. Furthermore, both evaluations are valuable self-assessment measures for supervisees and allow for initial wellness goal setting. WPs should be developed during early supervision sessions and used as a check-in mechanism for formative wellness feedback. Concurrently, the starfish assessment can be used early on to gauge initial wellness and areas for wellness growth.
Progress evaluation is assessed with the 5F-Wel (Myers et al., 2004), a model used to consider factors contributing to healthy lifestyles. The 5F-Wel is a frequently used assessment of wellness and is based on the creative, coping, essential, physical and spiritual self components of the indivisible self model (Myers et al., 2004; Myers & Sweeney, 2005). Supervisees take this assessment during the initial and final sessions to assess their wellness. Myers and Sweeney (2005) have reported the internal consistency of the 5F-Wel as ranging from .89 to .96.
Supervisee counseling skills should be evaluated using a standardized assessment tool. For example, the Counselor Competency Scale (CCS; Swank et al., 2012) can be used as a formative (e.g., midterm or weekly) and summative (e.g., end of semester) assessment of supervisee competencies. In addition, the CCS examines whether supervisees have the knowledge, self-awareness and counseling skills to progress to additional advanced clinical practicum or internship experiences. The CCS assesses supervisee development of skill, professional behavior and professional disposition (Swank et al., 2012). Therefore, supervisors can utilize the CCS to match and support supervisees’ growth by taking on appropriate roles (i.e., teacher, counselor, consultant) to enhance work on specific developmental issues.
Evaluation allows supervisors to monitor supervisee development of career-sustaining mechanisms that enhance well-being, as well as counseling skills, dispositions and professional behaviors. Specifically, the goals of supervisee development are to increase or maintain level of wellness and increase or maintain counseling skills by the end of the supervision process. However, if a supervisee does not improve well-being, the WP should be reevaluated and a remediation plan set so that the supervisee continues to work toward increased wellness. Similarly, if a student does not meet the minimal counseling skill requirements, a remediation plan can be created to support the student’s continued development.
Matching. Supervisors gain a picture of where counseling trainees are developmentally based on the assessment and evaluation process. Then supervisors can match supervisee developmental levels (of skill and wellness) by assuming the appropriate role (i.e., counselor, teacher, consultant) and using the role to provide the appropriate level of support for each trainee. This process allows for individualization of the supervision process and for supervisors to tailor specific events, techniques and learning experiences to the needs of their supervisees. Furthermore, matching supervisee developmental needs and gauging levels of awareness and anxiety allows for appropriate discussions during supervision. Discussing wellness during the latter part of supervision is appropriate for beginning counselors who may be anxious about their skills and work with clients (Borders, 1990) and may not absorb information about their wellness. Each supervisee is an individual, and as a result, it is important to make sure that the supervisee is ready to hear wellness feedback during the supervision session.
IWM: Goals, Strengths and Limitations
The overall goals of the IWM of supervision are for supervisees to increase their wellness, progress through developmental stages and gain counseling skills required to be effective counselors. Additionally, supervisors using the IWM can aid supervisees in increasing wellness awareness via completion of wellness-related assessments (e.g., WPs and starfish technique). Furthermore, supervisors can work to increase supervisees’ self-awareness and professional awareness of counseling issues such as multicultural wellness concerns, the therapeutic alliance, becoming a reflective practitioner, and positive, strengths-based approaches of counseling under the IWM framework.
The IWM is innovative in that it is one of a few supervision models to contain a wellness component. Additionally, the IWM tenets (i.e., wellness, discrimination, development) are empirically supported on individual levels. Furthermore, the IWM includes techniques and assessments for promoting open communication relating to supervisee wellness and counseling skills, and therefore supports supervisory relationships and greater self-awareness, and ultimately allows supervisors to encourage and promote wellness.
As with all models of supervision, the IWM has limitations. Specifically, the IWM may not be applicable to advanced counselors and supervisees. The IWM includes three developmental phases, which are applicable to CITs. In addition, the model may not be as beneficial to supervisees who already have a balanced wellness plan or practice wellness, because the wellness component may be repetitive for such individuals. Additionally, all aspects of the IWM might not be effective or appropriate across all multicultural groups (i.e., races, ethnicities, genders, religions). For example, in relation to wellness, supervisees may not adhere to a holistic paradigm or believe in certain wellness constructs. Lastly, the IWM is in its infancy and empirical evidence directly associated with the integrative prototype does not exist. Nevertheless, supervisors using the IWM can tailor the wellness, developmental and role-matching components to meet specific supervisee needs. The following case study depicts the use of the IWM with a counseling supervisee.
Case Study
Kayla is a 25-year-old female master’s-level counseling student taking her first practicum course. She is excited about the idea of putting the skills she has learned during her program into practice with clients. However, Kayla also is anxious about seeing her first clients and often questions whether she will be able to remember everything she is supposed to do. People tell her she will be fine; however, Kayla questions whether she will actually be able to help her clients.
In addition to the practicum course, Kayla is taking three other graduate courses. She has a full-time job and is in a steady relationship. Family is very important to her, but since beginning her graduate program, she has been unable to find enough time to spend with friends and family. Kayla feels the pull between these areas of her life and struggles to find a balance between family, school, work and her partner.
Kayla is in phase one (i.e., high anxiety); therefore, her supervisor assumes the counselor and teacher roles most often, to match Kayla developmentally. This choice of roles allows Kayla to receive appropriate levels of support and structure to help ease anxiety. During this phase, the supervisor introduces a WP to Kayla and has her complete the 5F-Wel and starfish activity. After discussing the supervisory process and explaining the IWM, Kayla and the supervisor have a conversation about the areas influencing her overall wellness. Based on her starfish results, Kayla is encouraged to develop a WP that coincides with the areas depicted on the starfish, emphasizing those that she wishes to develop further. Additionally, the 5F-Wel provides a baseline of well-being to use in future sessions. Along with the wellness focus, the supervisor explains how imbalance or unwellness influences counselors and, in turn, how it can influence clients.
Initial supervision sessions will continue to provide Kayla with appropriate levels of support and psychoeducation so that she will be able to transition from low awareness to a greater sense of counseling skill awareness and increased mindfulness regarding her overall wellness. If the supervisor and supervisee are able to establish a strong working relationship, it is expected that Kayla will eventually move developmentally into phase two, where she will continue to gain insight into her counseling and wellness, begin to increase her autonomy, and work on increasing self-efficacy.
Implications for Counseling
The IWM integrates developmental and DM supervision tenets with domains of wellness. A supervision model that incorporates wellness is a logical fit in counseling and counselor education, where programs can and should address personal development through wellness strategies for CITs (Roach & Young, 2007). Furthermore, the IWM supports the idea that wellness is important. According to White and Franzoni (1990), CITs often show higher psychological disturbances than the general population. Cummins, Massey, and Jones (2007) highlighted the fact that counselors and CITs often struggle to take their own advice about wellness in their personal lives. Thus, while counseling is theoretically and historically a wellness-oriented field, many counselors are unwell and failing to practice what they preach (Lawson, Venart, Hazler, & Kottler, 2007; Myers & Sweeney, 2005). Implementing the IWM can aid in supporting overall wellness in supervisees as well as educating CITs to practice wellness with their clients and with themselves.
In relation to developmental matching and DM roles, counseling supervisors using the IWM have the following theoretical issues (e.g., Bernard, 1997; Myers et al., 2004; Myers & Sweeney, 2005) to facilitate: supervisee change, skill development, increased self-awareness and increased professional development. The IWM is a holistic, strengths-based model that focuses on supervisee development, matching supervisee needs through supervisor role changing, and wellness to promote knowledgeable, well and effective counseling supervisees.
Conclusion
The IWM is designed to integrate wellness, developmental stages and role matching to allow supervisors to encourage holistic wellness through supervision. Wellness has a positive relationship with counselors’ increased use of career-sustaining mechanisms and increased professional quality of life (Lawson, 2007; Lawson & Myers, 2011). Likewise, increased professional quality of life has been shown to make a positive contribution to counselors’ self-efficacy and counseling service delivery (Mullen, 2014). Therefore, it is logical to promote wellness and career-sustaining behaviors throughout the supervision process.
In summary, the IWM offers a new, integrated model of supervision for use with CITs. Supervisors using the IWM have the unique opportunity to operate from a wellness paradigm, familiarize their supervisees with wellness practices, and monitor supervisees’ wellness and how their wellness influences their client outcomes, while simultaneously supporting supervisee growth, counseling skill development and awareness of professional dispositions.
Conflict of Interest and Funding Disclosure
The authors reported no conflict of
interest or funding contributions for
the development of this manuscript.
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Ashley J. Blount, NCC, is a doctoral student at the University of Central Florida. Patrick R. Mullen, NCC, is an Assistant Professor at East Carolina University. Correspondence can be addressed to Ashley J. Blount, The Department of Child, Family, and Community Sciences, University of Central Florida, P.O. Box 161250, Orlando, Florida, 32816-1250, ashleyjwindt@gmail.com.
Feb 9, 2015 | Article, Volume 5 - Issue 1
Susan A. Adams, Alice Vasquez, Mindy Prengler
Teaching basic skills to beginning counseling students can be an overwhelming experience. In each therapy session, students bring their own human qualities and life experiences that have shaped them as individuals. Trainees must understand that their needs, motivations, values and personality traits can either enhance or interfere with their counselor effectiveness. Cognitive mapping can help expand students’ awareness while building the foundation of their counseling skills because it involves practical integration of learning attributes and prior knowledge into a new situation. Through the use of simple graphic visual learning tools, students can successfully incorporate basic skills into their development as counselors in an attempt to enable a positive initial learning experience that does not overwhelm them with the nuances and complexities of advanced counselor development.
Keywords: counseling students, basic skills, counseling formula, cognitive mapping, graphic visual learning tools
Why does change occur in therapy? Theorists have attempted to answer this question over the decades. Certainly the starting place is to focus on the importance of the therapeutic relationship, which is “central and foundational to therapeutic growth” (Slattery & Park, 2011, p. 235). Specifically, the outcome of counseling involves a connection between the counselor and client that begins with warmth, empathy, respect and genuineness (Chang, Scott, & Decker, 2009; Flaskas, 2004; McClam & Woodside, 2010; Smith, Thomas, & Jackson, 2004).
Rogers (1951, 1957, 1958) discussed his ideas about unconditional positive regard, congruence and empathy as basic key factors in the development of a therapeutic relationship. Moursund and Kenny (2002) summarized Lazarus’ perspective and proposed that establishing the therapeutic relationship is the most important skill for clinicians, and involves a connection between the counselor and the client. Each influences the other by bringing individual strengths, knowledge of the situation, life experiences, as well as their own personal values and beliefs. “The therapeutic relationship is viewed as both a precondition of change and a process of change” (Prochaska & Norcross, 2003, p. 492). The purpose of this article is to explore one method of breaking down basic counseling skills into a manageable counseling formula in order to enable a positive initial learning experience for students without overwhelming them with the nuances and complexities of advanced counselor development.
Challenges of Mastering Basic Skills
Initially, when introduced to counseling basic skills from a written textbook, students can find acquiring this knowledge to be challenging. Without prior experience, the challenge may intensify and become daunting when successful academic progress becomes an expectation defined by mastery of clearly defined basic skills. Counseling students struggle to appropriately apply these skills, while linked with timing and delivery.
Counseling is a unique experience that is different from daily communications in social interactions. As counselors-in-training learn the art of counseling, they become aware of the necessity of using their skills to empower their clients to set appropriate goals. Often empowerment, a concept that focuses on clients’ ability to choose their own solutions in life situations and issues, is a lofty ideal that is difficult to define. Even the definition of empowerment is ever-evolving (Asimakopoulou, Gilbert, Newton, & Scrambler, 2012). Empowerment’s overarching theme further contributes to the complexities of the learning process for beginning students (Hill, 2005).
While no one would argue the importance of empowerment or the significance of the therapeutic relationship, it also is critical that beginning students master many interpersonal skills while learning to observe, effectively attend to, and play an interpersonal role in shaping and guiding the counseling session (Ackerman & Hilsenroth, 2001; Chang et al., 2009; Jacobs, 1994; Jacobs, Masson, Harvill, & Schimmel, 2012; Meier & Davis, 2011). In fact, the second belief of Jacob’s impact therapy is that “people don’t mind being led if they are led well” (1994, p. 8). Therefore, it becomes imperative that educators incorporate logical process teaching methods in order to simplify this initial learning process, and cognitive mapping pedagogy provides that logical process.
Cognitive Mapping Pedagogy
A concept map is “a schematic device for representing a set of concepts and meanings embedded in a framework of propositions” (Novak & Gowin, 1984, p. 15). According to Akinsanya & Williams (2004), cognitive mapping provides an interactive teaching environment incorporating communication, group dynamics and motivation. Concept maps promote awareness of the roles of relationships within the categories and are ideal for the measurement of students’ learning (Akinsanya & Williams, 2004). Nurses have been successful in the utilization of cognitive mapping in order to build upon new concepts and incorporate these new concepts into their working framework. The cognitive mapping strategy ensures that both the curriculum and learning processes align with the nurses’ practical application of patient care (Akinsanya & Williams, 2004).
Counselor educators, in an initial basic skills course, focus on improving how students understand their basic counseling skills and navigate their individual learning styles. The counselor educator’s goal is for students to become successful counselors. Creating a classroom of trust filled with simplistic, graphic learning tools can generate a safe learning environment and reduce anxiety. “The reduction of anxiety removes unnecessary barriers to learning and to performing complex, multidimensional, and multisensory tasks, of which counseling is a prime example” (McAuliffe & Eriksen, 2002, p. 50).
Furthermore, by using graphic learning tools, the counselor educator links what is in his or her mind with what is in the student counselor’s mind in order to enable the student counselor to effectively utilize past experiences with new knowledge. In other words, cognitive mapping helps graphically relate a foreign concept to prior learning experience by using experiential links between old knowledge and new learning. These experiential links create a deeper level of learning (Akinsanya & Williams, 2004). By using cognitive mapping in this research, the counselor educator forms a visual representation of the links of communication between student counselor and client. The cognitive mapping visual representation can track student counselor awareness with the communication of the client.
Cognitive mapping helps the student understand the structure of knowledge by providing a process for acquiring, storing and using information. This process helps students think more effectively by creating a pictorial view of their ideas and concepts and how these are interrelated (Kostovich, Poradzisz, Wood, & O’Brien, 2007). Svinicki and McKeachie (2011) explained that visual cues serve as points of reference. Using a diagram or other graphic representative, in addition to an oral presentation, serves as a point of reference for visual cues to enhance learning opportunities within cognitive mapping, which in turn gives the students a visual representation that supports learning. According to Veletsianos (2010), students have learning expectations before the learning process begins. Both learning preferences and personality style are incorporated into the students’ learning process. As Veletsianos discovered, when given a graphic such as a cognitive map, the material is organized in a way that influences students’ “expectations, impressions, and learning” (2010, p. 583). The combination of human interaction with a visual graphic as part of the classroom experience allows the student to expect that learning is about to occur.
Concept mapping helps the counselor educator track the progress of student learning by allowing the professor to track what the student does not understand. The role that the common language plays in concept mapping allows the counselor educator to correct the links that might confuse the student. Cognitive mapping is not only a visual tool, but also adds verbal and kinesthetic tools to role playing in initial counselor training courses.
According to Henriksen and Trusty (2005), development of specific counselor education pedagogy also must incorporate diversity. Cognitive mapping is a schematic tool that appeals to the diverse learner since it provides a progressive visual that counseling students can follow and understand (Hill, 2005). Cognitive mapping is diverse in itself, as it appeals to a variety of learning styles, culturally diverse students and adult learners. Students have consistently given feedback that this method of teaching has simplified both learning and understanding how the map fits together within the therapeutic process. The following examples provide a reflection of students’ perspective.
Student Feedback
Example 1. Typical students learn systematically as they acquire practice and understand how to apply the counseling formula to what is happening in their sessions. One of the current authors was taught the counseling formula during her first clinical graduate course and describes her experience this way:
For me, I could plug in where my parts were and back off on parts where the client needs to do his or her work. It made me feel more confident as I entered my second tape recording and verbatim assignment because I knew that my basic skills of reflection of content, feelings, and meaning would get me where I needed to go with my client. This is where he or she could begin to gain insight into their experience, and begin to have the option to make optimal changes in life.
Example 2. Struggling students are those trying to connect the dots until they apply the cognitive mapping formula to what is happening when working through their second tape. This student defines his experience and the insights he gained as follows:
When I was introduced to the counseling formula, I thought it was definitely something useful, but not something I fully grasped at the time. Before that point, everything I had learned had been more complex, and the formula seemed almost too simple. How could reflection of feeling and content lead to reflection of meaning? Also, how is the client able to know or receive the response the way the counselor wants him or her to? I was confused because the formula seemed so black and white—or at least that is how I made it out to be.
After our second counseling tape was recorded, our transcription was scored. To my surprise, I did not do well. I met with my professor who had taught me the formula at the beginning of the semester. Instead of her telling me exactly where in the formula I had gone wrong, we discussed what elements I was missing during the session and what I focused on too much. As we discussed my struggles, I kept the formula in mind. As we talked, I realized I had forgotten one of my key formula elements; I was stricken by the realization that I did not understand how to make meaning of this seemingly simplified equation. In no way is the equation simple as it is up to the counselor to do his or her part so the client can do theirs. This light bulb moment was a key part of my learning experience during my first basic clinical course.
Counselor Educators
A counselor educator developing a counselor training program that is culturally diverse can use cognitive mapping as a teaching tool to meet the needs of culturally diverse learners. Cognitive mapping provides counselor educators with a multicultural pedagogy which incorporates the race and ethnicity of their students during counselor training (Henriksen & Trusty, 2005). As a multicultural pedagogy, it further reduces cultural clashing by providing common, visual language (Dansereau & Dees, 2002). The cognitive map becomes the students’ tool for spoken language, as it parallels verbal thought and expression by breaking down complex thoughts into visual expression. Cognitive mapping, although an effective tool, is more likely to be effective with African Americans and Mexican Americans than Caucasians (Van Velsor & Cox, 2000). The cognitive map represents knowledge graphically; therefore, students whose initial language is not English can pictorially grasp the concepts with more ease.
Just as culturally diverse students can learn using cognitive mapping, adult learners also can benefit from using this schematic tool. According to Hill (2005), cognitive mapping or concept mapping (as she refers to it) is a learning tool that is well suited to the adult learner due to greater accumulation of experiences. Adult students find cognitive mapping useful in organizing their ideas, retaining information and relating content material to other knowledge. When processing content material using cognitive mapping, meaningful learning occurs; the adult student learner engages complex cognitive structures within the brain integrating it with existing knowledge.
Student Feedback
Example 3. A student who is a mature adult learner and whose second language is English shared that she learns better visually and that cognitive mapping helped her comprehend the content as she followed graphically what the counselor educator was explaining. She stated the following:
I am an older Hispanic student and English is my second language. Although I have excellent command of the English language, I still find myself translating from English to Spanish to better understand what the professor is saying. When the professor taught us the counseling formula in class, the methodology of how the counseling process works made sense to me. I was able to visualize in my head how the counseling process functions. From that point on, I was able to grasp the concept of what I need to do as a counselor to get clients to move toward change.
Theory & Basic Skills
The counseling process influences the outcome of counseling. This simple statement can easily lead to a developmental crisis as counseling students struggle with skill acquisition. According to Meier and Davis (2011), “To master process, beginning counselors must develop a repertoire of helping skills as well as a theory of counseling that directs their application” (p. 1). Most counseling programs separate acquisition of basic skills from theoretical knowledge. Gaining these skills can be like learning a foreign language—learned patterns of human interaction change as students assume their counselor identity and acquire new counseling skills.
Certain critical skills are absent from this formula because, due to prior knowledge and experience, students easily understand them. For example, when given the opportunity to talk about attending skills, most students can easily identify basic posture, facial expressions and space limitations with reasonable accuracy. Minimal encouragers and questioning are both necessary skills that have a useful purpose in the counseling session; nevertheless, students usually have mastered these in normal daily conversation. Therefore, both minimal encouragers and questioning must receive great attention in order to substantially reduce and manage their utilization and avoid hindering or distracting from the effectiveness of a counseling session.
A Cognitive Mapping Formula
The creation of a cognitive mapping formula for counseling was designed to graphically depict the counseling process utilized in the therapeutic process. The formula and the inclusion of certain basic skills illustrate the concept of client empowerment so that clients can take personal responsibility for their actions and make desired changes. The counseling formula works as follows: Cognition (C) plus feelings (F) equals meaning (M), which leads to awareness (A), which promotes insights (I), which facilitates change (see Figure 1).
Through reflections of cognition, feeling and meaning, counselors help clients explore their world and determine what will be effective and ineffective. These reflections encourage exploration on multiple levels. Deeper levels of exploration are achieved through reflection of feeling and meaning so that clients connect what is happening in their heads (cognitions) and what is happening emotionally (feelings), therefore ultimately understanding their experience (meaning). Through counselors’ proper application of the top line of the cognitive mapping equation, clients begin to understand that their situation is solvable if they are willing to take personal responsibility for the change, as reflected in the bottom line of the equation. In other words, change occurs as a result of clients’ personal commitment. The concept of universality and the inclusion of all basic skills are part of all theoretical applications.
The didactic application of the cognitive mapping, as seen in Figure 1, tracks how the counselor shapes the session in classroom role plays. The equation shows how the session crosslinks and builds. The counselor influences the session through the choices the counselor makes to reflect feeling, meaning or cognition. Each counseling session looks different, but all sessions need balance in order for sessions to flow.
Subsumed within this simplistic graphic are additional important counseling skills. Paraphrasing and summarization contain elements of cognition, feeling and meaning, and tend to center the client in the content of these elements. While using content elements is not negative, doing so sparingly prevents clients from intellectualizing their issues and avoiding taking responsibility for their desired change. Silence is located between the elements of cognition, feeling and meaning on the first line of the formula as a counseling skill, but is not represented in the graphic because of the invisible nature of this skill. The absence of spoken words can have a significant impact on the session if used appropriately, allowing clients the opportunity to think about, process and often discover insight related to their personal struggle.
A concept map can be applied to learning basic skills; it also can be applied to connect theory application and theoretical interventions with basic skills. An open umbrella is an excellent graphic that unites these disjointed pieces and crystallizes them into a working concept. The metal ribs of the umbrella are basic skills. The ribs provide the structure of the session and are the tools counselors use to work with their clients. The fabric of the umbrella is the theory imagery application. Theory and basic skills work together to determine how counselors do their job, just as the metal frame and umbrella fabric work together to do their job, which is to keep the user protected from the elements. Umbrella fabric comes in different colors and patterns, and so do counseling theories. Each counselor must find one that fits his or her style, personality, and perspective or viewpoint on how clients are best helped (Evans, Hearn, Uhlemann, & Ivey, 2011; MacCluskie, 2010).
The handle of the umbrella is important since it provides something to hold on to, and comes in various shapes and sizes. Some handles collapse so that the umbrella will fold up and can be carried easily in a briefcase or purse. Some handles are rigid, and can serve another purpose such as providing walking assistance. Counseling techniques, or therapeutic interventions, are the equivalent of the umbrella handle, since it is possible to utilize a variety of techniques with more than one theoretical orientation. Techniques are versatile and can be a significant part of the session, just as the handle is a significant part of the umbrella. However, students must understand the importance of establishing the framework structure first (basic skills illustrated in the counseling formula) before they can move toward conceptualizing a client with their theory of choice (see Figure 2). After counseling students have mastered basic skills, they can move to more advanced intervention techniques (e.g., empty chair, genogram). Mastery allows students to develop a new understanding through building upon different concepts to fit with the open umbrella graphic; this strategy also is known as concept management (Akinsanya & Williams, 2004).
The counselor’s job is not to make clients change; that is the client’s responsibility. Clients are the experts of their situations or issues, and it is up to them to determine what they are willing and capable to change. Before they can make decisions about change (Chg), they must first have insight (I) to understand that they have choices (see Figure 1). Before they develop insight (I), they initially must have an awareness (A) of what is creating their struggle. The counselor’s timing with active listening skills, appropriate confrontation and silence facilitates client awareness (A) and insight (I).
Clients work on the second line (A à I = Change), but the second line is ultimately facilitated by the first line (C + F = M), which is similar to the five stages of change presented by Evans et al. (2011, p. 292). Therefore, this formula indicates that the counselor’s work focuses on the first line and the client’s work focuses on the second.
The second line of the concept map formula also serves as a crosslink in one’s development from student to counselor. In making this transition in the professor–student relationship, the professor explores the student’s understanding by focusing on the first line of the formula, and the student struggles with personal and professional change in the second line of the formula. As student counselors map out their progress in a counseling session, they are simultaneously developing awareness (A) through the growth and practice of basic skills, which leads to insight (I) related to development of professional effectiveness in shaping the session. This process gives beginning counselors a sense of professional identity development and the ability to track progression at the top of the equation. Just as clients are ready for change when they develop awareness and insight, student counselors cannot include their theoretical orientation and techniques until they develop their own awareness in the therapy room and grasp the application of skills employed in the therapeutic session. Therefore, the client’s role in counseling also is the student’s role in professional development; and caution must be exercised not to initiate change too quickly with either the student or client, depending on how the formula is applied.
Counseling students often have heard from family and friends that they are great listeners; however, their sense of homeostasis is challenged when they sit across from clients while trying to master basic skills. They are anxious to jump ahead and learn to use techniques that are appropriate for their counseling theory of choice. Because counseling students jump ahead, they tend to overlook the importance of mastering fundamental skills. Since students have not mastered basic skills, they struggle to understand how theory and techniques work together to help clients. This situation can lead to ineffective use of both theories and techniques.
When the counselor moves too quickly, the client’s sense of balance is thrown off and resistance may occur because of low commitment or discomfort with change (Reiter, 2008; Wachtel, 1999). Resistance is the client’s attempt to return to a sense of homeostasis, even if homeostasis is not effectively meeting the client’s needs. MacCluskie (2010) posited that “the concept of homeostasis, borrowed from physiology, refers to the process by which an organism regulates its internal environment to maintain a stable, constant condition” (p. 212).
According to the formula, when the counseling process focuses on the cognitive content, resistance surfaces through the initial “storytelling” that clients offer. Beginning counselors often jump from hearing clients’ stories (cognition) to problem solving or advice giving (change) and encounter polarity or the yes, but type of resistance. Clients may agree with their counselors’ reflections, but respond with multiple excuses for why the suggestions or advice will not work (MacCluskie, 2010; Reiter, 2008; Wachtel, 1999). However, resistance or excuse making is the clients’ means of protection or attempt to return to a state of homeostasis when the counseling process threatens to push them to abandon their familiar life patterns or concepts of themselves, or push them too quickly to embrace change (Omer, 2000; Patterson & Welfel, 2000).
Basically, counselors forget to take their clients with them through the therapeutic process and must return to the beginning of the first line of the equation (C + F = M). As counselors work here, they must learn to trust the therapeutic process enough to allow clients to do their work on the second line (A promotes I, which facilitates Chg). Through clients’ responses and explorations, their awareness is raised, they gain insight and they are then empowered to make choices related to their personal change comfort level.
Two skills not included as part of the formula are confrontation and immediacy, because these advanced skills come later in the training process. Beginning counselors must first develop mastery of initial skills before they are ready to tackle confrontation and immediacy. While confrontation and immediacy may be powerful methods of intensifying emotions, they also may result in significant disengagement of the client if misused or if the timing is inappropriate (Cormier & Hackney, 2012; Evans et al., 2011; Smaby & Maddux, 2011).
Implications for Future Research
This counseling formula study supports the conclusion that a complex learning strategy, such as cognitive mapping, can be effective for counseling students of varied learning styles and cultures. In addition, evidence suggests that forcing students to use strategies that challenge their learning style preferences can be a beneficial attempt to increase their problem-solving skills (Kostovich et al., 2007). Further investigation of the influence of the counseling formula with beginning counseling students could provide counselor educators insight as to how their students are learning the counseling process using cognitive mapping. It is an organized method of teaching basic skills so that students do not find themselves overwhelmed with too much new learning to master at one time. Future research would be helpful to validate the general application of this formula and the umbrella concept when introducing beginning students to the basic tools of their future profession.
Conclusion
The simple images of a counseling formula and a symbolic umbrella help beginning counselors initially understand the interconnectedness of the different counseling skills of their new profession. However, this article is not suggesting that counseling is simplistic or that it does not utilize higher order skills and concepts. Counselor educators can use these symbolic representations as cognitive schemas to build upon students’ knowledge as they integrate practical application into their counseling sessions. Cognitive maps provide a way for counselor educators to see where students get stuck in the beginning counselor process, and provide a tool that allows a way of learning that is visual and communicative. This visual representation outlines and crosslinks the critical roles of the therapy process by connecting the communication and experiences of the student counselor to those of the client.
The student counselor stays at the top of the equation, while the client remains at the bottom. As student counselors become more seasoned, they also begin to experience personal and professional growth that results in their own awareness, insight and change; therefore, they experience crosslinking at the bottom of the equation that is similar to how clients begin to change. As clinicians gain experience, they move to a deeper understanding of how to use basic skills with theory, incorporated with existing intentional therapeutic interventions and techniques, in order to facilitate change for their clients. Through this process, clinicians come to fully appreciate both the therapeutic relationship and the counseling process.
Initial learning experiences in kindergarten are designed to help beginning students master simple, repetitive writing tasks. This initial learning experience can be compared to beginning experiences for master’s-level counselors through the effective utilization of initial basic skills linked in the counseling session. The formula and umbrella graphics can provide valuable visual tools to lay a solid foundation for the beginning counselor.
Utilizing the formula and umbrella graphics to gain an understanding of the application of basic skills is a valuable tool on the clinician’s lifelong learning journey to become a more effective counselor. When clinicians are “stuck” with a client, what better tools are within our grasp than to return to basic skills and use the formula? Basic skills are an integral part of the clinician’s toolbox, regardless of theoretical orientation or therapeutic interventions. These tools open clients’ awareness (A), promote insight (I), and unlock a myriad of options for clients to embrace (Chg) change (Asimakopoulou et al., 2012; Jacobs, 1994; Jacobs et al., 2012; Meier & Davis, 2011).
Conflict of Interest and Funding Disclosure
The authors reported no conflict of
interest or funding contributions for
the development of this manuscript.
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Susan A. Adams, NCC, is a private practice counselor and supervisor in Denton, TX. Alice Vasquez, NCC, is a doctoral student at Texas A&M – Commerce. Mindy Prengler, NCC, is a counseling intern at Fine Marriage & Family Therapy, Plano, TX. Correspondence can be addressed to Susan A. Adams, 225 West Hickory Street, Suite C, Denton, TX 76201, drsadams@centurylink.net.
